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1. Current trends in patients with chronic total occlusions undergoing coronary CT angiography

Author

Opolski, MP, Hartaigh, BO, Berman, DS, Budoff, MJ, Achenbach, S, Al-Mallah, M, Andreini, D, Cademartiri, F, Chang, HJ, Chinnaiyan, K, Chow, BJW, Hadamitzky, M, Hausleiter, J, Feuchtner, G, Kim, YJ, Kaufmann, PA, Leipsic, J, Maffei, E, Pontone, G, Raff, G, Shaw, LJ, Villines, TC, and Min, JK

Subjects
Cardiovascular System & Hematology, Cardiorespiratory Medicine and Haematology
Abstract

Objective: Data describing the prevalence, characteristics and management of coronary chronic total occlusions (CTOs) in patients undergoing coronary CT angiography (CCTA) have not been reported. The purpose of this study was to determine the prevalence, characteristics and treatment strategies of CTO identified by CCTA. Methods: We identified 23 745 patients who underwent CCTA for suspected coronary artery disease (CAD) from the prospective international CCTA registry. Baseline clinical data were collected, and allocation to early coronary revascularisation performed within 90 days of CCTA was determined. Multivariable hierarchical mixed-effects logistic regression reporting OR with 95% CI was performed. Results: The prevalence of CTO was 1.4% (342/23 745) in all patients and 6.2% in patients with obstructive CAD (≥50% stenosis). The presence of CTO was independently associated with male sex (OR 3.12, 95% CI 2.39 to 4.08, p

Published
2015

2. Probiotic administration in congenital heart disease: a pilot study

Author

Ellis, CL, Bokulich, NA, Kalanetra, KM, Mirmiran, M, Elumalai, J, Haapanen, L, Schegg, T, Rutledge, JC, Raff, G, Mills, DA, and Underwood, MA

Subjects
Clinical Research, Heart Disease, Pediatric, Nutrition, Complementary and Integrative Health, Clinical Trials and Supportive Activities, Cardiovascular, Bifidobacterium, Cohort Studies, Cytokines, Feces, Female, Heart Defects, Congenital, Humans, Infant, Newborn, Male, Pilot Projects, Probiotics, probiotic, bifidobacteria, necrotizing enterocolitis, congenital heart disease, microbiota, Clinical Sciences, Paediatrics and Reproductive Medicine, Pediatrics
Abstract

ObjectiveTo investigate the impact of probiotic Bifidobacterium longum ssp. infantis on the fecal microbiota and plasma cytokines in neonates with congenital heart disease.Study designSixteen infants with congenital heart disease were randomly assigned to receive either B. infantis (4.2 × 10(9) colony-forming units two times daily) or placebo for 8 weeks. Stool specimens from enrolled infants and from six term infants without heart disease were analyzed for microbial composition. Plasma cytokines were analyzed weekly in the infants with heart disease.ResultsHealthy control infants had increased total bacteria, total Bacteroidetes and total bifidobacteria compared to the infants with heart disease, but there were no significant differences between the placebo and probiotic groups. Plasma interleukin (IL)10, interferon (IFN)γ and IL1β levels were transiently higher in the probiotic group.ConclusionCongenital heart disease in infants is associated with dysbiosis. Probiotic B. infantis did not significantly alter the fecal microbiota. Alterations in plasma cytokines were found to be inconsistent.

Published
2013

3. L-Carnitine preserves endothelial function in a lamb model of increased pulmonary blood flow

Author

Fineman, Jeffrey, Oishi, Peter, Sharma, S, Aramburo, A, Rafikov, R, Sun, X, Kumar, S, Datar, SA, Raff, G, Xoinis, K, and Kalkan, G

Abstract

Background: In our model of a congenital heart defect (CHD) with increased pulmonary blood flow (PBF; shunt), we have recently shown a disruption in carnitine homeostasis, associated with mitochondrial dysfunction and decreased endothelial nitric oxide syn

Published
2013

4. Rosiglitazone preserves pulmonary vascular function in lambs with increased pulmonary blood flow

Author

Fineman, Jeffrey, Oishi, Peter, Sharma, S, Datar, SA, Kumar, S, Aggarwal, S, Lu, Q, Raff, G, Azakie, A, Hsu, JH, and Sajti, E

Abstract

Pulmonary vascular function is impaired with increased pulmonary blood flow (PBF). We hypothesized that a peroxisome proliferator-activated receptor-γ (PPAR-γ) agonist would mitigate this effect.Methods:An aorta-to-pulmonary-artery shunt was placed in 11 f

Published
2013

5. PPAR-γ Regulates Carnitine Homeostasis and Mitochondrial Function in a Lamb Model of Increased Pulmonary Blood Flow

Author

Fineman, Jeffrey, Oishi, Peter, Sharma, S, Sun, X, Rafikov, R, Kumar, S, Hou, Y, Datar, SA, Raff, G, Fineman, JR, and Black, SM

Abstract

Objective: Carnitine homeostasis is disrupted in lambs with endothelial dysfunction secondary to increased pulmonary blood flow (Shunt). Our recent studies have also indicated that the disruption in carnitine homeostasis correlates with a decrease in PPAR-

Published
2012

6. 11206 Risk of Spontaneous Pregnancy After Bilateral Salpingectomy.

Author

Spielman, SC, Meandor, C, Raff, G, Pugh, M, Oshinowo, A, and Kasper, K

Abstract

The primary objective of this study is to determine the rate of spontaneous pregnancy after bilateral salpingectomy within two high volume tertiary health care centers. The secondary objective is to compare the calculated rate of pregnancy after BS with published rates of pregnancy after other methods of sterilization, such as bilateral tubal ligation. This is a retrospective chart review study. Two high volume tertiary health care centers Any patient who underwent bilateral salpingectomy for sterilization in the Indiana University Health or Eskenazi Health systems between January 2018 and September 2023. N/A. 2967 patients were identified as having undergone a procedure with a CPT code that represented tubal surgery (58600, 58605, 58611, 58661, 58670). Of these patients, 1028 were identified as having undergone a bilateral salpingectomy (including laparoscopic, postpartum, or at the time of cesarean section). 186 patients were excluded because of postmenopausal status, incomplete records, or being deceased within a year of their surgery. 14 patients were excluded because they were undergoing IVF after their surgery. Of the 1028 patients who underwent bilateral salpingectomy, 3 patients reported having a positive home pregnancy test. All 3 of these patients had negative pregnancy testing in the office shortly afterwards, thus, the rate of spontaneous pregnancy after bilateral salpingectomy in our study population was 0-0.3% over a 5-year period of time. Based on our data, the rate of spontaneous pregnancy after bilateral salpingectomy is 0-0.3%. This is lower than the published rate of pregnancy after all methods of sterilization of 1.33% by Peterson, et al 1996. This supports bilateral salpingectomy as a high-quality method of contraception and should encourage providers to perform salpingectomy when feasible. Future studies with a larger patient population and longer follow-up are needed to further support our findings. [ABSTRACT FROM AUTHOR]

Published
2024
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7. Prognostic Significance Of Subtle Coronary Calcification In Patients With Zero Coronary Artery Calcium Score: From The Confirm Registry

Author

Han, D., primary, Klein, E., additional, Achenbach, S., additional, Al-Mallah, M., additional, Budoff, M., additional, Cademartiri, F., additional, Maffei, E., additional, Callister, T., additional, Chinnaiyan, K., additional, Chow, B., additional, DeLago, A., additional, Hadamitzky, M., additional, Hausleiter, J., additional, Kaufmann, P., additional, Raff, G., additional, Villines, T., additional, Kim, Y., additional, Leipsic, J., additional, Feuchtner, G., additional, Cury, R., additional, Pontone, G., additional, Andreini, D., additional, Marques, H., additional, Rubinshtein, R., additional, Chang, H., additional, Lin, F., additional, Shaw, L., additional, Min, J., additional, and Berman, D., additional

Published
2020
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8. The Relationship Between Coronary Calcification And The Natural History Of Coronary Artery Disease

Author

Jin, H., primary, Son, J., additional, Weir-McCall, J., additional, Sellers, S., additional, Shao, M., additional, Blanke, P., additional, Hadamitzky, M., additional, Kim, Y., additional, Ahmadi, A., additional, Conte, E., additional, Andreini, D., additional, Pontone, G., additional, Budoff, M., additional, Gottlieb, I., additional, Lee, B., additional, Chun, E., additional, Cademartiri, F., additional, Maffei, E., additional, Marques, H., additional, Goncalves, P., additional, Shin, S., additional, Choi, J., additional, Virmani, R., additional, Samady, H., additional, Stone, P., additional, Berman, D., additional, Narula, J., additional, Shaw, L., additional, Bax, J., additional, Chinnaiyan, K., additional, Raff, G., additional, Al-Mallah, M., additional, Lin, F., additional, Min, J., additional, Sung, J., additional, Lee, S., additional, Chang, H., additional, and Leipsic, J., additional

Published
2020
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9. Superior Risk Stratification With Coronary Computed Tomography Angiography Using a Comprehensive Atherosclerotic Risk Score

Author

Rosendael, A.R. van, Shaw, L.J., Xie, J.X., Dimitriu-Leen, A.C., Smit, J.M., Scholte, A.J., Werkhoven, J.M. van, Callister, T.Q., DeLago, A., Berman, D.S., Hadamitzky, M., Hausleiter, J., Al-Mallah, M.H., Budoff, M.J., Kaufmann, P.A., Raff, G., Chinnaiyan, K., Cademartiri, F., Maffei, E., Villines, T.C., Kim, Y. J., Feuchtner, G., Lin, F.Y., Jones, E.C., Pontone, G., Andreini, D., Marques, H., Rubinshtein, R., Achenbach, S., Dunning, A., Gomez, M., Hindoyan, N., Gransar, H., Leipsic, J., Narula, J., Min, J.K., Bax, J.J., Rosendael, A.R. van, Shaw, L.J., Xie, J.X., Dimitriu-Leen, A.C., Smit, J.M., Scholte, A.J., Werkhoven, J.M. van, Callister, T.Q., DeLago, A., Berman, D.S., Hadamitzky, M., Hausleiter, J., Al-Mallah, M.H., Budoff, M.J., Kaufmann, P.A., Raff, G., Chinnaiyan, K., Cademartiri, F., Maffei, E., Villines, T.C., Kim, Y. J., Feuchtner, G., Lin, F.Y., Jones, E.C., Pontone, G., Andreini, D., Marques, H., Rubinshtein, R., Achenbach, S., Dunning, A., Gomez, M., Hindoyan, N., Gransar, H., Leipsic, J., Narula, J., Min, J.K., and Bax, J.J.

Abstract

Item does not contain fulltext, OBJECTIVES: This 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). BACKGROUND: Current 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. METHODS: A 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). RESULTS: The 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. CONCLUSIONS: The 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

Published
2019

10. Determinants of Rejection Rate for Coronary CT Angiography Fractional Flow Reserve Analysis

Author

Pontone, G, Weir-McCall, J, Baggiano, A, Del Torto, A, Fusini, L, Guglielmo, M, Muscogiuri, G, Guaricci, A, Andreini, D, Patel, M, Nieman, K, Akasaka, T, Rogers, C, Nørgaard, B, Bax, J, Raff, G, Chinnaiyan, K, Berman, D, Fairbairn, T, Koweek, L, Leipsic, J, Pontone G, Weir-McCall JR, Baggiano A, Del Torto A, Fusini L, Guglielmo M, Muscogiuri G, Guaricci AI, Andreini D, Patel M, Nieman K, Akasaka T, Rogers C, Nørgaard BL, Bax J, Raff GL, Chinnaiyan K, Berman D, Fairbairn T, Koweek LH, Leipsic J, Pontone, G, Weir-McCall, J, Baggiano, A, Del Torto, A, Fusini, L, Guglielmo, M, Muscogiuri, G, Guaricci, A, Andreini, D, Patel, M, Nieman, K, Akasaka, T, Rogers, C, Nørgaard, B, Bax, J, Raff, G, Chinnaiyan, K, Berman, D, Fairbairn, T, Koweek, L, Leipsic, J, Pontone G, Weir-McCall JR, Baggiano A, Del Torto A, Fusini L, Guglielmo M, Muscogiuri G, Guaricci AI, Andreini D, Patel M, Nieman K, Akasaka T, Rogers C, Nørgaard BL, Bax J, Raff GL, Chinnaiyan K, Berman D, Fairbairn T, Koweek LH, and Leipsic J

Abstract

Background: Coronary artery fractional flow reserve (FFR) derived from CT angiography (FFTCT) enables functional assessment of coronary stenosis. Prior clinical trials showed 13%-33% of coronary CT angiography studies had insufficient quality for quantitative analysis with FFRCT. Purpose: To determine the rejection rate of FFRCT analysis and to determine factors associated with technically unsuccessful calculation of FFRCT. Materials and Methods: Prospectively acquired coronary CT angiography scans submitted as part of the Assessing Diagnostic Value of Noninvasive FFRCT in Coronary Care (ADVANCE) registry (https://ClinicalTrials.gov: NCT02499679) and coronary CT angiography series submitted for clinical analysis were included. The primary outcome was the FFRCT rejection rate (defined as an inability to perform quantitative analysis with FFRCT). Factors that were associated with FFRCT rejection rate were assessed with multiple linear regression. Results: In the ADVANCE registry, FFRCT rejection rate due to inadequate image quality was 2.9% (80 of 2778 patients; 95% confidence interval [CI]: 2.1%, 3.2%). In the 10 621 consecutive patients who underwent clinical analysis, the FFRCT rejection rate was 8.4% (n = 892; 95% CI: 6.2%, 7.2%; P , .001 vs the ADVANCE cohort). The main reason for the inability to perform FFRCT analysis was the presence of motion artifacts (63 of 80 [78%] and 729 of 892 [64%] in the ADVANCE and clinical cohorts, respectively). At multivariable analysis, section thickness in the ADVANCE (odds ratio [OR], 1.04; 95% CI: 1.001, 1.09; P = .045) and clinical (OR, 1.03; 95% CI: 1.02, 1.04; P , .001) cohorts and heart rate in the ADVANCE (OR, 1.05; 95% CI: 1.02, 1.08; P , .001) and clinical (OR, 1.06; 95% CI: 1.05, 1.07; P , .001) cohorts were independent predictors of rejection. Conclusion: The rates for technically unsuccessful CT-derived fractional flow reserve in the ADVANCE registry and in a large clinical cohort were 2.9% and 8.4%, respectively. Th

Published
2019

11. Effects of Statins on Coronary Atherosclerotic Plaques The PARADIGM Study

Author

Lee, S.E., Chang, H.J., Sung, J.M., Park, H.B., Heo, R., Rizvi, A., Lin, F.Y., Kumar, A., Hadamitzky, M., Kim, Y.L., Conte, E., Andreini, D., Pontone, G., Budoff, M.J., Gottlieb, I., Lee, B.K., Chun, E.J., Cademartiri, F., Maffei, E., Marques, H., Leipsic, J.A., Shin, S., Choi, J.H., Chinnaiyan, K., Raff, G., Virmani, R., Samady, H., Stone, P.H., Berman, D.S., Narula, J., Shaw, L.J., Bax, J.J., and Min, J.K.

Subjects
coronary computed tomography angiography, coronary artery disease, coronary artery atherosclerosis, statins
Abstract

This study sought to describe the impact of statins on individual coronary atherosclerotic plaques.Although statins reduce the risk of major adverse cardiovascular events, their long-term effects on coronary atherosclerosis remain unclear.We performed a prospective, multinational study consisting of a registry of consecutive patients without history of coronary artery disease who underwent serial coronary computed tomography angiography at an interscan interval of ≥2 years. Atherosclerotic plaques were quantitatively analyzed for percent diameter stenosis (%DS), percent atheroma volume (PAV), plaque composition, and presence of high-risk plaque (HRP), defined by the presence of ≥2 features of low-attenuation plaque, positive arterial remodeling, or spotty calcifications.Among 1,255 patients (60 ± 9 years of age; 57% men), 1,079 coronary artery lesions were evaluated in statin-naive patients (n = 474), and 2,496 coronary artery lesions were evaluated in statin-taking patients (n = 781). Compared with lesions in statin-naive patients, those in statin-taking patients displayed a slower rate of overall PAV progression (1.76 ± 2.40% per year vs. 2.04 ± 2.37% per year, respectively; p = 0.002) but more rapid progression of calcified PAV (1.27 ± 1.54% per year vs. 0.98 ± 1.27% per year, respectively; p < 0.001). Progression of noncalcified PAV and annual incidence of new HRP features were lower in lesions in statin-taking patients (0.49 ± 2.39% per year vs. 1.06 ± 2.42% per year and 0.9% per year vs. 1.6% per year, respectively; all p < 0.001). The rates of progression to >50%DS were not different (1.0% vs. 1.4%, respectively; p > 0.05). Statins were associated with a 21% reduction in annualized total PAV progression above the median and 35% reduction in HRP development.Statins were associated with slower progression of overall coronary atherosclerosis volume, with increased plaque calcification and reduction of high-risk plaque features. Statins did not affect the progression of percentage of stenosis severity of coronary artery lesions but induced phenotypic plaque transformation. (Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography Imaging [PARADIGM]; NCT02803411.).

Published
2018

12. Effects of Statins on Coronary Atherosclerotic Plaques: The PARADIGM Study

Author

Lee, S., Chang, H., Sung, J.M., Park, H., Heo, R., Rizvi, A., Lin, F.Y., Kumar, A., Hadamitzky, M., Kim, Y.J., Conte, E., Andreini, D., Pontone, G., Budoff, M.J., Gottlieb, I., Lee, B.K., Chun, E.J., Cademartiri, F., Maffei, E., Marques, H., Leipsic, J.A., Shin, S., Choi, J.H., Chinnaiyan, K., Raff, G., Virmani, R., Samady, H., Stone, P.H., Berman, D.S., Narula, J., Shaw, L.J., Bax, J.J., and Min, J.K.

Subjects
Male, Time Factors, Computed Tomography Angiography, Clinical Sciences, Settore MED/11 - Malattie dell'Apparato Cardiovascolare, Coronary Artery Disease, Cardiorespiratory Medicine and Haematology, Coronary Angiography, Severity of Illness Index, statins, Republic of Korea, Humans, Registries, Prospective Studies, Vascular Calcification, Aged, Plaque, Atherosclerotic, Coronary Stenosis, coronary artery atherosclerosis, coronary artery disease, coronary computed tomography angiography, Middle Aged, Coronary Vessels, Europe, Treatment Outcome, Cardiovascular System & Hematology, North America, Disease Progression, Female, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Brazil
Abstract

OBJECTIVES:This study sought to describe the impact of statins on individual coronary atherosclerotic plaques. BACKGROUND:Although statins reduce the risk of major adverse cardiovascular events, their long-term effects on coronary atherosclerosis remain unclear. METHODS:We performed a prospective, multinational study consisting of a registry of consecutive patients without history of coronary artery disease who underwent serial coronary computed tomography angiography at an interscan interval of ≥2 years. Atherosclerotic plaques were quantitatively analyzed for percent diameter stenosis (%DS), percent atheroma volume (PAV), plaque composition, and presence of high-risk plaque (HRP), defined by the presence of ≥2 features of low-attenuation plaque, positive arterial remodeling, or spotty calcifications. RESULTS:Among 1,255 patients (60 ± 9 years of age; 57% men), 1,079 coronary artery lesions were evaluated in statin-naive patients (n = 474), and 2,496 coronary artery lesions were evaluated in statin-taking patients (n = 781). Compared with lesions in statin-naive patients, those in statin-taking patients displayed a slower rate of overall PAV progression (1.76 ± 2.40% per year vs. 2.04 ± 2.37% per year, respectively; p = 0.002) but more rapid progression of calcified PAV (1.27 ± 1.54% per year vs. 0.98 ± 1.27% per year, respectively; p < 0.001). Progression of noncalcified PAV and annual incidence of new HRP features were lower in lesions in statin-taking patients (0.49 ± 2.39% per year vs. 1.06 ± 2.42% per year and 0.9% per year vs. 1.6% per year, respectively; all p < 0.001). The rates of progression to >50% DS were not different (1.0% vs. 1.4%, respectively; p > 0.05). Statins were associated with a 21% reduction in annualized total PAV progression above the median and 35% reduction in HRP development. CONCLUSIONS:Statins were associated with slower progression of overall coronary atherosclerosis volume, with increased plaque calcification and reduction of high-risk plaque features. Statins did not affect the progression of percentage of stenosis severity of coronary artery lesions but induced phenotypic plaque transformation. (Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography Imaging [PARADIGM]; NCT02803411).

Published
2018

13. P6162Difference in progression to obstructive lesions according to the presence of high-risk plaque features

Author

Lee, S E, primary, Pontone, G, additional, Gottlieb, I, additional, Hadamitzky, M, additional, Leipsic, J A, additional, Raff, G, additional, Stone, P H, additional, Samady, H, additional, Virmani, R, additional, Berman, D S, additional, Shaw, L J, additional, Narula, J, additional, Bax, J J, additional, Min, J K, additional, and Chang, H J, additional

Published
2019
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14. Real-world clinical utility and impact on clinical decision-making of coronary computed tomography angiography-derived fractional flow reserve: lessons from the ADVANCE Registry

Author

Fairbairn, TA, Nieman, Koen, Akasaka, T, Norgaard, BL, Berman, DS, Raff, G, Hurwitz-Koweek, LM, Pontone, G, Kawasaki, T, Sand, NP, Jensen, JM, Amano, T, Poon, M, Ovrehus, K, Sonck, J, Rabbat, M, Mullen, S, de Bruyne, B, Rogers, C, Matsuo, H, Bax, JJ, Leipsic, J, Patel, MR, Fairbairn, TA, Nieman, Koen, Akasaka, T, Norgaard, BL, Berman, DS, Raff, G, Hurwitz-Koweek, LM, Pontone, G, Kawasaki, T, Sand, NP, Jensen, JM, Amano, T, Poon, M, Ovrehus, K, Sonck, J, Rabbat, M, Mullen, S, de Bruyne, B, Rogers, C, Matsuo, H, Bax, JJ, Leipsic, J, and Patel, MR

Published
2018

15. Incremental prognostic value of coronary computed tomography angiography over coronary calcium scoring for major adverse cardiac events in elderly asymptomatic individuals

Author

Han, D, Hartaigh, BO, Gransar, H, v.d. Lee, JH, Rizvi, A, Baskaran, L, Schulman-Marcus, J, Dunning, A, Achenbach, S, Al-Mallah, MH, Berman, DS, Budoff, MJ, Cademartiri, F., Maffei, E, Callister, TQ, Chinnaiyan, K, Chow, BJW, Delago, A, Hadamitzky, M, Hausleiter, J, Kaufmann, PA, Raff, G, Shaw, LJ, Villines, TC, Kim, YJ, Leipsic, J, Feuchtner, G, Cury, RC, Pontone, G, Andreini, D, Marques, H, Rubinshtein, R, Hindoyan, N, Jones, EC, Gomez, M, Lin, FY, Chang, HJ, Min, JK, Han, D, Hartaigh, BO, Gransar, H, v.d. Lee, JH, Rizvi, A, Baskaran, L, Schulman-Marcus, J, Dunning, A, Achenbach, S, Al-Mallah, MH, Berman, DS, Budoff, MJ, Cademartiri, F., Maffei, E, Callister, TQ, Chinnaiyan, K, Chow, BJW, Delago, A, Hadamitzky, M, Hausleiter, J, Kaufmann, PA, Raff, G, Shaw, LJ, Villines, TC, Kim, YJ, Leipsic, J, Feuchtner, G, Cury, RC, Pontone, G, Andreini, D, Marques, H, Rubinshtein, R, Hindoyan, N, Jones, EC, Gomez, M, Lin, FY, Chang, HJ, and Min, JK

Published
2018

16. Atherosclerotic Plaque Burden Determined by Computed Tomography Coronary Angiography is Predictive of Long-Term Major Adverse Cardiovascular Events in Older Populations

Author

Gnanenthiran, S., primary, Naoum, C., additional, Achenbach, S., additional, Al-Mallah, M., additional, Andrieni, D., additional, Bax, J., additional, Berman, D., additional, Budoff, M., additional, Cademartiri, F., additional, Callister, T., additional, Chang, H., additional, Chinnaiyan, K., additional, Chow, B., additional, Cury, R., additional, DeLago, A., additional, Feuchtner, G., additional, Hadamitzky, M., additional, Hausleiter, J., additional, Kaufman, P., additional, Maffei, Y., additional, Marques, H., additional, Pontone, G., additional, Raff, G., additional, Rubenshtein, R., additional, Shaw, L., additional, Villines, T., additional, Gransar, H., additional, Jones, E., additional, Pena, J., additional, Lin, F., additional, Leipsic, J., additional, Kritharides, L., additional, and Min, J., additional

Published
2018
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17. Impact of age and sex on left ventricular function determined by coronary computed tomographic angiography: results from the prospective multicentre CONFIRM study

Author

Gebhard, C, Buechel, RR, Stahli, BE, Gransar, H, Achenbach, S, Berman, DS, Budoff, MJ, Canister, TQ, Chow, B, Dunning, A, Al-Mallah, MH, Cademartiri, F., Chinnaiyan, K, Rubinshtein, R, Marques, H, Delago, A, Villines, TC, Hadamitzky, M, Hausleiter, J, Shaw, LJ, Cury, RC, Feuchtner, G, Kim, YJ, Maffei, E, Raff, G, Pontone, G, Andreini, D, Chang, HJ, Leipsic, J, Minn, JK, Kaufmann, PA, Gebhard, C, Buechel, RR, Stahli, BE, Gransar, H, Achenbach, S, Berman, DS, Budoff, MJ, Canister, TQ, Chow, B, Dunning, A, Al-Mallah, MH, Cademartiri, F., Chinnaiyan, K, Rubinshtein, R, Marques, H, Delago, A, Villines, TC, Hadamitzky, M, Hausleiter, J, Shaw, LJ, Cury, RC, Feuchtner, G, Kim, YJ, Maffei, E, Raff, G, Pontone, G, Andreini, D, Chang, HJ, Leipsic, J, Minn, JK, and Kaufmann, PA

Published
2017

18. Prognostic implications of coronary artery calcium in the absence of coronary artery luminal narrowing

Author

Cho, I, Hartaigh, BO, Gransar, H, Valenti, V, Lin, FY, Achenbach, S, Berman, DS, Budoff, MJ, Callister, TQ, Al-Mallah, MH, Cademartiri, F., Chinnaiyan, K, Chow, BJW, Dunning, AM, Delago, A, Villines, TC, Hadamitzky, M, Hausleiter, J, Leipsic, J, Shaw, LJ, Kaufmann, PA, Cury, RC, Feuchtner, G, Kim, YJ, Maffei, E, Raff, G, Pontone, G, Andreini, D, Chang, HJ, Min, JK, Cho, I, Hartaigh, BO, Gransar, H, Valenti, V, Lin, FY, Achenbach, S, Berman, DS, Budoff, MJ, Callister, TQ, Al-Mallah, MH, Cademartiri, F., Chinnaiyan, K, Chow, BJW, Dunning, AM, Delago, A, Villines, TC, Hadamitzky, M, Hausleiter, J, Leipsic, J, Shaw, LJ, Kaufmann, PA, Cury, RC, Feuchtner, G, Kim, YJ, Maffei, E, Raff, G, Pontone, G, Andreini, D, Chang, HJ, and Min, JK

Published
2017

19. Long-term prognostic utility of coronary CT angiography in stable patients with diabetes mellitus

Author

Blanke, P, Naoum, C, Ahmadi, A, Cheruvu, C, Soon, J, Arepalli, C, Gransar, H, Achenbach, S, Berman, DS, Budoff, MJ, Callister, TQ, Al-Mallah, MH, Cademartiri, F, Chinnaiyan, K, Rubinshtein, R, Marquez, H, DeLago, A, Villines, TC, Hadamitzky, M, Hausleiter, J, Shaw, LJ, Kaufmann, PA, Cury, RC, Feuchtner, G, Kim, Y-J, Maffei, E, Raff, G, Pontone, G, Andreini, D, Chang, H-J, Chow, BW, Min, J, Leipsic, J, University of Zurich, Leipsic, Jonathon, and Radiology & Nuclear Medicine

Subjects
SDG 3 - Good Health and Well-being, diabetes mellitus, 2741 Radiology, Nuclear Medicine and Imaging, 610 Medicine & health, prognosis, 10181 Clinic for Nuclear Medicine, coronary CT angiography, 2705 Cardiology and Cardiovascular Medicine
Published
2016

23. Coronary dominance and prognosis in patients undergoing coronary computed tomographic angiography: results from the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry

Author

Gebhard, C, Fuchs, TA, Stehli, J, Gransar, H, Berman, DS, Budoff, MJ, Achenbach, S, Al-Mallah, M, Andreini, D, Cademartiri, F., Callister, TQ, Chang, HJ, Chinnaiyan, KM, Chow, BJW, Cury, RC, Delago, A, Gomez, MJ, Hadamitzky, M, Hausleiter, J, Hindoyan, N, Feuchtner, G, Kim, YJ, Leipsic, J, Lin, FY, Maffei, E, Pontone, G, Raff, G, Shaw, LJ, Villines, TC, Dunning, AM, Min, JK, Kaufmann, PA, Gebhard, C, Fuchs, TA, Stehli, J, Gransar, H, Berman, DS, Budoff, MJ, Achenbach, S, Al-Mallah, M, Andreini, D, Cademartiri, F., Callister, TQ, Chang, HJ, Chinnaiyan, KM, Chow, BJW, Cury, RC, Delago, A, Gomez, MJ, Hadamitzky, M, Hausleiter, J, Hindoyan, N, Feuchtner, G, Kim, YJ, Leipsic, J, Lin, FY, Maffei, E, Pontone, G, Raff, G, Shaw, LJ, Villines, TC, Dunning, AM, Min, JK, and Kaufmann, PA

Abstract

Aims Coronary computed tomographic angiography (CCTA) has become an important tool for non-invasive diagnosis of coronary artery disease (CAD). Coronary dominance can be assessed by CCTA; however, the predictive value of coronary dominance is controversially discussed. The aim of this study was to evaluate the prevalence and prognosis of coronary dominance in a large prospective, international multicentre cohort of patients undergoing CCTA. Methods and results The study population consisted of 6382 patients with or without CAD (47% females, 53% males, mean age 56.9 +/- 12.3 years) who underwent CCTA and were followed over a period of 60 months. Right or left coronary dominance was determined. Right dominance was present in 91% (n = 5817) and left in 9% (n = 565) of the study population. At the end of follow-up, outcome in patients with obstructive CAD (>50% luminal stenosis) and right dominance was similar compared with patients with left dominance [hazard ratio (HR) 0.46, 95% CI 0.16-1.32, P = 0.15]. Furthermore, no differences were observed for the type of coronary dominance in patients with non-obstructive CAD(HR 0.95, 95% CI 0.41-2.21, P = 0.8962) or normal coronary arteries (HR 1.04, 95% CI 0.68-1.59, P = 0.9). Subgroup analysis in patients with left main disease revealed an elevated hazard of the combined endpoint for left dominance (HR 6.45, 95% CI 1.66-25.0, P = 0.007), but not for right dominance. Conclusion In our study population, survival after 5 years of follow-up did not differ significantly between patients with left or right coronary dominance. Thus, assessment of coronary vessel dominance by CCTA may not enhance risk stratification in patients with normal coronary arteries or obstructive CAD, but may add prognostic information for specific subpopulations.

Published
2015

25. Prognostic assessment of coronary artery bypass patients with 64-slice computed tomography angiography: anatomical information is incremental to clinical risk prediction

Author

Small, GR, Yam, Y, Chen, L, Ahmed, O, Al-Mallah, M, Berman, DS, Cheng, VY, Chinnaiyan, K, Raff, G, Villines, TC, Achenbach, S, Budoff, MJ, Cademartiri, F., Callister, TQ, Chang, HJ, Delago, A, Dunning, A, Hadamitzky, M, Hausleiter, J, Kaufmann, P, Lin, F, Maffei, E, Min, JK, Shaw, LJ, Chow, BJW, University of Zurich, Chow, B J W, and Radiology & Nuclear Medicine

Subjects
Male, 610 Medicine & health, computed tomography, 10181 Clinic for Nuclear Medicine, Coronary Artery Disease, Middle Aged, Coronary Angiography, Global Health, Prognosis, Risk Assessment, 2705 Cardiology and Cardiovascular Medicine, Survival Rate, Predictive Value of Tests, Risk Factors, Cause of Death, all-cause mortality, Humans, Female, Coronary Artery Bypass, Tomography, X-Ray Computed, coronary artery bypass surgery, Aged, Follow-Up Studies, Retrospective Studies
Abstract

Objectives We sought to determine the incremental prognostic value of 64 multi-slice coronary computed tomography angiography (CCTA) in coronary artery bypass graft (CABG) patients. Background Prognostication in CABG patients can be difficult. Anatomical assessment of native coronary artery disease and graft patency might provide useful information, but the utility of CCTA in the assessment of CABG patients is unknown. Methods Six hundred fifty-seven CABG patients with all-cause mortality follow-up were identified from a multicenter CCTA registry, of 10,628 patients from 5 CCTA centers. Clinical risk was profiled with modified logistic and additive EuroSCOREs (European Systems for Cardiac Operative Risk Evaluations). The CCTA defined coronary anatomy. Patients were classified by unprotected coronary territory (UCT) or a summary of native vessel disease and graft patency: the coronary artery protection score (CAPS). Results Forty-four deaths occurred during a mean follow-up of 20 months. Left ventricular ejection fraction, creatinine, age, severity of native vessel disease, UCT, CAPS, and EuroSCOREs were univariate predictors of mortality (p < 0.001). In multivariate analysis with additive EuroSCORE, UCT (p = 0.004) and CAPS were predictive of events (p < 0.001). In comparison with additive EuroSCORE, CAPS score was associated with a 27% net reclassification index. Conclusions Coronary computed tomography angiography provides incremental anatomical data to clinical risk assessment to help determine the prognosis of patients after CABG. The CAPS evaluation with CCTA might help identify those patients at highest risk. (J Am Coll Cardiol 2011;58:2389-95) (C) 2011 by the American College of Cardiology Foundation

Published
2011

26. Current but not past smoking increases the risk of cardiac events: insights from coronary computed tomographic angiography

Author

Nakanishi, R., primary, Berman, D. S., additional, Budoff, M. J., additional, Gransar, H., additional, Achenbach, S., additional, Al-Mallah, M., additional, Andreini, D., additional, Cademartiri, F., additional, Callister, T. Q., additional, Chang, H.-J., additional, Cheng, V. Y., additional, Chinnaiyan, K., additional, Chow, B. J. W., additional, Cury, R., additional, Delago, A., additional, Hadamitzky, M., additional, Hausleiter, J., additional, Feuchtner, G., additional, Kim, Y.-J., additional, Kaufmann, P. A., additional, Leipsic, J., additional, Lin, F. Y., additional, Maffei, E., additional, Pontone, G., additional, Raff, G., additional, Shaw, L. J., additional, Villines, T. C., additional, Dunning, A., additional, and Min, J. K., additional

Published
2015
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27. Validation of the prognostic value of percentage total plaque score normalised to age on coronary computed tomography

Author

Ayoub, C., primary, Achenbach, S., additional, Al-Mallah, M., additional, Andreini, D., additional, Berman, D.S., additional, Budoff, M.J., additional, Cademartiri, F., additional, Callister, T.Q., additional, Chang, H., additional, Chinnaiyan, K.M., additional, Cury, R.C., additional, Delago, A., additional, Dunning, A.M., additional, Feuchtner, G., additional, Gomez, M., additional, Gransar, H., additional, Hadamitzky, M., additional, Hausleiter, J., additional, Hindoyan, N., additional, Jones, E., additional, Kaufmann, P.A., additional, Kim, Y., additional, Leipsic, J., additional, Lin, F.Y., additional, Maffei, E., additional, Marques, H., additional, Pontone, G., additional, Raff, G., additional, Rubinshtein, R., additional, Shaw, L.J., additional, Villines, T.C., additional, Min, J., additional, and Chow, B., additional

Published
2015
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28. Gender differences in the prevalence, severity, and composition of coronary artery disease in the young: a study of 1635 individuals undergoing coronary CT angiography from the prospective, multinational confirm registry

Author

Otaki, Y., primary, Gransar, H., additional, Cheng, V. Y., additional, Dey, D., additional, Labounty, T., additional, Lin, F. Y., additional, Achenbach, S., additional, Al-Mallah, M., additional, Budoff, M. J., additional, Cademartiri, F., additional, Callister, T. Q., additional, Chang, H.-J., additional, Chinnaiyan, K., additional, Chow, B. J. W., additional, Delago, A., additional, Hadamitzky, M., additional, Hausleiter, J., additional, Kaufmann, P., additional, Maffei, E., additional, Raff, G., additional, Shaw, L. J., additional, Villines, T. C., additional, Dunning, A., additional, Cury, R. C., additional, Feuchtner, G., additional, Kim, Y.-J., additional, Leipsic, J., additional, Berman, D. S., additional, and Min, J. K., additional

Published
2014
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29. Age-related risk of major adverse cardiac event risk and coronary artery disease extent and severity by coronary CT angiography: results from 15 187 patients from the International Multisite CONFIRM Study

Author

Nakazato, R., primary, Arsanjani, R., additional, Achenbach, S., additional, Gransar, H., additional, Cheng, V. Y., additional, Dunning, A., additional, Lin, F. Y., additional, Al-Mallah, M., additional, Budoff, M. J., additional, Callister, T. Q., additional, Chang, H.-J., additional, Cademartiri, F., additional, Chinnaiyan, K., additional, Chow, B. J. W., additional, DeLago, A., additional, Hadamitzky, M., additional, Hausleiter, J., additional, Kaufmann, P., additional, Raff, G., additional, Shaw, L. J., additional, Villines, T., additional, Cury, R. C., additional, Feuchtner, G., additional, Kim, Y.-J., additional, Leipsic, J., additional, Berman, D. S., additional, and Min, J. K., additional

Published
2014
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30. Does coronary CT angiography improve risk stratification over coronary calcium scoring in symptomatic patients with suspected coronary artery disease? Results from the prospective multicenter international CONFIRM registry

Author

Al-Mallah, M. H., primary, Qureshi, W., additional, Lin, F. Y., additional, Achenbach, S., additional, Berman, D. S., additional, Budoff, M. J., additional, Callister, T. Q., additional, Chang, H.-J., additional, Cademartiri, F., additional, Chinnaiyan, K., additional, Chow, B. J. W., additional, Cheng, V. Y., additional, DeLago, A., additional, Gomez, M., additional, Hadamitzky, M., additional, Hausleiter, J., additional, Kaufmann, P. A., additional, Leipsic, J., additional, Maffei, E., additional, Raff, G., additional, Shaw, L. J., additional, Villines, T. C., additional, Cury, R. C., additional, Feuchtner, G., additional, Plank, F., additional, Kim, Y.-J., additional, Dunning, A. M., additional, and Min, J. K., additional

Published
2013
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31. Coronary computed tomographic angiography for detection of coronary artery disease in patients presenting to the emergency department with chest pain: a meta-analysis of randomized clinical trials

Author

D'Ascenzo, F., primary, Cerrato, E., additional, Biondi-Zoccai, G., additional, Omede, P., additional, Sciuto, F., additional, Presutti, D. G., additional, Quadri, G., additional, Raff, G. L., additional, Goldstein, J. A., additional, Litt, H., additional, Frati, G., additional, Reed, M. J., additional, Moretti, C., additional, and Gaita, F., additional

Published
2012
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32. All-cause mortality benefit of coronary revascularization vs. medical therapy in patients without known coronary artery disease undergoing coronary computed tomographic angiography: results from CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter Registry)

Author

Min, J. K., primary, Berman, D. S., additional, Dunning, A., additional, Achenbach, S., additional, Al-Mallah, M., additional, Budoff, M. J., additional, Cademartiri, F., additional, Callister, T. Q., additional, Chang, H.-J., additional, Cheng, V., additional, Chinnaiyan, K., additional, Chow, B. J. W., additional, Cury, R., additional, Delago, A., additional, Feuchtner, G., additional, Hadamitzky, M., additional, Hausleiter, J., additional, Kaufmann, P., additional, Karlsberg, R. P., additional, Kim, Y.-J., additional, Leipsic, J., additional, Lin, F. Y., additional, Maffei, E., additional, Plank, F., additional, Raff, G., additional, Villines, T., additional, Labounty, T. M., additional, and Shaw, L. J., additional

Published
2012
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33. Body mass index and the prevalence, severity, and risk of coronary artery disease: an international multicentre study of 13 874 patients

Author

Labounty, T. M., primary, Gomez, M. J., additional, Achenbach, S., additional, Al-Mallah, M., additional, Berman, D. S., additional, Budoff, M. J., additional, Cademartiri, F., additional, Callister, T. Q., additional, Chang, H.-J., additional, Cheng, V., additional, Chinnaiyan, K. M., additional, Chow, B., additional, Cury, R., additional, Delago, A., additional, Dunning, A., additional, Feuchtner, G., additional, Hadamitzky, M., additional, Hausleiter, J., additional, Kaufmann, P., additional, Kim, Y.-J., additional, Leipsic, J., additional, Lin, F. Y., additional, Maffei, E., additional, Raff, G., additional, Shaw, L. J., additional, Villines, T. C., additional, and Min, J. K., additional

Published
2012
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34. 575 Prognostic assessment of coronary artery by-pass patients with 64-slice CT angiography: Anatomical information is incremental to clinical risk prediction

Author

Small, G.R., primary, Yam, Y., additional, Chen, L., additional, Ahmed, O., additional, Al-Mallah, M., additional, Berman, D., additional, Cheng, V.Y., additional, Chinnaiyan, K., additional, Raff, G., additional, Villines, T.C., additional, Achenbach, S., additional, Budoff, M.J., additional, Cademartiri, F., additional, Callister, T.Q., additional, Chang, H., additional, Delago, A., additional, Dunning, A., additional, Hadamitzky, M., additional, Hausleiter, J., additional, Kaufmann, P., additional, Lin, F., additional, Maffei, E., additional, Min, J.K., additional, Shaw, L.J., additional, and Chow, B.J., additional

Published
2011
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40. Cardiac magnetic resonance imaging assessment of regional and global left atrial function before and after catheter ablation for atrial fibrillation.

Author

Nori D, Raff G, Gupta V, Gentry R, Boura J, Haines DE, Nori, David, Raff, Gilbert, Gupta, Vikesh, Gentry, Ralph, Boura, Judith, and Haines, David E

Abstract

Background: Ablation of the left atrium and pulmonary veins antrum (PVAI) can be an effective treatment of atrial fibrillation (AF). However, there is discrepancy in the literature regarding the effect extensive ablation has on left atrial (LA) function. We sought to evaluate the effect that AF ablation procedures has on global and regional wall motion as assessed by cardiovascular magnetic resonance imaging (MRI).Methods: Consecutive patients undergoing PVAI had cardiac MRI performed preablation and 3 months post ablation. Patients included paroxysmal (n = 16) and persistent/permanent (n = 13). In addition, 12 volunteers underwent cardiac MRI to provide a control population. LA transport function was assessed by obtaining cyclical change indices, total percent emptying, LA stroke volume indices, and LA active percent emptying. Using chordal segment analysis and radial motion of the left atrium, regional motion was assessed throughout the LA emptying cycle.Results: All four PVs were isolated for all patients. Imaging revealed a significant reduction in LA volumes in AF patients post-PVAI. In the subset of patients with persistent AF, post-PVAI improvements were seen in global (p < 0.01) and regional LA functions (p = 0.01). In the paroxysmal AF patients, post-PVAI measurements revealed decreases in LA transport function (p = 0.02) as well as diminished regional function in the LA lateral wall (p = 0.02). The paroxysmal AF patients had global and regional LA functions comparable to the normal volunteers prior to ablation; however, these were significantly diminished post ablation.Conclusion: Extensive ablation during PVAI causes mild deterioration in LA function. However, in patients with a high burden of AF, it appears that the positive remodeling that occurs with rhythm restoration outweighs any negative effects of ablation. [ABSTRACT FROM AUTHOR]

Published
2009
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41. Hypertrophic obstructive cardiomyopathy. Effects of acute and chronic verapamil treatment on left ventricular systolic and diastolic function.

Author

Anderson, D M, Raff, G L, Ports, T A, Brundage, B H, Parmley, W W, and Chatterjee, K

Abstract

Changes in left ventricular systolic and diastolic function and outflow gradient were evaluated in patients with obstructive hypertrophic cardiomyopathy after intravenous acute treatment with verapamil (15 patients) and after six months of oral chronic treatment (11 patients). All patients had severe symptoms despite beta blockade, and the condition of all but two improved appreciably after chronic treatment with verapamil. Resting left ventricular outflow tract gradient decreased in six of 15 patients after intravenous verapamil, and in five of 11 patients after long term treatment, but there was no change in provocable gradients nor any correlation between changes in gradient and improvement in symptoms. Left ventricular ejection rate did not change after intravenous or oral treatment. End systolic pressure/end systolic volume index remained unchanged after oral verapamil treatment. Whereas left ventricular total stroke volume index and end diastolic volume index increased without any significant change in left ventricular end diastolic pressure, indicating improved left ventricular diastolic function. In some patients the left ventricular diastolic pressure-volume curve shifted downwards or to the right or both. These findings suggest that improvement in symptoms with verapamil in patients with obstructive hypertrophic cardiomyopathy is unlikely to be related to changes in left ventricular outflow gradient or in systolic function and may be related to improved diastolic function. [ABSTRACT FROM PUBLISHER]

Published
1984
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42. Optimized Prognostic Score for Coronary Computed Tomographic Angiography Results From the CONFIRM Registry (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter Registry)

Author

Hadamitzky, M, Achenbach, S, Al-Mallah, M, Berman, D, Budoff, M, Cademartiri, F., Callister, T, Chang, HJ, Cheng, V, Chinnaiyan, K, Chow, BJW, Cury, R, Delago, A, Dunning, A, Feuchtner, G, Gomez, M, Kaufmann, P, Kim, YJ, Leipsic, J, Lin, FY, Maffei, E, Min, JK, Raff, G, Shaw, LJ, Villines, TC, Hausleiter, J, University of Zurich, Hadamitzky, Martin, and Radiology & Nuclear Medicine

Subjects
610 Medicine & health, 10181 Clinic for Nuclear Medicine, prognosis, coronary CT angiography, 2705 Cardiology and Cardiovascular Medicine, coronary artery disease
Abstract

ObjectivesThe aim of this study was to analyze the predictive value of coronary computed tomography angiography (CCTA) and to model and validate an optimized score for prognosis of 2-year survival on the basis of a patient population with suspected coronary artery disease (CAD).BackgroundCoronary computed tomography angiography carries important prognostic information in addition to the detection of obstructive CAD. But it is still unclear how the results of CCTA should be interpreted in the context of clinical risk predictors.MethodsThe analysis is based on a test sample of 17,793 patients and a validation sample of 2,506 patients, all with suspected CAD, from the international CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry. On the basis of CCTA data and clinical risk scores, an optimized score was modeled. The endpoint was all-cause mortality.ResultsDuring a median follow-up of 2.3 years, 347 patients died. The best CCTA parameter for prediction of mortality was the number of proximal segments with mixed or calcified plaques (C-index 0.64, p < 0.0001) and the number of proximal segments with a stenosis >50% (C-index 0.56, p = 0.002). In an optimized score including both parameters, CCTA significantly improved overall risk prediction beyond National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) score as best clinical score. According to this score, a proximal segment with either a mixed or calcified plaque or a stenosis >50% is equivalent to a 5-year increase in age or the risk of smoking.ConclusionsIn CCTA, both plaque burden and stenosis, particularly in proximal segments, carry incremental prognostic value. A prognostic score on the basis of this data can improve risk prediction beyond clinical risk scores.

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