Associations between dyspnoea, coronary atherosclerosis, and cardiovascular outcomes: results from the long-term follow-up CONFIRM registry

2020 ◽  
Author(s):  
Alexander R van Rosendael ◽  
A Maxim Bax ◽  
Inge J van den Hoogen ◽  
Jeff M Smit ◽  
Subhi J Al’Aref ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Hazard Analysis ◽  
Multivariable Analysis ◽  
Clinical Predictors ◽  
Coronary Ct ◽  
Major Cardiovascular Events ◽  
Long Term Follow Up ◽  
Artery Disease ◽  
Incremental Prognostic Value

Abstract Aims  The relationship between dyspnoea, coronary artery disease (CAD), and major cardiovascular events (MACE) is poorly understood. This study evaluated (i) the association of dyspnoea with the severity of anatomical CAD by coronary computed tomography angiography (CCTA) and (ii) to which extent CAD explains MACE in patients with dyspnoea. Methods and results  From the international COronary CT Angiography EvaluatioN for Clinical Outcomes: An InteRnational Multicenter (CONFIRM) registry, 4425 patients (750 with dyspnoea) with suspected but without known CAD were included and prospectively followed for ≥5 years. First, the association of dyspnoea with CAD severity was assessed using logistic regression analysis. Second, the prognostic value of dyspnoea for MACE (myocardial infarction and death), and specifically, the interaction between dyspnoea and CAD severity was investigated using Cox proportional-hazard analysis. Mean patient age was 60.3 ± 11.9 years, 63% of patients were male and 592 MACE events occurred during a median follow-up duration of 5.4 (IQR 5.1–6.0) years. On uni- and multivariable analysis (adjusting for age, sex, body mass index, chest pain typicality, and risk factors), dyspnoea was associated with two- and three-vessel/left main (LM) obstructive CAD. The presence of dyspnoea increased the risk for MACE [hazard ratio (HR) 1.57, 95% confidence interval (CI): 1.29–1.90], which was modified after adjusting for clinical predictors and CAD severity (HR 1.26, 95% CI: 1.02–1.55). Conversely, when stratified by CAD severity, dyspnoea did not provide incremental prognostic value in one-, two-, or three-vessel/LM obstructive CAD, but dyspnoea did provide incremental prognostic value in non-obstructive CAD. Conclusion  In patients with suspected CAD, dyspnoea was independently associated with severe obstructive CAD on CCTA. The severity of obstructive CAD explained the elevated MACE rates in patients presenting with dyspnoea, but in patients with non-obstructive CAD, dyspnoea portended additional risk.

scholarly journals Prognostic value of coronary CT angiography on long-term follow-up of 6.9 years

2014 ◽  
Vol 30 (5) ◽  
pp. 969-976 ◽  
Author(s):  
Svetlana Dougoud ◽  
Tobias A. Fuchs ◽  
Julia Stehli ◽  
Olivier F. Clerc ◽  
Ronny R. Buechel ◽  
...  
Keyword(s):  
Ct Angiography ◽  
Prognostic Value ◽  
Coronary Ct Angiography ◽  
Coronary Ct ◽  
Long Term Follow Up

scholarly journals Stable Coronary Artery Disease: Prognostic Value of Myocardial Perfusion SPECT in Relation to Coronary Calcium Scoring—Long-term Follow-up

Radiology ◽  
2009 ◽  
Vol 252 (3) ◽  
pp. 682-690 ◽  
Author(s):  
Christopher Uebleis ◽  
Alexander Becker ◽  
Ines Griesshammer ◽  
Paul Cumming ◽  
Christoph Becker ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Prognostic Value ◽  
Stable Coronary Artery Disease ◽  
Myocardial Perfusion Spect ◽  
Calcium Scoring ◽  
Long Term Follow Up ◽  
Perfusion Spect ◽  
Artery Disease

scholarly journals Independent predictors of major cardiovascular events as quantitatively assessed by coronary CT-angiography: a long-term follow-up analysis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
D Bittner ◽  
C Roesner ◽  
T Kilian ◽  
M Goeller ◽  
D Dey ◽  
...  
Keyword(s):  
Cardiovascular Death ◽  
Plaque Volume ◽  
Coronary Ct ◽  
Major Cardiovascular Events ◽  
Framingham Risk ◽  
Long Term Follow Up ◽  
Remodeling Index ◽  
Automated Software

Abstract Introduction Quantitative CT coronary angiography using semi-automated software provides detailed information about plaque volume and high-risk plaque characteristics, beyond traditional measures like diameter stenosis. We assessed the potential value of plaque quantity and morphology to independently predict MACE in a cohort with long-term follow up. Methods In this secondary analysis of 301 symptomatic patients undergoing coronary CTA at baseline, total plaque volume (TPV), non-calcified- (NCPV), calcified- (CPV) and vulnerable coronary plaque volume (in mm3), diameter stenosis (in %) and remodeling index were quantified using semi-automated software (Autoplaque version 2.5, Cedars-Sinai Medical Center, Los Angeles, CA). Patients were followed for major cardiovascular events (MACE), defined as a composite of cardiovascular death, myocardial infarction and coronary revascularization. Optimal thresholds for each quantitative CTA measure were computed using CART-algorithm (Classification and Regression Trees). Results Complete follow-up was available for 234 (78%) patients. The mean age was 59±10 years. Over a median follow-up of 10.7 years, the composite outcome occurred in 34 (15%) patients (5 patients with cardiovascular death, 6 with myocardial infarction, 26 with revascularization). Patients experiencing MACE had more frequently hypertension (p=0.03) and a higher Framingham risk score (p=0.002). Survival anaylsis using cox proportional hazard ratios showed significant univariate associations between MACE and TPV (HR 5.16; 95% CI 1.58–16.89; p=0.007), NCPV (HR 4.83; 95% CI 1.45–15.81; p=0.009), CPV (HR 2.86; 95% CI 1.39–5.86; p=0.004), vulnerable plaque volume (HR 3.35; 95% CI 1.52–7.41; p=0.003), diameter stenosis (HR 5.19; 95% CI 2.64–10.22; p<0.001) and remodeling index (HR 4.24; 95% CI 2.03–8.86; p<0.001). In multivariable cox regression analysis diameter stenosis (HR 3.70; 95% CI 1.72–7.93; p=0.001) and remodeling index (HR 2.69; 95% CI 1.19–6.09; p=0.018) remained significant independent predictors of MACE, adjusted for Framingham risk score (HR 2.56; 95% CI 1.26–5.22; p=0.010), however plaque volume and plaque subcomponents did not. Conclusion On long term follow-up, remodeling index and coronary diameter stenosis obtained by quantitative coronary CT angiography independently predicted MACE on multivariable assessment. More comprehensive plaque assessment algorithms including plaque volume as well as plaque subcomponents were significantly associated with MACE in univariate, but not multivariate analysis after adjustment for diameter stenosis and remodeling index. FUNDunding Acknowledgement Type of funding sources: None.

Incremental prognostic value of quantitative plaque assessment in coronary CT angiography during 5 years of follow up

2016 ◽  
Vol 10 (2) ◽  
pp. 97-104 ◽  
Author(s):  
Jonathan Nadjiri ◽  
Jörg Hausleiter ◽  
Christin Jähnichen ◽  
Albrecht Will ◽  
Eva Hendrich ◽  
...  
Keyword(s):  
Ct Angiography ◽  
Prognostic Value ◽  
Coronary Ct Angiography ◽  
Coronary Ct ◽  
Incremental Prognostic Value

scholarly journals Mortality among patients undergoing dipyridamole 99mTc Sestamibi SPECT: impact of blunted heart rate response and abnormal scans

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Izhaki ◽  
A Migranov ◽  
D Geva ◽  
D Vorobeichik Pechersky ◽  
E Goshen ◽  
...  
Keyword(s):  
Heart Rate ◽  
Prognostic Value ◽  
Heart Rate Response ◽  
Multivariable Analysis ◽  
Funding Sources ◽  
All Cause Mortality ◽  
Incremental Prognostic Value ◽  
Post Stress ◽  
99Mtc Sestamibi

Abstract Background Blunted heart rate response (BHRR) caused by cardiac neuropathy associated with dipyridamole stress, has been linked to cardiovascular (CV) outcome events. Whether BHRR is necessarily associated with abnormal perfusion is unknown. The aim of the study was to assess the incremental prognostic value of BHRR in a single center population undergoing Dipyridamole 99mTc Sestamibi SPECT test (DSPECT) for predicting late CV events. Methods 388 patients (aged 73±10 years, 45% females, 51% with known coronary disease) that underwent DSPECT over 3 years period were included. Abnormal DSPECT and BHRR were evaluated in relation to late death. Results Mean follow up period was 1560±565 (15–2431) days. During follow up period, 90 patients died. Mode of death was CV in 20 and non-CV in 70. BHRR (<20% heart rate increase), abnormal DSPECT, post-stress LVEF <60% and reversible defects were observed in 63%, 41%, 23% and 20% of patients, respectively. BHRR (HR -2.41, p<0.0006) and abnormal DSPECT (HR-1.62, p=0.02) were predictors of all-cause death. BHRR had incremental prognostic value over abnormal DSPECT (Figure, p<0.0005). Multivariable analysis identified age, dyspnea, insulin treated diabetes mellitus and dialysis as independent predictors of death while DSPECT and BHRR did not. However, BHRR remained a significant predictor of CV death [HR 8.1 (1.06, 62.0), p<0.05]. Conclusions In this contemporary DSPECT cohort, BHRR and DSPECT failed to predict all-cause mortality. However, BHRR was an independent predictor of CV death. FUNDunding Acknowledgement Type of funding sources: None. BHRR stratifies abnormal DSPECT

scholarly journals Incremental Prognostic Value of Coronary CT Angiography in Patients With Suspected Coronary Artery Disease

2010 ◽  
Vol 3 (4) ◽  
pp. 351-359 ◽  
Author(s):  
Vincenzo Russo ◽  
Andrea Zavalloni ◽  
Maria Letizia Bacchi Reggiani ◽  
Katia Buttazzi ◽  
Valentina Gostoli ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Ct Angiography ◽  
Prognostic Value ◽  
Coronary Ct Angiography ◽  
Suspected Coronary Artery Disease ◽  
Coronary Ct ◽  
Artery Disease ◽  
Incremental Prognostic Value
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