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Although the presence of ischemia is a key prognostic factor in patients with coronary artery disease, the presence of high-risk plaque characteristics (HRPC) is also associated with increased risk of cardiovascular events. Limited data exist regarding the prognostic implications of combined information on physiological stenosis severity assessed by fractional flow reserve (FFR) and plaque vulnerability by coronary computed tomography angiography (CTA)-defined HRPC.The current study aimed to evaluate the: 1) association between physiological stenosis severity and coronary CTA-defined HRPC; and 2) prognostic implications of coronary CTA-defined HRPC according to physiological stenosis severity in patients with coronary artery disease.A total of 772 vessels (299 patients) evaluated by both coronary CTA and FFR were analyzed. The presence and number of HRPC (minimum lumen area 4 mmThe proportion of lesions with ≥3 HRPC was significantly decreased according to the increase in FFR values (58.6%, 46.5%, 36.8%, 15.7%, and 3.5% for FFR ≤0.60, 0.61 to ≤0.70, 0.71 to ≤0.80, 0.81 to ≤0.90, and0.90, respectively; overall p value 0.001). Both FFR and number of HRPC showed significant association with the estimated risk of VOCO (p = 0.008 and p = 0.023, respectively). In the FFR0.80 group, lesions with ≥3 HRPC showed significantly higher risk of VOCO than those with 3 HRPC (15.0% vs. 4.3%; hazard ratio: 3.964; 95% confidence interval: 1.451 to 10.828; p = 0.007). However, there was no significant difference in the risk of VOCO according to HRPC in the FFR ≤0.80 group. By multivariable analysis, the presence of ≥3 HRPC was independently associated with the risk of VOCO in the FFR0.80 group.Physiological stenosis severity and the number of HRPC were closely related, and both components had significant association with the risk of clinical events. However, the prognostic implication of HRPC was different according to FFR. Integration of both physiological stenosis severity and plaque vulnerability would provide better prognostic stratification of patients than either individual component alone, especially in patients with FFR0.80. (Clinical Implication of 3-vessel Fractional Flow Reserve [3V FFR-FRIENDS study]; NCT01621438).

The quantitative assessment of structures from Cardiac Computed Tomography Angiography (CCTA) usually requires manual segmentation and adjustment which can be time-consuming. We used Deep Learning to segment the proximal ascending and descending aorta (PAA, DA), superior and inferior vena cavae (SVC

Background Coronary lesions with low fractional flow reserve (FFR) that are treated medically are associated with higher revascularization rates. High wall shear stress (WSS) has been linked with increased plaque vulnerability. Objectives This study investigated the prognostic value of WSS measured in the proximal segments of lesions (WSSprox) to predict myocardial infarction (MI) in patients with stable coronary artery disease (CAD) and hemodynamically significant lesions. The authors hypothesized that in patients with low FFR and stable CAD, higher WSSprox would predict MI. Methods Among 441 patients in the FAME II (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation II) trial with FFR ≤0.80 who were randomized to medical therapy alone, 34 (8%) had subsequent MI within 3 years. Patients with vessel-related MI and adequate angiograms for 3-dimensional reconstruction (n = 29) were propensity matched to a control group with no MI (n = 29) by using demographic and clinical variables. Coronary lesions were divided into proximal, middle, and distal, along with 5-mm upstream and downstream segments. WSS was calculated for each segment. Results Median age was 62 years, and 46 (79%) were male. In the marginal Cox model, whereas lower FFR showed a trend (hazard ratio: 0.084; p = 0.064), higher WSSprox (hazard ratio: 1.234; p = 0.002, C-index = 0.65) predicted MI. Adding WSSprox to FFR resulted in a significant increase in global chi-square for predicting MI (p = 0.045), a net reclassification improvement of 0.69 (p = 0.005), and an integrated discrimination index of 0.11 (p = 0.010). Conclusions In patients with stable CAD and hemodynamically significant lesions, higher WSS in the proximal segments of atherosclerotic lesions is predictive of MI and has incremental prognostic value over FFR.

Current scores that predict the presence of obstructive coronary artery disease (CAD) have moderate accuracy. We sought to develop a machine learning (ML) model, utilizing clinical factors and the coronary artery calcium score (CACS), to predict patients likely to have obstructive CAD on CCTA. The

To explore the relationship between coronary atherosclerotic plaque volume, coronary lumen volume and coronary ischemia by coronary CT angiography (CCTA). 612 patients with suspected coronary artery disease at 17 sites (64 ± 10 years, 30% women) underwent CCTA, invasive coronary angiography and 3

Prior studies have reported discordant findings for the utility of transluminal attenuation gradient (TAG) to diagnosis vessel-specific ischemia. In the prospective, multicenter, international CREDENCE trial, 612 patients underwent non-emergent invasive angiography with FFR in all 40-90% stenoses.

Stenosis severity alone is unreliable to identify ischemia, but atherosclerotic plaque characteristics can improve accuracy. We thus evaluated a stepwise approach of coronary stenosis severity, non-calcified atheroma volume (NCAV) and coronary lumen volume (CLV) for diagnosis of vessel-specific

Risk scores derived from general populations of patients with chest pain often do not apply well to patients with diabetes mellitus (DM). To evaluate the performance of the Leiden coronary computed tomography angiography (CCTA) risk score—which incorporates many dimensions of coronary

Asymptomatic persons with elevated CAC scores have been shown to have increased cardiovascular risk. We measured event rates of those with established ASVCD and compared to a cohort of asymptomatic persons (stratified by CAC) to determine what CAC level approximates secondary risk. Using the CONFIRM

Objectives The aim of this study was to analyze the predictive value of coronary computed tomography angiography (CCTA) and to model and validate an optimized score for prognosis of 2-year survival on the basis of a patient population with suspected coronary artery disease (CAD). Background Coronary computed tomography angiography carries important prognostic information in addition to the detection of obstructive CAD. But it is still unclear how the results of CCTA should be interpreted in the context of clinical risk predictors. Methods The analysis is based on a test sample of 17,793 patients and a validation sample of 2,506 patients, all with suspected CAD, from the international CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry. On the basis of CCTA data and clinical risk scores, an optimized score was modeled. The endpoint was all-cause mortality. Results During a median follow-up of 2.3 years, 347 patients died. The best CCTA parameter for prediction of mortality was the number of proximal segments with mixed or calcified plaques (C-index 0.64, p 50% (C-index 0.56, p = 0.002). In an optimized score including both parameters, CCTA significantly improved overall risk prediction beyond National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) score as best clinical score. According to this score, a proximal segment with either a mixed or calcified plaque or a stenosis >50% is equivalent to a 5-year increase in age or the risk of smoking. Conclusions In CCTA, both plaque burden and stenosis, particularly in proximal segments, carry incremental prognostic value. A prognostic score on the basis of this data can improve risk prediction beyond clinical risk scores.

ObjectivesThis study was designed to determine the prognostic value of multidetector coronary computed tomography angiography (CTA) in relation to exercise electrocardiography (XECG) findings.BackgroundThe prognostic usefulness of coronary CTA findings of coronary artery disease in relation to XECG findings has not been explored systematically.MethodsPatients with suspected coronary artery disease who had undergone both coronary CTA and XECG (

Objectives This study sought to examine patterns of follow-up invasive coronary angiography (ICA) and revascularization (REV) after coronary computed tomography angiography (CCTA). Background CCTA is a noninvasive test that permits direct visualization of the extent and severity of coronary artery disease (CAD). Post-CCTA patterns of follow-up ICA and REV are incompletely defined. Methods We examined 15,207 intermediate likelihood patients from 8 sites in 6 countries; these patients were without known CAD, underwent CCTA, and were followed up for 2.3 +/- 1.2 years for all-cause mortality. Coronary artery stenosis was judged as obstructive when >= 50% stenosis was present. A multivariable logistic regression was used to estimate ICA use. A Cox proportional hazards model was used to estimate all-cause mortality. Results During follow-up, ICA rates for patients with no CAD to mild CAD according to CCTA were low (2.5% and 8.3%), with similarly low rates of REV (0.3% and 2.5%). Most ICA procedures (79%) occurred

Objectives The purpose of this study was to describe the prevalence and severity of coronary artery disease (CAD) in relation to prognosis in symptomatic patients without coronary artery calcification (CAC) undergoing coronary computed tomography angiography (CCTA). Background The frequency and clinical relevance of CAD in patients without CAC are unclear. Methods We identified 10,037 symptomatic patients without CAD who underwent concomitant CCTA and CAC scoring. CAD was assessed as Results Mean age was 57 years, 56% were men, and 51% had a CAC score of 0. Among patients with a CAC score of 0, 84% had no CAD, 13% had nonobstructive stenosis, and 3.5% had ≥50% stenosis (1.4% had ≥70% stenosis) on CCTA. A CAC score >0 had a sensitivity, specificity, and negative and positive predictive values for stenosis ≥50% of 89%, 59%, 96%, and 29%, respectively. During a median of 2.1 years, there was no difference in mortality among patients with a CAC score of 0 irrespective of obstructive CAD. Among 8,907 patients with follow-up for the composite endpoint, 3.9% with a CAC score of 0 and ≥50% stenosis experienced an event (hazard ratio: 5.7; 95% confidence interval: 2.5 to 13.1; p Conclusions In symptomatic patients with a CAC score of 0, obstructive CAD is possible and is associated with increased cardiovascular events. CAC scoring did not add incremental prognostic information to CCTA.

Objectives We sought to determine the incremental prognostic value of 64 multi-slice coronary computed tomography angiography (CCTA) in coronary artery bypass graft (CABG) patients. Background Prognostication in CABG patients can be difficult. Anatomical assessment of native coronary artery disease and graft patency might provide useful information, but the utility of CCTA in the assessment of CABG patients is unknown. Methods Six hundred fifty-seven CABG patients with all-cause mortality follow-up were identified from a multicenter CCTA registry, of 10,628 patients from 5 CCTA centers. Clinical risk was profiled with modified logistic and additive EuroSCOREs (European Systems for Cardiac Operative Risk Evaluations). The CCTA defined coronary anatomy. Patients were classified by unprotected coronary territory (UCT) or a summary of native vessel disease and graft patency: the coronary artery protection score (CAPS). Results Forty-four deaths occurred during a mean follow-up of 20 months. Left ventricular ejection fraction, creatinine, age, severity of native vessel disease, UCT, CAPS, and EuroSCOREs were univariate predictors of mortality (p aamp;amp;amp;lt; 0.001). In multivariate analysis with additive EuroSCORE, UCT (p = 0.004) and CAPS were predictive of events (p aamp;amp;amp;lt; 0.001). In comparison with additive EuroSCORE, CAPS score was associated with a 27% net reclassification index. Conclusions Coronary computed tomography angiography provides incremental anatomical data to clinical risk assessment to help determine the prognosis of patients after CABG. The CAPS evaluation with CCTA might help identify those patients at highest risk.

Objectives: We examined mortality in relation to coronary artery disease (CAD) as assessed by ≥64-detector row coronary computed tomography angiography (CCTA).Background: Although CCTA has demonstr...

The natural history of coronary plaque progression (PP) in patients with diabetes mellitus (DM) is not well established. We aimed to determine the rate and extent of PP, changes of plaque features and clinical predictors of PP in diabetics. 1602 patients who underwent serial coronary computed

The association of traditional risk factors (RFs) with the incidence and progression of coronary artery calcium (CAC) has been well known, but the effect of risk burden remains unclear, especially in non-Western populations. From a 6-center, observational registry, a total 10,033 asymptomatic

The association of cardiovascular risk factors (RFs) with coronary artery calcium (CAC) progression has not been well established, especially in non-Western populations. From a 6-center, single ethnicity observational registry, a total 10,033 asymptomatic Korean adults (mean age: 51±9 years, 85%

Data on the influence of strict glycemic control on the progression of coronary artery calcification, which is an important marker for future adverse cardiovascular events, in diabetic individuals are limited. A total of 1,637 asymptomatic diabetic adults (56 ± 8 years, 88.8% males) without

High-risk plaque (HRP) and diameter stenosis severity (%DS) by coronary computed tomographic angiography (CCTA) independently predict adverse events, but their relative importance and interaction have not been determined. Within the ICONIC study, a nested case-control study of CCTA, we included

Current cardiovascular risk prediction models employ limited sets of variables which confine their predictive potential. Machine learning has emerged as a novel approach to handle high-dimensional datasets, but has yet to be adequately explored for its ability to enhance clinical risk prediction. We

Acute coronary syndrome (ACS) in women is more frequently caused by plaque erosion, rather than plaque rupture, as compared with men. High risk plaque (HRP) features by coronary computed tomographic angiography (CCTA) are associated with advanced fibroatheromas and plaque rupture and may therefore

We aim to compare morphologic and functional characteristics of mitral annular calcification (MAC) between patients with or without previous stroke. A total of 460 patients with MAC from two dimensional echocardiography from single center (2005 to 2016) were retrospectively reviewed. Patients were

Epidemiologic studies exhibit conflicting data on the interaction between sex and smoking for myocardial infarction. We examined the interaction of sex, age and smoking for coronary artery disease (CAD) extent and severity by coronary computed tomography angiography (CCTA) Patients in the CONFIRM (

Metabolic syndrome (MS) is associated with faster progression of degenerative aortic stenosis (AS). However, the influence of MS on AS progression and clinical outcomes in patients with bicuspid aortic valve (BAV) has not been studied. A total of 1,640 patients with BAVs were identified at two

Sex-based differences in stenosis severity and high-risk plaque features have been observed in invasive coronary studies. Diameter stenosis severity (%DS) and high-risk plaque (HRP) by Coronary Computed Tomographic Angiography (CCTA) are prognostically important, but the impact by sex is not known.

Little information is available about very long-term follow-up of cardiac rhythm after percutaneous mitral balloon valvotomy (PMV). We aimed to investigate the characteristics and predictors for maintaining sinus rhythm (SR) at very long-term after PMV in patients with mitral stenosis (MS). We

Studies investigating the temporal relationship of coronary plaque characteristics with acute coronary syndrome (ACS) are lacking. The aim of this study was to identify differences in plaque characteristics on coronary computed tomography angiography (CCTA) between patients with early, intermediate

The purpose of this study was to evaluate the prevalence of occult coronary artery disease (CAD) with coronary computed tomography angiography (CTA) to characterize plaque composition and to evaluate the potential of this new technology to impact risk stratification in asymptomatic middle-aged subjects.There is a paucity of information regarding the role of CTA for the detection of occult CAD in asymptomatic individuals.We consecutively enrolled 1,000 middle-aged asymptomatic subjects (age 50 +/- 9 years, 63% men) who underwent CTA (64-slice multidetector row computed tomography) as part of a general health evaluation.Atherosclerotic plaques were identified in 215 (22%, 2 +/- 1 segments/subject) individuals; 40 individuals (4%) had only noncalcified plaques. Fifty-two (5%) subjects had significant (or=50%) diameter stenosis and 21 (2%) had severe (or=75%) stenosis. Thirteen (25%) and 30 (58%) subjects with significant stenosis were classified into National Cholesterol Education Program low-risk and mild coronary calcification (coronary artery calcium scores100), respectively. Midterm follow-up (17 +/- 2 months) revealed 15 cardiac events only in those with CAD on CTA: 1 unstable angina requiring hospital stay and 14 revascularization procedures. Most (87%) events occurred within 90 days of index CTA.The prevalence of occult CAD in apparently healthy individuals was not negligible, although their midterm prognosis was good. CTA has a potential to provide a better insight about the occult CAD in this population. However, on the basis of our results and considering present radiation exposure data, we cannot recommend that CTA be used as a screening tool for this population at this point.

ObjectivesThe aim of this study was to examine the relationship between individual components of left ventricular (LV) afterload and tissue Doppler echocardiography (TDE) velocities in humans.BackgroundAcute increases in afterload slow diastolic relaxation as assessed invasively, yet little is known about chronic effects of load and loading sequence on LV TDE velocities.MethodsForty-eight subjects underwent echo Doppler and color-coded TDE with comprehensive noninvasive vascular assessment. Arterial afterload was measured by effective arterial elastance (Ea) and systemic vascular resistance index (SVRI), and loading sequence was quantified by early- (carotid characteristic impedance [Zc]) and late-systolic loads (augmentation index [cAI]; late pressure-time integral [PTI3]). Vascular stiffness was measured by carotid-femoral pulse wave velocity (PWV) and total arterial compliance.ResultsEarly-diastolic velocity (E′) varied inversely with Zc, SVRI, Ea, and PWV (r = −0.4 to 0.5; β = 1.0 to 1.2; p ≤ 0.004), but late-systolic load (cAI and PTI3 r = −0.6; β = 1.6; both p < 0.0001) and arterial compliance (r = 0.6; β = 1.4; p < 0.0001) had the strongest associations with E′. Load dependence was not altered by the presence of hypertension, and in multivariate analysis only cAI and Zc significantly predicted E′, even after adjusting for age (p < 0.05). Peak systolic velocity was additionally found to be inversely related to afterload, whereas other measures of contractility were not.ConclusionsDiastolic and systolic tissue velocities vary inversely with arterial afterload, with late-systolic load having the greatest influence on E′. These findings may partly explain the decrease in early relaxation velocity noted with aging, hypertension, and patients with heart failure. Strategies to reduce afterload, vascular stiffening, and wave reflections may prove useful to enhance early diastolic relaxation.

Although coronary artery calcium score (CACS) has been known as a robust surrogate marker for subclinical coronary atherosclerosis in asymptomatic population, the incremental prognostic benefit over traditional risk factors in Asian population remains unknown. Hence, we aimed to explore the

Background: Conflicting data exist regarding the association of body weight changes with all-cause and cardiovascular (CV) mortality. The current study investigated the association between weight changes and all-cause, CV, and non-CV mortality in a large cohort of middle-aged adults. Methods: In

Background: Flow-gradient patterns in severe aortic stenosis (AS) with preserved ejection fraction provides prognostic information. We compared the prevalence of four flow-gradient patterns in severe AS between bicuspid and tricuspid phenotypes. Methods: 187 patients with severe AS (103 bicuspid vs

We have previously shown that left atrial (LA) flow vortex using transesophageal contrast echocardiography (TEE) was feasible and showed different pattern in normals and patients with atrial fibrillation (AF). However, the relationship between LA vortex pattern with hemodynamic and