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Madsen KT, Nørgaard BL, Øvrehus KA, Jensen JM, Parner E, Grove EL, Mortensen MB, Fairbairn TA, Nieman K, Patel MR, Rogers C, Mullen S, Mickley H, Thomsen KK, Bøtker HE, Leipsic J, Sand NPR. Coronary computed tomography angiography derived fractional flow reserve and risk of recurrent angina: A 3-year follow-up study. J Cardiovasc Comput Tomogr 2024; 18:243-250. [PMID: 38246785 DOI: 10.1016/j.jcct.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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: 11/08/2023] [Revised: 01/03/2024] [Accepted: 01/15/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND The association between coronary computed tomography angiography (CTA) derived fractional flow reserve (FFRCT) and risk of recurrent angina in patients with new onset stable angina pectoris (SAP) and stenosis by CTA is uncertain. METHODS Multicenter 3-year follow-up study of patients presenting with symptoms suggestive of new onset SAP who underwent first-line CTA evaluation and subsequent standard-of-care treatment. All patients had at least one ≥30 % coronary stenosis. A per-patient lowest FFRCT-value ≤0.80 represented an abnormal test result. Patients with FFRCT ≤0.80 who underwent revascularization were categorized according to completeness of revascularization: 1) Completely revascularized (CR-FFRCT), all vessels with FFRCT ≤0.80 revascularized; or 2) incompletely revascularized (IR-FFRCT) ≥1 vessels with FFRCT ≤0.80 non-revascularized. Recurrent angina was evaluated using the Seattle Angina Questionnaire. RESULTS Amongst 769 patients (619 [80 %] stenosis ≥50 %, 510 [66 %] FFRCT ≤0.80), 174 (23 %) reported recurrent angina at follow-up. An FFRCT ≤0.80 vs > 0.80 associated to increased risk of recurrent angina, relative risk (RR): 1.82; 95 % CI: 1.31-2.52, p < 0.001. Risk of recurrent angina in CR-FFRCT (n = 135) was similar to patients with FFRCT >0.80, 13 % vs 15 %, RR: 0.93; 95 % CI: 0.62-1.40, p = 0.72, while IR-FFRCT (n = 90) and non-revascularized patients with FFRCT ≤0.80 (n = 285) had increased risk, 37 % vs 15 % RR: 2.50; 95 % CI: 1.68-3.73, p < 0.001 and 30 % vs 15 %, RR: 2.03; 95 % CI: 1.44-2.87, p < 0.001, respectively. Use of antianginal medication was similar across study groups. CONCLUSION In patients with SAP and coronary stenosis by CTA undergoing standard-of-care guided treatment, FFRCT provides information regarding risk of recurrent angina.
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Affiliation(s)
| | - Bjarne Linde Nørgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | | | - Jesper Møller Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Erik Parner
- Department of Public Health, Section for Biostatistics, Aarhus University, Denmark
| | - Erik Lerkevang Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | | | - Timothy A Fairbairn
- Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Koen Nieman
- Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, CA, USA
| | - Manesh R Patel
- Division of Cardiology, Department of Medicine, Duke University, Durham, NC, USA
| | | | | | - Hans Mickley
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jonathon Leipsic
- Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Niels Peter Rønnow Sand
- Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Denmark; Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
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Holmes KR, Gulsin GS, Fairbairn TA, Hurwitz-Koweek L, Matsuo H, Nørgaard BL, Jensen JM, Sand NPR, Nieman K, Bax JJ, Pontone G, Chinnaiyan KM, Rabbat MG, Amano T, Kawasaki T, Akasaka T, Kitabata H, Rogers C, Patel MR, Payne GW, Leipsic JA, Sellers SL. Impact of Smoking on Coronary Volume-to-Myocardial Mass Ratio: An ADVANCE Registry Substudy. Radiol Cardiothorac Imaging 2024; 6:e220197. [PMID: 38483246 PMCID: PMC11056751 DOI: 10.1148/ryct.220197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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: 09/17/2022] [Revised: 10/30/2023] [Accepted: 01/26/2024] [Indexed: 04/19/2024]
Abstract
Purpose To examine the relationship between smoking status and coronary volume-to-myocardial mass ratio (V/M) among individuals with coronary artery disease (CAD) undergoing CT fractional flow reserve (CT-FFR) analysis. Materials and Methods In this secondary analysis, participants from the ADVANCE registry evaluated for suspected CAD from July 15, 2015, to October 20, 2017, who were found to have coronary stenosis of 30% or greater at coronary CT angiography (CCTA) were included if they had known smoking status and underwent CT-FFR and V/M analysis. CCTA images were segmented to calculate coronary volume and myocardial mass. V/M was compared between smoking groups, and predictors of low V/M were determined. Results The sample for analysis included 503 current smokers, 1060 former smokers, and 1311 never-smokers (2874 participants; 1906 male participants). After adjustment for demographic and clinical factors, former smokers had greater coronary volume than never-smokers (former smokers, 3021.7 mm3 ± 934.0 [SD]; never-smokers, 2967.6 mm3 ± 978.0; P = .002), while current smokers had increased myocardial mass compared with never-smokers (current smokers, 127.8 g ± 32.9; never-smokers, 118.0 g ± 32.5; P = .02). However, both current and former smokers had lower V/M than never-smokers (current smokers, 24.1 mm3/g ± 7.9; former smokers, 24.9 mm3/g ± 7.1; never-smokers, 25.8 mm3/g ± 7.4; P < .001 [unadjusted] and P = .002 [unadjusted], respectively). Current smoking status (odds ratio [OR], 0.74 [95% CI: 0.59, 0.93]; P = .009), former smoking status (OR, 0.81 [95% CI: 0.68, 0.97]; P = .02), stenosis of 50% or greater (OR, 0.62 [95% CI: 0.52, 0.74]; P < .001), and diabetes (OR, 0.67 [95% CI: 0.56, 0.82]; P < .001) were independent predictors of low V/M. Conclusion Both current and former smoking status were independently associated with low V/M. Keywords: CT Angiography, Cardiac, Heart, Ischemia/Infarction Clinical trial registration no. NCT02499679 Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Kenneth R. Holmes
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Gaurav S. Gulsin
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Timothy A. Fairbairn
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Lynne Hurwitz-Koweek
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Hitoshi Matsuo
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Bjarne L. Nørgaard
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Jesper M. Jensen
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Niels-Peter Rønnow Sand
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Koen Nieman
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Jeroen J. Bax
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Gianluca Pontone
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Kavitha M. Chinnaiyan
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Mark G. Rabbat
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Tetsuya Amano
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Tomohiro Kawasaki
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Takashi Akasaka
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Hironori Kitabata
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Campbell Rogers
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Manesh R. Patel
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Geoffrey W. Payne
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Jonathon A. Leipsic
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
| | - Stephanie L. Sellers
- From the Department of Radiology (K.R.H., G.S.G., J.A.L., S.L.S.) and
Centre for Heart Lung Innovation & Providence Research (G.S.G., J.A.L.,
S.L.S.), St Paul’s Hospital and University of British Columbia, 1081
Burrard St, Vancouver, BC, Canada V6Z 1Y6; Liverpool Heart and Chest Hospital,
Liverpool, England (T.A.F.); Department of Radiology, Duke University School of
Medicine, Durham, NC (L.H.K., M.R.P.); Wakayama Medical University, Wakayama,
Japan (H.M., T. Akasaka, H.K.); Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark (B.L.N., J.M.J.); Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark (N.P.R.S.); Department of
Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
(N.P.R.S.); Erasmus Medical Center, Rotterdam, the Netherlands (K.N.);
Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Centro Cardiologico Monzino, Scientific Institute for
Research, Hospitalization and Healthcare (IRCCS), University of Milan, Milan,
Italy (G.P.); William Beaumont Hospital, Royal Oak, Mich (K.M.C.); Loyola
University Medical Center, Maywood, Ill (M.G.R.); Aichi Medical University,
Aichi, Japan (T. Amano); Department of Cardiology, Shin Koga Hospital, Fukuoka,
Japan (T.K.); HeartFlow, Redwood City, Calif (C.R.); and University of Northern
British Columbia, Prince George, British Columbia, Canada (G.W.P.)
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3
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Gabara L, Hinton J, Kira M, Saunders A, Shambrook J, Abbas A, Leipsic JA, Rogers C, Mullen S, Ng N, Wilding S, Douglas PS, Patel M, Fairbairn TA, Hlatky MA, Curzen N. Derivation and validation of a novel functional FFR CT score incorporating the burden of coronary stenosis severity and flow impairment to predict clinical events. J Cardiovasc Comput Tomogr 2024; 18:33-42. [PMID: 37872028 DOI: 10.1016/j.jcct.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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: 06/21/2023] [Revised: 10/04/2023] [Accepted: 10/08/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND A score combining the burden of stenosis severity on coronary computed tomography angiography (CCTA) and flow impairment by fractional flow reserve derived from computed tomography (FFRCT) may be a better predictor of clinical events than either parameter alone. METHODS The Functional FFRCT Score (FFS) combines CCTA and FFRCT parameters in an allocated point-based system. The feasibility of the FFS was assessed in cohort of 72 stable chest pain patients with matched CCTA and FFRCT datasets. Validation was performed using 2 cohorts: (a) 4468 patients from the ADVANCE Registry to define its association with revascularization and major adverse cardiovascular events (MACE); (b) 212 patients from the FORECAST trial to determine predictors of MACE. RESULTS The median calculation time for the FFS was 10 (interquartile range 6-17) seconds, with strong intra-operator and inter-operator agreement (Cohen's Kappa 0.89 (±0.37, p < 0.001) and 0.83 (±0.04, p < 0.001, respectively). The FFS correlated strongly with both the CT-SYNTAX and the Functional CT-SYNTAX scores (rS = 0.808 for both, p < 0.001). In the ADVANCE cohort the FFS had good discriminatory abilities for revascularization with an area under the curve of 0.82, 95 % confidence interval (CI) 0.81-0.84, p < 0.001. Patients in the highest FFS tertile had significantly higher rates of revascularization (61 % vs 5 %, p < 0.001) and MACE (1.9 % vs 0.5 %, p = 0.001) compared with the lowest FFS tertile. In the FORECAST cohort the FFS was an independent predictor of MACE at 9-month follow-up (hazard ratio 1.04, 95 % CI 1.01-1.08, p < 0.01). CONCLUSION The FFS is a quick-to-calculate and reproducible score, associated with revascularization and MACE in two distinct populations of stable symptomatic patients.
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Affiliation(s)
- Lavinia Gabara
- Coronary Research Group, University Hospital Southampton NHS FT, Southampton, UK; Faculty of Medicine, University of Southampton, Southampton, UK
| | - Jonathan Hinton
- Coronary Research Group, University Hospital Southampton NHS FT, Southampton, UK; Faculty of Medicine, University of Southampton, Southampton, UK
| | - Mohamed Kira
- Coronary Research Group, University Hospital Southampton NHS FT, Southampton, UK
| | - Alec Saunders
- Coronary Research Group, University Hospital Southampton NHS FT, Southampton, UK
| | - James Shambrook
- Department of Cardiothoracic Radiology, Wessex Cardiac Centre, University Hospital Southampton NHS FT, Southampton, UK
| | - Ausami Abbas
- Department of Cardiothoracic Radiology, Wessex Cardiac Centre, University Hospital Southampton NHS FT, Southampton, UK
| | - Jonathon A Leipsic
- Department of Radiology and Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | | | | | - Sam Wilding
- Clinical Trials Unit, University of Southampton, UK
| | - Pamela S Douglas
- Division of Cardiology, Department of Medicine, Duke University Medical Centre, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Manesh Patel
- Division of Cardiology, Department of Medicine, Duke University Medical Centre, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | | | - Mark A Hlatky
- Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA; Department of Health Policy, Stanford University, Stanford, CA, USA
| | - Nick Curzen
- Coronary Research Group, University Hospital Southampton NHS FT, Southampton, UK; Faculty of Medicine, University of Southampton, Southampton, UK.
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4
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Gulsin GS, Tzimas G, Holmes KR, Takagi H, Sellers SL, Blanke P, Koweek LMH, Nørgaard BL, Jensen J, Rabbat MG, Pontone G, Fairbairn TA, Chinnaiyan KM, Douglas PS, Huey W, Matsuo H, Sand NPR, Nieman K, Bax JJ, Amano T, Kawasaki T, Akasaka T, Rogers C, Berman DS, Patel MR, De Bruyne B, Mullen S, Leipsic JA. Impact of Coronary CT Angiography-derived Fractional Flow Reserve on Downstream Management and Clinical Outcomes in Individuals with and without Diabetes. Radiol Cardiothorac Imaging 2023; 5:e220276. [PMID: 37908552 PMCID: PMC10613926 DOI: 10.1148/ryct.220276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 06/21/2023] [Accepted: 09/01/2023] [Indexed: 11/02/2023]
Abstract
Purpose To compare the clinical use of coronary CT angiography (CCTA)-derived fractional flow reserve (FFR) in individuals with and without diabetes mellitus (DM). Materials and Methods This secondary analysis included participants (enrolled July 2015 to October 2017) from the prospective, multicenter, international The Assessing Diagnostic Value of Noninvasive CT-FFR in Coronary Care (ADVANCE) registry (ClinicalTrials.gov identifier, NCT02499679) who were evaluated for suspected coronary artery disease (CAD), with one or more coronary stenosis ≥30% on CCTA images, using CT-FFR. CCTA and CT-FFR findings, treatment strategies at 90 days, and clinical outcomes at 1-year follow-up were compared in participants with and without DM. Results The study included 4290 participants (mean age, 66 years ± 10 [SD]; 66% male participants; 22% participants with DM). Participants with DM had more obstructive CAD (one or more coronary stenosis ≥50%; 78.8% vs 70.6%, P < .001), multivessel CAD (three-vessel obstructive CAD; 18.9% vs 11.2%, P < .001), and proportionally more vessels with CT-FFR ≤ 0.8 (74.3% vs 64.6%, P < .001). Treatment reclassification by CT-FFR occurred in two-thirds of participants which was consistent regardless of the presence of DM. There was a similar graded increase in coronary revascularization with declining CT-FFR in both groups. At 1 year, presence of DM was associated with higher rates of major adverse cardiovascular events (hazard ratio, 2.2; 95% CI: 1.2, 4.1; P = .01). However, no between group differences were observed when stratified by stenosis severity (<50% or ≥50%) or CT-FFR positivity. Conclusion Both anatomic CCTA findings and CT-FFR demonstrated a more complex pattern of CAD in participants with versus without DM. Rates of treatment reclassification were similar regardless of the presence of DM, and DM was not an adverse prognostic indicator when adjusted for diameter stenosis and CT-FFR.Clinical trial registration no. NCT 02499679Keywords: Fractional Flow Reserve, CT Angiography, Diabetes Mellitus, Coronary Artery Disease Supplemental material is available for this article. See also the commentary by Ghoshhajra in this issue.© RSNA, 2023.
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Affiliation(s)
- Gaurav S. Gulsin
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Georgios Tzimas
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Kenneth-Royce Holmes
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Hidenobu Takagi
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Stephanie L. Sellers
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Philipp Blanke
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Lynne M. H. Koweek
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Bjarne L. Nørgaard
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Jesper Jensen
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Mark G. Rabbat
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Gianluca Pontone
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Timothy A. Fairbairn
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Kavitha M. Chinnaiyan
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Pamela S. Douglas
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Whitney Huey
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Hitoshi Matsuo
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Niels P. R. Sand
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Koen Nieman
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Jeroen J. Bax
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Tetsuya Amano
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Tomohiro Kawasaki
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Takashi Akasaka
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Campbell Rogers
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Daniel S. Berman
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Manesh R. Patel
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Bernard De Bruyne
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Sarah Mullen
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
| | - Jonathon A. Leipsic
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H.,
H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University
of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital,
Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(G.T.); Centre for Heart Lung Innovation, University of British Columbia and St
Paul’s Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of
Cardiology, Department of Medicine, Duke University Medical Center, Duke
Clinical Research Institute, Duke University School of Medicine, Durham, NC
(L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of
Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA
Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico
Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool,
Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of
Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department
of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit,
Institute of Regional Health Research, University Hospital of SouthWest DK,
University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of
Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
(K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the
Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi,
Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan
(T.K.); Department of Cardiovascular Medicine, Wakayama Medical University,
Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R.,
S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart
Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst,
OLV-Clinic, Aalst, Belgium (B.D.B.)
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Madsen KT, Nørgaard BL, Øvrehus KA, Jensen JM, Parner E, Grove EL, Fairbairn TA, Nieman K, Patel MR, Rogers C, Mullen S, Mickley H, Rohold A, Bøtker HE, Leipsic J, Sand NPR. Prognostic Value of Coronary CT Angiography-derived Fractional Flow Reserve on 3-year Outcomes in Patients with Stable Angina. Radiology 2023; 308:e230524. [PMID: 37698477 DOI: 10.1148/radiol.230524] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Background The prognostic value of coronary CT angiography (CTA)-derived fractional flow reserve (FFR) beyond 1-year outcomes and in patients with high levels of coronary artery calcium (CAC) is uncertain. Purpose To assess the prognostic value of coronary CTA-derived FFR test results on 3-year clinical outcomes in patients with coronary stenosis and among a subgroup of patients with high levels of CAC. Materials and Methods This study represents a 3-year follow-up of patients with new-onset stable angina pectoris who were consecutively enrolled in the Assessing Diagnostic Value of Noninvasive CT-FFR in Coronary Care, known as ADVANCE (ClinicalTrials.gov: NCT02499679) registry, between December 2015 and October 2017 at three Danish sites. A high CAC was defined as an Agatston score of at least 400. A lesion-specific coronary CTA-derived FFR value of 2 cm with distal-to-stenosis value at or below 0.80 represented an abnormal test result. The primary end point was a composite of all-cause death and nonfatal spontaneous myocardial infarction. Event rates were estimated using the one-sample binomial model, and relative risk was compared between participants stratified by results of coronary CTA-derived FFR. Results This study included 900 participants: 523 participants with normal results (mean age, 64 years ± 9.6 [SD]; 318 male participants) and 377 with abnormal results from coronary CTA-derived FFR (mean age, 65 years ± 9.6; 264 male participants). The primary end point occurred in 11 of 523 (2.1%) and 25 of 377 (6.6%) participants with normal and abnormal coronary CTA-derived FFR results, respectively (relative risk, 3.1; 95% CI: 1.6, 6.3; P < .001). In participants with high CAC, the primary end point occurred in four of 182 (2.2%) and 19 of 212 (9.0%) participants with normal and abnormal coronary CTA-derived FFR results, respectively (relative risk, 4.1; 95% CI: 1.4, 11.8; P = .001). Conclusion In individuals with stable angina, a normal coronary CTA-derived FFR test result identified participants with a low 3-year risk of all-cause death or nonfatal spontaneous myocardial infarction, both in the overall cohort and in participants with high CAC scores. Clinical trial registration no. NCT02499679 Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Sinitsyn in this issue.
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Affiliation(s)
- Kristian T Madsen
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Bjarne L Nørgaard
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Kristian A Øvrehus
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Jesper M Jensen
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Erik Parner
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Erik L Grove
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Timothy A Fairbairn
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Koen Nieman
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Manesh R Patel
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Campbell Rogers
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Sarah Mullen
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Hans Mickley
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Allan Rohold
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Hans Erik Bøtker
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Jonathon Leipsic
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Niels Peter R Sand
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
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MacArthur JAL, Yong GL, Dweck MR, Fairbairn TA, Weir-McCall J, Puyol-Antón E, Meldrum J, Blakelock P, Khan S, Morrice L, Sudlow CLM, Williams MC. Cardiovascular imaging research priorities. Open Heart 2023; 10:e002378. [PMID: 37586846 PMCID: PMC10432634 DOI: 10.1136/openhrt-2023-002378] [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: 06/14/2023] [Accepted: 07/21/2023] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVES Two interlinked surveys were organised by the British Heart Foundation Data Science Centre, which aimed to establish national priorities for cardiovascular imaging research. METHODS First a single time point public survey explored their views of cardiovascular imaging research. Subsequently, a three-phase modified Delphi prioritisation exercise was performed by researchers and healthcare professionals. Research questions were submitted by a diverse range of stakeholders to the question 'What are the most important research questions that cardiovascular imaging should be used to address?'. Of these, 100 research questions were prioritised based on their positive impact for patients. The 32 highest rated questions were further prioritised based on three domains: positive impact for patients, potential to reduce inequalities in healthcare and ability to be implemented into UK healthcare practice in a timely manner. RESULTS The public survey was completed by 354 individuals, with the highest rated areas relating to improving treatment, quality of life and diagnosis. In the second survey, 506 research questions were submitted by diverse stakeholders. Prioritisation was performed by 90 researchers or healthcare professionals in the first round and 64 in the second round. The highest rated questions were 'How do we ensure patients have equal access to cardiovascular imaging when it is needed?' and 'How can we use cardiovascular imaging to avoid invasive procedures'. There was general agreement between healthcare professionals and researchers regarding priorities for the positive impact for patients and least agreement for their ability to be implemented into UK healthcare practice in a timely manner. There was broad overlap between the prioritised research questions and the results of the public survey. CONCLUSIONS We have identified priorities for cardiovascular imaging research, incorporating the views of diverse stakeholders. These priorities will be useful for researchers, funders and other organisations planning future research.
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Affiliation(s)
| | - Guo Liang Yong
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Timothy A Fairbairn
- Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Jonathan Weir-McCall
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Department of Radiology, Royal Papworth Hospital, Cambridge, UK
| | - Esther Puyol-Antón
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Julian Meldrum
- British Heart Foundation Data Science Centre, Health Data Research UK, London, UK
| | - Phillip Blakelock
- British Heart Foundation Data Science Centre, Health Data Research UK, London, UK
| | - Samaira Khan
- British Heart Foundation Data Science Centre, Health Data Research UK, London, UK
| | - Lynn Morrice
- British Heart Foundation Data Science Centre, Health Data Research UK, London, UK
| | - Cathie L M Sudlow
- British Heart Foundation Data Science Centre, Health Data Research UK, London, UK
| | - Michelle C Williams
- British Heart Foundation Data Science Centre, Health Data Research UK, London, UK
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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7
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van Rosendael SE, van Rosendael AR, Kuneman JH, Patel MR, Nørgaard BL, Fairbairn TA, Nieman K, Akasaka T, Berman DS, Koweek LMH, Pontone G, Kawasaki T, Sand NPR, Jensen JM, Amano T, Poon M, Øvrehus KA, Sonck J, Rabbat MG, Rogers C, Matsuo H, Leipsic JA, Marsan NA, Jukema JW, Bax JJ, Saraste A, Knuuti J. Coronary Volume to Left Ventricular Mass Ratio in Patients With Hypertension. Am J Cardiol 2023; 199:100-109. [PMID: 37198076 DOI: 10.1016/j.amjcard.2023.04.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/22/2023] [Accepted: 04/17/2023] [Indexed: 05/19/2023]
Abstract
The coronary vascular volume to left ventricular mass (V/M) ratio assessed by coronary computed tomography angiography (CCTA) is a promising new parameter to investigate the relation of coronary vasculature to the myocardium supplied. It is hypothesized that hypertension decreases the ratio between coronary volume and myocardial mass by way of myocardial hypertrophy, which could explain the detected abnormal myocardial perfusion reserve reported in patients with hypertension. Individuals enrolled in the multicenter ADVANCE (Assessing Diagnostic Value of Noninvasive FFRCT in Coronary Care) registry who underwent clinically indicated CCTA for analysis of suspected coronary artery disease with known hypertension status were included in current analysis. The V/M ratio was calculated from CCTA by segmenting the coronary artery luminal volume and left ventricular myocardial mass. In total, 2,378 subjects were included in this study, of whom 1,346 (56%) had hypertension. Left ventricular myocardial mass and coronary volume were higher in subjects with hypertension than normotensive patients (122.7 ± 32.8 g vs 120.0 ± 30.5 g, p = 0.039, and 3,105.0 ± 992.0 mm3 vs 2,965.6 ± 943.7 mm3, p <0.001, respectively). Subsequently, the V/M ratio was higher in patients with hypertension than those without (26.0 ± 7.6 mm3/g vs 25.3 ± 7.3 mm3/g, p = 0.024). After correcting for potential confounding factors, the coronary volume and ventricular mass remained higher in patients with hypertension (least square) mean difference estimate: 196.3 (95% confidence intervals [CI] 119.9 to 272.7) mm3, p <0.001, and 5.60 (95% CI 3.42 to 7.78) g, p <0.001, respectively), but the V/M ratio was not significantly different (least square mean difference estimate: 0.48 (95% CI -0.12 to 1.08) mm3/g, p = 0.116). In conclusion, our findings do not support the hypothesis that the abnormal perfusion reserve would be caused by reduced V/M ratio in patients with hypertension.
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Affiliation(s)
| | | | - Jurrien H Kuneman
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Manesh R Patel
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | | | - Timothy A Fairbairn
- Department of Cardiology, University of Liverpool, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Koen Nieman
- Department of Cardiovascular Medicine, Stanford University, Stanford, California; Department of Radiology, Stanford University, Stanford, California
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Daniel S Berman
- Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart Institute, Los Angeles, California
| | - Lynne M Hurwitz Koweek
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | | | | | - Niels Peter Rønnow Sand
- Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Denmark; Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
| | - Jesper M Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Aichi, Japan
| | - Michael Poon
- Department of Noninvasive Cardiac Imaging, Northwell Health, New York, New York
| | | | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Mark G Rabbat
- Division of Cardiology, Loyola University Chicago, Chicago, Illinois
| | | | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Jonathon A Leipsic
- Department of Radiology, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Antti Saraste
- Netherlands Heart Institute, Utrecht, The Netherlands; Turku PET Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Juhani Knuuti
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Turku PET Center, Turku University Hospital and University of Turku, Turku, Finland.
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8
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Pontone G, Mushtaq S, Al'Aref SJ, Andreini D, Baggiano A, Canan A, Cavalcante JL, Chelliah A, Chen M, Choi A, Damini D, De Cecco CN, Farooqi KM, Ferencik M, Feuchtner G, Hecht H, Gransar H, Kolossváry M, Leipsic J, Lu MT, Marwan M, Ng MY, Maurovich-Horvat P, Nagpal P, Nicol E, Weir-McCall J, Whelton SP, Williams MC, Reid A, Fairbairn TA, Villines T, Vliegenthart R, Arbab-Zadeh A. The journal of cardiovascular computed tomography: A year in review: 2022. J Cardiovasc Comput Tomogr 2023; 17:86-95. [PMID: 36934047 DOI: 10.1016/j.jcct.2023.03.001] [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: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/20/2023]
Abstract
This review aims to summarize key articles published in the Journal of Cardiovascular Computed Tomography (JCCT) in 2022, focusing on those that had the most scientific and educational impact. The JCCT continues to expand; the number of submissions, published manuscripts, cited articles, article downloads, social media presence, and impact factor continues to grow. The articles selected by the Editorial Board of the JCCT in this review highlight the role of cardiovascular computed tomography (CCT) to detect subclinical atherosclerosis, assess the functional relevance of stenoses, and plan invasive coronary and valve procedures. A section is dedicated to CCT in infants and other patients with congenital heart disease, in women, and to the importance of training in CT. In addition, we highlight key consensus documents and guidelines published in JCCT last year. The Journal values the tremendous work by authors, reviewers, and editors to accomplish these contributions.
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Affiliation(s)
- Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
| | - Saima Mushtaq
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Subhi J Al'Aref
- Division of Cardiology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Daniele Andreini
- Division of Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Italy
| | - Andrea Baggiano
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Arzu Canan
- Department of Radiology, Division of Cardiothoracic Imaging, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Joao L Cavalcante
- Allina Health Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Anjali Chelliah
- Department of Pediatrics, Division of Pediatric Cardiology, Goryeb Children's Hospital/Atlantic Medical Center, Morristown, NJ, USA; Columbia University Irving Medical Center, New York, NY, USA
| | - Marcus Chen
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Andrew Choi
- Cardiology and Radiology, The George Washington University School of Medicine, Washington, DC, USA
| | - Dey Damini
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Kanwal M Farooqi
- Division of Pediatric Cardiology, NewYork-Presbyterian, Columbia University Irving Medical Center, New York, NY, USA
| | - Maros Ferencik
- MCR, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
| | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Harvey Hecht
- Ican School of Medicine at Mount Sinai, Mount Sinai Morningside Medical Center, NYC, USA
| | - Heidi Gransar
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Márton Kolossváry
- Gottsegen National Cardiovascular Center, Budapest, Hungary; Physiological Controls Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary
| | - Jonathon Leipsic
- Department of Radiology and Medicine (Cardiology) UBC, Vancouver, Canada
| | - Michael T Lu
- Cardiovascular Imaging Research Center (CIRC), MGH Department of Radiology Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Mohamed Marwan
- Cardiology Department, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Ming-Yen Ng
- Department of Diagnostic Radiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, China
| | - Pál Maurovich-Horvat
- Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Prashant Nagpal
- Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Ed Nicol
- Royal Brompton Hospital, Sydney Street, London and School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
| | | | - Seamus P Whelton
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, 21287, USA
| | - Michelle C Williams
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Anna Reid
- Manchester Heart Institute, Manchester University NHS Foundation Trust, Manchester, UK; University of Manchester, Manchester, UK
| | - Timothy A Fairbairn
- Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | - Rosemarie Vliegenthart
- Department of Radiology, University of Groningen/University Medical Center Groningen, Groningen, the Netherlands
| | - Armin Arbab-Zadeh
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
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9
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Madsen KT, Noergaard BL, Oevrehus KA, Parner E, Jensen JM, Grove EL, Fairbairn TA, Nieman K, Patel M, Rogers C, Mickley H, Rohold A, Boetker HE, Leipsic J, Sand NPR. Prognostic value of FFRCT in patients with stable chest pain – a 3-year follow-up of the ADVANCE-DK registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.202] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
The short-term safety of using coronary CT angiography (CTA) derived fractional flow reserve (FFRCT) to guide downstream testing after CTA is well documented. Whether the prognostic information provided by FFRCT can be extended to sustained follow-up and to patients with a high degree of coronary artery calcification (CAC) is unknown.
Purpose
To evaluate the association between FFRCT and clinical outcomes in new onset stable symptomatic patients with coronary stenosis up to 3 years after CTA index testing.
Methods
Multicenter 3-year follow-up study of 900 patients from the Assessing Diagnostic Value of Non-invasive FFRCT in Coronary Care (ADVANCE) registry at three Danish sites, the “ADVANCE-DK Registry”. All patients had at least one ≥30% coronary stenosis by CTA and underwent subsequent core laboratory FFRCT analysis by HeartFlow. The criterium for an abnormal FFRCT test result was an FFRCT value ≤0.80 (2 cm distal to stenosis). High CAC was defined as a CAC score ≥400. The primary endpoint (PE) was a composite of all-cause death and spontaneous myocardial infarction (MI). The secondary endpoint (SE) was a composite of cardiovascular (CV) death and spontaneous MI. Events were adjudicated by an independent clinical committee.
Results
Patient characteristics are given in Table 1. Coronary stenosis ≥50% was present in 750 (83%) patients. In total 36 patients suffered a PE (all-cause death, n=24; MI, n=12) and 22 an SE (CV death, n=10; MI, n=12). An abnormal vs a normal FFRCT test result was associated with an increased risk of the PE and of the SE both overall and in patients with high CAC; PE (all), 6.6% vs 2.1%, relative risk (RR): 3.1; 95% CI: 1.6–6.3, p<0.001, SE (all), 5.0% vs 0.6%, RR: 8.7; 95% CI: non assessable, p<0.001, PE (high CAC), 9.0% vs 2.2%, RR: 4.1; 85% CI: 1.4–11.8, p=0.001, and SE (high CAC), 6.6% vs 0.5%, RR: 12.0; 95% CI: non assessable, p=0.01, respectively, Figure 1. The observed increased risk in patients with an abnormal vs a normal FFRCT test result persisted after adjustment for degree of stenosis by CCTA (< / ≥50%) and amount of CAC (< / ≥400): PE, adjusted RR: 2.5; 95% CI: 1.2–5.2, p=0.02, and SE, adjusted RR: 8.0; 95% CI: 2.1–30.2, p=0.002.
Conclusion
Patients with stable chest pain, stenosis by CTA and a normal FFRCT test result have a low risk of adverse outcomes during 3 years of follow-up. An abnormal FFRCT identifies patients at increased risk of death or spontaneous MI. These associations are consistent in patients with high levels of CAC.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K T Madsen
- University Hospital of Southern Denmark, Department of Cardiology , Esbjerg , Denmark
| | - B L Noergaard
- Aarhus University Hospital, Department of Cardiology , Aarhus , Denmark
| | - K A Oevrehus
- Odense University Hospital, Department of Cardiology , Odense , Denmark
| | - E Parner
- Aarhus University, Department of Public Health, Section for Biostatistics , Aarhus , Denmark
| | - J M Jensen
- Aarhus University Hospital, Department of Cardiology , Aarhus , Denmark
| | - E L Grove
- Aarhus University Hospital, Department of Cardiology , Aarhus , Denmark
| | - T A Fairbairn
- Liverpool Heart and Chest Hospital, Department of Cardiology , Liverpool , United Kingdom
| | - K Nieman
- Stanford University Medical Center, Department of Cardiovascular Medicine and Radiology , Stanford , United States of America
| | - M Patel
- Duke University, Division of Cardiology, Department of Medicine , Durham , United States of America
| | - C Rogers
- HeartFlow inc., Redwood City , California , United States of America
| | - H Mickley
- Odense University Hospital, Department of Cardiology , Odense , Denmark
| | - A Rohold
- University Hospital of Southern Denmark, Department of Cardiology , Esbjerg , Denmark
| | - H E Boetker
- Aarhus University Hospital, Department of Cardiology , Aarhus , Denmark
| | - J Leipsic
- St Paul's Hospital, Department of Radiology , Vancouver , Canada
| | - N P R Sand
- University Hospital of Southern Denmark, Department of Cardiology , Esbjerg , Denmark
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10
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Madsen KT, Noergaard BL, Oevrehus KA, Parner E, Jensen JM, Grove EL, Fairbairn TA, Nieman K, Patel M, Rogers C, Mickley H, Thomsen KK, Boetker HE, Leipsic J, Sand NPR. FFRCT and recurrent symptoms in patients with stable chest pain. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.200] [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
Introduction
The major benefit of coronary revascularization when compared with optimal medical treatment (OMT) in patients with stable chest pain (CP) relates to improvement of symptoms and reduction of reinterventions. Non-invasive methods are warranted to discriminate between patients at low and high risk of recurrent CP for subsequent guidance of antianginal treatment (invasive or OMT).
Purpose
To evaluate the association between coronary CT angiography (CTA) derived fractional flow reserve (FFRCT), recurrent CP and quality of life (QOL) in patients with new onset stable CP and stenosis by CTA.
Methods
Multicenter cohort 3-year follow-up sub-study of 769 patients from the Assessing Diagnostic Value of Non-invasive FFRCT in Coronary Care (ADVANCE) registry at three Danish sites, the “ADVANCE-DK Registry”. All patients had at least one ≥30% coronary stenosis by CTA and underwent subsequent core laboratory FFRCT analysis by HeartFlow. An abnormal FFRCT was defined as the lowest in vessel FFRCT value ≤0.80. Patients were classified according to completeness of revascularization by FFRCT: 1) completely revascularized (CR-FFRCT), all coronary arteries with an abnormal FFRCT test result revascularized; 2) incompletely revascularized (IR-FFRCT), ≥1 coronary artery with an abnormal FFRCT test result not revascularized. All patients completed the Seattle Angina Questionnaire (SAQ-7), the EuroQol questionnaire (EQ-5D-5L) and graded (0–100) overall health using the EQ VAS scale at 3-year follow-up. Recurrent CP was defined as CP within the last 4 weeks prior to this follow-up.
Results
Patient characteristics are given in Table 1. At follow-up 23% patients reported recurrent CP. An abnormal vs a normal FFRCT increased the risk of recurrent CP, 27% vs 15%, RR: 1.82; 95% CI: 1.31–2.52, p<0.001. Amongst patients with abnormal FFRCT, revascularization (+/−) was associated to a numerical, but not statistical significantly, reduced risk of recurrent CP, 23% vs 30%, RR: 0.76; 95% CI: 0.56–1.03, p=0.07. IR-FFRCT vs CR-FFRCT had a higher risk for recurrent CP, 31% vs 13%, RR: 2.34; 95% CI: 1.48–3.68, p<0.001, whilst no difference was observed for CR-FFRCT vs normal FFRCT, 13% vs 15%, RR: 0.92; 95% CI: 0.54–1.54, p=0.74. IR-FFRCT vs CR-FFRCT or normal FFRCT, had lower SAQ-7, EQ-5D-5L and EQ-VAS scores, Table 1, all p<0.005. Scores for three selected SAQ-7 domains are shown in Figure 1. Use of antianginal medicine was higher in IR-FFRCT compared to CR-FFRCT and normal FFRCT, mean ± SD: 1.2±0.05 vs 1.0±0.04, p=0.02.
Conclusion
An abnormal FFRCT identifies patients with an increased risk of recurrent CP up to 3 years after index testing. Completeness of revascularization by FFRCT reclassifies patients with abnormal FFRCT into groups with low and high risk for recurrent CP and impaired QOL.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K T Madsen
- University Hospital of Southern Denmark, Department of Cardiology , Esbjerg , Denmark
| | - B L Noergaard
- Aarhus University Hospital, Department of Cardiology , Aarhus , Denmark
| | - K A Oevrehus
- Odense University Hospital, Department of Cardiology , Odense , Denmark
| | - E Parner
- Aarhus University, Department of Public Health, Section for Biostatistics , Aarhus , Denmark
| | - J M Jensen
- Aarhus University Hospital, Department of Cardiology , Aarhus , Denmark
| | - E L Grove
- Aarhus University Hospital, Department of Cardiology , Aarhus , Denmark
| | - T A Fairbairn
- Liverpool Heart and Chest Hospital, Department of Cardiology , Liverpool , United Kingdom
| | - K Nieman
- Stanford University Medical Center, Department of Cardiovascular Medicine and Radiology , Stanford , United States of America
| | - M Patel
- Duke University, Division of Cardiology, Department of Medicine , Durham , United States of America
| | - C Rogers
- HeartFlow inc., Redwood City , California , United States of America
| | - H Mickley
- Odense University Hospital, Department of Cardiology , Odense , Denmark
| | - K K Thomsen
- University Hospital of Southern Denmark, Department of Cardiology , Esbjerg , Denmark
| | - H E Boetker
- Aarhus University Hospital, Department of Cardiology , Aarhus , Denmark
| | - J Leipsic
- St Paul's Hospital, Department of Radiology , Vancouver , Canada
| | - N P R Sand
- University Hospital of Southern Denmark, Department of Cardiology , Esbjerg , Denmark
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11
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Madsen KT, Noergaard BL, Oevrehus KA, Parner E, Jensen JM, Grove EL, Fairbairn TA, Nieman K, Patel M, Rogers C, Mickley H, Rohold A, Boetker HE, Leipsic J, Sand NPR. Completeness of revascularization by FFRCT and prognosis in stable chest pain. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.201] [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: 11/14/2022] Open
Abstract
Abstract
Introduction
Major randomized trials of patients with stable chest pain (CP) demonstrated no prognostic benefits of coronary revascularization over optimal medical treatment (OMT). However, in a recent large-scale study, completeness of revascularization was associated with a reduced risk of all-cause death and non-fatal myocardial infarction (MI).
Purpose
To evaluate the association between completeness of revascularization relative to the result of coronary CT angiography (CTA) derived fractional flow reserve (FFRCT) and 3-year prognosis in patients with new onset stable CP and coronary stenosis.
Methods
Multicenter cohort 3-year follow-up sub-study of 900 patients from the Assessing Diagnostic Value of Non-invasive FFRCT in Coronary Care (ADVANCE) registry at three Danish sites, the “ADVANCE-DK Registry”. All patients had at least one ≥30% coronary stenosis by CTA and underwent subsequent core laboratory FFRCT analysis by HeartFlow. The FFRCT result was abnormal when ≤0.80 (2 cm distal to stenosis). Patients were classified according to completeness of revascularization by FFRCT: 1) completely revascularized (CR-FFRCT), all coronary arteries with an abnormal FFRCT test result revascularized; 2) incompletely revascularized (IR-FFRCT), ≥1 coronary artery with an abnormal FFRCT test result not revascularized. The primary endpoint (PE) was a composite of all-cause death and spontaneous MI. The secondary endpoint (SE) was a composite of cardiovascular (CV) death and spontaneous MI.
Results
Patient characteristics are given in Table 1. In total 36 (4.0%) patients suffered a PE (all-cause death, n=24; MI, n=12) and 22 (2.4%) an SE (CV death, n=10; MI, n=12). Overall, an abnormal vs a normal FFRCT test result was associated with an increased risk of both the PE, 6.6% vs 2.1%, relative risk (RR): 3.1; 95% CI: 1.6–6.3, p<0.001 and of the SE, 5.0% vs 0.6%, RR: 8.7; 95% CI: non assessable, p<0.001. In patients with abnormal FFRCT, revascularization vs no revascularization did not reduce the risk of the PE or the SE (data not shown). Patients with IR-FFRCT vs CR-FFRCT had a numerical, but not statistical significantly, increased risk of the PE, 8.6% vs 4.2%, RR: 2.14; 95% CI: 0.87–5.26, p=0.10), and an increased risk of the SE, 7.1% vs 2.4%, RR: 3.13; 95% CI: 1.02–9.63, p=0.04, Figure 1. In CR-FFRCT versus normal FFRCT no difference in the risk of the PE or the SE was observed, Figure 1. Univariate sensitivity analyses performed in the IR-FFRCT group did not reveal any differences in the risk of the PE or the SE after adjustment for neither statin therapy at follow-up (−/+), baseline risk variables (< / ≥3), amount of CAC (< / ≥400), degree of stenosis by CTA (< / ≥50%) nor referral to ICA (−/+).
Conclusion
In symptomatic patients with coronary stenosis by CTA, incomplete revascularization determined by FFRCT is associated with an increased risk of adverse cardiovascular outcomes compared to complete revascularization.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K T Madsen
- University Hospital of Southern Denmark, Department of Cardiology , Esbjerg , Denmark
| | - B L Noergaard
- Aarhus University Hospital, Department of Cardiology , Aarhus , Denmark
| | - K A Oevrehus
- Odense University Hospital, Department of Cardiology , Odense , Denmark
| | - E Parner
- Aarhus University, Department of Public Health, Section for Biostatistics , Aarhus , Denmark
| | - J M Jensen
- Aarhus University Hospital, Department of Cardiology , Aarhus , Denmark
| | - E L Grove
- Aarhus University Hospital, Department of Cardiology , Aarhus , Denmark
| | - T A Fairbairn
- Liverpool Heart and Chest Hospital, Department of Cardiology , Liverpool , United Kingdom
| | - K Nieman
- Stanford University Medical Center, Department of Cardiovascular Medicine and Radiology , Stanford , United States of America
| | - M Patel
- Duke University, Division of Cardiology, Department of Medicine , Durham , United States of America
| | - C Rogers
- HeartFlow inc., Redwood City , California , United States of America
| | - H Mickley
- Odense University Hospital, Department of Cardiology , Odense , Denmark
| | - A Rohold
- University Hospital of Southern Denmark, Department of Cardiology , Esbjerg , Denmark
| | - H E Boetker
- Aarhus University Hospital, Department of Cardiology , Aarhus , Denmark
| | - J Leipsic
- St Paul's Hospital, Department of Radiology , Vancouver , Canada
| | - N P R Sand
- University Hospital of Southern Denmark, Department of Cardiology , Esbjerg , Denmark
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12
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Ihdayhid AR, Fairbairn TA, Gulsin GS, Tzimas G, Danehy E, Updegrove A, Jensen JM, Taylor CA, Bax JJ, Sellers SL, Leipsic JA, Nørgaard BL. Cardiac computed tomography-derived coronary artery volume to myocardial mass. J Cardiovasc Comput Tomogr 2022; 16:198-206. [PMID: 34740557 DOI: 10.1016/j.jcct.2021.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 07/17/2021] [Revised: 09/27/2021] [Accepted: 10/25/2021] [Indexed: 11/29/2022]
Abstract
In the absence of disease impacting the coronary arteries or myocardium, there exists a linear relationship between vessel volume and myocardial mass to ensure balanced distribution of blood supply. This balance may be disturbed in diseases of either the coronary artery tree, the myocardium, or both. However, in contemporary evaluation the coronary artery anatomy and myocardium are assessed separately. Recently the coronary lumen volume to myocardial mass ratio (V/M), measured noninvasively using coronary computed tomography angiography (CTCA), has emerged as an integrated measure of myocardial blood supply and demand in vivo. This has the potential to yield new insights into diseases where this balance is altered, thus impacting clinical diagnoses and management. In this review, we outline the scientific methodology underpinning CTCA-derived measurement of V/M. We describe recent studies describing alterations in V/M across a range of cardiovascular conditions, including coronary artery disease, cardiomyopathies and coronary microvascular dysfunction. Lastly, we highlight areas of unmet research need and future directions, where V/M may further enhance our understanding of the pathophysiology of cardiovascular disease.
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Affiliation(s)
- Abdul Rahman Ihdayhid
- Department of Cardiology, Fiona Stanley Hospital, Harry Perkins Institute of Medical Research, University of Western Australia, Perth, Australia.
| | - Timothy A Fairbairn
- Department of Cardiology, University of Liverpool, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
| | - Gaurav S Gulsin
- University of Leicester and the Leicester NIHR Biomedical Research Centre, Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, United Kingdom; Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Georgios Tzimas
- Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada; Department of Heart Vessels, Cardiology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | | | | | - Jesper M Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
| | | | - Jeroen J Bax
- Leiden University, Department of Medicine, Leiden, Netherlands.
| | - Stephanie L Sellers
- Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Bjarne L Nørgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
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13
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Takagi H, Leipsic JA, McNamara N, Martin I, Fairbairn TA, Akasaka T, Nørgaard BL, Berman DS, Chinnaiyan K, Hurwitz-Koweek LM, Pontone G, Kawasaki T, Rønnow Sand NP, Jensen JM, Amano T, Poon M, Øvrehus KA, Sonck J, Rabbat MG, Mullen S, De Bruyne B, Rogers C, Matsuo H, Bax JJ, Douglas PS, Patel MR, Nieman K, Ihdayhid AR. Trans-lesional fractional flow reserve gradient as derived from coronary CT improves patient management: ADVANCE registry. J Cardiovasc Comput Tomogr 2022; 16:19-26. [PMID: 34518113 PMCID: PMC9719736 DOI: 10.1016/j.jcct.2021.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 07/17/2021] [Accepted: 08/30/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND The role of change in fractional flow reserve derived from CT (FFRCT) across coronary stenoses (ΔFFRCT) in guiding downstream testing in patients with stable coronary artery disease (CAD) is unknown. OBJECTIVES To investigate the incremental value of ΔFFRCT in predicting early revascularization and improving efficiency of catheter laboratory utilization. MATERIALS Patients with CAD on coronary CT angiography (CCTA) were enrolled in an international multicenter registry. Stenosis severity was assessed as per CAD-Reporting and Data System (CAD-RADS), and lesion-specific FFRCT was measured 2 cm distal to stenosis. ΔFFRCT was manually measured as the difference of FFRCT across visible stenosis. RESULTS Of 4730 patients (66 ± 10 years; 34% female), 42.7% underwent ICA and 24.7% underwent early revascularization. ΔFFRCT remained an independent predictor for early revascularization (odds ratio per 0.05 increase [95% confidence interval], 1.31 [1.26-1.35]; p < 0.001) after adjusting for risk factors, stenosis features, and lesion-specific FFRCT. Among the 3 models (model 1: risk factors + stenosis type and location + CAD-RADS; model 2: model 1 + FFRCT; model 3: model 2 + ΔFFRCT), model 3 improved discrimination compared to model 2 (area under the curve, 0.87 [0.86-0.88] vs 0.85 [0.84-0.86]; p < 0.001), with the greatest incremental value for FFRCT 0.71-0.80. ΔFFRCT of 0.13 was the optimal cut-off as determined by the Youden index. In patients with CAD-RADS ≥3 and lesion-specific FFRCT ≤0.8, a diagnostic strategy incorporating ΔFFRCT >0.13, would potentially reduce ICA by 32.2% (1638-1110, p < 0.001) and improve the revascularization to ICA ratio from 65.2% to 73.1%. CONCLUSIONS ΔFFRCT improves the discrimination of patients who underwent early revascularization compared to a standard diagnostic strategy of CCTA with FFRCT, particularly for those with FFRCT 0.71-0.80. ΔFFRCT has the potential to aid decision-making for ICA referral and improve efficiency of catheter laboratory utilization.
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Affiliation(s)
- Hidenobu Takagi
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada; Department of Radiology, Iwate Medical University Hospital, Iwate, Japan; Department of Diagnostic Radiology, Tohoku University Hospital, Miyagi, Japan
| | - Jonathon A Leipsic
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada.
| | - Noah McNamara
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Isabella Martin
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Timothy A Fairbairn
- Department of Cardiology, Liverpool Heart and Chest Hospital, University of Liverpool, Liverpool, UK
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Bjarne L Nørgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Daniel S Berman
- Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Kavitha Chinnaiyan
- Division of Cardiology, Beaumont Academic Heart and Vascular Group, Royal Oak, MI, USA
| | - Lynne M Hurwitz-Koweek
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | | | | | - Niels Peter Rønnow Sand
- Cardiac Research Unit, Institute of Regional Health Research, University Hospital of Southern DK, Esbjerg and University of Southern DK, Denmark
| | - Jesper M Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Aichi, Japan
| | - Michael Poon
- Department of Noninvasive Cardiac Imaging, Northwell Health, New York, NY, USA
| | | | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Mark G Rabbat
- Division of Cardiology, Loyola University Chicago, Chicago, IL, USA
| | | | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Cardiology, University Hospital of Lausanne, Lausanne, CH, USA
| | | | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Pamela S Douglas
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Manesh R Patel
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Koen Nieman
- Department of Cardiovascular Medicine and Radiology, Stanford University, Stanford, CA, USA
| | - Abdul Rahman Ihdayhid
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada; Department of Cardiology, Fiona Stanley Hospital, Harry Perkins Institute of Medical Research, University of Western Australia, Perth, Australia
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14
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Nørgaard BL, Gaur S, Fairbairn TA, Douglas PS, Jensen JM, Patel MR, Ihdayhid AR, Ko BSH, Sellers SL, Weir-McCall J, Matsuo H, Sand NPR, Øvrehus KA, Rogers C, Mullen S, Nieman K, Parner E, Leipsic J, Abdulla J. Prognostic value of coronary computed tomography angiographic derived fractional flow reserve: a systematic review and meta-analysis. Heart 2021; 108:194-202. [PMID: 34686567 PMCID: PMC8762006 DOI: 10.1136/heartjnl-2021-319773] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/23/2021] [Indexed: 12/18/2022] Open
Abstract
Objectives To obtain more powerful assessment of the prognostic value of fractional flow reserveCT testing we performed a systematic literature review and collaborative meta-analysis of studies that assessed clinical outcomes of CT-derived calculation of FFR (FFRCT) (HeartFlow) analysis in patients with stable coronary artery disease (CAD). Methods We searched PubMed and Web of Science electronic databases for published studies that evaluated clinical outcomes following fractional flow reserveCT testing between 1 January 2010 and 31 December 2020. The primary endpoint was defined as ‘all-cause mortality (ACM) or myocardial infarction (MI)’ at 12-month follow-up. Exploratory analyses were performed using major adverse cardiovascular events (MACEs, ACM+MI+unplanned revascularisation), ACM, MI, spontaneous MI or unplanned (>3 months) revascularisation as the endpoint. Results Five studies were identified including a total of 5460 patients eligible for meta-analyses. The primary endpoint occurred in 60 (1.1%) patients, 0.6% (13/2126) with FFRCT>0.80% and 1.4% (47/3334) with FFRCT ≤0.80 (relative risk (RR) 2.31 (95% CI 1.29 to 4.13), p=0.005). Likewise, MACE, MI, spontaneous MI or unplanned revascularisation occurred more frequently in patients with FFRCT ≤0.80 versus patients with FFRCT >0.80. Each 0.10-unit FFRCT reduction was associated with a greater risk of the primary endpoint (RR 1.67 (95% CI 1.47 to 1.87), p<0.001). Conclusions The 12-month outcomes in patients with stable CAD show low rates of events in those with a negative FFRCT result, and lower risk of an unfavourable outcome in patients with a negative test result compared with patients with a positive test result. Moreover, the FFRCT numerical value was inversely associated with outcomes.
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Affiliation(s)
| | - Sara Gaur
- Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | | | | | | | - Brian S H Ko
- Cardiology, MonashHeart, Melbourne, Victoria, Australia
| | | | | | | | - Niels Peter R Sand
- Institute of Regional Health Services Research, University of Southern Denmark, Esbjerg, Denmark
| | | | | | | | - Koen Nieman
- Cardiology, Stanford University Hospital, Palo Alto, California, USA
| | - Erik Parner
- Department of Public Health, Aarhus Universitet Health, Aarhus, Denmark
| | - Jonathon Leipsic
- Radiology, St Pauls Hospital, Vancouver, British Columbia, Canada
| | - Jawdat Abdulla
- Cardiology, Glostrup University Hospital, Glostrup, Denmark
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15
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Anastasius M, Maggiore P, Huang A, Blanke P, Patel MR, Nørgaard BL, Fairbairn TA, Nieman K, Akasaka T, Berman DS, Raff GL, Hurwitz Koweek LM, Pontone G, Kawasaki T, Rønnow Sand NP, Jensen JM, Amano T, Poon M, Øvrehus KA, Sonck J, Rabbat MG, Mullen S, De Bruyne B, Rogers C, Matsuo H, Bax JJ, Leipsic J. The clinical utility of FFR CT stratified by age. J Cardiovasc Comput Tomogr 2020; 15:121-128. [PMID: 33032976 DOI: 10.1016/j.jcct.2020.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 05/07/2020] [Revised: 08/09/2020] [Accepted: 08/10/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND CT coronary angiography (CTA) with Fractional Flow Reserve as determined by CT (FFRCT) is a safe alternative to invasive coronary angiography. A negative FFRCT has been shown to have low cardiac event rates compared to those with a positive FFRCT. However, the clinical utility of FFRCT according to age is not known. METHODS Patients' in the ADVANCE (Assessing Diagnostic Value of Non-invasive FFRCT in Coronary Care) registry, were stratified into those ≥65 or <65 years of age. The impact of FFRCT on clinical decision-making, as assessed by patient age, was determined by evaluating patient management using CTA results alone, followed by site investigators submitting a report on the treatment plan based upon the newly provided FFRCT data. Outcomes at 1-year post CTA were assessed, including major adverse cardiovascular events (myocardial infarction, all-cause mortality or unplanned hospitalization for ACS leading to revascularisation) and total revascularisation. Positive FFRCT was deemed to be ≤ 0.8. RESULTS FFRCT was calculated in 1849 (40.6%) subjects aged <65 and 2704 (59.4%) ≥ 65 years of age. Subjects ≥65 years were more likely to have anatomic obstructive disease on CTA (≥50% stenosis), compared to those aged <65 (69.7% and 73.2% respectively, p = 0.008). There was a similar graded increase in recommended and actual revascularisation with either CABG or PCI, with declining FFRCT strata for subjects above and below the age of 65. MACE and revascularisation rates were not significantly different for those ≥ or <65, regardless of FFRCT positivity or stenosis severity <50% or ≥50%. With a negative FFRCT result, and anatomical stenosis ≥50%, those ≥ and <65 years of age, had similar rates of MACE (0.2% for both, p = 0.1) and revascularisation (8.7% and 10.4% respectively p = 0.4). Logistic regression analysis, with age as a continuous variable, and adjustment for Diamond Forrester Risk, baseline FFRCT and treatment (CABG, PCI, medical therapy), indicated a statistically significant, but small increase in the odds of a MACE event with increasing age (OR 1.04, 95% CI 1.006-1.08, p = 0.02). Amongst patients with a FFRCT > 0.80, there was no effect of age on the odds of revascularisation. CONCLUSION The findings of this study point to a low risk of MACE events or need for revascularisation in those aged ≥ or <65 with a FFRCT>0.80, despite the higher incidence of anatomic obstructive CAD in those ≥65 years. The findings show the clinical usefulness and outcomes of FFRCT are largely constant regardless of age.
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Affiliation(s)
- Malcom Anastasius
- Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Paul Maggiore
- Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Alex Huang
- Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Phillip Blanke
- Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Manesh R Patel
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | | | - Timothy A Fairbairn
- Department of Cardiology, University of Liverpool, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Koen Nieman
- Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, CA, USA
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Daniel S Berman
- Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Gilbert L Raff
- Division of Cardiology, Beaumont Academic Heart and Vascular Group, Royal Oak, MI, USA
| | - Lynne M Hurwitz Koweek
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | | | | | - Niels Peter Rønnow Sand
- Department of Cardiology, University Hospital of Southern DK, Esbjerg, and Department of Regional Health Research, University of Southern DK, Denmark
| | - Jesper M Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Aichi, Japan
| | - Michael Poon
- Department of Noninvasive Cardiac Imaging, Northwell Health, New York, NY, USA
| | - Kristian A Øvrehus
- Department of Cardiology, University Hospital of Southern DK, Esbjerg, and Department of Regional Health Research, University of Southern DK, Denmark
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Mark G Rabbat
- Division of Cardiology, Loyola University Chicago, Chicago, IL, USA
| | | | | | | | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jonathon Leipsic
- Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada.
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16
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Fairbairn TA, Dobson R, Hurwitz-Koweek L, Matsuo H, Norgaard BL, Rønnow Sand NP, Nieman K, Bax JJ, Pontone G, Raff G, Chinnaiyan KM, Rabbat M, Amano T, Kawasaki T, Akasaka T, Kitabata H, Binukrishnan S, Rogers C, Berman D, Patel MR, Douglas PS, Leipsic J. Sex Differences in Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve: Lessons From ADVANCE. JACC Cardiovasc Imaging 2020; 13:2576-2587. [PMID: 32861656 DOI: 10.1016/j.jcmg.2020.07.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [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: 04/09/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This study is to determine the management and clinical outcomes of patients investigated with coronary computed tomography angiography (CCTA)-derived fractional flow reserve (FFRCT) according to sex. BACKGROUND Women are underdiagnosed with conventional ischemia testing, have lower rates of obstructive coronary artery disease (CAD) at invasive coronary angiography (ICA), yet higher mortality compared to men. Whether FFRCT improves sex-based patient management decisions compared to CCTA alone is unknown. METHODS Subjects with symptoms and CAD on CCTA were enrolled (2015 to 2017). Demographics, symptom status, CCTA anatomy, coronary volume to myocardial mass ratio (V/M), lowest FFRCT values, and management plans were captured. Endpoints included reclassification rate between CCTA and FFRCT management plans, incidence of ICA demonstrating obstructive CAD (≥50% stenosis) and revascularization rates. RESULTS A total of 4,737 patients (n = 1,603 females, 33.8%) underwent CCTA and FFRCT. Women were older (age 68 ± 10 years vs. 65 ± 10 years; p < 0.0001) with more atypical symptoms (41.5% vs. 33.9%; p < 0.0001). Women had less obstructive CAD (65.4% vs. 74.7%; p < 0.0001) at CCTA, higher FFRCT (0.76 ± 0.10 vs. 0.73 ± 0.10; p < 0.0001), and lower likelihood of positive FFRCT ≤ 0.80 for the same degree stenosis (p < 0.0001). A positive FFRCT ≤0.80 resulted in equal referral to ICA (n = 510 [54.5%] vs. n = 1,249 [56.5%]; p = 0.31), but more nonobstructive CAD (n = 208 [32.1%] vs. n = 354 [24.5%]; p = 0.0003) and less revascularization (n = 294 [31.4%] vs. n = 800 [36.2%]; p < 0.0001) in women, unless the FFRCT was ≤0.75 where revascularization rates were similar (n = 253 [41.9%] vs. n = 715 [46.4%]; p = 0.06). Women have a higher V/M ratio (26.17 ± 7.58 mm3/g vs. 24.76 ± 7.22 mm3/g; p < 0.0001) that is associated with higher FFRCT independent of degree stenosis (p < 0.001). Predictors of revascularization included stenosis severity, FFRCT, symptoms, and V/M ratio (p < 0.001) but not female sex (p = 0.284). CONCLUSIONS FFRCT differs between the sexes, as women have a higher FFRCT for the same degree of stenosis. In FFRCT-positive CAD, women have less obstructive CAD at ICA and less revascularization, which is associated with higher V/M ratio. The findings suggest that CAD and FFRCT variations by sex need specific interpretation as these differences may affect therapeutic decision making and clinical outcomes. (Assessing Diagnostic Value of Non-invasive FFRCT in Coronary Care [ADVANCE]; NCT02499679).
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Affiliation(s)
| | - Rebecca Dobson
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | | | - Hitoshi Matsuo
- Wakayama Medical University, Wakayama, Japan; Gifu Heart Center, Gifu, Japan
| | | | | | - Koen Nieman
- Stanford University Medical Center, Palo Alto, California, USA
| | - Jeroen J Bax
- Leiden University Medical Center, Leiden, the Netherlands
| | - Gianluca Pontone
- Centro Cardiologico Monzino, IRCCS, University of Milan, Milan, Italy
| | - Gilbert Raff
- William Beaumont Hospital, Royal Oaks, Michigan, USA
| | | | - Mark Rabbat
- Loyola University Medical Center, Maywood, Illinois, USA
| | | | | | | | | | | | | | - Daniel Berman
- Cedars Sinai Medical Centre, Beverly Hills, California, USA
| | - Manesh R Patel
- Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Jonathon Leipsic
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
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17
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Matsuo H, Kawasaki T, Amano T, Kawase Y, Sobue Y, Kondo T, Morino Y, Yoda S, Sakamoto T, Ito H, Shite J, Otake H, Tanaka N, Terashima M, Kadota K, Patel MR, Nieman K, Rogers C, Norgaard BL, Bax JJ, Chinnaiyan KM, Berman DS, Fairbairn TA, Hurwitz Koweek LM, Leipsic J, Akasaka T. Effect of Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve on Physicians' Clinical Behavior - Differences Between Sites With and Without Appropriate Use Criteria as Designated by the Japanese Reimbursement System. Circ Rep 2020; 2:364-371. [PMID: 33693254 PMCID: PMC7932815 DOI: 10.1253/circrep.cr-20-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background:
Coronary computed tomography angiography (CCTA)-derived fractional flow reserve (FFRCT) is an established tool for identifying lesion-specific ischemia that is now approved for use by the Japanese insurance system. However, current clinical reimbursement is strictly limited to institutions with designated appropriate use criteria (AUC). This study assessed differences in physicians’ behavior (e.g., use and interpretation of FFRCT, final management) according to Japanese AUC and non-AUC site designation. Methods and Results:
Of 5,083 patients in the ADVANCE Registry, 1,829 from Japan were enrolled in this study. Physicians’ behavior after interrogating CCTA and FFRCT
was analyzed separately according to AUC and non-AUC site designation. Compared with AUC sites, patients referred for FFRCT
from non-AUC sites had a higher rate of negative FFRCT, less severe anatomic stenosis, and a slightly lower rate of management plan reclassification (51.2% vs. 61.3%), with near-identical utility in both groups. Actual care corresponded equally well to post-FFRCT
plans in both groups. The likelihood of revascularization for positive or negative FFRCT
was similar between the 2 groups. Importantly, AUC and non-AUC sites were equally unlikely to revascularize patients with negative FFRCT
and stenosis >50% or patients with positive FFRCT
and stenosis <50%. Conclusions:
Compared with AUC sites, non-AUC sites had lower disease burden and reclassification of management plans, but nearly identical clinical integration. Actual care corresponded equally well to post-FFRCT
recommendations at both sites.
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Affiliation(s)
- Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center Gifu Japan
| | | | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University Aichi Japan
| | - Yoshiaki Kawase
- Department of Cardiovascular Medicine, Gifu Heart Center Gifu Japan
| | - Yoshihiro Sobue
- Department of Cardiovascular Medicine, Gifu Heart Center Gifu Japan
| | - Takeshi Kondo
- Department of Cardiovascular Medicine, Gifu Heart Center Gifu Japan
| | - Yoshihiro Morino
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University Iwate Japan
| | - Shunichi Yoda
- Department of Cardiology, Nihon University Itabashi Hospital Tokyo Japan
| | - Tomohiro Sakamoto
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center Kumamoto Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine Okayama Japan
| | - Junya Shite
- Division of Cardiology, Osaka Saiseikai Nakatsu Hospital Osaka Japan
| | - Hiromasa Otake
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine Hyogo Japan
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center Tokyo Japan
| | | | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital Okayama Japan
| | - Manesh R Patel
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Duke University School of Medicine Durham, NC USA
| | - Koen Nieman
- Department of Cardiology, Erasmus Medical Center Rotterdam The Netherlands
| | | | | | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center Leiden Netherlands
| | - Kavitha M Chinnaiyan
- Division of Cardiology, Beaumont Academic Heart and Vascular Group Royal Oak, MI USA
| | - Daniel S Berman
- Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart Institute Los Angeles, CA USA
| | - Timothy A Fairbairn
- Department of Cardiology, University of Liverpool, Liverpool Heart and Chest Hospital Liverpool UK
| | - Lynne M Hurwitz Koweek
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Duke University School of Medicine Durham, NC USA
| | - Jonathon Leipsic
- Department of Radiology, University of British Columbia Vancouver, BC Canada
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University Wakayama Japan
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Nous F, Budde RPJ, Fairbairn TA, Akasaka T, Nørgaard BL, Berman DS, Raff G, Hurwitz-Koweek LM, Pontone G, Kawasaki T, Sand NPR, Jensen JM, Amano T, Poon M, Øvrehus KA, Sonck J, Rabbat MG, Mullen S, De Bruyne B, Rogers C, Matsuo H, Bax JJ, Leipsic J, Patel MR, Nieman K. Temporal changes in FFR CT-Guided Management of Coronary Artery Disease - Lessons from the ADVANCE Registry. J Cardiovasc Comput Tomogr 2020; 15:48-55. [PMID: 32418861 DOI: 10.1016/j.jcct.2020.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/28/2019] [Revised: 04/09/2020] [Accepted: 04/27/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The ADVANCE registry is a large prospective study of outcomes and resource utilization in patients undergoing coronary computed tomography angiography (CCTA) and CT-based fractional flow reserve (FFRCT). As experience with new technologies and practices develops over time, we investigated temporal changes in the use of FFRCT within the ADVANCE registry. METHODS 5083 patients with coronary artery disease (CAD) on CCTA were prospectively enrolled in the ADVANCE registry and were divided into 3 equally sized cohorts based on the temporal order of enrollment per site. Demographics, CCTA and FFRCT findings, and clinical outcomes through 1-year follow-up, were recorded and compared between tertiles. RESULTS The number of patients with a ≥70% stenosis on CCTA was similar over time (33.6%, 30.9%, and 33.8% for cohort 1-3). The rate of positive FFRCT ≤0.80 was higher for cohorts 2 (67.3%) and 3 (74.6%) than for cohort 1 (57.1%, p < 0.001). Invasive FFR rates decreased from 25.8% to 22.4% between cohort 1 and 3 (p = 0.023). Moreover, patients with a FFRCT ≤0.80 were less frequently referred for invasive coronary angiography (ICA) (from 62.9% to 52.9%, p < 0.001), and underwent fewer revascularizations between cohort 1 and 3 (from 41.9% to 32.0%, p < 0.001). The prevalence of major events was low (1.2%) and similar between cohorts. CONCLUSIONS Growing experience with FFRCT improved the likelihood of identifying hemodynamically significant CAD and safely reduced the need for ICA and revascularization in patients with anatomically significant disease even in the instance of an abnormal FFRCT.
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Affiliation(s)
- Fay Nous
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands.
| | - Ricardo P J Budde
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands.
| | - Timothy A Fairbairn
- Department of Cardiology, Liverpool Heart and Chest Hospital, University of Liverpool, Liverpool, United Kingdom.
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
| | - Bjarne L Nørgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
| | - Daniel S Berman
- Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart Institute, Los Angeles, CA, USA.
| | - Gilbert Raff
- Division of Cardiology, Beaumont Academic Heart and Vascular Group, Royal Oak, MI, USA.
| | - Lynne M Hurwitz-Koweek
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
| | | | | | - Niels Peter R Sand
- Cardiac Research Unit, Institute of Regional Health Research, University Hospital of Southern DK, Esbjerg and University of Southern DK, Denmark.
| | - Jesper M Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Aichi, Japan.
| | - Michael Poon
- Department of Noninvasive Cardiac Imaging, Northwell Health, New York, NY, USA.
| | | | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
| | - Mark G Rabbat
- Division of Cardiology, Loyola University Chicago, Chicago, IL, USA.
| | | | | | | | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan.
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Jonathon Leipsic
- Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada.
| | - Manesh R Patel
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
| | - Koen Nieman
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Cardiovascular Medicine, Stanford University, Stanford, CA, USA; Department of Radiology, Stanford University, Stanford, CA, USA.
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Weir-McCall JR, Fairbairn TA. Fractional Flow Reserve Derived from CT: The State of Play in 2020. Radiol Cardiothorac Imaging 2020; 2:e190153. [PMID: 33778538 PMCID: PMC7977733 DOI: 10.1148/ryct.2019190153] [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: 08/01/2019] [Revised: 10/19/2019] [Accepted: 10/23/2019] [Indexed: 06/12/2023]
Abstract
Fractional flow reserve derived from CT is a rapidly developing technique, with an increasing burden of literature supporting its potential role in the workup of patients suspected of having coronary artery disease.
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Affiliation(s)
- Jonathan R. Weir-McCall
- From the Department of Radiology, University of Cambridge School of Clinical Medicine, Box 219, Level 5, Biomedical Campus, Cambridge CB2 0QQ, England (J.R.W.); Royal Papworth Hospital, Cambridge, England (J.R.W.); and Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, England (T.A.F.)
| | - Timothy A. Fairbairn
- From the Department of Radiology, University of Cambridge School of Clinical Medicine, Box 219, Level 5, Biomedical Campus, Cambridge CB2 0QQ, England (J.R.W.); Royal Papworth Hospital, Cambridge, England (J.R.W.); and Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, England (T.A.F.)
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20
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Patel MR, Nørgaard BL, Fairbairn TA, Nieman K, Akasaka T, Berman DS, Raff GL, Hurwitz Koweek LM, Pontone G, Kawasaki T, Sand NPR, Jensen JM, Amano T, Poon M, Øvrehus KA, Sonck J, Rabbat MG, Mullen S, De Bruyne B, Rogers C, Matsuo H, Bax JJ, Leipsic J. 1-Year Impact on Medical Practice and Clinical Outcomes of FFRCT. JACC Cardiovasc Imaging 2020; 13:97-105. [DOI: 10.1016/j.jcmg.2019.03.003] [Citation(s) in RCA: 128] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 03/11/2019] [Indexed: 11/26/2022]
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21
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Nørgaard BL, Fairbairn TA, Safian RD, Rabbat MG, Ko B, Jensen JM, Nieman K, Chinnaiyan KM, Sand NP, Matsuo H, Leipsic J, Raff G. Coronary CT Angiography-derived Fractional Flow Reserve Testing in Patients with Stable Coronary Artery Disease: Recommendations on Interpretation and Reporting. Radiol Cardiothorac Imaging 2019; 1:e190050. [PMID: 33778528 PMCID: PMC7977999 DOI: 10.1148/ryct.2019190050] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [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: 03/20/2019] [Revised: 06/05/2019] [Accepted: 09/13/2021] [Indexed: 01/02/2023]
Abstract
Noninvasive fractional flow reserve derived from coronary CT angiography (FFRCT) is increasingly used in patients with coronary artery disease as a gatekeeper to the catheterization laboratory. While there is emerging evidence of the clinical benefit of FFRCT in patients with moderate coronary disease as determined with coronary CT angiography, there has been less focus on interpretation, reporting, and integration of FFRCT results into routine clinical practice. Because FFRCT analysis provides a plethora of information regarding pressure and flow across the entire coronary tree, standardized criteria on interpretation and reporting of the FFRCT analysis result are of crucial importance both in context of the clinical adoption and in future research. This report represents expert opinion and recommendation on a standardized FFRCT interpretation and reporting approach. Published under a CC BY 4.0 license.
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Affiliation(s)
- Bjarne L. Nørgaard
- From the Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark (B.L.N., J.M.J.); Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, England (T.A.F.); Department of Cardiology and Radiology, Beaumont Health System, Royal Oak, Mich (R.D.S., K.M.C., G.R.); Division of Cardiology, Loyola University Chicago, Chicago, Ill (M.G.R.); Monash Cardiovascular Research Centre, Monash University, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia (B.K.); Department of Cardiology, Stanford University School of Medicine, Palo Alto, Calif (K.N.); Department of Cardiology, Hospital of Southwest DK, Esbjerg, Denmark (N.P.S.); Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan (H.M.); and Department of Medical Imaging, St Paul’s Hospital, Vancouver, Canada (J.L.)
| | - Timothy A. Fairbairn
- From the Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark (B.L.N., J.M.J.); Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, England (T.A.F.); Department of Cardiology and Radiology, Beaumont Health System, Royal Oak, Mich (R.D.S., K.M.C., G.R.); Division of Cardiology, Loyola University Chicago, Chicago, Ill (M.G.R.); Monash Cardiovascular Research Centre, Monash University, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia (B.K.); Department of Cardiology, Stanford University School of Medicine, Palo Alto, Calif (K.N.); Department of Cardiology, Hospital of Southwest DK, Esbjerg, Denmark (N.P.S.); Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan (H.M.); and Department of Medical Imaging, St Paul’s Hospital, Vancouver, Canada (J.L.)
| | - Robert D. Safian
- From the Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark (B.L.N., J.M.J.); Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, England (T.A.F.); Department of Cardiology and Radiology, Beaumont Health System, Royal Oak, Mich (R.D.S., K.M.C., G.R.); Division of Cardiology, Loyola University Chicago, Chicago, Ill (M.G.R.); Monash Cardiovascular Research Centre, Monash University, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia (B.K.); Department of Cardiology, Stanford University School of Medicine, Palo Alto, Calif (K.N.); Department of Cardiology, Hospital of Southwest DK, Esbjerg, Denmark (N.P.S.); Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan (H.M.); and Department of Medical Imaging, St Paul’s Hospital, Vancouver, Canada (J.L.)
| | - Mark G. Rabbat
- From the Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark (B.L.N., J.M.J.); Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, England (T.A.F.); Department of Cardiology and Radiology, Beaumont Health System, Royal Oak, Mich (R.D.S., K.M.C., G.R.); Division of Cardiology, Loyola University Chicago, Chicago, Ill (M.G.R.); Monash Cardiovascular Research Centre, Monash University, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia (B.K.); Department of Cardiology, Stanford University School of Medicine, Palo Alto, Calif (K.N.); Department of Cardiology, Hospital of Southwest DK, Esbjerg, Denmark (N.P.S.); Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan (H.M.); and Department of Medical Imaging, St Paul’s Hospital, Vancouver, Canada (J.L.)
| | - Brian Ko
- From the Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark (B.L.N., J.M.J.); Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, England (T.A.F.); Department of Cardiology and Radiology, Beaumont Health System, Royal Oak, Mich (R.D.S., K.M.C., G.R.); Division of Cardiology, Loyola University Chicago, Chicago, Ill (M.G.R.); Monash Cardiovascular Research Centre, Monash University, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia (B.K.); Department of Cardiology, Stanford University School of Medicine, Palo Alto, Calif (K.N.); Department of Cardiology, Hospital of Southwest DK, Esbjerg, Denmark (N.P.S.); Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan (H.M.); and Department of Medical Imaging, St Paul’s Hospital, Vancouver, Canada (J.L.)
| | - Jesper M. Jensen
- From the Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark (B.L.N., J.M.J.); Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, England (T.A.F.); Department of Cardiology and Radiology, Beaumont Health System, Royal Oak, Mich (R.D.S., K.M.C., G.R.); Division of Cardiology, Loyola University Chicago, Chicago, Ill (M.G.R.); Monash Cardiovascular Research Centre, Monash University, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia (B.K.); Department of Cardiology, Stanford University School of Medicine, Palo Alto, Calif (K.N.); Department of Cardiology, Hospital of Southwest DK, Esbjerg, Denmark (N.P.S.); Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan (H.M.); and Department of Medical Imaging, St Paul’s Hospital, Vancouver, Canada (J.L.)
| | - Koen Nieman
- From the Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark (B.L.N., J.M.J.); Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, England (T.A.F.); Department of Cardiology and Radiology, Beaumont Health System, Royal Oak, Mich (R.D.S., K.M.C., G.R.); Division of Cardiology, Loyola University Chicago, Chicago, Ill (M.G.R.); Monash Cardiovascular Research Centre, Monash University, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia (B.K.); Department of Cardiology, Stanford University School of Medicine, Palo Alto, Calif (K.N.); Department of Cardiology, Hospital of Southwest DK, Esbjerg, Denmark (N.P.S.); Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan (H.M.); and Department of Medical Imaging, St Paul’s Hospital, Vancouver, Canada (J.L.)
| | - Kavitha M. Chinnaiyan
- From the Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark (B.L.N., J.M.J.); Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, England (T.A.F.); Department of Cardiology and Radiology, Beaumont Health System, Royal Oak, Mich (R.D.S., K.M.C., G.R.); Division of Cardiology, Loyola University Chicago, Chicago, Ill (M.G.R.); Monash Cardiovascular Research Centre, Monash University, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia (B.K.); Department of Cardiology, Stanford University School of Medicine, Palo Alto, Calif (K.N.); Department of Cardiology, Hospital of Southwest DK, Esbjerg, Denmark (N.P.S.); Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan (H.M.); and Department of Medical Imaging, St Paul’s Hospital, Vancouver, Canada (J.L.)
| | - Niels Peter Sand
- From the Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark (B.L.N., J.M.J.); Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, England (T.A.F.); Department of Cardiology and Radiology, Beaumont Health System, Royal Oak, Mich (R.D.S., K.M.C., G.R.); Division of Cardiology, Loyola University Chicago, Chicago, Ill (M.G.R.); Monash Cardiovascular Research Centre, Monash University, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia (B.K.); Department of Cardiology, Stanford University School of Medicine, Palo Alto, Calif (K.N.); Department of Cardiology, Hospital of Southwest DK, Esbjerg, Denmark (N.P.S.); Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan (H.M.); and Department of Medical Imaging, St Paul’s Hospital, Vancouver, Canada (J.L.)
| | - Hitoshi Matsuo
- From the Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark (B.L.N., J.M.J.); Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, England (T.A.F.); Department of Cardiology and Radiology, Beaumont Health System, Royal Oak, Mich (R.D.S., K.M.C., G.R.); Division of Cardiology, Loyola University Chicago, Chicago, Ill (M.G.R.); Monash Cardiovascular Research Centre, Monash University, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia (B.K.); Department of Cardiology, Stanford University School of Medicine, Palo Alto, Calif (K.N.); Department of Cardiology, Hospital of Southwest DK, Esbjerg, Denmark (N.P.S.); Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan (H.M.); and Department of Medical Imaging, St Paul’s Hospital, Vancouver, Canada (J.L.)
| | - Jonathon Leipsic
- From the Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark (B.L.N., J.M.J.); Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, England (T.A.F.); Department of Cardiology and Radiology, Beaumont Health System, Royal Oak, Mich (R.D.S., K.M.C., G.R.); Division of Cardiology, Loyola University Chicago, Chicago, Ill (M.G.R.); Monash Cardiovascular Research Centre, Monash University, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia (B.K.); Department of Cardiology, Stanford University School of Medicine, Palo Alto, Calif (K.N.); Department of Cardiology, Hospital of Southwest DK, Esbjerg, Denmark (N.P.S.); Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan (H.M.); and Department of Medical Imaging, St Paul’s Hospital, Vancouver, Canada (J.L.)
| | - Gilbert Raff
- From the Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark (B.L.N., J.M.J.); Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, England (T.A.F.); Department of Cardiology and Radiology, Beaumont Health System, Royal Oak, Mich (R.D.S., K.M.C., G.R.); Division of Cardiology, Loyola University Chicago, Chicago, Ill (M.G.R.); Monash Cardiovascular Research Centre, Monash University, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia (B.K.); Department of Cardiology, Stanford University School of Medicine, Palo Alto, Calif (K.N.); Department of Cardiology, Hospital of Southwest DK, Esbjerg, Denmark (N.P.S.); Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan (H.M.); and Department of Medical Imaging, St Paul’s Hospital, Vancouver, Canada (J.L.)
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Shantsila A, Oxborough D, Fairbairn TA, Lip GYH. Clinical factors and imaging leading to risk of incident atrial fibrillation. Eur Heart J Cardiovasc Imaging 2019; 20:988-989. [PMID: 31356655 DOI: 10.1093/ehjci/jez199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Alena Shantsila
- Liverpool Centre for Cardiovascular Science, University of Liverpool, 6 West Derby Street, Liverpool, L7 8TX, UK and Liverpool John Moores University, Tom Reilly Building, Liverpool, L3 3AF, UK
| | - David Oxborough
- Liverpool Centre for Cardiovascular Science, University of Liverpool, 6 West Derby Street, Liverpool, L7 8TX, UK and Liverpool John Moores University, Tom Reilly Building, Liverpool, L3 3AF, UK.,Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE UK
| | - Timothy A Fairbairn
- Liverpool Centre for Cardiovascular Science, University of Liverpool, 6 West Derby Street, Liverpool, L7 8TX, UK and Liverpool John Moores University, Tom Reilly Building, Liverpool, L3 3AF, UK.,Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, 6 West Derby Street, Liverpool, L7 8TX, UK and Liverpool John Moores University, Tom Reilly Building, Liverpool, L3 3AF, UK.,Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE UK.,Department of Clinical Medicine, Aalborg Thrombosis Research Unit, Aalborg University, 9000 Aalborg, Denmark
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Fairbairn TA, Bull R. How Well Does CT-derived Fractional Flow Reserve Predict Outcome? Radiol Cardiothorac Imaging 2019; 1:e190107. [PMID: 33779628 PMCID: PMC7970093 DOI: 10.1148/ryct.2019190107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 06/07/2019] [Indexed: 06/12/2023]
Affiliation(s)
- Timothy A. Fairbairn
- From the Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, England (T.A.F.); and Department of Radiology, Royal Bournemouth Hospital, Bournemouth, England (R.B.)
| | - Russell Bull
- From the Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, England (T.A.F.); and Department of Radiology, Royal Bournemouth Hospital, Bournemouth, England (R.B.)
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Shiono Y, Matsuo H, Kawasaki T, Amano T, Kitabata H, Kubo T, Morino Y, Yoda S, Sakamoto T, Ito H, Shite J, Otake H, Tanaka N, Terashima M, Kadota K, Patel MR, Nieman K, Rogers C, Nørgaard BL, Bax JJ, Raff GL, Chinnaiyan KM, Berman DS, Fairbairn TA, Hurwitz Koweek LM, Leipsic J, Akasaka T. Clinical Impact of Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve on Japanese Population in the ADVANCE Registry. Circ J 2019; 83:1293-1301. [DOI: 10.1253/circj.cj-18-1269] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Blackman DJ, Saraf S, MacCarthy PA, Myat A, Anderson SG, Malkin CJ, Cunnington MS, Somers K, Brennan P, Manoharan G, Parker J, Aldalati O, Brecker SJ, Dowling C, Hoole SP, Dorman S, Mullen M, Kennon S, Jerrum M, Chandrala P, Roberts DH, Tay J, Doshi SN, Ludman PF, Fairbairn TA, Crowe J, Levy RD, Banning AP, Ruparelia N, Spence MS, Hildick-Smith D. Long-Term Durability of Transcatheter Aortic Valve Prostheses. J Am Coll Cardiol 2019; 73:537-545. [DOI: 10.1016/j.jacc.2018.10.078] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 10/23/2018] [Accepted: 10/29/2018] [Indexed: 10/27/2022]
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Fairbairn TA, Nieman K, Akasaka T, Nørgaard BL, Berman DS, Raff G, Hurwitz-Koweek LM, Pontone G, Kawasaki T, Sand NP, Jensen JM, Amano T, Poon M, Øvrehus K, Sonck J, Rabbat M, Mullen S, De Bruyne B, Rogers C, Matsuo H, Bax JJ, Leipsic J, Patel MR. Real-world clinical utility and impact on clinical decision-making of coronary computed tomography angiography-derived fractional flow reserve: lessons from the ADVANCE Registry. Eur Heart J 2018; 39:3701-3711. [PMID: 30165613 PMCID: PMC6215963 DOI: 10.1093/eurheartj/ehy530] [Citation(s) in RCA: 193] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/09/2018] [Indexed: 11/18/2022] Open
Abstract
AIMS Non-invasive assessment of stable chest pain patients is a critical determinant of resource utilization and clinical outcomes. Increasingly coronary computed tomography angiography (CCTA) with selective CCTA-derived fractional flow reserve (FFRCT) is being used. The ADVANCE Registry, is a large prospective examination of using a CCTA and FFRCT diagnostic pathway in real-world settings, with the aim of determining the impact of this pathway on decision-making, downstream invasive coronary angiography (ICA), revascularization, and major adverse cardiovascular events (MACE). METHODS AND RESULTS A total of 5083 patients with symptoms concerning for coronary artery disease (CAD) and atherosclerosis on CCTA were enrolled at 38 international sites from 15 July 2015 to 20 October 2017. Demographics, symptom status, CCTA and FFRCT findings, treatment plans, and 90 days outcomes were recorded. The primary endpoint of reclassification between core lab CCTA alone and CCTA plus FFRCT-based management plans occurred in 66.9% [confidence interval (CI): 64.8-67.6] of patients. Non-obstructive coronary disease was significantly lower in ICA patients with FFRCT ≤0.80 (14.4%) compared to patients with FFRCT >0.80 (43.8%, odds ratio 0.19, CI: 0.15-0.25, P < 0.001). In total, 72.3% of subjects undergoing ICA with FFRCT ≤0.80 were revascularized. No death/myocardial infarction (MI) occurred within 90 days in patients with FFRCT >0.80 (n = 1529), whereas 19 (0.6%) MACE [hazard ratio (HR) 19.75, CI: 1.19-326, P = 0.0008] and 14 (0.3%) death/MI (HR 14.68, CI 0.88-246, P = 0.039) occurred in subjects with an FFRCT ≤0.80. CONCLUSIONS In a large international multicentre population, FFRCT modified treatment recommendation in two-thirds of subjects as compared to CCTA alone, was associated with less negative ICA, predicted revascularization, and identified subjects at low risk of adverse events through 90 days.
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Affiliation(s)
| | - Koen Nieman
- Stanford and Erasmus Medical Center, Rotterdam, Netherlands
| | - Takashi Akasaka
- Wakayama Medical University, 811-1 Kimiidera Wakayama, Wakayama, Japan
| | - Bjarne L Nørgaard
- Aarhus University Hospital, Department Cardiology B, Palle Juul-Jensens Boulevard 99, Aarhus N, Denmark
| | - Daniel S Berman
- Cedars Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, USA
| | - Gilbert Raff
- William Beaumont Hospital, 3601 West 13 Mile Road, Royal Oak, MI, USA
| | | | - Gianluca Pontone
- Centro Cardiologico Monzino, IRCCS, University of Milan, Via Carlo Parea 4, Milan, Italy
| | | | - Niels Peter Sand
- University of Southern Denmark, Sdr Boulevard 29, Odense, Denmark
| | - Jesper M Jensen
- Aarhus University Hospital, Department Cardiology B, Palle Juul-Jensens Boulevard 99, Aarhus N, Denmark
| | - Tetsuya Amano
- Aichi Medical University, 1-1 Yazakokarimata Nagakute, Aichi, Japan
| | - Michael Poon
- Northwell Health, 100 E 77th Street, New York, NY, USA
| | - Kristian Øvrehus
- University of Southern Denmark, Sdr Boulevard 29, Odense, Denmark
| | - Jeroen Sonck
- UZ Brussels, Laarbeeklaan 101, Brussels, Belgium
| | - Mark Rabbat
- Loyola University Medical Center, 2160 South First Avenue, Maywood, IL, USA
| | - Sarah Mullen
- HeartFlow Inc., 1400 Seaport Blvd, Bldg B, Redwood City, CA, USA
| | | | - Campbell Rogers
- HeartFlow Inc., 1400 Seaport Blvd, Bldg B, Redwood City, CA, USA
| | - Hitoshi Matsuo
- Gifu Heart Center, 4-14-4 Yabutaminami, Gifu Gifu, Japan
| | - Jeroen J Bax
- Leiden University Medical Center, Albinusdreef 2, Leiden, AZ, Netherlands
| | - Jonathon Leipsic
- Department of Radiology, University of British Columbia, 1081 Burrard Street, Vancouver, BC, Canada
| | - Manesh R Patel
- Duke University School of Medicine, 2301 Erwin Road, Durham, NC, USA
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Chew PG, Dobson LE, Garg P, Fairbairn TA, Musa TA, Uddin A, Swoboda PP, Foley JR, Fent GJ, Brown LAE, Onciul S, Plein S, Blackman DJ, Greenwood JP. CMR quantitation of change in mitral regurgitation following transcatheter aortic valve replacement (TAVR): impact on left ventricular reverse remodeling and outcome. Int J Cardiovasc Imaging 2018; 35:161-170. [PMID: 30182320 PMCID: PMC6373302 DOI: 10.1007/s10554-018-1441-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 08/13/2018] [Indexed: 12/11/2022]
Abstract
Current echocardiographic data reporting the impact of concomitant mitral regurgitation (MR) on outcome in patients who undergo transcatheter aortic valve replacement (TAVR) are conflicting. Using cardiovascular magnetic resonance (CMR) imaging, this study aimed to assess the impact of MR severity on cardiac reverse remodeling and patient outcome. 85 patients undergoing TAVR with CMR pre- and 6 m post-TAVR were evaluated. The CMR protocol included cines for left (LV) and right ventricular (RV) volumes, flow assessment, and myocardial scar assessment by late gadolinium enhancement (LGE). Patients were dichotomised according to CMR severity of MR fraction at baseline (‘non-significant’ vs ‘significant’) and followed up for a median duration of 3 years. Forty-two (49%) patients had ‘significant MR’ at baseline; they had similar LV and RV size and function compared to the ‘non-significant MR’ group but had greater LV mass at baseline. In those with significant MR at baseline, 77% (n = 32) had a reduction in MR post-TAVR, moving them into the ‘non-significant’ category at 6-months, with an overall reduction in MR fraction from 34 to 17% (p < 0.001). Improvement in MR was not associated with more favourable cardiac reverse remodeling when compared with the ‘non-improvers’. Significant MR at baseline was not associated with increased mortality at follow-up. Significant MR is common in patients undergoing TAVR and improves in the majority post-procedure. Improvement in MR was not associated with more favourable LV reverse remodeling and baseline MR severity was not associated with mortality.
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Affiliation(s)
- Pei G Chew
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT, UK
| | - Laura E Dobson
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT, UK
| | - Pankaj Garg
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT, UK
| | - Timothy A Fairbairn
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT, UK
| | - Tarique A Musa
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT, UK
| | - Akhlaque Uddin
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT, UK
| | - Peter P Swoboda
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT, UK
| | - James R Foley
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT, UK
| | - Graham J Fent
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT, UK
| | - Louise A E Brown
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT, UK
| | - Sebastian Onciul
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT, UK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT, UK
| | | | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT, UK.
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Dobson LE, Musa TA, Uddin A, Fairbairn TA, Bebb OJ, Swoboda PP, Haaf P, Foley J, Garg P, Fent GJ, Malkin CJ, Blackman DJ, Plein S, Greenwood JP. The impact of trans-catheter aortic valve replacement induced left-bundle branch block on cardiac reverse remodeling. J Cardiovasc Magn Reson 2017; 19:22. [PMID: 28222749 PMCID: PMC5320804 DOI: 10.1186/s12968-017-0335-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 01/24/2017] [Accepted: 02/02/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Left bundle branch block (LBBB) is common following trans-catheter aortic valve replacement (TAVR) and has been linked to increased mortality, although whether this is related to less favourable cardiac reverse remodeling is unclear. The aim of the study was to investigate the impact of TAVR induced LBBB on cardiac reverse remodeling. METHODS 48 patients undergoing TAVR for severe aortic stenosis were evaluated. 24 patients with new LBBB (LBBB-T) following TAVR were matched with 24 patients with a narrow post-procedure QRS (nQRS). Patients underwent cardiovascular magnetic resonance (CMR) prior to and 6 m post-TAVR. Measured cardiac reverse remodeling parameters included left ventricular (LV) size, ejection fraction (LVEF) and global longitudinal strain (GLS). Inter- and intra-ventricular dyssynchrony were determined using time to peak radial strain derived from CMR Feature Tracking. RESULTS In the LBBB-T group there was an increase in QRS duration from 96 ± 14 to 151 ± 12 ms (P < 0.001) leading to inter- and intra-ventricular dyssynchrony (inter: LBBB-T 130 ± 73 vs nQRS 23 ± 86 ms, p < 0.001; intra: LBBB-T 118 ± 103 vs. nQRS 13 ± 106 ms, p = 0.001). Change in indexed LV end-systolic volume (LVESVi), LVEF and GLS was significantly different between the two groups (LVESVi: nQRS -7.9 ± 14.0 vs. LBBB-T -0.6 ± 10.2 ml/m2, p = 0.02, LVEF: nQRS +4.6 ± 7.8 vs LBBB-T -2.1 ± 6.9%, p = 0.002; GLS: nQRS -2.1 ± 3.6 vs. LBBB-T +0.2 ± 3.2%, p = 0.024). There was a significant correlation between change in QRS and change in LVEF (r = -0.434, p = 0.002) and between change in QRS and change in GLS (r = 0.462, p = 0.001). Post-procedure QRS duration was an independent predictor of change in LVEF and GLS at 6 months. CONCLUSION TAVR-induced LBBB is associated with less favourable cardiac reverse remodeling at medium term follow up. In view of this, every effort should be made to prevent TAVR-induced LBBB, especially as TAVR is now being extended to a younger, lower risk population.
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Affiliation(s)
- Laura E. Dobson
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Tarique A. Musa
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Akhlaque Uddin
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Timothy A. Fairbairn
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Owen J. Bebb
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Peter P. Swoboda
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Philip Haaf
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - James Foley
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Pankaj Garg
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Graham J. Fent
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | | | - Daniel J. Blackman
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX UK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX UK
| | - John P. Greenwood
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX UK
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Musa TA, Uddin A, Swoboda PP, Fairbairn TA, Dobson LE, Singh A, Garg P, Steadman CD, Erhayiem B, Kidambi A, Ripley DP, McDiarmid AK, Haaf P, Blackman DJ, Plein S, McCann GP, Greenwood JP. Cardiovascular magnetic resonance evaluation of symptomatic severe aortic stenosis: association of circumferential myocardial strain and mortality. J Cardiovasc Magn Reson 2017; 19:13. [PMID: 28173819 PMCID: PMC5297161 DOI: 10.1186/s12968-017-0329-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 01/18/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND It is unknown whether circumferential strain is associated with prognosis after treatment of aortic stenosis (AS). We aimed to characterise strain in severe AS, using myocardial tagging cardiovascular magnetic resonance (CMR), prior to and following Transcatheter Aortic Valve Implantation (TAVI) and Surgical Aortic Valve Replacement (SAVR), and determine whether abnormalities in strain were associated with outcome. METHODS CMR was performed pre- and 6 m post-intervention in 98 patients (52 TAVI, 46 SAVR; 77 ± 8 years) with severe AS. TAVI patients were older (80.9 ± 6.4 vs. 73.0 ± 7.0 years, p < 0.01) with a higher STS score (2.06 ± 0.6 vs. 6.03 ± 3.4, p < 0.001). Tagged cine images were acquired at the basal, mid and apical LV levels with a complementary spatial modulation of magnetization (CSPAMM) pulse sequence. Circumferential strain, strain rate and rotation were calculated using inTag© software. RESULTS No significant change in basal or mid LV circumferential strain, or of diastolic strain rate, was seen following either intervention. However, a significant and comparable decline in LV torsion and twist was observed (SAVR: torsion 14.08 ± 8.40 vs. 7.81 ± 4.51, p < 0.001, twist 16.17 ± 7.01 vs.12.45 ± 4.78, p < 0.01; TAVI: torsion 14.43 ± 4.66 vs. 11.20 ± 4.62, p < 0.001, twist 16.08 ± 5.36 vs. 12.36 ± 5.21, p < 0.001) which likely reflects an improvement towards normal physiology following relief of AS. Over a maximum 6.0y follow up, there were 23 (16%) deaths following valve intervention. On multivariable Cox analysis, baseline mid LV circumferential strain was significantly associated with all-cause mortality (hazard ratio, 1.03; 1.01-1.05; p = 0.009) independent of age, LV ejection fraction and STS mortality risk score. ROC analysis indicated a mid LV circumferential strain > -18.7% was associated with significantly reduced survival. CONCLUSION TAVI and SAVR procedures are associated with comparable declines in rotational LV mechanics at 6 m, with largely unchanged strain and strain rates. Pre-operative peak mid LV circumferential strain is associated with post-operative mortality.
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Affiliation(s)
- Tarique Al Musa
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
| | - Akhlaque Uddin
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
| | - Peter P. Swoboda
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
| | - Timothy A. Fairbairn
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
| | - Laura E. Dobson
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
| | - Anvesha Singh
- Department of Cardiovascular Sciences, and the National Institute of Health Research (NIHR), Cardiovascular Biomedical Research Unit, Glenfield General Hospital, University of Leicester, Leicester, UK
| | - Pankaj Garg
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
| | - Christopher D. Steadman
- Department of Cardiovascular Sciences, and the National Institute of Health Research (NIHR), Cardiovascular Biomedical Research Unit, Glenfield General Hospital, University of Leicester, Leicester, UK
| | - Bara Erhayiem
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
| | - Ananth Kidambi
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
| | - David P. Ripley
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
| | - Adam K. McDiarmid
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
| | - Philip Haaf
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
| | | | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
- Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - Gerald P. McCann
- Department of Cardiovascular Sciences, and the National Institute of Health Research (NIHR), Cardiovascular Biomedical Research Unit, Glenfield General Hospital, University of Leicester, Leicester, UK
| | - John P. Greenwood
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
- Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
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Al Musa T, Uddin A, Swoboda PP, Garg P, Fairbairn TA, Dobson LE, Steadman CD, Singh A, Erhayiem B, Plein S, McCann GP, Greenwood JP. Myocardial strain and symptom severity in severe aortic stenosis: insights from cardiovascular magnetic resonance. Quant Imaging Med Surg 2017; 7:38-47. [PMID: 28275558 DOI: 10.21037/qims.2017.02.05] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Symptomatic severe aortic stenosis (AS) is a class I indication for replacement in patients when left ventricular ejection fraction (LVEF) is preserved. However, symptom reporting is often equivocal and decision making can be challenging. We aimed to quantify myocardial deformation using cardiovascular magnetic resonance (CMR) in patients classified by symptom severity. METHODS Forty-two patients with severe AS referred to heart valve clinic were studied using tagged CMR imaging. All had preserved LVEF. Patients were grouped by symptoms as either "none/mild" (n=21, NYHA class I, II) or "significant" (n=21, NYHA class III, IV, angina, syncope) but were comparable for age (72.8±5.4 vs. 71.0±6.8 years old, P=0.345), surgical risk (EuroSCORE II: 1.90±1.7 vs. 1.31±0.4, P=0.302) and haemodynamics (peak aortic gradient: 55.1±20.8 vs. 50.4±15.6, P=0.450). Thirteen controls matched in age and LVEF were also studied. LV circumferential strain was calculated using inTag© software and longitudinal strain using feature tracking analysis. RESULTS Compared to healthy controls, patients with severe AS had significantly worse longitudinal and circumferential strain, regardless of symptom status. Patients with "significant" symptoms had significantly worse peak longitudinal systolic strain rates (-83.352±24.802%/s vs. -106.301±43.276%/s, P=0.048) than those with "no/mild" symptoms, with comparable peak longitudinal strain (PLS), peak circumferential strain and systolic and diastolic strain rates. CONCLUSIONS Patients with severe AS who have no or only mild symptoms exhibit comparable reduction in circumferential and longitudinal fibre function to those with significant symptoms, in whom AVR is clearly indicated. Given these findings of equivalent subclinical dysfunction, reportedly borderline symptoms should be handled cautiously to avoid potentially adverse delays in intervention.
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Affiliation(s)
- Tarique Al Musa
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Akhlaque Uddin
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Peter P Swoboda
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Pankaj Garg
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Timothy A Fairbairn
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Laura E Dobson
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Christopher D Steadman
- Department of Cardiovascular Sciences, University of Leicester, Glenfield General Hospital, Leicester, UK;; the National Institute of Health Research (NIHR), Cardiovascular Biomedical Research Unit, Glenfield General Hospital, Leicester, UK
| | - Anvesha Singh
- Department of Cardiovascular Sciences, University of Leicester, Glenfield General Hospital, Leicester, UK;; the National Institute of Health Research (NIHR), Cardiovascular Biomedical Research Unit, Glenfield General Hospital, Leicester, UK
| | - Bara Erhayiem
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK;; Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - Gerald P McCann
- Department of Cardiovascular Sciences, University of Leicester, Glenfield General Hospital, Leicester, UK;; the National Institute of Health Research (NIHR), Cardiovascular Biomedical Research Unit, Glenfield General Hospital, Leicester, UK
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK;; Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
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Dobson LE, Musa TA, Uddin A, Fairbairn TA, Swoboda P, Ripley DP, McDiarmid AK, Erhayiem B, Garg P, Evans B, Malkin C, Blackman D, Plein S, Greenwood JP. Post-procedural myocardial infarction following surgical and trans-catheter aortic valve replacement - mechanistic insights from cardiovascular magnetic resonance imaging. J Cardiovasc Magn Reson 2016. [PMCID: PMC5032045 DOI: 10.1186/1532-429x-18-s1-p337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Dobson LE, Musa TA, Uddin A, Fairbairn TA, Swoboda PP, Erhayiem B, Foley J, Garg P, Haaf P, Fent GJ, Malkin CJ, Blackman DJ, Plein S, Greenwood JP. Acute Reverse Remodelling After Transcatheter Aortic Valve Implantation: A Link Between Myocardial Fibrosis and Left Ventricular Mass Regression. Can J Cardiol 2016; 32:1411-1418. [DOI: 10.1016/j.cjca.2016.04.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 04/18/2016] [Accepted: 04/21/2016] [Indexed: 10/21/2022] Open
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Musa TA, Uddin A, Fairbairn TA, Dobson LE, Steadman CD, Kidambi A, Ripley DP, Swoboda PP, McDiarmid AK, Erhayiem B, Garg P, Blackman DJ, Plein S, McCann GP, Greenwood JP. Right ventricular function following surgical aortic valve replacement and transcatheter aortic valve implantation: A cardiovascular MR study. Int J Cardiol 2016; 223:639-644. [PMID: 27565842 DOI: 10.1016/j.ijcard.2016.08.065] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 03/25/2016] [Revised: 08/01/2016] [Accepted: 08/03/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The response of the RV following treatment of aortic stenosis is poorly defined, reflecting the challenge of accurate RV assessment. Cardiovascular magnetic resonance (CMR) is the established reference for imaging of RV volumes, mass and function. We sought to define the impact of transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) upon RV function in patients treated for severe aortic stenosis using CMR. METHODS A 1.5T CMR scan was performed preoperatively and 6months postoperatively in 112 (56 TAVI, 56 SAVR; 76±8years) high-risk severe symptomatic aortic stenosis patients across two UK cardiothoracic centres. RESULTS TAVI patients were older (80.4±6.7 vs. 72.8±7.2years, p<0.05) with a higher STS score (2.13±0.73 vs. 5.54±3.41%, p<0.001). At 6months, SAVR was associated with a significant increase in RV end systolic volume (33±10 vs. 37±10ml/m2, p=0.008), and decrease in RV ejection fraction (58±8 vs. 53±8%, p=0.005) and tricuspid annular plane systolic excursion (22±5 vs. 14±3mm, p<0.001). Only 4 (7%) SAVR patients had new RV late gadolinium hyper-enhancement with no new cases seen in the TAVI patients at 6months. Longer surgical cross-clamp time was the only predictor of increased RV end systolic volume at 6months. Post-TAVI, there was no observed change in RV volumes or function. Over a maximum 6.3year follow-up, 18(32%) of TAVI patients and 1(1.7%) of SAVR patients had died (p=0.001). On multivariable Cox analysis, the RV mass at 6m post-TAVI was independently associated with all-cause mortality (HR 1.359, 95% CI 1.108-1.666, p=0.003). CONCLUSIONS SAVR results in a deterioration in RV systolic volumes and function associated with longer cross-clamp times and is not fully explained by suboptimal RV protection during cardiopulmonary bypass. TAVI had no adverse impact upon RV volumes or function.
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Affiliation(s)
- Tarique Al Musa
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
| | - Akhlaque Uddin
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
| | - Timothy A Fairbairn
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
| | - Laura E Dobson
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
| | - Christopher D Steadman
- Department of Cardiovascular Sciences, University of Leicester, Cardiovascular Research Centre and the National Institute of Health Research (NIHR), Cardiovascular Biomedical Research Unit, Glenfield General Hospital, Leicester, UK.
| | - Ananth Kidambi
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
| | - David P Ripley
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
| | - Peter P Swoboda
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
| | - Adam K McDiarmid
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
| | - Bara Erhayiem
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
| | - Pankaj Garg
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
| | - Daniel J Blackman
- Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK.
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
| | - Gerald P McCann
- Department of Cardiovascular Sciences, University of Leicester, Cardiovascular Research Centre and the National Institute of Health Research (NIHR), Cardiovascular Biomedical Research Unit, Glenfield General Hospital, Leicester, UK.
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
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Musa TA, Uddin A, Fairbairn TA, Dobson LE, Sourbron SP, Steadman CD, Motwani M, Kidambi A, Ripley DP, Swoboda PP, McDiarmid AK, Erhayiem B, Oliver JJ, Blackman DJ, Plein S, McCann GP, Greenwood JP. Assessment of aortic stiffness by cardiovascular magnetic resonance following the treatment of severe aortic stenosis by TAVI and surgical AVR. J Cardiovasc Magn Reson 2016; 18:37. [PMID: 27287000 PMCID: PMC4902992 DOI: 10.1186/s12968-016-0256-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 03/08/2016] [Accepted: 05/31/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Aortic stiffness is increasingly used as an independent predictor of adverse cardiovascular outcomes. We sought to compare the impact of transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) upon aortic vascular function using cardiovascular magnetic resonance (CMR) measurements of aortic distensibility and pulse wave velocity (PWV). METHODS AND RESULTS A 1.5 T CMR scan was performed pre-operatively and at 6 m post-intervention in 72 patients (32 TAVI, 40 SAVR; age 76 ± 8 years) with high-risk symptomatic severe aortic stenosis. Distensibility of the ascending and descending thoracic aorta and aortic pulse wave velocity were determined at both time points. TAVI and SAVR patients were comparable for gender, blood pressure and left ventricular ejection fraction. The TAVI group were older (81 ± 6.3 vs. 72.8 ± 7.0 years, p < 0.05) with a higher EuroSCORE II (5.7 ± 5.6 vs. 1.5 ± 1.0 %, p < 0.05). At 6 m, SAVR was associated with a significant decrease in distensibility of the ascending aorta (1.95 ± 1.15 vs. 1.57 ± 0.68 × 10(-3)mmHg(-1), p = 0.044) and of the descending thoracic aorta (3.05 ± 1.12 vs. 2.66 ± 1.00 × 10(-3)mmHg(-1), p = 0.018), with a significant increase in PWV (6.38 ± 4.47 vs. 11.01 ± 5.75 ms(-1), p = 0.001). Following TAVI, there was no change in distensibility of the ascending aorta (1.96 ± 1.51 vs. 1.72 ± 0.78 × 10(-3)mmHg(-1), p = 0.380), descending thoracic aorta (2.69 ± 1.79 vs. 2.21 ± 0.79 × 10(-3)mmHg(-1), p = 0.181) nor in PWV (8.69 ± 6.76 vs. 10.23 ± 7.88 ms(-1), p = 0.301) at 6 m. CONCLUSIONS Treatment of symptomatic severe aortic stenosis by SAVR but not TAVI was associated with an increase in aortic stiffness at 6 months. Future work should focus on the prognostic implication of these findings to determine whether improved patient selection and outcomes can be achieved.
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Affiliation(s)
- Tarique Al Musa
- Multidisciplinary Cardiovascular Research Centre and The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK.
| | - Akhlaque Uddin
- Multidisciplinary Cardiovascular Research Centre and The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Timothy A Fairbairn
- Multidisciplinary Cardiovascular Research Centre and The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Laura E Dobson
- Multidisciplinary Cardiovascular Research Centre and The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Steven P Sourbron
- Division of Medical Physics, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Christopher D Steadman
- Department of Cardiovascular Sciences, Cardiovascular Research Centre, Cardiovascular Biomedical Research Unit, University of Leicester, National Institute of Health Research (NIHR), Glenfield General Hospital, Leicester, UK
| | - Manish Motwani
- Multidisciplinary Cardiovascular Research Centre and The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Ananth Kidambi
- Multidisciplinary Cardiovascular Research Centre and The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - David P Ripley
- Multidisciplinary Cardiovascular Research Centre and The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Peter P Swoboda
- Multidisciplinary Cardiovascular Research Centre and The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Adam K McDiarmid
- Multidisciplinary Cardiovascular Research Centre and The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Bara Erhayiem
- Multidisciplinary Cardiovascular Research Centre and The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - James J Oliver
- Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - Daniel J Blackman
- Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre and The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Gerald P McCann
- Department of Cardiovascular Sciences, Cardiovascular Research Centre, Cardiovascular Biomedical Research Unit, University of Leicester, National Institute of Health Research (NIHR), Glenfield General Hospital, Leicester, UK
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre and The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
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Dobson L, Musa TA, Akhlaque U, Fairbairn TA, Bebb OJ, Swoboda PP, Haaf P, Foley J, Garg P, Fent GJ, Malkin CJ, Blackman DJ, Plein S, Greenwood JP. 39 The Impact of New Left Bundle Branch Block Following Trans-Catheter Aortic Valve Impantation. Is There a TAVI LBBB-induced Cardiomyopathy? Insights from Cardiovascular Magnetic Resonance Imaging. Heart 2016. [DOI: 10.1136/heartjnl-2016-309890.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Foley JRJ, Dobson LE, Musa TA, Fairbairn TA, Uddin A, Swoboda PP, Garg P, Fent G, Haaf P, Malkin CJ, Blackman DJ, Plein S, Greenwood JP. 42 Gender Differences in Response to Transcatheter Aortic Valve Implantation in Patients with Severe Aortic Stenosis Assessed by Feature Tracking. Heart 2016. [DOI: 10.1136/heartjnl-2016-309890.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Dobson L, Musa TA, Uddin A, Fairbairn TA, Swoboda PP, Ripley DP, Erhayiem B, McDiarmid AK, Garg P, Evans B, Malkin CJ, Blackman DJ, Plein S, Greenwood JP. 38 Myocardial Infarction following Surgical and Trans-Catheter Aortic Valve Replacement – Is Peri-Procedural Revascularisation for TAVI Necessary? Heart 2016. [DOI: 10.1136/heartjnl-2016-309890.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Dobson LE, Fairbairn TA, Musa TA, Uddin A, Mundie CA, Swoboda PP, Ripley DP, McDiarmid AK, Erhayiem B, Garg P, Malkin CJ, Blackman DJ, Sharples LD, Plein S, Greenwood JP. Sex-related differences in left ventricular remodeling in severe aortic stenosis and reverse remodeling after aortic valve replacement: A cardiovascular magnetic resonance study. Am Heart J 2016; 175:101-11. [PMID: 27179729 DOI: 10.1016/j.ahj.2016.02.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 02/10/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Cardiac adaptation to aortic stenosis (AS) appears to differ according to sex, but reverse remodeling after aortic valve replacement has not been extensively described. The aim of the study was to determine using cardiac magnetic resonance imaging whether any sex-related differences exist in AS in terms of left ventricular (LV) remodeling, myocardial fibrosis, and reverse remodeling after valve replacement. METHODS One hundred patients (men, n = 60) with severe AS undergoing either transcatheter or surgical aortic valve replacement underwent cardiac magnetic resonance scans at baseline and 6 months after valve replacement. RESULTS Despite similar baseline comorbidity and severity of AS, women had a lower indexed LV mass than did men (65.3 ± 18.4 vs 81.5 ± 21.3 g/m(2), P < .001) and a smaller indexed LV end-diastolic volume (87.3 ± 17.5 vs 101.2 ± 28.6 mL/m(2), P = .002) with a similar LV ejection fraction (58.6% ± 10.2% vs 54.8% ± 12.9%, P = .178). Total myocardial fibrosis mass was similar between sexes (2.3 ± 4.1 vs 1.3 ± 1.1 g, P = .714), albeit with a differing distribution according to sex. After aortic valve replacement, men had more absolute LV mass regression than did women (18.3 ± 10.6 vs 12.7 ± 8.8 g/m(2), P = .007). When expressed as a percentage reduction of baseline indexed LV mass, mass regression was similar between the sexes (men 21.7% ± 10.1% vs women 18.4% ± 11.0%, P = .121). There was no sex-related difference in postprocedural LV ejection fraction or aortic regurgitation. Sex was not found to be a predictor of LV reverse remodeling on multiple regression analysis. CONCLUSIONS There are significant differences in the way that male and female hearts adapt to AS. Six months after aortic valve replacement, there are no sex-related differences in reverse remodeling, but superior reverse remodeling in men as a result of their more adverse remodeling profile at baseline.
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Musa TA, Uddin A, Fairbairn TA, Dobson LE, Kidambi A, Ripley DP, Swoboda PP, McDiarmid AK, Erhayiem B, Garg P, Steadman CD, McCann GP, Plein S, Greenwood JP. Right ventricular function following Surgical Aortic Valve Replacement (SAVR). J Cardiovasc Magn Reson 2015. [PMCID: PMC4328260 DOI: 10.1186/1532-429x-17-s1-p177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Musa TA, Dobson LE, Uddin A, Fairbairn TA, Kidambi A, Ripley DP, Swoboda PP, Erhayiem B, Garg P, McDiarmid AK, Plein S, Greenwood JP. Left atrial remodelling following transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR). J Cardiovasc Magn Reson 2015. [PMCID: PMC4328939 DOI: 10.1186/1532-429x-17-s1-p182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Dobson LE, Musa TA, Fairbairn TA, Uddin A, Blackman DJ, Ripley DP, Swoboda PP, McDiarmid AK, Erhayiem B, Garg P, Plein S, Greenwood JP. Left ventricular mass regression may occur very early following transcatheter aortic valve implantation for severe aortic stenosis. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328315 DOI: 10.1186/1532-429x-17-s1-p341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Dobson LE, Musa TA, Fairbairn TA, Uddin A, Blackman DJ, Ripley DP, Swoboda PP, McDiarmid AK, Erhayiem B, Garg P, Plein S, Greenwood JP. CMR assessment of longitudinal left ventricular function following transcatheter aortic valve implantation (TAVI) for severe aortic stenosis. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328201 DOI: 10.1186/1532-429x-17-s1-p180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Dobson LE, Musa TA, Uddin A, Fairbairn TA, Blackman DJ, Ripley DP, McDiarmid AK, Swoboda PP, Erhayiem B, Garg P, Plein S, Greenwood JP. Gender influences left ventricular remodelling in the setting of aortic stenosis but does not appear to impact on reverse remodelling following transcatheter aortic valve implantation. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328163 DOI: 10.1186/1532-429x-17-s1-p332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Uddin A, Fairbairn TA, Djoukhader IK, Igra M, Kidambi A, Motwani M, Herzog B, Ripley DP, Musa TA, Goddard AJP, Blackman DJ, Plein S, Greenwood JP. Consequence of cerebral embolism after transcatheter aortic valve implantation compared with contemporary surgical aortic valve replacement: effect on health-related quality of life. Circ Cardiovasc Interv 2015; 8:e001913. [PMID: 25737407 DOI: 10.1161/circinterventions.114.001913] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Incidence of cerebral microinfarcts is higher after transcatheter aortic valve implantation (TAVI) compared with surgical aortic valve replacement (SAVR). It is unknown whether these lesions persist and what direct impact they have on health-related quality of life. The objective was to identify predictors of cerebral microinfarction and measure their effect on health-related quality of life during 6 months after TAVI when compared with SAVR. METHODS AND RESULTS Cerebral MRI was conducted at baseline, post procedure, and 6 months using diffusion-weighted imaging. Health-related quality of life was measured at baseline, 30 days, and 6 months with short form-12 health outcomes and EuroQol 5 dimensions questionnaires. One hundred eleven patients (TAVI, n=71; SAVR, n=40) were studied. The incidence (54 [77%] versus 17 [43%]; P=0.001) and number (3.4±4.9 versus 1.2±1.8; P=0.001) of new microinfarcts were greater after TAVI than after SAVR. The total volume per microinfarct was smaller in TAVI than in SAVR (0.23±0.24 versus 0.76±1.8 mL; P=0.04). The strongest associations for microinfarction were: TAVI (arch atheroma grade: r=0.46; P=0.0001) and SAVR (concomitant coronary artery bypass grafting: r=-0.33; P=0.03). Physical component score in TAVI increased after 30 days (32.1±6.6 versus 38.9±7.0; P<0.0001) and 6 months (40.4±9.3; P<0.0001); the improvement occurred later in SAVR (baseline: 34.9±10.6; 30 days: 35.9±10.2; 6 months: 42.8±11.2; P<0.001). After TAVI, there were no differences in the short form-12 health outcome scores according to the presence or size of new cerebral infarction. CONCLUSIONS Cerebral microinfarctions are more common after TAVI compared with SAVR but seem to have no negative effect on early (30 days) or medium term (6 months) health-related quality of life. Aortic atheroma (TAVI) and concomitant coronary artery bypass grafting (SAVR) are independent risk factors for cerebral microinfarction.
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Affiliation(s)
- Akhlaque Uddin
- From the Multidisciplinary Cardiovascular Research Centre and Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom (A.U., T.A.F., A.K., M.M., B.H., D.P.R., T.A.M., S.P., J.P.G.); and Departments of Cardiology and Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom (I.K.D., M.I., A.J.P.G., D.J.B., S.P., J.P.G.)
| | - Timothy A Fairbairn
- From the Multidisciplinary Cardiovascular Research Centre and Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom (A.U., T.A.F., A.K., M.M., B.H., D.P.R., T.A.M., S.P., J.P.G.); and Departments of Cardiology and Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom (I.K.D., M.I., A.J.P.G., D.J.B., S.P., J.P.G.)
| | - Ibrahim K Djoukhader
- From the Multidisciplinary Cardiovascular Research Centre and Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom (A.U., T.A.F., A.K., M.M., B.H., D.P.R., T.A.M., S.P., J.P.G.); and Departments of Cardiology and Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom (I.K.D., M.I., A.J.P.G., D.J.B., S.P., J.P.G.)
| | - Mark Igra
- From the Multidisciplinary Cardiovascular Research Centre and Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom (A.U., T.A.F., A.K., M.M., B.H., D.P.R., T.A.M., S.P., J.P.G.); and Departments of Cardiology and Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom (I.K.D., M.I., A.J.P.G., D.J.B., S.P., J.P.G.)
| | - Ananth Kidambi
- From the Multidisciplinary Cardiovascular Research Centre and Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom (A.U., T.A.F., A.K., M.M., B.H., D.P.R., T.A.M., S.P., J.P.G.); and Departments of Cardiology and Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom (I.K.D., M.I., A.J.P.G., D.J.B., S.P., J.P.G.)
| | - Manish Motwani
- From the Multidisciplinary Cardiovascular Research Centre and Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom (A.U., T.A.F., A.K., M.M., B.H., D.P.R., T.A.M., S.P., J.P.G.); and Departments of Cardiology and Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom (I.K.D., M.I., A.J.P.G., D.J.B., S.P., J.P.G.)
| | - Bernhard Herzog
- From the Multidisciplinary Cardiovascular Research Centre and Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom (A.U., T.A.F., A.K., M.M., B.H., D.P.R., T.A.M., S.P., J.P.G.); and Departments of Cardiology and Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom (I.K.D., M.I., A.J.P.G., D.J.B., S.P., J.P.G.)
| | - David P Ripley
- From the Multidisciplinary Cardiovascular Research Centre and Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom (A.U., T.A.F., A.K., M.M., B.H., D.P.R., T.A.M., S.P., J.P.G.); and Departments of Cardiology and Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom (I.K.D., M.I., A.J.P.G., D.J.B., S.P., J.P.G.)
| | - Tarique Al Musa
- From the Multidisciplinary Cardiovascular Research Centre and Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom (A.U., T.A.F., A.K., M.M., B.H., D.P.R., T.A.M., S.P., J.P.G.); and Departments of Cardiology and Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom (I.K.D., M.I., A.J.P.G., D.J.B., S.P., J.P.G.)
| | - Anthony J P Goddard
- From the Multidisciplinary Cardiovascular Research Centre and Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom (A.U., T.A.F., A.K., M.M., B.H., D.P.R., T.A.M., S.P., J.P.G.); and Departments of Cardiology and Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom (I.K.D., M.I., A.J.P.G., D.J.B., S.P., J.P.G.)
| | - Daniel J Blackman
- From the Multidisciplinary Cardiovascular Research Centre and Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom (A.U., T.A.F., A.K., M.M., B.H., D.P.R., T.A.M., S.P., J.P.G.); and Departments of Cardiology and Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom (I.K.D., M.I., A.J.P.G., D.J.B., S.P., J.P.G.)
| | - Sven Plein
- From the Multidisciplinary Cardiovascular Research Centre and Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom (A.U., T.A.F., A.K., M.M., B.H., D.P.R., T.A.M., S.P., J.P.G.); and Departments of Cardiology and Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom (I.K.D., M.I., A.J.P.G., D.J.B., S.P., J.P.G.)
| | - John P Greenwood
- From the Multidisciplinary Cardiovascular Research Centre and Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom (A.U., T.A.F., A.K., M.M., B.H., D.P.R., T.A.M., S.P., J.P.G.); and Departments of Cardiology and Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom (I.K.D., M.I., A.J.P.G., D.J.B., S.P., J.P.G.).
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Dobson LE, Fairbairn TA, Plein S, Greenwood JP. Sex Differences in Aortic Stenosis and Outcome Following Surgical and Transcatheter Aortic Valve Replacement. J Womens Health (Larchmt) 2015; 24:986-95. [PMID: 26653869 DOI: 10.1089/jwh.2014.5158] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Aortic stenosis is the commonest valve defect in the developed world and is associated with a high mortality once symptomatic. There is a difference in the way that male and female hearts remodel in the face of chronic pressure overload: women develop a concentrically hypertrophied, small cavity left ventricle (LV), whereas men are more prone to the development of eccentric hypertrophy. At a cellular level, there is an increase in collagen and metalloproteinase gene expression in males suggesting a different regulation of extracellular volume composition according to sex. Male hearts with aortic stenosis appear to have more fibrosis than their female comparators. The trigger for this appears to be in part related to estrogen receptor signaling, but other factors such as renin-angiotensin activation, nitric oxide, and circulating noradrenaline levels may also be implicated. Treatment options include surgical valve replacement (SAVR) and more recently transcatheter aortic valve replacement (TAVR). Female sex may be a risk factor for adverse outcome following SAVR and conversely appears to confer a survival advantage when undergoing TAVR. Whether the lower mortality seen following TAVR in women compared with men (despite their increased age and frailty) reflects their longer life expectancy, smaller annular size (and less post-TAVR aortic regurgitation), more favorable LV reverse remodeling, or more likely, a combination of these factors remains to be established.
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Affiliation(s)
- Laura E Dobson
- Multidisciplinary Cardiovascular Research Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds, United Kingdom
| | - Timothy A Fairbairn
- Multidisciplinary Cardiovascular Research Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds, United Kingdom
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds, United Kingdom
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds, United Kingdom
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Musa TA, Uddin A, Fairbairn TA, Dobson LE, Steadman C, Kidambi A, Motwani M, Ripley DP, McDiarmid AK, Swoboda P, Erhayiem B, Garg P, Sourbron S, Plein S, McCann G, Greenwood JP. 21 Left atrial remodelling following treatment of symptomatic severe aortic stenosis. Heart 2015. [DOI: 10.1136/heartjnl-2015-307845.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Musa TA, Uddin A, Fairbairn TA, Dobson LE, Steadman C, Kidambi A, Motwani M, Ripley DP, McDiarmid AK, Swoboda P, Erhayiem B, Garg P, Sourbron S, Plein S, McCann G, Greenwood JP. 22 Surgical aortic valve replacement (SAVR) upon right ventricular function: a cardiac mri study: Abstract 22 Table 1. Heart 2015. [DOI: 10.1136/heartjnl-2015-307845.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Motwani M, Kidambi A, Sourbron S, Fairbairn TA, Uddin A, Kozerke S, Greenwood JP, Plein S. Quantitative three-dimensional cardiovascular magnetic resonance myocardial perfusion imaging in systole and diastole. J Cardiovasc Magn Reson 2014; 16:19. [PMID: 24565078 PMCID: PMC3941945 DOI: 10.1186/1532-429x-16-19] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [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: 10/09/2013] [Accepted: 01/29/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Two-dimensional (2D) perfusion cardiovascular magnetic resonance (CMR) remains limited by a lack of complete myocardial coverage. Three-dimensional (3D) perfusion CMR addresses this limitation and has recently been shown to be clinically feasible. However, the feasibility and potential clinical utility of quantitative 3D perfusion measurements, as already shown with 2D-perfusion CMR and positron emission tomography, has yet to be evaluated. The influence of systolic or diastolic acquisition on myocardial blood flow (MBF) estimates, diagnostic accuracy and image quality is also unknown for 3D-perfusion CMR. The purpose of this study was to establish the feasibility of quantitative 3D-perfusion CMR for the detection of coronary artery disease (CAD) and to compare systolic and diastolic estimates of MBF. METHODS Thirty-five patients underwent 3D-perfusion CMR with data acquired at both end-systole and mid-diastole. MBF and myocardial perfusion reserve (MPR) were estimated on a per patient and per territory basis by Fermi-constrained deconvolution. Significant CAD was defined as stenosis ≥70% on quantitative coronary angiography. RESULTS Twenty patients had significant CAD (involving 38 out of 105 territories). Stress MBF and MPR had a high diagnostic accuracy for the detection of CAD in both systole (area under curve [AUC]: 0.95 and 0.92, respectively) and diastole (AUC: 0.95 and 0.94). There were no significant differences in the AUCs between systole and diastole (p values >0.05). At stress, diastolic MBF estimates were significantly greater than systolic estimates (no CAD: 3.21 ± 0.50 vs. 2.75 ± 0.42 ml/g/min, p < 0.0001; CAD: 2.13 ± 0.45 vs. 1.98 ± 0.41 ml/g/min, p < 0.0001); but at rest, there were no significant differences (p values >0.05). Image quality was higher in systole than diastole (median score 3 vs. 2, p = 0.002). CONCLUSIONS Quantitative 3D-perfusion CMR is feasible. Estimates of MBF are significantly different for systole and diastole at stress but diagnostic accuracy to detect CAD is high for both cardiac phases. Better image quality suggests that systolic data acquisition may be preferable.
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Affiliation(s)
- Manish Motwani
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute of Genetics, Health & Therapeutics, University of Leeds, Leeds, UK
| | - Ananth Kidambi
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute of Genetics, Health & Therapeutics, University of Leeds, Leeds, UK
| | | | - Timothy A Fairbairn
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute of Genetics, Health & Therapeutics, University of Leeds, Leeds, UK
| | - Akhlaque Uddin
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute of Genetics, Health & Therapeutics, University of Leeds, Leeds, UK
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute of Genetics, Health & Therapeutics, University of Leeds, Leeds, UK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute of Genetics, Health & Therapeutics, University of Leeds, Leeds, UK
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Motwani M, Maredia N, Fairbairn TA, Kozerke S, Greenwood JP, Plein S. Assessment of ischaemic burden in angiographic three-vessel coronary artery disease with high-resolution myocardial perfusion cardiovascular magnetic resonance imaging. Eur Heart J Cardiovasc Imaging 2014; 15:701-8. [PMID: 24493156 PMCID: PMC4024983 DOI: 10.1093/ehjci/jet286] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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: 12/25/2022] Open
Abstract
Aims This study compared the myocardial ischaemic burden (MIB) in patients with angiographic three-vessel coronary artery disease (3VD) using high-resolution and standard-resolution myocardial perfusion cardiovascular magnetic resonance (perfusion CMR) imaging. Methods and results One hundred and five patients undergoing coronary angiography had two separate stress/rest perfusion CMR studies, one with standard-resolution (2.5 mm in-plane) and another with high-resolution (1.6 mm in-plane). Quantitative coronary angiography was used to define patients with angiographic 3VD. Perfusion CMR images were anonymized, randomly ordered and visually reported by two observers acting in consensus and blinded to all clinical and angiographic data. Perfusion was graded in each segment on a four-point scale and summed to produce a perfusion score and estimate of MIB for each patient. In patients with angiographic 3VD (n = 35), high-resolution acquisition identified more abnormal segments (7.2 ± 3.8 vs. 5.3 ± 4.0; P = 0.004) and territories (2.4 ± 0.9 vs. 1.6 ± 1.1; P = 0.002) and a higher overall perfusion score (20.1 ± 7.7 vs. 11.9 ± 9.4; P < 0.0001) per patient compared with standard-resolution. The number of segments with subendocardial ischaemia was greater with high-resolution acquisition (195 vs. 101; P < 0.0001). Hypoperfusion in all three territories was identified in 57% of 3VD patients by high-resolution compared with only 29% by standard-resolution (P = 0.04). The area-under-the-curve (AUC) for detecting angiographic 3VD using the estimated MIB was significantly greater with high-resolution than standard-resolution acquisition (AUC = 0.90 vs. 0.69; P < 0.0001). Conclusion In patients with angiographic 3VD, the ischaemic burden detected by perfusion CMR is greater with high-resolution acquisition due to better detection of subendocardial ischaemia. High-resolution perfusion CMR may therefore be preferred for risk stratification and management of this high-risk patient group.
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Affiliation(s)
- Manish Motwani
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds LS2 9JT, UK
| | - Neil Maredia
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds LS2 9JT, UK
| | - Timothy A Fairbairn
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds LS2 9JT, UK
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds LS2 9JT, UK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds LS2 9JT, UK
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