Screening For Coronary Artery Disease Research Articles

Comparison of Myocardial Layer-Specific Strain and Global Myocardial Work Efficiency During Treadmill Exercise Stress in Detecting Significant Coronary Artery Disease.

BackgroundMyocardial layer-specific strain can identify myocardial ischemia. Global myocardial work efficiency (GWE) based on non-invasive left ventricular (LV) pressure-strain loops is a novel parameter to determine LV function considering afterload. The study aimed to compare the diagnostic value of GWE and myocardial layer-specific strain during treadmill exercise stress testing to detect significant coronary artery disease (CAD) with normal baseline wall motion.MethodsEighty-nine patients who referred for coronary angiography due to suspected of CAD were included. Forty patients with severe coronary artery stenosis were diagnosed with significant CAD, and 49 were defined as non-significant CAD. Stress echocardiography was performed 24 h before angiography. Layer-specific longitudinal strains were assessed from the endocardium, mid-myocardium, and epicardium by 2D speckle-tracking echocardiography. Binary logistic regression analyses were performed to evaluate the association between significant CAD and echocardiographic parameters. A receiver operating characteristic curve was used to assess the capability of layer-specific strain and GWE to diagnose significant CAD.ResultsPatients with significant CAD had the worse function in all three myocardial layers at peak exercise compared with those with non-significant CAD when assessed with global longitudinal strain (GLS). At the peak exercise and recovery periods, GWE was lower in patients with significant CAD than in patients with non-significant CAD. In multivariable binary logistic regression analysis, peak endocardial GLS (OR: 1.35, p = 0.006) and peak GWE (OR: 0.76, p = 0.001) were associated with significant CAD. Receiver operating characteristic curves showed peak GWE to be superior to mid-myocardial, epicardial, and endocardial GLS in identifying significant CAD. Further, adding peak GWE to endocardial GLS could improve diagnostic capabilities.ConclusionsBoth GWE and endocardial GLS contribute to improving the diagnostic performance of exercise stress echocardiography. Furthermore, adding peak GWE to peak endocardial GLS provides incremental diagnostic value during a non-invasive screening of significant CAD before radioactive or invasive examinations.

ATHEROSCLEROSIS and LDL-cholesterol : Another Brick In The Wall

Atherosclerosis is one of the two major causes of mortality worldwide along with cancer and is responsible for myocardial infarction, stroke, and arteritis. Its pathophysiology is still partially understood which allows doubts referring to the preventive and curative treatments. Population screening for atherosclerosis remains marginal even though it should be the common practice. To encourage preventive screening and therapies, we propose a simple and easily understandable pathophysiology of atherosclerosis, explaining how the brick-wall of atheroma is build inside the intima of arteries using a metaphor: the LDL-cholesterol bricks, the oxidation cement, and the inflammatory mason.

Use of Coronary CT Angiography as a Screening Tool for Coronary Artery Disease in Asymptomatic Healthy Individuals or Patients

심장 돌연사 환자들은 종종 흉통 또는 운동성 호흡곤란 등의 전조증상이 나타나지 않기 때문에 잠재적인 무증상 관상동맥 질환을 조기에 발견하는 것이 매우 중요하다. 관상동맥 전산화단층촬영 혈관조영술은 방사선 노출로 인한 위험성 때문에 무증상 환자에서 스크리닝 검사로 정당화되지 못했었지만 최근에 전산화단층촬영 기술의 비약적인 발전으로 방사선량을 1 mSv 미만으로 최소화함으로써 무증상 환자의 관상동맥 질환 선별 검사의 유용성에 대한 많은 연구가 진행되어 왔다. 그러나, 여전히 무증상 정상인 또는 환자의 관상동맥 질환 선별 검사에 대한 관상동맥 전산화단층촬영 혈관조영술의 유용성에 대해서는 다양한 의견들이 있다. 이 종설에서는 무증상 정상인 또는 환자들에게 관상동맥 질환 선별 검사로 관상동맥 칼슘 점수와 관상동맥 전산화단층촬영 혈관조영술 유용성에 대해서 다양한 문헌고찰을 통해서 알아보았다. 관상동맥 전산화단층촬영 혈관조영술상 무증상 정상인의 2.6%에서 70% 이상의 유의한 관상동맥 협착이 발견되었고, 선별 목적의 관상동맥 전산화단층촬영 혈관조영술이 무증상 건강한 사람의 미래의 심혈관 질환 발생을 예측할 수 있다. 그러나 현재 미국국립보건원에서 진행하고 있는 SCOT-HEART 2 연구가 끝나면 관상동맥 전산화단층촬영 혈관조영술이 무증상 성인의 심혈관 예방에 선별 검사로 적절한지 결정을 내릴 수 있을 것으로 생각된다.

Importance of myocardial perfusion scintigraphy for early detection of coronary artery disease in patients with positive family history of premature CAD -case study

Background: Acute coronary syndrome refers to a spectrum of clinical presentations ranging from those for ST-segment elevation myocardial infarction (STEMI) to presentations found in non-STEMI or unstable angina. Case presentation: We present a case of a 36-year-old female who visited cardiac outdoor patient department with continuous left arm pain. She was then referred to nuclear cardiology for screening of coronary artery disease (CAD). A pharmacological stress study was planned but the rest study was done instead due to the patient having persistent pain in the left arm. The rest study showed a large perfusion defect in left anterior descending artery (LAD) territory. As the patient was not having any previous history of CAD except for positive family history of premature CAD, she was immediately referred to an interventional cardiologist where her primary percutaneous coronary revascularization to LAD (3 × drug eluting stent) got done and she was saved from impending MI. Conclusion: Regular follow-up and monitoring should be fine in young adults with a positive family history of premature CAD. This may help in early detection leading to time management and acute coronary events in young adults may be avoided. This will eventually reduce mortality and morbidity.

Unexpected Elevation of Infection Parameters in a Heart Transplanted Patient with Chronic Kidney Disease: A Case Report

Patients with end-stage kidney disease are under an increased risk for morbidity and mortality due to cardiovascular reasons. Yet, patients might show only atypical symptoms during cardiac events and routinely performed pre-transplant diagnostic measures are discussed controversially. A heart transplanted 50-year-old male with end-stage kidney disease was assessed for kidney transplantation. Myocardial scintigraphy, chest x-ray, pulmonary function test, urological and gastrointestinal assessment showed normal results. A routinely performed blood test revealed elevated procalcitonin, C-reactive protein and leucocytes. Measured vital parameters and physical examination revealed no pathologies. Coughing, shortness of breath or chest pain were denied. CT-scan showed no signs of infection but lack of contrast media enhancement in the heart. Myocardial infarction was confirmed in electrocardiogram and transthoracic echocardiogram demonstrated an impaired ejection fraction of 20%. Treatment with anti-platelet medication and anticoagulation was followed by invasive heart catheterization, which revealed no acute stenosis but a dissolved in-stent thrombosis. Since kidney failure was progressing the patient required dialysis treatment. Microbiological analyses of blood and urine samples stayed negative. Chronic kidney disease patients are at increased cardiovascular risk. However, invasiveness of cardiac diagnostics for potential kidney transplant is debated controversially. KDIGO guideline 2020 advises non-invasive screening for coronary artery disease for asymptomatic patients at high risk. However, there is no specific guideline for previously heart transplanted candidates for kidney transplant and patients with high pretest probability benefit from invasive diagnostics. A risk stratification for cardiac complications and pre-kidney transplant evaluation should be executed in clinical practice.

Incremental value of global longitudinal strain to predict stress echocardiography positivity in asymptomatic diabetic patients

French guideline recently added the presence of an “abnormal left ventricle” on transthoracic echocardiography (TTE) to define very high-risk diabetic patients who may benefit from silent coronary artery disease (CAD) screening. We aimed to investigate the incremental value of resting Global Longitudinal Strain (GLS) in predicting stress TTE positivity in asymptomatic patients with diabetes mellitus (DM). Consecutive asymptomatic patients with DM referred for screening for silent CAD by stress TTE (effort of dobutamine) between January 2017 and December 2018 were included ( n = 273). Stress test positivity was defined as stress-induced new or worsening of preexisting left ventricular wall motion abnormalities. Patients with a positive stress test ( n = 28; 10%) were more likely to be smokers (71% vs. 17%), to have known diabetes for more than 10 years, carotid atheroma, diabetic nephropathy, diabetic retinopathy (57.1% vs. 18.0%), moderate or severe aortic or mitral calcifications and a lower GLS (−16.7 ± 2.9 vs. −18.9 ± 2.2%) than those with a negative test (all P ≤ 0.014). On multivariate logistic regression analysis, a DM duration > 10 years, diabetic retinopathy and lower GLS (OR [95% CI] = 0.76 [0.64–0.93] per % decrease) remained independently associated with a positive stress TTE. The Chi 2 of the model was significantly improved by the addition of GLS on top of the baseline clinical variables, repolarization abnormalities and DM related complications (Chi 2 56.9 to 73.8; P < 0.001) ( Table 1 , Fig. 1 ). Screening CAD in asymptomatic patients with DM is challenging and debated. In this context, it is crucial to identify early markers of CAD in this population. Our study shows that GLS is strongly associated with the presence of silent ischemia and could be one of these new parameters to be routinely assessed in this population.

A novel fluorescent digitonin derivative for non-invasive skin cholesterol detection: potential application in atherosclerosis screening.

There is a great demand for the rapid and non-invasive atherosclerosis screening method. Cholesterol content in the epidermis of the skin is an early biomarker for atherosclerosis. Risk assessment of atherosclerosis can be achieved by measuring cholesterol in the epidermis. Here, we synthesised a new fluorescent digitonin derivative (FDD) for the non-invasive detection of skin cholesterol. The results of fluorescence spectroscopy studies indicated that the probe exhibited desirable selectivity for cholesterol. The proof-of-concept preclinical study confirmed that FDD can detect different concentrations of skin cholesterol; patients diagnosed with atherosclerotic cardiovascular disease and the at-risk atherosclerosis group exhibited higher skin cholesterol content than the normal group. The area under the ROC curve for distinguishing the normal/disease group was 0.9228 (95% confidence interval, 0.8938 to 0.9518), and the area under the ROC curve for distinguishing the normal/risk group was 0.9422 (95% confidence interval, 0.9178 to 0.9665). We anticipate that this non-invasive skin cholesterol test may be used as a risk assessment tool for atherosclerosis screening in a large population for further examination and intervention in high-risk populations.

Normative Clinical Reference for Intima-media Thickness of Carotid Arteries among Nigerian Adults.

Background:The intima-media thickness (IMT) of the carotid arteries is said to be predictive of the risk of cerebrovascular accidents in patients and said to be affected by sex, age, and race. The lack of normative reference values of carotid IMT can adversely affect the screening of subclinical atherosclerosis in Nigeria. Sonography is the most widely used tool in clinical practice for IMT determination.Aim:This study was aimed at obtaining sonographic reference values of the IMT of the carotid arteries of healthy adult Nigerians for clinical use.Study Design:This is a prospective study, where participants were selected by a simple random technique.Setting:The study was carried out in 2019 on adult Nigerians from different ethnic backgrounds that resided in Bayelsa State.Materials and Methods:The study population was 104 healthy Nigerian adults both male and female between 18 and 64 years of age. Excluded were those without informed consent, Nigerians aged below 18 and above 65 years, anyone with a history of cardiovascular, cerebrovascular, or metabolic disorders, and athletes. After confirming normal blood pressure and taking their physical measurements, participants’ necks were scanned with an “EcoMed” ultrasound machine version VERTU-3 Portable USG with a linear transducer and a frequency of 7.0 MHz by an experienced radiologist.Results:The IMT was recorded for the subjects in millimetres where common carotid artery: males = 0.487 ± 0.014, females = 0.480 ± 0.010 with a reference range of 0.200–0.750 mm; internal carotid artery: males = 0.500 ± 0.019, females = 0.459 ± 0.013 with a reference range of 0.200–0.750 mm; external carotid artery: males = 0.479 ± 0.018, females = 0.437 ± 0.014 with a reference range of 0.180–0.780 mm. The values for the males were higher than those of the females; however, they were not statistically significant. There was also no statistically significant difference between right and left sides in the IMT despite the right persistently being higher than the left in the general study population.Conclusion:This study has been able to provide reference values for IMT of the carotid arteries among Nigerians for clinical use in the meantime. We believe that a systematic review of similar data can further be done for the standardisation of national reference.

Detecting Coronary Artery Disease Using Rest Seismocardiography and Gyrocardiography.

In this study, we present a non-invasive solution to identify patients with coronary artery disease (CAD) defined as ⩾50% stenosis in at least one coronary artery. The solution is based on the analysis of linear acceleration (seismocardiogram, SCG) and angular velocity (gyrocardiogram, GCG) of the heart recorded in the x, y, and z directional axes from an accelerometer/gyroscope sensor mounted on the sternum. The database was collected from 310 individuals through a multicenter study. The time-frequency features extracted from each SCG and GCG data channel were fed to a one-dimensional Convolutional Neural Network (1D CNN) to train six separate classifiers. The results from different classifiers were later fused to estimate the CAD risk for each participant. The predicted CAD risk was validated against related results from angiography. The SCG z and SCG y classifiers showed better performance relative to the other models (p < 0.05) with the area under the curve (AUC) of 91%. The sensitivity range for CAD detection was 92–94% for the SCG models and 73–87% for the GCG models. Based on our findings, the SCG models achieved better performance in predicting the CAD risk compared to the GCG models; the model based on the combination of all SCG and GCG classifiers did not achieve higher performance relative to the other models. Moreover, these findings showed that the performance of the proposed 3-axial SCG/GCG solution based on recordings obtained during rest was comparable, or better than stress ECG. These data may indicate that 3-axial SCG/GCG could be used as a portable at-home CAD screening tool.

A Meta-Analysis and Systematic Review on the Global Prevalence, Risk Factors, and Outcomes of Coronary Artery Disease in Liver Transplantation Recipients.

The shift in the changing etiology of cirrhosis requiring liver transplantation (LT) has resulted in an increasing prevalence of coronary artery disease (CAD) that can potentially impact post-LT outcomes. This systematic review and meta-analysis evaluates the prevalence of CAD, risk factors, and outcomes of patients diagnosed with CAD before LT. MEDLINE and EMBASE were searched for articles describing CAD in pre-LT patients. Meta-analysis of proportions using the generalized linear mix model was conducted to analyze the pooled prevalence of CAD in pre-LT patients. Associated risk factors for CAD in pre-LT patients and outcomes were evaluated in conventional pairwise meta-analysis. A total of 39 studies were included. The pooled prevalence of patients diagnosed with CAD before LT was 15.9% (95% CI, 9.8%-24.7%). Age, male sex, diabetes mellitus, hypertension, hyperlipidemia, smoking, nonalcoholic steatohepatitis, hepatitis B virus, and hepatocellular carcinoma were significantly associated with CAD. Patients from high-income countries especially North America, Europe, and South America, with the associated risk factors were at increased risk for CAD before LT. CAD before LT was associated with an increased odds of overall mortality (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.4-1.4; P=0.01) and cardiac-related mortality (OR, 1.2; 95% CI, 1.1-1.3; P=0.03). A total of 48.7% of included articles considered the presence of cardiovascular risk factors for CAD screening. However, 10.3% of the studies screened for CAD in pre-LT patients via invasive coronary angiography only, without stress testing or risk stratification. This study demonstrates the high prevalence of CAD in pre-LT patients, associated risk factors, and outcomes. There is heterogeneity among guidelines and practice in screening for pre-LT CAD, and more studies are needed to establish consensus.

Abstract 9412: Establishing a Coronary Calcium Scoring Threshold as a Gateway to Invasive Testing for Firefighters Undergoing Fitness for Duty Exams

Introduction: Heart disease is the leading cause of death amongst active firefighters. Firefighters undergo exercise treadmill test as a part of fitness for duty examinations screening for heart disease. It has been previously shown that coronary artery calcium (CAC) scoring and CT angiography (CTA) together can be used cost effectively in further screening for obstructive coronary artery disease amongst firefighters. A coronary artery calcium score threshold to predict obstructive CAD however is yet to be established. Methods: Firefighters in the County of Los Angeles Fire Department underwent fitness for training tests over a twenty-year period using treadmill ECG tests for cardiac screening. Those with positive tests were referred for further evaluation with coronary calcium scoring (CCS). Individuals with a CCS of &amp;gt; 10 went on to have CTA as prior studies have shown that CCS &amp;lt; 10 is highly unlikely to correlate with obstruction. We used receiver-operating characteristic (ROC) analysis to determine the optimal sensitivity and specificity of a CCS threshold needed to predict which individuals were likely to have a CTA showing greater than 50% stenosis. Results: Annually, about 3000 firefighters undergo fitness for duty testing in Los Angeles County. In our sample population from 1999 to 2019, a total of 1425 firefighters had a positive treadmill test. All 1425 of these firefighters underwent CCS with scores varying from 0 to 1400, the distribution vastly skewed toward 0. A ROC curve analysis indicated that a CCS score of 75 was the optimal cutoff for sensitivity (82%) and specificity (62%), in predicting a stenosis greater than 50% in any segment in the CTA firefighter population. However, given the high stress associated with firefighter duty and the high mortality both on-duty and after-duty, we believe prioritization should be geared toward detection and prevention. For this reason, we chose to maximize sensitivity in our statistical analysis and determined that a CAC score of 10 (sensitivity 95%, specificity 13%) to be the most appropriate threshold. Conclusion: For future testing, a CCS threshold score of 10 can confidently be used to guide further testing for obstructive coronary artery disease with CTA.

Association Between Major Adverse Cardiovascular Events and the Ratio of Subcutaneous Fat Area to Visceral Fat Area in Patients Who Have Undergone Multidetector Row Computed Tomography.

Background: Obesity is a critical cardiovascular risk factor that has been defined in terms of body mass index (BMI), abdominal circumference (AC), and fat area. In this study, we examined which markers of obesity are most closely associated with major adverse cardiovascular events (MACE).Methods and Results: This prospective cohort study enrolled 529 consecutive patients who initially underwent coronary computed tomography angiography for screening of coronary atherosclerosis at Fukuoka University Hospital (FU-CCTA Registry) and either were clinically suspected of having coronary artery disease (CAD) or had at least 1 cardiovascular risk factor with a follow-up of up to 5 years. Measurements of subcutaneous fat area (SFA), visceral fat area (VFA), and AC were quantified using multidetector row computed tomography. The primary endpoint was MACE. SFA and the SFA to VFA ratio (SFA/VFA) were significantly lower in the MACE than non-MACE group. SFA, AC, BMI, and SFA/VFA were each independently associated with MACE. Receiver operating characteristic curve analysis revealed a greater area under the curve for SFA/VFA than for the other parameters. The cut-off level of SFA/VFA with the greatest sensitivity and specificity for the diagnosis of MACE was 1.45 (sensitivity 0.849, specificity 0.472).Conclusions: Our results suggest that SFA/VFA may be a marker for evaluating the presence of MACE.

Psychological distress and quality of life following provision of vascular imaging results of the coronary and carotid arteries to asymptomatic adults: a scoping review protocol

Background:Non-invasive screening for atherosclerosis or asymptomatic cardiovascular disease of the coronary and carotid arteries is commonly undertaken, and research has been focussed on how results from these screenings lead to behaviour change. However, no review has focused on the effects of these results on psychological distress and health-related quality of life (HRQoL). This protocol will outline how a scoping review will be conducted to map all available evidence on psychological distress and/or HRQoL outcomes following the provision of vascular imaging results of the coronary and carotid arteries.Methods:Arksey and O’Malley’s (2005) framework subsequently enhanced by Levac et al. (2010) and Peters et al (2015, 2017) will guide the scoping review. Databases such as MEDLINE (Clarivate), APA PsychINFO, EMBASE, Social Work Abstracts, Psychology and Behavioural Sciences Collection, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) will be searched using MeSH terms such as "Coronary stenosis", "Carotid Stenosis", "Psychological Distress" and "Quality of Life" and related terms. Two investigators will screen title and abstract and all articles meeting inclusion criteria will be extracted. Data on authors, publication year, country of origin, aims/purpose, methodology, intervention, outcome measures as well as key findings that relate to the scoping review questions will be extracted for each included study. The findings will be presented using tables and thematic narrative synthesis. The scoping review will not produce a pooled estimate of the impact of vascular imaging results on psychological distress and HRQoL but will present information from the included studies related to psychological distress and HRQoL.Conclusion: The review will highlight and address gaps in knowledge and provide direction for future investigations.

Resting Left Ventricular Global Longitudinal Strain to Identify Silent Myocardial Ischemia in Asymptomatic Patients with Diabetes Mellitus

Screening for silent coronary artery disease in asymptomatic patients with diabetes mellitus (DM) is challenging and controversial. In this context, it seems crucial to identify early markers of coronary artery disease. The aim of this study was to investigate the incremental value of resting left ventricular (LV) global longitudinal strain (GLS) for the prediction of positive results on stress (exercise or dobutamine) transthoracic echocardiography in 273 consecutive asymptomatic high-risk patients with DM. Positive results on stress transthoracic echocardiography were defined as stress-induced LV wall motion abnormalities (new or worsening preexisting abnormalities). Compared with patients with negative stress results, those with positive stress results (n=28 [10%]) more frequently had cardiovascular risk factors, complications of DM, vascular disease, moderate and severe calcification of the aortic valve and mitral annulus, and worse resting LV GLS (-16.7±2.9% vs -19.0±1.9%, P<.001). On multivariable logistic regression analysis, DM duration > 10years, diabetic retinopathy, LV hypertrophy, and impaired LV GLS (odds ratio, 1.39 [95% CI, 1.14-1.70] per percentage increase; odds ratio, 5.16 [95% CI, 1.96-13.59] for LV GLS worse than -18%) were independently associated with positive results on stress transthoracic echocardiography. The area under the curve to predict positive results was 0.74 for LV GLS with a cutoff of -18.0% (sensitivity 68%, specificity 78%). The area under the curve of the multivariable model to predict test results was improved by the addition of LV GLS (P<.001), with a bias-corrected area under the curve after bootstrapping of 0.842 [95% CI, 0.753-0.893]. The present findings show that resting LV GLS is associated with the presence of silent ischemia and could be useful to better identify asymptomatic patients with DM who might benefit from coronary artery disease screening.

Influence of Prediabetes on Coronary Atherosclerotic Plaque Burden Assessed by Coronary Computed Tomography Angiography (CCTA).

IntroductionAccording to CDC there are 88.0 million Americans aged 18 years or older with prediabetes. Cardiovascular disease is the primary cause of morbidity and mortality in diabetes. The relationship between prediabetes and coronary atherosclerosis is not well established. We evaluated the association between prediabetes and coronary atherosclerosis and compared it to non-diabetic population. MethodsIn this retrospective study all patients who underwent CCTA and coronary artery calcium (CAC) testing at our outpatient imaging center for the past 5 years were screened. 253 patients had recorded HbA1c values and were included in the study. 256 slice multi detector CT (GE Revolution, Milwaukee WI) scanner was used for imaging. CAC was scored using non-contrast CT. Total plaque score (TPS) and total stenosis score (TSS) were quantified using coronary CTA. Each of the scores were compared between prediabetic (125) and non-diabetic groups (128). ResultsMean age of the study cohort was 53.2 ± 17.1 years, 66% were males, 114 had hyperlipidemia (45%), 108 had hypertension (43%), 96 were present smokers (38%) and the mean HbA1c was 5.6 ±0.4. In multivariate adjusted regression models, the odds of TPS (OR:2.93; CI: 1.54,5.57) P<0.001, TSS (OR:2.82; CI:1.48,5.38) P<0.002 and CAC score (OR:3.43; CI: 1.74,6.74) p<0.001, were all higher in prediabetic patients. ConclusionOur findings suggest that prediabetics have higher atherosclerotic plaque burden compared to non-diabetics. In prediabetes, increased plaque burden most likely contributes to cardiovascular events. The application of these findings may guide early screening and pharmacological prevention strategies for atherosclerosis in patients with prediabetes.

Socioeconomics of coronary artery calcium: Is it scored or ignored?

ImportanceChicago is one of the most racially segregated cities in the US, with the largest mortality gap between neighborhoods. Computed tomographic coronary artery calcium scoring (CACS) is an excellent risk stratification tool, but costs about $200 out-of-pocket, making it inaccessible to some. ObjectiveTo determine whether this ACC/AHA guideline-recommended screening tool is accessible to all populations and neighborhoods, we evaluated the price and availability of CACS in Chicago area hospitals. DesignWe used the Illinois Department of Public Health list of area hospitals to inquire about CACS availability and price. We compared these results to US Census Bureau data for each hospital's service area's demographic, ethnic and socioeconomic population characteristics. ResultsOut of the 40 hospitals in Chicagoland, 30 offered CACS. The 10 hospitals without CACS were smaller hospitals in zip codes with a higher population density (p ​< ​0.01), higher poverty rates (22% vs. 13%, p ​< ​0.01), lower percentage of white population (p ​< ​0.02), lower frequency of higher education (35% vs. 51%, p ​< ​0.05), and a trend toward more black residents (p ​< ​0.10). Life expectancy was greater in areas with CACS available (78 vs. 75 years, p ​< ​0.05).Even in areas with CACS, there was wide price variation, with higher prices in poorer areas (r ​= ​0.57, p ​< ​0.01). The highest vs. lowest quintile of income had higher education, larger white population (80% vs. 14%, p ​< ​0.0001), and longer life expectancy (81 vs. 72 years, p ​< ​0.0002), but tended to have a lower price of CACS ($86 vs. $487, p ​< ​0.08). Conclusions and relevanceCACS is a powerful, evidenced-based clinical tool, but the availability and price vary widely in Chicagoland, and directly correlate with the socioeconomic and health care disparities that are known to exist. Removing these barriers to coronary artery disease screening may be one method to improve the poor cardiovascular outcomes in these areas.

The atherosclerosis profile by coronary CTA compared to the coronary artery calcium score (CACS) in a young symptomatic high-risk population between 19 and 49 years

Abstract Background Whether the coronary artery calcium score (CACS) or coronary CTA should be used in young high-risk adults for screening of coronary artery disease (CAD), is an open debate and data sparse. Aims To evaluate the coronary atherosclerosis profile by coronary computed tomography angiography (CTA) in a young symptomatic high-risk population (age, 19–49 years) in comparison with the coronary artery calcium score (CACS). Methods and results 1137 symptomatic high-risk patients between 19–49 years (mean 42.4y; 33.2%females) with suspected CAD who underwent CTA and CACS were assigned into 6 age groups (19–30; 31–35; 36–40; 41–45; 46–47; 48–49y).CTA-analysis included stenosis severity (CADRADS) and high-risk-plaque (“HRP”) criteria. Atherosclerosis was more often detected by CTA than by CACS (45% vs. 27%; p&amp;lt;0.001), &amp;gt;50% stenosis in 13.6% and HRP in 17.7%. Prevalence of atherosclerosis was low and not different between CACS and CTA in the youngest (19–30y:5.2% and 6.4%; 30–35y:10.6% and 16%). Above &amp;gt;35 years, atherosclerosis detection by CTA increased (p=0.004, OR: 2.8, 95% CI: 1.45–5.89); and was higher by CTA as compared to CACS (34.9% vs 16.7%; p&amp;lt;0.001). CTA outperformed CACS among all higher age groups &amp;gt;35 years, with an increasing gap towards a superior performance of CTA along with age: Above 35 years, stenosis severity (CADRADS) (p=0.002) and &amp;gt;50% stenosis increased from 2.6% to 12.5% (p&amp;lt;0.001). The rate of HRP increased linearly with age from 6.4% to 26.5%.The distribution of HRP into CACS0 and CACS&amp;gt;0.1AU was similar among all age groups (CACS 0:45.1% had HRP), with an increasing proportion of HRP in CACS&amp;gt;0.1AU with age. 24.9% of CACS 0 patients had CAD by CTA, 4.4% &amp;gt;50% stenosis and 11.5% HRP. Conclusion Above 35 years of age, CTA outperforms CACS with an increasing power. Between 19 and 35 years, CACS 0 does not reliably rule out CAD and high-risk-plaque; hence for “noRISK100%safety”, CTA is superior.(#eachlifematters) Funding Acknowledgement Type of funding sources: None. 30 YOM diabetic, CACS 0 and HRP by CTAAtherosclerosis vs age: CACS vs CTA

Breast Arterial Calcifications: Reporting Preferences and Impact on Screening for Coronary Artery Disease.

Breast arterial calcifications (BAC) have been shown to correlate with measures of coronary artery disease risk stratification, although reporting of BAC is optional by BI-RADS guidelines. The purpose of this study is to determine referring provider preferences in BAC reporting on mammography reports and if such reporting has any impact on patient management. This study was approved by the local institutional review board. A voluntary eight-question survey regarding the preferences and outcomes of BAC reporting on mammography was distributed to 1085 primary care physicians, obstetrics and gynecologists, medical oncologists, and breast and general surgeons in our health system via a secure online platform. Data analysis including Pearson chi-square was performed with a P-value of <0.05 for significance. A response rate of 19.1% (207/1085) was attained, with 21/207 (10.1%) of respondents indicating they do not routinely order mammograms excluded from further analysis. A total of 62.4% (116/186) of ordering physicians indicated a preference for reporting of BAC in both the body and impression of the radiology report, with 82.3% (153/186) of respondents placing importance on the quantity of atherosclerotic calcifications. Most participants (148/186, 79.6%) reported that the presence of BAC would prompt further investigation for coronary artery disease and associated risk factors. The majority of responding physicians indicated a preference for detailed reporting of BAC and that such reporting would impact patient care. Understanding referring provider preferences regarding ancillary findings of BAC will allow for improved communication and value in mammography.

A comparison of coronary angiography and myocardial perfusion studies, using quantitative scoring systems

Background: Results of myocardial perfusion for screening coronary artery disease (CAD), and angiography for diagnosing CAD, can be quantified using summed difference score (SDS) and Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score, respectively. Aim: The aim is to quantitatively compare myocardial perfusion studies with angiography amongst South African patients using scoring systems. Methods: SDS on myocardial perfusion and SYNTAX score on angiography were compared. Regional scores within each vessel (left anterior descending (LAD), circumflex and right coronary artery (RCA)) were also compared. Scores were further risk categorised and evaluated. Results: The weak correlation between SDS and SYNTAX score (rs=0.210, p=0.015), became slightly negative when SYNTAX scores were stratified into low and intermediate-high risk groups. Regionally, LAD had very slight positive correlation (rs=0.171, p=0.048), circumflex (rs=0.164, p=0.058), and RCA (rs=0.116, p=0.184) no correlation. Conversely, comparison of scores categories was signifi cant (p=0.001). Conclusions: Inherent differences in the design of 2 scoring systems that evaluate the LAD territory may explain these findings. These differences were dominance, regional blood flow distribution and significant luminal diameter reduction. This study highlights the need to interpret myocardial perfusion results contextually during CAD screening.

Intelligence artificielle et téléradiologie en imagerie cardiaque en coupe

Cardiac CT-Scan and cardiac magnetic resonance imaging (MRI) are two booming cardiac imaging modalities especially in chest pain screening for CT-Scan and in surveillance of patients with known coronary artery disease for MRI. Artificial Intelligence is already of great help in radiologic diagnosis and its use should widen in the next few years. Teleradiology allows remote interpretation of all radiology exams and should develop in cardiac imaging. Expert radiology diagnosis centers should develop gathering cardiologists and radiologists with great experience in the field of cardiac imaging interpretation. Peripheral acquisition radiology centers would be disseminated all across the country without a need for a local expert and would send their images to the expert center for interpretation. The expert center would be the middle of this spider web, sending back the report and the selected images to the peripheral center, allowing optimal care for all patients nationwide. Artificial Intelligence would be a major asset of these expert centers, improving through the years. This operating mode would allow the onset of systematic screening for coronary artery disease in the global population and the surveillance of known coronary artery disease treated patients.