Coronary Computed Tomography Angiography Findings Research Articles

Prognostic value of metabolic dysfunction-associated steatotic liver disease over coronary computed tomography angiography findings: comparison with no-alcoholic fatty liver disease

BackgroundMetabolic dysfunction-associated steatotic liver disease (MASLD) is the proposed name change for non-alcoholic fatty liver disease (NAFLD). This study aimed to investigate the association of cardiovascular disease risk with MASLD and NAFLD in patients who underwent clinically indicated coronary computed tomography angiography (CCTA).MethodsThis retrospective study included 2289 patients (60% men; mean age: 68 years) with no history of coronary artery disease who underwent CCTA. The steatotic liver was defined as a hepatic-to-spleen attenuation ratio of < 1.0 on CT just before CCTA. MASLD is defined as the presence of hepatic steatosis along with at least one of the five cardiometabolic risk factors. Adverse CCTA findings were defined as obstructive and/or high-risk plaques. Major adverse cardiac events (MACE) encompassed composite coronary events, including cardiovascular death, acute coronary syndrome, and late coronary revascularization.ResultsMASLD and NAFLD were identified in 415 (18%) and 368 (16%) patients, respectively. Adverse CCTA findings were observed in 40% and 38% of the patients with MASLD and with NAFLD, respectively. Adverse CCTA findings were significantly associated with MASLD (p = 0.007) but not NAFLD (p = 0.253). During a median follow-up of 4.4 years, 102 (4.4%) MACE were observed. MASLD was significantly associated with MACE (hazard ratio 1.82, 95% CI 1.18–2.83, p = 0.007), while its association with NAFLD was not significant (p = 0.070). By incorporating MASLD into a prediction model of MACE, including the risk score and adverse CCTA findings, global chi-squared values significantly increased from 87.0 to 94.1 (p = 0.008).ConclusionsPatients with MASLD are likely to have a higher risk of cardiovascular disease than those with NAFLD. Concurrent assessment of MASLD during CCTA improves the identification of patients at a higher risk of cardiovascular disease among those with clinically indicated CCTA.

THE USEFULNESS OF CORONARY CTA IN IDENTIFYING CASES OF CORONARY ARTERY DISEASE

Ischemic heart disease is the leading cause of mortality worldwide. A complete diagnosis assessment is essential for patients with suspected CAD since it influences many treatment decisions. Invasive coronary angiography is the gold standard for detecting CAD. Objective: To investigate the diagnostic effectiveness of coronary computed tomography angiography (CTA) in diagnosing coronary artery disease. Method: This cross-sectional research comprised 100 patients with suspected coronary artery disease admitted to the Chaudhary Pervez Ellahi Institute of Cardiology Hospital between March 2022 and March 2023. All patients received a coronary CTA and coronary angiography. The findings of the patients' coronary CTAs and coronary angiography were evaluated. The practical uses of coronary CTA in the identification of CAD were investigated, as well as the identification and coincidence frequency of coronary CTA for assessing the degree of coronary stenosis. Results: There were no significant differences between coronary CTAs and coronary angiographies in detecting positive CAD or coronary stenosis. Regarding identifying coronary artery disease, coronary CTA had a sensitivity of 81.69% (58/71) and a specificity of 75.8% (22/29). The positive predictive value was 90.6% (58/64), while the negative predictive value was 62.8% (22/35). The coronary CTA findings revealed that 18 patients had coronary stenosis of no more than 70% and 40 patients had coronary stenosis of more than 70% among the total 58 patients with coronary artery disease that were found using both coronary angiography and coronary CTA. According to the findings of the coronary angiography, there were 37 patients with coronary stenosis greater than 70% and 21 patients with coronary stenosis below seventy percent. P value p=0.326 indicates that no significant differences were detected. Conclusions: In conclusion, coronary CTA has a beneficial and valuable role in the early detection of CAD. It is non-invasive and simple to use. Furthermore, coronary CTA can precisely find the locations of coronary stenosis and determine the degree of stenosis. As a result, it merits widespread adoption as a CAD screening tool.

A Bridging Vein Connecting Left Atrium and Coronary Sinus: Coronary Computed Tomography Angiography Findings

A Bridging Vein Connecting Left Atrium and Coronary Sinus: Coronary Computed Tomography Angiography Findings

Contact with general practice in patients with suspected chronic coronary syndrome before and after CT angiography compared with the general population.

Most patients undergoing coronary computed tomography angiography (CCTA) to diagnose coronary artery disease (CAD) are referred from general practitioners (GP). The burden in contacts to GP in relation to investigation on suspected CAD is unknown. All patients undergoing CCTA in Western Denmark from 2014-2022 were included. CCTA stenosis was defined as diameter stenosis of≥50%. Patients with and without stenosis were matched, in each group, 1:5 to a reference population based on birth-year, gender and municipality using data from national registries. All GP visits were registered in up to five years preceding and one year after the CTA and stratified by gender and age. Charlson comorbidity index (CCI) were calculated in all groups. Of the 62512 patients included, 12886 had a stenosis while 49626 did not. Patients in both groups had a substantially higher GP visit frequency compared to reference populations. In the year of coronary CTA median GP contacts in patients with stenosis was 11 [6-17] vs. 6 [2-11] in the reference population (P<0.001), in patients without stenosis 10 [6-17] vs. 5 [2-11] (P<0.001). These findings were consistent across age and gender. CCI was higher among both patients with and without stenosis compared to reference groups. In patients undergoing CCTA to diagnose CAD, a substantially increased frequency of contacts to GP was observed in the five-year period prior to examination compared to the reference populations regardless of the CCTA findings. Obtaining the CCTA result did not seem to substantially affect the GP visit frequency.

Rationale and design of the CONFIRM2 (Quantitative COroNary CT Angiography Evaluation For Evaluation of Clinical Outcomes: An InteRnational, Multicenter Registry) study

BackgroundIn the last 15 years, large registries and several randomized clinical trials have demonstrated the diagnostic and prognostic value of coronary computed tomography angiography (CCTA). Advances in CT scanner technology and developments of analytic tools now enable accurate quantification of coronary artery disease (CAD), including total coronary plaque volume and low attenuation plaque volume. The primary aim of CONFIRM2, (Quantitative COroNary CT Angiography Evaluation For Evaluation of Clinical Outcomes: An InteRnational, Multicenter Registry) is to perform comprehensive quantification of CCTA findings, including coronary, non-coronary cardiac, non-cardiac vascular, non-cardiac findings, and relate them to clinical variables and cardiovascular clinical outcomes. DesignCONFIRM2 is a multicenter, international observational cohort study designed to evaluate multidimensional associations between quantitative phenotype of cardiovascular disease and future adverse clinical outcomes in subjects undergoing clinically indicated CCTA. The targeted population is heterogenous and includes patients undergoing CCTA for atherosclerotic evaluation, valvular heart disease, congenital heart disease or pre-procedural evaluation. Automated software will be utilized for quantification of coronary plaque, stenosis, vascular morphology and cardiac structures for rapid and reproducible tissue characterization. Up to 30,000 patients will be included from up to 50 international multi-continental clinical CCTA sites and followed for 3–4 years. SummaryCONFIRM2 is one of the largest CCTA studies to establish the clinical value of a multiparametric approach to quantify the phenotype of cardiovascular disease by CCTA using automated imaging solutions.

Left atrioventricular coupling index assessed using cardiac CT as a prognostic marker of cardiovascular death

Abstract Background Although the left atrioventricular coupling index (LACI) measured by cardiovascular magnetic resonance (CMR) is a strong predictor of cardiovascular events, the availability to CMR remains limited in clinical routine. Therefore, it would be useful to validate LACI assessment using other imaging methods such as computed tomography (CT). However, the feasibility of LACI measurement using cardiac CT and its prognostic value are not established. Purpose We aimed to investigate the prognostic value of the LACI assessed by cardiac CT, to predict the occurrence of cardiovascular death in consecutive patients without known CVD referred for coronary CT angiography (CCTA). Methods Between 2010 and 2020, we conducted a single-center study with all consecutive patients without known CVD referred for CCTA. LACI was defined as the ratio of LA to LV end-diastolic volumes. The primary outcome was cardiovascular death. Cox regressions were used to evaluate the association of LACI with the primary outcome after adjustment for traditional risk factors and CCTA findings. Results In 1,444 patients (70±12 years, 43% men), 92 (6.4%) patients experienced all-cause death, including 67 (4.3%) patients with cardiovascular death after a median (IQR) follow-up of 6.8 (5.9-9.1) years. After adjustment for risk factors and CCTA findings, LACI was positively associated with the occurrence of cardiovascular death (adjusted hazard ratio [HR], 1.07 [95% CI, 1.05-1.09] per 1% increment, p&amp;lt;0.001), and all-cause death (adjusted HR, 1.05 [95% CI, 1.03-1.07] per 1% increment, p&amp;lt;0.001). After adjustment, a LACI ≥25% showed the best improvement in model discrimination and reclassification above traditional risk factors and CCTA findings (C-statistic improvement: 0.27; NRI=0.826; IDI=0.209, all p&amp;lt;0.001; LR-test p&amp;lt;0.001). Conclusions LACI measured by CCTA is independently associated with cardiovascular death and all-cause death in patients without known CVD referred for CCTA, with an incremental prognostic value over traditional risk factors and CCTA findings.LACI measurement using CCTASurvival curves stratified by LACI value

Incremental prognostic value of metabolic dysfunction-associated fatty liver disease over coronary computed tomography angiography findings in patients with suspected coronary artery disease

Abstract Background Fatty liver caused by nutritional metabolic disorders regardless of other chronic liver diseases has been proposed as a new liver disease concept, metabolic dysfunction-associated fatty liver disease (MAFLD). With the alteration from non-alcoholic fatty liver disease to MAFLD, MAFLD can be recognized as higher CVD risk. However, the association of MAFLD with adverse coronary CT angiography (CCTA) findings, such as the presence of obstructive and high-risk plaque, and cardiovascular events has not been fully elucidated. Purpose This study was aimed to investigate additional risk stratification benefits of MAFLD diagnosed by hepatic steatosis assessed during CCTA in patients with suspected coronary artery disease (CAD). Methods A total of 2289 patients without a history of CAD who underwent CCTA in our institute from August 2011 and December 2016 were enrolled. Hepatic steatosis, defined on CT as a hepatic-to-spleen attenuation ratio of &amp;lt;1.0, was examined just before the evaluation of CCTA. Adverse CCTA findings were defined as obstructive and/or high-risk plaque. The major adverse cardiovascular events (MACE) were composite coronary events including cardiovascular death, acute coronary syndrome, and late coronary revascularization. The incremental predictive value of MAFLD was evaluated using the global chi-square values and C-statistic. Results Among 2289 patients (60% men, mean age 68 years), MAFLD was identified in 382 (17%) patients. The presence of adverse CCTA findings in patients with MAFLD was significantly greater than that in patients without MAFLD (40% and 35%, p=0.039). During a median follow-up of 4.4 years, 103 (4.4%) MACE were observed. In the multivariate Cox regression analysis, MAFLD was significantly associated with MACE in a model included traditional risk factors and adverse CCTA findings (HR 1.73, 95%CI 1.10–2.72, P = 0.017). The Kaplan–Meier analysis showed that patients with both MAFLD and adverse CCTA findings had highest event rates compared with patients without MAFLD or adverse CTA findings (log rank test, p=0.004). By adding MAFLD to a prediction model including adverse CCTA findings, the global chi-square values and C-statistic significantly increased from 80.6 to 86.2 (P = 0.017) and 0.72 to 0.74 (P = 0.044), respectively. Conclusions MAFLD concurrently assessed during CCTA enables more accurate detection of patients at higher risk of MACE In patients with suspected stable CAD.

Incidence of coronary anomalies in patients with D-transposition of great arteries (D-TGA) after arterial switch operation (ASO)

Abstract Background and purpose D-transposition of great arteries (D-TGA) is a congenital cardiac defect defined by atrioventricular concordance and ventriculo-arterial discordance. Arterial switch operation (ASO) is currently the surgical repair and implies reimplantation of the coronary arteries from the aorta into the neo-aortic root. As such, long-term coronary anomalies and complications are possible and potentially dangerous. Recently, coronary computed tomography angiography (CCTA) has gained a prominent role for characterization of the coronary anatomy in these patients (pts) and its relationship with adjacent structures. However, routine coronary evaluation among asymptomatic pts after ASO remains controverse, as the reported incidence of coronary-related complications is low. The purpose of this study is to perform a descriptive analysis of CCTA findings in pts with D-TGA after ASO. Methods We performed a retrospective single center study that included patients with D-TGA submitted to ASO who underwent CCTA. Demographic, clinical and imaging data were collected. Results We identified 57 pts with D-TGA submitted to ASO. Of these, 39 (68%) performed a CCTA. Mean age of pts was 20.4 (± 3.8) years; 54% were male; 32% had complex D-TGA. In 35 patients (90%), CCTA was performed as part of a routine screening. In 4 (10%) pts CCTA was done due to symptoms or an abnormal non-invasive test suggestive of myocardial ischemia. Eighteen (46%) pts had coronary anomalies: 5 (13%) had an acute angulation at the coronary origin; 13 (33%) pts had anomalous origin of the coronary arteries, ranging from presence of a single coronary artery in 3 (8%) pts, common independent origin from a single sinus of Valsalva in 6 (15%) cases and anomalous origin of the circumflex artery from the right coronary artery (RCA) in 4 (10%) pts. An interarterial course was described in 2 (5%) pts and a retroaortic course was reported in 8 (21%) cases. One patient had anomalous course of the LAD into the right ventricle, a mild calcified ostial stenosis of the left main coronary artery and a chronic total occlusion of the RCA. Conclusions D-TGA patients submitted to ASO have a high incidence of coronary anomalies. Routine screening with CCTA may be justified to identify patients who may be at higher risk of coronary events.

Incremental prognostic value of coronary plaque features on CT angiography in symptomatic patients with obstructive CAD

Abstract Background Several coronary computed tomography angiography (CCTA) studies have shown the strong prognostic value of the coronary artery disease (CAD) burden and the potential interest of the plaque composition analysis. However, the incremental prognostic value of this plaque analysis above the CAD burden in patients with obstructive CAD is not well established. Purpose To assess the incremental prognostic value of the plaque composition analysis using CCTA to predict major adverse cardiovascular events (MACEs) above traditional risk factors and CAD burden in consecutive symptomatic patients with obstructive CAD. Methods In a large multicentric registry, consecutive symptomatic patients without known CAD referred for CCTA were screened between 2008-2020. All patients with obstructive CAD (at least 1 ≥50% stenosis on CCTA) were included. The primary composite outcome was MACE defined by cardiovascular death or nonfatal myocardial infarction. CCTA data were interpreted using multiplanar reconstruction according to the 16-segment coronary artery model. Coronary segments were scored visually for both degree of luminal stenosis and composition of coronary plaque which were classified as noncalcified, mixed, or calcified. To assess the prognostic value of each CCTA findings, different multivariable Cox regression models were used (Model 1: clinical [traditional risk factors]; Model 2: model 1 + CAD burden [number of proximal segments with stenosis ≥50% + number of vessels with obstructive CAD]; Model 3: model 2 + plaques feature [number of segments with noncalcified plaques]). The additional predictive value of each model for predicting MACEs was calculated using C-statistic increment, continuous net reclassification improvement (NRI), and the integrative discrimination index (IDI). Results Of 2,312 patients referred for CCTA, 2,038 (mean age 70±12 years, 46% men) completed follow-up (median 6.7 years; interquartile range: 5.9-9.1 years), and 319 experienced a MACE (14%). After adjustment for traditional risk factors, number of proximal segments with &amp;gt;50% stenosis, number of vessels with obstructive CAD, number of segments with noncalcified were all strongly associated with MACEs (all p&amp;lt;0.001). After adjustment, the addition of the analysis of plaque features (model 3) showed the best improvement in model discrimination and reclassification above a model including traditional risk factors and CAD burden (model 2) (C-statistic improvement=0.03; NRI=45.0%; IDI=9.8%, Chi-2 global=412, all p&amp;lt;0.001; LR-test p&amp;lt;0.001). Conclusions In a large cohort of symptomatic patients with obstructive CAD on CCTA, the analysis of plaque features had an incremental prognostic value to predict MACEs over and above a model combining traditional risk factors and CAD burden.Survival curves for MACEIncremental prognostic value of CCTA

Resting echocardiographic parameters can exclude significant coronary artery disease: A comparison with coronary computed tomography angiography.

Coronary computed tomography angiography (CCTA) is known to have a high negative predictive value (NPV) in identifying coronary artery disease (CAD). This study aimed to examine whether resting echocardiographic parameters could exclude significant CAD on CCTA. We recruited 142 patients who had undergone both CCTA and echocardiography within a 3-month window. Based on the CCTA findings, patients were divided into two groups: Group A (non-significant CAD, defined as all coronary segments having <50% stenosis) and Group B (significant CAD). Resting echocardiographic parameters were compared between the two groups to identify predictors of non-significant CAD on CCTA. A total 92 patients (mean age, 68±13years; males, 62%) were eligible for this study; 50 in Group A and 42 in Group B. Among the various echo parameters, left atrial volume index (LAVI) and left ventricular (LV) global longitudinal strain (GLS) were significantly lower in Group A (23.5±7.6 vs. 33.6±7.4mL/m2 , p<.001; -20.2±1.8% vs. -16.8±2.0%, p<.001, respectively). Analysis of the receiver operating characteristic curve revealed that the cutoff value to exclude significant CAD on CCTA was 29.0mL/m2 for LAVI (NPV 80.8%) and -18.1% for GLS (NPV 80.7%). The NPV increased to 95.0% when these parameters were combined (LAVI<29.0mL/m2 and GLS<-18.1%). The combination of resting LAVI and GLS was clinically useful in excluding significant CAD via CCTA.

Preoperative diagnostic value of coronary CT angiography in acute Stanford type A aortic dissection involving the coronary arteries

To assess the diagnostic value of coronary computed tomography angiography (CCTA) in acute type A aortic dissection (ATAAD) with coronary artery involvement and to evaluate whether CCTA could provide potentially useful information for selecting the surgical method. Patients with ATAAD treated from January 2019 to December 2020 were reviewed retrospectively. Involvement of the coronary arteries based on CCTA findings were grouped into three major types and five subtypes. Interobserver and intraobserver diagnostic agreement for five subtypes were determined. The patients were divided into the coronary artery bypass grafting (CABG) and non-CABG groups, and the proportions of the five subtypes between the two groups were compared. A total of 95 patients were enrolled in this study. Interobserver and intraobserver diagnostic agreement were both substantial in the left and right coronary arteries. Overall, the proportions of the five subtypes of coronary artery involvement were significantly different between the two groups (p<0.001). The proportion of Type A was elevated in the non-CABG group compared with the CABG group (22.6% versus 71.9%); by contrast, the proportions of Type B1 (35.5% versus 14.1%), Type B2 (19.4% versus 10.9%), Type C1 (6.5% versus 0%), and Type C2 (16.1% versus 3.1%) were elevated in the CABG group. CCTA is reliable in evaluating coronary artery involvement by ATAAD. The present retrospective study indicated that CABG may be considered if the intimal flap disrupts the coronary orifice and causes luminal stenosis >50%, particularly Type B, or if an intimal tear occurs in the coronary orifice (Type C), which deserve further validation through prospective studies.

Coronary Atherosclerosis Across the Glycemic Spectrum Among Asymptomatic Adults: The Miami Heart Study at Baptist Health South Florida.

The contemporary burden and characteristics of coronary atherosclerosis, assessed using coronary computed tomography angiography (CCTA), is unknown among asymptomatic adults with diabetes and prediabetes in the United States. The pooled cohort equations and coronary artery calcium (CAC) score stratify atherosclerotic cardiovascular disease risk, but their association with CCTA findings across glycemic categories is not well established. Asymptomatic adults without atherosclerotic cardiovascular disease enrolled in the Miami Heart Study were included. Participants underwent CAC and CCTA testing and were classified into glycemic categories. Prevalence of coronary atherosclerosis (any plaque, noncalcified plaque, plaque with ≥1 high-risk feature, maximal stenosis ≥50%) assessed by CCTA was described across glycemic categories and further stratified by pooled cohort equations-estimated atherosclerotic cardiovascular disease risk and CAC score. Adjusted logistic regression was used to evaluate the associations between glycemic categories and coronary outcomes. Among 2352 participants (49.5% women), the prevalence of euglycemia, prediabetes, and diabetes was 63%, 30%, and 7%, respectively. Coronary plaque was more commonly present across worsening glycemic categories (euglycemia, 43%; prediabetes, 58%; diabetes, 69%), and similar pattern was observed for other coronary outcomes. In adjusted analyses, compared with euglycemia, prediabetes and diabetes were each associated with higher odds of any coronary plaque (OR, 1.30 [95% CI, 1.05-1.60] and 1.75 [1.17-2.61], respectively), noncalcified plaque (OR, 1.47 [1.19-1.81] and 1.99 [1.38-2.87], respectively), and plaque with ≥1 high-risk feature (OR, 1.65 [1.14-2.39] and 2.53 [1.48-4.33], respectively). Diabetes was associated with stenosis ≥50% (OR, 3.01 [1.79-5.08]; reference=euglycemia). Among participants with diabetes and estimated atherosclerotic cardiovascular disease risk <5%, 46% had coronary plaque and 10% had stenosis ≥50%. Among participants with diabetes and CAC=0, 30% had coronary plaque and 3% had stenosis ≥50%. Among asymptomatic adults, worse glycemic status is associated with higher prevalence and extent of coronary atherosclerosis, high-risk plaque, and stenosis. In diabetes, CAC was more closely associated with CCTA findings and informative in a larger population than the pooled cohort equations.

Prognostic utility of the pericoronary fat attenuation index in patients with takotsubo cardiomyopathy

BackgroundThe etiology of takotsubo cardiomyopathy (TCM) remains poorly understood and no optimal management strategy has been established. Identification of features associated with poor outcomes may improve the prognosis of patients with TCM. We aimed to identify the predictors of poor prognosis in patients with TCM using coronary computed tomography angiography (CCTA). MethodsWe enrolled consecutive patients with TCM who underwent CCTA during the acute disease phase. The pericoronary fat attenuation index (FAI) of adipose tissue was obtained from CCTA images. Major adverse cardiac and cerebrovascular events (MACCE) were defined as all-cause death, non-fatal myocardial infarction, stroke, rehospitalization due to congestive heart failure, and TCM recurrence. The relationships between patient characteristics and CCTA findings were compared between patients with and without MACCE. ResultsA total of 52 patients were included (10 men [19.2%]; mean age, 71 years). After a median follow-up of 23 months, MACCE had developed in 10 patients (19.2%). There were significant differences in clinical characteristics [including the three-vessel mean FAI (FAI-mean)] between patients with and without MACCE. Univariate Cox regression analyses showed that FAI-mean ​≥ ​−68.94 Hounsfield units (cut-off value derived from receiver operating characteristic curve analysis) (hazard ratio [HR], 13.52; 95% confidence interval [CI], 1.705–107.2; p ​= ​0.014) and NT-proBNP (HR, 1.000; 95% CI, 1.000–1.000; p ​= ​0.022) were significant predictors of MACCE. FAI-mean ​≥ ​−68.94 HU was significantly associated with MACCE (chi-squared statistic ​= ​10.3, p ​= ​0.001). ConclusionIn patients with TCM, a higher FAI-mean was significantly associated with poorer outcomes independent of the conventional risk factors.

Early computed tomography coronary angiography and preventative treatment in patients with suspected acute coronary syndrome: A secondary analysis of the RAPID-CTCA trial

Computed tomography coronary angiography (CTCA) offers detailed assessment of the presence of coronary atherosclerosis and helps guide patient management. We investigated influences of early CTCA on the subsequent use of preventative treatment in patients with suspected acute coronary syndrome. In this secondary analysis of a multicenter randomized controlled trial of early CTCA in intermediate-risk patients with suspected acute coronary syndrome, prescription of aspirin, P2Y12 receptor antagonist, statin, renin-angiotensin system blocker, and beta-blocker therapies from randomization to discharge were compared within then between those randomized to early CTCA or to standard of care only. Effects of CTCA findings on adjustment of these therapies were further examined. In 1,743 patients (874 randomized to early CTCA and 869 to standard of care only), prescription of P2Y12 receptor antagonist, dual antiplatelet, and statin therapies increased more in the early CTCA group (between-group difference: 4.6% [95% confidence interval, 0.3-8.9], 4.5% [95% confidence interval, 0.2-8.7], and 4.3% [95% confidence interval, 0.2-8.5], respectively), whereas prescription of other preventative therapies increased by similar extent in both study groups. Among patients randomized to early CTCA, there were additional increments of preventative treatment in those with obstructive coronary artery disease and higher rates of reductions in antiplatelet and beta-blocker therapies in those with normal coronary arteries. Prescription patterns of preventative treatment varied during index hospitalization in patients with suspected acute coronary syndrome. Early CTCA facilitated targeted individualization of these therapies based on the extent of coronary artery disease.

Exploring how enrolment in the TARGET-CTCA clinical trial may modify patient perception of heart health

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): British Heart Foundation Background The TARGET-CTCA trial aims to determine whether the use of high-sensitivity cardiac troponin to target computed tomography coronary angiography (CTCA) improves outcomes in patients presenting to hospital with suspected acute coronary syndrome in whom myocardial infarction has been ruled out. What patients understand of their subsequent risk of cardiovascular disease in this setting, and how intervention with CTCA may influence this is unknown. Purpose To explore how trial participants perceive their heart health and whether this has been modified by trial participation. Methods The TARGET-CTCA trial randomises patients with intermediate high sensitivity cardiac troponin levels to standard care, or CTCA plus standard care. Patients receive CTCA scan results informing them if they have a normal heart or they have mild, moderate or obstructive coronary artery disease. Forty semi-structured interviews were conducted with trial participants across standard care and intervention arms ensuring representation across disease category, age, sex and socioeconomic status groups. Data were coded and organized into themes. Results Emergent themes from the data included insights into attitudes to future health, perception of heart health, and health education needs. While some participants displayed a proactive approach to maintaining health, the consideration of future health goals was often a reactive process in response to the initial chest pain episode or the CTCA findings. While some patients discussed personal responsibility for health maintenance others described a passive approached requiring direct management from a health professional. For some standard care participants, the absence of myocardial infarction was a sign of a healthy heart. Others were left with unanswered questions after the hospital assessment. Confirmation of the absence of coronary artery disease with CTCA gave patients great confidence and a positive change to health seeking behaviour patterns was reported. Patients differed in their interpretation of the terms mild, moderate and obstructive coronary artery disease. This affected their subsequent action with some using the presence of disease as an opportunity to appraise their risk of future cardiac events and begin a preventative approach. Others reported fear and reducing activity to avoid precipitating a possible event. Many patients reported a desire to implement lifestyle changes but did not have the knowledge to do so. Conclusion Exploring how the information contained in participant result letters may contribute to the understanding of risk of future cardiac events has provided valuable information for application of the trial intervention outside of the main trial setting.

Relationship of OCT-defined plaque characteristics with CCTA-derived coronary inflammation and CMR-derived global coronary flow reserve in patients with acute coronary syndrome.

The relationship of layered plaque detected by optical coherence tomography (OCT) with coronary inflammation and coronary flow reserve (CFR) remains elusive. We aimed to investigate the association of OCT-defined layered plaque with pericoronary adipose tissue (PCAT) inflammation assessed by coronary computed tomography angiography (CCTA) and global (G)-CFR assessed by cardiac magnetic resonance imaging (CMR) in patients with acute coronary syndrome (ACS). We retrospectively investigated 88 patients with first ACS who underwent preprocedural CCTA, OCT imaging of the culprit lesion prior to primary/urgent percutaneous coronary intervention (PCI), and postprocedural CMR. All patients were divided into two groups according to the presence and absence of OCT-defined layered plaque at the culprit lesion. Coronary inflammation was assessed by the mean value of PCAT attenuation (-190 to -30 HU) of the three major coronary vessels. G-CFR was obtained by quantifying absolute coronary sinus flow at rest and during maximum hyperemia. CCTA and CMR findings were compared between the groups. In a total of 88 patients, layered plaque was detected in 51 patients (58.0%). The patients with layered plaque had higher three-vessel-PCAT attenuation value (-68.58 ± 6.41 vs. -71.60 ± 5.21 HU, P = 0.021) and culprit vessel-PCAT attenuation value (-67.69 ± 7.76 vs. -72.07 ± 6.57 HU, P = 0.007) than those with non-layered plaque. The patients with layered plaque had lower G-CFR value (median, 2.26 [interquartile range, 1.78, 2.89] vs. 3.06 [2.41, 3.90], P = 0.003) than those with non-layered plaque. The presence of OCT-defined layered plaque at the culprit lesion was associated with high PCAT attenuation and low G-CFR after primary/urgent PCI in patients with ACS. OCT assessment of culprit plaque morphology and detection of layered plaque may help identify increased pericoronary inflammation and impaired CFR, potentially providing the risk stratification in patients with ACS and residual microvascular dysfunction after PCI.

Coronary Computed Tomography Angiography Findings of Plaque Erosion

Compared with plaque rupture, plaque erosion has distinct features, which can be diagnosed only by intravascular optical coherence tomography. Computed tomography angiography (CTA) features of plaque erosion have not been reported. The aim of the present study was to identify the CTA features specific for plaque erosion in patients with non-ST-segment elevation acute coronary syndromes to enable a diagnosis of erosion without invasive procedures. Patients with non-ST-segment elevation acute coronary syndromes who underwent preintervention CTA and optical coherence tomography imaging of culprit lesions were enrolled. Plaque volume and high-risk plaque (HRP) features were assessed by CTA. Among 191 patients, plaque erosion was the underlying mechanism in 89 patients (46.6%) and plaque rupture in 102 patients (53.4%). The total plaque volume (TPV) was lower in plaque erosion than in plaque rupture (133.6 vs 168.8mm3, p=0.001). Plaque erosion had a lower prevalence of positive remodeling than plaque rupture (75.3% vs 87.3%, p=0.033). As the number of HRP features decreased, plaque erosion became more prevalent (p=0.014). In the multivariable logistic regression analysis, lower TPV and less prevalent HRP features were associated with a higher prevalence of plaque erosion. The addition of TPV ≤116mm3 and HRP features ≤1 to the known predictors significantly increased the area under the curve of the plaque erosion prediction receiver operator characteristics. Plaque erosion, compared with plaque rupture, had a lower plaque volume and less prevalent HRP features. CTA may be helpful for identifying the underlying pathology of acute coronary syndromes.

Transient left bundle branch block associated with very high coronary artery calcium: a case report.

Coronary artery calcium (CAC) is the measure of subclinical coronary artery atherosclerosis most strongly associated with atherosclerotic cardiovascular disease (ASCVD) risk. However, CAC is rarely reported in the inpatient setting to guide chest pain management. We present a case of very high CAC in a 64-year-old woman with hypertension, type 2 diabetes, and hyperlipidemia presenting with dyspnea. Initial electrocardiogram (ECG) demonstrated normal conduction with a heart rate of 76 beats/min, but new T-wave inversions in V1-V4 and a high-sensitivity troponin-I (hsTnI) value of 6 ng/L (normal < 6 ng/L). Repeat ECG in the emergency department showed normal sinus rhythm (heart rate of 80 beats/min); however, it subsequently demonstrated a left bundle branch block (LBBB) with a repeat hsTnI of 7 ng/L. Stress testing with pharmacologic single-photon emission computerized tomography did not show scintigraphic evidence of ischemia but noted extensive CAC and a concern for balanced ischemia. Subsequent coronary computed tomography angiography (CCTA) showed nonobstructive disease and a total Agatston CAC score of 1262. Invasive evaluation with left heart catheterization was deferred given the patient's unchanged symptoms and CCTA findings. Statin therapy was intensified and aspirin, metoprolol succinate, and antihypertension therapies were continued. Initiation of glucose-lowering therapy and lipoprotein(a) testing was strongly recommended on follow-up. Our case suggests that CAC ⩾ 1000 may be incidentally associated with transient LBBB during the workup of coronary artery disease. Here, we specifically show that functional testing that incorporates measurement of CAC burden can help to improve ASCVD-preventive pharmacotherapy initiation and intensification beyond the identification of obstructive disease alone.

Vulnerable Plaque Characteristics at Coronary Computed Tomography Angiography

According to morbidity and mortality indicators, cardiovascular diseases are the leading public health issue in the Republic of Croatia and the European Union. Although mortality rates from ischemic disease have been reduced, Croatia is still categorized among countries with high cardiovascular risk. The guidelines of the European Society of Cardiology from 2020 for acute coronary syndrome (ACS) in patients with low to intermediate risk of coronary atherosclerotic heart disease (CHD) recommend coronary computed tomography angiography (CCTA) as an alternative to invasive coronarography. In most patients with suspicion of CHD, CCTA leads to the diagnosis of non-obstructive diseases, which causes the majority of ACS cases. Multi-slice Computed Tomography scanners of the newest generation employ low doses of radiation and low contrast volume to reliably show the characteristics of vulnerable plaque: (i) positive remodeling, (ii) low attenuation plaque, (iii) spotty calcifi cation, and the (iv) napkin-ring sign. Due to positive remodeling, these plaques are often non-obstructive, and according to the CAD-RADS 2.0 guidelines from 2022 all their characteristics should be specifi cally emphasized in CCTA fi ndings. Based on the assessment of the prognostic value of vulnerable plaque characteristics for adverse cardiac events, CCTA has been shown to be equally valid as other invasive diagnostic methods. Additionally, it was shown to be useful in indicating the optimal medication therapy and monitoring its eff ects. The results of large international randomized trials indicate the direction of the treatment approach for vulnerable plaque.

Relationship between sexual differences and cardiovascular risk factors in the prevalence of asymptomatic coronary disease

BackgroundThis study investigated the sexual differences of coronary artery disease (CAD) prevalence and its association with cardiovascular risk factors in the asymptomatic population. MethodsIn total 6434 asymptomatic participants without known CAD (1740 women and 4694 men) underwent coronary computed tomography angiography (CCTA). The prevalence of significant CAD (diameter stenosis ≥50%) and other CCTA findings were compared by sex, and its influence on CAD was investigated in groups stratified by the number of cardiovascular risk factors, including age (>55 years), hypertension, diabetes, dyslipidemia, and current smoking. ResultsThe prevalence of current smokers, hypertension, and diabetes were higher in men than women. The mean coronary artery calcium score was 13.1 ± 58.4 for women and 51.1 ± 158.2 for men; the coronary atherosclerosis burden indices were significantly higher in men than women. Significant CAD was identified in 65 women (3.7%) and 429 men (9.1%), showing a significant association (adjusted odds ratio [OR] 2.38, P < 0.001). The relatively higher risk for significant CAD in men was observed in patients with fewer risk factors, and the risk difference was not significant in patients with many risk factors (adjusted ORs: 7.69, 3.37, 1.71, 1.31, and 0.88 in patients with 0, 1, 2, 3, and 4–5 risk factors, respectively). The association between sex and risk factor groups was significant (P < 0.001). ConclusionsIn the asymptomatic population, a significantly higher CAD prevalence was noted in men than women. However, women with a high number of cardiovascular risk factors showed a CAD prevalence similar to that of men.