174 results on '"Leipsic, Jonathon"'
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2. How early can atherosclerosis be detected by coronary CT angiography? Insights from quantitative CT analysis of serial scans in the PARADIGM trial.
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Cardoso R, Choi AD, Shiyovich A, Besser SA, Min JK, Earls J, Andreini D, Al-Mallah MH, Budoff MJ, Cademartiri F, Chinnaiyan K, Choi JH, Chun EJ, Conte E, Gottlieb I, Hadamitzky M, Kim YJ, Lee BK, Leipsic JA, Maffei E, Marques H, de Araújo Gonçalves P, Pontone G, Lee SE, Sung JM, Virmani R, Samady H, Lin FY, Stone PH, Berman DS, Narula J, Shaw LJ, Bax JJ, Chang HJ, and Blankstein R
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- Humans, Male, Middle Aged, Female, Computed Tomography Angiography methods, Retrospective Studies, Predictive Value of Tests, Coronary Angiography methods, Tomography, X-Ray Computed methods, Plaque, Atherosclerotic, Atherosclerosis, Coronary Artery Disease diagnostic imaging
- Abstract
Background: Non-obstructing small coronary plaques may not be well recognized by expert readers during coronary computed tomography angiography (CCTA) evaluation. Recent developments in atherosclerosis imaging quantitative computed tomography (AI-QCT) enabled by machine learning allow for whole-heart coronary phenotyping of atherosclerosis, but its diagnostic role for detection of small plaques on CCTA is unknown., Methods: We performed AI-QCT in patients who underwent serial CCTA in the multinational PARADIGM study. AI-QCT results were verified by a level III experienced reader, who was blinded to baseline and follow-up status of CCTA. This retrospective analysis aimed to characterize small plaques on baseline CCTA and evaluate their serial changes on follow-up imaging. Small plaques were defined as a total plaque volume <50 mm
3 ., Results: A total of 99 patients with 502 small plaques were included. The median total plaque volume was 6.8 mm3 (IQR 3.5-13.9 mm3 ), most of which was non-calcified (median 6.2 mm3 ; 2.9-12.3 mm3 ). The median age at the time of baseline CCTA was 61 years old and 63% were male. The mean interscan period was 3.8 ± 1.6 years. On follow-up CCTA, 437 (87%) plaques were present at the same location as small plaques on baseline CCTA; 72% were larger and 15% decreased in volume. The median total plaque volume and non-calcified plaque volume increased to 18.9 mm3 (IQR 8.3-45.2 mm3 ) and 13.8 mm3 (IQR 5.7-33.4 mm3 ), respectively, among plaques that persisted on follow-up CCTA. Small plaques no longer visualized on follow-up CCTA were significantly more likely to be of lower volume, shorter in length, non-calcified, and more distal in the coronary artery, as compared with plaques that persisted at follow-up., Conclusion: In this retrospective analysis from the PARADIGM study, small plaques (<50 mm3 ) identified by AI-QCT persisted at the same location and were often larger on follow-up CCTA., (Copyright © 2023 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.)- Published
- 2023
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3. When Does a Calcium Score Equate to Secondary Prevention?: Insights From the Multinational CONFIRM Registry.
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Budoff MJ, Kinninger A, Gransar H, Achenbach S, Al-Mallah M, Bax JJ, Berman DS, Cademartiri F, Callister TQ, Chang HJ, Chow BJW, Cury RC, Feuchtner G, Hadamitzky M, Hausleiter J, Kaufmann PA, Leipsic J, Lin FY, Kim YJ, Marques H, Pontone G, Rubinshtein R, Shaw LJ, Villines TC, and Min JK
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- Humans, Male, Middle Aged, Aged, Female, Cohort Studies, Calcium, Secondary Prevention, Risk Assessment methods, Predictive Value of Tests, Disease Progression, Registries, Risk Factors, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease epidemiology, Coronary Artery Disease therapy, Vascular Calcification diagnostic imaging, Vascular Calcification therapy, Vascular Calcification complications, Myocardial Infarction diagnostic imaging, Myocardial Infarction epidemiology, Myocardial Infarction prevention & control, Atherosclerosis
- Abstract
Background: Elevated coronary artery calcium (CAC) scores in subjects without prior atherosclerotic cardiovascular disease (ASCVD) have been shown to be associated with increased cardiovascular risk., Objectives: The authors sought to determine at what level individuals with elevated CAC scores who have not had an ASCVD event should be treated as aggressively for cardiovascular risk factors as patients who have already survived an ASCVD event., Methods: The authors performed a cohort study comparing event rates of patients with established ASVCD to event rates in persons with no history of ASCVD and known calcium scores to ascertain at what level elevated CAC scores equate to risk associated with existing ASCVD. In the multinational CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter) registry, the authors compared ASCVD event rates in persons without a history of myocardial infarction (MI) or revascularization (as categorized on CAC scores) to event rates in those with established ASCVD. They identified 4,511 individuals without known coronary artery disease (CAC) who were compared to 438 individuals with established ASCVD. CAC was categorized as 0, 1 to 100, 101 to 300, and >300. Cumulative major adverse cardiovascular events (MACE), MACE plus late revascularization, MI, and all-cause mortality incidence was assessed using the Kaplan-Meier method for persons with no ASCVD history by CAC level and persons with established ASCVD. Cox proportional hazards regression analysis was used to calculate HRs with 95% CIs, which were adjusted for traditional cardiovascular risk factors., Results: The mean age was 57.6 ± 12.4 years (56% male). In total, 442 of 4,949 (9%) patients experienced MACEs over a median follow-up of 4 years (IQR: 1.7-5.7 years). Incident MACEs increased with higher CAC scores, with the highest rates observed with CAC score >300 and in those with prior ASCVD. All-cause mortality, MACEs, MACE + late revascularization, and MI event rates were not statistically significantly different in those with CAC >300 compared with established ASCVD (all P > 0.05). Persons with a CAC score <300 had substantially lower event rates., Conclusions: Patients with CAC scores >300 are at an equivalent risk of MACE and its components as those treated for established ASCVD. This observation, that those with CAC >300 have event rates comparable to those with established ASCVD, supplies important background for further study related to secondary prevention treatment targets in subjects without prior ASCVD with elevated CAC. Understanding the CAC scores that are associated with ASCVD risk equivalent to stable secondary prevention populations may be important for guiding the intensity of preventive approaches more broadly., Competing Interests: Funding Support and Author Disclosures Dr Budoff has received grant support from the National Institute of Health and General Electric. Dr Al-Mallah has received support from the American Heart Association, BCBS Foundation of Michigan, and Astellas. Dr Cademartiri has received grant support from GE Healthcare; and has served on the Speakers Bureau of Bracco and as a consultant for Servier. Dr Chow holds the Saul and Edna Goldfarb Chair in Cardiac Imaging Research; and has received research support from TD Bank, AusculSciences, Siemens Healthineers, and Artrya. Dr Hausleiter has received a research grant from Siemens Medical Systems. Dr Kaufmann has received institutional research support from GE Healthcare; and has received grant support from Swiss National Science Foundation. Dr Berman has a consultant agreement with General Electric. Dr Min has served as an employee and retains equity from Cleerly, Inc; has served on the medical advisory board for Arineta; and has received grant support from the National Institutes of Health. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
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- 2023
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4. Advances in Coronary Computed Tomographic Angiographic Imaging of Atherosclerosis for Risk Stratification and Preventive Care.
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Bienstock S, Lin F, Blankstein R, Leipsic J, Cardoso R, Ahmadi A, Gelijns A, Patel K, Baldassarre LA, Hadley M, LaRocca G, Sanz J, Narula J, Chandrashekhar YS, Shaw LJ, and Fuster V
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- Humans, Female, Computed Tomography Angiography, Coronary Angiography methods, Constriction, Pathologic, Predictive Value of Tests, Coronary Vessels diagnostic imaging, Risk Assessment, Coronary Artery Disease diagnostic imaging, Plaque, Atherosclerotic, Atherosclerosis
- Abstract
The diagnostic evaluation of coronary artery disease is undergoing a dramatic transformation with a new focus on atherosclerotic plaque. This review details the evidence needed for effective risk stratification and targeted preventive care based on recent advances in automated measurement of atherosclerosis from coronary computed tomography angiography (CTA). To date, research findings support that automated stenosis measurement is reasonably accurate, but evidence on variability by location, artery size, or image quality is unknown. The evidence for quantification of atherosclerotic plaque is unfolding, with strong concordance reported between coronary CTA and intravascular ultrasound measurement of total plaque volume (r >0.90). Statistical variance is higher for smaller plaque volumes. Limited data are available on how technical or patient-specific factors result in measurement variability by compositional subgroups. Coronary artery dimensions vary by age, sex, heart size, coronary dominance, and race and ethnicity. Accordingly, quantification programs excluding smaller arteries affect accuracy for women, patients with diabetes, and other patient subsets. Evidence is unfolding that quantification of atherosclerotic plaque is useful to enhance risk prediction, yet more evidence is required to define high-risk patients across varied populations and to determine whether such information is incremental to risk factors or currently used coronary computed tomography techniques (eg, coronary artery calcium scoring or visual assessment of plaque burden or stenosis). In summary, there is promise for the utility of coronary CTA quantification of atherosclerosis, especially if it can lead to targeted and more intensive cardiovascular prevention, notably for those patients with nonobstructive coronary artery disease and high-risk plaque features. The new quantification techniques available to imagers must not only provide sufficient added value to improve patient care, but also add minimal and reasonable cost to alleviate the financial burden on our patients and the health care system., Competing Interests: Funding Support and Author Disclosures Dr Blankstein has served as a consultant for Caristo Inc, Elucid Inc, HeartFlow Inc, and Nanox AI. Dr Leipsic has served as a consultant for and has stock options in HeartFlow and Circle CV Imaging. Dr Shaw has received speaker honoraria from HeartFlow and Elucid Imaging. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
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- 2023
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5. Low-Density Lipoprotein Cholesterol Is Predominantly Associated With Atherosclerotic Cardiovascular Disease Events in Patients With Evidence of Coronary Atherosclerosis: The Western Denmark Heart Registry.
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Mortensen MB, Dzaye O, Bøtker HE, Jensen JM, Maeng M, Bentzon JF, Kanstrup H, Sørensen HT, Leipsic J, Blankstein R, Nasir K, Blaha MJ, and Nørgaard BL
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- Middle Aged, Humans, Cholesterol, LDL, Risk Factors, Risk Assessment methods, Registries, Denmark epidemiology, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease epidemiology, Coronary Artery Disease complications, Cardiovascular Diseases complications, Atherosclerosis, Vascular Calcification complications
- Abstract
Background: Low-density lipoprotein cholesterol (LDL-C) is an important causal risk factor for atherosclerotic cardiovascular disease (ASCVD). However, a sizable proportion of middle-aged individuals with elevated LDL-C level have not developed coronary atherosclerosis as assessed by coronary artery calcification (CAC). Whether presence of CAC modifies the association of LDL-C with ASCVD risk is unknown. We evaluated the association of LDL-C with future ASCVD events in patients with and without CAC., Methods: The study included 23 132 consecutive symptomatic patients evaluated for coronary artery disease using coronary computed tomography angiography (CTA) from the Western Denmark Heart Registry, a seminational, multicenter-based registry with longitudinal registration of patient and procedure data. We assessed the association of LDL-C level obtained before CTA with ASCVD (myocardial infarction and ischemic stroke) events occurring during follow-up stratified by CAC>0 versus CAC=0 using Cox regression models adjusted for baseline characteristics. Outcomes were identified through linkage among national registries covering all hospitals in Denmark. We replicated our results in the National Heart, Lung, and Blood Institute -funded Multi-Ethnic Study of Atherosclerosis., Results: During a median follow-up of 4.3 years, 552 patients experienced a first ASCVD event. In the overall population, LDL-C (per 38.7 mg/dL increase) was associated with ASCVD events occurring during follow-up (adjusted hazard ratio [aHR], 1.14 [95% CI, 1.04-1.24]). When stratified by the presence or absence of baseline CAC, LDL-C was only associated with ASCVD in the 10 792/23 132 patients (47%) with CAC>0 (aHR, 1.18 [95% CI, 1.06-1.31]); no association was observed among the 12 340/23 132 patients (53%) with CAC=0 (aHR, 1.02 [95% CI, 0.87-1.18]). Similarly, a very high LDL-C level ( > 193 mg/dL) versus LDL-C <116 mg/dL was associated with ASCVD in patients with CAC>0 (aHR, 2.42 [95% CI, 1.59-3.67]) but not in those without CAC (aHR, 0.92 [0.48-1.79]). In patients with CAC=0, diabetes, current smoking, and low high-density lipoprotein cholesterol levels were associated with future ASCVD events. The principal findings were replicated in the Multi-Ethnic Study of Atherosclerosis., Conclusions: LDL-C appears to be almost exclusively associated with ASCVD events over ≈5 years of follow-up in middle-aged individuals with versus without evidence of coronary atherosclerosis. This information is valuable for individualized risk assessment among middle-aged people with or without coronary atherosclerosis.
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- 2023
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6. Clinical and Coronary Plaque Predictors of Atherosclerotic Nonresponse to Statin Therapy.
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van Rosendael SE, van den Hoogen IJ, Lin FY, Andreini D, Al-Mallah MH, Budoff MJ, Cademartiri F, Chinnaiyan K, Choi JH, Conte E, Marques H, de Araújo Gonçalves P, Gottlieb I, Hadamitzky M, Leipsic JA, Maffei E, Pontone G, Raff GL, Shin S, Kim YJ, Lee BK, Chun EJ, Sung JM, Lee SE, Virmani R, Samady H, Stone PH, Min JK, Narula J, Shaw LJ, Chang HJ, van Rosendael AR, and Bax JJ
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- Humans, Middle Aged, Aged, Coronary Angiography methods, Coronary Vessels pathology, Prospective Studies, Disease Progression, Predictive Value of Tests, Computed Tomography Angiography methods, Plaque, Atherosclerotic drug therapy, Coronary Artery Disease pathology, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Atherosclerosis pathology
- Abstract
Background: Statins reduce the incidence of major cardiovascular events, but residual risk remains. The study examined the determinants of atherosclerotic statin nonresponse., Objectives: This study aimed to investigate factors associated with statin nonresponse-defined atherosclerosis progression in patients treated with statins., Methods: The multicenter PARADIGM (Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography Imaging) registry included patients who underwent serial coronary computed tomography angiography ≥2 years apart, with whole-heart coronary tree quantification of vessel, lumen, and plaque, and matching of baseline and follow-up coronary segments and lesions. Patients with statin use at baseline and follow-up coronary computed tomography angiography were included. Atherosclerotic statin nonresponse was defined as an absolute increase in percent atheroma volume (PAV) of 1.0% or more per year. Furthermore, a secondary endpoint was defined by the additional requirement of progression of low-attenuation plaque or fibro-fatty plaque., Results: The authors included 649 patients (age 62.0 ± 9.0 years, 63.5% male) on statin therapy and 205 (31.5%) experienced atherosclerotic statin nonresponse. Age, diabetes, hypertension, and all atherosclerotic plaque features measured at baseline scan (high-risk plaque [HRP] features, calcified and noncalcified PAV, and lumen volume) were significantly different between patients with and without atherosclerotic statin nonresponse, whereas only diabetes, number of HRP features, and noncalcified and calcified PAV were independently associated with atherosclerotic statin nonresponse (odds ratio [OR]: 1.41 [95% CI: 0.95-2.11], OR: 1.15 [95% CI: 1.09-1.21], OR: 1.06 [95% CI: 1.02-1.10], OR: 1.07 [95% CI: 1.03-1.12], respectively). For the secondary endpoint (N = 125, 19.2%), only noncalcified PAV and number of HRP features were the independent determinants (OR: 1.08 [95% CI: 1.03-1.13] and OR: 1.21 [95% CI: 1.06-1.21], respectively)., Conclusions: In patients treated with statins, baseline plaque characterization by plaque burden and HRP is associated with atherosclerotic statin nonresponse. Patients with the highest plaque burden including HRP were at highest risk for plaque progression, despite statin therapy. These patients may need additional therapies for further risk reduction., Competing Interests: Funding Support and Author Disclosures This work was supported by the Leading Foreign Research Institute Recruitment Program through the National Research Foundation (NRF) of Korea funded by the Ministry of Science and ICT (MSIT) (grant no. 2012027176). The study was also funded in part by a generous gift from the Dalio Institute of Cardiovascular Imaging (New York, New York, USA) and the Michael Wolk Foundation (New York, New York, USA). Dr Min is an employee of Cleerly Inc. Dr Leipsic is a consultant to and holds stock options in Circle CVI and HeartFlow; and has received modest speaking fees from Philips and GE Healthcare. Dr Chinnaiyan is a noncompensated medical advisory board member of Heartflow Inc. Dr Samady serves on the scientific advisory board of Philips; has equity interest in Covanos Inc; and has a research grant from Medtronic, Abbott Vascular, and Philips. Dr Virmani is a consultant of Abbott Vascular, Boston Scientific, Celonova, OrbusNeich Medical, Terumo Corporation, W.L. Gore, Edwards Lifesciences, Cook Medical, CSI, ReCor Medical, SinoMedical Sciences Technology, Surmodics, and Bard BD; and is a scientific Advisory Board Member of Medtronic and Xeltis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2023 American College of Cardiology Foundation. All rights reserved.)
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- 2023
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7. Ischemia With Nonobstructive Coronary Arteries: Insights From the ISCHEMIA Trial.
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Reynolds HR, Diaz A, Cyr DD, Shaw LJ, Mancini GBJ, Leipsic J, Budoff MJ, Min JK, Hague CJ, Berman DS, Chaitman BR, Picard MH, Hayes SW, Scherrer-Crosbie M, Kwong RY, Lopes RD, Senior R, Dwivedi SK, Miller TD, Chow BJW, de Silva R, Stone GW, Boden WE, Bangalore S, O'Brien SM, Hochman JS, and Maron DJ
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- Female, Humans, Male, Coronary Angiography methods, Coronary Vessels diagnostic imaging, Ischemia, Predictive Value of Tests, Atherosclerosis, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease epidemiology, Coronary Artery Disease therapy, Myocardial Ischemia diagnostic imaging, Myocardial Ischemia epidemiology
- Abstract
Background: Ischemia with nonobstructive coronary arteries (INOCA) is common clinically, particularly among women, but its prevalence among patients with at least moderate ischemia and the relationship between ischemia severity and non-obstructive atherosclerosis severity are unknown., Objectives: The authors investigated predictors of INOCA in enrolled, nonrandomized participants in ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches), sex differences, and the relationship between ischemia and atherosclerosis in patients with INOCA., Methods: Core laboratories independently reviewed screening noninvasive stress test results (nuclear imaging, echocardiography, magnetic resonance imaging or nonimaging exercise tolerance testing), and coronary computed tomography angiography (CCTA), blinded to results of the screening test. INOCA was defined as all stenoses <50% on CCTA in a patient with moderate or severe ischemia on stress testing. INOCA patients, who were excluded from randomization, were compared with randomized participants with ≥50% stenosis in ≥1 vessel and moderate or severe ischemia., Results: Among 3,612 participants with core laboratory-confirmed moderate or severe ischemia and interpretable CCTA, 476 (13%) had INOCA. Patients with INOCA were younger, were predominantly female, and had fewer atherosclerosis risk factors. For each stress testing modality, the extent of ischemia tended to be less among patients with INOCA, particularly with nuclear imaging. There was no significant relationship between severity of ischemia and extent or severity of nonobstructive atherosclerosis on CCTA. On multivariable analysis, female sex was independently associated with INOCA (odds ratio: 4.2 [95% CI: 3.4-5.2])., Conclusions: Among participants enrolled in ISCHEMIA with core laboratory-confirmed moderate or severe ischemia, the prevalence of INOCA was 13%. Severity of ischemia was not associated with severity of nonobstructive atherosclerosis. (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches [ISCHEMIA]; NCT01471522)., Competing Interests: Funding Support and Author Disclosures This project was supported by National Institutes of Health grants (U01HL105907, U01HL105462, U01HL105561, and U01HL105565) and supported in part by Clinical Translational Science Award (11UL1 TR001445 and UL1 TR002243) from the National Center for Advancing Translational Sciences and by grants from Arbor Pharmaceuticals LLC and AstraZeneca Pharmaceuticals LP. The manuscript contents are solely the responsibility of the authors and do not necessarily represent official views of the National Center for Advancing Translational Sciences, the National Heart, Lung, and Blood Institute, the National Institutes of Health, or the Department of Health and Human Services. Devices or medications were provided by Abbott Vascular (previously St. Jude Medical, Inc); Medtronic, Inc; Phillips (previously Volcano Corporation); and Omron Healthcare, Inc; medications were provided by Amgen Inc; Arbor Pharmaceuticals, LLC; AstraZeneca Pharmaceuticals, LP; Espero Pharmaceuticals; Merck, Sharp & Dohme Corp; and Sunovion Pharmaceuticals. All authors have received funding from the National Heart, Lung and Blood Institute for the study. Dr Reynolds has received nonfinancial support from Abbott Vascular, Siemens, BioTelemetry, and Leipsic; is a consultant and holder of stock options from Circle CVI and HeartFlow; is the recipient of research grants from GE Healthcare and Edwards; and serves on speakers bureaus for Philips and GE Healthcare. Dr Budoff has received grant support from General Electric; has been on the Medical Advisory Board of Arineta; and has received salary from and has ownership interest in Cleerly, Inc. Dr Berman has received software royalties from Cedars-Sinai Medical Center. Dr Lopes has received grants and other support from Bayer, Boehringer Ingleheim, Bristol-Myers Squibb, Daiichi Sankyo, and Glaxo Smith Kline; and has received grants from Medtronic, Merck, Pfizer, Portola, and Sanofi. Dr Chow holds the Saul and Edna Goldfarb Chair in Cardiac Imaging Research; has received research support from TD Bank, CV Diagnostix and AusculSciences, and Siemens Healthineers; and has equity interest in General Electric. Dr Stone has received personal fees from Terumo, Amaranth, Shockwave, Valfix, TherOx, Reva, Vascular Dynamics, Robocath, HeartFlow, Gore, Ablative Solutions, Matrizyme, Miracor, Neovasc, V-wave, SpectreWave, MAIA Pharmaceuticals, Orchestra Biomed, Vectorious Abiomed, Claret, Sirtex, Ancora, and Qool Therapeutics; other considerations from Cagent, Applied Therapeutics, Biostar family of funds; support from MedFocus family of funds, Aria; and personal fees from Cardiac Success work. Dr Boden has received support from Abbvie and Amarin; grants from Amgen; and personal fees from Amgen, Cleveland Clinic Clinical Coordinating Center, and Janssen. Dr Bangalore has received grants and personal fees from Abbott Vascular; and personal fees from Biotronik, Pfizer, and Amgen. Dr Hochman is principal investigator for the ISCHEMIA trial, for which grant, devices, and medications were provided by Abbott Vascular; Medtronic, Inc; St. Jude Medical, Inc; Volcano Corporation; Arbor Pharmaceuticals, LLC; AstraZeneca Pharmaceuticals, LP; Merck Sharp & Dohme Corp; Omron Healthcare, Inc; and financial donations from Arbor Pharmaceuticals LLC and AstraZeneca Pharmaceuticals LP., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)
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- 2023
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8. Extent of subclinical atherosclerosis on coronary computed tomography and impact of statins in patients with diabetes without known coronary artery disease: Results from CONFIRM registry.
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Shaikh K, Ahmed A, Gransar H, Lee J, Leipsic J, Nakanishi R, Alla V, Bax JJ, Chow BJW, Berman DS, Maffei E, Lin FY, Ahmad A, DeLago A, Pontone G, Feuchtner G, Marques H, Min JK, Hausleiter J, Hadamitzky M, Kaufmann PA, de Araújo Gonçalves P, Cury RC, Kim YJ, Chang HJ, Rubinshtein R, Villines TC, Lu Y, Shaw LJ, Acenbach S, Al Mallah MH, Andreini D, Cademartiri F, Callister TQ, and Budoff MJ
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- Adult, Humans, Middle Aged, Tomography, X-Ray Computed, Registries, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Coronary Artery Disease complications, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease drug therapy, Atherosclerosis complications, Atherosclerosis diagnostic imaging, Atherosclerosis drug therapy, Diabetes Mellitus drug therapy, Diabetes Mellitus epidemiology
- Abstract
Background: Absence of subclinical atherosclerosis is considered safe to defer statin therapy in general population. However, impact of statins on atherosclerotic cardiovascular disease in patients with diabetes stratified by coronary artery calcium (CAC) scores and extent of non-obstructive CAD on coronary computed tomography angiography (CCTA) has not been evaluated., Methods: CONFIRM (Coronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multi-center Registry) study enrolled consecutive adults 18 years of age between 2005 and 2009 who underwent
3 64-detector row CCTA for suspected CAD. The long-term registry includes data on 12,086 subjects who underwent CCTA at 17 centers in 9 countries. In this sub-study of CONFIRM registry, patients with diabetes mellitus (DM) and without diabetes mellitus with normal CCTA or non-obstructive plaque (<50 % diameter stenosis) for whom data on baseline statin use was available were included. CAC score was calculated using Agatston score. The magnitude of non-obstructive coronary artery disease on CCTA was quantified using segment involvement score (SIS). Primary outcome was major cardiovascular events (MACE) which included all-cause mortality, myocardial infarction, and target vessel re-vascularization., Results: A total of 7247 patients (Mean age 56.8 years) with a median follow up of 5 years were included. For DM patients, baseline statin therapy significantly reduced MACE for patients with CAC ≥100 (HR: 0.24; 95 % CI 0.07-0.87; p = 0.03) and SIS≥3 (HR: 0.23; 95 % CI 0.06-0.83; p = 0.024) compared to those not on statin therapy. Among Diabetics with lower CAC (<100) and SIS (≤3) scores, MACE was similar in statin and non-statin groups. In contrast, among non-DM patients, MACE was similar in statin and no statin groups irrespective of baseline CAC (1-99 or ≥100) and SIS., Conclusion: In this large multicenter cohort of patients, the presence and extent of subclinical atherosclerosis as assessed by CAC and SIS identified patients most likely to derive benefit from statin therapy., (Copyright © 2022. Published by Elsevier Inc.)- Published
- 2022
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9. Age related compositional plaque burden by CT in patients with future ACS.
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van Rosendael AR, van den Hoogen IJ, Lin FY, Gianni U, Lu Y, Andreini D, Al-Mallah MH, Cademartiri F, Chinnaiyan K, Chow BJW, Conte E, Cury RC, Feuchtner G, de Araújo Gonçalves P, Hadamitzky M, Kim YJ, Leipsic JA, Maffei E, Marques H, Plank F, Pontone G, Raff GL, Villines TC, Lee SE, Al'Aref SJ, Baskaran L, Cho I, Danad I, Gransar H, Budoff MJ, Samady H, Virmani R, Min JK, Narula J, Berman DS, Chang HJ, Shaw LJ, and Bax JJ
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- Humans, Middle Aged, Aged, Aged, 80 and over, Coronary Angiography methods, Cross-Sectional Studies, Predictive Value of Tests, Computed Tomography Angiography methods, Tomography, X-Ray Computed methods, Coronary Artery Disease diagnostic imaging, Plaque, Atherosclerotic, Atherosclerosis
- Abstract
Background: We examined age differences in whole-heart volumes of non-calcified and calcified atherosclerosis by coronary computed tomography angiography (CCTA) of patients with future ACS., Methods: A total of 234 patients with core-lab adjudicated ACS after baseline CCTA were enrolled. Atherosclerotic plaque was quantified and characterized from the main epicardial vessels and side branches on a 0.5 mm cross-sectional basis. Calcified plaque and non-calcified plaque were defined by above or below 350 Hounsfield units. Patients were categorized according to their age by deciles. Also, coronary artery calcium scores (CACS) were evaluated when available., Results: Patients were on average 62.2 ± 11.5 years old. On the pre-ACS CCTA, patients showed diffuse, multi-site, predominantly non-obstructive atherosclerosis across all age categories, with plaque being detected in 93.5% of all ACS cases. The proportion calcified plaque from the total plaque burden increased significantly with older presentation (10% calcification in those <50 years, and 50% calcification in those >80 years old). Patients with ACS <50 years had remarkably lower atherosclerotic burden compared with older patients, but a high proportion of high risk markers such as low-attenuation plaque. CACS was >0 in 85% of the patients older than 50 years, and in 57% of patients younger than 50 years., Conclusion: The proportion of calcified plaque varied depending on patient age at the time of ACS. Only a small proportion of plaque was calcified when ACS occurred at <50 years old, while this increased gradually with older age. Purely non-calcified atherosclerotic plaque was not uncommon in patients <50 years., Competing Interests: Declaration of competing interest Dr. Chinnaiyan is a non-compensated medical advisory board member of Heartflow Inc. Dr. Chow holds the Saul and Edna Goldfarb Chair in Cardiac Imaging Research, receives support from CV Diagnostix and Ausculsciences, receives educational support from TeraRecon Inc., and has equity interest in General Electric. Dr. Min is an employee of Cleerly, Inc. Dr. Samady serves on the scientific advisory board of Philips, has equity interest in Covanos Inc., and has a research grant from Medtronic, Abbott Vascular, and Philips. Dr. Shaw is on the scientific advisory board for Covanos, Inc. The remaining authors have no relevant conflicts to disclose., (Copyright © 2022. Published by Elsevier Inc.)
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- 2022
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10. Marked variation in atherosclerotic plaque progression between the major epicardial coronary arteries.
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Bax AM, Lin FY, van Rosendael AR, Ma X, Lu Y, van den Hoogen IJ, Gianni U, Tantawy SW, Andreini D, Budoff MJ, Cademartiri F, Chinnaiyan K, Choi JH, Conte E, de Araújo Gonçalves P, Gottlieb I, Hadamitzky M, Leipsic JA, Maffei E, Pontone G, Stone G, Shin S, Kim YJ, Lee BK, Chun EJ, Sung JM, Lee SE, Berman DS, Narula J, Chang HJ, and Shaw LJ
- Subjects
- Humans, Male, Middle Aged, Aged, Female, Coronary Vessels, Coronary Angiography methods, Prospective Studies, Plaque, Atherosclerotic diagnostic imaging, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Atherosclerosis
- Abstract
Aims: Atherosclerosis develops progressively and worsens over time, yet event risk patterns vary in the left circumflex (LCx), right coronary artery (RCA) and left anterior descending (LAD). The aim of this analysis was to examine varying progressive disease alterations between the three major coronary arteries., Methods and Results: Patients were included from a prospective, international registry of consecutive patients who underwent serial CCTA at a median interval of 3.3 years. Annual progression of quantitative total and compositional plaque volume were compared between the three coronary arteries (LCx, LAD, and RCA). Other analyses compared stenosis ≥50% and new high-risk plaque (HRP; ≥2 of the following: spotty calcification, positive remodelling, napkin-ring sign, and low-attenuation plaque) on follow-up. Generalized estimating equations and marginal Cox regression models were used to compare progression, with covariate adjustment by the baseline atherosclerotic cardiovascular disease risk score, statin use, and plaque burden. Quantitative plaque measurements were calculated in 1344 patients (age 60 ± 9 years, 57% men). Plaque progression occurred less often in the LCx (41.0%) as compared to the RCA (52.7%) and LAD (77.4%, P < 0.001). Odds for annual plaque burden increase ≥population mean were 1.98- and 1.43-fold as high in the LAD (P < 0.001) and RCA (P < 0.001) as compared to the LCx. Similarly, the LAD was associated with a 2.45 higher risk of progression to obstructive CAD (P < 0.001), as compared to the LCx; with no differences between the RCA and LCx (P = 0.13). New HRP lesions formed least often in the LCx (3.4%), followed by the RCA (8.1%) and most often in the LAD (10.1%; P < 0.001)., Conclusions: Our findings reveal novel insights into varied patterns of atherosclerotic plaque progression within the LCx as compared to the other epicardial coronary arteries. These varied patterns reflect differing stages in the disease process or differing pathogenic milieu across the coronary arteries., Competing Interests: Conflict of interest: K.C. is a non-compensated medical advisor for Heartflow Inc. L.J.S. is on the scientific advisory board for Covanos Inc. J.A.L. is a consultant to and hold stock options in Circle CVI and HeartFlow and receives research support from GE Healthcare and serves on the speakers’ bureau for Philips and GE Healthcare. G.S. has received speaker or other honoraria from Cook, Terumo, QOOL Therapeutics, and Orchestra Biomed; has served as a consultant to Valfix, TherOx, Vascular Dynamics, Robocath, HeartFlow, Gore, Ablative Solutions, Miracor, Neovasc, V-Wave, Abiomed, Ancora, MAIA Pharmaceuticals, Vectorious, Reva, Matrizyme, Cardiomech; and has equity/options from Ancora, Qool Therapeutics, Cagent, Applied Therapeutics, Biostar family of funds, SpectraWave, Orchestra Biomed, Aria, Cardiac Success, MedFocus family of funds, and Valfix., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2022. For permissions, please email: journals.permissions@oup.com.)
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- 2022
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11. Vessel-specific plaque features on coronary computed tomography angiography among patients of varying atherosclerotic cardiovascular disease risk.
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Bax AM, Yoon YE, Gianni U, van Rosendael AR, Lu Y, Ma X, Goebel BP, Tantawy SW, Andreini D, Budoff MJ, Cademartiri F, Chinnaiyan K, Choi JH, Conte E, de Araújo Gonçalves P, Gottlieb I, Hadamitzky M, Leipsic JA, Maffei E, Pontone G, Shin S, Kim YJ, Lee BK, Chun EJ, Sung JM, Lee SE, Berman DS, Narula J, Lin FY, Chang HJ, and Shaw LJ
- Subjects
- Aged, Computed Tomography Angiography, Coronary Angiography methods, Coronary Vessels, Female, Humans, Male, Middle Aged, Prospective Studies, Atherosclerosis, Cardiovascular Diseases, Coronary Artery Disease diagnostic imaging, Plaque, Atherosclerotic diagnostic imaging
- Abstract
Aims: The relationship between AtheroSclerotic CardioVascular Disease (ASCVD) risk and vessel-specific plaque evaluation using coronary computed tomography angiography (CCTA), focusing on plaque extent and composition, has not been examined. To evaluate differences in quantified plaque characteristics (using CCTA) between the three major coronary arteries [left anterior descending (LAD), right coronary (RCA), and left circumflex (LCx)] among subgroups of patients with varying ASCVD risk., Methods and Results: Patients were included from a prospective, international registry of consecutive patients who underwent CCTA for evaluation of coronary artery disease. ASCVD risk groups were <7.5% (low), 7.5-20% (intermediate), and ≥20% (high). Among the ASCVD risk groups, the three coronary arteries were compared regarding quantified plaque volume and composition. Whole-heart plaque quantification was performed in 1340 patients (age 60 ± 9 years, 58% men). Across low, intermediate, and high ASCVD risk patients, the volume of plaque increased proportionally but was least in the LCx (7.4, 9.0, and 25.3 mm3, respectively) as compared with the RCA (19.3, 32.6, and 67.0 mm3, respectively, all P ≤ 0.006) and LAD (39.9, 60.8, and 93.3 mm3, respectively, all P < 0.001). In each ASCVD risk group, the composition of plaque in the LCx exhibited the least necrotic core and fibrofatty plaque (P < 0.05 vs. LAD and RCA)., Conclusion: Among patients with varying risk of ASCVD, plaque in the LCx is decidedly less and is comprised of less non-calcified plaque supporting prior evidence of the lower rates of acute coronary events in this vessel., Competing Interests: Conflict of interest: K.C. is a non-compensated medical advisor for Heartflow, Inc. L.J.S. is on the scientific advisory board for Covanos, Inc. J.A.L. is a consultant to and has stock options in Circle CVI and HeartFlow, receives research support from GE Healthcare and serves on the speakers’ bureau for Philips and GE Healthcare. All other authors have no conflicts of interest to report., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2022. For permissions, please email: journals.permissions@oup.com.)
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- 2022
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12. Relationship Between Coronary Artery Calcium and Atherosclerosis Progression Among Patients With Suspected Coronary Artery Disease.
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Hollenberg EJ, Lin F, Blaha MJ, Budoff MJ, van den Hoogen IJ, Gianni U, Lu Y, Bax AM, van Rosendael AR, Tantawy SW, Andreini D, Cademartiri F, Chinnaiyan K, Choi JH, Conte E, de Araújo Gonçalves P, Hadamitzky M, Maffei E, Pontone G, Shin S, Kim YJ, Lee BK, Chun EJ, Sung JM, Gimelli A, Lee SE, Bax JJ, Berman DS, Sellers SL, Leipsic JA, Blankstein R, Narula J, Chang HJ, and Shaw LJ
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- Calcium, Computed Tomography Angiography methods, Constriction, Pathologic complications, Coronary Angiography methods, Coronary Vessels diagnostic imaging, Disease Progression, Humans, Predictive Value of Tests, Risk Factors, Atherosclerosis, Coronary Artery Disease complications, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease epidemiology, Plaque, Atherosclerotic
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Background: Among symptomatic patients, it remains unclear whether a coronary artery calcium (CAC) score alone is sufficient or misses a sizeable burden and progressive risk associated with obstructive and nonobstructive atherosclerotic plaque., Objectives: Among patients with low to high CAC scores, our aims were to quantify co-occurring obstructive and nonobstructive noncalcified plaque and serial progression of atherosclerotic plaque volume., Methods: A total of 698 symptomatic patients with suspected coronary artery disease (CAD) underwent serial coronary computed tomographic angiography (CTA) performed 3.5 to 4.0 years apart. Atherosclerotic plaque was quantified, including by compositional subgroups. Obstructive CAD was defined as ≥50% stenosis. Multivariate linear regression models were used to measure atherosclerotic plaque progression by CAC scores. Cox proportional hazard models estimated CAD event risk (median of 10.7 years of follow-up)., Results: Across baseline CAC scores from 0 to ≥400, total plaque volume ranged from 30.4 to 522.4 mm
3 (P < 0.001) and the prevalence of obstructive CAD increased from 1.4% to 49.1% (P < 0.001). Of those with a 0 CAC score, 97.9% of total plaque was noncalcified. Among patients with baseline CAC <100, nonobstructive CAD was prevalent (40% and 89% in CAC scores of 0 and 1-99), with plaque largely being noncalcified. On the follow-up coronary CTA, volumetric plaque growth (P < 0.001) and the development of new or worsening stenosis (P < 0.001) occurred more among patients with baseline CAC ≥100. Progression varied compositionally by baseline CAC scores. Patients with no CAC had disproportionate growth in noncalcified plaque, and for every 1 mm3 increase in calcified plaque, there was a 5.5 mm3 increase in noncalcified plaque volume. By comparison, patients with CAC scores of ≥400 exhibited disproportionate growth in calcified plaque with a volumetric increase 15.7-fold that of noncalcified plaque. There was a graded increase in CAD event risk by the CAC with rates from 3.3% for no CAC to 21.9% for CAC ≥400 (P < 0.001)., Conclusions: CAC imperfectly characterizes atherosclerotic disease burden, but its subgroups exhibit pathogenic patterns of early to advanced disease progression and stratify long-term prognostic risk., Competing Interests: Funding Support and Author Disclosures Partial funding was provided by a gift from the Dalio Foundation (New York, New York) and supported by the Leading Foreign Research Institute Recruitment Program through the National Research Foundation funded by the Ministry of Science and Information and Communications Technology of Korea (Grant number 2012027176). Dr Chinnaiyan is a medical advisor (unpaid) for Heartflow, Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)- Published
- 2022
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13. Progression of whole-heart Atherosclerosis by coronary CT and major adverse cardiovascular events.
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van Rosendael AR, Lin FY, van den Hoogen IJ, Ma X, Gianni U, Al Hussein Alawamlh O, Al'Aref SJ, Peña JM, Andreini D, Budoff MJ, Cademartiri F, Chinnaiyan K, Choi JH, Conte E, Marques H, de Araújo Gonçalves P, Gottlieb I, Hadamitzky M, Leipsic J, Maffei E, Pontone G, Raff GL, Shin S, Kim YJ, Lee BK, Chun EJ, Sung JM, Lee SE, Han D, Berman DS, Virmani R, Samady H, Stone P, Narula J, Bax JJ, Shaw LJ, Min JK, and Chang HJ
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- Aged, Computed Tomography Angiography, Coronary Angiography, Disease Progression, Female, Humans, Male, Middle Aged, Predictive Value of Tests, Prognosis, Tomography, X-Ray Computed, Atherosclerosis, Coronary Artery Disease diagnostic imaging, Plaque, Atherosclerotic
- Abstract
Background: The current study aimed to examine the independent prognostic value of whole-heart atherosclerosis progression by serial coronary computed tomography angiography (CCTA) for major adverse cardiovascular events (MACE)., Methods: The multi-center PARADIGM study includes patients undergoing serial CCTA for symptomatic reasons, ≥2 years apart. Whole-heart atherosclerosis was characterized on a segmental level, with co-registration of baseline and follow-up CCTA, and summed to per-patient level. The independent prognostic significance of atherosclerosis progression for MACE (non-fatal myocardial infarction [MI], death, unplanned coronary revascularization) was examined. Patients experiencing interval MACE were not omitted., Results: The study population comprised 1166 patients (age 60.5 ± 9.5 years, 54.7% male) who experienced 139 MACE events during 8.2 (IQR 6.2, 9.5) years of follow up (15 death, 5 non-fatal MI, 119 unplanned revascularizations). Whole-heart percent atheroma volume (PAV) increased from 2.32% at baseline to 4.04% at follow-up. Adjusted for baseline PAV, the annualized increase in PAV was independently associated with MACE: OR 1.23 (95% CI 1.08, 1.39) per 1 standard deviation increase, which was consistent in multiple subpopulations. When categorized by composition, only non-calcified plaque progression associated independently with MACE, while calcified plaque did not. Restricting to patients without events before follow-up CCTA, those with future MACE showed an annualized increase in PAV of 0.93% (IQR 0.34, 1.96) vs 0.32% (IQR 0.02, 0.90), P < 0.001., Conclusions: Whole-heart atherosclerosis progression examined by serial CCTA is independently associated with MACE, with a prognostic threshold of 1.0% increase in PAV per year., Competing Interests: Declaration of competing interest Dr. James K. Min receives funding from the Dalio Foundation, National Institutes of Health, and GE Healthcare. Dr. Min serves on the scientific advisory board of Arineta and GE Healthcare, and has an equity interest in Cleerly. Dr. Habib Samady serves on the medical advisory board of Philips and has equity holding in Covanos. The remaining authors have no relevant disclosures., (Copyright © 2020 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.)
- Published
- 2021
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14. Atherogenic index of plasma and the risk of rapid progression of coronary atherosclerosis beyond traditional risk factors.
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Won KB, Heo R, Park HB, Lee BK, Lin FY, Hadamitzky M, Kim YJ, Sung JM, Conte E, Andreini D, Pontone G, Budoff MJ, Gottlieb I, Chun EJ, Cademartiri F, Maffei E, Marques H, de Araújo Gonçalves P, Leipsic JA, Lee SE, Shin S, Choi JH, Virmani R, Samady H, Chinnaiyan K, Berman DS, Narula J, Shaw LJ, Bax JJ, Min JK, and Chang HJ
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- Adult, Computed Tomography Angiography, Coronary Angiography, Female, Humans, Male, Risk Factors, Atherosclerosis, Coronary Artery Disease diagnostic imaging, Plaque, Atherosclerotic
- Abstract
Background and Aims: The atherogenic index of plasma (AIP) has been suggested as a marker of plasma atherogenicity. This study aimed to assess the association between AIP and the rapid progression of coronary atherosclerosis using serial coronary computed tomography angiography (CCTA)., Methods: A total of 1488 adults (60.9 ± 9.2 years, 58.9% male) who underwent serial CCTA with a median inter-scan period of 3.4 years were included. AIP was defined as the base 10 logarithm of the ratio of the concentrations of triglyceride to high-density lipoprotein cholesterol. Rapid plaque progression (RPP) was defined as the change of percentage atheroma volume (PAV) ≥1.0%/year. All participants were divided into three groups based on AIP tertiles., Results: Baseline total PAV (median [interquartile range (IQR)]) (%) (group I [lowest]: 1.91 [0.00, 6.21] vs. group II: 2.82 [0.27, 8.83] vs. group III [highest]: 2.70 [0.41, 7.50]), the annual change of total PAV (median [IQR]) (%/year) (group I: 0.27 [0.00, 0.81] vs. group II: 0.37 [0.04, 1.11] vs. group III: 0.45 [0.06, 1.25]), and the incidence of RPP (group I: 19.7% vs. group II: 27.3% vs. group III: 31.4%) were significantly different among AIP tertiles (all p < 0.05). In multiple logistic regression analysis, the risk of RPP was increased in group III (odds ratio: 1.52, 95% confidence interval: 1.02-2.26; p = 0.042) compared to group I after adjusting for clinical factors and baseline total PAV., Conclusions: Based on serial CCTA findings, AIP is an independent predictive marker for RPP beyond traditional risk factors., (Copyright © 2021 Elsevier B.V. All rights reserved.)
- Published
- 2021
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15. Age- and sex-related features of atherosclerosis from coronary computed tomography angiography in patients prior to acute coronary syndrome: results from the ICONIC study.
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Conte E, Dwivedi A, Mushtaq S, Pontone G, Lin FY, Hollenberg EJ, Lee SE, Bax J, Cademartiri F, Chinnaiyan K, Chow BJW, Cury RC, Feuchtner G, Hadamitzky M, Kim YJ, Baggiano A, Leipsic J, Maffei E, Marques H, Plank F, Raff GL, van Rosendael AR, Villines TC, Weirich HG, Al'Aref SJ, Baskaran L, Cho I, Danad I, Han D, Heo R, Lee JH, Stuijfzand WJ, Gransar H, Lu Y, Sung JM, Park HB, Al-Mallah MH, de Araújo Gonçalves P, Berman DS, Budoff MJ, Samady H, Shaw LJ, Stone PH, Virmani R, Narula J, Min JK, Chang HJ, and Andreini D
- Subjects
- Aged, Computed Tomography Angiography, Coronary Angiography, Female, Humans, Male, Acute Coronary Syndrome diagnostic imaging, Acute Coronary Syndrome epidemiology, Atherosclerosis, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease epidemiology, Plaque, Atherosclerotic diagnostic imaging, Plaque, Atherosclerotic epidemiology
- Abstract
Aims: Although there is increasing evidence supporting coronary atherosclerosis evaluation by coronary computed tomography angiography (CCTA), no data are available on age and sex differences for quantitative plaque features. The aim of this study was to investigate sex and age differences in both qualitative and quantitative atherosclerotic features from CCTA prior to acute coronary syndrome (ACS)., Methods and Results: Within the ICONIC study, in which 234 patients with subsequent ACS were propensity matched 1:1 with 234 non-event controls, our current subanalysis included only the ACS cases. Both qualitative and quantitative advance plaque analysis by CCTA were performed by a core laboratory. In 129 cases, culprit lesions identified by invasive coronary angiography at the time of ACS were co-registered to baseline CCTA precursor lesions. The study population was then divided into subgroups according to sex and age (<65 vs. ≥ 65 years old) for analysis. Older patients had higher total plaque volume than younger patients. Within specific subtypes of plaque volume, however, only calcified plaque volume was higher in older patients (135.9 ± 163.7 vs. 63.8 ± 94.2 mm3, P < 0.0001, respectively). Although no sex-related differences were recorded for calcified plaque volume, females had lower fibrous and fibrofatty plaque volume than males (Fibrofatty volume 29.6 ± 44.1 vs. 75.3 ± 98.6 mm3, P = 0.0001, respectively). No sex-related differences in the prevalence of qualitative high-risk plaque features were found, even after separate analyses considering age were performed., Conclusion: Our data underline the importance of age- and sex-related differences in coronary atherosclerosis presentation, which should be considered during CCTA-based atherosclerosis quantification., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.)
- Published
- 2021
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16. From Subclinical Atherosclerosis to Plaque Progression and Acute Coronary Events: JACC State-of-the-Art Review.
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Ahmadi A, Argulian E, Leipsic J, Newby DE, and Narula J
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- Acute Coronary Syndrome prevention & control, Acute Disease, Disease Progression, Humans, Plaque, Atherosclerotic prevention & control, Acute Coronary Syndrome etiology, Atherosclerosis complications, Plaque, Atherosclerotic etiology
- Abstract
It has been believed that most acute coronary events result from the rupture of mildly stenotic plaques, based on studies in which angiographic information was available from many months to years before the event. However, serial studies in which angiographic data were available from the past as also within 1 to 3 months of myocardial infarction have clarified that nonobstructive lesions progressively enlarged relatively rapidly before the acute event occurred. Noninvasive computed tomography angiography imaging data have confirmed that lesions that did not progress voluminously over time rarely led to events, regardless of the extent of luminal stenosis or baseline high-risk plaque morphology. Therefore, plaque progression could be proposed as a necessary step between early, uncomplicated atherosclerosis and plaque rupture. On the other hand, it has been convincingly demonstrated that intensive lipid-lowering therapy (to a low-density lipoprotein cholesterol level of <70 mg/dl) halts plaque progression. Given the current ability to noninvasively detect the presence of early atherosclerosis, the importance of plaque progression in the pathogenesis of myocardial infarction, and the efficacy of maximum lipid-lowering therapy, it has been suggested that plaque progression is a modifiable step in the evolution of atherosclerotic plaque. A personalized approach based on the detection of early atherosclerosis can trigger the necessary treatment to prevent plaque progression and hence plaque instability. Therefore, this approach can redefine the traditional paradigm of primary and secondary prevention based on population-derived risk estimates and can potentially improve long-term outcomes., (Copyright © 2019. Published by Elsevier Inc.)
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- 2019
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17. Is it time to move from treating risk factors of the disease to treating the disease?
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Ahmadi A and Leipsic J
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- Calcium, Coronary Vessels, Humans, Risk Factors, Atherosclerosis, Cardiovascular Diseases
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- 2018
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18. Defining the relationship between atherosclerotic plaque, ischaemia, and risk-the story unfolds.
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Leipsic J, Blanke P, and Norgaard BL
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- Humans, Risk, Atherosclerosis, Plaque, Atherosclerotic
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- 2017
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19. Risk factors based vessel‐specific prediction for stages of coronary artery disease using Bayesian quantile regression machine learning method: Results from the PARADIGM registry
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Park, Hyung‐Bok, Lee, Jina, Hong, Yongtaek, Byungchang, So, Kim, Wonse, Lee, Byoung K, Lin, Fay Y, Hadamitzky, Martin, Kim, Yong‐Jin, Conte, Edoardo, Andreini, Daniele, Pontone, Gianluca, Budoff, Matthew J, Gottlieb, Ilan, Chun, Eun Ju, Cademartiri, Filippo, Maffei, Erica, Marques, Hugo, de A. Gonçalves, Pedro, Leipsic, Jonathon A, Shin, Sanghoon, Choi, Jung H, Virmani, Renu, Samady, Habib, Chinnaiyan, Kavitha, Stone, Peter H, Berman, Daniel S, Narula, Jagat, Shaw, Leslee J, Bax, Jeroen J, Min, James K, Kook, Woong, and Chang, Hyuk‐Jae
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Atherosclerosis ,Heart Disease - Coronary Heart Disease ,Prevention ,Cardiovascular ,Heart Disease ,Humans ,Angina Pectoris ,Bayes Theorem ,Coronary Angiography ,Coronary Artery Disease ,Coronary Vessels ,Machine Learning ,Registries ,Risk Factors ,cardiovascular risk factors ,coronary artery disease ,machine learning ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology - Abstract
Background and hypothesisThe recently introduced Bayesian quantile regression (BQR) machine-learning method enables comprehensive analyzing the relationship among complex clinical variables. We analyzed the relationship between multiple cardiovascular (CV) risk factors and different stages of coronary artery disease (CAD) using the BQR model in a vessel-specific manner.MethodsFrom the data of 1,463 patients obtained from the PARADIGM (NCT02803411) registry, we analyzed the lumen diameter stenosis (DS) of the three vessels: left anterior descending (LAD), left circumflex (LCx), and right coronary artery (RCA). Two models for predicting DS and DS changes were developed. Baseline CV risk factors, symptoms, and laboratory test results were used as the inputs. The conditional 10%, 25%, 50%, 75%, and 90% quantile functions of the maximum DS and DS change of the three vessels were estimated using the BQR model.ResultsThe 90th percentiles of the DS of the three vessels and their maximum DS change were 41%-50% and 5.6%-7.3%, respectively. Typical anginal symptoms were associated with the highest quantile (90%) of DS in the LAD; diabetes with higher quantiles (75% and 90%) of DS in the LCx; dyslipidemia with the highest quantile (90%) of DS in the RCA; and shortness of breath showed some association with the LCx and RCA. Interestingly, High-density lipoprotein cholesterol showed a dynamic association along DS change in the per-patient analysis.ConclusionsThis study demonstrates the clinical utility of the BQR model for evaluating the comprehensive relationship between risk factors and baseline-grade CAD and its progression.
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- 2023
20. Ischemia With Nonobstructive Coronary Arteries: Insights From the ISCHEMIA Trial.
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Min, James, Hague, Cameron, Berman, Daniel, Chaitman, Bernard, Picard, Michael, Hayes, Sean, Scherrer-Crosbie, Marielle, Kwong, Raymond, Lopes, Renato, Senior, Roxy, Dwivedi, Sudhanshu, Miller, Todd, Chow, Benjamin, de Silva, Ramesh, Stone, Gregg, Boden, William, Bangalore, Sripal, OBrien, Sean, Hochman, Judith, Maron, David, Reynolds, Harmony, Diaz, Ariel, Cyr, Derek, Shaw, Leslee, Mancini, G, Leipsic, Jonathon, and Budoff, Matthew
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coronary CT angiography ,ischemia ,ischemia with nonobstructive coronary arteries ,stress testing ,Female ,Humans ,Male ,Atherosclerosis ,Coronary Angiography ,Coronary Artery Disease ,Coronary Vessels ,Ischemia ,Myocardial Ischemia ,Predictive Value of Tests - Abstract
BACKGROUND: Ischemia with nonobstructive coronary arteries (INOCA) is common clinically, particularly among women, but its prevalence among patients with at least moderate ischemia and the relationship between ischemia severity and non-obstructive atherosclerosis severity are unknown. OBJECTIVES: The authors investigated predictors of INOCA in enrolled, nonrandomized participants in ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches), sex differences, and the relationship between ischemia and atherosclerosis in patients with INOCA. METHODS: Core laboratories independently reviewed screening noninvasive stress test results (nuclear imaging, echocardiography, magnetic resonance imaging or nonimaging exercise tolerance testing), and coronary computed tomography angiography (CCTA), blinded to results of the screening test. INOCA was defined as all stenoses
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- 2023
21. CAD-RADS™ 2.0 – 2022 Coronary Artery Disease – Reporting and Data System An Expert Consensus Document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Cardiology (ACC), the American College of Radiology (ACR) and the North America Society of Cardiovascular Imaging (NASCI)
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Cury, Ricardo C, Leipsic, Jonathon, Abbara, Suhny, Achenbach, Stephan, Berman, Daniel, Bittencourt, Marcio, Budoff, Matthew, Chinnaiyan, Kavitha, Choi, Andrew D, Ghoshhajra, Brian, Jacobs, Jill, Koweek, Lynne, Lesser, John, Maroules, Christopher, Rubin, Geoffrey D, Rybicki, Frank J, Shaw, Leslee J, Williams, Michelle C, Williamson, Eric, White, Charles S, Villines, Todd C, and Blankstein, Ron
- Subjects
Biomedical and Clinical Sciences ,Engineering ,Biomedical Engineering ,Heart Disease ,Heart Disease - Coronary Heart Disease ,Biomedical Imaging ,Cardiovascular ,Atherosclerosis ,Detection ,screening and diagnosis ,4.2 Evaluation of markers and technologies ,Coronary Artery Disease ,Coronary CTA ,CAD-RADS ,Reporting and Data System ,Stenosis Severity ,Report Standardization Termi-nology ,Plaque Burden ,Ischemia ,Report Standardization Terminology - Abstract
Coronary Artery Disease Reporting and Data System (CAD-RADS) was created to standardize reporting system for patients undergoing coronary CT angiography (CCTA) and to guide possible next steps in patient management. The goal of this updated 2022 CAD-RADS 2.0 is to improve the initial reporting system for CCTA by considering new technical developments in Cardiac CT, including data from recent clinical trials and new clinical guidelines. The updated CAD-RADS classification will follow an established framework of stenosis, plaque burden, and modifiers, which will include assessment of lesion-specific ischemia using CT fractional-flow-reserve (CT-FFR) or myocardial CT perfusion (CTP), when performed. Similar to the method used in the original CAD-RADS version, the determinant for stenosis severity classification will be the most severe coronary artery luminal stenosis on a per-patient basis, ranging from CAD-RADS 0 (zero) for absence of any plaque or stenosis to CAD-RADS 5 indicating the presence of at least one totally occluded coronary artery. Given the increasing data supporting the prognostic relevance of coronary plaque burden, this document will provide various methods to estimate and report total plaque burden. The addition of P1 to P4 descriptors are used to denote increasing categories of plaque burden. The main goal of CAD-RADS, which should always be interpreted together with the impression found in the report, remains to facilitate communication of test results with referring physicians along with suggestions for subsequent patient management. In addition, CAD-RADS will continue to provide a framework of standardization that may benefit education, research, peer-review, artificial intelligence development, clinical trial design, population health and quality assurance with the ultimate goal of improving patient care. Keywords: Coronary Artery Disease, Coronary CTA, CAD-RADS, Reporting and Data System, Stenosis Severity, Report Standardization Terminology, Plaque Burden, Ischemia Supplemental material is available for this article. This article is published synchronously in Radiology: Cardiothoracic Imaging, Journal of Cardiovascular Computed Tomography, JACC: Cardiovascular Imaging, Journal of the American College of Radiology, and International Journal for Cardiovascular Imaging. © 2022 Society of Cardiovascular Computed Tomography. Published by RSNA with permission.
- Published
- 2022
22. Prognostic significance of plaque location in non-obstructive coronary artery disease: from the CONFIRM registry.
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Han, Donghee, Chen, Billy, Gransar, Heidi, Achenbach, Stephan, Al-Mallah, Mouaz H, Budoff, Matthew J, Cademartiri, Filippo, Maffei, Erica, Callister, Tracy Q, Chinnaiyan, Kavitha, Chow, Benjamin JW, DeLago, Augustin, Hadamitzky, Martin, Hausleiter, Joerg, Kaufmann, Philipp A, Villines, Todd C, Kim, Yong Jin, Leipsic, Jonathon, Feuchtner, Gudrun, Cury, Ricardo C, Pontone, Gianluca, Andreini, Daniele, Marques, Hugo, Rubinshtein, Ronen, Chang, Hyuk Jae, Lin, Fay Y, Shaw, Leslee J, Min, James K, and Berman, Daniel S
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Heart Disease - Coronary Heart Disease ,Prevention ,Clinical Research ,Heart Disease ,Atherosclerosis ,Biomedical Imaging ,Cardiovascular ,4.2 Evaluation of markers and technologies ,Detection ,screening and diagnosis ,Computed Tomography Angiography ,Coronary Angiography ,Coronary Artery Disease ,Humans ,Plaque ,Atherosclerotic ,Predictive Value of Tests ,Prognosis ,Registries ,Risk Assessment ,Risk Factors ,coronary artery disease ,non-obstructive ,plaque location ,prognosis ,computed tomography ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology - Abstract
AimObstructive coronary artery disease (CAD) in proximal coronary segments is associated with a poor prognosis. However, the relative importance of plaque location regarding the risk for major adverse cardiovascular events (MACE) in patients with non-obstructive CAD has not been well defined.Methods and resultsFrom the Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter (CONFIRM) registry, 4644 patients without obstructive CAD were included in this study. The degree of stenosis was classified as 0 (no) and 1-49% (non-obstructive). Proximal involvement was defined as any plaque present in the left main or the proximal segment of the left anterior descending artery, left circumflex artery, and right coronary artery. Extensive CAD was defined as segment involvement score of >4. During a median follow-up of 5.2 years (interquartile range 4.1-6.0), 340 (7.3%) MACE occurred. Within the non-obstructive CAD group (n = 2065), proximal involvement was observed in 1767 (85.6%) cases. When compared to non-obstructive CAD patients without proximal involvement, those with proximal involvement had an increased MACE risk (log-rank P = 0.033). Multivariate Cox analysis showed when compared to patients with no CAD, proximal non-obstructive CAD was associated with increased MACE risk [hazard ratio (HR) 1.90, 95% confidence interval (CI) 1.47-2.45, P < 0.001] after adjusting for extensive CAD and conventional cardiovascular risk factors; however, non-proximal non-obstructive CAD did not increase MACE risk (HR 1.26, 95% CI 0.79-2.01, P = 0.339).ConclusionsIndependent of plaque extent, proximal coronary involvement was associated with increased MACE risk in patients with non-obstructive CAD. The plaque location information by coronary computed tomography angiography may provide additional risk prediction over CAD extent in patients with non-obstructive CAD.
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- 2022
23. Longitudinal quantitative assessment of coronary atherosclerosis related to normal systolic blood pressure maintenance in the absence of established cardiovascular disease.
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Won, Ki-Bum, Park, Hyung-Bok, Heo, Ran, Lee, Byoung Kwon, Lin, Fay Y, Hadamitzky, Martin, Kim, Yong-Jin, Sung, Ji Min, Conte, Edoardo, Andreini, Daniele, Pontone, Gianluca, Budoff, Matthew J, Gottlieb, Ilan, Chun, Eun Ju, Cademartiri, Filippo, Maffei, Erica, Marques, Hugo, Gonçalves, Pedro de Araújo, Leipsic, Jonathon A, Lee, Sang-Eun, Shin, Sanghoon, Choi, Jung Hyun, Virmani, Renu, Samady, Habib, Chinnaiyan, Kavitha, Berman, Daniel S, Narula, Jagat, Bax, Jeroen J, Min, James K, and Chang, Hyuk-Jae
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Humans ,Cardiovascular Diseases ,Disease Progression ,Polyvinyl Chloride ,Coronary Angiography ,Risk Factors ,Blood Pressure ,Female ,Male ,Coronary Artery Disease ,Plaque ,Atherosclerotic ,Computed Tomography Angiography ,atherosclerosis ,coronary artery disease ,coronary computed tomography angiography ,systolic blood pressure ,Aging ,Clinical Research ,Cardiovascular ,Heart Disease ,Atherosclerosis ,Heart Disease - Coronary Heart Disease ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology - Abstract
BackgroundAtherosclerosis-related adverse events are commonly observed even in conditions with low cardiovascular (CV) risk. Longitudinal data regarding the association of normal systolic blood pressure maintenance (SBPmaintain ) with coronary plaque volume changes (PVC) has been limited in adults without traditional CV disease.HypothesisNormal SBPmaintain is important to attenuate coronary atherosclerosis progression in adults without baseline CV disease.MethodsWe analyzed 95 adults (56.7 ± 8.5 years; 40.0% men) without baseline CV disease who underwent serial coronary computed tomographic angiography with mean 3.5 years of follow-up. All participants were divided into two groups of normal SBPmaintain (follow-up SBP
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- 2022
24. Longitudinal Quantitative Assessment of Coronary Atherosclerotic Plaque Burden Related to Serum Hemoglobin Levels
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Won, Ki-Bum, Lee, Byoung Kwon, Heo, Ran, Park, Hyung-Bok, Lin, Fay Y, Hadamitzky, Martin, Kim, Yong-Jin, Sung, Ji Min, Conte, Edoardo, Andreini, Daniele, Pontone, Gianluca, Budoff, Matthew J, Gottlieb, Ilan, Chun, Eun Ju, Cademartiri, Filippo, Maffei, Erica, Marques, Hugo, de Araújo Gonçalves, Pedro, Leipsic, Jonathon A, Lee, Sang-Eun, Shin, Sanghoon, Choi, Jung Hyun, Virmani, Renu, Samady, Habib, Chinnaiyan, Kavitha, Berman, Daniel S, Narula, Jagat, Bax, Jeroen J, Min, James K, and Chang, Hyuk-Jae
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Biomedical and Clinical Sciences ,Clinical Sciences ,Heart Disease ,Clinical Research ,Cardiovascular ,Hematology ,Atherosclerosis ,Heart Disease - Coronary Heart Disease ,Evaluation of treatments and therapeutic interventions ,6.1 Pharmaceuticals ,CCTA ,coronary computed tomographic angiography ,CV ,cardiovascular ,PVC ,plaque volume changes ,atherosclerosis ,coronary computed tomography angiography ,hemoglobin ,Δ hemoglobin ,hemoglobin level changes - Abstract
BackgroundDespite a potential role of hemoglobin in atherosclerosis, data on coronary plaque volume changes (PVC) related to serum hemoglobin levels are limited.ObjectivesThe authors sought to evaluate coronary atherosclerotic plaque burden changes related to serum hemoglobin levels using serial coronary computed tomographic angiography (CCTA).MethodsA total of 830 subjects (age 61 ± 10 years, 51.9% male) who underwent serial CCTA were analyzed. The median interscan period was 3.2 (IQR: 2.5-4.4) years. Quantitative assessment of coronary plaques was performed at both scans. All participants were stratified into 4 groups based on the quartile of baseline hemoglobin levels. Annualized total PVC (mm3/year) was defined as total PVC divided by the interscan period.ResultsBaseline total plaque volume (mm3) was not different among all groups (group I [lowest]: 34.1 [IQR: 0.0-127.4] vs group II: 28.8 [IQR: 0.0-123.0] vs group III: 49.9 [IQR: 5.6-135.0] vs group IV [highest]: 34.3 [IQR: 0.0-130.7]; P = 0.235). During follow-up, serum hemoglobin level changes (Δ hemoglobin; per 1 g/dL) was related to annualized total PVC (β = -0.114) in overall participants (P < 0.05). After adjusting for age, sex, traditional risk factors, baseline hemoglobin and creatinine levels, baseline total plaque volume, and the use of aspirin, beta-blocker, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and statin, Δ hemoglobin significantly affected annualized total PVC in only the composite of groups I and II (β = -2.401; P = 0.004).ConclusionsSerial CCTA findings suggest that Δ hemoglobin has an independent effect on coronary atherosclerosis. This effect might be influenced by baseline hemoglobin levels. (Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging [PARADIGM]; NCT02803411).
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- 2022
25. Bypass Grafting and Native Coronary Artery Disease Activity
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Kwiecinski, Jacek, Tzolos, Evangelos, Fletcher, Alexander J, Nash, Jennifer, Meah, Mohammed N, Cadet, Sebastien, Adamson, Philip D, Grodecki, Kajetan, Joshi, Nikhil, Williams, Michelle C, van Beek, Edwin JR, Lai, Chi, Tavares, Adriana AS, MacAskill, Mark G, Dey, Damini, Baker, Andrew H, Leipsic, Jonathon, Berman, Daniel S, Sellers, Stephanie L, Newby, David E, Dweck, Marc R, and Slomka, Piotr J
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Heart Disease - Coronary Heart Disease ,Atherosclerosis ,Cardiovascular ,Heart Disease ,Clinical Research ,Aged ,Calcinosis ,Calcium ,Coronary Angiography ,Coronary Artery Disease ,Disease Progression ,Female ,Humans ,Male ,Middle Aged ,Plaque ,Atherosclerotic ,Predictive Value of Tests ,Sodium Fluoride ,F-18-NaF ,CABG ,coronary artery bypass graft ,coronary artery disease ,PET/CT ,(18)F-NaF ,Cardiorespiratory Medicine and Haematology ,Clinical Sciences ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Abstract
ObjectivesThe aim of this study was to describe the potential of 18F-sodium fluoride (18F-NaF) positron emission tomography (PET) to identify graft vasculopathy and to investigate the influence of coronary artery bypass graft (CABG) surgery on native coronary artery disease activity and progression.BackgroundAs well as developing graft vasculopathy, CABGs have been proposed to accelerate native coronary atherosclerosis.MethodsPatients with established coronary artery disease underwent baseline 18F-NaF PET, coronary artery calcium scoring, coronary computed tomographic angiography, and 1-year repeat coronary artery calcium scoring. Whole-vessel coronary microcalcification activity (CMA) on 18F-NaF PET and change in calcium scores were quantified in patients with and without CABG surgery.ResultsAmong 293 participants (mean age 65 ± 9 years, 84% men), 48 (16%) underwent CABG surgery 2.7 years [IQR: 1.4-10.4 years] previously. Although all arterial and the majority (120 of 128 [94%]) of vein grafts showed no 18F-NaF uptake, 8 saphenous vein grafts in 7 subjects had detectable CMA. Bypassed native coronary arteries had 3 times higher CMA values (2.1 [IQR: 0.4-7.5] vs 0.6 [IQR: 0-2.7]; P < 0.001) and greater progression of 1-year calcium scores (118 Agatston unit [IQR: 48-194 Agatston unit] vs 69 [IQR: 21-142 Agatston unit]; P = 0.01) compared with patients who had not undergone CABG, an effect confined largely to native coronary plaques proximal to the graft anastomosis. In sensitivity analysis, bypassed native coronary arteries had higher CMA (2.0 [IQR: 0.4-7.5] vs 0.8 [IQR: 0.3-3.2]; P < 0.001) and faster disease progression (24% [IQR: 16%-43%] vs 8% [IQR: 0%-24%]; P = 0.002) than matched patients (n = 48) with comparable burdens of coronary artery disease and cardiovascular comorbidities in the absence of bypass grafting.ConclusionsNative coronary arteries that have been bypassed demonstrate increased disease activity and more rapid disease progression than nonbypassed arteries, an observation that appears independent of baseline atherosclerotic plaque burden. Microcalcification activity is not a dominant feature of graft vasculopathy.
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- 2022
26. Aspirin and Statin Therapy for Nonobstructive Coronary Artery Disease: Five-year Outcomes from the CONFIRM Registry
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Indraratna, Praveen, Naoum, Christopher, Ben Zekry, Sagit, Gransar, Heidi, Blanke, Philipp, Sellers, Stephanie, Achenbach, Stephan, Al-Mallah, Mouaz H, Andreini, Daniele, Berman, Daniel S, Budoff, Matthew J, Cademartiri, Filippo, Callister, Tracy Q, Chang, Hyuk-Jae, Chinnaiyan, Kavitha, Chow, Benjamin JW, Cury, Ricardo C, DeLago, Augustin, Feuchtner, Gudrun, Hadamitzky, Martin, Hausleiter, Joerg, Kaufmann, Philipp A, Kim, Yong-Jin, Maffei, Erica, Marques, Hugo, Gonçalves, Pedro de Araújo, Pontone, Gianluca, Raff, Gilbert L, Rubinshtein, Ronen, Villines, Todd C, Lin, Fay Y, Shaw, Leslee J, Narula, Jagat, Bax, Jeroen J, and Leipsic, Jonathon A
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Epidemiology ,Biomedical and Clinical Sciences ,Health Sciences ,Clinical Research ,Cardiovascular ,Heart Disease - Coronary Heart Disease ,Heart Disease ,Clinical Trials and Supportive Activities ,Atherosclerosis ,4.2 Evaluation of markers and technologies ,Detection ,screening and diagnosis ,Good Health and Well Being ,Aspirin ,CT Angiography ,Coronary Artery Disease ,Nonobstructive Coronary Artery Disease ,Statin - Abstract
PurposeIn this cohort study, 5-year data from the Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry (ie, CONFIRM) were examined to identify associations of baseline aspirin and statin use with mortality, major adverse cardiovascular events (MACE), and myocardial infarction (MI) in individuals without substantial (≥50%) stenosis.Materials and methodsIn this prospective cohort study, all participants in the registry underwent coronary CT angiography and were classified as having no detectable coronary plaque or having nonobstructive coronary artery disease (CAD) (1%-49% stenosis). Participants with obstructive (≥50%) stenosis were excluded from analysis. The study commenced in June 2003 and was completed in March 2016. All unadjusted and risk-adjusted analyses utilized the Cox proportional hazard model with hospital sites modeled using shared frailty.ResultsA total of 6386 participants with no detectable plaque or with nonobstructive CAD were included (mean age, 56.0 years ± 13.3 [SD], 52% men). The mean follow-up period was 5.66 years ± 1.10. Nonobstructive CAD (n = 2815, 44% of all participants included in the study) was associated with a greater risk of all-cause mortality (10.6% [298 of 2815] vs 4.8% [170 of 3571], P < .001) compared to those without CAD (n = 3571, 56%). Baseline aspirin and statin use was documented for 1415 and 1429 participants, respectively, with nonobstructive CAD, and for 1560 and 1565 participants without detectable plaque, respectively. In individuals with nonobstructive CAD, baseline aspirin use was not associated with a reduction in MACE (10.9% [102 of 936] vs 14.7% [52 of 355], P = .06), all-cause mortality (9.6% [95 of 991] vs 10.9% [46 of 424], P = .468), or MI (4.4% [41 of 936] vs 6.2% [22 of 355], P = .18). On multivariate risk-adjusted analysis, baseline statin use was associated with a lower rate of MACE (hazard ratio, 0.59; 95% CI: 0.40, 0.87; P = .007). Neither therapy improved clinical outcomes for participants with no detectable plaque.ConclusionIn participants with nonobstructive CAD, baseline use of statins, but not of aspirin, was associated with improved clinical outcomes. Neither therapy was associated with benefit in participants without plaque.Keywords: Aspirin, Statin, Coronary Artery Disease, CT Angiography, Nonobstructive Coronary Artery DiseaseClinical trial registration no. NCT01443637 Supplemental material is available for this article. © RSNA, 2022See also the commentary by Canan and Navar in this issue.
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- 2022
27. Associations between dyspnoea, coronary atherosclerosis, and cardiovascular outcomes: results from the long-term follow-up CONFIRM registry.
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van Rosendael, Alexander R, Bax, A Maxim, van den Hoogen, Inge J, Smit, Jeff M, Al'Aref, Subhi J, Achenbach, Stephan, Al-Mallah, Mouaz H, Andreini, Daniele, Berman, Daniel S, Budoff, Matthew J, Cademartiri, Filippo, Callister, Tracy Q, Chang, Hyuk-Jae, Chinnaiyan, Kavitha, Chow, Benjamin JW, Cury, Ricardo C, DeLago, Augustin, Feuchtner, Gudrun, Hadamitzky, Martin, Hausleiter, Joerg, Kaufmann, Philipp A, Kim, Yong-Jin, Leipsic, Jonathon A, Maffei, Erica, Marques, Hugo, de Araújo Gonçalves, Pedro, Pontone, Gianluca, Raff, Gilbert L, Rubinshtein, Ronen, Villines, Todd C, Gransar, Heidi, Lu, Yao, Peña, Jessica M, Lin, Fay Y, Shaw, Leslee J, Narula, Jagat, Min, James K, and Bax, Jeroen J
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Atherosclerosis ,Cardiovascular ,Clinical Research ,Biomedical Imaging ,Heart Disease ,Heart Disease - Coronary Heart Disease ,4.2 Evaluation of markers and technologies ,Detection ,screening and diagnosis ,Aged ,Coronary Angiography ,Coronary Artery Disease ,Dyspnea ,Follow-Up Studies ,Humans ,Male ,Middle Aged ,Predictive Value of Tests ,Prognosis ,Prospective Studies ,Registries ,Risk Factors ,coronary artery disease ,coronary computed tomography angiography ,dyspnoea ,prognosis ,Cardiovascular medicine and haematology - Abstract
AimsThe relationship between dyspnoea, coronary artery disease (CAD), and major cardiovascular events (MACE) is poorly understood. This study evaluated (i) the association of dyspnoea with the severity of anatomical CAD by coronary computed tomography angiography (CCTA) and (ii) to which extent CAD explains MACE in patients with dyspnoea.Methods and resultsFrom the international COronary CT Angiography EvaluatioN for Clinical Outcomes: An InteRnational Multicenter (CONFIRM) registry, 4425 patients (750 with dyspnoea) with suspected but without known CAD were included and prospectively followed for ≥5 years. First, the association of dyspnoea with CAD severity was assessed using logistic regression analysis. Second, the prognostic value of dyspnoea for MACE (myocardial infarction and death), and specifically, the interaction between dyspnoea and CAD severity was investigated using Cox proportional-hazard analysis. Mean patient age was 60.3 ± 11.9 years, 63% of patients were male and 592 MACE events occurred during a median follow-up duration of 5.4 (IQR 5.1-6.0) years. On uni- and multivariable analysis (adjusting for age, sex, body mass index, chest pain typicality, and risk factors), dyspnoea was associated with two- and three-vessel/left main (LM) obstructive CAD. The presence of dyspnoea increased the risk for MACE [hazard ratio (HR) 1.57, 95% confidence interval (CI): 1.29-1.90], which was modified after adjusting for clinical predictors and CAD severity (HR 1.26, 95% CI: 1.02-1.55). Conversely, when stratified by CAD severity, dyspnoea did not provide incremental prognostic value in one-, two-, or three-vessel/LM obstructive CAD, but dyspnoea did provide incremental prognostic value in non-obstructive CAD.ConclusionIn patients with suspected CAD, dyspnoea was independently associated with severe obstructive CAD on CCTA. The severity of obstructive CAD explained the elevated MACE rates in patients presenting with dyspnoea, but in patients with non-obstructive CAD, dyspnoea portended additional risk.
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- 2022
28. Glycemic control is independently associated with rapid progression of coronary atherosclerosis in the absence of a baseline coronary plaque burden: a retrospective case–control study from the PARADIGM registry
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Won, Ki-Bum, Lee, Byoung Kwon, Lin, Fay Y, Hadamitzky, Martin, Kim, Yong-Jin, Sung, Ji Min, Conte, Edoardo, Andreini, Daniele, Pontone, Gianluca, Budoff, Matthew J, Gottlieb, Ilan, Chun, Eun Ju, Cademartiri, Filippo, Maffei, Erica, Marques, Hugo, de Araújo Gonçalves, Pedro, Leipsic, Jonathon A, Lee, Sang-Eun, Shin, Sanghoon, Choi, Jung Hyun, Virmani, Renu, Samady, Habib, Chinnaiyan, Kavitha, 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 ,Clinical Sciences ,Aging ,Heart Disease - Coronary Heart Disease ,Atherosclerosis ,Cardiovascular ,Heart Disease ,Biomedical Imaging ,Clinical Research ,Prevention ,Humans ,Male ,Middle Aged ,Aged ,Female ,Plaque ,Atherosclerotic ,Coronary Artery Disease ,Retrospective Studies ,Coronary Angiography ,Case-Control Studies ,Glycemic Control ,Glycated Hemoglobin ,Prospective Studies ,Disease Progression ,Computed Tomography Angiography ,Coronary Vessels ,Registries ,Predictive Value of Tests ,Hemoglobin A1c ,Coronary artery disease ,Progression ,Coronary computed tomography angiography ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology - Abstract
The baseline coronary plaque burden is the most important factor for rapid plaque progression (RPP) in the coronary artery. However, data on the independent predictors of RPP in the absence of a baseline coronary plaque burden are limited. Thus, this study aimed to investigate the predictors for RPP in patients without coronary plaques on baseline coronary computed tomography angiography (CCTA) images. A total of 402 patients (mean age: 57.6 ± 10.0 years, 49.3% men) without coronary plaques at baseline who underwent serial coronary CCTA were identified from the Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging (PARADIGM) registry and included in this retrospective study. RPP was defined as an annual change of ≥ 1.0%/year in the percentage atheroma volume (PAV). During a median inter-scan period of 3.6 years (interquartile range: 2.7-5.0 years), newly developed coronary plaques and RPP were observed in 35.6% and 4.2% of the patients, respectively. The baseline traditional risk factors, i.e., advanced age (≥ 60 years), male sex, hypertension, diabetes mellitus, hyperlipidemia, obesity, and current smoking status, were not significantly associated with the risk of RPP. Multivariate linear regression analysis showed that the serum hemoglobin A1c level (per 1% increase) measured at follow-up CCTA was independently associated with the annual change in the PAV (β: 0.098, 95% confidence interval [CI]: 0.048-0.149; P
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- 2022
29. Differential progression of coronary atherosclerosis according to plaque composition: a cluster analysis of PARADIGM registry data.
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Yoon, Yeonyee E, Baskaran, Lohendran, Lee, Benjamin C, Pandey, Mohit Kumar, Goebel, Benjamin, Lee, Sang-Eun, Sung, Ji Min, Andreini, Daniele, Al-Mallah, Mouaz H, Budoff, Matthew J, Cademartiri, Filippo, Chinnaiyan, Kavitha, Choi, Jung Hyun, Chun, Eun Ju, Conte, Edoardo, Gottlieb, Ilan, Hadamitzky, Martin, Kim, Yong Jin, Lee, Byoung Kwon, Leipsic, Jonathon A, Maffei, Erica, Marques, Hugo, de Araújo Gonçalves, Pedro, Pontone, Gianluca, Shin, Sanghoon, Narula, Jagat, Bax, Jeroen J, Lin, Fay Yu-Huei, Shaw, Leslee, and Chang, Hyuk-Jae
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Heart Disease - Coronary Heart Disease ,Cardiovascular ,Heart Disease ,Biomedical Imaging ,Aging ,Atherosclerosis ,2.1 Biological and endogenous factors - Abstract
Patient-specific phenotyping of coronary atherosclerosis would facilitate personalized risk assessment and preventive treatment. We explored whether unsupervised cluster analysis can categorize patients with coronary atherosclerosis according to their plaque composition, and determined how these differing plaque composition profiles impact plaque progression. Patients with coronary atherosclerotic plaque (n = 947; median age, 62 years; 59% male) were enrolled from a prospective multi-national registry of consecutive patients who underwent serial coronary computed tomography angiography (median inter-scan duration, 3.3 years). K-means clustering applied to the percent volume of each plaque component and identified 4 clusters of patients with distinct plaque composition. Cluster 1 (n = 52), which comprised mainly fibro-fatty plaque with a significant necrotic core (median, 55.7% and 16.0% of the total plaque volume, respectively), showed the least total plaque volume (PV) progression (+ 23.3 mm3), with necrotic core and fibro-fatty PV regression (- 5.7 mm3 and - 5.6 mm3, respectively). Cluster 2 (n = 219), which contained largely fibro-fatty (39.2%) and fibrous plaque (46.8%), showed fibro-fatty PV regression (- 2.4 mm3). Cluster 3 (n = 376), which comprised mostly fibrous (62.7%) and calcified plaque (23.6%), showed increasingly prominent calcified PV progression (+ 21.4 mm3). Cluster 4 (n = 300), which comprised mostly calcified plaque (58.7%), demonstrated the greatest total PV increase (+ 50.7mm3), predominantly increasing in calcified PV (+ 35.9 mm3). Multivariable analysis showed higher risk for plaque progression in Clusters 3 and 4, and higher risk for adverse cardiac events in Clusters 2, 3, and 4 compared to that in Cluster 1. Unsupervised clustering algorithms may uniquely characterize patient phenotypes with varied atherosclerotic plaque profiles, yielding distinct patterns of progressive disease and outcome.
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- 2021
30. Topological Data Analysis of Coronary Plaques Demonstrates the Natural History of Coronary Atherosclerosis
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Hwang, Doyeon, Kim, Haneol J, Lee, Seung-Pyo, Lim, Seonhee, Koo, Bon-Kwon, Kim, Yong-Jin, Kook, Woong, Andreini, Daniele, Al-Mallah, Mouaz H, Budoff, Matthew J, Cademartiri, Filippo, Chinnaiyan, Kavitha, Choi, Jung Hyun, Conte, Edoardo, Marques, Hugo, de Araújo Gonçalves, Pedro, Gottlieb, Ilan, Hadamitzky, Martin, Leipsic, Jonathon A, Maffei, Erica, Pontone, Gianluca, Raff, Gilbert L, Shin, Sanghoon, Lee, Byoung Kwon, Chun, Eun Ju, Sung, Ji Min, Lee, Sang-Eun, Berman, Daniel S, Lin, Fay Y, Virmani, Renu, Samady, Habib, Stone, Peter H, Narula, Jagat, Bax, Jeroen J, Shaw, Leslee J, Min, James K, and Chang, Hyuk-Jae
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Clinical Sciences ,Atherosclerosis ,Cardiovascular ,Heart Disease ,Biomedical Imaging ,Heart Disease - Coronary Heart Disease ,Clinical Research ,Coronary Artery Disease ,Data Analysis ,Exercise ,Humans ,Predictive Value of Tests ,coronary computed tomography angiography ,coronary plaque ,topological data analysis ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Abstract
ObjectivesThis study sought to identify distinct patient groups and their association with outcome based on the patient similarity network using quantitative coronary plaque characteristics from coronary computed tomography angiography (CTA).BackgroundCoronary CTA can noninvasively assess coronary plaques quantitatively.MethodsPatients who underwent 2 coronary CTAs at a minimum of 24 months' interval were analyzed (n = 1,264). A similarity Mapper network of patients was built by topological data analysis (TDA) based on the whole-heart quantitative coronary plaque analysis on coronary CTA to identify distinct patient groups and their association with outcome.ResultsThree distinct patient groups were identified by TDA, and the patient similarity network by TDA showed a closed loop, demonstrating a continuous trend of coronary plaque progression. Group A had the least coronary plaque amount (median 12.4 mm3 [interquartile range (IQR): 0.0 to 39.6 mm3]) in the entire coronary tree. Group B had a moderate coronary plaque amount (31.7 mm3 [IQR: 0.0 to 127.4 mm3]) with relative enrichment of fibrofatty and necrotic core (32.6% [IQR: 16.7% to 46.2%] and 2.7% [IQR: 0.1% to 6.9%] of the total plaque, respectively) components. Group C had the largest coronary plaque amount (187.0 mm3 [IQR: 96.7 to 306.4 mm3]) and was enriched for dense calcium component (46.8% [IQR: 32.0% to 63.7%] of the total plaque). At follow-up, total plaque volume, fibrous, and dense calcium volumes increased in all groups, but the proportion of fibrofatty component decreased in groups B and C, whereas the necrotic core portion decreased in only group B (all p
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- 2021
31. The Relationship Between Coronary Calcification and the Natural History of Coronary Artery Disease
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Jin, Han-Young, Weir-McCall, Jonathan R, Leipsic, Jonathon A, Son, Jang-Won, Sellers, Stephanie L, Shao, Michael, Blanke, Philipp, Ahmadi, Amir, 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, de Araujo Goncalves, Pedio, Shin, Sanghoon, Choi, Jung Hyun, Virmani, Renu, Samady, Habib, Stone, Peter H, Berman, Daniel S, Narula, Jagat, Shaw, Leslee J, Bax, Jeroen J, Chinnaiyan, Kavitha, Raff, Gilbert, Al-Mallah, Mouaz H, Lin, Fay Y, Min, James K, Sung, Ji Min, Lee, Sang-Eun, and Chang, Hyuk-Jae
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Clinical Sciences ,Biomedical Imaging ,Heart Disease ,Cardiovascular ,Heart Disease - Coronary Heart Disease ,Atherosclerosis ,Clinical Research ,Aetiology ,2.1 Biological and endogenous factors ,Computed Tomography Angiography ,Coronary Angiography ,Coronary Artery Disease ,Coronary Vessels ,Disease Progression ,Humans ,Plaque ,Atherosclerotic ,Predictive Value of Tests ,Risk Factors ,Vascular Calcification ,atherosclerosis ,coronary artery calcium ,coronary artery disease ,coronary computed tomography angiography ,statins ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Abstract
ObjectivesThe aim of the current study was to explore the impact of plaque calcification in terms of absolute calcified plaque volume (CPV) and in the context of its percentage of the total plaque volume at a lesion and patient level on the progression of coronary artery disease.BackgroundCoronary artery calcification is an established marker of risk of future cardiovascular events. Despite this, plaque calcification is also considered a marker of plaque stability, and it increases in response to medical therapy.MethodsThis analysis included 925 patients with 2,568 lesions from the PARADIGM (Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging) registry, in which patients underwent clinically indicated serial coronary computed tomography angiography. Plaque calcification was examined by using CPV and percent CPV (PCPV), calculated as (CPV/plaque volume) × 100 at a per-plaque and per-patient level (summation of all individual plaques).ResultsCPV was strongly correlated with plaque volume (r = 0.780; p
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- 2021
32. Age- and sex-related features of atherosclerosis from coronary computed tomography angiography in patients prior to acute coronary syndrome: results from the ICONIC study
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Conte, Edoardo, Dwivedi, Aeshita, Mushtaq, Saima, Pontone, Gianluca, Lin, Fay Y, Hollenberg, Emma J, Lee, Sang-Eun, Bax, Jeroen, Cademartiri, Filippo, Chinnaiyan, Kavitha, Chow, Benjamin JW, Cury, Ricardo C, Feuchtner, Gudrun, Hadamitzky, Martin, Kim, Yong-Jin, Baggiano, Andrea, Leipsic, Jonathon, Maffei, Erica, Marques, Hugo, Plank, Fabian, Raff, Gilbert L, van Rosendael, Alexander R, Villines, Todd C, Weirich, Harald G, Al’Aref, Subhi J, Baskaran, Lohendran, Cho, Iksung, Danad, Ibrahim, Han, Donghee, Heo, Ran, Lee, Ji Hyun, Stuijfzand, Wijnand J, Gransar, Heidi, Lu, Yao, Sung, Ji Min, Park, Hyung-Bok, Al-Mallah, Mouaz H, de Araújo Gonçalves, Pedro, Berman, Daniel S, Budoff, Matthew J, Samady, Habib, Shaw, Leslee J, Stone, Peter H, Virmani, Renu, Narula, Jagat, Min, James K, Chang, Hyuk-Jae, and Andreini, Daniele
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Biomedical and Clinical Sciences ,Clinical Sciences ,Heart Disease ,Atherosclerosis ,Biomedical Imaging ,Aging ,Clinical Research ,Heart Disease - Coronary Heart Disease ,Cardiovascular ,Acute Coronary Syndrome ,Aged ,Computed Tomography Angiography ,Coronary Angiography ,Coronary Artery Disease ,Female ,Humans ,Male ,Plaque ,Atherosclerotic ,atherosclerosis ,gender medicine ,cardiac CT ,high-risk plaque features ,CCTA ,Cardiovascular medicine and haematology - Abstract
AimsAlthough there is increasing evidence supporting coronary atherosclerosis evaluation by coronary computed tomography angiography (CCTA), no data are available on age and sex differences for quantitative plaque features. The aim of this study was to investigate sex and age differences in both qualitative and quantitative atherosclerotic features from CCTA prior to acute coronary syndrome (ACS).Methods and resultsWithin the ICONIC study, in which 234 patients with subsequent ACS were propensity matched 1:1 with 234 non-event controls, our current subanalysis included only the ACS cases. Both qualitative and quantitative advance plaque analysis by CCTA were performed by a core laboratory. In 129 cases, culprit lesions identified by invasive coronary angiography at the time of ACS were co-registered to baseline CCTA precursor lesions. The study population was then divided into subgroups according to sex and age (
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- 2021
33. Quantitative assessment of coronary plaque volume change related to triglyceride glucose index: The Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography IMaging (PARADIGM) registry
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Won, Ki-Bum, Lee, Byoung Kwon, Park, Hyung-Bok, Heo, Ran, Lee, Sang-Eun, Rizvi, Asim, Lin, Fay Y, Kumar, Amit, Hadamitzky, Martin, Kim, Yong-Jin, Sung, Ji Min, Conte, Edoardo, Andreini, Daniele, Pontone, Gianluca, Budoff, Matthew J, Gottlieb, Ilan, Chun, Eun Ju, Cademartiri, Filippo, Maffei, Erica, Marques, Hugo, de Araújo Gonçalves, Pedro, Leipsic, Jonathon A, Shin, Sanghoon, Choi, Jung Hyun, Virmani, Renu, Samady, Habib, Chinnaiyan, Kavitha, Raff, Gilbert L, 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 ,Clinical Sciences ,Heart Disease - Coronary Heart Disease ,Clinical Research ,Biomedical Imaging ,Cardiovascular ,Aging ,Atherosclerosis ,Heart Disease ,Aged ,Biomarkers ,Blood Glucose ,Computed Tomography Angiography ,Coronary Angiography ,Coronary Artery Disease ,Coronary Vessels ,Disease Progression ,Female ,Humans ,Male ,Middle Aged ,Multidetector Computed Tomography ,Plaque ,Atherosclerotic ,Predictive Value of Tests ,Registries ,Time Factors ,Triglycerides ,Triglyceride glucose index ,Coronary artery disease ,Coronary computed tomography angiography ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology - Abstract
BackgroundThe association between triglyceride glucose (TyG) index and coronary atherosclerotic change remains unclear. We aimed to evaluate the association between TyG index and coronary plaque progression (PP) using serial coronary computed tomography angiography (CCTA).MethodsA total of 1143 subjects (aged 60.7 ± 9.3 years, 54.6% male) who underwent serial CCTA with available data on TyG index and diabetic status were analyzed from The Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography IMaging (PARADIGM) registry. PP was defined as plaque volume (PV) (mm3) at follow-up minus PV at index > 0. Annual change of PV (mm3/year) was defined as PV change divided by inter-scan period. Rapid PP was defined as the progression of percent atheroma volume (PV divided by vessel volume multiplied by 100) ≥ 1.0%/year.ResultsThe median inter-scan period was 3.2 (range 2.6-4.4) years. All participants were stratified into three groups based on TyG index tertiles. The overall incidence of PP was 77.3%. Baseline total PV (group I [lowest]: 30.8 (0.0-117.7), group II: 47.2 (6.2-160.4), and group III [highest]: 57.5 (8.4-154.3); P
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- 2020
34. A Boosted Ensemble Algorithm for Determination of Plaque Stability in High-Risk Patients on Coronary CTA
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Al'Aref, Subhi J, Singh, Gurpreet, Choi, Jeong W, Xu, Zhuoran, Maliakal, Gabriel, van Rosendael, Alexander R, Lee, Benjamin C, Fatima, Zahra, Andreini, Daniele, Bax, Jeroen J, Cademartiri, Filippo, Chinnaiyan, Kavitha, Chow, Benjamin JW, Conte, Edoardo, Cury, Ricardo C, Feuchtner, Gudruf, Hadamitzky, Martin, Kim, Yong-Jin, Lee, Sang-Eun, Leipsic, Jonathon A, Maffei, Erica, Marques, Hugo, Plank, Fabian, Pontone, Gianluca, Raff, Gilbert L, Villines, Todd C, Weirich, Harald G, Cho, Iksung, Danad, Ibrahim, Han, Donghee, Heo, Ran, Lee, Ji Hyun, Rizvi, Asim, Stuijfzand, Wijnand J, Gransar, Heidi, Lu, Yao, Sung, Ji Min, Park, Hyung-Bok, Berman, Daniel S, Budoff, Matthew J, Samady, Habib, Stone, Peter H, Virmani, Renu, Narula, Jagat, Chang, Hyuk-Jae, Lin, Fay Y, Baskaran, Lohendran, Shaw, Leslee J, and Min, James K
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Clinical Sciences ,Cardiovascular ,Clinical Research ,Heart Disease ,Heart Disease - Coronary Heart Disease ,Atherosclerosis ,Detection ,screening and diagnosis ,4.2 Evaluation of markers and technologies ,Algorithms ,Case-Control Studies ,Computed Tomography Angiography ,Coronary Angiography ,Coronary Artery Disease ,Coronary Stenosis ,Humans ,Plaque ,Atherosclerotic ,Predictive Value of Tests ,Severity of Illness Index ,acute coronary syndrome ,coronary computed tomography angiography ,diameter stenosis ,machine learning ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Abstract
ObjectivesThis study sought to identify culprit lesion (CL) precursors among acute coronary syndrome (ACS) patients based on qualitative and quantitative computed tomography-based plaque characteristics.BackgroundCoronary computed tomography angiography (CTA) has been validated for patient-level prediction of ACS. However, the applicability of coronary CTA to CL assessment is not known.MethodsUtilizing the ICONIC (Incident COroNary Syndromes Identified by Computed Tomography) study, a nested case-control study of 468 patients with baseline coronary CTA, the study included ACS patients with invasive coronary angiography-adjudicated CLs that could be aligned to CL precursors on baseline coronary CTA. Separate blinded core laboratories adjudicated CLs and performed atherosclerotic plaque evaluation. Thereafter, the study used a boosted ensemble algorithm (XGBoost) to develop a predictive model of CLs. Data were randomly split into a training set (80%) and a test set (20%). The area under the receiver-operating characteristic curve of this model was compared with that of diameter stenosis (model 1), high-risk plaque features (model 2), and lesion-level features of CL precursors from the ICONIC study (model 3). Thereafter, the machine learning (ML) model was applied to 234 non-ACS patients with 864 lesions to determine model performance for CL exclusion.ResultsCL precursors were identified by both coronary angiography and baseline coronary CTA in 124 of 234 (53.0%) patients, with a total of 582 lesions (containing 124 CLs) included in the analysis. The ML model demonstrated significantly higher area under the receiver-operating characteristic curve for discriminating CL precursors (0.774; 95% confidence interval [CI]: 0.758 to 0.790) compared with model 1 (0.599; 95% CI: 0.599 to 0.599; p
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- 2020
35. Non-obstructive high-risk plaques increase the risk of future culprit lesions comparable to obstructive plaques without high-risk features: the ICONIC study
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Ferraro, Richard A, van Rosendael, Alexander R, Lu, Yao, Andreini, Daniele, Al-Mallah, Mouaz H, Cademartiri, Filippo, Chinnaiyan, Kavitha, Chow, Benjamin JW, Conte, Edoardo, Cury, Ricardo C, Feuchtner, Gudrun, de Araújo Gonçalves, Pedro, Hadamitzky, Martin, Kim, Yong-Jin, Leipsic, Jonathon, Maffei, Erica, Marques, Hugo, Plank, Fabian, Pontone, Gianluca, Raff, Gilbert L, Villines, Todd C, Lee, Sang-Eun, Al’Aref, Subhi J, Baskaran, Lohendran, Cho, Iksung, Danad, Ibrahim, Gransar, Heidi, Budoff, Matthew J, Samady, Habib, Stone, Peter H, Virmani, Renu, Narula, Jagat, Berman, Daniel S, Chang, Hyuk-Jae, Bax, Jeroen J, Min, James K, Shaw, Leslee J, and Lin, Fay Y
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Clinical Research ,Heart Disease - Coronary Heart Disease ,Heart Disease ,Atherosclerosis ,Cardiovascular ,4.2 Evaluation of markers and technologies ,Detection ,screening and diagnosis ,Acute Coronary Syndrome ,Aged ,Case-Control Studies ,Coronary Angiography ,Coronary Artery Disease ,Coronary Vessels ,Female ,Humans ,Male ,Middle Aged ,Plaque ,Atherosclerotic ,Predictive Value of Tests ,Retrospective Studies ,Risk Factors ,Coronary computed tomographic angiography ,coronary artery disease ,myocardial infarction ,Cardiovascular medicine and haematology - Abstract
AimsHigh-risk plaque (HRP) and non-obstructive coronary artery disease independently predict adverse events, but their importance to future culprit lesions has not been resolved. We sought to determine in patients prior to confirmed acute coronary syndrome (ACS) the association between lesion percent diameter stenosis (%DS), and the absolute number and prevalence of HRP. The secondary objective was to examine the relative importance of non-obstructive HRP in future culprit lesions.Methods and resultsWithin the ICONIC study, a nested case-control study of patients undergoing coronary computed tomographic angiography (coronary CT), we included ACS cases with culprit lesions confirmed by invasive coronary angiography and coregistered to baseline coronary CT. Quantitative CT was used to evaluate obstructive (≥50%) and non-obstructive (
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- 2020
36. Percent atheroma volume: Optimal variable to report whole-heart atherosclerotic plaque burden with coronary CTA, the PARADIGM study
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van Rosendael, Alexander R, Lin, Fay Y, Ma, Xiaoyue, van den Hoogen, Inge J, Gianni, Umberto, Al Hussein, Omar, Al'Aref, Subhi J, Peña, Jessica M, Andreini, Daniele, Al-Mallah, Mouaz H, Budoff, Matthew J, Cademartiri, Filippo, Chinnaiyan, Kavitha, Choi, Jung Hyun, Conte, Edoardo, Marques, Hugo, de Araújo Gonçalves, Pedro, Gottlieb, Ilan, Hadamitzky, Martin, Leipsic, Jonathon A, Maffei, Erica, Pontone, Gianluca, Raff, Gilbert L, Shin, Sanghoon, Kim, Yong-Jin, Lee, Byoung Kwon, Chun, Eun Ju, Sung, Ji Min, Lee, Sang-Eun, Berman, Daniel S, Virmani, Renu, Samady, Habib, Stone, Peter H, Narula, Jagat, Bax, Jeroen J, Shaw, Leslee J, Min, James K, and Chang, Hyuk-Jae
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Clinical Sciences ,Cardiovascular ,Atherosclerosis ,Heart Disease - Coronary Heart Disease ,Aging ,Biomedical Imaging ,Clinical Research ,Heart Disease ,Aged ,Body Surface Area ,Computed Tomography Angiography ,Coronary Angiography ,Coronary Artery Disease ,Coronary Vessels ,Disease Progression ,Female ,Humans ,Male ,Middle Aged ,Plaque ,Atherosclerotic ,Predictive Value of Tests ,Prospective Studies ,Registries ,Severity of Illness Index ,Sex Factors ,Time Factors ,Imaging ,Percent atheroma volume ,Coronary CTA ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences ,Applied computing - Abstract
BACKGROUND AND AIMS:Different methodologies to report whole-heart atherosclerotic plaque on coronary computed tomography angiography (CCTA) have been utilized. We examined which of the three commonly used plaque burden definitions was least affected by differences in body surface area (BSA) and sex. METHODS:The PARADIGM study includes symptomatic patients with suspected coronary atherosclerosis who underwent serial CCTA >2 years apart. Coronary lumen, vessel, and plaque were quantified from the coronary tree on a 0.5 mm cross-sectional basis by a core-lab, and summed to per-patient. Three quantitative methods of plaque burden were employed: (1) total plaque volume (PV) in mm3, (2) percent atheroma volume (PAV) in % [which equaled: PV/vessel volume * 100%], and (3) normalized total atheroma volume (TAVnorm) in mm3 [which equaled: PV/vessel length * mean population vessel length]. Only data from the baseline CCTA were used. PV, PAV, and TAVnorm were compared between patients in the top quartile of BSA vs the remaining, and between sexes. Associations between vessel volume, BSA, and the three plaque burden methodologies were assessed. RESULTS:The study population comprised 1479 patients (age 60.7 ± 9.3 years, 58.4% male) who underwent CCTA. A total of 17,649 coronary artery segments were evaluated with a median of 12 (IQR 11-13) segments per-patient (from a 16-segment coronary tree). Patients with a large BSA (top quartile), compared with the remaining patients, had a larger PV and TAVnorm, but similar PAV. The relation between larger BSA and larger absolute plaque volume (PV and TAVnorm) was mediated by the coronary vessel volume. Independent from the atherosclerotic cardiovascular disease risk (ASCVD) score, vessel volume correlated with PV (P
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- 2020
37. Clinical risk factors and atherosclerotic plaque extent to define risk for major events in patients without obstructive coronary artery disease: the long-term coronary computed tomography angiography CONFIRM registry
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van Rosendael, Alexander R, Bax, A Maxim, Smit, Jeff M, van den Hoogen, Inge J, Ma, Xiaoyue, Al’Aref, Subhi, Achenbach, Stephan, Al-Mallah, Mouaz H, Andreini, Daniele, Berman, Daniel S, Budoff, Matthew J, Cademartiri, Filippo, Callister, Tracy Q, Chang, Hyuk-Jae, Chinnaiyan, Kavitha, Chow, Benjamin JW, Cury, Ricardo C, DeLago, Augustin, Feuchtner, Gudrun, Hadamitzky, Martin, Hausleiter, Joerg, Kaufmann, Philipp A, Kim, Yong-Jin, Leipsic, Jonathon A, Maffei, Erica, Marques, Hugo, de Araújo Gonçalves, Pedro, Pontone, Gianluca, Raff, Gilbert L, Rubinshtein, Ronen, Villines, Todd C, Gransar, Heidi, Lu, Yao, Peña, Jessica M, Lin, Fay Y, Shaw, Leslee J, Min, James K, and Bax, Jeroen J
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Heart Disease - Coronary Heart Disease ,Aging ,Patient Safety ,Cardiovascular ,Clinical Research ,Atherosclerosis ,Biomedical Imaging ,Heart Disease ,Prevention ,Diabetes ,2.1 Biological and endogenous factors ,Aetiology ,4.2 Evaluation of markers and technologies ,Detection ,screening and diagnosis ,Good Health and Well Being ,Aged ,Computed Tomography Angiography ,Coronary Angiography ,Coronary Artery Disease ,Female ,Humans ,Male ,Middle Aged ,Plaque ,Atherosclerotic ,Predictive Value of Tests ,Prognosis ,Registries ,Risk Factors ,coronary computed tomography angiography ,risk stratification ,atherosclerosis ,imaging ,preventive cardiology ,Cardiovascular medicine and haematology - Abstract
AimsIn patients without obstructive coronary artery disease (CAD), we examined the prognostic value of risk factors and atherosclerotic extent.Methods and resultsPatients from the long-term CONFIRM registry without prior CAD and without obstructive (≥50%) stenosis were included. Within the groups of normal coronary computed tomography angiography (CCTA) (N = 1849) and non-obstructive CAD (N = 1698), the prognostic value of traditional clinical risk factors and atherosclerotic extent (segment involvement score, SIS) was assessed with Cox models. Major adverse cardiac events (MACE) were defined as all-cause mortality, non-fatal myocardial infarction, or late revascularization. In total, 3547 patients were included (age 57.9 ± 12.1 years, 57.8% male), experiencing 460 MACE during 5.4 years of follow-up. Age, body mass index, hypertension, and diabetes were the clinical variables associated with increased MACE risk, but the magnitude of risk was higher for CCTA defined atherosclerotic extent; adjusted hazard ratio (HR) for SIS >5 was 3.4 (95% confidence interval [CI] 2.3-4.9) while HR for diabetes and hypertension were 1.7 (95% CI 1.3-2.2) and 1.4 (95% CI 1.1-1.7), respectively. Exclusion of revascularization as endpoint did not modify the results. In normal CCTA, presence of ≥1 traditional risk factors did not worsen prognosis (log-rank P = 0.248), while it did in non-obstructive CAD (log-rank P = 0.025). Adjusted for SIS, hypertension and diabetes predicted MACE risk in non-obstructive CAD, while diabetes did not increase risk in absence of CAD (P-interaction = 0.004).ConclusionAmong patients without obstructive CAD, the extent of CAD provides more prognostic information for MACE than traditional cardiovascular risk factors. An interaction was observed between risk factors and CAD burden, suggesting synergistic effects of both.
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- 2020
38. Coronary atherosclerosis scoring with semiquantitative CCTA risk scores for prediction of major adverse cardiac events: Propensity score-based analysis of diabetic and non-diabetic patients
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van den Hoogen, Inge J, van Rosendael, Alexander R, Lin, Fay Y, Lu, Yao, Dimitriu-Leen, Aukelien C, Smit, Jeff M, Scholte, Arthur JHA, Achenbach, Stephan, Al-Mallah, Mouaz H, Andreini, Daniele, Berman, Daniel S, Budoff, Matthew J, Cademartiri, Filippo, Callister, Tracy Q, Chang, Hyuk-Jae, Chinnaiyan, Kavitha, Chow, Benjamin JW, Cury, Ricardo C, DeLago, Augustin, Feuchtner, Gudrun, Hadamitzky, Martin, Hausleiter, Joerg, Kaufmann, Philipp A, Kim, Yong-Jin, Leipsic, Jonathon A, Maffei, Erica, Marques, Hugo, de Araújo Gonçalves, Pedro, Pontone, Gianluca, Raff, Gilbert L, Rubinshtein, Ronen, Villines, Todd C, Gransar, Heidi, Jones, Erica C, Peña, Jessica M, Shaw, Leslee J, Min, James K, and Bax, Jeroen J
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Biomedical and Clinical Sciences ,Clinical Sciences ,Patient Safety ,Prevention ,Diabetes ,Heart Disease ,Cardiovascular ,Heart Disease - Coronary Heart Disease ,Clinical Research ,Atherosclerosis ,Biomedical Imaging ,4.2 Evaluation of markers and technologies ,Detection ,screening and diagnosis ,Aged ,Case-Control Studies ,Computed Tomography Angiography ,Coronary Angiography ,Coronary Artery Disease ,Coronary Stenosis ,Diabetes Mellitus ,Disease Progression ,Female ,Humans ,Male ,Middle Aged ,Multidetector Computed Tomography ,Predictive Value of Tests ,Prognosis ,Propensity Score ,Registries ,Risk Assessment ,Risk Factors ,Severity of Illness Index ,Computed tomography ,Diabetes mellitus ,Prognostic application ,Risk stratification ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences ,Applied computing - Abstract
AimsWe aimed to compare semiquantitative coronary computed tomography angiography (CCTA) risk scores - which score presence, extent, composition, stenosis and/or location of coronary artery disease (CAD) - and their prognostic value between patients with and without diabetes mellitus (DM). Risk scores derived from general chest-pain populations are often challenging to apply in DM patients, because of numerous confounders.MethodsOut of a combined cohort from the Leiden University Medical Center and the CONFIRM registry with 5-year follow-up data, we performed a secondary analysis in diabetic patients with suspected CAD who were clinically referred for CCTA. A total of 732 DM patients was 1:1 propensity-matched with 732 non-DM patients by age, sex and cardiovascular risk factors. A subset of 7 semiquantitative CCTA risk scores was compared between groups: 1) any stenosis ≥50%, 2) any stenosis ≥70%, 3) stenosis-severity component of the coronary artery disease-reporting and data system (CAD-RADS), 4) segment involvement score (SIS), 5) segment stenosis score (SSS), 6) CT-adapted Leaman score (CT-LeSc), and 7) Leiden CCTA risk score. Cox-regression analysis was performed to assess the association between the scores and the primary endpoint of all-cause death and non-fatal myocardial infarction. Also, area under the receiver-operating characteristics curves were compared to evaluate discriminatory ability.ResultsA total of 1,464 DM and non-DM patients (mean age 58 ± 12 years, 40% women) underwent CCTA and 155 (11%) events were documented after median follow-up of 5.1 years. In DM patients, the 7 semiquantitative CCTA risk scores were significantly more prevalent or higher as compared to non-DM patients (p ≤ 0.022). All scores were independently associated with the primary endpoint in both patients with and without DM (p ≤ 0.020), with non-significant interaction between the scores and diabetes (interaction p ≥ 0.109). Discriminatory ability of the Leiden CCTA risk score in DM patients was significantly better than any stenosis ≥50% and ≥70% (p = 0.003 and p = 0.007, respectively), but comparable to the CAD-RADS, SIS, SSS and CT-LeSc that also focus on the extent of CAD (p ≥ 0.265).ConclusionCoronary atherosclerosis scoring with semiquantitative CCTA risk scores incorporating the total extent of CAD discriminate major adverse cardiac events well, and might be useful for risk stratification of patients with DM beyond the binary evaluation of obstructive stenosis alone.
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- 2020
39. Increased long-term mortality in women with high left ventricular ejection fraction: data from the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) long-term registry
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Gebhard, Catherine, Maredziak, Monika, Messerli, Michael, Buechel, Ronny R, Lin, Fay, Gransar, Heidi, Achenbach, Stephan, Al-Mallah, Mouaz H, Andreini, Daniele, Bax, Jeroen J, Berman, Daniel S, Budoff, Matthew J, Cademartiri, Filippo, Callister, Tracy Q, Chang, Hyuk-Jae, Chinnaiyan, Kavitha, Chow, Benjamin JW, Cury, Ricardo C, DeLago, Augustin, Feuchtner, Gudrun, Hadamitzky, Martin, Hausleiter, Joerg, Kim, Yong-Jin, Leipsic, Jonathon, Maffei, Erica, Marques, Hugo, de Araújo Gonçalves, Pedro, Pontone, Gianluca, Raff, Gilbert L, Rubinshtein, Ronen, Shaw, Leslee J, Villines, Todd C, Lu, Yao, Jones, Erica C, Peña, Jessica M, Min, James K, and Kaufmann, Philipp A
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Biomedical and Clinical Sciences ,Clinical Sciences ,Aging ,Cardiovascular ,Heart Disease ,Clinical Trials and Supportive Activities ,Biomedical Imaging ,Clinical Research ,Atherosclerosis ,Detection ,screening and diagnosis ,4.2 Evaluation of markers and technologies ,Good Health and Well Being ,Aged ,Computed Tomography Angiography ,Coronary Angiography ,Coronary Artery Disease ,Female ,Humans ,Male ,Middle Aged ,Prognosis ,Prospective Studies ,Registries ,Severity of Illness Index ,Stroke Volume ,Ventricular Function ,Left ,women ,gender ,coronary computed tomography angiography ,left ventricular ejection fraction ,cardiovascular ,cardiovascular ,Cardiovascular medicine and haematology - Abstract
AimsThere are significant sex-specific differences in left ventricular ejection fraction (LVEF), with a higher LVEF being observed in women. We sought to assess the clinical relevance of an increased LVEF in women and men.Methods and resultsA total of 4632 patients from the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry (44.8% women; mean age 58.7 ± 13.2 years in men and 59.5 ± 13.3 years in women, P = 0.05), in whom LVEF was measured by cardiac computed tomography, were categorized according to LVEF (low 65%). The prevalence of high LVEF was similar in both sexes (33.5% in women and 32.5% in men, P = 0.46). After 6 years of follow-up, no difference in mortality was observed in patients with high LVEF in the overall cohort (P = 0.41). When data were stratified by sex, women with high LVEF died more often from any cause as compared to women with normal LVEF (8.6% vs. 7.1%, log rank P = 0.032), while an opposite trend was observed in men (5.8% vs. 6.8% in normal LVEF, log rank P = 0.89). Accordingly, a first order interaction term of male sex and high LVEF was significant (hazard ratios 0.63, 95% confidence intervals 0.41-0.98, P = 0.043) in a Cox regression model of all-cause mortality adjusted for age, cardiovascular risk factors, and severity of coronary artery disease (CAD).ConclusionIncreased LVEF is highly prevalent in patients referred for evaluation of CAD and is associated with an increased risk of death in women, but not in men. Differentiating between normal and hyperdynamic left ventricles might improve risk stratification in women with CAD.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/NCT01443637.
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- 2020
40. Machine Learning Framework to Identify Individuals at Risk of Rapid Progression of Coronary Atherosclerosis: From the PARADIGM Registry
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Han, Donghee, Kolli, Kranthi K, Al'Aref, Subhi J, Baskaran, Lohendran, van Rosendael, Alexander R, Gransar, Heidi, Andreini, Daniele, Budoff, Matthew J, Cademartiri, Filippo, Chinnaiyan, Kavitha, Choi, Jung Hyun, Conte, Edoardo, Marques, Hugo, de Araújo Gonçalves, Pedro, Gottlieb, Ilan, Hadamitzky, Martin, Leipsic, Jonathon A, Maffei, Erica, Pontone, Gianluca, Raff, Gilbert L, Shin, Sangshoon, Kim, Yong‐Jin, Lee, Byoung Kwon, Chun, Eun Ju, Sung, Ji Min, Lee, Sang‐Eun, Virmani, Renu, Samady, Habib, Stone, Peter, Narula, Jagat, Berman, Daniel S, Bax, Jeroen J, Shaw, Leslee J, Lin, Fay Y, Min, James K, and Chang, Hyuk‐Jae
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Atherosclerosis ,Heart Disease ,Aging ,Heart Disease - Coronary Heart Disease ,Cardiovascular ,Biomedical Imaging ,Clinical Research ,4.2 Evaluation of markers and technologies ,Detection ,screening and diagnosis ,Aged ,Computed Tomography Angiography ,Coronary Angiography ,Coronary Artery Disease ,Diagnosis ,Computer-Assisted ,Disease Progression ,Female ,Humans ,Machine Learning ,Male ,Middle Aged ,Multidetector Computed Tomography ,Plaque ,Atherosclerotic ,Predictive Value of Tests ,Prospective Studies ,Radiographic Image Interpretation ,Computer-Assisted ,Registries ,Time Factors ,coronary artery disease ,coronary computed tomography angiography ,machine learning ,plaque progression ,risk prediction ,Cardiorespiratory Medicine and Haematology ,Cardiovascular medicine and haematology - Abstract
Background Rapid coronary plaque progression (RPP) is associated with incident cardiovascular events. To date, no method exists for the identification of individuals at risk of RPP at a single point in time. This study integrated coronary computed tomography angiography-determined qualitative and quantitative plaque features within a machine learning (ML) framework to determine its performance for predicting RPP. Methods and Results Qualitative and quantitative coronary computed tomography angiography plaque characterization was performed in 1083 patients who underwent serial coronary computed tomography angiography from the PARADIGM (Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging) registry. RPP was defined as an annual progression of percentage atheroma volume ≥1.0%. We employed the following ML models: model 1, clinical variables; model 2, model 1 plus qualitative plaque features; model 3, model 2 plus quantitative plaque features. ML models were compared with the atherosclerotic cardiovascular disease risk score, Duke coronary artery disease score, and a logistic regression statistical model. 224 patients (21%) were identified as RPP. Feature selection in ML identifies that quantitative computed tomography variables were higher-ranking features, followed by qualitative computed tomography variables and clinical/laboratory variables. ML model 3 exhibited the highest discriminatory performance to identify individuals who would experience RPP when compared with atherosclerotic cardiovascular disease risk score, the other ML models, and the statistical model (area under the receiver operating characteristic curve in ML model 3, 0.83 [95% CI 0.78-0.89], versus atherosclerotic cardiovascular disease risk score, 0.60 [0.52-0.67]; Duke coronary artery disease score, 0.74 [0.68-0.79]; ML model 1, 0.62 [0.55-0.69]; ML model 2, 0.73 [0.67-0.80]; all P
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- 2020
41. Machine learning of clinical variables and coronary artery calcium scoring for the prediction of obstructive coronary artery disease on coronary computed tomography angiography: analysis from the CONFIRM registry.
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Al'Aref, Subhi J, Maliakal, Gabriel, Singh, Gurpreet, van Rosendael, Alexander R, Ma, Xiaoyue, Xu, Zhuoran, Alawamlh, Omar Al Hussein, Lee, Benjamin, Pandey, Mohit, Achenbach, Stephan, Al-Mallah, Mouaz H, Andreini, Daniele, Bax, Jeroen J, Berman, Daniel S, Budoff, Matthew J, Cademartiri, Filippo, Callister, Tracy Q, Chang, Hyuk-Jae, Chinnaiyan, Kavitha, Chow, Benjamin JW, Cury, Ricardo C, DeLago, Augustin, Feuchtner, Gudrun, Hadamitzky, Martin, Hausleiter, Joerg, Kaufmann, Philipp A, Kim, Yong-Jin, Leipsic, Jonathon A, Maffei, Erica, Marques, Hugo, Gonçalves, Pedro de Araújo, Pontone, Gianluca, Raff, Gilbert L, Rubinshtein, Ronen, Villines, Todd C, Gransar, Heidi, Lu, Yao, Jones, Erica C, Peña, Jessica M, Lin, Fay Y, Min, James K, and Shaw, Leslee J
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Biomedical and Clinical Sciences ,Clinical Sciences ,Biomedical Imaging ,Clinical Research ,Atherosclerosis ,Cardiovascular ,Heart Disease ,Heart Disease - Coronary Heart Disease ,4.2 Evaluation of markers and technologies ,Detection ,screening and diagnosis ,Calcium ,Computed Tomography Angiography ,Coronary Angiography ,Coronary Artery Disease ,Coronary Vessels ,Female ,Humans ,Machine Learning ,Male ,Middle Aged ,Multidetector Computed Tomography ,Predictive Value of Tests ,Prospective Studies ,ROC Curve ,Registries ,Coronary artery disease ,Coronary artery calcium score ,Machine learning ,Coronary computed tomography angiography ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Abstract
AimsSymptom-based pretest probability scores that estimate the likelihood of obstructive coronary artery disease (CAD) in stable chest pain have moderate accuracy. We sought to develop a machine learning (ML) model, utilizing clinical factors and the coronary artery calcium score (CACS), to predict the presence of obstructive CAD on coronary computed tomography angiography (CCTA).Methods and resultsThe study screened 35 281 participants enrolled in the CONFIRM registry, who underwent ≥64 detector row CCTA evaluation because of either suspected or previously established CAD. A boosted ensemble algorithm (XGBoost) was used, with data split into a training set (80%) on which 10-fold cross-validation was done and a test set (20%). Performance was assessed of the (1) ML model (using 25 clinical and demographic features), (2) ML + CACS, (3) CAD consortium clinical score, (4) CAD consortium clinical score + CACS, and (5) updated Diamond-Forrester (UDF) score. The study population comprised of 13 054 patients, of whom 2380 (18.2%) had obstructive CAD (≥50% stenosis). Machine learning with CACS produced the best performance [area under the curve (AUC) of 0.881] compared with ML alone (AUC of 0.773), CAD consortium clinical score (AUC of 0.734), and with CACS (AUC of 0.866) and UDF (AUC of 0.682), P
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- 2020
42. Long-term prognostic utility of computed tomography coronary angiography in older populations.
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Gnanenthiran, Sonali R, Naoum, Christopher, Leipsic, Jonathon A, Achenbach, Stephan, Al-Mallah, Mouaz H, Andreini, Daniele, Bax, Jeroen J, Berman, Daniel S, Budoff, Matthew J, Cademartiri, Filippo, Callister, Tracy Q, Chang, Hyuk-Jae, Chinnaiyan, Kavitha, Chow, Benjamin JW, Cury, Ricardo C, DeLago, Augustin, Feuchtner, Gudrun, Hadamitzky, Martin, Hausleiter, Joerg, Kaufman, Philipp A, Kim, Yong-Jin, Maffei, Erica, Marques, Hugo, de Araújo Gonçalves, Pedro, Pontone, Gianluca, Raff, Gilbert L, Rubinshtein, Ronen, Shaw, Leslee J, Villines, Todd C, Gransar, Heidi, Lu, Yao, Jones, Erica C, Peña, Jessica M, Lin, Fay Y, Kritharides, Leonard, and Min, James K
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Prevention ,Biomedical Imaging ,Heart Disease - Coronary Heart Disease ,Aging ,Cardiovascular ,Clinical Research ,Atherosclerosis ,Heart Disease ,4.2 Evaluation of markers and technologies ,Detection ,screening and diagnosis ,Good Health and Well Being ,Age Factors ,Aged ,Aged ,80 and over ,Computed Tomography Angiography ,Coronary Angiography ,Coronary Artery Disease ,Female ,Humans ,Male ,Middle Aged ,Predictive Value of Tests ,Prognosis ,Prospective Studies ,Registries ,coronary computed tomography angiography ,age ,older populations ,mortality ,major adverse cardiovascular events ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology - Abstract
AimsThe long-term prognostic value of coronary computed tomography angiography (CCTA)-identified coronary artery disease (CAD) has not been evaluated in elderly patients (≥70 years). We compared the ability of coronary CCTA to predict 5-year mortality in older vs. younger populations.Methods and resultsFrom the prospective CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry, we analysed CCTA results according to age 50%); (ii) segment involvement score (SIS): number of segments with plaque. Cox-proportional hazard models assessed the relationship between CCTA findings and time to mortality. At a mean 5.6 ± 1.1 year follow-up, CCTA-identified CAD predicted increased mortality compared with patients with a normal CCTA in both
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- 2019
43. Differential association between the progression of coronary artery calcium score and coronary plaque volume progression according to statins: the Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography Imaging (PARADIGM) study
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Lee, Sang-Eun, Sung, Ji Min, Andreini, Daniele, Budoff, Matthew J, Cademartiri, Filippo, Chinnaiyan, Kavitha, Choi, Jung Hyun, Chun, Eun Ju, Conte, Edoardo, Gottlieb, Ilan, Hadamitzky, Martin, Kim, Yong Jin, Kumar, Amit, Lee, Byoung Kwon, Leipsic, Jonathon A, Maffei, Erica, Marques, Hugo, Pontone, Gianluca, Raff, Gilbert, Shin, Sanghoon, Stone, Peter H, Samady, Habib, Virmani, Renu, Narula, Jagat, Berman, Daniel S, Shaw, Leslee J, Bax, Jeroen J, Lin, Fay Y, Min, James K, and Chang, Hyuk-Jae
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Atherosclerosis ,Biomedical Imaging ,Cardiovascular ,Heart Disease ,Heart Disease - Coronary Heart Disease ,Clinical Research ,Computed Tomography Angiography ,Coronary Angiography ,Coronary Artery Disease ,Disease Progression ,Female ,Humans ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,Male ,Middle Aged ,Plaque ,Atherosclerotic ,Prospective Studies ,Registries ,Vascular Calcification ,coronary artery atherosclerosis ,statins ,coronary computed tomography angiography ,coronary artery calcium score ,coronary artery calcification ,Agatston score ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology - Abstract
AimsCoronary artery calcium score (CACS) is a strong predictor of major adverse cardiac events (MACE). Conversely, statins, which markedly reduce MACE risk, increase CACS. We explored whether CACS progression represents compositional plaque volume (PV) progression differently according to statin use.Methods and resultsFrom a prospective multinational registry of consecutive patients (n = 2252) who underwent serial coronary computed tomography angiography (CCTA) at a ≥ 2-year interval, 654 patients (61 ± 10 years, 56% men, inter-scan interval 3.9 ± 1.5 years) with information regarding the use of statins and having a serial CACS were included. Patients were divided into non-statin (n = 246) and statin-taking (n = 408) groups. Coronary PVs (total, calcified, and non-calcified; sum of fibrous, fibro-fatty, and lipid-rich) were quantitatively analysed, and CACS was measured from both CCTAs. Multivariate linear regression models were constructed for both statin-taking and non-statin group to assess the association between compositional PV change and change in CACS. In multivariate linear regression analysis, in the non-statin group, CACS increase was positively associated with both non-calcified (β = 0.369, P = 0.004) and calcified PV increase (β = 1.579, P
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- 2019
44. Superior Risk Stratification With Coronary Computed Tomography Angiography Using a Comprehensive Atherosclerotic Risk Score
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van Rosendael, Alexander R, Shaw, Leslee J, Xie, Joe X, Dimitriu-Leen, Aukelien C, Smit, Jeff M, Scholte, Arthur J, van Werkhoven, Jacob M, Callister, Tracy Q, DeLago, Augustin, Berman, Daniel S, Hadamitzky, Martin, Hausleiter, Jeorg, Al-Mallah, Mouaz H, Budoff, Matthew J, Kaufmann, Philipp A, Raff, Gilbert, Chinnaiyan, Kavitha, Cademartiri, Filippo, Maffei, Erica, Villines, Todd C, Kim, Yong-Jin, Feuchtner, Gudrun, Lin, Fay Y, Jones, Erica C, Pontone, Gianluca, Andreini, Daniele, Marques, Hugo, Rubinshtein, Ronen, Achenbach, Stephan, Dunning, Allison, Gomez, Millie, Hindoyan, Niree, Gransar, Heidi, Leipsic, Jonathon, Narula, Jagat, Min, James K, and Bax, Jeroen J
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Biomedical and Clinical Sciences ,Clinical Sciences ,Heart Disease ,Atherosclerosis ,Biomedical Imaging ,Prevention ,Patient Safety ,Cardiovascular ,Clinical Research ,Heart Disease - Coronary Heart Disease ,4.2 Evaluation of markers and technologies ,Detection ,screening and diagnosis ,Adult ,Aged ,Computed Tomography Angiography ,Coronary Angiography ,Coronary Artery Disease ,Coronary Stenosis ,Coronary Vessels ,Female ,Humans ,Male ,Middle Aged ,Multidetector Computed Tomography ,Myocardial Infarction ,Plaque ,Atherosclerotic ,Predictive Value of Tests ,Progression-Free Survival ,Reproducibility of Results ,Risk Assessment ,Risk Factors ,Severity of Illness Index ,coronary computed tomography angiography ,risk stratification ,stable coronary artery disease ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Abstract
ObjectivesThis study was designed to assess the prognostic value of a new comprehensive coronary computed tomography angiography (CTA) score compared with the stenosis severity component of the Coronary Artery Disease-Reporting and Data System (CAD-RADS).BackgroundCurrent risk assessment with coronary CTA is mainly focused on maximal stenosis severity. Integration of plaque extent, location, and composition in a comprehensive model may improve risk stratification.MethodsA total of 2,134 patients with suspected but without known CAD were included. The predictive value of the comprehensive CTA score (ranging from 0 to 42 and divided into 3 groups: 0 to 5, 6 to 20, and >20) was compared with the CAD-RADS combined into 3 groups (0% to 30%, 30% to 70% and ≥70% stenosis). Its predictive performance was internally and externally validated (using the 5-year follow-up dataset of the CONFIRM [Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry], n = 1,971).ResultsThe mean age of patients was 55 ± 13 years, mean follow-up 3.6 ± 2.8 years, and 130 events (myocardial infarction or death) occurred. The new, comprehensive CTA score showed strong and independent predictive value using the Cox proportional hazard analysis. A model including clinical variables plus comprehensive CTA score showed better discrimination of events compared with a model consisting of clinical variables plus CAD-RADS (0.768 vs. 0.742, p = 0.001). Also, the comprehensive CTA score correctly reclassified a significant proportion of patients compared with the CAD-RADS (net reclassification improvement 12.4%, p < 0.001). Good predictive accuracy was reproduced in the external validation cohort.ConclusionsThe new comprehensive CTA score provides better discrimination and reclassification of events compared with the CAD-RADS score based on stenosis severity only. The score retained similar prognostic accuracy when externally validated. Anatomic risk scores can be improved with the addition of extent, location, and compositional measures of atherosclerotic plaque. (Comprehensive CTA risk score calculator is available at: http://18.224.14.19/calcApp/).
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- 2019
45. Point of Care Clinical Risk Score to Improve the Negative Diagnostic Utility of an Agatston Score of Zero: Averting the Need for Coronary Computed Tomography Angiography.
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Alshahrani, Ali M, Mahmood, Hamza, Wells, George A, Hossain, Alomgir, Rybicki, Frank J, Achenbach, Stephan, Al-Mallah, Mouaz H, Andreini, Daniele, Bax, Jeroen J, Berman, Daniel S, Budoff, Matthew J, Cademartiri, Filippo, Callister, Tracy Q, Chang, Hyuk-Jae, Chinnaiyan, Kavitha, Cury, Ricardo C, DeLago, Augustin, Feuchtner, Gudrun, Hadamitzky, Martin, Hausleiter, Joerg, Kaufmann, Philipp A, Kim, Yong-Jin, Leipsic, Jonathon A, Maffei, Erica, Marques, Hugo, Pontone, Gianluca, Raff, Gilbert, Rubinshtein, Ronen, Shaw, Leslee J, Villines, Todd C, Lin, Fay Y, Min, James K, and Chow, Benjamin J
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Humans ,Coronary Stenosis ,Registries ,Risk Assessment ,Risk Factors ,Retrospective Studies ,Predictive Value of Tests ,Algorithms ,Middle Aged ,Unnecessary Procedures ,Point-of-Care Systems ,Female ,Male ,Computed Tomography Angiography ,chest pain ,coronary artery disease ,diabetes mellitus ,humans ,registries ,Prevention ,Cardiovascular ,Atherosclerosis ,Clinical Research ,Heart Disease - Coronary Heart Disease ,Biomedical Imaging ,Heart Disease ,4.2 Evaluation of markers and technologies ,Clinical Sciences ,Cardiovascular System & Hematology - Abstract
BackgroundCoronary artery calcification is a marker of underlying atherosclerotic vascular disease. The absence of coronary artery calcification is associated with a low prevalence of obstructive coronary artery disease (CAD), but it cannot be ruled out completely. We sought to develop a clinical tool that can be added to Agatston score of zero to rule out obstructive CAD with high accuracy.MethodsWe developed a clinical score retrospectively from a cohort of 4903 consecutive patients with an Agatston score of zero. Patients with prior diagnosis of CAD, coronary percutaneous coronary intervention, or surgical revascularization were excluded. Obstructive CAD was defined as any epicardial vessel diameter narrowing of ≥50%. The score was validated using an external cohort of 4290 patients with an Agatston score of zero from a multinational registry.ResultsThe score consisted of 7 variables: age, sex, typical chest pain, dyslipidemia, hypertension, family history, and diabetes mellitus. The model was robust with an area under the curve of 0.70 (95% CI, 0.65-0.76) in the derivation cohort and 0.69 (95% CI, 0.65-0.72) in the validation cohort. Patients were divided into 3 risk groups based on the score: low (≤6), intermediate (7-13), and high (≥14). Patients who score ≤6 have a negative likelihood ratio of 0.42 for obstructive CAD, whereas those who score ≥14 have a positive likelihood ratio of >5.5 for obstructive CAD. The outcome was ruled out in >98% of patients with a score ≤6 in the validation cohort.ConclusionsWe developed a score that may be used to identify the likelihood of obstructive CAD in patients with an Agatston score of zero, which may be used to direct the need for additional testing. However, the results of this retrospective analysis are hypothesis generating and before clinical implementation should be validated in a trial with a prospectively collected data.
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- 2019
46. How accurate is atherosclerosis imaging by coronary computed tomography angiography?
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Nakanishi, Rine, Motoyama, Sadako, Leipsic, Jonathon, and Budoff, Matthew J
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Clinical Sciences ,Atherosclerosis ,Biomedical Imaging ,Bioengineering ,Cardiovascular ,Heart Disease - Coronary Heart Disease ,Aging ,Heart Disease ,4.1 Discovery and preclinical testing of markers and technologies ,Detection ,screening and diagnosis ,4.2 Evaluation of markers and technologies ,Computed Tomography Angiography ,Coronary Angiography ,Coronary Artery Disease ,Coronary Vessels ,Humans ,Plaque ,Atherosclerotic ,Predictive Value of Tests ,Prognosis ,Reproducibility of Results ,Severity of Illness Index ,Coronary computed tomographic angiography ,Intravascular ultrasound ,Optical coherence tomography ,Coronary atherosclerosis ,Plaque ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences ,Applied computing - Abstract
Invasive coronary plaque imaging such as intravascular ultrasound and optical coherence tomography has been widely used to observe culprit or non-culprit coronary atherosclerosis, as well as optimize stent sizing, apposition and deployment. Coronary computed tomographic angiography (CTA) is non-invasively available to assess coronary artery disease (CAD) and has become an appropriate strategy to evaluate patients with suspected CAD. Given recent technologies, semi-automated plaque software is available to identify coronary plaque stenosis, volume and characteristics and potentially allows to be used for the assessment of more details of plaque information, progression and future risk as a surrogate tool of the invasive imaging modalities. This review article aims to focus on various evidence in coronary plaque imaging by coronary CTA and describes how accurate coronary CTA can classify coronary atherosclerosis.
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- 2019
47. Longitudinal quantitative assessment of coronary plaque progression related to body mass index using serial coronary computed tomography angiography.
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Won, Ki-Bum, Lee, Sang-Eun, Lee, Byoung Kwon, Park, Hyung-Bok, Heo, Ran, Rizvi, Asim, Hadamitzky, Martin, Kim, Yong-Jin, Sung, Ji Min, Conte, Edoardo, Andreini, Daniele, Pontone, Gianluca, Budoff, Matthew J, Gottlieb, Ilan, Chun, Eun Ju, Cademartiri, Filippo, Maffei, Erica, Marques, Hugo, Leipsic, Jonathon A, Shin, Sanghoon, Choi, Jung Hyun, 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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Clinical Research ,Obesity ,Heart Disease - Coronary Heart Disease ,Nutrition ,Cardiovascular ,Biomedical Imaging ,Heart Disease ,Aged ,Body Mass Index ,Computed Tomography Angiography ,Coronary Angiography ,Coronary Artery Disease ,Disease Progression ,Female ,Humans ,Longitudinal Studies ,Male ,Middle Aged ,Plaque ,Atherosclerotic ,Prospective Studies ,Radiographic Image Interpretation ,Computer-Assisted ,Registries ,atherosclerosis ,coronary computed tomography angiography ,body mass index ,obesity ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology - Abstract
AimsThis study explored the coronary plaque volume change (PVC) according to the change of percent body mass index (BMI) and categorical BMI group using serial coronary computed tomography angiography (CCTA).Methods and resultsA total of 1568 subjects who underwent serial CCTA with available BMI at baseline (CCTA1) and follow-up (CCTA2) were included. Median inter-scan period was 3.3 (interquartile range: 2.6-4.6) years. Quantitative assessment of coronary plaque was performed at both scans. All participants were categorized into three BMI (kg/m2) groups: normal:
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- 2019
48. A cross-sectional survey of coronary plaque composition in individuals on non-statin lipid lowering drug therapies and undergoing coronary computed tomography angiography
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Al'Aref, Subhi J, Su, Amanda, Gransar, Heidi, van Rosendael, Alexander R, Rizvi, Asim, Berman, Daniel S, Callister, Tracy Q, DeLago, Augustin, Hadamitzky, Martin, Hausleiter, Joerg, Al-Mallah, Mouaz H, Budoff, Matthew J, Kaufmann, Philipp A, Raff, Gilbert L, Chinnaiyan, Kavitha, Cademartiri, Filippo, Maffei, Erica, Villines, Todd C, Kim, Yong-Jin, Leipsic, Jonathon, Feuchtner, Gudrun, Pontone, Gianluca, Andreini, Daniele, Marques, Hugo, de Araújo Gonçalves, Pedro, Rubinshtein, Ronen, Achenbach, Stephan, Chang, Hyuk-Jae, Chow, Benjamin JW, Cury, Ricardo, Lu, Yao, Bax, Jeroen J, Jones, Erica C, Peña, Jessica M, Shaw, Leslee J, Min, James K, and Lin, Fay Y
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Biomedical and Clinical Sciences ,Clinical Sciences ,Heart Disease - Coronary Heart Disease ,Atherosclerosis ,Cardiovascular ,Heart Disease ,Clinical Research ,Clinical Trials and Supportive Activities ,6.1 Pharmaceuticals ,Aetiology ,2.1 Biological and endogenous factors ,Evaluation of treatments and therapeutic interventions ,Aged ,Asia ,Biomarkers ,Computed Tomography Angiography ,Coronary Angiography ,Coronary Artery Disease ,Coronary Stenosis ,Coronary Vessels ,Cross-Sectional Studies ,Drug Therapy ,Combination ,Dyslipidemias ,Europe ,Female ,Humans ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,Hypolipidemic Agents ,Lipids ,Male ,Middle Aged ,North America ,Plaque ,Atherosclerotic ,Predictive Value of Tests ,Prevalence ,Registries ,Risk Factors ,Coronary computed tomography angiography ,Coronary plaque composition ,Non-statin therapy ,Ezetimibe ,Fibrate ,Niacin ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences ,Applied computing - Abstract
IntroductionNon-statin therapy (NST) is used as second-line treatment when statin monotherapy is inadequate or poorly tolerated.ObjectiveTo determine the association of NST with plaque composition, alone or in combination with statins, in patients undergoing coronary computed tomography angiography (coronary CTA).MethodsFrom the multicenter CONFIRM registry, we analyzed individuals who underwent coronary CTA with known lipid-lowering therapy status and without prior coronary artery disease at baseline. We created a propensity score for being on NST, followed by stepwise multivariate linear regression, adjusting for the propensity score as well as risk factors, to determine the association between NST and the number of coronary artery segments with each plaque type (non-calcified (NCP), partially calcified (PCP) or calcified (CP)) and segment stenosis score (SSS).ResultsOf the 27,125 subjects in CONFIRM, 4,945 met the inclusion criteria; 371 (7.5%) took NST. At baseline, patients on NST had more prevalent risk factors and were more likely to be on concomitant cardiac medications. After multivariate and propensity score adjustment, NST was not associated with plaque composition: NCP (0.07 increase, 95% CI: -0.05, 0.20; p = 0.26), PCP (0.10 increase, 95% CI: -0.10, 0.31; p = 0.33), CP (0.18 increase, 95% CI: -0.10, 0.46; p = 0.21) or SSS (0.45 increase, 95% CI: -0.02,0.93; p = 0.06). The absence of an effect of NST on plaque type was not modified by statin use (p for interaction > 0.05 for all).ConclusionIn this cross-sectional study, non-statin therapy was not associated with differences in plaque composition as assessed by coronary CTA.
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- 2019
49. Prognostic value of age adjusted segment involvement score as measured by coronary computed tomography: a potential marker of vascular age
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Ayoub, Chadi, Kritharides, Leonard, Yam, Yeung, Chen, Li, Hossain, Alomgir, Achenbach, Stephan, Al-Mallah, Mouaz H, Andreini, Daniele, Berman, Daniel S, Budoff, Matthew J, Cademartiri, Filippo, Callister, Tracy Q, Chang, Hyuk-Jae, Chinnaiyan, Kavitha, Cury, Ricardo C, Delago, Augustin, Dunning, Allison, Feuchtner, Gudrun, Gomez, Millie, Gransar, Heidi, Hadamitzky, Martin, Hausleiter, Joerg, Hindoyan, Niree, Kaufmann, Philipp A, Kim, Yong-Jin, Leipsic, Jonathon, Maffei, Erica, Marques, Hugo, Pontone, Gianluca, Raff, Gilbert, Rubinshtein, Ronen, Shaw, Leslee J, Villines, Todd C, Min, James K, and Chow, Benjamin JW
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Biomedical and Clinical Sciences ,Clinical Sciences ,Heart Disease ,Clinical Research ,Biomedical Imaging ,Cardiovascular ,Atherosclerosis ,Aging ,Heart Disease - Coronary Heart Disease ,4.2 Evaluation of markers and technologies ,Detection ,screening and diagnosis ,Good Health and Well Being ,Age Factors ,Aged ,Computed Tomography Angiography ,Coronary Angiography ,Coronary Artery Disease ,Coronary Vessels ,Female ,Follow-Up Studies ,Humans ,Male ,Middle Aged ,Plaque ,Atherosclerotic ,Predictive Value of Tests ,Prognosis ,Prospective Studies ,Registries ,Risk Factors ,Time Factors ,Coronary ,Computed tomography ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology - Abstract
Extent of coronary atherosclerotic disease (CAD) burden on coronary computed tomography angiography (CCTA) as measured by segment involvement score (SIS) has a prognostic value. We sought to investigate the incremental prognostic value of 'age adjusted SIS' (aSIS), which may be a marker of premature atherosclerosis and vascular age. Consecutive patients were prospectively enrolled into the CONFIRM (Coronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicentre) multinational observational study. Patients were followed for the outcome of all-cause death. aSIS was calculated on CCTA for each patient, and its incremental prognostic value was evaluated. A total of 22,211 patients [mean age 58.5 ± 12.7 years, 55.8% male) with a median follow-up of 27.3 months (IQR 17.8, 35.4)] were identified. After adjustment for clinical factors and presence of obstructive CAD, higher aSIS was associated with increased death on multivariable analysis, with hazard ratio (HR) 2.40 (1.83-3.16, p
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- 2018
50. Natural History of Diabetic Coronary Atherosclerosis by Quantitative Measurement of Serial Coronary Computed Tomographic Angiography Results of the PARADIGM Study
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Kim, Ung, Leipsic, Jonathon A, Sellers, Stephanie L, Shao, Michael, Blanke, Philipp, 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, Shin, Sanghoon, Choi, Jung Hyun, 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 ,Clinical Sciences ,Biomedical Imaging ,Cardiovascular ,Atherosclerosis ,Prevention ,Clinical Research ,Heart Disease ,Diabetes ,Heart Disease - Coronary Heart Disease ,Detection ,screening and diagnosis ,4.2 Evaluation of markers and technologies ,Aged ,Computed Tomography Angiography ,Coronary Angiography ,Coronary Artery Disease ,Diabetic Angiopathies ,Female ,Humans ,Male ,Middle Aged ,Plaque ,Atherosclerotic ,Predictive Value of Tests ,Prognosis ,Registries ,Retrospective Studies ,Risk Assessment ,Risk Factors ,Sex Factors ,Time Factors ,computed tomography ,coronary artery disease ,diabetes mellitus ,plaque ,progression ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Abstract
ObjectivesThis study aimed to determine the rate and extent of plaque progression (PP), changes in plaque features, and clinical predictors of PP in patients with diabetes mellitus (DM).BackgroundThe natural history of coronary PP in patients with DM is not well established.MethodsA total of 1,602 patients (age 61.3 ± 9.0 years; 60.3% men; median scan interval 3.8 years) who underwent serial coronary computed tomography angiography over a period of at least 24 months were enrolled and analyzed from the PARADIGM (Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging) trial. Study endpoints were changes in plaque features in diabetics with PP and risk factors for PP by serial coronary computed tomography angiography between patients with and without DM. PP was defined if plaque volume at follow-up minus plaque volume at baseline was >0.ResultsDM was an independent risk factor for PP (84.6%; 276 of 326 patients with PP) in multivariate analysis (odds ratio [OR]: 1.526; 95% confidence interval [CI]: 1.100 to 2.118; p = 0.011). Independent risk factors for PP in patients with DM were male sex (OR: 1.485; 95% CI: 1.003 to 2.199; p = 0.048) and mean plaque burden at baseline ≥75% (OR: 3.121; 95% CI: 1.701 to 5.725; p ≤0.001). After propensity matching, percent changes in overall plaque volume (30.3 ± 36.9% in patients without DM and 36.0 ± 29.7% in those with DM; p = 0.032) and necrotic core volume (-7.0 ± 35.8% in patients without DM and 21.5 ± 90.5% in those with DM; p = 0.007) were significantly greater in those with DM. The frequency of spotty calcification, positive remodeling, and burden of low-attenuation plaque were significantly greater in patients with DM.ConclusionsPeople with DM experience greater PP, particularly significantly greater progression in adverse plaque, than those without DM. Male sex and mean plaque burden >75% at baseline were identified as independent risk factors for PP.
- Published
- 2018
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