scholarly journals Diagnostic Efficacy of CCTA And CT-FFR Based On Risk Factors For Myocardial Ischemia

2021 ◽  
Author(s):  
Yongguang Gao ◽  
Yibing Shi ◽  
Ping Xia ◽  
Jinyao Zhang ◽  
Yufei Fu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Computed Tomography ◽  
Regression Analysis ◽  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Plaque Volume ◽  
Diagnostic Efficacy ◽  
Ischemic Group ◽  
Calcified Plaque ◽  
Ischemia Group

Abstract Background: Coronary artery CCTA can observe the degree of coronary artery stenosis and FFR can evaluate the physiological function of coronary artery. However, noninvasive imaging examination that can both observe the above two methods at the same time has not yet been elucidated.Objective: To investigate the diagnostic efficacy of coronary computed tomography angiography (CCTA) and computed tomography-derived fractional flow reserve (CT-FFR) based on different risk factors for myocardial ischemia.Methods: Patients undergoing CCTA in our hospital from August 18, 2020 to April 28, 2021 were randomly selected, and the data were subjected to CT-FFR analysis. Vascular characteristics were measured, including total plaque volume, calcified plaque volume, non-calcified plaque volume, plaque length, and lumen stenosis, and the patients were categorized into a non-ischemia group (FFR>0.8) and an ischemia group (FFR≤0.8). Plaque characteristics were compared between the two groups, and logistic regression analysis was employed to explore the correlations between plaque characteristics and ischemic lesions.Results: From a total of 122 patients enrolled in the study, there were 218 vascular branches with FFR>0.8 and 174 vascular branches with FFR≤0.8. There were significant group differences in total plaque volume, calcified plaque volume, plaque length, and lumen stenosis >50% (n). The obtained data were as follows: non-ischemic group 10.57 (4.80, 259.65), ischemic group 14.87 (3.39, 424.45), Z=9.772, p=0.002, non-ischemic group 10.57 (0, 168.77), ischemic group 14.87 (0, 191.00), Z=2.503，p≤0.001), non-ischemic group 8.17 (37.05, 40.53), ischemic group 8.38 (56.66, 86.47), Z=5.923, p=0.016, and lumen stenosis >50%, non-ischemic group 46, ischemic group 90, x2=14.77，p≤0.001. The regression analysis results indicated that total plaque volume, calcified plaque volume, plaque length and lumen stenosis >50% were risk factors for myocardial ischemia, with ORs and p values of (2.311, p=0.002), (1.021, p=0.004), (2.159, p<0.001), and (0.181, p<0.001), respectively.Conclusion: Total plaque volume, calcified plaque volume, plaque length and lumen stenosis >50% are predictors for myocardial ischemia. Coronary artery CCTA combined with CT-FFR could simultaneously observe the anatomical stenosis and evaluate myocardial blood supply at the functional level. Thus, myocardial ischemia could be better diagnosed.

Coronary computed tomography

2019 ◽  
pp. 153-159
Author(s):  
Stefan Möhlenkamp
Keyword(s):  
Risk Factors ◽  
Computed Tomography ◽  
Coronary Artery ◽  
Subclinical Atherosclerosis ◽  
Atypical Chest Pain ◽  
Coronary Computed Tomography ◽  
Improve Risk Stratification ◽  
Calcified Plaque ◽  
Resolution Imaging ◽  
Artery Disease

Coronary computed tomography (CCT) allows high resolution imaging of coronary atherosclerosis, coronary artery stenosis, and other coronary pathology or anomaly, such as abnormal origin of coronary arteries or myocardial bridging. Coronary artery calcium (CAC) imaging to quantify calcified plaque or CT angiography (CTA) to detect calcified, mixed, or non-calcified plaque may help to improve risk stratification and exclusion of coronary artery disease, especially in master athletes with present or past cardiovascular risk factors or athletes with atypical chest pain. Initial data suggest that the extent of subclinical atherosclerosis may be underestimated in athletes and that an increased atherosclerosis burden is associated with impaired prognosis. Careful risk–benefit assessment of radiation exposure, contrast agent, and costs of the test is necessary, particularly for asymptomatic athletes with risk factors and young athletes.

scholarly journals Use of Coronary Computed Tomography Angiography to Screen Hospital Employees with Cardiovascular Risk Factors

2021 ◽  
Vol 18 (10) ◽  
pp. 5462
Author(s):  
Po-Yi Li ◽  
Ru-Yih Chen ◽  
Fu-Zong Wu ◽  
Guang-Yuan Mar ◽  
Ming-Ting Wu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Computed Tomography Angiography ◽  
Coronary Computed Tomography Angiography ◽  
Significant Risk ◽  
Coronary Computed Tomography ◽  
Hospital Employees ◽  
Artery Disease

The objective of this study was to determine how coronary computed tomography angiography (CCTA) can be employed to detect coronary artery disease in hospital employees, enabling early treatment and minimizing damage. All employees of our hospital were assessed using the Framingham Risk Score. Those with a 10-year risk of myocardial infarction or death of >10% were offered CCTA; the Coronary Artery Disease Reporting and Data System (CAD-RADS) score was the outcome. A total of 3923 hospital employees were included, and the number who had received CCTA was 309. Among these 309, 31 (10.0%) had a CAD-RADS score of 3–5, with 10 of the 31 (32.3%) requiring further cardiac catheterization; 161 (52.1%) had a score of 1–2; and 117 (37.9%) had a score of 0. In the multivariate logistic regression, only age of ≥ 55 years (p < 0.05), hypertension (p < 0.05), and hyperlipidemia (p < 0.05) were discovered to be significant risk factors for a CAD-RADS score of 3–5. Thus, regular and adequate control of chronic diseases is critical for patients, and more studies are required to be confirmed if there are more significant risk factors.

scholarly journals Resveratrol modifies risk factors for coronary artery disease in swine with metabolic syndrome and myocardial ischemia

2011 ◽  
Vol 664 (1-3) ◽  
pp. 45-53 ◽  
Author(s):  
Michael P. Robich ◽  
Robert M. Osipov ◽  
Louis M. Chu ◽  
Yuchi Han ◽  
Jun Feng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Metabolic Syndrome ◽  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Artery Disease

scholarly journals Incremental prognostic value of calcified vs non-calcified plaque burden on computed tomography angiography and myocardial perfusion imaging

2021 ◽  
Vol 22 (Supplement_3) ◽  
Author(s):  
AI Ahmed ◽  
Y Han ◽  
M Al Rifai ◽  
T Alnabelsi ◽  
F Nabi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Myocardial Perfusion Imaging ◽  
Cardiovascular Events ◽  
Prognostic Value ◽  
Plaque Burden ◽  
Left Main ◽  
Calcified Plaque ◽  
Risk Patients ◽  
Incremental Prognostic Value

Abstract Funding Acknowledgements Type of funding sources: None. Background Coronary computed tomography angiography (CCTA) is currently guideline-endorsed for diagnosing suspected coronary artery disease (CAD) in low-intermediate risk patients. Single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) has an established role in both the accurate detection of ischemia and identification of patients at high risk of future cardiovascular events. Recent studies have shown that the burden of atherosclerotic plaque is an independent predictor of cardiovascular events, and that this effect depends on the degree of calcification. Purpose To compare the incremental prognostic value of calcified vs non-calcified plaque burden to CCTA anatomic assessment and SPECT physiologic assessment in patients evaluated with both tests. Methods Consecutive patients who underwent clinically indicated CCTA and SPECT myocardial imaging for suspected CAD were included. Ischemia on SPECT was defined as summed difference score &gt; 0 using perfusion graded on a 5-point scale. Anatomically obstructive CAD by CCTA was defined as ≥50% in the left main artery and ≥70% stenosis severity in proximal, mid and distal branches of the left anterior descending, left circumflex and right coronary artery without including side branches. Segment involvement score was defined as the sum of segments with plaque irrespective of the degree of stenosis using an 18-segment coronary artery model. A Hounsfield unit threshold of &gt; =130 was used to classify plaques composition as calcified/mixed (C-SIS) vs non-calcified plaque (NC-SIS). Patients were followed for major adverse cardiovascular events (MACE, inclusive of all-cause death, non-fatal myocardial infarction, and percutaneous coronary intervention or coronary artery bypass grafting 90-days after imaging test.) Results A total of 956 patients were included. (Mean age 61.1 ± 14.2 years, 54% men, 89% hypertension, 81% diabetes, 84% dyslipidemia). Obstructive stenosis (left main ≥ 50%, all other coronary segments ≥ 70%) and ischemia were observed in similar number of patients (14%). After a median follow-up of 31 months, 102 patients (11%, 29.2 events per 1000 person-year) experienced a MACE. In multivariable Cox regression models, C-SIS, but not NC-SIS significantly predicted outcomes and improved risk discrimination in models with CCTA obstructive stenosis (HR 1.14 95% CI 1.08 - 1.20 p= &lt;0.001; Harrel’s C 0.74, p = 0.011) and SPECT ischemia (HR 1.14 95% CI 1.08 - 1.20, p &lt; 0.001; Harrel’s C 0.76, p = 0.015). Conclusion In the current study of high-risk patients with suspected CAD, calcified plaque burden, but not non-calcified plaque incrementally added to measures in predicting incident cardiovascular outcomes

Abstract 2941: Combined Assessment of Coronary Artery Stenosis and Myocardial Ischemia by Rest-Dipyridamole Stress Multidetector Computed Tomography

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Patricia M Carrascosa ◽  
Carlos Capuñay ◽  
Jorge Carrascosa ◽  
Alejandro Deviggiano ◽  
Alejandro Goldsmit ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Contrast Enhancement ◽  
Coronary Artery Stenosis ◽  
Artery Stenosis ◽  
Artery Disease ◽  
Mdct Coronary Angiography ◽  
Dipyridamole Stress

Introduction: MDCT coronary angiography has been evolving as a noninvasive method for the assessment of coronary artery disease (CAD). More recently, It has been demonstrated that MDCT identifies reduced contrast enhancement in ischemic and/or scarred myocardial segments. Objective: to determine the ability of rest-stress multidetector computed tomography (RS-MDCT) to detect myocardial ischemia and to assess the relationship between MDCT myocardial perfusion abnormalities and coronary artery stenosis. Methods: Forty seven patients underwent stress/rest 99mTc sestamibi SPECT and RS-MDCT, using a 16-row detector scanner (Philips Brilliance-16). Myocardial segments were classified by SPECT as normal, ischemic or scarred. SPECT results were then compared with MDCT regional myocardial contrast enhancement. The results of MDCT coronary angiography were also analyzed in 20 patients who underwent invasive catheterization. Results: The presence of a reduction in contrast enhancement at rest by MDCT identified scar by SPECT with 96% sensitivity and 98% specificity. A stress-induced reduction in contrast enhancement by MDCT identified ischemia by SPECT with 77% sensitivity and 99% specificity. The segment-based sensitivity and specificity for the detection of significant stenosis by MDCT were 92% and 98%, respectively. Conclusion: Our results showed that a rest-dipyridamole stress MDCT protocol can identify the presence of myocardial ischemia as well as the severity of coronary artery stenosis in patients with suspected coronary artery disease.

Abstract 5813: Vascular Function Measured By Digital Thermal Monitoring Strongly Correlates with the Severity of Coronary Artery Disease Diagnosed by 64 Slice Multidetector Computed Tomography

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Naser Ahmadi ◽  
Vivek Nuguri ◽  
Sumithra Tirunagaram ◽  
Anila Saeed ◽  
Fereshteh Hajsadeghi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Multidetector Computed Tomography ◽  
Vascular Function ◽  
List Type ◽  
Thermal Monitoring ◽  
Luminal Stenosis ◽  
Artery Disease

Background: Digital Thermal Monitoring (DTM) of vascular reactivity is a new test of vascular function that correlates well with the Framingham Risk Score and subclinical coronary artery disease measured by the coronary calcium score. This study evaluates whether DTM correlates with the severity of coronary artery disease (CAD) measured by 64 slice multidetector computed tomography (MDCT). Methods: 151 patients, mean age 64±9 years, 69% male, were studied. Each underwent DTM during a 5 minute supra systolic arm-cuff occlusion and MDCT. Post-cuff deflation fingertip temperature rebound (TR) was correlated with CAD severity assessed by MDCT. Results: After adjusting for age, gender and CAD risk factors using logistic regression analysis, the odds ratio for TR in the lowest tertile vs. upper 2 tertiles was 1.3 (95% CI 0.89 –1.6, p=0.4) for mild CAC (luminal stenosis<30%), 2.7 (95% CI 1.2–3.9, p=0.0001) for moderate CAD (30 –70% luminal stenosis) and 6.94 (95% CI 2.2–10.7, p=0.0001) for severe CAD (luminal stenosis>70%) compared to normal coronaries. Additionally, TR was lower in coronary segments with mixed plaque compared to calcified plaque (0.43±0.17 vs. 0.91±0.19, p=0.001). Conclusions: Vascular dysfunction measured by DTM strongly correlates with the severity and characteristics of coronary plaques measured by MDCT, independent of age, gender and cardiac risk factors. DTM may be a useful tool for the identification of high risk patients, additional studies are warranted.

scholarly journals 0721 Coronary Atherosclerotic Plaque Burden and Composition in Patients with Obstructive Sleep Apnea by Coronary CT Angiography

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A274-A274
Author(s):  
M Lu ◽  
Y Wei ◽  
Z Wang ◽  
F Fang ◽  
S E John ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Linear Regression Analysis ◽  
Coronary Plaque ◽  
Plaque Burden ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Calcified Plaque

Abstract Introduction OSA is closely associated with increased risk of coronary artery disease. Although previous small studies have investigated coronary plaque in OSA patients, limited data are available regarding the association of OSA with plaque morphology and composition. Therefore, we aimed to quantitatively characterize and compare coronary plaque burden and composition between patients with no or mild obstructive sleep apnea (OSA) and moderate-severe OSA using coronary computed tomography angiography (CTA) in a large-scale study. Methods We retrospectively analyzed consecutive patients who underwent sleep monitoring and coronary CTA. Metrics reflecting coronary plaque characteristics were compared between patients with no or mild OSA with apnea hypoxic index (AHI) ≤15 and moderate-severe OSA (AHI&gt;15). The associations of OSA with coronary plaque components were determined by logistic and linear regression analysis. Results A total of 854 patients were enrolled in the study. Of these, 162 did not meet the inclusion criteria and of the remaining 692 patients 400 (57.8%) had moderate-severe OSA and 292 had no or mild OSA. Patients with moderate-severe OSA had a significantly higher total plaque volume, total non-calcified plaque (NCP) volume and total low density non-calcified plaque (LD-NCP) volume, and corresponding burden than those with no or mild OSA (all with p&lt;0.05). Multivariate logistic regression analysis revealed that moderate-severe OSA patients are more likely to have any plaque, NCP and LD-NCP than those without no or mild OSA (p&lt;0.05). In addition, stepwise multivariate linear regression analysis further revealed an independent relationship between moderate OSA (15&lt;AHI≤30) and more so between severe OSA (AHI&gt;30) and, NCP volume, LD-NCP volume, NCP composition, and LD-NCP composition, following adjustment for traditional cardiovascular risk factors, compared to no or mild OSA (AHI&lt;15) (all with a p&lt;0.05). Moderate-severe OSA conferred a similar odds ratio for LD-NCPs (a high-risk plaque) as the usual cardiovascular risk factors. Conclusion In this large cross-sectional study, OSA severity was associated with high-risk plaque features independent of traditional cardiovascular risk factors, suggesting an increased risk for cardiovascular events. Support This study was supported by NSFC (Project 81870335), International Science & Technology Cooperation Program of China (No.2015DFA30160), Beijing Municipal Science & Technology Commission (No. Z141100006014057)

scholarly journals Clinical risk factors and atherosclerotic plaque extent to define risk for major events in patients without obstructive coronary artery disease: the long-term coronary computed tomography angiography CONFIRM registry

2020 ◽  
Vol 21 (5) ◽  
pp. 479-488 ◽  
Author(s):  
Alexander R van Rosendael ◽  
A Maxim Bax ◽  
Jeff M Smit ◽  
Inge J van den Hoogen ◽  
Xiaoyue Ma ◽  
...  
Keyword(s):  
Risk Factors ◽  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Computed Tomography Angiography ◽  
Prognostic Value ◽  
Coronary Computed Tomography Angiography ◽  
Obstructive Coronary Artery Disease ◽  
Artery Disease

Abstract Aims In patients without obstructive coronary artery disease (CAD), we examined the prognostic value of risk factors and atherosclerotic extent. Methods and results Patients from the long-term CONFIRM registry without prior CAD and without obstructive (≥50%) stenosis were included. Within the groups of normal coronary computed tomography angiography (CCTA) (N = 1849) and non-obstructive CAD (N = 1698), the prognostic value of traditional clinical risk factors and atherosclerotic extent (segment involvement score, SIS) was assessed with Cox models. Major adverse cardiac events (MACE) were defined as all-cause mortality, non-fatal myocardial infarction, or late revascularization. In total, 3547 patients were included (age 57.9 ± 12.1 years, 57.8% male), experiencing 460 MACE during 5.4 years of follow-up. Age, body mass index, hypertension, and diabetes were the clinical variables associated with increased MACE risk, but the magnitude of risk was higher for CCTA defined atherosclerotic extent; adjusted hazard ratio (HR) for SIS &gt;5 was 3.4 (95% confidence interval [CI] 2.3–4.9) while HR for diabetes and hypertension were 1.7 (95% CI 1.3–2.2) and 1.4 (95% CI 1.1–1.7), respectively. Exclusion of revascularization as endpoint did not modify the results. In normal CCTA, presence of ≥1 traditional risk factors did not worsen prognosis (log-rank P = 0.248), while it did in non-obstructive CAD (log-rank P = 0.025). Adjusted for SIS, hypertension and diabetes predicted MACE risk in non-obstructive CAD, while diabetes did not increase risk in absence of CAD (P-interaction = 0.004). Conclusion Among patients without obstructive CAD, the extent of CAD provides more prognostic information for MACE than traditional cardiovascular risk factors. An interaction was observed between risk factors and CAD burden, suggesting synergistic effects of both.

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