scholarly journals Machine learning aids clinical decision making in patients presenting with angina and non-obstructive coronary artery disease

2021 ◽  
Author(s):  
Ali Ahmad ◽  
Michal Shelly-Cohen ◽  
Michel T Corban ◽  
Dennis H Murphree ◽  
Takumi Toya ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Stress Test ◽  
Obstructive Coronary Artery Disease ◽  
Coronary Microvascular Dysfunction ◽  
Clinical Guidance ◽  
Flow Reserve ◽  
Artery Disease ◽  
Functional Stress

Abstract Aims The current gold-standard comprehensive assessment of coronary microvascular dysfunction (CMD) is through a limited-access invasive catheterization lab procedure. We aimed to develop a point-of-care tool to assist clinical guidance in patients presenting with chest pain and/or an abnormal cardiac functional stress test and with non-obstructive coronary artery disease (NOCAD). Methods and Results This study included 1,893 NOCAD patients (<50% angiographic stenosis) who underwent CMD evaluation as well as an ECG up to 1-year prior. Endothelial-independent CMD was defined by coronary flow reserve (CFR)≤2.5 in response to intracoronary adenosine. Endothelial-dependent CMD was defined by a maximal percent increase in coronary blood flow (%ΔCBF) ≤50% in response to intracoronary acetylcholine infusion. We trained algorithms to distinguish between the following outcomes: CFR ≤ 2.5, %ΔCBF ≤ 50, and the combination of both. Two classes of algorithms were trained, one depending on ECG waveforms as input, and another using tabular clinical data. Mean age was 51 ± 12 years and 66% were females (n = 1,257). AUC values ranged from 0.49–0.67 for all the outcomes. The best performance in our analysis was for the outcome CFR ≤ 2.5 with clinical variables. AUC and accuracy were 0.67 and 60%. When decreasing the threshold of positivity, sensitivity and NPV increased to 92% and 90% respectively, while specificity and PPV decreased to 25% and 29% respectively. Conclusion An AI-enabled algorithm may be able to assist clinical guidance by ruling out CMD in patients presenting with chest pain and/or an abnormal functional stress test. This algorithm needs to be prospectively validated in different cohorts.

Abstract 14277: Serum Nt-prob-type Natriuretic Peptide is Associated With Coronary Microvascular Dysfunction in Patients With Angina and Non-obstructive Coronary Artery Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ali Ahmad ◽  
Jaskanwal D Sara ◽  
Michel T Corban ◽  
Takumi Toya ◽  
Ilke Ozcan ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Natriuretic Peptide ◽  
Obstructive Coronary Artery Disease ◽  
Inverse Correlation ◽  
Microvascular Dysfunction ◽  
Coronary Microvascular Dysfunction ◽  
Flow Reserve ◽  
Artery Disease ◽  
And Gender

Title: Serum NT-proB-type Natriuretic Peptide is associated with Coronary Microvascular Dysfunction in Patients with Angina and Non-obstructive Coronary Artery Disease Authors: Ali Ahmad, MD, Jaskanwal D. Sara, MBChB, Michel T. Corban, MD, Takumi Toya, MD, Ilke Özcan, MD, Lilach O. Lerman, MD PhD, Amir Lerman, MD Introduction: Coronary microvascular dysfunction (CMD) is prevalent in patients with heart failure with preserved ejection fraction. Subclinical ischemia and myocardial fibrosis in CMD might raise filling pressure, a hallmark of HFpEF, which induces secretion of NT-proB-type natriuretic peptide (NTpro-BNP). We sought to explore the relationship between CMD and NT-proBNP. Methods: We studied 698 patients with signs and/or symptoms of ischemia and with non-obstructive CAD (<40% angiographic stenosis) who underwent invasive CMD evaluation and had NT-proBNP checked within 6 weeks. CMD was defined as coronary flow reserve (CFR) (hyperemic flow/baseline flow as measured by the doppler wire) of ≤2.5 in response to intracoronary adenosine injection. Results: Overall mean age was 52.8±12.2 years, and women represented 69% of the patients. Log NT-proBNP showed a modest inverse correlation with CFR (Pearson’s R = -0.22, P<0.0001; Figure 1 ), which remained significant after adjusting for age and gender (Standardized ß coefficient = -0.14; P = 0.001). Patients with CMD had higher levels of NT-proBNP than those without (82 [44-190] vs. 62 (33-130], P <0.0001; Figure 2) . Conclusion: Declining coronary microvascular function is correlated with higher NT-proBNP levels. Patients with CMD had higher levels of NT-proBNP, a marker of elevated LV pressure, contributing to the possible role of CMD in early HFpEF pathophysiology. Keywords: Coronary microvascular dysfunction, NT-proBNP

scholarly journals Relationship of Stress Test Findings to Anatomic or Functional Extent of Coronary Artery Disease Assessed by Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Demetrios Doukas ◽  
Sorcha Allen ◽  
Amy Wozniak ◽  
Siri Kunchakarra ◽  
Rina Verma ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Stress Testing ◽  
Stress Test ◽  
Exercise Duration ◽  
Fractional Flow ◽  
Coronary Cta ◽  
Flow Reserve ◽  
Artery Disease

Background. In the United States, functional stress testing is the primary imaging modality for patients with stable symptoms suspected to represent coronary artery disease (CAD). Coronary computed tomography angiography (CTA) is excellent at identifying anatomic coronary artery disease (CAD). The application of computational fluid dynamics to coronary CTA allows fractional flow reserve (FFR) to be calculated noninvasively (FFRCT). The relationship of noninvasive stress testing to coronary CTA and FFRCT in real-world clinical practice has not been studied. Methods. We evaluated 206 consecutive patients at Loyola University Chicago with suspected CAD who underwent noninvasive stress testing followed by coronary CTA and FFRCT when indicated. Patients were categorized by stress test results (positive, negative, indeterminate, and equivocal). Duke treadmill score (DTS), METS, exercise duration, and chest pain with exercise were analyzed. Lesions ≥ 50 % stenosis were considered positive by coronary CTA. FF R CT < 0.80 was considered diagnostic of ischemia. Results. Two hundred and six patients had paired noninvasive stress test and coronary CTA/FFRCT results. The median time from stress test to coronary CTA was 49 days. Average patient age was 60.3 years, and 42% were male. Of the 206 stress tests, 75% were exercise (70% echocardiographic, 26% nuclear, and 4% EKG). There were no associations of stress test results with CAD > 50 % or FF R CT < 0.80 ( p = 0.927 and p = 0.910 , respectively). Of those with a positive stress test, only 30% (3/10) had CAD > 50 % and only 50% (5/10) had FF R CT < 0.80 . Chest pain with exercise did not correlate with CAD > 50 % or FF R CT < 0.80 ( p = 0.66 and p = 0.12 , respectively). There were no significant correlations between METS, DTS, or exercise duration and FFRCT ( r = 0.093 , p = 0.274 ; r = 0.012 , p = 0.883 ; and r = 0.034 , p = 0.680 ; respectively). Conclusion. Noninvasive stress testing, functional capacity, chest pain with exercise, and DTS are not associated with anatomic or functional CAD using a diagnostic strategy of coronary CTA and FFRCT.

scholarly journals Combining body mass index with waist circumference to assess coronary microvascular function in patients with non-obstructive coronary artery disease

2021 ◽  
Author(s):  
Ruonan Wang ◽  
Xiang Li ◽  
Shihao Huangfu ◽  
Qi Yao ◽  
Ping Wu ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Waist Circumference ◽  
Obstructive Coronary Artery Disease ◽  
Normal Weight ◽  
Excess Weight ◽  
Coronary Microvascular Dysfunction ◽  
Flow Reserve ◽  
Increased Risk ◽  
Artery Disease

Abstract Background Coronary microvascular dysfunction (CMD) may precede clinically overt coronary artery disease (CAD). Overall and central obesity (CO) are major risk factors for CAD. This study sought to investigate the subclinical significance of body adiposity patterns based on the CMD risk. Methods A total of 128 patients with non-obstructive CAD were prospectively enrolled. Patients were categorized into 4 anthropometric groups: normal weight and non-CO (NWNCO, n = 41), normal weight and CO (NWCO, n = 20), excess weight and non-CO (EWNCO, n = 26), and excess weight and CO (EWCO, n = 41). Patients underwent rest/stress electrocardiography-gated 13N-ammonia positron emission tomography to measure absolute myocardial blood flow (MBF), myocardial flow reserve (MFR), hemodynamic parameters, and cardiac function. Results Resting MBF did not differ between groups (P = .36). Compared with the NWNCO group, hyperemic MBF and MFR were significantly lower in the NWCO and EWCO groups. Notably, patients with NWCO presented the lowest hyperemic MBF and MFR and the highest incidence of CMD. Waist circumference was an independent risk factor for CMD (OR 1.05, 95% CI 1.01 to 1.10, P = .02). Conclusion In patients with non-obstructive CAD, CO may be associated with an increased risk of CMD to better fit the study findings which did not assess management or monitoring of MBF and MFR.

scholarly journals Prevalence and characteristics of coronary microvascular dysfunction among chest pain patients in the emergency department

2018 ◽  
Vol 9 (1) ◽  
pp. 5-13 ◽  
Author(s):  
Basmah Safdar ◽  
Gail D’Onofrio ◽  
James Dziura ◽  
Raymond R Russell ◽  
Caitlin Johnson ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Emergency Department ◽  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Flow Reserve ◽  
Coronary Flow ◽  
Coronary Microvascular Dysfunction ◽  
Flow Reserve ◽  
Artery Disease

Aims: Coronary microvascular dysfunction (CMD) is common in patients with non-obstructive coronary arteries but has not been described in low-risk symptomatic patients. We therefore assessed the prevalence and characteristics of CMD in low to moderate risk patients with chest pain in an emergency department. Methods and results: We used three-dimensional Rb82 cardiac positron emission tomography/computed tomography to diagnose coronary artery disease (known or new regional defect, any coronary calcification) and CMD (low coronary flow reserve without coronary artery disease) in chest pain patients after being ruled out for acute myocardial infarction. Exclusions included age 30 years or less, acute myocardial infarction, hemodynamic instability, heart failure and dialysis. Among 195 participants undergoing cardiac positron emission tomography/computed tomography, 42% had CMD, 36% had coronary artery disease and 22% had normal flows; 70% were women and 84% were obese. Patients with CMD and coronary artery disease had significantly lower coronary flow reserve than normal patients (mean coronary flow reserve 1.6 and 1.9 vs. 2.6, respectively, P<0.05). However, CMD patients were younger (mean age 51 vs. 61 years), and had fewer traditional cardiac risk factors ( P<0.05) than patients with coronary artery disease. Nearly one third (31%) of patients had a prior emergency department visit for chest pain within three years of index presentation. Women were four times as likely to have CMD as men (adjusted odds ratio 4.2; 95% confidence interval 1.8, 9.6) after controlling for age, race, hypertension, diabetes, smoking, dyslipidemia, obesity and family history of coronary artery disease. Conclusions: Despite their low-risk profile, nearly one half of symptomatic and mostly obese emergency department patients without evidence of myocardial infarction or coronary artery disease had CMD. The results could explain the high rates of return visits associated with chest pain, although their application to the general emergency department population require validation.

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