scholarly journals Phenotypic clustering of patients with coronary artery disease newly diagnosed using coronary computed tomography angiography and stress cardiovascular magnetic resonance

2022 ◽  
Vol 14 (1) ◽  
pp. 50-51
Author(s):  
T. Pezel ◽  
T. Hovasse ◽  
A. Asselin ◽  
T. Lefevre ◽  
B. Chevalier ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Cardiovascular Magnetic Resonance ◽  
Coronary Artery ◽  
Magnetic Resonance ◽  
Coronary Computed Tomography Angiography ◽  
Newly Diagnosed ◽  
Artery Disease ◽  
Phenotypic Clustering ◽  
Stress Cardiovascular Magnetic Resonance

scholarly journals Phenotypic Clustering of Patients With Newly Diagnosed Coronary Artery Disease Using Cardiovascular Magnetic Resonance and Coronary Computed Tomography Angiography

2021 ◽  
Vol 8 ◽  
Author(s):  
Théo Pezel ◽  
Thierry Unterseeh ◽  
Thomas Hovasse ◽  
Anouk Asselin ◽  
Thierry Lefèvre ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Cluster Analysis ◽  
Coronary Artery ◽  
Magnetic Resonance ◽  
Coronary Computed Tomography Angiography ◽  
Newly Diagnosed ◽  
Inducible Ischemia ◽  
Artery Disease ◽  
Stress Cmr

Background: Epidemiological characteristics and prognostic profiles of patients with newly diagnosed coronary artery disease (CAD) are heterogeneous. Therefore, providing individualized cardiovascular (CV) risk stratification and tailored prevention is crucial.Objective: Phenotypic unsupervised clustering integrating clinical, coronary computed tomography angiography (CCTA), and cardiac magnetic resonance (CMR) data were used to unveil pathophysiological differences between subgroups of patients with newly diagnosed CAD.Materials and Methods: Between 2008 and 2020, consecutive patients with newly diagnosed obstructive CAD on CCTA and further referred for vasodilator stress CMR were followed for the occurrence of major adverse cardiovascular events (MACE), defined by cardiovascular death or non-fatal myocardial infarction. For this exploratory work, a cluster analysis was performed on clinical, CCTA, and CMR variables, and associations between phenogroups and outcomes were assessed.Results: Among 2,210 patients who underwent both CCTA and CMR, 2,015 (46% men, mean 70 ± 12 years) completed follow-up [median 6.8 (IQR 5.9–9.2) years], in which 277 experienced a MACE (13.7%). Three mutually exclusive and clinically distinct phenogroups (PG) were identified based upon unsupervised hierarchical clustering of principal components: (PG1) CAD in elderly patients with few traditional risk factors; (PG2) women with metabolic syndrome, calcified plaques on CCTA, and preserved left ventricular ejection fraction (LVEF); (PG3) younger men smokers with proximal non-calcified plaques on CCTA, myocardial scar, and reduced LVEF. Using survival analysis, the occurrence of MACE, cardiovascular mortality, and all-cause mortality (all p < 0.001) differed among the three PG, in which PG3 had the worse prognosis. In each PG, inducible ischemia was associated with MACE [PG1, Hazards Ratio (HR) = 3.09, 95% CI, 1.70–5.62; PG2, HR = 3.62, 95% CI, 2.31–5.7; PG3, HR = 3.55, 95% CI, 2.3–5.49; all p < 0.001]. The study presented some key limitations that may impact generalizability.Conclusions: Cluster analysis of clinical, CCTA, and CMR variables identified three phenogroups of patients with newly diagnosed CAD that were associated with distinct clinical and prognostic profiles. Inducible ischemia assessed by stress CMR remained associated with the occurrence of MACE within each phenogroup. Whether automated unsupervised phenogrouping of CAD patients may improve clinical decision-making should be further explored in prospective studies.

scholarly journals Evidence-based cardiovascular magnetic resonance cost-effectiveness calculator for the detection of significant coronary artery disease

2022 ◽  
Vol 24 (1) ◽  
Author(s):  
Ankur Pandya ◽  
Yuan-Jui Yu ◽  
Yin Ge ◽  
Eike Nagel ◽  
Raymond Y. Kwong ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Cardiovascular Magnetic Resonance ◽  
Cost Effectiveness ◽  
Coronary Artery ◽  
Magnetic Resonance ◽  
Significant Coronary Artery Disease ◽  
Cost Effective ◽  
Artery Disease ◽  
The Cost

Abstract Background Although prior reports have evaluated the clinical and cost impacts of cardiovascular magnetic resonance (CMR) for low-to-intermediate-risk patients with suspected significant coronary artery disease (CAD), the cost-effectiveness of CMR compared to relevant comparators remains poorly understood. We aimed to summarize the cost-effectiveness literature on CMR for CAD and create a cost-effectiveness calculator, useable worldwide, to approximate the cost-per-quality-adjusted-life-year (QALY) of CMR and relevant comparators with context-specific patient-level and system-level inputs. Methods We searched the Tufts Cost-Effectiveness Analysis Registry and PubMed for cost-per-QALY or cost-per-life-year-saved studies of CMR to detect significant CAD. We also developed a linear regression meta-model (CMR Cost-Effectiveness Calculator) based on a larger CMR cost-effectiveness simulation model that can approximate CMR lifetime discount cost, QALY, and cost effectiveness compared to relevant comparators [such as single-photon emission computed tomography (SPECT), coronary computed tomography angiography (CCTA)] or invasive coronary angiography. Results CMR was cost-effective for evaluation of significant CAD (either health-improving and cost saving or having a cost-per-QALY or cost-per-life-year result lower than the cost-effectiveness threshold) versus its relevant comparator in 10 out of 15 studies, with 3 studies reporting uncertain cost effectiveness, and 2 studies showing CCTA was optimal. Our cost-effectiveness calculator showed that CCTA was not cost-effective in the US compared to CMR when the most recent publications on imaging performance were included in the model. Conclusions Based on current world-wide evidence in the literature, CMR usually represents a cost-effective option compared to relevant comparators to assess for significant CAD.

scholarly journals Evidence and Applicability of Stress Cardiovascular Magnetic Resonance in Detecting Coronary Artery Disease: State of the Art

2021 ◽  
Vol 10 (15) ◽  
pp. 3279
Author(s):  
Anna Baritussio ◽  
Alessandra Scatteia ◽  
Santo Dellegrottaglie ◽  
Chiara Bucciarelli-Ducci
Keyword(s):  
Coronary Artery Disease ◽  
Cardiovascular Magnetic Resonance ◽  
Coronary Artery ◽  
Magnetic Resonance ◽  
Imaging Technique ◽  
Clear Cut ◽  
Diagnosis And Prognosis ◽  
Artery Disease ◽  
Stress Cmr ◽  
Stress Cardiovascular Magnetic Resonance

Cardiovascular magnetic resonance is increasingly used in clinical practice, as it has emerged over the years as an invaluable imaging technique for diagnosis and prognosis, with clear-cut applications in managing patients with both ischemic and non-ischemic heart disease. In this review, we focus on the evidence and clinical application of stress CMR in coronary artery disease from diagnosis to prognosis.

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