scholarly journals Risk stratification in coronary artery disease using NH3-PET myocardial flow reserve and CAD-RADS on coronary CT angiography

2021 ◽  
Author(s):  
Atsushi Yamamoto ◽  
Michinobu Nagao ◽  
Kiyoe Ando ◽  
Risako Nakao ◽  
Kenji Fukushima ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Risk Stratification ◽  
Ct Angiography ◽  
Coronary Ct Angiography ◽  
Myocardial Flow Reserve ◽  
Coronary Ct ◽  
Flow Reserve ◽  
Artery Disease ◽  
Myocardial Flow

scholarly journals Risk Stratification in Coronary Artery Disease using NH3-PET Myocardial Flow Reserve and CAD-RADS on Coronary CT Angiography

2021 ◽  
Author(s):  
Atsushi Yamamoto ◽  
Michinobu Nagao ◽  
Kiyoe Ando ◽  
Risako Nakao ◽  
Kenji Fukushima ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Risk Stratification ◽  
Heart Diseases ◽  
Myocardial Flow Reserve ◽  
Coronary Syndrome ◽  
Flow Reserve ◽  
Significant Difference ◽  
Artery Disease ◽  
Myocardial Flow

Abstract PurposeMyocardial flow reserve (MFR) derived from 13N-ammonia positron emission tomography (NH3-PET) can predict the prognosis of patients with various heart diseases. Coronary computed tomography angiography (CCTA) is a non-invasive investigation for ischemic heart disease. The coronary artery disease reporting and data system (CAD-RADS) was established to standardize and facilitate the reporting of CCTA data regarding CAD. This study aimed to investigate the prognostic value of CAD-RADS and MFR.MethodsA total of 133 patients who underwent NH3-PET and CCTA within 3 months were enrolled. Patients were divided into groups with CAD-RADS 0-2 and ≥3 and into groups with MFR ≥2.0 and <2.0. The endpoint was major adverse cardiac events (MACE) comprising all-cause death, acute coronary syndrome, hospitalization due to heart failure, and cerebrovascular disease. The ability of CAD-RADS and MFR to predict MACE was analyzed using Kaplan-Meier analysis.ResultsThere was no significant difference in MFR between patients with CAD-RADS 0-2 and ≥3 (2.3±0.9 vs. 2.2±0.7, p=0.50). The MACE rate for patients with CAD-RADS 0-2 and ≥3 was equivalent (log-rank test, p=0.64). Patients with MFR <2.0 had a significantly higher MACE rate than those with MFR ≥2.0 (p=0.017). In patients with CAD-RADS ≥3, patients with MFR <2.0 had a significantly higher MACE rate than those with MFR ≥2.0 (p=0.034).ConclusionCAD-RADS did not contribute to MACE prediction. Conversely, MFR was useful in predicting MACE, allowing for further risk stratification in addition to CAD-RADS.

scholarly journals Impact of Coronary CT angiography in combination with CAD-RADS on the management of coronary artery disease patients

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
F Andre ◽  
S Seitz ◽  
P Fortner ◽  
R Sokiranski ◽  
F Gueckel ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Risk Stratification ◽  
Coronary Ct Angiography ◽  
Patient Management ◽  
Male Gender ◽  
Coronary Ct ◽  
History Of ◽  
Artery Disease ◽  
The Impact

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Siemens Healthineers Introduction Coronary CT angiography (CCTA) plays an increasing role in the detection and risk stratification of patients with coronary artery disease (CAD). The Coronary Artery Disease – Reporting and Data System (CAD-RADS) allows for standardized classification of CCTA results and, thus, may improve patient management. Purpose Aim of this study was to assess the impact of CCTA in combination with CAD-RADS on patient management and to identify the impact of cardiovascular risk factors (CVRF) on CAD severity. Methods CCTA was performed on a third-generation dual-source CT scanner in patients, who were referred to a radiology centre by their attending physicians. In a total of 4801 patients, CVRF were derived from medical reports and anamnesis. Results The study population consisted of 4770 patients (62.0 (54.0-69.0) years, 2841 males) with CAD (CAD-RADS 1-5), while 31 patients showed no CAD and were excluded from further analyses. Age, male gender and the number of CVRF were associated with more severe CAD stages (all p &lt; 0.001). 3040 patients (63.7 %) showed minimal or mild CAD requiring optimization of CVRF i.e. medical therapy but no further assessment at his time. A group of 266 patients (5.6 %) had a severe CAD defined as CAD-RADS 4B/5. In the multivariate regression analysis, age, male gender, history of smoking, diabetes mellitus and hyperlipidaemia were significant predictors for severe CAD, whereas arterial hypertension and family history of CAD did not reach significance. Of note, a subgroup of 28 patients (10.5 %) with a severe CAD (68.5 (65.5-70.0) years, 26 males, both p = n.s.) had no CVRF. Conclusions CCTA in combination with the CAD-RADS allowed for effective risk stratification of CAD patients. The majority of the patients showed non-obstructive CAD and, thus, could be treated conservatively without the need for further CAD assessment. CVRF out of arterial hypertension and family history had an impact on CAD severity reflected in higher CAD-RADs gradings. Of note, a relevant fraction of patients with CAD did not have any CVRF and, thus, may not be covered by risk stratification models. CAD-RADS n Age (years) Males (%) 1 1453 56.0 (50.0-62.0) 623 (42.9 %) 2 1587 62.0 (55.0-69.0) 918 (57.8 %) 3 1067 66.0 (59.0-71.0) 749 (70.2 %) 4A 397 66.0 (59.0-72.0) 317 (79.8 %) 4B 162 67.0 (61.0-74.0) 139 (85.8 %) 5 104 66.0 (58.5.0-77.0) 95 (91.3 %)

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