Artery Disease In Symptomatic Patients Research Articles

Polygenic Risk Scores in Predicting Coronary Artery Disease in Symptomatic Patients. A Validation Study.

Clinical risk scores for coronary artery disease (CAD) are used in clinical practice to select patients for diagnostic testing and therapy. Several studies have proposed that polygenic risk scores (PRSs) can improve the prediction of CAD, but the scores need to be validated in clinical populations with accurately characterized phenotypes. We assessed the predictive power of the three most promising PRSs for the prediction of coronary atherosclerosis and obstructive CAD. This study was conducted on 943 symptomatic patients with suspected CAD for whom the phenotype was accurately characterized using anatomic and functional imaging. Previously published genome-wide polygenic scores were generated to compare a genetic model based on PRSs with a model based on clinical data. The test and PRS cohorts were predominantly Caucasian of northern European ancestry. All three PRSs predicted coronary atherosclerosis and obstructive CAD statistically significantly. The predictive accuracy of the models combining clinical data and different PRSs varied between 0.778 and 0.805 in terms of the area under the receiver operating characteristic (AUROC), being close to the model including only clinical variables (AUROC 0.769). The difference between the clinical model and combined clinical + PRS model was not significant for PRS1 (p=0.627) and PRS3 (p=0.061). Only PRS2 slightly improved the predictive power of the model (p=0.04). The likelihood ratios showed the very weak diagnostic power of all PRSs. The addition of PRSs to conventional risk factors did not clinically significantly improve the predictive accuracy for either coronary atherosclerosis or obstructive CAD, showing that current PRSs are not justified for routine clinical use in CAD.

Predictive role of monocyte count for significant coronary artery disease identification in patients with stable coronary artery disease.

The coronary artery disease (CAD) remains the leading cause of morbidity that is characterized by broad spectrum of symptoms. Up to 30% of performed angiographies reveal normal coronary arteries. The aim of the study was to find simple predictor for significant epicardial artery stenosis among patients with chronic coronary syndrome. There were 187 patients (131 (709%) men and 56 (30%) women) in the median (Q1-Q3) age of 67 [58-72] presenting with stable CAD symptoms enrolled into the present retrospective analysis. The demographical, clinical and laboratory characteristics between patients with normal and significant coronary artery stenosis were compared. The multivariable analysis revealed coexistence of hypercholesterolemia as significant differentiation factor (odds ratio [OR]: 4.38, 95% confidence interval [CI]: 1.78-10.80, p = 0.001) for significant CAD and inverse relation to serum high density lipoprotein (OR: 0.19, 95% CI: 0.05-0.72, p = 0.015) and relation to creatinine concentration (OR: 1.03, 95% CI: 1.00-1.05, p = 0.012). Among whole peripheral blood count analysis, the significant relation was noticed to be hemoglobin concentration (OR: 1.09, 95% CI: 1.10-1.18, p = 0.022) and monocyte count (OR: 32.3, 95% CI: 1.09-653.6, p = 0.017). Receiver operator curve revealed (AUC: 0.641, p = 0.001) with the optimal cut-off value above 0.45 K/uL for monocyte, yelding sensitivity of 81.82% and specificity of 58.06%. The peripheral monocyte count above 0.45 k/uL may be considered as a predictor of significant coronary artery disease in symptomatic patients with chronic coronary syndrome.

Polygenic risk scores in predicting the presence of coronary artery disease in symptomatic patients - A validation study utilizing an accurate phenotype based on state-of-the-art imaging

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Academy of Finland Turku University Hospital. Background Clinical risk scores for coronary artery disease (CAD) are used routinely in clinical practice to identify high risk patients in which diagnostic testing and therapy are warranted. Several recent studies suggested that polygenic risk scores (PRS) derived from millions genetic variants and hundreds of thousands subjects are able to identify those with higher risk of developing CAD. PRSs have been proposed to be included in clinical care, but their performance in clinical setting has not been validated. Purpose Our aim was to assess the predictive power of 4 established PRSs in prediction of CAD. Methods The study was carried out in 943 symptomatic patients with suspected CAD for whom the phenotype has been accurately characterized using state-of-the-art anatomic (CTA) and functional imaging (PET perfusion). Results The ROC curves for models combining clinical data and PRS in predicting obstructive CAD are shown in Figure. The predictive accuracy of the models combining clinical data and different PRS varied between 0.778–0.805 (in terms of AUROC), being close to the model including only clinical variables (AUROC 0.769) and yielding an improvement of only 0.9–3.6 percentage points over clinical data alone. The difference between clinical model and combined clinical + PRS model was not significant for PRS1 (p = 0.479), PRS2 (p = 0.627) and PRS4 (p = 0.061), respectively. Only PRS3 slightly (AUC change 0.036) but nominally significantly improved the predictive power of the model (p = 0.04). Conclusions We found that the addition of PRSs to conventional risk factors did not clinically significantly improve the predictive accuracy for either coronary atherosclerosis or obstructive CAD, suggesting that current PRSs are not justified for clinical routine for CAD.

Can prediabetes diagnosed using HemoglobinA1c or oral glucose tolerance test predict presence and severity of coronary artery disease in symptomatic patients?

We investigated whether prediabetes diagnosed by hemoglobinA1c (HbA1c) or oral glucose tolerance test (OGTT) could predict presence and severity of coronary artery disease (CAD) in symptomatic patients. The presence of plaque, stenosis, plaque characteristics, and coronary artery calcium (CAC) were evaluated by coronary CT angiography in 702 patients with suspicion of CAD. Patients were classified by glycemic status using the American Diabetes Association criteria for HbA1c and OGTT, and compared to their respective normal ranges. Prediabetes was observed in 24% by HbA1c and 72% by OGTT. Both prediabetes classifications were associated with increased presence of plaque, stenosis, calcified plaques, CAC >400, and a lower frequency of zero CAC compared to their respective normal range (all, p < 0.05). After adjusting for potential confounders, patients with HbA1c-prediabetes had an odds ratio of 2.1 (95% CI: 1.3-3.5) for CAC >400 and 1.5 (95% CI: 1.0-2.4) for plaque presence, while none of the associations for OGTT-prediabetes were significant. The receiver operating characteristic-curve for HbA1c-prediabetes showed an area under the curve of 0.81 for CAC >400 and 0.77 for plaque presence. Prediabetes defined by HbA1c predicts presence and severity of CAD. Although OGTT identified more patients with prediabetes, their risk of CAD were not explained by prediabetes using these diagnostic-criteria.

Coronary artery calcium score: pivotal role as a predictor for detecting coronary artery disease in symptomatic patients.

Chest pain and dyspnea are common presentations for symptomatic individuals with suspected coronary artery disease (CAD) in the primary care office and cardiology clinics. However, it is imperative to properly diagnose who should undergo further evaluation for cardiac etiologies of chest pain, with either noninvasive or invasive imaging tests. The purpose of this review is to highlight the role of coronary artery calcium (CAC) score as a screening tool for symptomatic patients to detect CAD. The purpose of CAC scoring is to establish the presence and severity of coronary atherosclerosis that can play a vital role in symptomatic patients. The use of CAC testing in symptomatic patients has traditionally been limited due to fundamental concerns, including the occurrence of coronary calcification relatively late in the atherosclerotic process and high prevalence of CAC in the population. Further issue relates to its low specificity for obstructive CAD, as well as demonstration of significant ethnic variability in plaque composition and calcification patterns. CAC testing gained attention as an inexpensive, rapid, reproducible and a well-tolerated alternative to exclude CAD in symptomatic patients and defer further invasive imaging tests. This article will review the available literature in regard to the use of CAC in symptomatic populations.

Association of hepatic steatosis with epicardial fat volume and coronary artery disease in symptomatic patients.

This study aims to investigate whether HS-when associated with an excessive amount of epicardial adipose tissue-correlates with CAD in subjects with symptoms suggestive of CVD. CCTA images, demographic and clinical variables of 1.182 individuals were retrieved: semi-automated measurements for EFV, CAC, and MLD were obtained. Individuals were grouped into three categories according to the presence of CAD, resulting in absent (CAD0), non-obstructive (CAD1) or obstructive (CAD2) disease-groups, and into two categories based on the presence of HS (with no HS, named HS-, and with HS, named HS+). EFV was significantly higher in HS+ than in HS- group (p < 0.001), whereas MLD was lower in CAD+ than in CAD- subjects (p < 0.001). Two predictive models for CAD were tested: the former included clinical risk factors for CAD along with age, gender, EFV and MLD, whereas the latter did not include clinical variables. The logistic regression analysis of the second proposed model reliably discriminated CAD0 from CAD1 and CAD2 (AUC of 0.712, range 0.682-0.742). Lower MLD was associated with increased EFV, and MLD-as a marker of HS-discriminate symptomatic patients with CAD from whom without.

Impact of sex-specific differences in calculating the pretest probability of obstructive coronary artery disease in symptomatic patients: a coronary computed tomographic angiography study.

ObjectivesLittle is known about the impact of sex-specific differences in calculating the pretest probability (PTP) of obstructive coronary artery disease. We sought to determine whether the calculation of PTP differ by sex in symptomatic patients referred to coronary computed tomographic angiography (CCTA).Patients and methodsThe characteristics of 5777 men and women who underwent CCTA were compared. For each patient, PTP was calculated according to the updated Diamond–Forrester method (UDFM) and the Duke clinical score (DCS), respectively. Follow-up clinical data were also recorded. Area under the receiver operating characteristic curve, integrated discrimination improvement, net reclassification improvement, and the Hosmer–Lemeshow goodness-of-fit statistic were used to assess the models’ performance.ResultsThe area under the receiver operating characteristic curve of UDFM and DCS showed little difference in men (0.782 vs. 0.785, P=0.4708) and women (0.668 vs. 0.654, P=0.1255), and calibration of neither model was satisfactory. Compared with UDFM, DCS showed positive integrated discrimination improvement (10% in men, P<0.0001, and 8% in women, P<0.0001, respectively), net reclassification improvement (12.17% in men, P<0.0001, and 27.19% in women, P<0.0001, respectively), and obviously reduced unnecessary noninvasive testing for women with negative CCTA.ConclusionAlthough the performance of neither model was favorable, DCS offered a more accurate calculation of PTP than UDFM and application of DCS instead of UDFM would result in a significant decrease in inappropriate testing, especially in women.

Is Zero Coronary Artery Calcification Score Sufficient Ruling out Significant Coronary Artery Disease in Symptomatic Patients?

Background: The presence of atherosclerotic plaque or significant coronary artery disease (CAD) is considered highly unlikely in asymptomatic patients with zero coronary artery calcification (CAC) score. This analysis is to determine whether CAC score alone is a sufficient tool to investigate patients presenting with cardiac symptoms and normal cardiac enzymes.

Coronary artery calcium score as a gatekeeper in the non-invasive evaluation of suspected coronary artery disease in symptomatic patients

Coronary artery calcium score as a gatekeeper in the non-invasive evaluation of suspected coronary artery disease in symptomatic patients

Circulating microRNAs correlated with the level of coronary artery calcification in symptomatic patients.

The purpose of this study was to find the circulating microRNAs (miRNAs) co-related with the severity of coronary artery calcification (CAC), and testify whether the selected miRNAs could reflect the obstructive coronary artery disease in symptomatic patients. Patients with chest pain and moderated risk for coronary artery disease (CAD) were characterized with coronary artery calcium score (CACS) from cardiac computed tomography (CT). We analyzed plasma miRNA levels of clinical matched 11 CAC (CACS > 100) and 6 non-CAC (CACS = 0) subjects by microarray profile. Microarray analysis identified 34 differentially expressed miRNAs between CAC and non CAC groups. Eight miRNAs (miR-223, miR-3135b, miR-133a-3p, miR-2861, miR-134, miR-191-3p, miR-3679-5p, miR-1229 in CAC patients) were significantly increased in CAC plasma in an independent clinical matched cohort. Four miRNAs (miR-2861, 134, 1229 and 3135b) were correlated with the degree of CAC. Validation test in angiographic cohort showed that miR-134, miR-3135b and miR-2861 were significantly changed in patients with obstructive CAD . We identified three significantly upregulated circulating miRNAs (miR-134, miR-3135b and 2861) correlated with CAC while detected obstructive coronary disease in symptomatic patients.

COMPARISON OF DUKE CLINICAL SCORE VERSUS A SIMPLIFIED LOCAL RISK MODEL IN PREDICTING OBSTRUCTIVE CORONARY ARTERY DISEASE IN A SOUTH EAST ASIAN POPULATION

The Duke Clinical Score (DCS) was developed to estimate the pre-test probability of obstructive coronary artery disease in symptomatic patients. However, it has not been validated in a South East Asian population and its use is limited to health care workers with the ability to interpret ECGs. We

Familiaridade e perceções dos cardiologistas portugueses acerca da ressonância magnética cardíaca e angio-TC cardíaca - dimensão da tarefa à nossa frente

IntroductionRapid advances in cardiac magnetic resonance (CMR) and cardiac computed tomography angiography (CCTA) pose challenges for practicing physicians in terms of awareness of their indications, contraindications, advantages and pitfalls. MethodsWe conducted a nationwide online survey assessing the familiarity, perceptions and patterns of use concerning these imaging modalities based on a questionnaire sent to all physician members of the Portuguese Society of Cardiology. ResultsThe responses from 205 physicians (21% response rate) were analyzed. Roughly half of them requested less than one CMR (51%) or CCTA (52%) per week.Suspected coronary artery disease in symptomatic patients with intermediate pretest probability was considered a good or excellent indication for CCTA by 59% of respondents when performed as a second-line exam, and by 29% as a first-line exam. Cardiac masses, congenital heart disease and cardiomyopathies were considered good or excellent indications for CMR by over 90% of respondents, while assessment of myocardial viability and acute myocardial infarction with normal coronary arteries were considered good or excellent indications by 75% and 65% of respondents, respectively. Less than half (39%) answered all the questions regarding contraindications for CMR correctly, and 15% were unaware that CMR does not involve ionizing radiation. The main reasons for not referring a patient for CMR were limited availability (45%) and cost (36%). ConclusionsPortuguese cardiologists appear to be moderately aware of the indications, contraindications and advantages of these new imaging modalities. Greater efforts should be made to improve physician education on this subject in order to improve patient care.

Familiarity and perceptions of Portuguese cardiologists concerning cardiac magnetic resonance and cardiac computed tomography: The extent of the task ahead

IntroductionRapid advances in cardiac magnetic resonance (CMR) and cardiac computed tomography angiography (CCTA) pose challenges for practicing physicians in terms of awareness of their indications, contraindications, advantages and pitfalls. MethodsWe conducted a nationwide online survey assessing the familiarity, perceptions and patterns of use concerning these imaging modalities based on a questionnaire sent to all physician members of the Portuguese Society of Cardiology. ResultsThe responses from 205 physicians (21% response rate) were analyzed. Roughly half of them requested less than one CMR (51%) or CCTA (52%) per week.Suspected coronary artery disease in symptomatic patients with intermediate pretest probability was considered a good or excellent indication for CCTA by 59% of respondents when performed as a second-line exam, and by 29% as a first-line exam. Cardiac masses, congenital heart disease and cardiomyopathies were considered good or excellent indications for CMR by over 90% of respondents, while assessment of myocardial viability and acute myocardial infarction with normal coronary arteries were considered good or excellent indications by 75% and 65% of respondents, respectively. Less than half (39%) answered all the questions regarding contraindications for CMR correctly, and 15% were unaware that CMR does not involve ionizing radiation. The main reasons for not referring a patient for CMR were limited availability (45%) and cost (36%). ConclusionsPortuguese cardiologists appear to be moderately aware of the indications, contraindications and advantages of these new imaging modalities. Greater efforts should be made to improve physician education on this subject in order to improve patient care.

Serum protein profiles predict coronary artery disease in symptomatic patients referred for coronary angiography.

BackgroundMore than a million diagnostic cardiac catheterizations are performed annually in the US for evaluation of coronary artery anatomy and the presence of atherosclerosis. Nearly half of these patients have no significant coronary lesions or do not require mechanical or surgical revascularization. Consequently, the ability to rule out clinically significant coronary artery disease (CAD) using low cost, low risk tests of serum biomarkers in even a small percentage of patients with normal coronary arteries could be highly beneficial.MethodsSerum from 359 symptomatic subjects referred for catheterization was interrogated for proteins involved in atherogenesis, atherosclerosis, and plaque vulnerability. Coronary angiography classified 150 patients without flow-limiting CAD who did not require percutaneous intervention (PCI) while 209 required coronary revascularization (stents, angioplasty, or coronary artery bypass graft surgery). Continuous variables were compared across the two patient groups for each analyte including calculation of false discovery rate (FDR ≤ 1%) and Q value (P value for statistical significance adjusted to ≤ 0.01).ResultsSignificant differences were detected in circulating proteins from patients requiring revascularization including increased apolipoprotein B100 (APO-B100), C-reactive protein (CRP), fibrinogen, vascular cell adhesion molecule 1 (VCAM-1), myeloperoxidase (MPO), resistin, osteopontin, interleukin (IL)-1β, IL-6, IL-10 and N-terminal fragment protein precursor brain natriuretic peptide (NT-pBNP) and decreased apolipoprotein A1 (APO-A1). Biomarker classification signatures comprising up to 5 analytes were identified using a tunable scoring function trained against 239 samples and validated with 120 additional samples. A total of 14 overlapping signatures classified patients without significant coronary disease (38% to 59% specificity) while maintaining 95% sensitivity for patients requiring revascularization. Osteopontin (14 times) and resistin (10 times) were most frequently represented among these diagnostic signatures. The most efficacious protein signature in validation studies comprised osteopontin (OPN), resistin, matrix metalloproteinase 7 (MMP7) and interferon γ (IFNγ) as a four-marker panel while the addition of either CRP or adiponectin (ACRP-30) yielded comparable results in five protein signatures.ConclusionsProteins in the serum of CAD patients predominantly reflected (1) a positive acute phase, inflammatory response and (2) alterations in lipid metabolism, transport, peroxidation and accumulation. There were surprisingly few indicators of growth factor activation or extracellular matrix remodeling in the serum of CAD patients except for elevated OPN. These data suggest that many symptomatic patients without significant CAD could be identified by a targeted multiplex serum protein test without cardiac catheterization thereby eliminating exposure to ionizing radiation and decreasing the economic burden of angiographic testing for these patients.

TCT-373 Impact of Epicardial Fat Volume on Coronary Artery Disease in Symptomatic Patients with a Zero Calcium Score

TCT-373 Impact of Epicardial Fat Volume on Coronary Artery Disease in Symptomatic Patients with a Zero Calcium Score

Impact of epicardial fat volume on coronary artery disease in symptomatic patients with a zero calcium score

BackgroundThis study sought to evaluate the prevalence of coronary artery disease (CAD) and the impact of epicardial fat volume (EFV) on CAD in symptomatic patients with a zero calcium score (CS) using multislice computed tomography (MSCT). MethodsIn this study, 1308 consecutive symptomatic patients who underwent 64-slice MSCT with a zero CS were evaluated. EFV was quantified with CS data sets. Presence of an obstructive plaque (diameter stenosis >50%) and a CT-derived vulnerable plaque, which was defined as a plaque with remodeling index >1.10 and mean CT density value <30HU, was assessed with a CT coronary angiography. ResultsObstructive plaques were detected in 86 patients (7%) and CT-derived vulnerable plaques in 63 (5%). EFV was larger in patients with obstructive plaques than no plaque (124.3±43.2cm3 vs. 95.1±40.3cm3; p<0.01). Patients with CT-derived vulnerable plaques had a greater amount of EFV than no plaque (133.0±40.2cm3 vs. 95.1±40.3cm3; p<0.01). Multivariate analysis revealed EFV as a predictor of the presence of an obstructive and a CT-derived vulnerable plaque (per 10cm3; Odds ratio (OR) 1.10; 95% confidence interval (CI), 1.04-1.16; p<0.01 and OR 1.19; 95% CI, 1.12-1.27; p<0.01). The combination of EFV and Framingham risk score (FRS) resulted in an area under the receiver-operating characteristic curve for prediction of obstructive and CT-derived vulnerable plaque of 0.75 and 0.75, which was significantly higher than 0.68 and 0.64 for FRS alone (p=0.02 and p<0.01). ConclusionsA zero CS doesn't exclude CAD and EFV can be a useful marker of CAD in symptomatic zero CS patients.

Abstract 9416: The Impact of Epicardial Fat Volume on Coronary Artery Disease in Symptomatic Patients of Zero Calcium Sore

Background Patients without detectable coronary calcium by computed tomography (CT) have a low rate of obstructive coronary disease and good prognosis. However, in some patients with zero coronary calcium score (zero CS), obstructive coronary stenosis exists and fatal cardiovascular events occur, especially among symptomatic patients. Epicardial fat is known to be a rich source of free fatty acid and inflammatory cytokines and epicardial fat volume (EFV) has been suggested as a predictor of coronary artery disease. The aim of our study is to investigate the impact of EFV on coronary artery disease in symptomatic patients with zero CS. Methods and Results From June 2009 to April 2011, consecutive 483 symptomatic patients who underwent multislice CT (MSCT) with zero CS were evaluated. EFV was calculated using dedicated software with manual assistance in defining the epicardial contour on CT images. In each patient, obstructive coronary disease (diameter stenosis&gt;50% on MSCT) and CT-derived vulnerable plaque were assessed with 64-slice CT coronary angiography. CT-derived vulnerable plaque was defined as a plaque with positive vessel remodeling (lesion vessel area&gt;proximal reference vessel area) and low CT attenuation (mean CT density value of the plaque&lt;30Hounsfield Units). In patients with obstructive coronary disease (n=25), EFV was larger (117.8±40.9cm 3 vs 95.9±41.1cm 3 , p&lt;0.01) and diabetes mellitus (DM) was more common(24% vs 6%, p&lt;0.01) than without obstructive coronary disease. In multivariate analysis, EFV (per 10cm 3 ) remained the independent predictor for obstructive coronary disease (Odds ratio(OR);1.20, 95% confidence interval (CI)1.09-1.31, p&lt;0.01). The patients with CT-derived vulnerable plaque (n=20) had larger EFV than without CT-derived vulnerable plaque (136.4±34.2cm 3 vs 95.4±40.8cm 3 , p&lt;0.01). CT-derived vulnerable plaques were more frequently observed in males (70 % vs 44%, p=0.03) and DM patients (25 % vs 6%, p&lt; 0.01). After adjustment for DM and gender, EFV (per 10cm 3 ) remained the independent predictor of the presence of CT-derived vulnerable plaque (OR; 1.20, 95%CI; 1.09-1.32, p&lt;0.01). Conclusions EFV can be a useful marker of coronary artery disease in symptomatic patients with zero CS.

Abstract 9602: Serum Proteomic Profiles Predict Coronary Artery Disease in Symptomatic Patients Referred for Coronary Angiography

Coronary angiography is a definitive assay for coronary artery disease (CAD). However, high rates of normals and exposure to ionizing radiation warrant development of tests to identify patients lacking significant CAD without cardiac catheterization. We hypothesized that combinatorial proteomic changes in patient sera correlated with coronary artery disease status. Methods: We performed targeted immunoassay profiling of serum from 359 symptomatic patients undergoing coronary angiography. A cohort of 208 patients required stent, angioplasty or bypass graft for hemodynamically significant CAD based on angiography while 151 had no significant disease (No CAD). Both cohorts were comparable in gender, BSA, cholesterol, LDL, creatinine, hypertension and clinical symptoms with a slight difference in age (No CAD: 58+/-10; CAD: 63 +/-11 years, p&lt;0.001). Forty one target proteins implicated in atherogenesis were tested across the 2 groups. Thirty-three proteins were screened among 56 samples, 24 analytes were tested across a 239 sample training set and 12 analytes were validated in 120 additional serum samples. Results: Highly significant increases were detected (false detection level=0.018) in patients with CAD for Apo-B100, fibrinogen, VCAM-1, myeloperoxidase, CRP, resistin, osteopontin, IL-6, IL-1b, IL-10 and NT-pBNP. Apo-A1 fell significantly in this group. A scoring algorithm was derived for patient classification (CAD vs. No CAD) using signatures of 2 to 5 analytes from the 239 patient study. Discrimination of patients without CAD was achieved (86% Negative Predictive Value: NPV) while correctly classifying 95% (PPV) of patients with CAD. Osteopontin, resistin, MMP7 and interferon-g were the most frequent classification biomarkers among diagnostic signatures. Validation studies (120 samples) confirmed this signature plus ACRP30 as the strongest multiplex classifier. Conclusions: A non-invasive serum biomarker test has been developed to discriminate between patients with angiographically-confirmed, significant CAD and those without it. The ability to exempt even a small percentage of patients from cardiac catheterization provides significant medical and economic benefits given the growing epidemic of coronary artery disease.

Step-and-shoot prospectively ECG-gated vs. retrospectively ECG-gated with tube current modulation coronary CT angiography using 128-slice MDCT patients with chest pain: diagnostic performance and radiation dose

With increasing awareness for radiation exposure, the study of diagnostic accuracy of coronary CT angiography (CCTA) with low radiation dose techniques is mandatory to both radiologist and clinician. To compare diagnostic performance and effective radiation dose between step-and-shoot prospectively ECG-gated and retrospectively ECG-gated with tube current modulation (TCM) CCTA using 128-slice multidetector computed tomography (MDCT). We retrospectively evaluated 60 patients who underwent CCTA with either of two different low-dose techniques using 128-slice MDCT (23 patients for step-and shoot-prospectively ECG-gated and 37 patients for retrospectively ECG-gated with TCM CCTA) followed by conventional coronary angiography. All coronary arteries and all segments thereof, except anatomical variants or small size (< 1.5 mm) ones, were included in analysis. In per-segment analysis, sensitivity, specificity, positive predictive value, and negative predictive value were 91/96%, 95/94%, 75/73%, and 98/99% for step-and-shoot prospectively ECG-gated and retrospectively ECG gated with TCM CCTA, respectively, relative to conventional coronary angiography. Effective radiation dose were 1.75 ± 0.83 mSv, 4.91 ± 1.71 mSv in the step-and-shoot prospectively ECG-gated and retrospectively ECG-gated with TCM CCTA groups, respectively. The two low-radiation dose CCTA techniques using 128-slice MDCT yields comparable diagnostic performance for coronary artery disease in symptomatic patients with low heart rates.

Higher Prevalence and More Severe Coronary Artery Disease in HCV Infected Patients: A Case Control Study: ACG/AstraZeneca Fellow Award

Purpose: Coronary artery disease (CAD) continues to be the most common cause of morbidity and mortality worldwide. An association of CAD with hepatitis C has been suggested, but definitive data are still lacking. Our study is aimed to estimate the prevalence and severity of CAD in hepatitis C patients and to compare it with age, sex and race matched controls without hepatitis C virus infection. Methods: Sixty-three of 934 hepatitis C patients had coronary angiography for evaluation of CAD seen between May 2002 and December 2008 at our center was included in the study. An age, race and sex matched controls (1:1 ratio) were than obtained from 6017 patients who had cardiac angiography for evaluation of CAD seen between October 2008 to September 2010. Patients with known HCV infections were excluded from the controls. Coronary artery disease was defined as more than 50% blockage in any of the proximal coronary arteries on angiogram. The severity of the stenosis was defined by the Modified Reardon severity scoring system: <50% stenosis of the luminal diameter, 1 point; 50- 74%, 2 points; 75-99%, 3 points; 100% or total obstruction, 4 points. The points for each lesion in the proximal coronary circulation were summed to give the score for severity. Results: No significant differences were noted in the prevalence of DM, hypertension, hyperlipidemia, and family history of CAD, alcohol abuse, tobacco dependence, IVDU and HIV infections in the HCV infected populations compared to the controls. However, a significantly higher level of serum triglyceride levels and serum alanine amino transferases was noted in the HCV populations. A significantly higher prevalence of coronary artery disease was noted in the HCV population compared to the controls (69.8% vs 47.6%, P= 0.01). More severe stenosis was noted in the HCV populations in majority of the most commonly affected coronary arteries (Table 1). Multivariate logistic regression analysis revealed age (P=0.03, OR =1.04, 95% CI 1.00-1.08), tobacco dependence (P=0.007, OR 3.26, 95% CI 1.39-7.63) and HCV positive status (P=0.007, OR 3.12, 95% CI 1.37-7.10) were significant factors that predicted coronary artery disease.Table 1: Prevalence and severity of coronary artery diseaseConclusion: Hepatitis C virus infected patients have significantly higher prevalence and severity of coronary artery disease in symptomatic patients undergoing coronary angiogram. HCV positive status is potentially a risk factor for coronary artery disease.