Quantified coronary total plaque volume from computed tomography angiography provides superior 10-year risk stratification

2020 ◽  
Author(s):  
Simon Deseive ◽  
Maximilian Kupke ◽  
Ramona Straub ◽  
Thomas J Stocker ◽  
Alexander Broersen ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Computed Tomographic Angiography ◽  
Study Endpoint ◽  
Plaque Volume ◽  
Coronary Cta ◽  
Computed Tomographic ◽  
Coronary Syndrome ◽  
Coronary Artery Disease Severity ◽  
Net Reclassification Improvement ◽  
Tomographic Angiography

Abstract Aims  Automated coronary total plaque volume (TPV) quantification derived from coronary computed tomographic angiography (CTA) datasets provide exact and reliable assessment of calcified and non-calcified coronary atherosclerosis burden. The aim of this analysis was to investigate the long-term predictive value of TPV. Methods and results  TPV was quantified in 1577 patients undergoing coronary CTA and cardiovascular events were collected during 10.5 years (interquartile range 6.0–11.4) of follow-up. The study endpoint comprised cardiac death and acute coronary syndrome and occurred in 59 (3.7%) patients. Coronary TPV provided additive prognostic value over clinical risk assessed with the Morise Score and coronary artery disease severity (rise in C-index from 0.744 to 0.769, P = 0.03). A category-based reclassification approach combining the Morise Score and TPV revealed superior risk stratification (categorical net reclassification improvement: 0.48 with 95% CI 0.13–0.68, P < 0.001) and resulted in reclassification of 800 (51%) patients compared with the Morise Score alone. The 10-year risk for the study endpoint was 0.6% (95% CI 0–1.3) for patients classified as low risk (n = 807), 4.8% (95% CI 2.4–7.2) for patients at intermediate risk (n = 400), and 10.3% (95% CI 6.6–13.9) for patients at high risk (n = 370) using the combined reclassification approach. Conclusion  Quantification of TPV from coronary CTA permits an improved 10-year cardiovascular risk stratification.

scholarly journals Practice Pattern, Diagnostic Yield, and Long‐Term Prognostic Impact of Coronary Computed Tomographic Angiography

2020 ◽  
Vol 9 (18) ◽  
Author(s):  
Min Soo Cho ◽  
Jae‐Hyung Roh ◽  
Hanbit Park ◽  
Sang‐Cheol Cho ◽  
Do‐Yoon Kang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Diagnostic Yield ◽  
Computed Tomographic Angiography ◽  
Therapeutic Interventions ◽  
Coronary Cta ◽  
Coronary Computed Tomographic Angiography ◽  
Computed Tomographic ◽  
Asymptomatic Patients ◽  
Tomographic Angiography

Background Although guidelines recommend the use of coronary computed tomographic angiography (CTA) in patients with stable pain syndromes, the clinical benefits of the use of coronary CTA in a broad spectrum of patients is unknown. We evaluated the contemporary practice pattern and diagnostic yield of coronary CTA and their impact on the subsequent diagnostic‐therapeutic cascade and clinical outcomes. Methods and Results We identified 39 906 patients without known coronary artery disease (CAD) who underwent coronary CTA between January 2007 and December 2013. The patients' demographic characteristics, risk factors, symptoms, results of coronary CTA, the appropriateness of downstream diagnostic and therapeutic interventions, and long‐term outcomes (death or myocardial infarction) were evaluated. The number of coronary CTAs had increased over time, especially in asymptomatic patients. Coronary CTA revealed that 6108 patients (15.3%) had obstructive CAD (23.7% of symptomatic and 9.3% of asymptomatic patients). Subsequent cardiac catheterization was performed in 19.2% of symptomatic patients (appropriate, 80.6%) and in 3.9% of asymptomatic patients (appropriate, 7.9%). The 5‐year rate of death or myocardial infarction was significantly higher in patients with obstructive CAD on CTA than those without (7.2% versus 3.0%; P <0.001; adjusted hazard ratio [95% CI], 1.34 [1.17–1.54]). However, obstructive CAD on CTA had limited added value over conventional risk factors for predicting death or myocardial infarction. Conclusions Although the use of coronary CTA had substantially increased, CTA had a low diagnostic yield for obstructive CAD, especially in asymptomatic patients. The use of CTA in asymptomatic patients seemed to have led to inappropriate subsequent diagnostic or therapeutic interventions without clinical benefit.

P6149Coronary computed tomographic angiography (CTA) for risk stratification in the diagnostic triage of patients undergoing liver transplantation (LT): A long-term outcome study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Strobl ◽  
T Senoner ◽  
A Finkenstedt ◽  
G Widmann ◽  
F Plank ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Calcium Score ◽  
Computed Tomographic Angiography ◽  
Plaque Burden ◽  
Computed Tomographic ◽  
All Cause Mortality ◽  
Stenosis Severity ◽  
Tomographic Angiography

Abstract Background Cardiovascular (CV) risk stratification in patients with end-stage liver disease (ESLD) prior to liver transplantation (LT) is crucial: CV-disease poses a major threat for posttransplant survival. Therefore, our purpose was to assess safety of coronary computed tomographic angiography (CTA) in patients prior to orthotopic LT over a long-term follow up period, and its value for CV risk stratification. Methods In this single center, retrospective observational study 458 patients underwent coronary calcium score (CCS) and coronary CTA for pre-LT risk stratification between 2005 and 2016. CTA was evaluated for 1) stenosis severity (CADRADS: 4-severe>70%/3-intermediate50–70%/2-mild<50%/1-minimal<25%/0=no CAD) 2) plaque burden (SIS, G-score), 3) high–risk plaque features (Napkin Ring Sign, low attenuation plaque, positive remodelling) and 4) Coronary Calcium Score. Primary endpoint was mortality (all-cause and cardiovascular), secondary endpoint major cardiovascular events (MACE). Results Finally 270 patients (79.3% males, age 61±8.5 years) who underwent orthotopic LT were included (mean follow-up 7.5 years±3.1, range 2–13). 87 (32.2%) had CCS zero and 60 (22.2%) CCS >300 Agatston Units (CCS 335.6 AU± 868.9). 248 patients underwent CTA after CCS. The majority had CAD (n=173, 72.3%) by CTA while only 75 (27.7%) had no CAD. 102 patients (38.8%) had minimal-or-mild stenosis<50% (CADRADS 1–2), 34 (12.9%) intermediate and 17 (6.5%) severe stenosis.Out of CCS 0 patients, 13 had non-calcified plaque. All-cause mortality rate was 46 (17.0%), with the majority of patients (43 (93.5%) experiencing non-cardiac death and 3 (6.5%) cardiovascular death due to 1 myocardial infarction and 2 cardiopulmonary failure. CADRADS predicted mortality (Kaplan Meir, p<0.001). On multivariate Cox Regression modell, SIS and G-score predicted all-cause mortality (HR 1.1:p=0.034; 95% CI: 0.649–0.983 and HR 1.1, p=0.029; 95% CI: 1.0–1.6), while Calcium Score did not. There were 6 MACE (3 STEMI, 3 NSTEMI). MACE rate was 0% in CADRADS 0 or 1, 1 in CADRADS-2 and increasing to 5 in CADRADS 3 and 4 groups. Coronary CTA for LT risk stratification Conclusion Cardiac CT is a reliable non-invasive modality for pre-LT assessment of CV-risk over a long-term period, with 0% MACE in patients with no CAD or minimal CAD. CTA allows for an improved CV-risk stratification by stenosis severity (CADRADS) and plaque burden as compared to calcium scoring.

Coronary Atherosclerotic Plaque Volume Quantified by Computed Tomographic Angiography in Smokers Compared to Nonsmokers

2019 ◽  
Vol 26 (12) ◽  
pp. 1581-1588 ◽  
Author(s):  
Zhi-hui Hou ◽  
Bin Lu ◽  
Zhen-nan Li ◽  
Yun-qiang An ◽  
Yang Gao ◽  
...  
Keyword(s):  
Atherosclerotic Plaque ◽  
Computed Tomographic Angiography ◽  
Plaque Volume ◽  
Computed Tomographic ◽  
Coronary Atherosclerotic Plaque ◽  
Tomographic Angiography

scholarly journals A New Approach in Risk Stratification by Coronary CT Angiography

Scientifica ◽  
2014 ◽  
Vol 2014 ◽  
pp. 1-10
Author(s):  
Rine Nakanishi ◽  
Matthew J. Budoff
Keyword(s):  
Risk Stratification ◽  
Invasive Coronary Angiography ◽  
Coronary Plaque ◽  
Computed Tomographic Angiography ◽  
Plaque Burden ◽  
Cardiovascular Risks ◽  
Computed Tomographic ◽  
Coronary Ct ◽  
Hemodynamic Information ◽  
Tomographic Angiography

For a decade, coronary computed tomographic angiography (CCTA) has been used as a promising noninvasive modality for the assessment of coronary artery disease (CAD) as well as cardiovascular risks. CCTA can provide more information incorporating the presence, extent, and severity of CAD; coronary plaque burden; and characteristics that highly correlate with those on invasive coronary angiography. Moreover, recent techniques of CCTA allow assessing hemodynamic significance of CAD. CCTA may be potentially used as a substitute for other invasive or noninvasive modalities. This review summarizes risk stratification by anatomical and hemodynamic information of CAD, coronary plaque characteristics, and burden observed on CCTA.

scholarly journals Computed Tomographic Angiography Characteristics of Atherosclerotic Plaques Subsequently Resulting in Acute Coronary Syndrome

2009 ◽  
Vol 54 (1) ◽  
pp. 49-57 ◽  
Author(s):  
Sadako Motoyama ◽  
Masayoshi Sarai ◽  
Hiroto Harigaya ◽  
Hirofumi Anno ◽  
Kaori Inoue ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Computed Tomographic Angiography ◽  
Atherosclerotic Plaques ◽  
Computed Tomographic ◽  
Coronary Syndrome ◽  
Tomographic Angiography
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