Early detection of obstructive coronary artery disease in the asymptomatic high-risk population: objectives and study design of the EARLY-SYNERGY trial

Preoperative non-invasive testing aims to provide informed choices about the appropriateness of surgery, guide perioperative management, and assess the long-term risk of a cardiac event through identification of left ventricular dysfunction, heart valve abnormalities, and myocardial ischaemia. Preoperative non-invasive testing is not recommended routinely, but it should be considered in patients in whom initial clinical evaluation indicates increased risk for perioperative cardiac complications and who are scheduled for intermediate- or high-risk surgery. Pharmacological stress testing combined with myocardial perfusion imaging or echocardiography is more suitable than physical exercise for the detection of myocardial ischaemia in patients with limited exercise tolerance that is common in the preoperative setting. Alternatively, non-invasive coronary computed tomography angiography can identify obstructive coronary artery disease. A negative stress testing with imaging or the absence of high-risk coronary anatomy on computed tomography angiography is associated with a low incidence of perioperative cardiac events, but the positive predictive value is relatively low, that is, the risk is relatively low despite a positive result. In patients with extensive stress-induced ischaemia or extensive obstructive coronary artery disease detected by non-invasive testing, individualized perioperative management is recommended considering the potential benefit of the proposed surgical procedure, weighed against the predicted risk of adverse outcome.

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Early detection of coronary artery disease by 64-slice multidetector computed tomography in asymptomatic hypertensive high-risk patients

International Journal of Cardiology ◽

10.1016/j.ijcard.2008.03.091 ◽

2009 ◽

Vol 135 (3) ◽

pp. 280-286 ◽

Cited By ~ 15

Author(s):

Carlo Gaudio ◽

Francesca Mirabelli ◽

Francesco Pelliccia ◽

Marco Francone ◽

Gaetano Tanzilli ◽

...

Keyword(s):

Computed Tomography ◽

Coronary Artery Disease ◽

Coronary Artery ◽

High Risk ◽

Early Detection ◽

Multidetector Computed Tomography ◽

High Risk Patients ◽

Risk Patients ◽

Artery Disease

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Epicardial adipose tissue volume is associated with low-attenuation plaque volume in subjects with or without increased visceral fat: a 3-vessel coronary artery analysis with CT angiography

European Heart Journal ◽

10.1093/eurheartj/ehab724.0208 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

K Otsuka ◽

H Ishikawa ◽

H Yamaura ◽

K Shirasawa ◽

N Kasayuki

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

High Risk ◽

Coronary Arteries ◽

Visceral Fat ◽

Obstructive Coronary Artery Disease ◽

Visceral Obesity ◽

P Value ◽

Plaque Volume ◽

Artery Disease

Abstract Background Low-attenuation plaque (LAP) with a CT value of less than or equal 30 HU on coronary CT angiography (CCTA) is a marker of high-risk plaque features that leads to future acute coronary syndromes. Perivascular and epicardial adipose tissue (EAT) have been shown to be associated with progression of high-risk coronary plaques through metabolic and inflammatory mechanisms. However, association of EAT with LAP volume in three coronary arteries in subjects with or without visceral obesity remain unclear. Aims This study aimed to investigate the association of EAT volume (EAV) and coronary 3-vessel LAP volume in subjects with or without visceral obesity who underwent CCTA. Methods Patients who underwent CCTA without known coronary artery disease were included in the study (525 patients). Study subjects were classified as having non-obstructive or obstructive coronary artery disease according to the degree of coronary artery stenosis on CCTA. The plaque volume and EAV of the main vessel of the left anterior descending artery, left circumflex artery, and right coronary artery were measured with VINCENT software. Coronary plaque composition was classified as calcified plaque (CP, >150HU), noncalcified plaque (NCP, 30–150HU), and Lap (<30HU). The %LAP volume of the three coronary arteries was classified into quartiles. Multiple logistic regression analysis was used to analyze the factors associated with the %LAP volume. Results Compared with subjects without increase visceral fat, subjects with increased visceral fat had a significantly higher BMI, a greater total plaque volume, a greater total %LAP volume, a greater EAV, and a lower mean CT value of EAT. A significant correlation was observed between EAV and %LAP volume (R=0.24, p<0.001). EAV (odds ratio; 1.83, 95% confidence interval 1.071–3.141, p-value 0.027) and type 2 diabetes mellitus (odds ratio 1.76, 95%confidence interval 1.042–3.000, p-value 0.034) appeared to be independent predictors of %LAP volume (Q4), when adjusted by age, gender, BMI>25 kg/m2, visceral fat >100cm2, LogCRP, coronary artery calcium score>300, and obstructive coronary artery disease requiring revascularization. Conclusion This study suggests that LAP volume, which reflects the high-risk plaques in the three coronary arteries, is associated with EAV in subjects with or without increased visceral fat. Further research is needed whether pharmacological therapeutic intervention enables the prevention of coronary plaque progression and destabilization through the reduction of EAV in patients. FUNDunding Acknowledgement Type of funding sources: None.

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