scholarly journals Epicardial fat attenuation, not volume, predicts obstructive coronary artery disease and high risk plaque features in patients with atypical chest pain

2020 ◽  
Vol 93 (1114) ◽  
pp. 20200540 ◽  
Author(s):  
Niraj Nirmal Pandey ◽  
Sanjiv Sharma ◽  
Priya Jagia ◽  
Sanjeev Kumar
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Multivariate Analysis ◽  
Cardiovascular Risk ◽  
Chest Pain ◽  
Coronary Artery ◽  
Obstructive Coronary Artery Disease ◽  
Epicardial Fat ◽  
Atypical Chest Pain ◽  
Artery Disease

Objective: This study sought to investigate the association between volume and attenuation of epicardial fat and presence of obstructive coronary artery disease (CAD) and high-risk plaque features (HRPF) on CT angiography (CTA) in patients with atypical chest pain and whether the association, if any, is independent of conventional cardiovascular risk factors and coronary artery calcium score (CACS). Methods: Patients referred for coronary CTA with atypical chest pain and clinical suspicion of CAD were included in the study. Quantification of CACS, epicardial fat volume (EFV) and epicardial fat attenuation (EFat) was performed on non-contrast images. CTA was evaluated for presence of obstructive CAD and presence of HRPF. Results: 255 patients (median age [interquartile range; IQR]: 51[41-60] years, 51.8% males) were included. On CTA, CAD, obstructive CAD (≥50% stenosis) and CTA-derived HRPFs was present in 133 (52.2%), 37 (14.5%) and 82 (32.2%) patients respectively. A significantly lower EFat was seen in patients with obstructive CAD than in those without (−86HU [IQR:−88 to −82 HU] vs −84 [IQR:−87 HU to −82 HU]; p = 0.0486) and in patients with HRPF compared to those without (−86 HU [IQR:−88 to −83 HU] vs −83 HU [−86 HU to −81.750 HU]; p < 0.0001). EFat showed significant association with obstructive CAD (unadjusted Odd’s ratio (OR) [95% CI]: 0.90 [0.81–0.99];p = 0.0248) and HRPF (unadjusted OR [95% CI]: 0.83 [0.76–0.90];p < 0.0001) in univariate analysis, which remained significant in multivariate analysis. However, EFV did not show any significant association with neither obstructive CAD nor HRPF in multivariate analysis. Adding EFat to conventional coronary risk factors and CACS in the pre-test probability models increased the area-under curve (AUC) for prediction of both obstructive CAD (AUC[95% CI]: 0.76 [0.70–0.81] vs 0.71 [0.65–0.77)) and HRPF (AUC [95% CI]: 0.92 [0.88–0.95] vs 0.89 [0.85–0.93]), although not reaching statistical significance. Conclusion: EFat, but not EFV, is an independent predictor of obstructive CAD and HRPF. Addition of EFat to traditional cardiovascular risk factors and CACS improves estimation for pretest probability of obstructive CAD and HRPF. Advances in knowledge: EFat is an important attribute of epicardial fat as it reflects the “quality” of fat, taking into account the effects of brown-white fat transformation and fibrosis, as opposed to mere evaluation of “quantity” of fat by EFV. Our study shows that EFat is a better predictor of obstructive CAD and HRPF than EFV and can thus explain the inconsistent association of increased EFV alone with CAD.

Coronary artery disease--ignored in women or inherently more lethal in women?

1998 ◽  
Vol 7 (1) ◽  
pp. 77-79 ◽  
Author(s):  
KB Keller ◽  
L Lemberg
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Coronary Artery Disease ◽  
Heart Disease ◽  
Cardiovascular Risk ◽  
Chest Pain ◽  
Coronary Artery ◽  
Noninvasive Testing ◽  
Atypical Chest Pain ◽  
Artery Disease

The leading cause of death in women is cardiovascular disease. The major cardiovascular risk factors have a greater impact on women. The prognosis for women with CAD is worse than for men. Women frequently present with symptoms of heart disease at a much later age and have a greater frequency of atypical chest pain. Noninvasive testing is less reliable in women. Do these facts indicate that CAD is inherently a more lethal disease in women? Or is CAD, as some would suggest, traditionally ignored in women? Stay tuned!

Traditional Cardiovascular Risk Factors and the Presence of Obstructive Coronary Artery Disease in Men and Women

2014 ◽  
Vol 30 (7) ◽  
pp. 820-826 ◽  
Author(s):  
Dennis T. Ko ◽  
Harindra C. Wijeysundera ◽  
Jacob A. Udell ◽  
Viola Vaccarino ◽  
Peter C. Austin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
Cardiovascular Risk Factors ◽  
Obstructive Coronary Artery Disease ◽  
Men And Women ◽  
Artery Disease

scholarly journals Incorporating coronary calcification into pretest assessment of the likelihood of coronary artery disease: validation and recalibration of a new diagnostic tool

2021 ◽  
Vol 22 (Supplement_3) ◽  
Author(s):  
P Lopes ◽  
J Presume ◽  
P Araujo Goncalves ◽  
F Albuquerque ◽  
P Freitas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Prediction Model ◽  
Obstructive Coronary Artery Disease ◽  
P Value ◽  
Discrimination Power ◽  
Coronary Syndrome ◽  
Artery Disease

Abstract Funding Acknowledgements Type of funding sources: None. Background A new clinical tool was recently proposed to improve the estimation of pre-test probability of obstructive coronary artery disease (CAD) by incorporating coronary artery calcium score (CACS) with clinical risk factors. This new model (Clinical + CACS) showed improved prediction when compared to the method recommended by the 2019 ESC guidelines on chronic coronary syndromes, but was never tested or adjusted for use in our population. The aim of this study was to assess the performance of this new method in a Portuguese cohort of symptomatic patients referred for coronary computed tomography angiography (CCTA), and to recalibrate it if necessary. Methods We conducted a two-center cross-sectional study assessing symptomatic patients who underwent CCTA for suspected CAD. Key exclusion criteria were age &lt; 30 years, known CAD, suspected acute coronary syndrome, or symptoms other than chest pain or dyspnea. Obstructive CAD was defined as any luminal stenosis ≥50% on CCTA. The Clinical + CACS prediction model was assessed for discrimination and calibration. A logistical recalibration of the model was conducted in a random sample of 50% of the patients and subsequently validated in the other half. Results A total of 1910 patients (mean age 60 ± 11 years, 60% women) were included in the analysis. Symptom characteristics were: 39% non-anginal chest pain, 30% atypical angina, 19% dyspnea and 12% typical angina. The observed prevalence of obstructive CAD was 12.9% (n = 247). Patients with obstructive CAD were more often male, were significantly older, had higher prevalence of typical angina and cardiovascular risk factors, and higher CACS values. The new Clinical + CACS tool showed greater discriminative power than the ESC 2019 prediction model, with a C-statistic of 0.83 (CI 95% 0.81-0.86) versus 0.67 (CI 95% 0.64-0.71), respectively (p-value for comparison &lt; 0.001). Before recalibration, the Clinical + CACS model underestimated the likelihood of CAD in our population across all quartiles of pretest probability (mean relative underestimation of 49%), which was subsequently corrected by the recalibration procedure - Figure. Conclusions In a Portuguese cohort of symptomatic patients undergoing CCTA for suspected CAD, the new Clinical + CACS model showed better discrimination power than the 2019 ESC method. The underestimation of the Clinical + CACS model was corrected by recalibrating it for our population. This new tool might prove useful for guiding decisions on the need for further testing.

scholarly journals Incorporating coronary calcification into pretest assessment of the likelihood of coronary artery disease: validation and recalibration of a new diagnostic tool

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
P Lopes ◽  
J Presume ◽  
P A Goncalves ◽  
F Albuquerque ◽  
P Freitas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Prediction Model ◽  
Obstructive Coronary Artery Disease ◽  
P Value ◽  
Discrimination Power ◽  
Coronary Syndrome ◽  
Artery Disease

Abstract Background A new clinical tool was recently proposed to improve the estimation of pre-test probability of obstructive coronary artery disease (CAD) by incorporating coronary artery calcium score (CACS) with clinical risk factors. This new model (Clinical+CACS) showed improved prediction when compared to the method recommended by the 2019 ESC guidelines on chronic coronary syndromes, but was never tested or adjusted for use in our population. The aim of this study was to assess the performance of this new method in a Portuguese cohort of symptomatic patients referred for coronary computed tomography angiography (CCTA), and to recalibrate it if necessary. Methods We conducted a two-center cross-sectional study assessing symptomatic patients who underwent CCTA for suspected CAD. Key exclusion criteria were age &lt;30 years, known CAD, suspected acute coronary syndrome, or symptoms other than chest pain or dyspnea. Obstructive CAD was defined as any luminal stenosis ≥50% on CCTA. The Clinical+CACS prediction model was assessed for discrimination and calibration. A logistical recalibration of the model was conducted in a random sample of 50% of the patients and subsequently validated in the other half. Results A total of 1910 patients (mean age 60±11 years, 60% women) were included in the analysis. Symptom characteristics were: 39% non-anginal chest pain, 30% atypical angina, 19% dyspnea and 12% typical angina. The observed prevalence of obstructive CAD was 12.9% (n=247). Patients with obstructive CAD were more often male, were significantly older, had higher prevalence of typical angina and cardiovascular risk factors, and higher CACS values. The new Clinical+CACS tool showed greater discriminative power than the ESC 2019 prediction model, with a C-statistic of 0.83 (CI 95% 0.81–0.86) versus 0.67 (CI 95% 0.64–0.71), respectively (p-value for comparison &lt;0.001). Before recalibration, the Clinical+CACS model underestimated the likelihood of CAD in our population across all quartiles of pretest probability (mean relative underestimation of 49%), which was subsequently corrected by the recalibration procedure - Figure. Conclusions In a Portuguese cohort of symptomatic patients undergoing CCTA for suspected CAD, the new Clinical+CACS model showed better discrimination power than the 2019 ESC method. The underestimation of the Clinical+CACS model was corrected by recalibrating it for our population. This new tool might prove useful for guiding decisions on the need for further testing. FUNDunding Acknowledgement Type of funding sources: None.

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