Coronary Artery Disease Reporting And Data System Research Articles

Association between severity of nonalcoholic fatty liver disease and major adverse cardiovascular events in patients assessed by coronary computed tomography angiography

BackgroundThe effect of nonalcoholic fatty liver disease (NAFLD) on major adverse cardiovascular events (MACEs) can be influenced by the degree of coronary artery stenosis. However, the association between the severity of NAFLD and MACEs in patients who underwent coronary computed tomography angiography (CCTA) is unclear.MethodsA total of 341 NAFLD patients who underwent CCTA were enrolled. The severity of NAFLD was divided into mild NAFLD and moderate-severe NAFLD by abdominal CT results. The degree of coronary artery stenosis was evaluated by using Coronary Artery Disease Reporting and Data System (CAD-RADS) category. Cox regression analysis and Kaplan–Meier analysis were used to assess poor prognosis.ResultsDuring the follow-up period, 45 of 341 NAFLD patients (13.20%) who underwent CCTA occurred MACEs. The severity of NAFLD (hazard ratio [HR] = 2.95[1.54–5.66]; p = 0.001) and CAD-RADS categories 3–5 (HR = 16.31[6.34–41.92]; p < 0.001) were independent risk factors for MACEs. The Kaplan–Meier analysis showed that moderate to severe NAFLD patients had a worsen prognosis than mild NAFLD patients (log-rank p < 0.001). Moreover, the combined receiver operating characteristic curve of the severity of NAFLD and CAD-RADS category showed a good predicting performance for the risk of MACEs, with an area under the curve of 0.849 (95% CI = 0.786–0.911).ConclusionThe severity of NAFLD was independent risk factor for MACEs in patients with obstructive CAD, having CAD-RADS 3–5 categories on CCTA.

Prognostic significance of CAD-RADS for patients with suspected coronary artery disease: A systematic review and meta-analysis

Abstract Background Coronary Artery Disease-Reporting and Data System (CAD-RADS) is a standardized reporting system that offers a structured method for interpreting and reporting results obtained through coronary computed tomography angiography. It has been deemed useful in the prognostication of patients with suspected coronary artery disease (CAD). Purpose The present meta-analysis sought to assess the prognostic value of CAD-RADS in individuals with suspected CAD. Materials and Methods We conducted a systematic search of the electronic databases of PubMed, Web of Science Core Collection, Cochrane advanced search, and EMBASE. A random-effects model was implemented to evaluate the pooled hazard ratio (HR) for each CAD-RADS category and area under the receiver operating characteristics curve for predicting major adverse cardiovascular events. Results Data from 37 596 coronary computed tomography angiography examinations from 13 studies were analyzed. During follow-up, 2,536 (6.7%) adverse events were observed. Pooled HRs for prediction of adverse events were significant for all CAD-RADS categories, with incremental increase in HRs with progressively higher categories. For prediction of all-cause mortality, all categories except CAD-RADS 1 showed significant HR compared with CAD-RADS 0. Combination of CAD-RADS to conventional clinical risk factors and CAC resulted in a high predictive capacity for adverse events (pooled area under the receiver operating characteristics curve: 0.82 ([95% confidence interval, 0.73-0.91]). Conclusion The CAD-RADS category imparts information on the CAD severity and shows incremental increase in HR for adverse events with progressively higher categories, especially beyond CAD-RADS4b.

Diagnostic performance of 3.0 T unenhanced Dixon water-fat separation coronary MR angiography in patients with low-to-intermediate risk of coronary artery disease

PurposeTo evaluate the diagnostic performance of 3.0 T unenhanced compressed-sensing sensitivity encoding (CS-SENSE) Dixon water-fat separation coronary MR angiography (CMRA) in patients with low-to-intermediate risk of coronary artery disease (CAD) and its ability to grade the severity of CAD based on Coronary Artery Disease Reporting and Data System (CAD-RADS). MethodsA total of 55 patients who was clinically evaluated as low-to-intermediate risk of CAD were finally included to undergo both 3.0 T CS-SENSE water-fat separation CMRA and coronary computed tomography angiography (CCTA), and 11 of them also underwent X-ray coronary angiography (CAG). The severity of coronary artery disease was graded in patients who had completed both CCTA and CMRA examinations by the use of CAD-RADS reports for the patients with stable chest pain, and the diagnostic consistency between the two approaches was evaluated. Diagnostic performance of CMRA was assessed using the combination of CCTA and CAG as the reference standard for excluding or confirming CAD respectively. ResultsThe sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of 3.0 T unenhanced water-fat separation coronary MRA were 90.0%, 95.0%, 81.8%, 97.4% and 94.0% for a patient-based analysis respectively. In comparison with CCTA, 3.0 T Dixon water-fat separation CMRA demonstrated excellent consistency in grading the severity of coronary heart disease according to CAD-RADS (0.77 for kappa value). ConclusionIn the group of low-to-intermediate probability for CAD, 3.0 T unenhanced CS-SENSE Dixon water-fat separation CMRA can present satisfactory diagnostic performance for the exclusion of CAD with high sensitivity and negative predictive value as well as the evaluation of grading the severity of coronary artery disease.

Coronary computed tomography angiography for clinical practice.

Coronary artery disease (CAD) is a common condition caused by the accumulation of atherosclerotic plaques. It can be classified into stable CAD or acute coronary syndrome. Coronary computed tomography angiography (CCTA) has a high negative predictive value and is used as the first examination for diagnosing stable CAD, particularly in patients at intermediate-to-high risk. CCTA is also adopted for diagnosing acute coronary syndrome, particularly in patients at low-to-intermediate risk. Myocardial ischemia does not always co-exist with coronary artery stenosis, and the positive predictive value of CCTA for myocardial ischemia is limited. However, CCTA has overcome this limitation with recent technological advancements such as CT perfusion and CT-fractional flow reserve. In addition, CCTA can be used to assess coronary artery plaques. Thus, the indications for CCTA have expanded, leading to an increased demand for radiologists. The CAD reporting and data system (CAD-RADS) 2.0 was recently proposed for standardizing CCTA reporting. This RADS evaluates and categorizes patients based on coronary artery stenosis and the overall amount of coronary artery plaque and links this to patient management. In this review, we aimed to review the major trials and guidelines for CCTA to understand its clinical role. Furthermore, we aimed to introduce the CAD-RADS 2.0 including the assessment of coronary artery stenosis, plaque, and other key findings, and highlight the steps for CCTA reporting. Finally, we aimed to present recent research trends including the perivascular fat attenuation index, artificial intelligence, and the advancements in CT technology.

Ultrahigh-Spatial-Resolution Photon-counting Detector CT Angiography of Coronary Artery Disease for Stenosis Assessment.

Background Coronary CT angiography is a first-line test in coronary artery disease but is limited by severe calcifications. Photon-counting-detector (PCD) CT improves spatial resolution. Purpose To investigate the effect of improved spatial resolution on coronary stenosis assessment and reclassification. Materials and Methods Coronary stenoses were evaluated prospectively in a vessel phantom (in vitro) containing two stenoses (25%, 50%), and retrospectively in patients (in vivo) who underwent ultrahigh-spatial-resolution cardiac PCD CT (from July 2022 to April 2023). Images were reconstructed at standard resolution (section thickness, 0.6 mm; increment, 0.4 mm; Bv44 kernel), high spatial resolution (section thickness, 0.4 mm; increment, 0.2 mm; Bv44 kernel), and ultrahigh spatial resolution (section thickness, 0.2; increment, 0.1 mm; Bv64 kernel). Percentages of diameter stenosis (DS) were compared between reconstructions. In vitro values were compared with the manufacturer specifications of the phantom and patient results were assessed regarding effects on Coronary Artery Disease Reporting and Data System (CAD-RADS) reclassification. Results The in vivo sample included 114 patients (mean age, 68 years ± 9 [SD]; 71 male patients). In vitro percentage DS measurements were more accurate with increasing spatial resolution for both 25% and 50% stenoses (mean bias for standard resolution, high spatial resolution, and ultrahigh spatial resolution, respectively: 10.1%, 8.0%, and 2.3%; P < .001). In vivo results confirmed decreasing median percentage DS with increasing spatial resolution for calcified stenoses (n = 161) (standard resolution, high spatial resolution, and ultrahigh spatial resolution, respectively: 41.5% [IQR, 27.3%-58.2%], 34.8% [IQR, 23.7%-55.1%], and 26.7% [IQR, 18.6%-44.3%]; P < .001), whereas noncalcified (n = 13) and mixed plaques (n = 19) did not show evidence of a difference (P ≥ .88). Ultrahigh-spatial-resolution reconstructions led to reclassification of 62 of 114 (54.4%) patients to lower CAD-RADS category than that assigned using standard resolution. Conclusion In vivo and in vitro coronary stenosis assessment improved for calcified stenoses by using ultrahigh-spatial-resolution PCD CT reconstructions, leading to lower percentage DS compared with standard resolution and clinically relevant rates of reclassification. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by McCollough in this issue.

Prognostic value of mitral annular calcification in coronary atherosclerotic disease assessed by coronary computed tomographic angiography

Abstract Background: There is a lack of evidence on the link between mitral annular calcification (MAC) and coronary atherosclerotic diseases. The present investigation was undertaken to detect the clinical and prognostic value of MAC in coronary atherosclerotic diseases in patients who underwent coronary computed tomographic (CT) angiography. Materials and Methods: Two hundred and five individuals with MAC and without it (n = 85 and 120, respectively) were included in the present cross-sectional study. Coronary artery disease-reporting and data system (CAD-RADS) at coronary CT angiography was used to define the severity of coronary atherosclerotic diseases. Patients were classified into no or non-significant CAD (CAD-RADS 0–2) and significant CAD (CAD-RADS 3–5) according to the severity of coronary atherosclerotic diseases. The association of MAC with two mentioned groups (no or non-significant CAD and significant CAD) was assessed using the Chi-squared test and logistic regression in crude and adjusted models. Results: Patients with MAC were significantly older (69.34 ± 8.20 vs. 60.64 ± 11.42, P &lt; 0.001), had lower glomerular infiltration rate (69.67 ± 20.92 vs. 78.00 ± 20.23, P = 0.005), and higher coronary artery calcification score (352.87 ± 495.85 vs. 200.55 ± 426.13, P = 0.05) in comparison to those without MAC. However, the significant difference between the two groups regarding coronary artery calcification score disappeared after adjustment for confounders (P = 0.14). In addition, a statistically significant positive link between MAC and significant CAD was observed (odds ratio [OR] [95% confidence interval (CI)]: 1.96 [1.04–3.71], P = 0.04). Nevertheless, the association became statistically insignificant after adjustment for confounders (OR [95% CI]: 1.60 [0.78–3.28], P = 0.2). Conclusion: The findings of the study revealed that MAC has no independent prognostic value in coronary atherosclerotic diseases evaluated by coronary CT angiography.

Epicardial fat volume and its association with cardiac arrhythmias in CT coronary angiography.

This retrospective study aimed to investigate the epicardial fat volume in cardiac computed tomography (CT), its relationship with cardiac arrhythmias, and its correlation with the coronary artery disease reporting and data system (CAD-RADS) score. Ninety-six patients who underwent CT coronary angiography (CTCA) were included in this study. Patient data, including demographic information, clinical history, and imaging data were collected retrospectively. Epicardial fat volume was quantified using a standardised algorithm, the CAD-RADS scoring system was applied to assess the extent of coronary artery disease (CAD). Descriptive statistics, correlation analyses, and receiver operating characteristics methods were used. The study found a significant correlation between epicardial fat volume and CAD-RADS score (r2 = 0.31; p < 0.001), indicating the known influence of epicardial fat on CAD risk. Moreover, patients with higher epicardial fat volumes were more likely to experience cardiac tachyarrhythmia (p < 0.001). Receiver operating characteristic analysis established a threshold value of 123 cm3 for epicardial fat volume to predict tachyarrhythmia with 80% sensitivity (AUC = 0.69). In this study a volume of at least 123 cm3 epicardial fat in native coronary calcium scans is associated with cardiac tachyarrhythmia. In these patients, careful selection of suitable imaging protocols is advised.

Intra-individual comparison of coronary artery stenosis measurements between energy-integrating detector CT and photon-counting detector CT

AbstractPurposeTo compare intra-individual percentage diameter stenosis (PDS) measurements of coronary artery stenoses between energy-integrating detector computed tomography (EID-CT) and a clinical photon-counting detector computed tomography (PCD-CT) systems using similar acquisition and reconstruction settings.MethodsPatients (n = 23, mean age of 65 ± 12.1 years, out of these 16 (69.6%) male) were imaged on a conventional EID- and a clinical PCD-CT system with a median of 5.5 (3.0–12.5) days apart. Sequential CCTA scans were acquired and reconstructed using similar settings, including a vascular Bv36 kernel, a tube voltage of 110 kVp for EID-CT vs 120 kVp for PCD-CT, a slice thickness of 0.5 for EID-CT vs 0.6 for PCD-CT, and an iterative reconstruction strength of 3 on EID-CT vs a virtual monoenergetic reconstruction at 55 keV and quantum iterative reconstruction level of 3 on PCD-CT. Radiation dose, contrast volume, and injection parameters were matched as similarly as possible between the systems. PDS measurements were performed according to the coronary artery disease reporting and data system (CAD-RADS) by two trained readers and compared between the different modalities using the Wilcoxon rank sum test, Spearman correlation, and Bland-Altman analysis.ResultsPCD-CT measured significantly lower PDS values than EID-CT [PDSEID-CT: 45.1% (35.1%–64.0%) vs. PDSPCD-CT 44.2% (32.4%–61.0%), P &lt; 0.0001]. This difference led to a mean bias of 1.8 (LoA −3.0/6.5) with an excellent ICC (0.99) value among EID- and PCD-CT. The mean intra-individual deviation between the examinations was 1.8% between the scanners. This led to CAD-RADS re-classification in 3/23 cases (13.0%, new-lower class) for the first reader, and in 4/23 cases (13.0%, new-lower and 4.4%, new-higher class) for the second reader. Inter-reader agreement between the two readers for each stenosis was very strong (ICC = 0.98).ConclusionsCoronary artery stenosis measurements from PCD-CT correlate strongly to EID-CT-based measurements, despite the tendency of the measurement from PCD-CT being lower. This difference led to a change in CAD-RADS classification in 17.4% of patients. The effects on clinical decision-making, downstream testing, and prognosis have to be evaluated in future studies.

The differences between patients with nonalcoholic fatty liver disease (NAFLD) and those without NAFLD, as well as predictors of functional coronary artery ischemia in patients with NAFLD.

Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disease associated with metabolic syndrome. It is the most common cause of cryptogenic cirrhosis. The disease is also involved in the occurrence and development of type 2 diabetes and atherosclerosis and can directly affect the outcome of patients with coronary heart disease. Therefore, the focus of treatment of nonalcoholic fatty liver disease has also begun to focus on the treatment of risk factors for atherosclerotic heart disease. In this study, we investigated the difference between patients with coronary artery stenosis combined with NAFLD and those without NAFLD and evaluated the predictive factors and value of functional coronary artery ischemia in patients with NAFLD. Many clinical factors (such as age, BMI, hyperglycemia) and imaging parameters (such as CACS grade) in the NAFLD group were different from those in the non-NAFLD group. The predictive model combined with multiple influencing factors has a good value in predicting coronary artery ischemia in patients with NAFLD. We collected the clinical and imaging data of patients who underwent coronary computed tomography angiographyand coronary artery calcification score (CACS) scans between January and June 2023. A total of 392 patients were included and divided into the NAFLD group and the non-NAFLD group. Based on CT fractional flow reserve (CT-FFR), patients with NAFLD were divided into CT-FFR ≤ 0.08 group and CT-FFR > 0.08 group. Significant differences were observed between the non-NAFLD and NAFLD groups in terms of age, body mass index, hyperglycemia, hyperlipidemia, triglyceride, high-density lipoprotein, coronary artery disease-reporting and data system (CAD-RADS) classification, CACS classification, number of diseased coronary arteries, and CT-FFR ≤ 0.80 ratio (p < .05). The CAD-RADS and CACS classifications can independently predict functional coronary artery ischemia in NAFLD patients. The combined use of CAD-RADS and CACS classifications resulted in an area under the curve of 0.819 (95% confidence interval: 0.761-0.876) for predicting coronary artery ischemia in NAFLD patients, which was higher than the individual classification methods (CAD-RADS: 0.762, CACS: 0.742) (p = .000). There are differences between patients with coronary artery stenosis and NAFLD and those without NAFLD. The CAD-RADS classification and CACS classification can economically and efficiently predict functional coronary artery ischemia in patients with NAFLD, which has crucial value in clinical diagnosis and treatment.

Quantifying left ventricular myocardial strain in patients with different CAD-RADS levels based on computed tomography feature tracking technology

To evaluate myocardial strain in patients with different coronary artery disease-reporting and data system (CAD-RADS) levels using the computed tomography (CT) feature tracking technology and to investigate the relationship of myocardial strain with coronary artery calcium scores (CACs) and the degree of coronary artery stenosis. We prospectively enrolled 237 consecutive patients to undergo coronary CT angiography. The participants were divided into the following groups: control (n = 87), CAD-RADS 1 (n = 43), CAD-RADS 2 (n = 43), CAD-RADS 3 (n = 38), and CAD-RADS 4 and above (n = 26). Myocardial strains were analyzed by commercial software, and CACs and coronary stenosis were assessed on post-processing stations. Differences between multiple groups were analyzed using one-way analysis of variance or the Kruskal–Wallis test. Logistic regression were used to analyze the effects of dichotomous variables. As the CAD-RADS level increased, the global circumferential strain (GCS), global longitudinal strain (GLS) and global radial strain (GRS) of the left ventricle based on CT gradually decreased. A significant correlation was observed between global myocardial strain and CACs (GRS: r = − 0.219, GCS: r = 0.189, GLS: r = 0.491; P < 0.05). The independent predictors of obstructive CAD were age (β = 0.065, odds ratio [OR] = 1.067, P = 0.005), left ventricular ejection fraction (β = 0.145, OR = 1.156, P = 0.047), and GLS (β = 0.232, OR = 1.261, P = 0.01). CT-derived GLS of the left ventricle is correlated with CAD-RADS levels and CACs. It may be a better indicator than CACs to reflect the severity of CAD.

Coronary artery disease reporting and data system (CAD-RADS), vascular inflammation and plaque vulnerability

BackgroundCoronary artery disease reporting and data system (CAD-RADS) predicts future cardiovascular events in patients with coronary artery disease (CAD). However, information on vascular inflammation and vulnerability remains scarce. MethodsPatients who underwent coronary computed tomography angiography (CTA) and optical coherence tomography (OCT) prior to coronary intervention were enrolled. All three coronary arteries were evaluated for CAD-RADS score and pericoronary adipose tissue (PCAT) attenuation, while the culprit vessel was analyzed for plaque vulnerability by OCT. ResultsA total of 385 patients with 915 lesions were divided into two groups based on CAD-RADS score: 103 (26.8%) were categorized as CAD-RADS 4b/5 and 282 (73.2%) as CAD-RADS ≤4a. Patients with CAD-RADS 4b/5 had a higher level of PCAT attenuation (mean of 3 coronary arteries) than those with CAD-RADS ≤4a (−68.4 ​± ​6.7 HU vs. −70.1 ​± ​6.5, P ​= ​0.022). The prevalence of macrophage was higher, and lipid index was greater in patients with CAD-RADS 4b/5 than CAD-RADS ≤4a (94.2% vs. 83.0%, P ​= ​0.004, 1845 vs. 1477; P ​= ​0.003). These associations were significant in the culprit vessels of patients with chronic coronary syndrome but not in those with acute coronary syndromes. ConclusionsHigher CAD-RADS score was associated with higher levels of vascular inflammation and plaque vulnerability.

Coronary computed tomography angiography analysis using artificial intelligence for stenosis quantification and stent segmentation: a multicenter study.

Accurate interpretation of coronary computed tomography angiography (CCTA) is a labor-intensive and expertise-driven endeavor, as inexperienced readers may inadvertently overestimate stenosis severity. Recent artificial intelligence (AI) advances in medical imaging present compelling prospects for auxiliary diagnostic tools in CCTA. This study aimed to externally validate an AI-assisted analysis system capable of rapidly evaluating stenosis severity, exploring its potential integration into routine clinical workflows. This multicenter study consisted of an internal and external cohort of patients who underwent CCTA scans between April 2017 and February 2023. CCTA scans were evaluated using Coronary Artery Disease Reporting and Data System (CAD-RADS) scores to determine stenosis severity, while ground-truth stents were manually annotated by expert readers. The InferRead CT Heart (version 1.6; Infervision Medical Technology Co., Ltd., Beijing, China), which incorporates AI-assisted coronary artery stenosis quantification and automatic stent segmentation, was employed for CCTA scan analysis. AI-based stenosis assessment performance was determined using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), while the AI-based stent segmentation overlap was assessed using the Dice similarity coefficient (DSC). For ≥50% stenosis diagnoses, the AI system attained per-patient sensitivity, specificity, PPV, and NPV surpassing 90.0% for the internal dataset; for the external dataset, the per-patient values were 88.0% [95% confidence interval (CI): 81.0-94.4%], 94.5% (95% CI: 90.7-97.6%), 90.0% (95% CI: 83.3-95.6%), and 93.4% (95% CI: 89.2-96.8%), respectively. For ≥70% stenosis diagnoses, the per-patient values on the internal dataset were 94.2% (95% CI: 89.2-98.1%), 95.8% (95% CI: 94.1-97.4%), 80.8% (95% CI: 73.5-87.7%), and 98.9% (95% CI: 97.9-99.6%), respectively; for the external dataset, the per-patient values were 91.9% (95% CI: 82.6-100.0%), 97.3% (95% CI: 94.9-99.1%), 85.0% (95% CI: 72.5-94.6%), and 98.6% (95% CI: 96.8-100.0%), respectively. Regarding CAD-RADS categorization, the Cohen kappa was 0.75 and 0.81 for the internal per-patient and per-vessel basis, respectively, and 0.72 and 0.76 for the external per-patient and per-vessel basis, respectively. The DSC for stent segmentation was 0.96±0.06. The AI-assisted analysis system for CCTA interpretation exhibited exceptional proficiency in stenosis quantification and stent segmentation, indicating that AI holds considerable potential in advancing CCTA postprocessing techniques.

Comparison between the Computed Tomography (CT) Coronary Angiography by Using “Coronary Artery Disease - Reporting and Data System (CAD-RADS)” and the Conventional Coronary Angiography in Assessment of the Coronary Artery Stenosis Severity

Background Coronary CTA is established as the first-line diagnostic imaging tool to exclude coronary artery disease (CAD) at low to intermediate risk. Reporting and interpretation of the findings gap between the referring physicians and radiologist are wide. Aim of the Work To evaluate the clinical efficacy of Computed Tomography (CT) coronary angiography by using Coronary Artery Disease - Reporting and Data System (CAD-RADS) versus invasive coronary angiography in the assessment of coronary artery stenosis severity. Patients and Methods The study included 24 patients suffered from typical chest pain or fatigue, 9 were female patients and 15 were male patients, with mean patient ages above 40 years old. The study was conducted at Ain Shams University Hospitals. Results The main goals of the CAD-RADS are to decrease variability between readers and enhance communication between interpreting and referring doctors, which affects the best patient care outcome. Many clinical case scenarios are not accurately addressed by CAD-RADS and in which classes of CAD-RADS category is not straightforward. Multiple scenarios are still vague and at the maximum point of conflict about the adoption of CAD-RADS role in practice. Conclusion Hoping the next new versions of CAD-RADS classification would have addressed those vague situations and scenarios.

Risk factors for high CAD-RADS scoring in CAD patients revealed by machine learning methods: a retrospective study.

This study aimed to investigate a variety of machine learning (ML) methods to predict the association between cardiovascular risk factors and coronary artery disease-reporting and data system (CAD-RADS) scores. This is a retrospective cohort study. Demographical, cardiovascular risk factors and coronary CT angiography (CCTA) characteristics of the patients were obtained. Coronary artery disease (CAD) was evaluated using CAD-RADS score. The stenosis severity component of the CAD-RADS was stratified into two groups: CAD-RADS score 0-2 group and CAD-RADS score 3-5 group. CAD-RADS scores were predicted with random forest (RF), k-nearest neighbors (KNN), support vector machines (SVM), neural network (NN), decision tree classification (DTC) and linear discriminant analysis (LDA). Prediction sensitivity, specificity, accuracy and area under the curve (AUC) were calculated. Feature importance analysis was utilized to find the most important predictors. A total of 442 CAD patients with CCTA examinations were included in this study. 234 (52.9%) subjects were CAD-RADS score 0-2 group and 208 (47.1%) were CAD-RADS score 3-5 group. CAD-RADS score 3-5 group had a high prevalence of hypertension (66.8%), hyperlipidemia (50%) and diabetes mellitus (DM) (35.1%). Age, systolic blood pressure (SBP), mean arterial pressure, pulse pressure, pulse pressure index, plasma fibrinogen, uric acid and blood urea nitrogen were significantly higher (p<0.001), and high-density lipoprotein (HDL-C) lower (p<0.001) in CAD-RADS score 3-5 group compared to the CAD-RADS score 0-2 group. Nineteen features were chosen to train the models. RF (AUC = 0.832) and LDA (AUC = 0.81) outperformed SVM (AUC = 0.772), NN (AUC = 0.773), DTC (AUC = 0.682), KNN (AUC = 0.707). Feature importance analysis indicated that plasma fibrinogen, age and DM contributed most to CAD-RADS scores. ML algorithms are capable of predicting the correlation between cardiovascular risk factors and CAD-RADS scores with high accuracy.

Atherosclerosis on CT coronary angiography and the risk of long-term cardiovascular events after liver transplantation.

Computed tomography coronary angiography (CTCA) is increasingly utilized for preoperative risk stratification before liver transplantation (LT). We sought to assess the predictors of advanced atherosclerosis on CTCA using the recently developed Coronary Artery Disease-Reporting and Data System (CAD-RADS) score and its impact on the prediction of long-term major adverse cardiovascular events (MACE) following LT. We conducted a retrospective cohort study of consecutive patients who underwent CTCA for LT work-up between 2011 and 2018. Advanced atherosclerosis was defined as coronary artery calcium scores > 400 or CAD-RADS score ≥ 3 (≥50% coronary artery stenosis). MACE was defined as myocardial infarction, heart failure, stroke, or resuscitated cardiac arrest. Overall, 229 patients underwent CTCA (mean age 66 ± 5y, 82% male). Of these, 157 (68.5%) proceeded with LT. The leading etiology of cirrhosis was hepatitis (47%), and 53% of patients had diabetes before transplant. On adjusted analysis, male sex (OR 4.6, 95% CI 1.5-13.8, p = 0.006), diabetes (OR 2.2, 95% CI 1.2-4.2, p = 0.01) and dyslipidemia (OR 3.1, 95% CI 1.3-6.9, p = 0.005) were predictors of advanced atherosclerosis on CTCA. Thirty-two patients (20%) experienced MACE. At a median follow-up of 4 years, CAD-RADS ≥ 3, but not coronary artery calcium scores, was associated with a heightened risk of MACE (HR 5.8, 95% CI 1.6-20.6, p = 0.006). Based on CTCA results, 71 patients (31%) commenced statin therapy which was associated with a lower risk of all-cause mortality (HR 0.48, 95% CI 0.24-0.97, p = 0.04). The standardized CAD-RADS classification on CTCA predicted the occurrence of cardiovascular outcomes following LT, with a potential to increase the utilization of preventive cardiovascular therapies.

Lack of Incremental Prognostic Value of Pericoronary Adipose Tissue Computed Tomography Attenuation Beyond Coronary Artery Disease Reporting and Data System for Major Adverse Cardiovascular Events in Patients With Acute Chest Pain.

Pericoronary adipose tissue (PCAT) and Coronary Artery Disease Reporting and Data System (CAD-RADS) category had prognostic values for major adverse cardiovascular events (MACEs). However, little is known about the difference between CAD-RADS and PCAT computed tomography (CT) attenuation for predicting MACEs. This study was to compare the prognostic value of PCAT and CAD-RADS for MACEs in patients with acute chest pain. Between January 2010 and December 2021, all consecutive emergency patients with acute chest pain referred for coronary computed tomography angiography were enrolled in this retrospective study. MACEs included unstable angina requiring hospitalization, coronary revascularization, nonfatal myocardial infarction, and all-cause death. Patients' clinical characteristics, CAD-RADS, and PCAT CT attenuation were used to evaluate risk factors of MACEs using multivariable Cox regression analysis. A total of 1313 patients were evaluated (mean age, 57.13±12.57 years; 782 men). During a median follow-up of 38 months, 142 of the 1313 patients (10.81%) experienced MACEs. Multivariable Cox regression analysis showed that CAD-RADS categories 2, 3, 4, 5 (hazard ratio range, 2.286-8.325; all P<0.005) and right coronary artery PCAT CT attenuation (hazard ratio, 1.033; P=0.006) were independent predictors of MACEs after adjusting for clinical risk factors. The C statistics revealed that CAD-RADS improved risk stratification compared with PCAT CT alone (C-index, 0.760 versus 0.712; P=0.036). However, the benefit of right coronary artery PCAT CT attenuation combined with CAD-RADS was not significant compared with CAD-RADS alone (0.777 versus 0.760; P=0.129). Right coronary artery PCAT CT attenuation and CAD-RADS were independent predictors of MACEs. However, no incremental prognostic value of right coronary artery PCAT CT attenuation beyond CAD-RADS was detected for MACEs in patients with acute chest pain.

Association between Coronary Artery Disease Reporting and Data System–recommended Post–Coronary CT Angiography Management and Clinical Outcomes in Patients with Stable Chest Pain from a Chinese Registry

Background Coronary Artery Disease Reporting and Data System (CAD-RADS) was developed to standardize and optimize disease management in patients after coronary CT angiography (CCTA), but the impact of CAD-RADS management recommendations on clinical outcomes remains unclear. Purpose To retrospectively assess the association between the appropriateness of post-CCTA management according to CAD-RADS version 2.0 and clinical outcomes. Materials and Methods From January 2016 to January 2018, consecutive participants with stable chest pain referred for CCTA were prospectively included in a Chinese registry and followed for 4 years. Retrospectively, CAD-RADS 2.0 classification and the appropriateness of post-CCTA management were determined. Propensity score matching (PSM) was used to adjust for confounding variables. Hazard ratios (HRs) for a major adverse cardiovascular event (MACE), relative risks for invasive coronary angiography (ICA), and the corresponding number needed to treat were estimated. Results Of the 14 232 included participants (mean age, 61 years ± 13 [SD]; 8852 male), 2330, 2756, and 2614 were retrospectively categorized in CAD-RADS 1, 2, and 3, respectively. Only 26% of participants with CAD-RADS 1-2 disease and 20% with CAD-RADS 3 received appropriate post-CCTA management. After PSM, appropriate post-CCTA management was associated with lower risk of MACEs (HR, 0.34; 95% CI: 0.22, 0.51; P < .001), corresponding to a number needed to treat of 21 in CAD-RADS 1-2 but not CAD-RADS 3 (HR, 0.86; 95% CI: 0.49, 1.85; P = .42). Appropriate post-CCTA management was associated with decreased use of ICA in CAD-RADS 1-2 (relative risk, 0.40; 95% CI: 0.29, 0.55; P < .001) and 3 (relative risk, 0.33; 95% CI: 0.28, 0.39; P < .001), resulting in a number needed to treat of 14 and 2, respectively. Conclusion In this retrospective secondary analysis, appropriate disease management after CCTA according to CAD-RADS 2.0 was associated with lower risk of MACEs and more prudent use of ICA. ClinicalTrials.gov registration no. NCT04691037 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Leipsic and Tzimas in this issue.

Drugless and radiographer led: the start of a new era for CT coronary angiography

ObjectiveSince inception CT coronary angiography (CTCA) has required facilitating beta blockers (BB). However, CT technology has improved rapidly as has radiographer and reporter expertise. Using these factors, we instituted a...

Can You Reliably Achieve Diagnostic Image Quality in Morbidly Obese Patients Undergoing Computed Tomography Coronary Angiography?

There is concern about computed tomography coronary angiography (CTCA) image quality with the increasing numbers of obese and morbidly obese patients presenting with chest pain syndrome. This study evaluated the CTCA image quality in obese and morbidly obese patients in Counties Manukau, using a dual source scanner. Scan reports were prospectively collected using the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) CT database between 1 January 2022 and 31 December 2022. Image quality was subjectively graded by the reporting cardiologist as good, average, or suboptimal at the time of scan. Coronary Artery Disease Reporting and Data System (CAD-RADS) score N (non-diagnostic) due to suboptimal image quality was collected. Patients were divided into three body mass index groups: 1) normal/overweight <30 kg/m2; 2) obese 30–40 kg/m2; 3) morbidly obese > 40 kg/m2. A total of 1,137 CTCA were performed. A total of 575 patients were normal/overweight and image quality was suboptimal in 10 (1.7%), average in 78 (13.6%), and good in 487 patients (84.7%); two patients had CAD-RADS-N due to suboptimal image quality. A total of 544 patients were obese and image quality was suboptimal in 16 (3.6%), average in 106 (23.9%), and good in 321 patients (72.5%); three patients had CAD-RADS-N due to suboptimal image quality. A total of 119 patients were morbidly obese and image quality was suboptimal in 10 (8.4%), average in 57 (47.9%), and good in 52 patients (43.7%); three patients had CAD-RADS-N due to suboptimal image quality. Although proportionately more morbidly obese patients were likely to have suboptimal CTCA image quality, diagnostic scans were obtained in almost all patients.

Relationship of Atherosclerotic Plaque Structure with the History of COVID-19 in Patients Undergoing Coronary Computed Tomographic Angiography.

Although there is no sign of reinfection, individuals who have a history of coronavirus disease 2019 (COVID-19) may experience prolonged chest discomfort and shortness of breath on exertion. This study aimed to examine the relationship between atherosclerotic coronary plaque structure and COVID-19. This retrospective cohort comprised 1269 consecutive patients who had coronary computed tomographic angiography (CCTA) for suspected coronary artery disease (CAD) between July 2020 and April 2021. The type of atherosclerotic plaque was the primary outcome. Secondary outcomes included the severity of coronary stenosis as determined via the Coronary Artery Disease-Reporting and Data System (CAD-RADS) classification and the coronary artery calcium (CAC) score. To reveal the relationship between the history of COVID-19 and the extent and severity of CAD, propensity score analysis and further multivariate logistic regression analysis were performed. The median age of the study population was 52 years, with 53.5% being male. COVID-19 was present in 337 individuals. The median duration from COVID-19 diagnosis to CCTA extraction was 245 days. The presence of atherosclerotic soft plaque (OR: 2.05, 95% confidence interval [CI]: 1.32-3.11, P = 0.001), mixed plaque (OR: 2.48, 95% CI: 1.39-4.43, P = 0.001), and high-risk plaque (OR: 2.75, 95% CI: 1.98-3.84, P < 0.001) was shown to be linked with the history of COVID-19 on the conditional multivariate regression analysis of the propensity-matched population. However, no statistically significant association was found between the history of COVID-19 and the severity of coronary stenosis based on CAD-RADS and CAC score. We found that the history of COVID-19 might be associated with coronary atherosclerosis assessed via CCTA.