39 results on '"Leipsic, Jonathon"'
Search Results
2. Effectiveness of a low contrast load CT angiography protocol in octogenarians and nonagenarians being evaluated for transcatheter aortic valve replacement.
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Zemedkun M, LaBounty TM, Bergman G, Wong SC, Lin FY, Reynolds D, Gomez M, Dunning AM, Leipsic J, and Min JK
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- Aged, Aged, 80 and over, Angiography adverse effects, Contrast Media adverse effects, Feasibility Studies, Female, Humans, Male, Retrospective Studies, Tomography, X-Ray Computed adverse effects, Angiography methods, Aortic Valve Stenosis surgery, Contrast Media administration & dosage, Tomography, X-Ray Computed methods, Transcatheter Aortic Valve Replacement methods
- Abstract
Introduction: Transcatheter aortic valve replacement (TAVR) typically requires computed tomographic angiography (CTA) for aortoiliofemoral assessment to determine feasibility of a transfemoral approach, although many candidates being considered for TAVR are at increased risk of contrast-induced nephropathy (CIN)., Objective: To determine the feasibility and safety of a load contrast load CTA protocol in octogenarians and nonagenarians at risk of CIN., Approach: We evaluated 54 consecutive octogenarians and nonagenarians considered for TAVR who underwent CTA using a standard contrast protocol (n=21) versus a protocol incorporating low-dose contrast in patients at risk of CIN (n=33). We compared clinical characteristics, CTA image quality (score 1-4) and interpretability, and clinical outcomes, including CIN and vascular complications., Results: The mean age was 88.5±4.0 years, 37% were male, and chronic renal insufficiency was common in both the standard and low-dose contrast cohorts (57% vs. 70%, P=.39). The low-dose contrast protocol was associated with a significantly less contrast volume compared to standard contrast protocol (127±18 ml vs 76±55 ml, P<.001). Individuals imaged using low-dose (n=16) versus standard (n=17) contrast protocols received 80% less contrast volume (23±10 vs. 125±23 ml, P<.001). There was similar graded image quality (3.8±0.4 vs. 3.9±0.3, P=.76) and interpretability (100% for each, P=1.0) between standard and low-dose contrast protocol groups. There was no significant difference in rates of CIN after CTA between standard and low-dose contrast protocol groups (10% vs. 3%, P=.55), with no CIN events in those imaged by low-dose CTA. There were no major vascular injuries associated with TAVR or pigtail insertion, no major bleeding for CTA, and no noninterpretable studies in all patients., Conclusion: In this proof-of-principle study, a low-dose contrast protocol appears feasible and safe in octogenarians and nonagenarians undergoing screening for TAVR, and results in significant reduction in contrast load as compared to a standard contrast protocol without observed differences in image quality or safety., (Copyright © 2015 Elsevier Inc. All rights reserved.)
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- 2015
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3. Reduced iodine load at CT pulmonary angiography with dual-energy monochromatic imaging: comparison with standard CT pulmonary angiography--a prospective randomized trial.
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Yuan R, Shuman WP, Earls JP, Hague CJ, Mumtaz HA, Scott-Moncrieff A, Ellis JD, Mayo JR, and Leipsic JA
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- Chi-Square Distribution, Female, Humans, Image Interpretation, Computer-Assisted, Male, Middle Aged, Prospective Studies, Radiation Dosage, Signal-To-Noise Ratio, Statistics, Nonparametric, Angiography methods, Contrast Media administration & dosage, Pulmonary Embolism diagnostic imaging, Tomography, X-Ray Computed methods, Triiodobenzoic Acids administration & dosage
- Abstract
Purpose: To compare quantitative and subjective image quality and radiation dose between standard computed tomographic (CT) pulmonary angiography (CTPA) and CTPA with a dual-energy technique with reduced iodine load., Materials and Methods: This prospective study was approved by the institutional review board and each participant provided informed consent. Ninety-four patients (59% male; mean age ± standard deviation, 62 years ± 15) were randomized to one of two protocols: standard CTPA (100-120 kVp) with standard contrast medium injection (n = 46) and dual-energy CTPA (image reconstruction at 50 keV) with the same injection volume as in the standard protocol but composed of contrast medium and saline in a 1:1 fashion, resulting in 50% reduction in iodine load (n = 48). Signal intensity and noise in three central and two segmental pulmonary arteries were measured; signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. A five-point scale was used to subjectively evaluate vascular enhancement and image noise. The proportion of diagnostic (score, ≥ 3) studies and the interreader agreement regarding the dichotomized diagnostic versus nondiagnostic scale were compared between the two groups., Results: Compared with standard CTPA, dual-energy CTPA demonstrated higher signal intensity in all pulmonary arteries (all P < .01), inferior noise only in segmental arteries (P < .05), higher SNR and CNR (both P < .05), and compatible effective dose (P > .05). The five-point score was higher in the standard CTPA protocol (P < .05). The interreader agreement regarding the dichotomized diagnostic versus nondiagnostic scale was similar (P > .05) between the two groups., Conclusion: Dual-energy CTPA with image reconstruction at 50 keV allows a significant reduction in iodine load while improving intravascular signal intensity, maintaining SNR and with comparable radiation dose., (© RSNA, 2011.)
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- 2012
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4. Quantification of Coronary Atherosclerosis in the Assessment of Coronary Artery Disease
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Lee, Sang-Eun, Sung, Ji Min, Rizvi, Asim, Lin, Fay Y, Kumar, Amit, Hadamitzky, Martin, Kim, Yong-Jin, Conte, Edoardo, Andreini, Daniele, Pontone, Gianluca, Budoff, Matthew J, Gottlieb, Ilan, Lee, Byoung Kwon, Chun, Eun Ju, Cademartiri, Filippo, Maffei, Erica, Marques, Hugo, Leipsic, Jonathon A, Shin, Sanghoon, Choi, Jung Hyun, Chinnaiyan, Kavitha, Raff, Gilbert, Virmani, Renu, Samady, Habib, Stone, Peter H, Berman, Daniel S, Narula, Jagat, Shaw, Leslee J, Bax, Jeroen J, Min, James K, and Chang, Hyuk-Jae
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Clinical Research ,Heart Disease - Coronary Heart Disease ,Atherosclerosis ,Heart Disease ,Biomedical Imaging ,Cardiovascular ,4.2 Evaluation of markers and technologies ,Detection ,screening and diagnosis ,Aged ,Brazil ,Computed Tomography Angiography ,Coronary Angiography ,Coronary Artery Disease ,Coronary Stenosis ,Coronary Vessels ,Disease Progression ,Europe ,Female ,Humans ,Male ,Middle Aged ,Multidetector Computed Tomography ,Myocardial Infarction ,Myocardial Revascularization ,North America ,Plaque ,Atherosclerotic ,Predictive Value of Tests ,Prognosis ,Prospective Studies ,Registries ,Republic of Korea ,Risk Assessment ,Risk Factors ,Severity of Illness Index ,angiography ,atherosclerosis ,coronary artery disease ,myocardial infarction ,risk factors ,Clinical Sciences ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Abstract
BackgroundDiagnosis of coronary artery disease and management strategies have relied solely on the presence of diameter stenosis ≥50%. We assessed whether direct quantification of plaque burden (PB) and plaque characteristics assessed by coronary computed tomography angiography could provide additional value in terms of predicting rapid plaque progression.Methods and resultsFrom a 13-center, 7-country prospective observational registry, 1345 patients (60.4±9.4 years old; 57.1% male) who underwent repeated coronary computed tomography angiography >2 years apart were enrolled. For conventional angiographic analysis, the presence of stenosis ≥50%, number of vessel involved, segment involvement score, and the presence of high-risk plaque feature were determined. For quantitative analyses, PB and annual change in PB (△PB/y) in the entire coronary tree were assessed. Clinical outcomes (cardiac death, nonfatal myocardial infarction, and coronary revascularization) were recorded. Rapid progressors, defined as a patient with ≥median value of △PB/y (0.33%/y), were older, more frequently male, and had more clinical risk factors than nonrapid progressors (all P
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- 2018
5. Relationship of Hypertension to Coronary Atherosclerosis and Cardiac Events in Patients With Coronary Computed Tomographic Angiography
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Nakanishi, Rine, Baskaran, Lohendran, Gransar, Heidi, Budoff, Matthew J, Achenbach, Stephan, Al-Mallah, Mouaz, Cademartiri, Filippo, Callister, Tracy Q, Chang, Hyuk-Jae, Chinnaiyan, Kavitha, Chow, Benjamin JW, DeLago, Augustin, Hadamitzky, Martin, Hausleiter, Joerg, Cury, Ricardo, Feuchtner, Gudrun, Kim, Yong-Jin, Leipsic, Jonathon, Kaufmann, Philipp A, Maffei, Erica, Raff, Gilbert, Shaw, Leslee J, Villines, Todd C, Dunning, Allison, Marques, Hugo, Pontone, Gianluca, Andreini, Daniele, Rubinshtein, Ronen, Bax, Jeroen, Jones, Erica, Hindoyan, Niree, Gomez, Millie, Lin, Fay Y, Min, James K, and Berman, Daniel S
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Biomedical Imaging ,Atherosclerosis ,Heart Disease - Coronary Heart Disease ,Heart Disease ,Hypertension ,Cardiovascular ,Clinical Research ,4.1 Discovery and preclinical testing of markers and technologies ,2.1 Biological and endogenous factors ,Detection ,screening and diagnosis ,Aetiology ,Aged ,Computed Tomography Angiography ,Coronary Angiography ,Coronary Artery Disease ,Female ,Humans ,International Cooperation ,Male ,Middle Aged ,Myocardial Ischemia ,Outcome and Process Assessment ,Health Care ,Prognosis ,Proportional Hazards Models ,Prospective Studies ,Registries ,Risk Assessment ,Risk Factors ,Severity of Illness Index ,angiography ,atherosclerosis ,coronary artery disease ,hypertension ,risk factors ,Cardiorespiratory Medicine and Haematology ,Clinical Sciences ,Public Health and Health Services ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Abstract
Hypertension is an atherosclerosis factor and is associated with cardiovascular risk. We investigated the relationship between hypertension and the presence, extent, and severity of coronary atherosclerosis in coronary computed tomographic angiography and cardiac events risk. Of 17 181 patients enrolled in the CONFIRM registry (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) who underwent ≥64-detector row coronary computed tomographic angiography, we identified 14 803 patients without known coronary artery disease. Of these, 1434 hypertensive patients were matched to 1434 patients without hypertension. Major adverse cardiac events risk of hypertension and non-hypertensive patients was evaluated with Cox proportional hazards models. The prognostic associations between hypertension and no-hypertension with increasing degree of coronary stenosis severity (nonobstructive or obstructive ≥50%) and extent of coronary artery disease (segment involvement score of 1-5, >5) was also assessed. Hypertension patients less commonly had no coronary atherosclerosis and more commonly had nonobstructive and 1-, 2-, and 3-vessel disease than the no-hypertension group. During a mean follow-up of 5.2±1.2 years, 180 patients experienced cardiac events, with 104 (2.0%) occurring in the hypertension group and 76 (1.5%) occurring in the no-hypertension group (hazard ratios, 1.4; 95% confidence intervals, 1.0-1.9). Compared with no-hypertension patients without coronary atherosclerosis, hypertension patients with no coronary atherosclerosis and obstructive coronary disease tended to have higher risk of cardiac events. Similar trends were observed with respect to extent of coronary artery disease. Compared with no-hypertension patients, hypertensive patients have increased presence, extent, and severity of coronary atherosclerosis and tend to have an increase in major adverse cardiac events.
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- 2017
6. Prognostic implications of coronary artery calcium in the absence of coronary artery luminal narrowing
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Cho, Iksung, Hartaigh, Bríain Ó, Gransar, Heidi, Valenti, Valentina, Lin, Fay Y, Achenbach, Stephan, Berman, Daniel S, Budoff, Matthew J, Callister, Tracy Q, Al-Mallah, Mouaz H, Cademartiri, Filippo, Chinnaiyan, Kavitha, Chow, Benjamin JW, Dunning, Allison M, DeLago, Augustin, Villines, Todd C, Hadamitzky, Martin, Hausleiter, Joerg, Leipsic, Jonathon, Shaw, Leslee J, Kaufmann, Philipp A, Cury, Ricardo C, Feuchtner, Gudrun, Kim, Yong-Jin, Maffei, Erica, Raff, Gilbert, Pontone, Gianluca, Andreini, Daniele, Chang, Hyuk-Jae, and Min, James K
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Heart Disease - Coronary Heart Disease ,Heart Disease ,Prevention ,Clinical Research ,Atherosclerosis ,Cardiovascular ,Detection ,screening and diagnosis ,4.2 Evaluation of markers and technologies ,Good Health and Well Being ,Adult ,Aged ,Asymptomatic Diseases ,Computed Tomography Angiography ,Coronary Angiography ,Coronary Artery Disease ,Coronary Stenosis ,Coronary Vessels ,Europe ,Female ,Humans ,Israel ,Kaplan-Meier Estimate ,Male ,Middle Aged ,North America ,Predictive Value of Tests ,Prevalence ,Prognosis ,Proportional Hazards Models ,Prospective Studies ,Registries ,Risk Factors ,Time Factors ,Vascular Calcification ,Coronary computed tomographic ,angiography ,Coronary artery calcium scoring ,Coronary artery disease ,Coronary computed tomographic angiography ,Cardiorespiratory Medicine and Haematology ,Clinical Sciences ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Abstract
Background and aimsCoronary artery calcium (CAC) scoring is a predictor of future adverse clinical events, and a surrogate measure of overall coronary artery plaque burden. Coronary computed tomographic angiography (CCTA) is a contrast-enhanced method that allows for visualization of plaque as well as whether that plaque causes luminal narrowing. To date, the prognosis of individuals with CAC but without stenosis has not been reported. We explored the prevalence of CAC>0 and its prognostic utility for future mortality for patients without luminal narrowing by CCTA.MethodsFrom 17 sites in 9 countries, we identified patients without known coronary artery disease, who underwent CAC scoring and CCTA, and were followed for >3 years. CCTA was graded for % stenosis according to a modified American Heart Association 16-segment model. We calculated hazard ratios (HR) with 95% confidence intervals (95% CI) for incident mortality and compared risk of death for patients as a function of presence or absence of CAC and presence or absence of luminal narrowing by CCTA.ResultsAmong 6656 patients who underwent CCTA and CAC scoring, 399 patients (6.0%) had no coronary luminal narrowing but CAC>0. During a median follow-up of 5.1 years (IQR: 3.9-5.9 years), 456 deaths occurred. Compared to individuals without luminal narrowing or CAC, individuals without luminal narrowing but CAC>0 were older, more likely to be male and had higher rates of diabetes, hypertension, and dyslipidemia. Individuals without luminal narrowing but CAC experienced a 2-fold increased risk of mortality, with increasing risk of mortality with higher CAC score. Following adjustment, incident death persisted (HR, 1.8; 95% CI, 1.1-2.9, p = 0.02) among patients without luminal narrowing but with CAC>0 compared with patients whose CACS = 0. Individuals without luminal narrowing but CAC ≥100 had mortality risks similar to individuals with non-obstructive CAD (0
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- 2017
7. Effects of cardiac medications for patients with obstructive coronary artery disease by coronary computed tomographic angiography: Results from the multicenter CONFIRM registry
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Schulman-Marcus, Joshua, Hartaigh, Bríain Ó, Giambrone, Ashley E, Gransar, Heidi, Valenti, Valentina, Berman, Daniel S, Budoff, Matthew J, Achenbach, Stephan, Al-Mallah, Mouaz, Andreini, Daniele, Cademartiri, Filippo, Callister, Tracy Q, Chang, Hyuk-Jae, Chinnaiyan, Kavitha, Chow, Benjamin JW, Cury, Ricardo, Delago, Augustin, Hadamitzky, Martin, Hausleiter, Joerg, Feuchtner, Gudrun, Kim, Yong-Jin, Kaufmann, Philipp A, Leipsic, Jonathon, Lin, Fay Y, Maffei, Erica, Pontone, Gianluca, Raff, Gilbert, Shaw, Leslee J, Villines, Todd C, Dunning, Allison, and Min, James K
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Atherosclerosis ,Biomedical Imaging ,Cardiovascular ,Heart Disease - Coronary Heart Disease ,Clinical Research ,Heart Disease ,Aged ,Algorithms ,Cohort Studies ,Coronary Angiography ,Coronary Artery Disease ,Female ,Heart ,Humans ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,Male ,Middle Aged ,Proportional Hazards Models ,Registries ,Tomography ,X-Ray Computed ,Treatment Outcome ,Coronary artery disease ,Coronary computed tomographic ,angiography ,Major adverse cardiac events ,Medication therapy ,Statins ,Coronary computed tomographic angiography ,Cardiorespiratory Medicine and Haematology ,Clinical Sciences ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Abstract
ObjectiveThis study sought to determine the correlation between baseline cardiac medications and cardiovascular outcomes in patients with obstructive coronary artery disease (CAD) diagnosed by coronary computed tomographic angiography (CCTA).Methods1637 patients (mean age 64.8 ± 10.2 years, 69.6% male) with obstructive CAD from the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry were followed over the course of three years. Obstructive CAD was defined as a ≥50% stenosis in an epicardial vessel. Medications analyzed included statins, aspirin, beta-blockers, angiotensin converting enzyme (ACE) inhibitors, and angiotensin receptor blockers (ARBs). Using Cox proportional-hazards models, we calculated the hazard ratio (HR) with 95% confidence intervals (95% CIs) for incident major adverse cardiovascular events (MACE), defined as death, acute coronary syndrome, or myocardial infarction.ResultsAt the time of CCTA, 59%, 54%, 40%, and 46% of patients were using statins, aspirin, beta-blockers, and ACE inhibitors or ARBs, respectively. Statins were associated with a 43% (95% CI = 0.38-0.87, p = 0.008) lower adjusted risk of MACE. Following adjustment, aspirin, beta-blockers, ACE inhibitors and ARBs did not attenuate the risk of MACE. When restricted to patients with multivessel obstructive CAD, only statins were associated with lower risk of MACE.ConclusionIn patients with obstructive CAD by CCTA, the baseline use of statins was associated with improved clinical outcomes. Other cardiac medications-including aspirin, beta-blockers, ACE inhibitors, and ARBs-were not associated with reduced risk of MACE.
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- 2015
8. Differences in prevalence, extent, severity, and prognosis of coronary artery disease among patients with and without diabetes undergoing coronary computed tomography angiography: results from 10,110 individuals from the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes): an InteRnational Multicenter Registry
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Rana, Jamal S., Dunning, Allison, Achenbach, Stephan, Mallah, Mouaz Al-, Budoff, Matthew J., Cademartiri, Filippo, Callister, Tracy Q., Chang, Hyuk-Jae, Cheng, Victor Y., Chinnaiyan, Kavitha, Chow, Benjamin J.W., Cury, Ricardo, Delago, Augustin, Feuchtner, Gudrun, Hadamitzky, Martin, Hausleiter, Jorg, Kaufmann, Philipp, Karlsberg, Ronald P., Kim, Yong-Jin, Leipsic, Jonathon, Labounty, Troy M., Lin, Fay Y., Maffei, Erica, Raff, Gilbert, Villines, Todd C., Shaw, Leslee J., Derman, Daniel S., and Min, James K.
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Coronary heart disease -- Prognosis -- Research -- Patient outcomes ,Diabetes -- Prognosis -- Research -- Patient outcomes ,Prevalence studies (Epidemiology) ,Angiography ,Tomography ,Health - Abstract
OBJECTIVE--We examined the prevalence, extent, severity, and prognosis of coronary artery disease (CAD) in individuals with and without diabetes (DM) who are similar in CAD risk factors. RESEARCH DESIGN AND [...]
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- 2012
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9. Molecular Coronary Plaque Imaging Using 18F-Fluoride.
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Moss, Alastair J., Doris, Mhairi K., Andrews, Jack P. M., Bing, Rong, Daghem, Marwa, van Beek, Edwin J. R., Forsyth, Laura, Shah, Anoop S. V., Williams, Michelle C., Sellers, Stephanie, Leipsic, Jonathon, Dweck, Marc R., Parker, Richard A., Newby, David E., and Adamson, Philip D.
- Abstract
Coronary
18 F-fluoride positron emission tomography identifies ruptured and high-risk atherosclerotic plaque. The optimal method to identify, to quantify, and to categorize increased coronary18 F-fluoride uptake and determine its reproducibility has yet to be established. This study aimed to optimize the identification, quantification, categorization, and scan-rescan reproducibility of increased18 F-fluoride activity in coronary atherosclerotic plaque. METHODS: In a prospective observational study, patients with multivessel coronary artery disease underwent serial18 F-fluoride positron emission tomography. Coronary18 F-fluoride activity was visually assessed, quantified, and categorized with reference to maximal tissue to background ratios. Levels of agreement for both visual and quantitative methods were determined between scans and observers. RESULTS: Thirty patients (90% male, 20 patients with stable coronary artery disease, and 10 with recent type 1 myocardial infarction) underwent paired serial positron emission tomography-coronary computed tomography angiography imaging within an interval of 12±5 days. A mean of 3.7±1.818 F-fluoride positive plaques per patient was identified after recent acute coronary syndrome, compared with 2.4±2.3 positive plaques per patient in stable coronary artery disease. The bias in agreement in maximum tissue to background ratio measurements in visually positive plaques was low between observers (mean difference, −0.01; 95% limits of agreement, −0.32 to 0.30) or between scans (mean difference, 0.06; 95% limits of agreement, −0.49 to 0.61). Good agreement in the categorization of focal18 F-fluoride uptake was achieved using visual assessment alone (κ=0.66) and further improved at higher maximum tissue to background ratio values. CONCLUSIONS: Coronary18 F-fluoride activity is a precise and reproducible metric in the coronary vasculature. The analytical performance of18 F-fluoride is sufficient to assess the prognostic utility of this radiotracer as a noninvasive imaging biomarker of plaque vulnerability [ABSTRACT FROM AUTHOR]- Published
- 2019
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10. Fractional flow reserve derived from coronary computed tomography angiography: diagnostic performance in hypertensive and diabetic patients.
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Eftekhari, Ashkan, Min, James, Achenbach, Stephan, Marwan, Mohamed, Budoff, Matthew, Leipsic, Jonathon, Gaur, Sara, Jensen, Jesper Møller, Ko, Brian S., Høj Christiansen, Evald, Kaltoft, Anne, Bøtker, Hans Erik, Flensted Jensen, Jens, and Linde Nørgaard, Bjarne
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CORONARY disease ,DIAGNOSIS ,CARDIOVASCULAR disease diagnosis ,HYPERTENSION ,ISCHEMIA diagnosis ,ANGIOGRAPHY ,BLOOD circulation ,CARDIAC catheterization ,COMPUTED tomography ,PEOPLE with diabetes ,MICROCIRCULATION ,CONTROL groups ,DATA analysis software ,DESCRIPTIVE statistics - Abstract
Aims Fractional flow reserve (FFR) derived from coronary computed tomography (FFRCT) has high diagnostic performance in stable coronary artery disease (CAD). The diagnostic performance of FFRCT in patients with hypertension (HTN) and diabetes (DM), who are at risk of microvascular impairment, is not known. Methods and results We analysed the diagnostic performance of FFRCT, in patients (vessels) with DM (n = 16), HTN (n = 186), DM + HTN (n = 58) vs. controls (n = 107) with or with suspected CAD. Patients (vessels) were further divided according to left ventricular mass index (LVMI) tertiles. Reference standard was invasively measured FFR ≤0.80. Per-patient diagnostic accuracy (95% CI) in control patients was 71.7% (61.6-81.8) vs. 79.3 (74.0-85.0) (P = 0.12), 75.0% (47.6-92.7) (P = 0.52), and 75.9% (62.8-86.1) (P = 0.39) in patients with HTN, DM, and HTM + DM, respectively. There was no difference in discrimination of ischaemia by FFRCT between groups. On a per-vessel level, there was no significant difference in diagnostic performance or discrimination of ischaemia by FFRCT between groups. There was a decline in both per-patient and -vessel diagnostic specificity of FFRCT in the upper LVMI tertile when compared with lower tertiles; however, discrimination of ischaemia by FFRCT was unaltered across LVMI tertiles. Conclusion The diagnostic performance of FFRCT is independent of the presence of HTN and DM. FFRCT is a robust method in a broad stable CAD population, including patients at high risk for microvascular disease. [ABSTRACT FROM AUTHOR]
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- 2017
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11. Relationship of Hypertension to Coronary Atherosclerosis and Cardiac Events in Patients With Coronary Computed Tomographic Angiography.
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Budoff, Matthew J., Nakanishi, Rine, Chinnaiyan, Kavitha, Raff, Gilbert, Chow, Benjamin J. W., DeLago, Augustin, Hadamitzky, Martin, Hausleiter, Joerg, Cury, Ricardo, Feuchtner, Gudrun, Yong-Jin Kim, Leipsic, Jonathon, Kaufmann, Philipp A., Gransar, Heidi, Berman, Daniel S., Shaw, Leslee J., Villines, Todd C., Dunning, Allison, Marques, Hugo, and Pontone, Gianluca
- Abstract
Hypertension is an atherosclerosis factor and is associated with cardiovascular risk. We investigated the relationship between hypertension and the presence, extent, and severity of coronary atherosclerosis in coronary computed tomographic angiography and cardiac events risk. Of 17 181 patients enrolled in the CONFIRM registry (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) who underwent ≥64-detector row coronary computed tomographic angiography, we identified 14 803 patients without known coronary artery disease. Of these, 1434 hypertensive patients were matched to 1434 patients without hypertension. Major adverse cardiac events risk of hypertension and non-hypertensive patients was evaluated with Cox proportional hazards models. The prognostic associations between hypertension and no-hypertension with increasing degree of coronary stenosis severity (nonobstructive or obstructive ≥50%) and extent of coronary artery disease (segment involvement score of 1-5, >5) was also assessed. Hypertension patients less commonly had no coronary atherosclerosis and more commonly had nonobstructive and 1-, 2-, and 3-vessel disease than the no-hypertension group. During a mean follow-up of 5.2±1.2 years, 180 patients experienced cardiac events, with 104 (2.0%) occurring in the hypertension group and 76 (1.5%) occurring in the no-hypertension group (hazard ratios, 1.4; 95% confidence intervals, 1.0-1.9). Compared with no-hypertension patients without coronary atherosclerosis, hypertension patients with no coronary atherosclerosis and obstructive coronary disease tended to have higher risk of cardiac events. Similar trends were observed with respect to extent of coronary artery disease. Compared with no-hypertension patients, hypertensive patients have increased presence, extent, and severity of coronary atherosclerosis and tend to have an increase in major adverse cardiac events. [ABSTRACT FROM AUTHOR]
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- 2017
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12. Is Metabolic Syndrome Predictive of Prevalence, Extent, and Risk of Coronary Artery Disease beyond Its Components? Results from the Multinational Coronary CT Angiography Evaluation for Clinical Outcome: An International Multicenter Registry (CONFIRM).
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Ahmadi, Amir, Leipsic, Jonathon, Feuchtner, Gudrun, Gransar, Heidi, Kalra, Dan, Heo, Ran, Achenbach, Stephan, Andreini, Daniele, Al-Mallah, Mouaz, Berman, Daniel S., Budoff, Matthew, Cademartiri, Filippo, Callister, Tracy Q., Chang, Hyuk-Jae, Chinnaiyan, Kavitha, Chow, Benjamin, Cury, Ricardo C., Delago, Augustin, Gomez, Millie J., and Hadamitzky, Martin
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METABOLIC syndrome , *DISEASE prevalence , *CORONARY heart disease risk factors , *ANGIOGRAPHY , *HEALTH outcome assessment - Abstract
Although metabolic syndrome is associated with increased risk of cardiovascular disease and events, its added prognostic value beyond its components remains unknown. This study compared the prevalence, severity of coronary artery disease (CAD), and prognosis of patients with metabolic syndrome to those with individual metabolic syndrome components. The study cohort consisted of 27125 consecutive individuals who underwent ≥64-detector row coronary CT angiography (CCTA) at 12 centers from 2003 to 2009. Metabolic syndrome was defined as per NCEP/ATP III criteria. Metabolic syndrome patients (n=690) were matched 1:1:1 to those with 1 component (n=690) and 2 components (n=690) of metabolic syndrome for age, sex, smoking status, and family history of premature CAD using propensity scoring. Major adverse cardiac events (MACE) were defined by a composite of myocardial infarction (MI), acute coronary syndrome, mortality and late target vessel revascularization. Patients with 1 component of metabolic syndrome manifested lower rates of obstructive 1-, 2-, and 3-vessel/left main disease compared to metabolic syndrome patients (9.4% vs 13.8%, 2.6% vs 4.5%, and 1.0% vs 2.3%, respectively; p<0.05), while those with 2 components did not (10.5% vs 13.8%, 2.8% vs 4.5% and 1.3% vs 2.3%, respectively; p>0.05). At 2.5 years, metabolic syndrome patients experienced a higher rate of MACE compared to patients with 1 component (4.4% vs 1.6%; p=0.002), while no difference observed compared to individuals with 2 components (4.4% vs 3.2% p=0.25) of metabolic syndrome. In conclusion, Metabolic syndrome patients have significantly greater prevalence, severity, and prognosis of CAD compared to patients with 1 but not 2 components of metabolic syndrome. [ABSTRACT FROM AUTHOR]
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- 2015
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13. Diagnostic Performance of Noninvasive Fractional Flow Reserve Derived From Coronary Computed Tomography Angiography in Suspected Coronary Artery Disease: The NXT Trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps).
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Nørgaard, Bjarne L., Leipsic, Jonathon, Gaur, Sara, Seneviratne, Sujith, Ko, Brian S., Ito, Hiroshi, Jensen, Jesper M., Mauri, Laura, De Bruyne, Bernard, Bezerra, Hiram, Osawa, Kazuhiro, Marwan, Mohamed, Naber, Christoph, Erglis, Andrejs, Park, Seung-Jung, Christiansen, Evald H., Kaltoft, Anne, Lassen, Jens F., Bøtker, Hans Erik, and Achenbach, Stephan
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NONINVASIVE diagnostic tests , *ANGIOGRAPHY , *COMPUTED tomography , *CORONARY disease , *DIAGNOSIS , *CORONARY artery stenosis , *CORONARY circulation - Abstract
Objectives: The goal of this study was to determine the diagnostic performance of noninvasive fractional flow reserve (FFR) derived from standard acquired coronary computed tomography angiography (CTA) datasets (FFRCT) for the diagnosis of myocardial ischemia in patients with suspected stable coronary artery disease (CAD). Background: FFR measured during invasive coronary angiography (ICA) is the gold standard for lesion-specific coronary revascularization decisions in patients with stable CAD. The potential for FFRCT to noninvasively identify ischemia in patients with suspected CAD has not been sufficiently investigated. Methods: This prospective multicenter trial included 254 patients scheduled to undergo clinically indicated ICA for suspected CAD. Coronary CTA was performed before ICA. Evaluation of stenosis (>50% lumen reduction) in coronary CTA was performed by local investigators and in ICA by an independent core laboratory. FFRCT was calculated and interpreted in a blinded fashion by an independent core laboratory. Results were compared with invasively measured FFR, with ischemia defined as FFRCT or FFR ≤0.80. Results: The area under the receiver-operating characteristic curve for FFRCT was 0.90 (95% confidence interval [CI]: 0.87 to 0.94) versus 0.81 (95% CI: 0.76 to 0.87) for coronary CTA (p = 0.0008). Per-patient sensitivity and specificity (95% CI) to identify myocardial ischemia were 86% (95% CI: 77% to 92%) and 79% (95% CI: 72% to 84%) for FFRCT versus 94% (86 to 97) and 34% (95% CI: 27% to 41%) for coronary CTA, and 64% (95% CI: 53% to 74%) and 83% (95% CI: 77% to 88%) for ICA, respectively. In patients (n = 235) with intermediate stenosis (95% CI: 30% to 70%), the diagnostic accuracy of FFRCT remained high. Conclusions: FFRCT provides high diagnostic accuracy and discrimination for the diagnosis of hemodynamically significant CAD with invasive FFR as the reference standard. When compared with anatomic testing by using coronary CTA, FFRCT led to a marked increase in specificity. (HeartFlowNXT–HeartFlow Analysis of Coronary Blood Flow Using Coronary CT Angiography [HFNXT]; NCT01757678) [Copyright &y& Elsevier]
- Published
- 2014
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14. A prospective randomized trial comparing image quality, study interpretability, and radiation dose of narrow acquisition window with widened acquisition window protocols in prospectively ECG-triggered coronary computed tomography angiography.
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Leipsic, Jonathon, LaBounty, Troy M., Ajlan, Amr M., Earls, James P., Strovski, E., Madden, Mark, Wood, David A., Hague, Cameron J., Poulter, Rohan, Branch, Kelly, Cury, Ricardo C., Heilbron, Brett, Taylor, Carolyn, Grunau, Gilat, Haiducu, Lawrence, and Min, James K.
- Subjects
RANDOMIZED controlled trials ,IMAGE quality in imaging systems ,ELECTROCARDIOGRAPHY ,TOMOGRAPHY ,ANGIOGRAPHY ,HEART blood-vessels - Abstract
Abstract: Background: Prospectively triggered coronary computed tomography angiography (CTA) is commonly performed with a widened acquisition window to provide flexibility in image reconstruction. Objective: We conducted a randomized controlled trial to determine whether the use of a narrow acquisition window in prospectively triggered coronary CTA would allow lower radiation dose while preserving image quality and interpretability. Methods: Prospective 2-center 2- platform randomized trial that evaluated 205 consecutive patients 96 with widened acquisition (WA) and 109 narrow acquisition (NA) referred for coronary CTA in sinus rhythm and heart rate <65 beats/min. Patients scanned with WA had phases reconstructed at 5% intervals, and each phase was assigned an individual study ID. Images were reviewed with individual phase reconstructions interpreted randomly by 2 level 3 readers with a third for consensus. Images were evaluated with a 5-point Likert scale on a per-vessel basis (best score on any phase). Scores were then dichotomized into diagnostic (score 3–5) compared with nondiagnostic (score 1–2). Readers also reported obstructive coronary artery disease on a per-patient basis. Agreement for the diagnosis of obstructive disease and per-artery interpretability was performed. Signal and noise measurements were also performed. Results: No difference in demographics between groups (P = NS). The signal-to-noise ratio was comparable 12.99 ± 3.4 NA and 12.53 ± 4.13 for the WA (P = 0.45). The median effective dose was 1.78 mSv for NA compared with 3.26 mSv for WA (P < 0.001). Image quality, diagnostic interpretability, interreader agreement, and downstream testing were not significantly different between the 2 groups (P= NS for all). Conclusions: Coronary CTA with NA resulted in a 47% lower radiation dose without significant difference in study interpretability or image quality or increased downstream resource use or testing. [Copyright &y& Elsevier]
- Published
- 2013
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15. Evaluation of myocardial CT perfusion in patients presenting with acute chest pain to the emergency department: comparison with SPECT-myocardial perfusion imaging.
- Author
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Feuchtner, Gudrun Maria, Plank, Fabian, Pena, Constantino, Battle, Juan, Min, James, Leipsic, Jonathon, Labounty, Troy, Janowitz, Warren, Katzen, Barry, Ziffer, Jack, and Cury, Ricardo C.
- Subjects
TOMOGRAPHY ,PERFUSION ,CHEST pain ,ANGIOGRAPHY ,PHOTON emission ,CARDIAC imaging ,PATIENTS - Abstract
Objective To determine whether evaluation of resting myocardial CT perfusion (CTP) from coronary CT angiography (CTA) datasets in patients presenting with chest pain (CP) to the emergency department (ED), might have added value to coronary CTA. Design, setting: 76 Patients (age 54.9 y613; 32 (42%) women) presenting with CP to the ED underwent coronary 64-slice CTA. Myocardial perfusion defects were evaluated for CTP (American Heart Association 17-segment model) and compared with rest sestamibi single-photon emission CT myocardial perfusion imaging (SPECT-MPI). CTA was assessed for >50% stenosis per vessel. Results: CTP demonstrated a sensitivity of 92% and 89%, specificity of 95% and 99%, positive predictive value (PPV) of 80% and 82% and negative predictive value (NPV) of 98% and 99% for each patient and for each segment, respectively. CTA showed an accuracy of 92%, sensitivity of 70.4%, specificity of 95.5%, PPV 67.8%, and NPV of 95% compared with SPECT-MPI. When CTP findings were added to CTA the PPV improved from 67% to 90.1%. Conclusions In patients presenting to the ED with CP, the evaluation of rest myocardial CTP demonstrates high diagnostic performance as compared with SPECT-MPI. Addition of CTP to CTA improves the accuracy of CTA, primarily by reducing rates of false-positive CTA. INSET: Key messages. [ABSTRACT FROM AUTHOR]
- Published
- 2012
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16. Diagnostic Accuracy of Fractional Flow Reserve From Anatomic CT Angiography.
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Min, James K., Leipsic, Jonathon, Pencina, Michael J., Berman, Daniel S., Bon-Kwon Koo, van Mieghem, Carlos, Erglis, Andrejs, Lin, Fay T., Dunning, Allison M., Apruzzese, Patricia, Budoff, Matthew J., Cole, Jason H., Jaffer, Farouc A., Leon, Martin B., Malpeso, Jennifer, Mancini, G. B. John, Seung-Jung Park, Schwartz, Ropert S., Shaw, Leslee J., and Mauri, Laura
- Subjects
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CATHETERIZATION , *TOMOGRAPHY , *CORONARY artery stenosis , *ANGIOGRAPHY , *CORONARY disease , *ISCHEMIA , *PHYSIOLOGICAL research , *CORONARY arterial radiography - Abstract
The article presents a study to assess the diagnostic performance of fractional flow reserve (FFR) and computed tomography (CT) for diagnosis of coronary stenosis. It informs that the coronary computed tomographic (CT) angiography is a noninvasive anatomic test for diagnosis of coronary artery disease (CAD) or stenosis irrespective of ischemia. It further adds that the fractional flow reserve (FFR) is a physiologic measure of coronary stenosis reflecting the amount of coronary flow stenosis and an invasive procedure. It is concluded that the use of noninvasive FFR and CT among stable patients of CAD are associated with improved diagnostic accuracy.
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- 2012
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17. Diagnostic Accuracy of Fractional Flow Reserve from Anatomic Computed TOmographic Angiography: The DeFACTO Study.
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Min, James K., Leipsic, Jonathon, Pencina, Michael J., Berman, Daniel S., Koo, Bon-Kwon, van Mieghem, Carlos, Erglis, Andrejs, Lin, Fay Y., Dunning, Allison M., Apruzzese, Patricia, Budoff, Matthew J., Cole, Jason H., Jaffer, Farouc A., Leon, Martin B., Malpeso, Jennifer, Mancini, G. B. John, Park, Seung-Jung, Schwartz, Robert S., Shaw, Leslee J., and Mauri, Laura
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TOMOGRAPHY , *ANGIOGRAPHY , *CORONARY disease , *CORONARY arteries ,HEART disease research - Abstract
The article provides information on the DeFACTO study which examined the diagnostic performance of fractional flow reserve (FFR) from computed tomography (CT) for the detection and exclusion of hemodynamically significant coronary artery disease (CAD) in a prospective multicenter international study. It outlines inclusion/exclusion criteria of the study participants. It also details study procedures.
- Published
- 2012
18. Prospectively ECG Gated CT pulmonary angiography versus helical ungated CT pulmonary angiography: Impact on cardiac related motion artifacts and patient radiation dose
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Shuman, William P., Leipsic, Jonathon A., Busey, Janet M., Green, Douglas E., Pipavath, Sudhakar N., Hague, Cameron J., and Koprowicz, Kent M.
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ELECTROCARDIOGRAPHY , *ANGIOGRAPHY , *TOMOGRAPHY , *LUNG radiography , *MEDICAL artifacts , *RADIATION doses , *PULMONARY embolism - Abstract
Abstract: Objective: To compare prospectively ECG gated CT pulmonary angiography (CTPA) with routine helical ungated CTPA for cardiac related motion artifacts and patient radiation dose. Subjects and methods: Twenty patients with signs and symptoms suspicious for pulmonary embolism and who had a heart rate below 85 were scanned with prospectively ECG gated CTPA. These gated exams were matched for several clinical parameters to exams from twenty similar clinical patients scanned with routine ungated helical CTPA. Three blinded independent reviewers subjectively evaluated all exams for overall pulmonary artery enhancement and for several cardiac motion related artifacts, including vessel blurring, intravascular shading, and double line. Reviewers also measured pulmonary artery intravascular density and image noise. Patient radiation dose for each technique was compared. Fourteen clinical prospectively ECG gated CTPA exams from a second institution were evaluated for the same parameters. Results: Prospectively ECG gated CTPA resulted in significantly decreased motion-related image artifact scores in lung segments adjacent to the heart compared to ungated CTPA. Measured image noise was not significantly different between the two types of CTPA exams. Effective dose was 28% less for prospectively ECG gated CTPA (4.9mSv versus 6.8mSv, p =0.02). Similar results were found in the prospectively ECG gated exams from the second institution. Conclusion: Compared to routine helical ungated CTPA, prospectively ECG gated CTPA may result in less cardiac related motion artifact in lung segments adjacent to the heart and significantly less patient radiation dose. [Copyright &y& Elsevier]
- Published
- 2012
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19. Prediction of Optimal Deployment Projection for Transcatheter Aortic Valve Replacement.
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Binder, Ronald K., Leipsic, Jonathon, Wood, David, Moore, Teri, Toggweiler, Stefan, Willson, Alex, Gurvitch, Ronen, Freeman, Melanie, and Webb, John G.
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HEART valve transplantation ,TOMOGRAPHY ,ANGIOGRAPHY ,PATIENT selection ,ARTIFICIAL organs ,AORTIC valve surgery - Abstract
The article discusses a study on the ability and practicability of 3DA to determine the optimal perpendicular valve projection for accurate positioning and deployment of valve prosthesis in transcatheter aortic valve replacement (TAVR) and compared the method with multidetector computed tomography (MDCT). Patient had MDC during the week before and 3DA at the start of TAVR. It suggests that the role of MDCT for patient selection, planning and conducting TAVR is well established.
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- 2012
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20. Rationale and design of the DeFACTO (Determination of Fractional Flow Reserve by Anatomic Computed Tomographic AngiOgraphy) study.
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Min, James K., Berman, Daniel S., Budoff, Matthew J., Jaffer, Farouc A., Leipsic, Jonathon, Leon, Martin B., Mancini, G.B. John, Mauri, Laura, Schwartz, Robert S., and Shaw, Leslee J.
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CORONARY disease ,COMPUTATIONAL fluid dynamics ,TOMOGRAPHY ,ANGIOGRAPHY ,ISCHEMIA ,CORONARY artery stenosis ,PERFORMANCE evaluation ,HEMODYNAMICS - Abstract
Background: Coronary computed tomographic angiography (CTA) allows for noninvasive identification of anatomic coronary artery disease (CAD) severity but does not discriminate whether a stenosis causes ischemia. Computational fluid dynamic techniques applied to CTA images now permit noninvasive computation of fractional flow reserve (FFR), a measure of lesion-specific ischemia, but the diagnostic performance of computed FFR (FFR
CT ) as compared with measured FFR at the time of invasive coronary angiography remains unexplored. Objective: We determined the diagnostic accuracy of noninvasive FFRCT for the detection and exclusion of ischemia-causing stenoses. Methods: DeFACTO (NCT01233518) is a prospective, international, multicenter study of 238 patients designed to evaluate the diagnostic performance of FFRCT for the detection of hemodynamically significant coronary artery stenoses identified by CTA, compared with invasive FFR as a reference standard. FFR values ≤ 0.80 will be considered hemodynamically significant. Patients enrolled in the DeFACTO study will undergo CTA, invasive coronary angiography, and 3-vessel FFR in the left anterior descending artery, left circumflex artery, and right coronary artery distributions. FFRCT will be computed with acquired CTA images, without modification to CTA image acquisition protocols and without additional image acquisition. Blinded core laboratory interpretation will be performed for CTA, invasive coronary angiography, FFR, and FFRCT . Results: The primary endpoint of the DeFACTO study is the per-patient diagnostic accuracy of FFRCT for noninvasive assessment of the hemodynamic significance of CAD, compared with FFR during invasive coronary angiography as a reference standard. The secondary endpoints include additional per-patient as well as per-vessel diagnostic performance characteristics, including sensitivity, specificity, positive predictive value, and negative predictive value. Conclusion: The DeFACTO study will determine whether the addition of FFRCT to conventional CTA improves the diagnosis of hemodynamically significant CAD. [Copyright &y& Elsevier]- Published
- 2011
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21. Multidetector Computed Tomography in Transcatheter Aortic Valve Implantation.
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Leipsic, Jonathon, Gurvitch, Ronen, LaBounty, Troy M., Min, James K., Wood, David, Johnson, Mark, Ajlan, Amr M., Wijesinghe, Namal, and Webb, John G.
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AORTIC stenosis ,AORTIC valve transplantation ,MEDICAL screening ,TOMOGRAPHY ,ANGIOGRAPHY ,ELECTROCARDIOGRAPHY - Abstract
Aortic stenosis is a common disorder. Aortic valve replacement is indicated in symptomatic patients with severe aortic stenosis, as the prognosis of untreated patients is poor. Nevertheless, many patients pose a prohibitively high surgical risk and are not candidates for surgical valve replacement. Transcatheter aortic valve implantation (TAVI) is a novel method to treat selected high-risk patients with aortic stenosis. Patient screening and anatomic measurements of the aortic root are of great importance to ensure procedural success and appropriate patient selection. Multidetector computed tomography (CT) is playing an increasingly important role in patient screening protocols before TAVI, provides detailed anatomic assessment of the aortic root and valve annulus, assesses the suitability of iliofemoral access, and determines appropriate coaxial angles to optimize the valve implantation procedure. Additionally, CT is providing a greater understanding of medium-term valve durability and integrity. This review outlines an evolving role for CT angiography in support of a TAVI program and describe step by step how CT can be used to enhance the procedure and provide a practical guide for the utilization of CT angiography in support of a transcatheter aortic valve program. [ABSTRACT FROM AUTHOR]
- Published
- 2011
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22. Multislice Computed Tomography for Prediction of Optimal Angiographic Deployment Projections During Transcatheter Aortic Valve Implantation.
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Gurvitch, Ronen, Wood, David A., Leipsic, Jonathon, Tay, Edgar, Johnson, Mark, Ye, Jian, Nietlispach, Fabian, Wijesinghe, Namal, Cheung, Anson, and Webb, John G.
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AORTIC stenosis ,TOMOGRAPHY ,ARTERIAL catheters ,ARTIFICIAL implants ,AORTIC valve surgery ,ANGIOGRAPHY - Abstract
Objectives: This study assessed whether multislice computed tomography (MSCT) could predict optimal angiographic projections for visualizing the plane of the native valve and facilitate accurate positioning during transcatheter aortic valve implantation (TAVI). Background: Accurate device positioning during TAVI depends on valve deployment in angiographic projections perpendicular to the native valve plane, but these may be difficult to determine. Methods: Twenty patients underwent MSCT before TAVI. Using a novel technique, multiple angiographic projections accurately representing the native valve plane in multiple axes were determined. The accuracy of all predicted projections was determined post-procedure using angiography according to new criteria, based on valve perpendicularity and the degree of strut overlap (defined as excellent, satisfactory, or poor). The accuracy of valve deployment using MSCT was compared with the results of 20 consecutive patients undergoing TAVI without such MSCT angle prediction. Results: Correct final deployment projections were more frequent in the MSCT-guided compared with non–MSCT-guided group: excellent or satisfactory projections (90% vs. 65%, p = 0.06). The MSCT angle prediction was accurate but dependent on optimal images (optimal images: 93% of predicted angles were excellent or satisfactory, suboptimal images: 73% of predicted angles were poor). A “line of perpendicularity” could be generated with optimal projections across the right-to-left anterior oblique plane by adding the correct cranial or caudal angulation. Conclusions: Pre-procedural MSCT can predict optimal angiographic deployment projections for implantation of transcatheter valves. An ideal deployment angle curve or “line of perpendicularity” can be generated. Understanding and applying these principles improves the accuracy of valve deployment and may improve outcomes. [ABSTRACT FROM AUTHOR]
- Published
- 2010
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23. What is the optimal number of readers needed to achieve high diagnostic accuracy in coronary computed tomographic angiography? A comparison of alternate reader combinations.
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LaBounty, Troy M., Leipsic, Jonathon, Srichai, Monvadi B., Mancini, G.B. John, Lin, Fay Y., Dunning, Allison M., and Min, James K.
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TOMOGRAPHY ,ANGIOGRAPHY ,RADIOSCOPIC diagnosis ,CORONARY artery stenosis ,CORONARY disease ,MEDICAL radiography ,MEDICAL statistics - Abstract
Background: Coronary computed tomographic angiography (CCTA) possesses high accuracy to detect coronary artery disease (CAD), although studies have reported differences in diagnostic performance. Prior trials used different numbers of interpreters, and the optimal number to detect CAD is unknown. Objective: We compared the diagnostic performance of 1, 2, 3, and 5 randomly selected interpreters for CCTA. Methods: We evaluated 50 patients randomly selected from 2 multicenter studies with both 64-detector CCTA and invasive quantitative coronary angiography (QCA). Five blinded, experienced readers independently interpreted CCTA and assessed for obstructive CAD (≥50% stenosis) and high-risk CAD (left main, proximal left anterior descending, or 3-vessel stenoses). A core laboratory performed QCA. For each patient, different random combinations of readers were selected; the accuracy of 1, 2, and 5 readers was compared with 3 readers. Results: Obstructive and high-risk CAD were observed in 20 of 50 (40%) and 6 of 50 (12%) patients, respectively. With combinations of 1, 2, 3, or 5 readers, there was a range of per-patient diagnostic performance (sensitivity, 100% each; specificity, 67%–90%; accuracy, 80%–94%; P = NS), per-segment diagnostic performance (sensitivity, 67%–83%; specificity, 87%–93%; accuracy, 87%–92%; P < .001 for 1 vs 3 and 2 vs 3 readers), and detection of high-risk CAD (sensitivity, 83%–100%; specificity, 73%–80%; accuracy, 76%–82%; P = NS). The highest diagnostic accuracy was observed with 3 readers for each comparison. Conclusion: The diagnostic performance of CCTA to detect obstructive or high-risk CAD is generally high irrespective of the number of readers. Consensus interpretation by ≥3 readers provides the highest diagnostic accuracy. [ABSTRACT FROM AUTHOR]
- Published
- 2010
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24. Effect of a Standardized Radiation Dose Reduction Protocol on Diagnostic Accuracy of Coronary Computed Tomographic Angiography
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LaBounty, Troy M., Leipsic, Jonathon, Mancini, G.B. John, Heilbron, Brett, Patel, Smita, Kazerooni, Ella A., Sundaram, Baskaran, Lin, Fay Y., Dunning, Allison, Saltzman, Adam J., Weisz, Giora, Weinsaft, Jonathan W., Choi, Jin-Ho, Koduru, Sunaina, and Min, James K.
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CARDIOGRAPHIC tomography , *CORONARY disease , *DIAGNOSIS , *RADIATION doses , *CORONARY arterial radiography , *CORONARY artery stenosis , *MEDICAL protocols , *ANGIOGRAPHY - Abstract
Although numerous strategies for radiation dose decrease in coronary computed tomographic angiography are effective, their combined impact on diagnostic performance is not known. We therefore assessed the effect of a standardized coronary computed tomographic angiographic protocol on diagnostic accuracy. We evaluated 80 consecutive patients from 3 sites with coronary computed tomographic angiography and quantitative coronary angiography. All sites initially used nonstandardized protocols; 2 sites then initiated a standardized protocol, and 1 site continued its nonstandardized protocol as a time-overlapping control. Two blinded readers interpreted coronary computed tomographic angiographic studies; a third obtained consensus. A blinded core laboratory performed quantitative coronary angiography. Each segment was graded as <50% or ≥50% diameter stenosis. Compared to those using nonstandardized protocols (n = 35), studies using standardized protocols (n = 45) had a trend to increased use of prospective gating (p = 0.09), lower voltage (p <0.01), decreased current (p <0.01), and shorter scan length (p <0.01). Median (interquartile range) radiation dose decreased from 5.7 mSv (4.0 to 10.8) to 2.0 mSv (1.3 to 3.4, p <0.001). There were no significant differences in sensitivity (100%, 20 of 20, vs 100%, 18 of 18, p = 1.0), specificity (93%, 14 of 15, vs 85%, 23 of 27, p = 0.61), or accuracy (97%, 34 of 35, vs 91%, 41 of 45, p = 0.27) by patient; sensitivity (83%, 33 of 40, vs 83%, 25 of 30, p = 0.93), specificity (92%, 86 of 93, vs 92%, 134 of 146, p = 0.85), or accuracy (89%, 119 of 133, vs 90%, 159 of 176, p = 0.80) by artery; or sensitivity (80%, 44 of 55, vs 72%, 26 of 36, p = 0.74), specificity (94%, 332 of 353, vs 94%, 499 of 531, p = 0.96), or accuracy (92%, 376 of 408, vs 93%, 525 of 567, p = 0.80) by segment. In conclusion, a standardized dose-decrease protocol for coronary computed tomographic angiography decreases radiation dose without affecting diagnostic performance. [Copyright &y& Elsevier]
- Published
- 2010
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25. Diagnostic Algorithms for Stable Chest Pain: From Opinion to Science Lessons From PROMISE.
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Leipsic, Jonathon, Naoum, Christopher, and Blanke, Philipp
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CORONARY disease , *CHEST pain diagnosis , *ANGIOGRAPHY , *PSYCHOLOGICAL stress , *GENDER differences (Psychology) , *MEDICAL decision making , *PROGNOSIS , *ALGORITHMS , *ATTITUDE (Psychology) , *CHEST pain - Published
- 2016
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26. Fractional Flow Reserve Derived from Coronary Computed Tomography Angiography Safely Defers Invasive Coronary Angiography in Patients with Stable Coronary Artery Disease.
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Rabbat, Mark, Leipsic, Jonathon, Bax, Jeroen, Kauh, Brian, Verma, Rina, Doukas, Demetrios, Allen, Sorcha, Pontone, Gianluca, Wilber, David, Mathew, Verghese, Rogers, Campbell, and Lopez, John
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CORONARY disease , *CORONARY angiography , *COMPUTED tomography , *ANGIOGRAPHY , *CARDIOGRAPHIC tomography , *STRESS echocardiography - Abstract
Objectives: In the United States, the real-world feasibility and outcome of using fractional flow reserve from coronary computed tomography angiography (FFRCT) is unknown. We sought to determine whether a strategy that combined coronary computed tomography angiography (CTA) and FFRCT could safely reduce the need for invasive coronary angiography (ICA), as compared to coronary CTA alone. Methods: The study included 387 consecutive patients with suspected CAD referred for coronary CTA with selective FFRCT and 44 control patients who underwent CTA alone. Lesions with 30–90% diameter stenoses were considered of indeterminate hemodynamic significance and underwent FFRCT. Nadir FFRCT ≤ 0.80 was positive. The rate of patients having ICA, revascularization and major adverse cardiac events were recorded. Results: Using coronary CTA and selective FFRCT, 121 patients (32%) had at least one vessel with ≥50% diameter stenosis; 67/121 (55%) patients had at least one vessel with FFRCT ≤ 0.80; 55/121 (45%) underwent ICA; and 34 were revascularized. The proportion of ICA patients undergoing revascularization was 62% (34 of 55). The number of patients with vessels with 30–50% diameter of stenosis was 90 (23%); 28/90 (31%) patients had at least one vessel with FFRCT ≤ 0.80; 8/90 (9%) underwent ICA; and five were revascularized. In our institutional practice, compared to coronary CTA alone, coronary CTA with selective FFRCT reduced the rates of ICA (45% vs. 80%) for those with obstructive CAD. Using coronary CTA with selective FFRCT, no major adverse cardiac events occurred over a mean follow-up of 440 days. Conclusion: FFRCT safely deferred ICA in patients with CAD of indeterminate hemodynamic significance. A high proportion of those who underwent ICA were revascularized. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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27. Percutaneous Aortic Valve Replacement: Vascular Outcomes With a Fully Percutaneous Procedure
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Toggweiler, Stefan, Gurvitch, Ronen, Leipsic, Jonathon, Wood, David A., Willson, Alexander B., Binder, Ronald K., Cheung, Anson, Ye, Jian, and Webb, John G.
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HEART valve transplantation , *SURGICAL complications , *ANGIOGRAPHY , *MORTALITY , *MEDICAL statistics , *LONGITUDINAL method ,AORTIC valve surgery - Abstract
Objectives: The aim of this study was to evaluate vascular complications in a consecutive patient population undergoing transfemoral percutaneous aortic valve replacement (PAVR) applying current Valve Academic Research Consortium definitions. Background: Vascular complications have been the major cause of mortality and morbidity associated with PAVR. Both open surgical and fully percutaneous access site strategies have been advocated. Methods: All patients undergoing transfemoral PAVR during fiscal years 2009 and 2010 were prospectively evaluated at baseline, after the procedure, and at 30 days. Results: PAVR was performed in 137 consecutive patients. All but 1 patient underwent planned arteriotomy closure using a percutaneous pre-closure technique. Smaller sheaths, rigorous angiographic and computed tomographic screening and patient selection, and percutaneous vascular repair techniques were increasingly used over this period. From 2009 to 2010, major vascular complications decreased from 8% to 1% (p = 0.06), minor vascular complications decreased from 24% to 8% (p < 0.01), major bleeds fell from 14% to 1% (p < 0.01), and unplanned surgery decreased from 28% to 2% (p < 0.01). A minimal artery diameter smaller than the external sheath diameter, moderate or severe calcification, and peripheral vascular disease were associated with higher vascular complication rates. Conclusions: Vascular complications occur more often if the minimal artery diameter is smaller than the external sheath diameter, in the presence of moderate or severe calcification, and in patients with peripheral vascular disease. With careful patient selection, advanced interventional techniques, and a fully percutaneous procedure, marked reductions in vascular and bleeding complications can be achieved. [ABSTRACT FROM AUTHOR]
- Published
- 2012
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28. Effect of a Standardized Quality-Improvement Protocol on Radiation Dose in Coronary Computed Tomographic Angiography
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LaBounty, Troy M., Earls, James P., Leipsic, Jonathon, Heilbron, Brett, Mancini, G.B. John, Lin, Fay Y., Dunning, Allison M., and Min, James K.
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MEDICAL protocols , *RADIATION doses , *ANGIOGRAPHY , *MEDICAL imaging systems , *CARDIOGRAPHIC tomography , *IMAGE quality in imaging systems , *ELECTROCARDIOGRAPHY - Abstract
Coronary computed tomographic angiography (CCTA) is associated with ionizing radiation, prompting concerns of future cancer risk. Recent studies have reported reduced radiation doses and similar image quality by the selective use of dose reduction techniques, although the clinical penetration of these methods has been limited. In a quality improvement initiative, a comprehensive, standardized radiation dose reduction protocol was implemented, and its effect on radiation dose and image quality was assessed. A total of 449 patients who underwent 64-detector CCTA at 3 centers were prospectively evaluated, and patients were compared before (n = 247) and after (n = 202) the implementation of a standardized body mass index–based and heart rate–based protocol that simultaneously incorporated multiple dose reduction strategies. Median radiation dose decreased from 2.6 mSv (interquartile range 2.0 to 4.2) to 1.3 mSv (interquartile range 0.8 to 1.9) after the implementation of the standardized protocol (p <0.001). On multivariate analysis, reduction in overall radiation dose was observed by numerous dose reduction techniques, with varying efficacy of dose lowering: prospective (vs retrospective) electrocardiographic gating (−82%), reduced tube voltage (−41% for 100 vs 120 kV), lower tube current (−25% per −100 mA), and reduced overall scan length (−6% per −1 cm) (p <0.001 for each). No differences were observed between patients before and after the initiation of the protocol for study interpretability (96% vs 96%, p = 0.66). There was an increase in signal-to-noise ratio after implementing the standardized protocol (11 ± 3 vs 12 ± 4, p <0.01). In conclusion, a quality improvement protocol for CCTA incorporating multiple dose reduction techniques permits significant radiation dose reduction and may improve the safety profile of CCTA. [ABSTRACT FROM AUTHOR]
- Published
- 2010
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29. Coronary Computed Tomographic Angiography for Complete Assessment of Coronary Artery Disease: JACC State-of-the-Art Review.
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Serruys, Patrick W., Hara, Hironori, Garg, Scot, Kawashima, Hideyuki, Nørgaard, Bjarne L., Dweck, Marc R., Bax, Jeroen J., Knuuti, Juhani, Nieman, Koen, Leipsic, Jonathon A., Mushtaq, Saima, Andreini, Daniele, and Onuma, Yoshinobu
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CORONARY artery disease , *COMPUTED tomography , *ANGIOGRAPHY , *CORONARY artery stenosis , *CORONARY angiography - Abstract
Coronary computed tomography angiography (CTA) has shown great technological improvements over the last 2 decades. High accuracy of CTA in detecting significant coronary stenosis has promoted CTA as a substitute for conventional invasive coronary angiography in patients with suspected coronary artery disease. In patients with coronary stenosis, CTA-derived physiological assessment is surrogate for intracoronary pressure and velocity wires, and renders possible decision-making about revascularization solely based on computed tomography. Computed tomography coronary anatomy with functionality assessment could potentially become a first line in diagnosis. Noninvasive imaging assessment of plaque burden and morphology is becoming a valuable substitute for intravascular imaging. Recently, wall shear stress and perivascular inflammation have been introduced. These assessments could support risk management for both primary and secondary cardiovascular prevention. Anatomy, functionality, and plaque composition by CTA tend to replace invasive assessment. Complete CTA assessment could provide a 1-stop-shop for diagnosis, risk management, and decision-making on treatment. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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30. Dual Energy CT Imaging for the Assessment of Coronary Artery Stenosis
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Rodriguez-Granillo, Gastón A., Carrascosa, Patricia M., García, Mario J., Carrascosa, Patricia M., editor, Cury, Ricardo C., editor, García, Mario J., editor, and Leipsic, Jonathon A., editor
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- 2015
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31. Angiography and Rotational Angiography for TAVR
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Daneault, Benoit, Moses, Jeffrey W., Min, James K., editor, Berman, Daniel S., editor, and Leipsic, Jonathon, editor
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- 2014
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32. Coronary CT Angiographic and Flow Reserve-Guided Management of Patients With Stable Ischemic Heart Disease.
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Nørgaard, Bjarne L., Terkelsen, Christian J., Mathiassen, Ole N., Grove, Erik L., Bøtker, Hans Erik, Parner, Erik, Leipsic, Jonathon, Steffensen, Flemming H., Riis, Anders H., Pedersen, Kamilla, Christiansen, Evald H., Mæng, Michael, Krusell, Lars R., Kristensen, Steen D., Eftekhari, Ashkan, Jakobsen, Lars, and Jensen, Jesper M.
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CHEST pain , *COMPUTED tomography , *ANGIOGRAPHY , *CORONARY artery stenosis ,CORONARY artery abnormalities - Abstract
Background: Clinical outcomes following coronary computed tomography-derived fractional flow reserve (FFRCT) testing in clinical practice are unknown.Objectives: This study sought to assess real-world clinical outcomes following a diagnostic strategy including first-line coronary computed tomography angiography (CTA) with selective FFRCT testing.Methods: The study reviewed the results of 3,674 consecutive patients with stable chest pain evaluated with CTA and FFRCT testing to guide downstream management in patients with intermediate stenosis (30% to 70%). The composite endpoint (all-cause death, myocardial infarction, hospitalization for unstable angina, and unplanned revascularization) was determined in 4 patient groups: 1) CTA stenosis <30%, optimal medical treatment (OMT), and no additional testing; 2) FFRCT >0.80, OMT, no additional testing; 3) FFRCT ≤0.80, OMT, no additional testing; and 4) FFRCT ≤0.80, OMT, and referral to invasive coronary angiography. Patients were followed for a median of 24 (range 8 to 41) months.Results: FFRCT was available in 677 patients, and the test result was negative (>0.80) in 410 (61%) patients. In 75% of the patients with FFRCT >0.80, maximum coronary stenosis was ≥50%. The cumulative incidence proportion (95% confidence interval [CI]) of the composite endpoint at the end of follow-up was comparable in groups 1 (2.8%; 95% CI: 1.4% to 4.9%) and 2 (3.9%; 95% CI: 2.0% to 6.9%) (p = 0.58) but was higher (when compared with group 1) in groups 3 (9.4%; p = 0.04) and 4 (6.6%; p = 0.08). Risk of myocardial infarction was lower in group 4 (1.3%) than in group 3 (8%; p < 0.001).Conclusions: In patients with intermediate-range coronary stenosis, FFRCT is effective in differentiating patients who do not require further diagnostic testing or intervention (FFRCT >0.80) from higher-risk patients (FFRCT ≤0.80) in whom further testing with invasive coronary angiography and possibly intervention may be needed. Further studies assessing the risk and optimal management strategy in patients undergoing first-line CTA with selective FFRCT testing are needed. [ABSTRACT FROM AUTHOR]- Published
- 2018
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33. TCT-494 Relationship Between the COVID-19 Public Health Restrictions and Severity of Coronary Artery Disease in Patients Undergoing Coronary Computed Tomography Angiography.
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Gulsin, Gaurav, Tzimas, Georgios, Takagi, Hidenobu, Eddy, Rachel, Park, Park, Blanke, Philipp, Ji-Cathriner, Wendy, Rogers, Campbell, Fonte, Tim, Taylor, Charles, and Leipsic, Jonathon
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CORONARY artery disease , *COVID-19 , *COMPUTED tomography , *ANGIOGRAPHY , *PUBLIC health - Published
- 2021
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34. Determinants of Rejection Rate for Coronary CT Angiography Fractional Flow Reserve Analysis
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Jonathan R. Weir-McCall, Marco Guglielmo, Andrea Baggiano, Takashi Akasaka, Daniel S. Berman, Manesh R. Patel, Bjarne L. Nørgaard, Gilbert L. Raff, Andrea Igoren Guaricci, Jeroen J. Bax, Jonathon Leipsic, Giuseppe Muscogiuri, Alberico Del Torto, Daniele Andreini, Campbell Rogers, Koen Nieman, Gianluca Pontone, Kavitha Chinnaiyan, Laura Fusini, Lynne Hurwitz Koweek, Timothy A. Fairbairn, Pontone, Gianluca [0000-0002-1339-6679], Weir-McCall, Jonathan R [0000-0001-5842-842X], Baggiano, Andrea [0000-0002-8261-4529], Del Torto, Alberico [0000-0001-5074-2078], Fusini, Laura [0000-0003-0309-6231], Guglielmo, Marco [0000-0003-1718-9949], Muscogiuri, Giuseppe [0000-0003-4757-2420], Guaricci, Andrea Igoren [0000-0001-7133-4401], Andreini, Daniele [0000-0002-5996-9209], Patel, Manesh [0000-0002-2393-0855], Nieman, Koen [0000-0002-8312-0598], Rogers, Campbell [0000-0003-3955-7650], Nørgaard, Bjarne L [0000-0002-4758-7203], Raff, Gilbert L [0000-0002-8363-2024], Berman, Daniel [0000-0002-3793-9578], Fairbairn, Timothy [0000-0003-1491-6231], Koweek, Lynne Hurwitz [0000-0001-9990-3397], Leipsic, Jonathon [0000-0002-6133-8334], Apollo - University of Cambridge Repository, Pontone, G, Weir-McCall, J, Baggiano, A, Del Torto, A, Fusini, L, Guglielmo, M, Muscogiuri, G, Guaricci, A, Andreini, D, Patel, M, Nieman, K, Akasaka, T, Rogers, C, Nørgaard, B, Bax, J, Raff, G, Chinnaiyan, K, Berman, D, Fairbairn, T, Koweek, L, and Leipsic, J
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Registrie ,Male ,medicine.medical_specialty ,Coronary Stenosi ,IMPACT ,Computed Tomography Angiography ,ACCURACY ,COMPUTED-TOMOGRAPHY ANGIOGRAPHY ,MULTICENTER ,SOCIETY ,Reproducibility of Result ,Fractional flow reserve ,Coronary Angiography ,RADIATION-EXPOSURE ,Severity of Illness Index ,030218 nuclear medicine & medical imaging ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Severity of illness ,SCCT GUIDELINES ,medicine ,ARTERY-DISEASE ,Humans ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,Registries ,Prospective cohort study ,Aged ,medicine.diagnostic_test ,business.industry ,Coronary Stenosis ,Reproducibility of Results ,Odds ratio ,Confidence interval ,DIAGNOSTIC PERFORMANCE ,Fractional Flow Reserve, Myocardial ,Prospective Studie ,030220 oncology & carcinogenesis ,Angiography ,Cohort ,Cardiology ,Female ,Cohort Studie ,business ,IMAGE QUALITY ,Human ,Cohort study - Abstract
Background Coronary artery fractional flow reserve (FFR) derived from CT angiography (FFTCT) enables functional assessment of coronary stenosis. Prior clinical trials showed 13%-33% of coronary CT angiography studies had insufficient quality for quantitative analysis with FFRCT. Purpose To determine the rejection rate of FFRCT analysis and to determine factors associated with technically unsuccessful calculation of FFRCT. Materials and Methods Prospectively acquired coronary CT angiography scans submitted as part of the Assessing Diagnostic Value of Noninvasive FFRCT in Coronary Care (ADVANCE) registry (https://ClinicalTrials.gov: NCT02499679) and coronary CT angiography series submitted for clinical analysis were included. The primary outcome was the FFRCT rejection rate (defined as an inability to perform quantitative analysis with FFRCT). Factors that were associated with FFRCT rejection rate were assessed with multiple linear regression. Results In the ADVANCE registry, FFRCT rejection rate due to inadequate image quality was 2.9% (80 of 2778 patients; 95% confidence interval [CI]: 2.1%, 3.2%). In the 10 621 consecutive patients who underwent clinical analysis, the FFRCT rejection rate was 8.4% (n = 892; 95% CI: 6.2%, 7.2%; P < .001 vs the ADVANCE cohort). The main reason for the inability to perform FFRCT analysis was the presence of motion artifacts (63 of 80 [78%] and 729 of 892 [64%] in the ADVANCE and clinical cohorts, respectively). At multivariable analysis, section thickness in the ADVANCE (odds ratio [OR], 1.04; 95% CI: 1.001, 1.09; P = .045) and clinical (OR, 1.03; 95% CI: 1.02, 1.04; P < .001) cohorts and heart rate in the ADVANCE (OR, 1.05; 95% CI: 1.02, 1.08; P < .001) and clinical (OR, 1.06; 95% CI: 1.05, 1.07; P < .001) cohorts were independent predictors of rejection. Conclusion The rates for technically unsuccessful CT-derived fractional flow reserve in the ADVANCE registry and in a large clinical cohort were 2.9% and 8.4%, respectively. Thinner CT section thickness and lower patient heart rate may increase rates of completion of CT fractional flow reserve analysis. Published under a CC BY 4.0 license. Online supplemental material is available for this article. See also the editorial by Sakuma in this issue.
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- 2019
35. Aggregate Plaque Volume by Coronary Computed Tomography Angiography Is Superior and Incremental to Luminal Narrowing for Diagnosis of Ischemic Lesions of Intermediate Stenosis Severity.
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Nakazato, Ryo, Shalev, Aryeh, Doh, Joon-Hyung, Koo, Bon-Kwon, Gransar, Heidi, Gomez, Millie J., Leipsic, Jonathon, Park, Hyung-Bok, Berman, Daniel S., and Min, James K.
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COMPUTED tomography , *ANGIOGRAPHY , *ISCHEMIA diagnosis , *SEVERITY of illness index , *CORONARY artery stenosis , *ISCHEMIA , *PATIENTS - Abstract
Objectives: This study examined the performance of percent aggregate plaque volume (%APV), which represents cumulative plaque volume as a function of total vessel volume, by coronary computed tomography angiography (CTA) for identification of ischemic lesions of intermediate stenosis severity. Background: Coronary lesions of intermediate stenosis demonstrate significant rates of ischemia. Coronary CTA enables quantification of luminal narrowing and %APV. Methods: We identified 58 patients with intermediate lesions (30% to 69% diameter stenosis) who underwent invasive angiography and fractional flow reserve. Coronary CTA measures included diameter stenosis, area stenosis, minimal lumen diameter (MLD), minimal lumen area (MLA) and %APV. %APV was defined as the sum of plaque volume divided by the sum of vessel volume from the ostium to the distal portion of the lesion. Fractional flow reserve ≤0.80 was considered diagnostic of lesion-specific ischemia. Area under the receiver operating characteristic curve and net reclassification improvement (NRI) were also evaluated. Results: Twenty-two of 58 lesions (38%) caused ischemia. Compared with nonischemic lesions, ischemic lesions had smaller MLD (1.3 vs. 1.7 mm, p = 0.01), smaller MLA (2.5 vs. 3.8 mm2, p = 0.01), and greater %APV (48.9% vs. 39.3%, p < 0.0001). Area under the receiver operating characteristic curve was highest for %APV (0.85) compared with diameter stenosis (0.68), area stenosis (0.66), MLD (0.75), or MLA (0.78). Addition of %APV to other measures showed significant reclassification over diameter stenosis (NRI 0.77, p < 0.001), area stenosis (NRI 0.63, p = 0.002), MLD (NRI 0.62, p = 0.001), and MLA (NRI 0.43, p = 0.01). Conclusions: Compared with diameter stenosis, area stenosis, MLD, and MLA, %APV by coronary CTA improves identification, discrimination, and reclassification of ischemic lesions of intermediate stenosis severity. [Copyright &y& Elsevier]
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- 2013
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36. Usefulness of Noninvasive Fractional Flow Reserve Computed from Coronary Computed Tomographic Angiograms for Intermediate Stenoses Confirmed by Quantitative Coronary Angiography
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Min, James K., Koo, Bon-Kwon, Erglis, Andrejs, Doh, Joon-Hyung, Daniels, David V., Jegere, Sanda, Kim, Hyo-Soo, Dunning, Allison M., DeFrance, Tony, Lansky, Alexandra, and Leipsic, Jonathon
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NONINVASIVE diagnostic tests , *ANGIOGRAPHY , *CARDIOGRAPHIC tomography , *CORONARY artery stenosis , *PERFORMANCE evaluation , *ISCHEMIA - Abstract
Coronary lesions of intermediate severity often cause ischemia, and fractional flow reserve (FFR)-guided revascularization for these coronary lesions is safe and effective. FFR derived from coronary computed tomography (FFRCT) is a noninvasive method for diagnosis of lesion-specific ischemia, but its performance for intermediate stenoses has not been examined to date. We examined the performance of FFRCT versus FFR at the time of invasive angiography in 66 vessels of 60 patients who were identified as having an intermediate stenosis, defined by quantitative coronary angiographic percent diameter stenosis 40% to 69%. Ischemia for FFRCT and FFR was defined as ≤0.80. Diagnostic performance of FFRCT was determined compared to an invasive FFR standard. Mean age of the study group was 63.5 ± 8.1 years (81% men). Thirty-one patients (47%) demonstrated ischemia with an FFR ≤0.80, with 2 of 16 (12.5%), 21 of 37 (56.8%), and 8 of 13 (61.5%) lesions of 40% to 49%, 50% to 59%, and 60% to 69% stenosis causal of ischemia, respectively. At an FFR ≤0.80 cutoff for lesion-specific ischemia, accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of FFRCT were 86.4%, 90.3%, 82.9%, 82.4%, and 90.6%, respectively, with an area under the receiver operator characteristics curve of 0.95 (p <0.001) and good correlation to FFR (0.60, p <0.0001). No biases between FFRCT and FFR were noted by Bland–Altman analysis (0.03 ± 0.12, p = 0.054). In conclusion, FFRCT is a novel noninvasive method for diagnosis of lesion-specific ischemia of coronary lesions of intermediate stenosis severity. [ABSTRACT FROM AUTHOR]
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- 2012
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37. TCT-62 Assessment of Coronary Artery Stenoses on Computed Tomography Angiography: Reproducibility and Repeatability Level 3 Readers Compared With Artificial Intelligence-Supported Analysts.
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Tzimas, Georgios, Gulsin, Gaurav, Takagi, Hidenobu, Blanke, Philipp, Fournier, Stephane, Muller, Olivier, Sellers, Stephanie, and Leipsic, Jonathon
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COMPUTED tomography , *CORONARY arteries , *ANGIOGRAPHY , *STENOSIS , *STATISTICAL reliability - Published
- 2021
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38. ASSOCIATION OF BASELINE CORONARY PLAQUE BURDEN AND FRACTIONAL FLOW RESERVE DERIVED FROM CORONARY COMPUTED TOMOGRAPHY ANGIOGRAPHY (CCTA) IN THE EVAPORATE TRIAL.
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Lakshmanan, Suvasini, Kinninger, April, Golub, Ilana, Rabbat, Mark, Rogers, Campbell, Leipsic, Jonathon, Bhatt, Deepak, and Budoff, Matthew
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COMPUTED tomography , *ANGIOGRAPHY - Published
- 2021
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39. Abstract 15831: Novel Prediction Model Based on Machine Learning Algorithm to Identify Rapid Coronary Plaque Progressor Using Quantitative Assessment of Coronary Computed Tomography Angiography.
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Han, Donghee, Kolli, Kranthi K, Gransar, Heidi, Lin, Fay Y, Lee, Ji Hyun, Rizvi, Asim, Kumar, Amit, Lee, Sang-Eun, Sung, Ji-Min, Park, Hyung-bok, Heo, Ran, Andreini, Daniele, Budoff, Matthew J, Cademartiri, Filippo, Chinnaiyan, Kavitha, Choi, Jung Hyun, Conte, Edoardo, Gottlieb, Ilan, Hadamitzky, Martin, and Leipsic, Jonathon
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COMPUTED tomography , *MACHINE learning , *PREDICTION models , *ANGIOGRAPHY , *FEATURE selection - Abstract
Background: Rapid progression of coronary atherosclerosis is related to high risk of future cardiovascular events. Recent developments in coronary computed tomography angiography (CCTA) enable the comprehensive evaluation and quantification of coronary plaques. Utilizing quantitative CT plaque analysis, we aim to examine the predictive value of a machine learning (ML) based prediction model to identify patients with rapid plaque progression (RPP). Method: A total 1,255 patients (mean age: 60, 712 (57%) male) who underwent repeated CCTA were enrolled. Quantitative CT plaque analysis was performed and RPP was defined as annual progression of percent plaque volume more than estimated cut-off (0.48%/year). ML involved feature selection by information gain ranking, splitting data randomly into a training (70%) and test set (30%), and model building with a boosted ensemble algorithm. We employed the following models: Model 1, clinical and laboratory variables (e.g., age, diabetes); Model 2, Model 1+Qualitative CT parameters (e.g., presence of high risk plaque features); Model 3, Model 2+Quantitative CT parameters (e.g., %plaque volume, fibrous plaque). The performance of ML to predict RPP was compared using ROC analysis. Result: 516 patients (41%) were identified as RPP. Among a total 82 variables, feature selection in ML identified quantitative CT variables as higher-ranking features, followed by qualitative CT variables and clinical/laboratory variables (Figure). The ML model 3 exhibited a higher performance to predict RPP when compared with Framingham risk score (FRS) and the other ML models (Model 3: 0.84 (95% CI: 0.80-0.88) vs FRS: 0.59 (0.53-0.65), Model 1: 0.65 (0.59-0.71), Model 2: 0.73 (0.68-0.78), all p<0.001) Conclusion: The ML-based novel prediction algorithm using quantitative CT analysis showed a high performance to predict patients with rapid plaque progression. Comprehensive quantitative evaluation of coronary plaque by CCTA can help optimize the management of these patients. [ABSTRACT FROM AUTHOR]
- Published
- 2018
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