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Alyami B, Santer M, Seetharam K, Velu D, Gadde E, Patel B, Hamirani YS. Non-Calcified Coronary Artery Plaque on Coronary Computed Tomography Angiogram: Prevalence and Significance. Tomography 2023; 9:1755-1771. [PMID: 37736993 PMCID: PMC10514817 DOI: 10.3390/tomography9050140] [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] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/10/2023] [Accepted: 09/12/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVE We aimed to assess the prevalence of non-calcified plaque (NCP) on computed tomography angiography (CCTA) in symptomatic and asymptomatic individuals. In addition, we seek to compare plaque assessment on CCTA with intravascular ultrasound-virtual histology (IVUS-VH) and to assess the prognostic value of non-calcified plaques (NCPs). BACKGROUND The CCTA can characterize coronary plaques and help quantify burden. Furthermore, it can provide additional prognostic information which can enable further risk stratification of patients. METHODS We performed a broad comprehensive review of the current literature pertaining to CCTA and primarily isolated NCP in symptomatic and asymptomatic patients. In addition, our review included studies correlating plaque on CT with IVUS-VH. CONCLUSIONS NCP is the initial precursor of calcified plaque and serves as a prominent marker of early coronary atherosclerosis. By detecting NCP during early stages, several measures can be implemented which can alter the evolutionary course of the underlying disease. This can potentially lead to a lower incidence of cardiovascular events.
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Affiliation(s)
- Bandar Alyami
- Department of Medicine, School of Medicine, West Virginia University, Morgantown, WV 26506, USA; (B.A.); (M.S.); (B.P.)
| | - Matthew Santer
- Department of Medicine, School of Medicine, West Virginia University, Morgantown, WV 26506, USA; (B.A.); (M.S.); (B.P.)
| | - Karthik Seetharam
- Department of Cardiology, Heart and Vascular Institute, West Virginia University, Morgantown, WV 26506, USA; (K.S.); (D.V.)
| | - Dhivya Velu
- Department of Cardiology, Heart and Vascular Institute, West Virginia University, Morgantown, WV 26506, USA; (K.S.); (D.V.)
| | - Eswar Gadde
- Department of Medicine, West Virginia University, Charleston, WV 25304, USA;
| | - Bansari Patel
- Department of Medicine, School of Medicine, West Virginia University, Morgantown, WV 26506, USA; (B.A.); (M.S.); (B.P.)
| | - Yasmin S. Hamirani
- Department of Cardiology, Heart and Vascular Institute, West Virginia University, Morgantown, WV 26506, USA; (K.S.); (D.V.)
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Cademartiri F, Meloni A, Pistoia L, Degiorgi G, Clemente A, Gori CD, Positano V, Celi S, Berti S, Emdin M, Panetta D, Menichetti L, Punzo B, Cavaliere C, Bossone E, Saba L, Cau R, Grutta LL, Maffei E. Dual-Source Photon-Counting Computed Tomography-Part I: Clinical Overview of Cardiac CT and Coronary CT Angiography Applications. J Clin Med 2023; 12:jcm12113627. [PMID: 37297822 DOI: 10.3390/jcm12113627] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 06/12/2023] Open
Abstract
The photon-counting detector (PCD) is a new computed tomography detector technology (photon-counting computed tomography, PCCT) that provides substantial benefits for cardiac and coronary artery imaging. Compared with conventional CT, PCCT has multi-energy capability, increased spatial resolution and soft tissue contrast with near-null electronic noise, reduced radiation exposure, and optimization of the use of contrast agents. This new technology promises to overcome several limitations of traditional cardiac and coronary CT angiography (CCT/CCTA) including reduction in blooming artifacts in heavy calcified coronary plaques or beam-hardening artifacts in patients with coronary stents, and a more precise assessment of the degree of stenosis and plaque characteristic thanks to its better spatial resolution. Another potential application of PCCT is the use of a double-contrast agent to characterize myocardial tissue. In this current overview of the existing PCCT literature, we describe the strengths, limitations, recent applications, and promising developments of employing PCCT technology in CCT.
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Affiliation(s)
| | - Antonella Meloni
- Department of Radiology, Fondazione Monasterio/CNR, 56124 Pisa, Italy
- Department of Bioengineering, Fondazione Monasterio/CNR, 56124 Pisa, Italy
| | - Laura Pistoia
- Department of Radiology, Fondazione Monasterio/CNR, 56124 Pisa, Italy
| | - Giulia Degiorgi
- Department of Radiology, Fondazione Monasterio/CNR, 56124 Pisa, Italy
| | - Alberto Clemente
- Department of Radiology, Fondazione Monasterio/CNR, 56124 Pisa, Italy
| | - Carmelo De Gori
- Department of Radiology, Fondazione Monasterio/CNR, 56124 Pisa, Italy
| | - Vincenzo Positano
- Department of Radiology, Fondazione Monasterio/CNR, 56124 Pisa, Italy
- Department of Bioengineering, Fondazione Monasterio/CNR, 56124 Pisa, Italy
| | - Simona Celi
- BioCardioLab, Department of Bioengineering, Fondazione Monasterio/CNR, 54100 Massa, Italy
| | - Sergio Berti
- Cardiology Unit, Ospedale del Cuore, Fondazione Monasterio/CNR, 54100 Massa, Italy
| | - Michele Emdin
- Department of Cardiology, Fondazione Monasterio/CNR, 56124 Pisa, Italy
| | - Daniele Panetta
- Institute of Clinical Physiology, National Council of Research, 56124 Pisa, Italy
| | - Luca Menichetti
- Institute of Clinical Physiology, National Council of Research, 56124 Pisa, Italy
| | - Bruna Punzo
- Department of Radiology, IRCCS SynLab-SDN, 80131 Naples, Italy
| | - Carlo Cavaliere
- Department of Radiology, IRCCS SynLab-SDN, 80131 Naples, Italy
| | - Eduardo Bossone
- Department of Cardiology, Ospedale Cardarelli, 80131 Naples, Italy
| | - Luca Saba
- Department of Radiology, University Hospital, 09042 Monserrato, Italy
| | - Riccardo Cau
- Department of Radiology, University Hospital, 09042 Monserrato, Italy
| | - Ludovico La Grutta
- Department of Radiology, University Hospital "P. Giaccone", 90127 Palermo, Italy
| | - Erica Maffei
- Department of Radiology, Fondazione Monasterio/CNR, 56124 Pisa, Italy
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Tan N, Dey D, Marwick TH, Nerlekar N. Pericoronary Adipose Tissue as a Marker of Cardiovascular Risk: JACC Review Topic of the Week. J Am Coll Cardiol 2023; 81:913-923. [PMID: 36858711 DOI: 10.1016/j.jacc.2022.12.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 11/28/2022] [Accepted: 12/21/2022] [Indexed: 03/03/2023]
Abstract
Vascular inflammation is a key driver in atherosclerotic progression and plaque rupture. Recent evidence has shown that coronary computed tomography provides a noninvasive method of quantifying coronary inflammation by mapping changes in pericoronary adipose tissue (PCAT) radiodensity, which are associated with cardiovascular diseases. However, there are significant knowledge gaps in the performance and measurement of PCAT that complicate its interpretation. In this review the authors aim to summarize the role of PCAT in cardiac imaging and explore the clinical implications and applicability as a novel biomarker of cardiovascular risk, as well as to discuss its limitations and potential pitfalls.
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Affiliation(s)
- Neville Tan
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Thomas H Marwick
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
| | - Nitesh Nerlekar
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
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Kim Y, Choi AD, Telluri A, Lipkin I, Bradley AJ, Sidahmed A, Jonas R, Andreini D, Bathina R, Baggiano A, Cerci R, Choi EY, Choi JH, Choi SY, Chung N, Cole J, Doh JH, Ha SJ, Her AY, Kepka C, Kim JY, Kim JW, Kim SW, Kim W, Pontone G, Villines TC, Cho I, Danad I, Heo R, Lee SE, Lee JH, Park HB, Sung JM, Crabtree T, Earls JP, Min JK, Chang HJ. Atherosclerosis Imaging Quantitative Computed Tomography (AI-QCT) to guide referral to invasive coronary angiography in the randomized controlled CONSERVE trial. Clin Cardiol 2023; 46:477-483. [PMID: 36847047 PMCID: PMC10189079 DOI: 10.1002/clc.23995] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/25/2023] [Indexed: 03/01/2023] Open
Abstract
AIMS We compared diagnostic performance, costs, and association with major adverse cardiovascular events (MACE) of clinical coronary computed tomography angiography (CCTA) interpretation versus semiautomated approach that use artificial intelligence and machine learning for atherosclerosis imaging-quantitative computed tomography (AI-QCT) for patients being referred for nonemergent invasive coronary angiography (ICA). METHODS CCTA data from individuals enrolled into the randomized controlled Computed Tomographic Angiography for Selective Cardiac Catheterization trial for an American College of Cardiology (ACC)/American Heart Association (AHA) guideline indication for ICA were analyzed. Site interpretation of CCTAs were compared to those analyzed by a cloud-based software (Cleerly, Inc.) that performs AI-QCT for stenosis determination, coronary vascular measurements and quantification and characterization of atherosclerotic plaque. CCTA interpretation and AI-QCT guided findings were related to MACE at 1-year follow-up. RESULTS Seven hundred forty-seven stable patients (60 ± 12.2 years, 49% women) were included. Using AI-QCT, 9% of patients had no CAD compared with 34% for clinical CCTA interpretation. Application of AI-QCT to identify obstructive coronary stenosis at the ≥50% and ≥70% threshold would have reduced ICA by 87% and 95%, respectively. Clinical outcomes for patients without AI-QCT-identified obstructive stenosis was excellent; for 78% of patients with maximum stenosis < 50%, no cardiovascular death or acute myocardial infarction occurred. When applying an AI-QCT referral management approach to avoid ICA in patients with <50% or <70% stenosis, overall costs were reduced by 26% and 34%, respectively. CONCLUSIONS In stable patients referred for ACC/AHA guideline-indicated nonemergent ICA, application of artificial intelligence and machine learning for AI-QCT can significantly reduce ICA rates and costs with no change in 1-year MACE.
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Affiliation(s)
- Yumin Kim
- The George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Andrew D Choi
- The George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Anha Telluri
- The George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Isabella Lipkin
- The George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Andrew J Bradley
- The George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Alfateh Sidahmed
- The George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Rebecca Jonas
- Jefferson Medical Institute, Philadelphia, Pennsylvania, USA
| | | | - Ravi Bathina
- CARE Hospital and FACTS Foundation, Hyderabad, India
| | | | | | | | | | - So-Yeon Choi
- Ajou University Hospital, Gyeonggi-do, South Korea
| | - Namsik Chung
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, South Korea
| | - Jason Cole
- Cardiology Associates of Mobile, Mobile, Alabama, USA
| | - Joon-Hyung Doh
- Inje University, Ilsan Paik Hospital, Gyeonggi-do, South Korea
| | - Sang-Jin Ha
- Gangneung Asan Hospital, Gangwon-do, South Korea
| | - Ae-Young Her
- Kangwon National University Hospital, Gangwon-do, South Korea
| | - Cezary Kepka
- National Institute of Cardiology, Warsaw, Poland
| | | | - Jin Won Kim
- Korea University Guro Hospital, Seoul, South Korea
| | | | - Woong Kim
- Yeungnam University Hospital, Daegu, South Korea
| | | | - Todd C Villines
- University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - Iksung Cho
- Chung-Ang University Hospital, Seoul, South Korea
| | | | - Ran Heo
- Hanyang University, Hanyang University Medical Center, Seoul, South Korea
| | - Sang-Eun Lee
- Myongji Hospital, Seonam University College of Medicine, Gyeonggi-do, South Korea
| | - Ji Hyun Lee
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, South Korea
| | - Hyung-Bok Park
- Myongji Hospital, Seonam University College of Medicine, Gyeonggi-do, South Korea.,International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, South Korea
| | - Ji-Min Sung
- Jefferson Medical Institute, Philadelphia, Pennsylvania, USA
| | | | - James P Earls
- The George Washington University School of Medicine, Washington, District of Columbia, USA.,Cleerly Inc, New York, New York, USA
| | | | - Hyuk-Jae Chang
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, South Korea
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Griffin WF, Choi AD, Riess JS, Marques H, Chang HJ, Choi JH, Doh JH, Her AY, Koo BK, Nam CW, Park HB, Shin SH, Cole J, Gimelli A, Khan MA, Lu B, Gao Y, Nabi F, Nakazato R, Schoepf UJ, Driessen RS, Bom MJ, Thompson R, Jang JJ, Ridner M, Rowan C, Avelar E, Généreux P, Knaapen P, de Waard GA, Pontone G, Andreini D, Earls JP. AI Evaluation of Stenosis on Coronary CTA, Comparison With Quantitative Coronary Angiography and Fractional Flow Reserve: A CREDENCE Trial Substudy. JACC Cardiovasc Imaging 2023; 16:193-205. [PMID: 35183478 DOI: 10.1016/j.jcmg.2021.10.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 10/18/2021] [Accepted: 10/22/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Clinical reads of coronary computed tomography angiography (CTA), especially by less experienced readers, may result in overestimation of coronary artery disease stenosis severity compared with expert interpretation. Artificial intelligence (AI)-based solutions applied to coronary CTA may overcome these limitations. OBJECTIVES This study compared the performance for detection and grading of coronary stenoses using artificial intelligence-enabled quantitative coronary computed tomography (AI-QCT) angiography analyses to core lab-interpreted coronary CTA, core lab quantitative coronary angiography (QCA), and invasive fractional flow reserve (FFR). METHODS Coronary CTA, FFR, and QCA data from 303 stable patients (64 ± 10 years of age, 71% male) from the CREDENCE (Computed TomogRaphic Evaluation of Atherosclerotic DEtermiNants of Myocardial IsChEmia) trial were retrospectively analyzed using an Food and Drug Administration-cleared cloud-based software that performs AI-enabled coronary segmentation, lumen and vessel wall determination, plaque quantification and characterization, and stenosis determination. RESULTS Disease prevalence was high, with 32.0%, 35.0%, 21.0%, and 13.0% demonstrating ≥50% stenosis in 0, 1, 2, and 3 coronary vessel territories, respectively. Average AI-QCT analysis time was 10.3 ± 2.7 minutes. AI-QCT evaluation demonstrated per-patient sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 94%, 68%, 81%, 90%, and 84%, respectively, for ≥50% stenosis, and of 94%, 82%, 69%, 97%, and 86%, respectively, for detection of ≥70% stenosis. There was high correlation between stenosis detected on AI-QCT evaluation vs QCA on a per-vessel and per-patient basis (intraclass correlation coefficient = 0.73 and 0.73, respectively; P < 0.001 for both). False positive AI-QCT findings were noted in in 62 of 848 (7.3%) vessels (stenosis of ≥70% by AI-QCT and QCA of <70%); however, 41 (66.1%) of these had an FFR of <0.8. CONCLUSIONS A novel AI-based evaluation of coronary CTA enables rapid and accurate identification and exclusion of high-grade stenosis and with close agreement to blinded, core lab-interpreted quantitative coronary angiography. (Computed TomogRaphic Evaluation of Atherosclerotic DEtermiNants of Myocardial IsChEmia [CREDENCE]; NCT02173275).
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Qiu T, Liang C, Ming B, Liu G, Zhang F, Zeng R, Xie D, Zou Q. Comparison and Optimization of Cardiovascular Risk Scores in Predicting the 4-Year Outcome of Patients with Obstructive Coronary Arteries Disease. Ther Clin Risk Manag 2023; 19:319-328. [PMID: 37038594 PMCID: PMC10082600 DOI: 10.2147/tcrm.s404351] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/12/2023] [Indexed: 04/12/2023] Open
Abstract
Objective How well cardiovascular risk models perform in selected atherosclerosis patients for predicting outcomes is unknown. We sought to compare the performance of cardiovascular risk models (Framingham, Globorisk, SCORE2 & SCORE2-OP, and an updated new model) in predicting the 4-year outcome of patients with obstructive coronary artery disease (CAD). Methods Patients with suspected CAD who underwent coronary computed tomography angiography (CCTA) were recruited. Obstructive CAD was defined from CCTA as ≥ 50% stenosis. Computed tomography images, the scores of the cardiovascular risk models, and 4-year composite endpoints were assessed. Whether the patients underwent revascularization within 60 days after CCTA was also recorded. Multivariate regression analysis and receiver operating characteristics (ROC) curve analysis were performed. Results A total of 95 patients (mean age: 69.5 ± 10.33 years; 69 males) with obstructive CAD were included in this study. After the ROC analysis, the Framingham, Globorisk, SCORE2 & SCORE2-OP risk score showed prediction values with AUC 0.628 (95% CI: 0.532-0.725), 0.647 (95% CI: 0.542-0.742), 0.684 (95% CI: 0.581-0.776), respectively. Multivariate regression analysis showed that, among the three risk models, only SCORE2 & SCORE2-OP risk score was associated with composite endpoints (hazard ratio: 1.050; 95% CI: 1.021-1.079; p = 0.001) after adjusting for confounding factors. The AUC of the new risk model by combing SCORE2 & SCORE2-OP risk score with revascularization and the number of obstructive vessels in predicting composite endpoints reached 0.898 (95% CI: 0.819-0.951). Conclusion The SCORE2 & SCORE2-OP risk score combined with the number of obstructive vessels and revascularization is predictive for adverse outcomes in patients with obstructive CAD.
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Affiliation(s)
- Taichun Qiu
- Department of Radiology, Deyang People’s Hospital, Deyang, Sichuan, People’s Republic of China
| | - Chunxiao Liang
- Department of Radiology, Deyang People’s Hospital, Deyang, Sichuan, People’s Republic of China
| | - Bing Ming
- Department of Radiology, Deyang People’s Hospital, Deyang, Sichuan, People’s Republic of China
| | - Gaoyuan Liu
- Department of Radiology, Deyang People’s Hospital, Deyang, Sichuan, People’s Republic of China
| | - Furong Zhang
- Department of Radiology, Deyang People’s Hospital, Deyang, Sichuan, People’s Republic of China
| | - Ruxue Zeng
- Department of Radiology, Deyang People’s Hospital, Deyang, Sichuan, People’s Republic of China
| | - Dongmei Xie
- Department of Radiology, Deyang People’s Hospital, Deyang, Sichuan, People’s Republic of China
| | - Qing Zou
- Department of Radiology, Deyang People’s Hospital, Deyang, Sichuan, People’s Republic of China
- Correspondence: Qing Zou, Department of Radiology, Deyang People’s Hospital, 173# Section 3 Tai Shan Road, Deyang, Sichuan, People’s Republic of China, Tel +86 15283804266, Email
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Pergola V, Mattesi G, Cabrelle G, Corradin S, De Conti G, Cacciavillani L, Deola P, Cecchetto A, Iliceto S, Mele D, Motta R. Pericardial Cyst or Something Else? Do Not Forget Echocontrast in the Drawer! Circ Cardiovasc Imaging 2022; 15:e014261. [PMID: 36256727 DOI: 10.1161/circimaging.122.014261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Valeria Pergola
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Italy (V.P., G.M., L.C., P.D., A.C., S.I., D.M.)
| | - Giulia Mattesi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Italy (V.P., G.M., L.C., P.D., A.C., S.I., D.M.)
| | - Giulio Cabrelle
- Radiology Unit, Padova University Hospital, Padua, Italy (G.C., S.C., G.D.C., R.M.)
| | - Simone Corradin
- Radiology Unit, Padova University Hospital, Padua, Italy (G.C., S.C., G.D.C., R.M.)
| | - Giorgio De Conti
- Radiology Unit, Padova University Hospital, Padua, Italy (G.C., S.C., G.D.C., R.M.)
| | - Luisa Cacciavillani
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Italy (V.P., G.M., L.C., P.D., A.C., S.I., D.M.)
| | - Petra Deola
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Italy (V.P., G.M., L.C., P.D., A.C., S.I., D.M.)
| | - Antonella Cecchetto
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Italy (V.P., G.M., L.C., P.D., A.C., S.I., D.M.)
| | - Sabino Iliceto
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Italy (V.P., G.M., L.C., P.D., A.C., S.I., D.M.)
| | - Donato Mele
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Italy (V.P., G.M., L.C., P.D., A.C., S.I., D.M.)
| | - Raffaella Motta
- Radiology Unit, Padova University Hospital, Padua, Italy (G.C., S.C., G.D.C., R.M.)
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Eslami P, Seo JH, Rahsepar AA, Shafique A, Rollison SF, Lardo AC, Mittal R, Chen MY. A Noninvasive Assessment of Flow Based on Contrast Dispersion in Computed Tomography Angiography: A Computational and Experimental Phantom Study. J Biomech Eng 2022; 144:091009. [PMID: 35237785 PMCID: PMC8990739 DOI: 10.1115/1.4053997] [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] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 12/27/2021] [Indexed: 11/08/2022]
Abstract
Transluminal attenuation gradient (TAG), defined as the gradient of the contrast agent attenuation drop along the vessel, is an imaging biomarker that indicates stenosis in the coronary arteries. The transluminal attenuation flow encoding (TAFE) equation is a theoretical platform that quantifies blood flow in each coronary artery based on computed tomography angiography (CTA) imaging. This formulation couples TAG (i.e., contrast dispersion along the vessel) with fluid dynamics. However, this theoretical concept has never been validated experimentally. The aim of this proof-of-principle phantom study is to validate TAFE based on CTA imaging. Dynamic CTA images were acquired every 0.5 s. The average TAFE estimated flow rates were compared against four predefined pump values in a straight (20, 25, 30, 35, and 40 ml/min) and a tapered phantom (25, 35, 45, and 55 ml/min). Using the TAFE formulation with no correction, the flow rates were underestimated by 33% and 81% in the straight and tapered phantoms, respectively. The TAFE formulation was corrected for imaging artifacts focusing on partial volume averaging and radial variation of contrast enhancement. After corrections, the flow rates estimated in the straight and tapered phantoms had an excellent Pearson correlation of r = 0.99 and 0.87 (p < 0.001), respectively, with only a 0.6%±0.2 mL/min difference in estimation of the flow rate. In this proof-of-concept phantom study, we corrected the TAFE formulation and showed a good agreement with the actual pump values. Future clinical validations are needed for feasibility of TAFE in clinical use.
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Affiliation(s)
- Parastou Eslami
- Department of Radiology, Harvard Medical School, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA 02114
| | - Jung-Hee Seo
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD 21218
| | - Amir Ali Rahsepar
- Division of Cardiology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD 21205
| | - Asim Shafique
- School of Osteopathic Medicine, Rowan University, Stratford, NJ 08084
| | - Shirley F. Rollison
- National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD 2089
| | - Albert C. Lardo
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218
| | - Rajat Mittal
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD 21218; Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD 21287
| | - Marcus Y. Chen
- National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD 2089
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Antonopoulos AS, Angelopoulos A, Papanikolaou P, Simantiris S, Oikonomou EK, Vamvakaris K, Koumpoura A, Farmaki M, Trivella M, Vlachopoulos C, Tsioufis K, Antoniades C, Tousoulis D. Biomarkers of Vascular Inflammation for Cardiovascular Risk Prognostication: A Meta-Analysis. JACC Cardiovasc Imaging 2022; 15:460-471. [PMID: 34801448 DOI: 10.1016/j.jcmg.2021.09.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [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: 08/12/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The purpose of this study was to systematically explore the added value of biomarkers of vascular inflammation for cardiovascular prognostication on top of clinical risk factors. BACKGROUND Measurement of biomarkers of vascular inflammation is advocated for the risk stratification for coronary heart disease (CHD). METHODS We systematically explored published reports in MEDLINE for cohort studies on the prognostic value of common biomarkers of vascular inflammation in stable patients without known CHD. These included common circulating inflammatory biomarkers (ie, C-reactive protein, interleukin-6 and tumor necrosis factor-a, arterial positron emission tomography/computed tomography and coronary computed tomography angiography-derived biomarkers of vascular inflammation, including anatomical high-risk plaque features and perivascular fat imaging. The main endpoint was the difference in c-index (Δ[c-index]) with the use of inflammatory biomarkers for major adverse cardiovascular events (MACEs) and mortality. We calculated I2 to test heterogeneity. This study is registered with PROSPERO (CRD42020181158). RESULTS A total of 104,826 relevant studies were screened and a final of 39 independent studies (175,778 individuals) were included in the quantitative synthesis. Biomarkers of vascular inflammation provided added prognostic value for the composite endpoint and for MACEs only (pooled estimate for Δ[c-index]% 2.9, 95% CI: 1.7-4.1 and 3.1, 95% CI: 1.8-4.5, respectively). Coronary computed tomography angiography-related biomarkers were associated with the highest added prognostic value for MACEs: high-risk plaques 5.8%, 95% CI: 0.6 to 11.0, and perivascular adipose tissue (on top of coronary atherosclerosis extent and high-risk plaques): 8.2%, 95% CI: 4.0 to 12.5). In meta-regression analysis, the prognostic value of inflammatory biomarkers was independent of other confounders including study size, length of follow-up, population event incidence, the performance of the baseline model, and the level of statistical adjustment. Limitations in the published literature include the lack of reporting of other metrics of improvement of risk stratification, the net clinical benefit, or the cost-effectiveness of such biomarkers in clinical practice. CONCLUSIONS The use of biomarkers of vascular inflammation enhances risk discrimination for cardiovascular events.
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Affiliation(s)
- Alexios S Antonopoulos
- 1(st) Cardiology Department, School of Health Sciences, National and Kapodistrian University of Athens, Greece; RDM Division of Cardiovascular Medicine, University of Oxford, United Kingdom.
| | - Andreas Angelopoulos
- 1(st) Cardiology Department, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Paraskevi Papanikolaou
- 1(st) Cardiology Department, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Spyridon Simantiris
- 1(st) Cardiology Department, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Evangelos K Oikonomou
- RDM Division of Cardiovascular Medicine, University of Oxford, United Kingdom; Department of Internal Medicine, Yale School of Medicine, Yale-New Haven Hospital, Connecticut, USA
| | - Konstantinos Vamvakaris
- 1(st) Cardiology Department, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Alkmini Koumpoura
- 1(st) Cardiology Department, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Maria Farmaki
- 1(st) Cardiology Department, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | | | - Charalambos Vlachopoulos
- 1(st) Cardiology Department, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Konstantinos Tsioufis
- 1(st) Cardiology Department, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | | | - Dimitris Tousoulis
- 1(st) Cardiology Department, School of Health Sciences, National and Kapodistrian University of Athens, Greece
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Nitta K, Kurisu S, Erasta R, Ikenaga H, Ishibashi K, Fukuda Y, Kihara Y. Aortic valve calcium is associated with left ventricular diastolic function in patients without evidence of ischaemic heart disease: assessment by gated single-photon emission computed tomography. Acta Cardiol 2021; 76:359-364. [PMID: 32153249 DOI: 10.1080/00015385.2020.1737781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/24/2022]
Abstract
BACKGROUND Several studies have shown that aortic valve calcium (AVC) is associated with cardiovascular events. Furthermore, the extent of AVC is associated with adverse prognosis even in patients without significant aortic stenosis. We investigated the relationship between AVC and left ventricular (LV) diastolic parameters determined by gated single-photon emission computed tomography (SPECT) in patients with no evidence of ischaemic heart disease. METHODS This study included 157 patients with no evidence of ischaemic heart disease who underwent both coronary computed tomography and gated SPECT. The AVC scores were calculated by the Agatston method, and peak filling rate (PFR) and one-third mean filling rate (1/3 MFR) were determined as LV diastolic parameters. RESULTS There were 93 (59%) and 64 (41%) patients with and without AVC, respectively, and the AVC scores ranged from 0 to 1251. There was no significant difference in LV end-diastolic volume (EDV) (60 ± 18 vs 62 ± 25 mL, p = 0.52) or LV ejection fraction (67% ± 10% vs 66% ± 8%, p = 0.60) between the two groups. Patients with AVC had lower PFR (2.2 ± 0.5 vs 2.4 ± 0.5 EDV/s, p = 0.002) and 1/3 MFR (1.3 ± 0.3 vs 1.5 ± 0.4 EDV/s, p = 0.003) than those without AVC. Multivariate linear regression analysis showed that ln(AVC score + 1) was significantly associated with PFR and 1/3 MFR. CONCLUSION In patients without evidence of ischaemic heart disease, the extent of AVC was inversely correlated with gated SPECT-derived parameters of LV diastolic function.
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Affiliation(s)
- Kazuhiro Nitta
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Satoshi Kurisu
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Ramandika Erasta
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hiroki Ikenaga
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Ken Ishibashi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yukihiro Fukuda
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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11
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Caiati C, Scardapane A, Iacovelli F, Pollice P, Achille TI, Favale S, Lepera ME. Coronary Flow and Reserve by Enhanced Transthoracic Doppler Trumps Coronary Anatomy by Computed Tomography in Assessing Coronary Artery Stenosis. Diagnostics (Basel) 2021; 11:diagnostics11020245. [PMID: 33562448 PMCID: PMC7914993 DOI: 10.3390/diagnostics11020245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/30/2021] [Accepted: 02/03/2021] [Indexed: 12/28/2022] Open
Abstract
We report the case of a 71-year-old patient with many risk factors for coronary atherosclerosis, who underwent computed coronary angiography (CTA), in accordance with the guidelines, for recent onset atypical chest pain. CTA revealed critical (>50% lumen diameter narrowing) stenosis of the proximal anterior descending coronary, and the patient was scheduled for invasive coronary angiography (ICA). Before ICA he underwent enhanced transthoracic echo-Doppler (E-Doppler TTE) for coronary flow detection by color-guided pulsed-wave Doppler recording of the left main (LMCA) and whole left anterior descending coronary artery (LAD,) along with coronary flow reserve (CFR) in the distal LAD calculated as the ratio, of peak flow velocity during i.v. adenosine (140 mcg/Kg/m) to resting flow velocity. E-Doppler TTE mapping revealed only mild stenosis (28% area narrowing) of the mid LAD and a CFR of 3.20, in perfect agreement with the color mapping showing no flow limiting stenosis in the LMCA and LAD. ICA revealed only a very mild stenosis in the mid LAD and mild atherosclerosis in the other coronaries (intimal irregularities). Thus, coronary stenosis was better predicted by E-Doppler TTE than by CTA. Coronary flow and reserve as assessed by E-Doppler TTE trumps coronary anatomy as assessed by CTA, without exposing the patient to harmful radiation and iodinated contrast medium.
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Affiliation(s)
- Carlo Caiati
- Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantations, University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.I.); (P.P.); (T.I.A.); (S.F.); (M.E.L.)
- Correspondence: ; Tel.: +39-080-5592117; Fax: +39-080-5478796
| | - Arnaldo Scardapane
- Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Bari Medical School, 70124 Bari, Italy;
| | - Fortunato Iacovelli
- Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantations, University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.I.); (P.P.); (T.I.A.); (S.F.); (M.E.L.)
| | - Paolo Pollice
- Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantations, University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.I.); (P.P.); (T.I.A.); (S.F.); (M.E.L.)
| | - Teresa Immacolata Achille
- Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantations, University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.I.); (P.P.); (T.I.A.); (S.F.); (M.E.L.)
| | - Stefano Favale
- Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantations, University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.I.); (P.P.); (T.I.A.); (S.F.); (M.E.L.)
| | - Mario Erminio Lepera
- Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantations, University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.I.); (P.P.); (T.I.A.); (S.F.); (M.E.L.)
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Kwiecinski J, Tzolos E, Adamson PD, Cadet S, Moss AJ, Joshi N, Williams MC, van Beek EJR, Dey D, Berman DS, Newby DE, Slomka PJ, Dweck MR. Coronary 18F-Sodium Fluoride Uptake Predicts Outcomes in Patients With Coronary Artery Disease. J Am Coll Cardiol 2021; 75:3061-3074. [PMID: 32553260 DOI: 10.1016/j.jacc.2020.04.046] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/09/2020] [Accepted: 04/21/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Reliable methods for predicting myocardial infarction in patients with established coronary artery disease are lacking. Coronary 18F-sodium fluoride (18F-NaF) positron emission tomography (PET) provides an assessment of atherosclerosis activity. OBJECTIVES This study assessed whether 18F-NaF PET predicts myocardial infarction and provides additional prognostic information to current methods of risk stratification. METHODS Patients with known coronary artery disease underwent 18F-NaF PET computed tomography and were followed up for fatal or nonfatal myocardial infarction over 42 months (interquartile range: 31 to 49 months). Total coronary 18F-NaF uptake was determined by the coronary microcalcification activity (CMA). RESULTS In a post hoc analysis of data collected for prospective observational studies, the authors studied 293 study participants (age: 65 ± 9 years; 84% men), of whom 203 (69%) showed increased coronary 18F-NaF activity (CMA >0). Fatal or nonfatal myocardial infarction occurred only in patients with increased coronary 18F-NaF activity (20 of 203 with a CMA >0 vs. 0 of 90 with a CMA of 0; p < 0.001). On receiver operator curve analysis, fatal or nonfatal myocardial infarction prediction was highest for 18F-NaF CMA, outperforming coronary calcium scoring, modified Duke coronary artery disease index and Reduction of Atherothrombosis for Continued Health (REACH) and Secondary Manifestations of Arterial Disease (SMART) risk scores (area under the curve: 0.76 vs. 0.54, 0.62, 0.52, and 0.54, respectively; p < 0.001 for all). Patients with CMA >1.56 had a >7-fold increase in fatal or nonfatal myocardial infarction (hazard ratio: 7.1; 95% confidence interval: 2.2 to 25.1; p = 0.003) independent of age, sex, risk factors, segment involvement and coronary calcium scores, presence of coronary stents, coronary stenosis, REACH and SMART scores, the Duke coronary artery disease index, and recent myocardial infarction. CONCLUSIONS In patients with established coronary artery disease, 18F-NaF PET provides powerful independent prediction of fatal or nonfatal myocardial infarction.
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Affiliation(s)
- Jacek Kwiecinski
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California; Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Evangelos Tzolos
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California; British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Philip D Adamson
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Sebastien Cadet
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Alastair J Moss
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Nikhil Joshi
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Michelle C Williams
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Edwin J R van Beek
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Damini Dey
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Daniel S Berman
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Piotr J Slomka
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California.
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
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Curta A, Jaber A, Rieber J, Hetterich H. Estimation of endothelial shear stress in atherosclerotic lesions detected by intravascular ultrasound using computational fluid dynamics from coronary CT scans with a pulsatile blood flow and an individualized blood viscosity. Clin Hemorheol Microcirc 2021; 79:505-518. [PMID: 33459702 DOI: 10.3233/ch-201025] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Endothelial shear stress (ESS) is a local hemodynamic factor that is dependent on vessel geometry and influences the process of atherogenesis. As in vivo measurements of ESS are not possible, it must be calculated using computational fluid dynamics (CFD). In this feasibility study we explore CFD-models generated from coronary CT-angiography (CCTA) using an individualised blood viscosity and a pulsatile flow profile derived from in vivo measurements. MATERIALS AND METHODS We retrospectively recruited 25 consecutive patients who received a CCTA followed by a coronary angiography including intravascular ultrasound (IVUS) and generated 3D models of the coronary arteries from the CT-datasets. We then performed CFD-simulations on these models. Hemodynamically non-relevant stenosis were identified in IVUS. They were isolated in the CFD-model and separated longitudinally into a half with atherosclerotic lesion (AL) and one without (NAL). ESS was measured and compared for both halves. RESULTS After excluding vessels with no IVUS data or relevant stenosis we isolated 31 hemodynamically non-relevant excentric AL from a total of 14 vessels. AL segments showed consistently significantly lower ESS when compared to their corresponding NAL segments when regarding minimum (0.9 Pa, CI [0.6, 1.2] vs. 1.3 Pa, CI [0.9, 1.8]; p = 0.004), mean (5.0 Pa, CI [3.4, 6.0] vs. 6.7 Pa, CI [5.5, 8.4]; p = 0.008) and maximum ESS values (12.4 Pa, CI [8.6, 14.6] vs. 19.6 Pa, CI [12.4, 21.0]; p = 0.005). Qualitatively ESS was lower on the inside of bifurcations and curvatures. CONCLUSION CFD simulations of coronary arteries from CCTA with an individualised flow profile and blood viscosity are feasible and could provide further prognostic information and a better risk stratification in coronary artery disease. Further prospective studies are needed to investigate this claim.
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Affiliation(s)
- Adrian Curta
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Ahmad Jaber
- Department of Cardiology, Privatklinik Dr. Robert Schindlbeck, Herrsching am Ammersee, Germany
| | - Johannes Rieber
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany
| | - Holger Hetterich
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
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Ding YD, Pei YQ, Rui-Wang, Yang JX, Zhao YX, Liu XL, Shen H, Ma Q, Zhang S, Ge HL. Association of Plasma MiRNA-204 and the Presence and Severity of Coronary Artery Calcification in Patients With Type 2 Diabetes. Angiology 2021; 72:451-458. [PMID: 33401931 DOI: 10.1177/0003319720984592] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 01/11/2023]
Abstract
We investigated the association between plasma microRNA (miR)-204 and coronary artery calcification (CAC) in patients with type 2 diabetes mellitus (T2DM). We consecutively enrolled 179 individuals with T2DM who underwent coronary computed tomography at Anzhen Hospital from January 2015 to September 2016. The CAC score (CACS) was expressed in Agatston units and >10 Hounsfield units were defined as CAC-positive status. Significant CAC was observed in 98 (54.7%) patients. Plasma miR-204 levels (relative expression) were significantly lower in patients with significant CAC than controls (1.001 ± 0.100 vs 0.634 ± 0.211, P < .001). Plasma miR-204 levels were also negatively correlated with the glycosylated hemoglobin A1c (HbA1c) level (r = -0.702, P < .001), CACS (r = -0.710, P < .001), and the United Kingdom Prospective Diabetes Study (UKPDS) score (r = -0.355, P < .001). After multivariate logistic analyses, plasma miR-204 levels were still significantly and independently associated with the presence of CAC (odds ratio = 0.103, CI = 0.018-0.583, P < .001) after adjustment for conventional risk factors. Receiver operating characteristic curve analysis showed that plasma miR-204 levels can predict the severity and extent of CAC, and the specificity was higher than that of the traditional risk factors UKPDS score and HbA1c. In conclusion, the downregulation of miR-204 was independently associated with CAC in patients with T2DM.
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Affiliation(s)
- Yao-Dong Ding
- Department of Cardiology, 12667Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yu-Qiang Pei
- Department of Cardiology, 12667Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Rui-Wang
- Department of Cardiology, 12667Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Jia-Xin Yang
- Department of Cardiology, 12667Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Ying-Xin Zhao
- Department of Cardiology, 12667Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiao-Li Liu
- Department of Cardiology, 12667Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hua Shen
- Department of Cardiology, 12667Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Qian Ma
- Department of Cardiology, 12667Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Shuo Zhang
- 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hai-Long Ge
- Department of Cardiology, 12667Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
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Henzel J, Kępka C, Kruk M, Makarewicz-Wujec M, Wardziak Ł, Trochimiuk P, Dzielińska Z, Demkow M. High-Risk Coronary Plaque Regression After Intensive Lifestyle Intervention in Nonobstructive Coronary Disease: A Randomized Study. JACC Cardiovasc Imaging 2020; 14:1192-1202. [PMID: 33341413 DOI: 10.1016/j.jcmg.2020.10.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/19/2020] [Accepted: 10/22/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The authors sought to study the impact of diet and lifestyle intervention on changes in atherosclerotic plaque volume and composition. BACKGROUND Lifestyle and diet modification are the leading strategies to manage coronary artery disease; however, their direct impact on atherosclerosis remains unknown. Coronary plaque composition is related to the risk of future cardiovascular events independent of stenosis severity and can be conveniently evaluated with computed tomography angiography (CTA). METHODS We enrolled 92 patients (41% women; mean age 60 ± 7.7 years) with nonobstructive (<70% stenosis) coronary atherosclerosis identified by CTA. Participants were randomized (1:1) to either the DISCO (Dietary Intervention to Stop Coronary Atherosclerosis in Computed Tomography) intervention group (systematic follow-up by a dietitian to adhere to the Dietary Approaches to Stop Hypertension nutrition model together with optimal medical therapy [OMT]) or the control group (OMT alone). In all patients, CTA was repeated after 66.9 ± 13.7 weeks. The outcome was change (Δ) in atheroma volume and plaque composition. Based on atherosclerotic tissue attenuation ranges in Hounsfield units (HU), the following components of coronary plaque were distinguished: dense calcium (>351 HU), fibrous plaque (151 to 350 HU), and fibrofatty plaque combined with necrotic core (-30 to 150 HU), referred to as noncalcified plaque. RESULTS Percent atheroma volume increased in the control arm (Δ = +1.1 ± 3.4%; p = 0.033) versus no significant change in the experimental arm (Δ = +1.0% ± 4.2%; p = 0.127; intergroup p = 0.851). There was a reduction in noncalcified plaque in both the experimental arm (Δ = -51.3 ± 79.5 mm3 [-1.7 ± 2.7%]; p < 0.001) and the control arm (Δ = -21.3 ± 57.7 [-0.7 ± 1.9%]; p = 0.018), which was greater in the DISCO intervention group (intergroup p = 0.045). No differences in fibrous component or dense calcium changes were observed between the groups. CONCLUSIONS Controlled diet and lifestyle intervention together with OMT may slow the progression of atherosclerosis and reduce noncalcified plaque volume compared to OMT alone. (Dietary Intervention to Stop Coronary Atherosclerosis in Computed Tomography [DISCO-CT]; NCT02571803).
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Affiliation(s)
- Jan Henzel
- Department of Coronary Artery and Structural Heart Diseases, National Institute of Cardiology in Warsaw, Warsaw, Poland
| | - Cezary Kępka
- Department of Coronary Artery and Structural Heart Diseases, National Institute of Cardiology in Warsaw, Warsaw, Poland.
| | - Mariusz Kruk
- Department of Coronary Artery and Structural Heart Diseases, National Institute of Cardiology in Warsaw, Warsaw, Poland
| | | | - Łukasz Wardziak
- Department of Coronary Artery and Structural Heart Diseases, National Institute of Cardiology in Warsaw, Warsaw, Poland
| | - Piotr Trochimiuk
- Department of Coronary Artery and Structural Heart Diseases, National Institute of Cardiology in Warsaw, Warsaw, Poland
| | - Zofia Dzielińska
- Department of Coronary Artery and Structural Heart Diseases, National Institute of Cardiology in Warsaw, Warsaw, Poland
| | - Marcin Demkow
- Department of Coronary Artery and Structural Heart Diseases, National Institute of Cardiology in Warsaw, Warsaw, Poland
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Baessato F, Guglielmo M, Muscogiuri G, Baggiano A, Fusini L, Scafuri S, Babbaro M, Mollace R, Collevecchio A, Guaricci AI, Rabbat M, D'Andrea A, Pontone G. The Incremental Role of Coronary Computed Tomography in Chronic Coronary Syndromes. J Clin Med 2020; 9:E3925. [PMID: 33287329 DOI: 10.3390/jcm9123925] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 11/29/2020] [Accepted: 12/01/2020] [Indexed: 02/03/2023] Open
Abstract
In the context of chronic coronary syndromes (CCS), coronary computed tomography angiography (CCTA) has gained broad acceptance as a noninvasive anatomical imaging tool with ability of excluding coronary stenosis with strong negative predictive value. Atherosclerotic plaque lesions are independent predictors of cardiovascular outcomes in high risk patients with known coronary artery disease (CAD). Calcium detection is commonly expressed through the coronary artery calcium score (CACS), but further research is warranted to confirm the powerness of a CACS-only strategy in both diagnosis and prognosis assessment. Recent studies evidence how defined plaque composition characteristics effectively relate to the risk of plaque instabilization and the overall ischemic burden. Fractional flow reserve from CCTA (FFR-CT) has been demonstrated as a reliable method for noninvasive functional evaluation of coronary lesions severity, while the assessment of perfusion imaging under stress conditions is growing as a useful tool for assessment of myocardial ischemia. Moreover, specific applications in procedural planning of transcatheter valve substitution and follow-up of heart transplantation have gained recent importance. This review illustrates the incremental role of CCTA, which can potentially revolutionize the diagnosis and management pathway within the wide clinical spectrum of CCS.
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Vamvakidou A, Danylenko O, Pradhan J, Kelshiker M, Jones T, Whiteside D, Sethi A, Senior R. Relative clinical value of coronary computed tomography and stress echocardiography-guided management of stable chest pain patients: a propensity-matched analysis. Eur Heart J Cardiovasc Imaging 2020:jeaa303. [PMID: 33232454 DOI: 10.1093/ehjci/jeaa303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 05/25/2020] [Accepted: 10/22/2020] [Indexed: 12/11/2022] Open
Abstract
AIMS The European Society of Cardiology recommends coronary computed tomography (CCT) for the assessment of low-risk patients with suspected stable angina. We aimed to assess in a real-life setting the relative clinical value of stress echocardiography (SE)- and CCT-guided management in this population. METHODS AND RESULTS Patients with stable chest pain and no prior history of coronary artery disease (CAD) who underwent CCT or SE as the initial investigative strategy were propensity-matched (990 patients each group-age: 59 ± 13.2 years, males: 47.9%) to account for baseline differences in cardiovascular risk factors. Inconclusive tests were 6% vs. 3% (P < 0.005) in CCT vs. SE. Severe (≥70% stenosis) on CCT and inducible ischaemia on SE detected obstructive CAD by invasive coronary angiography in 63% vs. 57% patients (P = 0.33). Over the follow-up period (median 717, interquartile range 93-1069 days) more patients underwent invasive coronary angiography (21.5% vs. 7.3%, P < 0.005), revascularization (7.3% vs. 3.5%, P < 0.005), further functional testing 33.4% vs. 8.7% (P < 0.005), but more patients were prescribed statins 8.8% vs. 3.8% (P < 0.005) in the CCT vs. the SE arm, respectively. Combined all-cause mortality and acute myocardial infarction was low-CCT-2.3% and SE-3.3%-with no significant difference (P = 0.16). CONCLUSION Initial SE-guided management was similar for the detection of obstructive CAD, demonstrated better resource utilization, but was associated with reduced prescription of statins although with no difference in medium-term outcome compared to CCT in this very low-risk population. However, a randomized study with longer follow-up is needed to confirm the clinical value of our findings.
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Affiliation(s)
- Anastasia Vamvakidou
- Department of Cardiology, The Northwick Park Hospital, Watford Rd, Harrow, HA1 3UJ, UK
- The Royal Brompton Hospital, Sydney Street, Chelsea, SW3 6NP, UK
- National Heart and Lung Institute, Imperial College London, Exhibition Rd, South Kensington, London, SW7 2BU, UK
| | - Oleksandr Danylenko
- Department of Cardiology, The Northwick Park Hospital, Watford Rd, Harrow, HA1 3UJ, UK
- The Royal Brompton Hospital, Sydney Street, Chelsea, SW3 6NP, UK
| | - Jiwan Pradhan
- Department of Cardiology, The Northwick Park Hospital, Watford Rd, Harrow, HA1 3UJ, UK
| | - Mihir Kelshiker
- Department of Cardiology, The Northwick Park Hospital, Watford Rd, Harrow, HA1 3UJ, UK
| | - Timothy Jones
- Department of Cardiology, The Northwick Park Hospital, Watford Rd, Harrow, HA1 3UJ, UK
| | - David Whiteside
- Department of Cardiology, The Northwick Park Hospital, Watford Rd, Harrow, HA1 3UJ, UK
| | - Amarjit Sethi
- National Heart and Lung Institute, Imperial College London, Exhibition Rd, South Kensington, London, SW7 2BU, UK
- The Ealing Hospital, Uxbridge Road, Southall, UB1 3HW, UK
| | - Roxy Senior
- Department of Cardiology, The Northwick Park Hospital, Watford Rd, Harrow, HA1 3UJ, UK
- The Royal Brompton Hospital, Sydney Street, Chelsea, SW3 6NP, UK
- National Heart and Lung Institute, Imperial College London, Exhibition Rd, South Kensington, London, SW7 2BU, UK
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Fayad ZA, Robson PM. 18F-Sodium Fluoride PET Imaging Passes an Important Milestone Toward Noninvasive Prediction of Clinical Events. J Am Coll Cardiol 2020; 75:3075-3077. [PMID: 32553261 DOI: 10.1016/j.jacc.2020.04.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Zahi A Fayad
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Philip M Robson
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York
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20
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Christensen JL, Sharma E, Gorvitovskaia AY, Watts JP, Assali M, Neverson J, Wu WC, Choudhary G, Morrison AR. Impact of Slice Thickness on the Predictive Value of Lung Cancer Screening Computed Tomography in the Evaluation of Coronary Artery Calcification. J Am Heart Assoc 2020; 8:e010110. [PMID: 30620261 PMCID: PMC6405734 DOI: 10.1161/jaha.118.010110] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Image reconstruction thickness may impact quantitative coronary artery calcium scoring (CACS) from lung cancer screening computed tomography (LCSCT), limiting its application in practice. Methods and Results We evaluated Agatston‐based quantitative CACS from 1.25‐mm LCSCT and cardiac computed tomography for agreement in 87 patients. We then evaluated Agatston‐based quantitative CACS from 1.25‐, 2.5‐, and 5.0‐mm slice thickness LCSCT for agreement in 258 patients. Secondary analysis included the impact of slice thickness on predictive value of 4‐year outcomes. Median age of patients who underwent 1.25‐mm LCSCT and cardiac computed tomography was 63 years (interquartile interval, 57, 68). CACS from 1.25‐mm LCSCT and cardiac computed tomography demonstrated a strong Pearson correlation, R=0.9770 (0.965, 0.985), with good agreement. The receiver operating characteristic curve areas under the curve for cardiac computed tomography and LCSCT were comparable at 0.8364 (0.6628, 1.01) and 0.8208 (0.6431, 0.9985), respectively (P=0.733). Median age of patients who underwent LCSCT with 3 slice thicknesses was 66 years (interquartile interval, 63, 73). Compared with CACS from 1.25‐mm scans, CACS from 2.5‐ and 5.0‐mm scans demonstrated strong Pearson correlations, R=0.9949 (0.9935, 0.996) and R=0.9478 (0.9338, 0.959), respectively, though bias was largely negative for 5.0‐mm scans. Receiver operating characteristic curve areas under the curve for 1.25‐, 2.5‐, and 5.0‐mm scans were comparable at 0.7040 (0.6307, 0.7772), 0.7063 (0.6327, 0.7799), and 0.7194 (0.6407, 0.7887), respectively (P=0.6487). When using individualized high‐risk thresholds derived from respective receiver operating characteristic curves, all slice thicknesses demonstrated similar prognostic value. Conclusions Slice thickness is an important consideration when interpreting Agatston CACS from LCSCTs. Despite the absence of ECG gating, it appears reasonable to report CACS from either 1.25‐ or 2.5‐mm slice thickness LCSCT to help stratify cardiovascular risk. Conversely, 5.0‐mm scans largely underidentify calcium, limiting practical use within the established CACS values used to categorize cardiovascular risk.
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Affiliation(s)
- Jared L Christensen
- 1 Providence Veterans Affairs Medical Center, Ocean State Research Institute, Inc, and the Warren Alpert Medical School at Brown University Providence RI
| | - Esseim Sharma
- 1 Providence Veterans Affairs Medical Center, Ocean State Research Institute, Inc, and the Warren Alpert Medical School at Brown University Providence RI
| | - Anastassia Y Gorvitovskaia
- 1 Providence Veterans Affairs Medical Center, Ocean State Research Institute, Inc, and the Warren Alpert Medical School at Brown University Providence RI
| | - Jerome P Watts
- 1 Providence Veterans Affairs Medical Center, Ocean State Research Institute, Inc, and the Warren Alpert Medical School at Brown University Providence RI
| | - Maen Assali
- 1 Providence Veterans Affairs Medical Center, Ocean State Research Institute, Inc, and the Warren Alpert Medical School at Brown University Providence RI
| | - Jade Neverson
- 1 Providence Veterans Affairs Medical Center, Ocean State Research Institute, Inc, and the Warren Alpert Medical School at Brown University Providence RI
| | - Wen-Chih Wu
- 1 Providence Veterans Affairs Medical Center, Ocean State Research Institute, Inc, and the Warren Alpert Medical School at Brown University Providence RI
| | - Gaurav Choudhary
- 1 Providence Veterans Affairs Medical Center, Ocean State Research Institute, Inc, and the Warren Alpert Medical School at Brown University Providence RI
| | - Alan R Morrison
- 1 Providence Veterans Affairs Medical Center, Ocean State Research Institute, Inc, and the Warren Alpert Medical School at Brown University Providence RI
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Brutkiewicz A, Kruk M, Demkow M, Maurovich-Horvat P, Pleban W, Witowicz A, Pręgowski J, Dzielinska Z, Ruzyllo W, Kępka C. The natural history of napkin-ring sign by coronary computed tomography angiography. Postepy Kardiol Interwencyjnej 2019; 15:314-20. [PMID: 31592255 DOI: 10.5114/aic.2019.87886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/01/2019] [Indexed: 12/30/2022] Open
Abstract
Introduction Despite their significance, the prevalence and the incidence of vulnerable plaques in coronary arteries, as well as their natural history, remain poorly known. Aim To evaluate the prevalence, incidence and evolution of napkin-ring sign (NRS), and to establish factors associated with its presence, progression, or regression, in patients with suspected coronary artery disease (CAD). Material and methods The study is based on a single-center prospective registry. Eighty-nine patients with suspected CAD underwent two computed tomography angiography (CTA) examinations within an interval of at least 24 months. High-risk plaque was defined by the presence of a low-attenuation area adjacent to the coronary lumen, surrounded by a ring of higher attenuation – NRS. Results At the baseline 53 NRS were observed in 22 (25%) patients, 7 (8%) patients had single NRS and 15 (17%) had multiple NRS. After the follow-up period, there were 68 NRS in 32 patients. In 18 patients progression was observed with 23 additional NRS. Presence of single NRS and diabetes were independent predictors of NRS progression. Conclusions The number of NRS plaque tends to increase over time in patients with suspected CAD. The progression may be predicted by the presence of diabetes or single NRS.
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22
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Cho KH, Lee DH, Kim KM, Choi YH, Nam HS, Heo JH, Heo K, Kim YD. Relationship Between Sleep Apnea and Coronary Artery Calcium in Patients With Ischemic Stroke. Front Neurol 2019; 10:819. [PMID: 31417490 PMCID: PMC6684953 DOI: 10.3389/fneur.2019.00819] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/16/2019] [Indexed: 12/20/2022] Open
Abstract
Study Objectives: Coronary artery disease is considered to be the major cause of death amongst patients with ischemic stroke. The coronary artery calcium (CAC) score is related not only to sleep-disordered breathing, but also with future risk of cardiovascular mortality. We investigated the association between the severity of sleep-disordered breathing and CAC score in patients with ischemic stroke. Methods: We included 32 patients who underwent coronary multichannel computed tomography and polysomnography (within 2 years of the stroke event) amongst the patients admitted to our clinic due to acute ischemic stroke. We investigated vascular risk factors, polysomnography findings, and sleep questionnaire scores, and their relationships with the CAC score. Results: All patients were found to have sleep apnea of any degree, and 23 (72%) had severe sleep apnea. Twenty-three (72%) patients had a positive CAC score. Higher CAC scores were associated with elevated respiratory disturbance index (RDI), apnea index, oxygen desaturation index, and STOP-BANG test scores. Multivariate analysis after adjusting for potential confounding factors revealed independent relationships between the CAC score and the RDI (ß [SE] = 5.3 [2.1], p = 0.01), oxygen desaturation index (ß [SE] = 6.8 [2.8], p = 0.02), and STOP-BANG test score (ß [SE] = 90.3 [37.7], p = 0.02). Conclusion: Our findings indicate a relationship between coronary atherosclerotic burden measured by the CAC score and the severity of sleep apnea. Performing polysomnography could be useful for investigating the severity of hidden coronary artery disease among these patients.
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Affiliation(s)
- Kyoo Ho Cho
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong Hyun Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyung Min Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Yun Ho Choi
- Department of Neurology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Ji Hoe Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyoung Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
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23
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Devuyst S, Gigase A, Spapen J, Brouwers S, Couck T, Sonck J, Mizukami T, Gigante C, de Raedt H, Schelfaut D, Heggermont W, De Bruyne B, Penicka M, Van Camp G, Collet C. Impact of non-invasive anatomical testing on optimal medical prescription in patients with suspected coronary artery disease. Cardiovasc Diagn Ther 2019; 9:221-228. [PMID: 31275812 DOI: 10.21037/cdt.2019.04.10] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Compared to functional testing, coronary computed tomography angiography (CTA) improves clinical outcomes in patients with suspected coronary artery disease (CAD). This is thought to be the result of an increased prescription of preventive medical therapy (statins and aspirin) when relying on a CTA imaging strategy. We compared the rate of statins prescription in a patient cohort assessed either with coronary CTA or exercise testing, and evaluated the agreement on medication prescriptions. Methods Consecutive patients who underwent coronary CTA and exercise test for suspected CAD were included. Four clinical cardiologists independently analysed each case based on clinical information and the result of either coronary CTA or exercise test. For each case, treatment strategy and prescription were recorded while blinded to the results of the other cardiac test. Treatment strategy was reassessed using the alternative imaging modality three weeks after the first evaluation. Results A total of 113 patients were included. Mean age was 56.7±11.5 years, 52% were males and diabetes were present in 6%. Coronary CTA showed an obstructive epicardial stenosis in 21.4% and any type of atherosclerotic plaque in 54.2%. Functional testing identified ischemia in 9.1%. The use of coronary CTA resulted in higher number of statin (64.9% vs. 44.5%, P<0.001) and aspirin (21.4% vs. 4.3%, P<0.001) prescriptions. There was a substantial agreement on the prescription of statins (mean Cohen's κ coefficient of 0.79±0.07). Conclusions Epicardial atherosclerotic disease was found in half of patients with suspected CAD as assessed by coronary CTA. Compared to functional testing, coronary CTA evaluation by coronary was associated with an increase in the rate preventive therapy prescription.
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Affiliation(s)
- Stijn Devuyst
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Arno Gigase
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Jerrold Spapen
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Sofie Brouwers
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Thomas Couck
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | | | - Carlo Gigante
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | | | - Dan Schelfaut
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | | | | | - Martin Penicka
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Guy Van Camp
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
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Hemu M, Zimmerman A, Kalra D, Okwuosa T. Pretransplant Cardiac Evaluation Using Novel Technology. J Clin Med 2019; 8:E690. [PMID: 31100854 DOI: 10.3390/jcm8050690] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 05/11/2019] [Accepted: 05/14/2019] [Indexed: 12/03/2022] Open
Abstract
Hematopoietic stem-cell transplantation (HSCT) is a complex procedure that has been increasingly successful in treating malignant and nonmalignant conditions. Despite its effectiveness, it can be associated with potentially life-threatening adverse effects. New onset heart failure, ischemic disease, and arrhythmias are among the most notable cardiovascular complications post-HSCT. As a result, appropriate cardiac risk stratification prior to transplant could result in decreased morbidity and mortality by identifying patients with a higher probability of tolerating possible toxicities associated with HSCT. In this review, we aim to discuss the utility of cardiac screening using novel modalities of imaging technology in the pre-HSCT phase.
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25
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Krylova NS, Kovalevskaya EA, Poteshkina NG, Titov DV, Vanyukov AE, Mershina EA, Sinitsin VE. [A Case of Apical Hypertrophic Cardiomyopathy With Rare Anomaly of Coronary Arteries Origin]. Kardiologiia 2018; 58:95-100. [PMID: 30362443] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A clinical case of apical hypertrophic cardiomyopathy (HCM) in 44‑years old man is presented. In this patient exercise ECG testing and 24‑hour ECG monitoring revealed exercise-induced ST depression in the angiographically confirmed absence of coronary atherosclerosis. The uncommonness of this observation was the combination of HCM with a rare anomaly of coronary arteries origin.
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Affiliation(s)
- N S Krylova
- Federal State Budgetary Educational Institution of Higher Education, "Pirogov Russian National Research Medical University" of the Ministry of Health of the Russian Federation
| | - E A Kovalevskaya
- State Budgetary Institution of Health Care, "Municipal Clinical Hospital #52 of the Moscow Department of Health Care"
| | - N G Poteshkina
- Federal State Budgetary Educational Institution of Higher Education, "Pirogov Russian National Research Medical University" of the Ministry of Health of the Russian Federation
| | - D V Titov
- State Budgetary Institution of Health Care, "Municipal Clinical Hospital #52 of the Moscow Department of Health Care"
| | - A E Vanyukov
- State Budgetary Institution of Health Care, "Municipal Clinical Hospital #52 of the Moscow Department of Health Care"
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Mrgan M, Funck KL, Gaur S, Øvrehus KA, Dey D, Kusk MW, Nørgaard BL, Gram JB, Olsen MH, Gram J, Sand NPR. High burden of coronary atherosclerosis in patients with a new diagnosis of type 2 diabetes. Diab Vasc Dis Res 2017; 14:468-476. [PMID: 28866908 DOI: 10.1177/1479164117728014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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] [Indexed: 01/08/2023] Open
Abstract
PURPOSE The purposes of this study were to compare the presence, extent and composition of coronary plaques in asymptomatic patients with newly diagnosed type 2 diabetes to age- and sex-matched controls. METHODS Patients with newly diagnosed (<1 year) type 2 diabetes ( n = 44) and controls ( n = 44) underwent contrast-enhanced coronary computed tomography angiography. Advanced plaque analysis including total plaque volume and volumes of plaque components (calcified plaque and non-calcified plaque, including low-attenuation [low-density non-calcified plaque]) was performed using validated semi-automated software. RESULTS Coronary artery calcification was more often seen in patients with type 2 diabetes (66%) versus controls (48%), p < 0.05. Both the absolute volume (median; interquartile range) of low-density non-calcified plaque (7.9 mm3; 0-50.5 mm3 vs 0; 0-34.3 mm3, p < 0.05) and the increase in low-density non-calcified plaque ratio in relation to total plaque volume ( τ = 0.5, p < 0.001) were significantly higher in patients with type 2 diabetes. More patients with type 2 diabetes had spotty calcification (31% vs 0%, p < 0.05). By multivariate analysis, the presence of any low-density non-calcified plaque was higher in males (odds ratio: 4.06, p < 0.05), who also demonstrated a larger low-density non-calcified plaque volume ( p < 0.001). The presence and extent of low-density non-calcified plaque increased with age, smoking, hypertension and hyperglycaemia, all p < 0.05. CONCLUSION Asymptomatic patients with newly diagnosed type 2 diabetes had plaque features associated with increased vulnerability as compared with age- and sex-matched controls.
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Affiliation(s)
- Monija Mrgan
- 1 Department of Cardiology, Hospital of Southwest Denmark, Esbjerg, Denmark
| | - Kristian L Funck
- 2 Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Sara Gaur
- 3 Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Damini Dey
- 5 Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Martin W Kusk
- 6 Department of Radiology, Hospital of Southwest Denmark, Esbjerg, Denmark
| | - Bjarne L Nørgaard
- 3 Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jørgen B Gram
- 7 Unit for Thrombosis Research, University of Southern Denmark, Esbjerg, Denmark
- 8 Department of Clinical Biochemistry, Hospital of Southwest Denmark, Esbjerg, Denmark
| | - Michael H Olsen
- 9 Cardiology Section, Department of Internal Medicine, Holbæk Hospital, Holbæk, Denmark
- 10 Centre for Individualized Medicine in Arterial Diseases, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Jeppe Gram
- 11 Department of Endocrinology, Hospital of Southwest Denmark, Esbjerg, Denmark
| | - Niels Peter R Sand
- 1 Department of Cardiology, Hospital of Southwest Denmark, Esbjerg, Denmark
- 12 Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Roifman I, Wijeysundera HC, Austin PC, Rezai MR, Wright GA, Tu JV. Comparison of Anatomic and Clinical Outcomes in Patients Undergoing Alternative Initial Noninvasive Testing Strategies for the Diagnosis of Stable Coronary Artery Disease. J Am Heart Assoc 2017; 6:JAHA.116.005462. [PMID: 28729409 PMCID: PMC5586282 DOI: 10.1161/jaha.116.005462] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background The optimal initial noninvasive diagnostic testing strategy for stable coronary artery disease (CAD) is unknown. Although American guidelines recommend an exercise stress test as the first‐line test, European guidelines suggest that stress imaging (myocardial perfusion imaging or stress echocardiography) or coronary computed tomography angiography may be preferable. Understanding the relationship between the initial strategy and downstream yield of obstructive CAD and major adverse cardiac events may provide insight as to the optimal strategy. Methods and Results We conducted a population‐based retrospective cohort study of adults in Ontario, Canada, using health administrative and clinical data. The relationship between the initial testing strategy and obstructive CAD on invasive angiography was examined. Patients were then followed from their angiogram onward to determine whether they developed a composite end point of major adverse cardiac events. After adjusting for covariates, patients with initial myocardial perfusion imaging (odds ratio: 0.92; 95% confidence interval, 0.85, 1.00), coronary computed tomography angiography (odds ratio: 1.51; 95% confidence interval, 0.91, 2.49), or stress echo (odds ratio: 0.95; 95% confidence interval, 0.84, 1.08) did not a have significantly different yield of obstructive CAD compared with those with an initial exercise stress test. Furthermore, there was no significant difference in downstream major adverse cardiac events after invasive angiography among the 4 initial testing strategies after adjusting for clinically relevant covariates. Conclusions Our study found no evidence to suggest significant differences in either yield of obstructive CAD or downstream major adverse cardiac events in patients undergoing an initial noninvasive testing strategy with stress or anatomical imaging compared with those undergoing an initial exercise stress test.
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Affiliation(s)
- Idan Roifman
- Institute for Clinical Evaluative Sciences (ICES), University of Toronto, Ontario, Canada
- Schulich Heart Program and the Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Harindra C Wijeysundera
- Institute for Clinical Evaluative Sciences (ICES), University of Toronto, Ontario, Canada
- Schulich Heart Program and the Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Peter C Austin
- Institute for Clinical Evaluative Sciences (ICES), University of Toronto, Ontario, Canada
- Schulich Heart Program and the Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Mohammad R Rezai
- Institute for Clinical Evaluative Sciences (ICES), University of Toronto, Ontario, Canada
| | - Graham A Wright
- Schulich Heart Program and the Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Ontario, Canada
| | - Jack V Tu
- Institute for Clinical Evaluative Sciences (ICES), University of Toronto, Ontario, Canada
- Schulich Heart Program and the Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
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Alderazi AA, Lynch M. An Audit on the Appropriateness of Coronary Computed Tomography Angiography Referrals in a Tertiary Cardiac Center. Heart Views 2017; 18:8-12. [PMID: 28584585 PMCID: PMC5448255 DOI: 10.4103/1995-705x.206203] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND In response to growing concerns regarding the overuse of coronary computed tomography angiography (CCTA) in the clinical setting, multiple societies, including the American College of Cardiology Foundation, have jointly published revised criteria regarding the appropriate use of this imaging modality. However, previous research indicates significant discrepancies in the rate of adherence to these guidelines. AIM To assess the appropriateness of CCTA referrals in a tertiary cardiac center in Bahrain. METHODS This retrospective clinical audit examined the records of patients referred to CCTA between the April 1, 2015 and December 31, 2015 in Mohammed bin Khalifa Cardiac Center. Using information from medical records, each case was meticulously audited against guidelines to categorize it as appropriate, inappropriate, or uncertain. RESULTS Of the 234 records examined, 176 (75.2%) were appropriate, 47 (20.1%) were uncertain, and 11 (4.7%) were inappropriate. About 74.4% of all referrals were to investigate coronary artery disease (CAD). The most common indication that was deemed appropriate was the detection of CAD in the setting of suspected ischemic equivalent in patients with an intermediate pretest probability of CAD (65.9%). Most referrals deemed inappropriate were requested to detect CAD in asymptomatic patients at low or intermediate risk of CAD (63.6%). CONCLUSION This audit demonstrates a relatively low rate of inappropriate CCTA referrals, indicating the appropriate and efficient use of this resource in the Mohammed bin Khalifa Cardiac Center. Agreement on and reclassification of "uncertain" cases by guideline authorities would facilitate a deeper understanding of referral appropriateness.
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Affiliation(s)
- Ahmed Ali Alderazi
- Department of Medicine, Royal College of Surgeons in Ireland, Medical University of Bahrain, Busiateen, Bahrain
| | - Mary Lynch
- Mohammed bin Khalifa Cardiac Centre, Bahrain
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Watanabe N, Kurisu S, Sumimoto Y, Ikenaga H, Shimonaga T, Higaki T, Tatsugami F, Ishibashi K, Kitagawa T, Dohi Y, Fukuda Y, Yamamoto H, Awai K, Kihara Y. Use of the augmentation index from applanation tonometry of the radial artery for assessing the extent of coronary artery calcium as assessed by coronary computed tomography. Clin Exp Hypertens 2017; 39:355-360. [PMID: 28513225 DOI: 10.1080/10641963.2016.1267195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 10/19/2022]
Abstract
BACKGROUND The augmentation index (AI) obtained from applanation tonometry of the radial artery is technically the easiest and quickest of available methods for assessing arterial stiffness. We tested the hypothesis that the radial AI is associated with the extent of coronary artery calcium (CAC) as assessed by coronary computed tomography (CCT). METHODS AND RESULTS This study included 161 patients with known or suspected coronary artery disease undergoing central hemodynamic measurements and CCT. Radial AI was recorded and was corrected in accordance with heart rate (radial AI@75). Thirty-seven patients had no CAC (CAC score = 0), 85 had low-grade CAC (CAC score = 1-399), and 39 had high-grade CAC (CAC score ≥400). Coronary risk factors, except for age and serum creatinine, were similar among the three groups. There were significant differences in brachial systolic blood pressure (SBP) (p = 0.011) and radial AI@75 (%) (p = 0.006). Multivariate analysis showed that age (β = 0.27, p = 0.001), serum creatinine (β = 0.18, p = 0.03), and radial AI@75 (β = 0.24, p = 0.005) were significantly associated with ln (CAC score + 1), whereas brachial SBP was not. Additionally, serum creatinine (odds ratio: 11.91, 95% confidence interval: 1.46-112.0, p = 0.02) and radial AI@75 (per 10%) (odds ratio: 1.76, 95% confidence interval: 1.22-2.64, p = 0.002) were independent factors associated with high-grade CAC. CONCLUSIONS Our results suggest that the radial AI is better for estimating CAC than brachial SBP in patients with known or suspected coronary artery disease.
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Affiliation(s)
- Noriaki Watanabe
- a Department of Cardiovascular Medicine , Hiroshima University Graduate School of Biomedical and Health Sciences , Hiroshima , Japan
| | - Satoshi Kurisu
- a Department of Cardiovascular Medicine , Hiroshima University Graduate School of Biomedical and Health Sciences , Hiroshima , Japan
| | - Yoji Sumimoto
- a Department of Cardiovascular Medicine , Hiroshima University Graduate School of Biomedical and Health Sciences , Hiroshima , Japan
| | - Hiroki Ikenaga
- a Department of Cardiovascular Medicine , Hiroshima University Graduate School of Biomedical and Health Sciences , Hiroshima , Japan
| | - Takashi Shimonaga
- a Department of Cardiovascular Medicine , Hiroshima University Graduate School of Biomedical and Health Sciences , Hiroshima , Japan
| | - Tadanao Higaki
- a Department of Cardiovascular Medicine , Hiroshima University Graduate School of Biomedical and Health Sciences , Hiroshima , Japan
| | - Fuminari Tatsugami
- b Department of Diagnostic Radiology , Hiroshima University Graduate School of Biomedical and Health Sciences , Hiroshima , Japan
| | - Ken Ishibashi
- a Department of Cardiovascular Medicine , Hiroshima University Graduate School of Biomedical and Health Sciences , Hiroshima , Japan
| | - Toshiro Kitagawa
- a Department of Cardiovascular Medicine , Hiroshima University Graduate School of Biomedical and Health Sciences , Hiroshima , Japan
| | - Yoshihiro Dohi
- a Department of Cardiovascular Medicine , Hiroshima University Graduate School of Biomedical and Health Sciences , Hiroshima , Japan
| | - Yukihiro Fukuda
- a Department of Cardiovascular Medicine , Hiroshima University Graduate School of Biomedical and Health Sciences , Hiroshima , Japan
| | - Hideya Yamamoto
- a Department of Cardiovascular Medicine , Hiroshima University Graduate School of Biomedical and Health Sciences , Hiroshima , Japan
| | - Kazuo Awai
- b Department of Diagnostic Radiology , Hiroshima University Graduate School of Biomedical and Health Sciences , Hiroshima , Japan
| | - Yasuki Kihara
- a Department of Cardiovascular Medicine , Hiroshima University Graduate School of Biomedical and Health Sciences , Hiroshima , Japan
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Gräni C, Benz DC, Possner M, Clerc OF, Mikulicic F, Vontobel J, Stehli J, Fuchs TA, Pazhenkottil AP, Gaemperli O, Kaufmann PA, Buechel RR. Fused cardiac hybrid imaging with coronary computed tomography angiography and positron emission tomography in patients with complex coronary artery anomalies. CONGENIT HEART DIS 2016; 12:49-57. [PMID: 27539240 DOI: 10.1111/chd.12402] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 04/14/2016] [Revised: 07/01/2016] [Accepted: 07/15/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To provide data on the value of fused cardiac hybrid imaging with coronary computed tomography angiography (CCTA) and positron emission tomography myocardial perfusion imaging (PET-MPI) in patients with complex coronary artery anomalies (CCAA). DESIGN/SETTING This is a retrospective, single-center study. PATIENTS Seven consecutive patients with CCAA (mean 57 ± 7 y, 86% were male) who underwent clinically indicated hybrid CCTA/PET-MPI between 2005 and 2015 in our clinic were included. The findings from both modalities and fused cardiac hybrid imaging were evaluated in these patients. RESULTS Out of the seven patients with CCAA, two patients had Bland-White-Garland anomaly, two patients showed a coronary artery fistula, two patients showed a "single right," and one patient showed a "single left" coronary artery. Semiquantitative fused hybrid CCTA/PET-MPI depicted inferolateral scar matching the territory of a nonanomalous vessel with significant concomitant coronary artery disease (CAD) in one patient only. In contrast, analysis of quantitative myocardial blood flow (MBF) as assessed by fused hybrid CCTA/PET-MPI revealed abnormally reduced flow capacities in the territories subtended by the anomalous vessels in 4 patients. CONCLUSIONS In this case series of middle-aged patients with CCAA, perfusion defects as assessed by semiquantitative PET-MPI were rare and attributable to concomitant CAD rather than to the anomalous vessel itself. By contrast, impaired MBF as assessed by quantitative hybrid CCTA/PET-MPI was revealed in the majority of patients in the vessel territories subtended by the anomalous coronary artery itself. Fused hybrid CCTA/PET-MPI incorporating information on morphology and on semiquantitative and quantitative myocardial perfusions may provide added value for the management of patients with CCAA.
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Affiliation(s)
- Christoph Gräni
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Dominik C Benz
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Mathias Possner
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Olivier F Clerc
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Fran Mikulicic
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Jan Vontobel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Julia Stehli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Tobias A Fuchs
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Oliver Gaemperli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
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Agarwal P, Prakash M, Singhal M, Bhadada SK, Gupta Y, Khandelwal N. To assess vascular calcification in the patients of hypoparathyroidism using multidetector computed tomography scan. Indian J Endocrinol Metab 2015; 19:785-790. [PMID: 26693429 PMCID: PMC4673807 DOI: 10.4103/2230-8210.167545] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Our pilot data showed an increased intima media thickness in the patients with sporadic idiopathic hypoparathyroidism (SIH). Alteration in homeostasis of calcium, phosphate, and parathyroid hormone (PTH) may predispose to increase the risk of cardiovascular morbidity and mortality. The data on objective assessment of this increased risk is however lacking. OBJECTIVE To assess the effect of altered calcium, phosphate, and PTH homeostasis in the patients with SIH on coronary calcium score (a marker of increase vascular risk) by multidetector computed tomography scan (MDCT). METHODS In this case-control study, we measured coronary CT calcium score in 30 patients of SIH and compared with 40 age and sex matched healthy subjects. Correlation of coronary calcium score with biochemical parameters was evaluated. RESULTS Three of the 30 cases (10%) with SIH were found to have coronary artery calcification (CAC) of varying degree, whereas none of the control showed CAC (P = 0.07). The patients with CAC had significantly lower serum calcium levels (albumin corrected), as compared to the patients without CAC. Inverse correlation of CAC was found with serum calcium levels. No correlation was found with other biochemical parameters. CONCLUSION The vascular risk is increased in the patients with SIH as assessed by coronary calcium score measured by MDCT. Low serum calcium levels might be a predisposing factor for this increased risk.
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Affiliation(s)
- Pooja Agarwal
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mahesh Prakash
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manphool Singhal
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Kumar Bhadada
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Yashdeep Gupta
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Desai MY, Schoenhagen P. Noninvasive testing strategies in symptomatic, intermediate-risk CAD patients: a perspective on the "PROMISE" trial and its potential implementation in clinical practice. Cardiovasc Diagn Ther 2015; 5:166-8. [PMID: 25984459 DOI: 10.3978/j.issn.2223-3652.2015.03.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 03/17/2015] [Indexed: 12/29/2022]
Abstract
While the results of the Prospective Multicenter Imaging Study for Evaluation of Chest Pain trial (PROMISE trial) are negative for the primary outcome, the results from this large, contemporary trial of >10,000 patients provide important insights into clinical management of patients presenting with chest pain. The results reinforce that while diagnostic testing is an important component of modern management, its choice should be directed by a clinician in a clinical context and with subsequent management in mind. Based on presentation and pre-test probability, the clinician will decide if any additional testing necessary is necessary and if that is the case chose the most appropriate test according to current guidelines, applied to the individual patient and clinical scenario.
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Affiliation(s)
- Milind Y Desai
- Heart and Vascular Institute and Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Paul Schoenhagen
- Heart and Vascular Institute and Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
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Makaryus AN, Sison C, Kohansieh M, Makaryus JN. Implications of Gender Difference in Coronary Calcification as Assessed by CT Coronary Angiography. Clin Med Insights Cardiol 2015; 8:51-5. [PMID: 25983560 PMCID: PMC4412426 DOI: 10.4137/cmc.s18764] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 03/12/2015] [Accepted: 03/18/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND Arterial calcium as measured by 64-slice computed tomography coronary angiography (64-CT) is a reliable predictor of cardiovascular disease risk. Lipid-rich plaques with lower degrees of calcification may pose greater risk for adverse coronary events than more stabilized calcified plaques as a result of the increased risk of plaque rupture, migration, and subsequent acute coronary syndrome. We sought to examine coronary artery calcium scores as measured via 64-CT to assess the extent of calcification and plaque distribution in women compared to men. METHODS A total of 138 patients referred for 64-CT were evaluated. Computerized tomographic angiography was performed using the GE LightSpeed VCT. Subgroup analysis comparing male and female data (including demographic data) was performed. All major coronary arteries were analyzed for coronary stenosis/plaque characterization as well as total vessel calcium (Agatston) score quantification. Patient demographics and coronary risk factors were recorded. RESULTS A total of 552 coronary arteries were evaluated in 138 patients (85 men, 53 women). The average age for females was 64.4 ± 10.8 years and for males 60.0 ± 12.8 years. The only demographic/cardiovascular risk factor in which the difference between men and women was significant was smoking history, where 23.5% of men had a history of smoking while only 9.6% of females endorsed having a smoking history (P < 0.044). On comparison of all total vessel calcium scores, males had a higher total mean calcium score than females in each individual vessel. The results were as follows for males versus females, respectively: left main total vessel calcium score 46.49 versus 16.71 (P = 0.167); left anterior descending 265.21 versus 109.6 (P < 0.003); left circumflex 130.5 versus 39.7 (P < 0.004); and right coronary 213.5 versus 73.8 (P < 0.01). The odds of having a total calcium score >100 (versus not) was 3.62 times greater in males relative to females, given that all the other cardiovascular risk factors are adjusted for (95% confidence interval: 1.37-9.54). On average, men had an average of 2.1 ± 1.5 epicardial vessels with a calcium score ≥11 compared to 1.3 ± 1.4 for women (P < 0.005). CONCLUSION There are clear differences between males and females regarding total vessel calcium scores and therefore risk of future adverse coronary events. Males tended to have higher average calcium scores in each coronary artery than females with a greater tendency to have multiple vessel involvement. Using this information, more large-scale, randomized controlled studies should be performed to correlate differences in the extent of coronary calcification with the observed variance in clinical presentation during coronary events between males and females as a means to potentially establish gender-specific therapeutic regimens.
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Affiliation(s)
- Amgad N Makaryus
- North Shore-LIJ Health System, Hofstra NSLIJ School of Medicine, New York, USA. ; Department of Cardiology, NuHealth, Nassau University Medical Center, East Meadow, NY, USA
| | - Cristina Sison
- Biostatistics Unit, Feinstein Institute for Medical Research at the North Shore-LIJ Health System, Hofstra NSLIJ School of Medicine, New York, USA
| | - Michelle Kohansieh
- North Shore-LIJ Health System, Hofstra NSLIJ School of Medicine, New York, USA
| | - John N Makaryus
- North Shore-LIJ Health System, Hofstra NSLIJ School of Medicine, New York, USA
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Puchner SB, Liu T, Mayrhofer T, Truong QA, Lee H, Fleg JL, Nagurney JT, Udelson JE, Hoffmann U, Ferencik M. High-risk plaque detected on coronary CT angiography predicts acute coronary syndromes independent of significant stenosis in acute chest pain: results from the ROMICAT-II trial. J Am Coll Cardiol 2014; 64:684-92. [PMID: 25125300 DOI: 10.1016/j.jacc.2014.05.039] [Citation(s) in RCA: 380] [Impact Index Per Article: 38.0] [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: 01/12/2014] [Revised: 03/26/2014] [Accepted: 05/12/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND It is not known whether high-risk plaque, as detected by coronary computed tomography angiography (CTA), permits improved early diagnosis of acute coronary syndromes (ACS) independently to the presence of significant coronary artery disease (CAD) in patients with acute chest pain. OBJECTIVES The primary aim of this study was to determine whether high-risk plaque features, as detected by CTA in the emergency department (ED), may improve diagnostic certainty of ACS independently and incrementally to the presence of significant CAD and clinical risk assessment in patients with acute chest pain but without objective evidence of myocardial ischemia or myocardial infarction (MI). METHODS We included patients randomized to the coronary CTA arm of the ROMICAT-II (Rule Out Myocardial Infarction/Ischemia Using Computer-Assisted Tomography II) trial. Readers assessed coronary CTA qualitatively for the presence of nonobstructive CAD (1% to 49% stenosis), significant CAD (≥50% or ≥70% stenosis), and the presence of at least 1 of the high-risk plaque features (positive remodeling, low <30 Hounsfield units plaque, napkin-ring sign, spotty calcium). In logistic regression analysis, we determined the association of high-risk plaque with ACS (MI or unstable angina pectoris) during the index hospitalization and whether this was independent of significant CAD and clinical risk assessment. RESULTS Overall, 37 of 472 patients who underwent coronary CTA with diagnostic image quality (mean age 53.9 ± 8.0 years; 52.8% men) had ACS (7.8%; MI n = 5; unstable angina pectoris n = 32). CAD was present in 262 patients (55.5%; nonobstructive CAD in 217 patients [46.0%] and significant CAD with ≥50% stenosis in 45 patients [9.5%]). High-risk plaques were more frequent in patients with ACS and remained a significant predictor of ACS (odds ratio [OR]: 8.9; 95% CI: 1.8 to 43.3; p = 0.006) after adjustment for ≥50% stenosis (OR: 38.6; 95% CI: 14.2 to 104.7; p < 0.001) and clinical risk assessment (age, sex, number of cardiovascular risk factors). Similar results were observed after adjustment for ≥70% stenosis. CONCLUSIONS In patients presenting to the ED with acute chest pain but negative initial electrocardiogram and troponin, presence of high-risk plaques on coronary CTA increased the likelihood of ACS independent of significant CAD and clinical risk assessment (age, sex, and number of cardiovascular risk factors). (Multicenter Study to Rule Out Myocardial Infarction by Cardiac Computed Tomography [ROMICAT-II]; NCT01084239).
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Affiliation(s)
- Stefan B Puchner
- Department of Radiology and Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Vienna, Austria
| | - Ting Liu
- Department of Radiology and Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Thomas Mayrhofer
- Department of Radiology and Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Quynh A Truong
- Department of Radiology and Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Hang Lee
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jerome L Fleg
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - John T Nagurney
- Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - James E Udelson
- Division of Cardiology and the Cardio-Vascular Center, Tufts Medical Center, Boston, Massachusetts
| | - Udo Hoffmann
- Department of Radiology and Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Maros Ferencik
- Department of Radiology and Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon.
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Korosoglou G, Giusca S, Gitsioudis G, Erbel C, Katus HA. Cardiac magnetic resonance and computed tomography angiography for clinical imaging of stable coronary artery disease. Diagnostic classification and risk stratification. Front Physiol 2014; 5:291. [PMID: 25147526 PMCID: PMC4123729 DOI: 10.3389/fphys.2014.00291] [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] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 07/18/2014] [Indexed: 12/18/2022] Open
Abstract
Despite advances in the pharmacologic and interventional treatment of coronary artery disease (CAD), atherosclerosis remains the leading cause of death in Western societies. X-ray coronary angiography has been the modality of choice for diagnosing the presence and extent of CAD. However, this technique is invasive and provides limited information on the composition of atherosclerotic plaque. Coronary computed tomography angiography (CCTA) and cardiac magnetic resonance (CMR) have emerged as promising non-invasive techniques for the clinical imaging of CAD. Hereby, CCTA allows for visualization of coronary calcification, lumen narrowing and atherosclerotic plaque composition. In this regard, data from the CONFIRM Registry recently demonstrated that both atherosclerotic plaque burden and lumen narrowing exhibit incremental value for the prediction of future cardiac events. However, due to technical limitations with CCTA, resulting in false positive or negative results in the presence of severe calcification or motion artifacts, this technique cannot entirely replace invasive angiography at the present time. CMR on the other hand, provides accurate assessment of the myocardial function due to its high spatial and temporal resolution and intrinsic blood-to-tissue contrast. Hereby, regional wall motion and perfusion abnormalities, during dobutamine or vasodilator stress, precede the development of ST-segment depression and anginal symptoms enabling the detection of functionally significant CAD. While CT generally offers better spatial resolution, the versatility of CMR can provide information on myocardial function, perfusion, and viability, all without ionizing radiation for the patients. Technical developments with these 2 non-invasive imaging tools and their current implementation in the clinical imaging of CAD will be presented and discussed herein.
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Affiliation(s)
| | - Sorin Giusca
- Department of Cardiology, University of Heidelberg Heidelberg, Germany
| | | | - Christian Erbel
- Department of Cardiology, University of Heidelberg Heidelberg, Germany
| | - Hugo A Katus
- Department of Cardiology, University of Heidelberg Heidelberg, Germany
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Kaczmarska E, Kępka C, Dzielińska Z, Pracoń R, Kryczka K, Petryka J, Pręgowski J, Kruk M, Demkow M. What is the optimal cut-off point for low coronary artery calcium score assessed by computed tomography? Multi-Detector Computed Tomography ANIN Registry. Postepy Kardiol Interwencyjnej 2013; 9:9-15. [PMID: 24570687 DOI: 10.5114/pwki.2013.34024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 01/24/2013] [Accepted: 01/28/2013] [Indexed: 11/17/2022] Open
Abstract
AIM This prospective study was conducted to evaluate the incidence and predictors of coronary artery disease (CAD) in relation to the low coronary artery calcium (CAC) score among patients with intermediate probability of CAD. MATERIAL AND METHODS A total of 1132 consecutive patients were included in the analysis (58.7 ±10.9 years, 46.7% males). Coronary computed tomography (CCT) angiography was performed in a multi-detector computed tomography scanner. Coronary artery calcium score was calculated by the Agatston method. Obstructive CAD was defined as the presence of coronary artery stenosis ≥ 50% on CCT angiography. RESULTS Coronary artery disease was diagnosed in nearly one-fourth of patients (n = 272, 24%). In the receiver operating characteristics (ROC) curve analysis a CAC score of 10 was used as an optimal cut-off point for discriminating obstructive CAD (sensitivity: 0.79, specificity: 0.75, p < 0.0001) whereas for a CAC score of 100 the sensitivity and specificity were 0.48 and 0.92, respectively. On multivariate analysis after adjustment for age, gender, hypertension, hyperlipidemia, creatinine levels, only in patients with CAC score ≤ 10 age (OR = 1.05, 95% CI: 1.02-1.08, p = 0.0005, OR = 1.05, 95% CI: 1.03-1.08, p < 0.0001) and male gender (OR = 3.45, 95% CI: 1.92-6.22, p < 0.0001), likewise in group with CAC score ≤ 100 age (OR = 1.05, 95% CI: 1.03-1.08, p < 0.0001) and male gender (OR = 3.31, 95% CI: 1.88-5.81, p < 0.0001) were independent predictors of obstructive CAD. CONCLUSIONS The cut-off point of 10 for CAC score determined patients with CAD with the best sensitivity and specificity. Therefore, a total CAC score < 10 should be classified as "low". In patients with a low CAC score obstructive high risk plaques prone to rupture are presented and are associated with increasing age and male gender.
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