Tool For Coronary Artery Disease Research Articles

A new non-invasive diagnostic tool in coronary artery disease: artificial intelligence as an essential element of predictive, preventive, and personalized medicine.

Known coronary artery disease (CAD) risk scores (e.g., Framingham) estimate the CAD-related event risk rather than presence/absence of CAD. Artificial intelligence (AI) is rarely used in this context. This study aims to evaluate the diagnostic power of AI (memetic pattern-based algorithm (MPA)) in CAD and to expand its applicability to a broader patient population. Nine hundred eighty-seven patients of the Ludwigshafen Risk and Cardiovascular Health Study (LURIC) were divided into a training (n = 493) and a test population (n = 494). They were evaluated by the Basel MPA. The "training population" was further used to expand and optimize the Basel MPA, and after modifications, a final validation was carried out on the "test population." The results were compared with the Framingham Risk Score (FRS) using receiver operating curves (ROC; area-under-the-curve (AUC)). Of the 987 LURIC patients, 71% were male, age 62 ± 11years and 68% had documented CAD. AUC of Framingham and BASEL MPA to diagnose CAD in "LURIC training" were 0.69 and 0.80, respectively. AUC of the optimized MPA in the training and test cohort were 0.88 and 0.87, respectively. The positive predictive values (PPV) of the optimized MPA for exclusion of CAD in "training" and "test" were 98 and 95%, respectively. The PPV of MPA for identification of CAD was 93 and 94%, respectively. The successful use of the MPA approach has been demonstrated in a broad-risk spectrum of patients undergoing CAD evaluation, as an element of predictive, preventive, personalized medicine, and may be used instead of further non-invasive diagnostic procedures.

Feasibility of using ultra-low pulse rate fluoroscopy during routine diagnostic coronary angiography.

IntroductionCoronary angiogram, while a powerful diagnostic tool in coronary artery disease, is not without an associated risk from ionising radiation. There are a number of factors that influence the amount of radiation the patient receives during the procedure, some of which are under the control of the operator. One of these is an adjustment of the fluoroscopic pulse rate. This study aims to assess the feasibility of using ultra‐low pulse rate (3 pulses per second(pps)) fluoroscopy during routine diagnostic coronary angiogram procedures and the effect it has on fluoroscopy time, diagnostic clarity and radiation dose.MethodsA retrospective study of three operators each undertaking 50 coronary angiogram procedures was performed. One of the operators used a pulse rate of 3 pps and 6 pps for fluoroscopic screening while the control groups used the standard 10 pps mode utilised at this centre.ResultsResults demonstrated no reduction of diagnostic clarity, up to a 58% reduction in Dose Area Product and no increase in fluoroscopy time with the 3 pps setting.ConclusionsFindings from this pilot study suggest that utilisation of ultra‐low pulse rate fluoroscopy in routine transfemoral diagnostic coronary angiography in the catheterisation laboratory is feasible.

Low-Cost Mobile Device for Screening of Atherosclerosis and Coronary Arterial Disease.

In the context of global health, telemedicine, and low-resource settings, we present a non-invasive smart-phone based device that can be used to screen for atherosclerosis,which is the leading factor for ischemic heart attacks and strokes. Using acustom Android mobile application, our device computes Pulse Wave Velocity(PWV) using the pulse signals from photo-plethysmographic (PPG) probes, which are simultaneously clipped onto the ear, index finger, and big toe of a human subject. Unlike other designs which require the use of an ECG reference, our mobile device uses only PPG signals and is entirely powered by the mobile phone via the USB port. Using the ear signal as a reference, we derived PWV values from two locations: the right index finger, and the right big toe.We present data from a recent clinical study with 78 participants (age 26 to 74) who were divided into three groups: Coronary Arterial Disease ("CAD"), hypertensive group ("PreCAD"), and Healthy controls. The CAD group was clinically diagnosed and confirmed with a CT-scan and calcium scoring. PWV values derived from the finger was found to have too much variance to be clinically useful. However, PWV values derived from the toe location showed significant differences between the groups, even after accounting for age. Measured PWV values were: 10.07 (8.51-12.01) for the older CAD group, 9.39 (7.44-9.75) for the younger CAD group, 8.26 (7.26-9.22) for the older Pre-CAD group, 10.57 m/s (8.5-11.2) for the younger Pre-CAD group, 7.13 m/s (5.97-7.69) for older healthy controls, and 6.71 m/s (4.86-7.26) for the younger healthy control subjects. These results demonstrate good potential value of this mobile PWV device as a simple low-cost screening tool for atherosclerosis and coronary arterial disease.

Coronary Artery Calcium Scoring in Young Adults: Evidence and Challenges.

This review aims to summarize the evidence and challenges of coronary artery calcium (CAC) scoring as a screening tool for coronary artery disease (CAD) in young adults. Several cohort studies have highlighted the value of CAC scoring in CAD risk assessment in young adults. The largest study to date is the Coronary Artery Risk Development in Young Adults (CARDIA) study. The study examined patients at 18-30years of age and demonstrated that the presence of any degree of CAC was associated with a higher risk of coronary events compared to zero CAC, with an incremental increase in the risk of events with higher scores. However, it is important to note that 70% of patients screened had CAC = 0 at the age of 56. Despite the evidence that higher CAC score cutoff used in guidelines for predicting cardiovascular risk may be "falsely reassuring," however, mass screening of young adults using CAC score may be challenging. The development of prediction tools and scoring systems to identify patients at higher risk of developing CAC based on known CAD risk factors may help reduce the number needed to screen to detect patients with positive CAC.

The Relationship Between Absence Coronary Artery Calcification and Myocardial Perfusion Single Photon Emission Computed Tomography

BackgroundCoronary artery calcification score (CACS) is well validated prognostic tool in coronary artery disease (CAD). The data on the prevalence of myocardial ischemia on myocardial perfusion single photon emission computed tomography (MPS) in symptomatic patients with zero CACS and low to intermediate risk probability is lacking and controversial. The aim of our study was to evaluate the capability of zero CACS to exclude myocardial ischemia on MPS.MethodsA total of 157 patients ((mean age 53 ± 10 years), 88 (56%) female patients, 69 (44%) male patients) who were suspected to have CAD and having low to intermediate pretest likelihood for CAD underwent CACS on dedicated computed tomography (CT) scanners. CACS was reported as zero in all patients, subsequently all patients underwent MPS. Patients with abnormal MPS underwent additional imaging with coronary computed tomography angiography (CCTA).ResultsAll patients had zero CACS, of which 122 (78%) had normal MPS, and 35 (22%) had abnormal MPS. Abnormal MPS included fixed defect in 22 (13%), equivocal in 10 (6%), and reversible defect in four (3%) patients. All patients with abnormal MPS had further imaging with CTCA. CTCA was normal in 30 (85%) patients, one patient had coronary artery stenosis more than 50%, one patient had coronary artery stenosis less than 50%, one patient had anomalous origin coronary artery, and two patients had myocardial bridging. Patients with abnormal MPS and normal coronary artery had dilated cardiomyopathy in 14 (40%), asymmetrical septal hypotrophy in one (3%), and mitral valve disease in three (9%).ConclusionsZero CACS in stable patients with low or intermediate risk indicated very low likelihood of obstructive CAD, less than 1%. Patients with zero CACS and normal MPS most likely will not benefit from further testing; however, patients with abnormal MPS will need further imaging with CCTA. CCTA is helpful in this group of patients for evaluation of coronary artery and cardiac morphology.

Upright T Wave in Lead V1 as an Important Predictor of Significant Coronary Artery Disease in Patients with Chest Pain

Background: Cardiovascular disease is a worldwide great burden on the health care syste early diagnosis and treatment of CAD can reduce the mortality and morbidity. We aimed to determine the association between upright T wave in lead V1 and coronary artery disease (CAD) in patients who presented with chest pain or positive non-invasive tests in emergency department. Methods: In this retrospective cross sectional design we reviewed the clinical and coronary angiography data of patients who had normal ECG. Presence of coronary artery disease was compared between patients with and without upright T waves in V1. Results: Data of 100 patients with upright T wave more than 1.5 mm in V1 was compared with 100 patients with completely normal ECG. Male patients with coronary artery disease (CAD) were dominant in upright T wave group. However, other traditional cardiovascular risk factors were not statistically different between groups. Based on the multivariate logistic regression model and after adjustment for confounding factors (i.e. gender, dyslipidemia and smoking), presence of upright T wave in the V1 and male gender were still associated with greater risk of coronary artery disease, Odds ratio 4.6 CI 95% (3.1 - 6.3) and 3.4 CI 95% (2.2 - 4.8), respectively. Conclusions: In patients with chest pain and unremarkable ECG, presence of upright T wave in lead V1, is an early diagnostic tool for CAD. Male patients with chest pain and upright T wave in lead V1 probably have significant CAD.

The Role of Coronary CT Calcium as a Stand-Alone Screening Tool for Coronary Artery Disease in a Younger Multi-Racial Asian Population

The Role of Coronary CT Calcium as a Stand-Alone Screening Tool for Coronary Artery Disease in a Younger Multi-Racial Asian Population

Strain imaging – An underused non-invasive diagnostic tool for coronary artery disease

Strain imaging – An underused non-invasive diagnostic tool for coronary artery disease

An intelligent noninvasive model for coronary artery disease detection

Coronary artery disease (CAD) is one of the leading causes of death globally. Angiography is one of the benchmarked diagnoses for detection of CAD; however, it is costly, invasive, and requires a high level of technical expertise. This paper discusses a data mining technique that uses noninvasive clinical data to identify CAD cases. The clinical data of 335 subjects were collected at the cardiology department, Indira Gandhi Medical College, Shimla, India, over the period of 2012–2013. Only 48.9% subjects showed coronary stenosis in coronary angiography and were confirmed cases of CAD. A large number of cases (171 out of 335) were found normal after invasive diagnosis. Hence, a requirement of noninvasive technique was felt that could identify CAD cases without going for invasive diagnosis. We applied data mining classification techniques on noninvasive clinical data. The data set is analyzed using a hybrid and novel k-means cluster centroid-based method for missing value imputation and C4.5, NB Tree and multilayer perceptron for modeling to predict CAD patients. The proposed hybrid method increases the accuracy achieved by the basic techniques of classification. This framework is a promising tool for screening CAD and its severity with high probability and low cost.

Brief Review - Emerging Cardiac Biomarkers as Screening Tool for Atherosclerosis

Brief Review - Emerging Cardiac Biomarkers as Screening Tool for Atherosclerosis

Contribution of Myocardial Perfusion’s Tomoscintigraphy in the Management of Coronarian Disease in Senegal: About 42 Cases

The aim of the study was to evaluate the contribution to moscintigraphy of myocardial perfusion (TSMP) with 99mTc-sestamibi in the management of suspected or known coronary patients’s population. It included 42 patients with an average age of 57.02 ± 9.77 years with extremes ranging from 36 to 77 years. The pre-test probability in 38 patients was high in 7 patients (18.42%), intermediate in 29 patients (76.31%) and low in 2 patients (5.26%). Patients with a high pre-test probability had a positive scintigraphy. Among the 26 patients who underwent transthoracic ultrasound (TTU), 10 with normal kinetics on trans-thoracic ultrasound (TTU) had positive scintigraphy. For 16 patients with TTU abnormalities, 6 had negative scintigraphy and 10 had positive scintigraphy. The TSMP was positive for 28 patients (66.66%). Among these patients, 16 had pure ischemia, 57.14% (16/28), 7 pure necrosis (25%), and 5 both necrosis and ischemia. Myocardial perfusion scintigraphy remains a very contributory consideration in the management of coronary disease. This is synchronized with the electrocardiogram (ECG) and is an important diagnostic and prognostic tool for coronary artery disease. It also provides a good indication of coronary angiography.

Diagnostic Test of Urine Proteome during Atherosclerotic Process Among White Rat (Rattus Novergicus Strain Wistar) Induced by Atherogenic Diet

Introduction: Around twenty five million people in United State have at least one complications of atherosclerosis such as cardiovascular disease. Therefore screening in atherosclerotic process is important. Atherosclerosis is a multistage process that begins with damage to the endothelium due to LDL exposure. Angiography Coronary is the primary diagnostic tool for atherosclerosis. Imaging, as one way of non-invasive diagnosis, have limitation in sensitivity, specificity, and cost. Proteome urine analysis is alternative for atherosclerosis diagnostic.Objective: The aim of this study was analyse diagnostic performance of urine proteome among white rat (Rattus Novergicus strain wistar) induced by atherogenic diet.Material and methods: This study was quasi experimental in laboratory with randomized posttest only for control group design. The rat samples were divided to two groups i.e. group with atherogenic diet and non-atherogenic diet. Each group consisted of 10 rats. The treatment was done for 15 weeks. Urine sample collection was performed in week 16 of treatment. Urine proteome, collagen type I, was analyzed by ELISA to obtain biomarkers of atherosclerosis. Then determined sensitivity and specificity of the proteome urine analysis was compared with histopathology findings of the aortic arch and its branches.Result: In week 16, the researchers collected sample from 16 rats i.e. 11 rats with atherogenic diet and 5 ratswith non-atherogenic diet. Urine proteome, collagen type I, had area under the receiver operator with the characteristic curve of 98.2% (95% IK 92.6%-100%), p 0,003. The bestcut offis 0.9025 ng/ml with sensitivity of 100% and specificity of 90.9%.Conclusion: Urine proteome analyse, collagen type I, had high accuracy for atherosclerosis diagnostic.Bangladesh Journal of Medical Science Vol.15(4) 2016 p.522-528

Measuring Electromechanical Coupling in Patients with Coronary Artery Disease and Healthy Subjects

Coronary artery disease (CAD) is the most common cause of death globally. To detect CAD noninvasively at an early stage before clinical symptoms occur is still nowadays challenging. Analysis of the variation of heartbeat interval (RRI) opens a new avenue for evaluating the functional change of cardiovascular system which is accepted to occur at the subclinical stage of CAD. In addition, systolic time interval (STI) and diastolic time interval (DTI) also show potential. There may be coupling in these electromechanical time series due to their physiological connection. However, to the best of our knowledge no publication has systematically investigated how can the coupling be measured and how it changes in CAD patients. In this study, we enrolled 39 CAD patients and 36 healthy subjects and for each subject the electrocardiogram (ECG) and photoplethysmography (PPG) signals were recorded simultaneously for 5 min. The RRI series, STI series, and DTI series were constructed, respectively. We used linear cross correlation (CC), coherence function (CF), as well as nonlinear mutual information (MI), cross conditional entropy (XCE), cross sample entropy (XSampEn), and cross fuzzy entropy (XFuzzyEn) to analyse the bivariate RRI-DTI coupling, RRI-STI coupling, and STI-DTI coupling, respectively. Our results suggest that the linear CC and CF generally have no significant difference between the two groups for all three types of bivariate coupling. The MI only shows weak change in RRI-DTI coupling. By comparison, the three entropy-based coupling measurements show significantly decreased coupling in CAD patients except XSampEn for RRI-DTI coupling (less significant) and XCE for STI-DTI and RRI-STI coupling (not significant). Additionally, the XFuzzyEn performs best as it was still significant if we further applied the Bonferroni correction in our statistical analysis. Our study indicates that the intrinsic electromechanical coupling is most probably nonlinear and can better be measured by nonlinear entropy-based measurements especially the XFuzzyEn. Besides, CAD patients are accompanied by a loss of electromechanical coupling. Our results suggest that cardiac electromechanical coupling may potentially serve as a noninvasive diagnostic tool for CAD.

Abstract 14609: Serum Protein Fingerprinting: A New Approach to the Clinical Screening of Coronary Artery Disease

Introduction: A major goal of the 21st century is to mitigate disease and healthcare costs. Coronary artery disease (CAD) kills 370,000 Americans and costs the United States $109 billion each year. More accurate screening tools are needed to ameliorate CAD related morbidity and mortality. A new approach to the direct analysis of blood serum led to the development of a prospective clinical screening tool for CAD involving sodium dodecyl sulfate (SDS) capillary gel electrophoresis (CGE). Hypothesis: The novel method generates serum protein profiles which can be used to screen individuals for heart disease by distinguishing profile features of macromolecules involved in CAD. Methods: Serum profiles were generated by SDS-CGE for each study participant (n=48), 30 with CAD and 18 ‘NonCAD’ as identified by histories of CAD or unremarkable coronary angiographies. Univariate and multivariate analyses of the profile features were conducted to identify biomarkers and statistically classify participants as CAD or NonCAD. To compare the accuracy of the method with that of an established clinical tool, participants’ 10 Year Framingham Risk Scores (FRS) were calculated. Individuals with FRS scores less than 10% (low) risk were classified as NonCAD and those with greater than 10% (moderate to severe) risk were classified as CAD. Results: A “serum protein fingerprint” profile is shown. Relative standard deviations of 2% for MW and 20% for absorbance indicate method repeatability. In the classification of participants as CAD or NonCAD, the respective accuracies of the multivariate canonical and linear discriminant analyses were 90% (p-value of 7E-5) and 94%. The classification accuracy of FRS was less than 42%. Two features of the serum profiles (#’s 3 and 7 (with Prob>F values of 0.01 and 4E-5 respectively)) are potentially novel markers for CAD. Conclusions: The proposed serum protein analysis method correlated proteins with CAD and was more accurate than the FRS method in this study.

Feasibility and safety of adenosine cardiovascular magnetic resonance in patients with MR conditional pacemaker systems at 1.5 Tesla.

BackgroundCardiovascular Magnetic Resonance (CMR) with adenosine stress is a valuable diagnostic tool in coronary artery disease (CAD). However, despite the development of MR conditional pacemakers CMR is not yet established in clinical routine for pacemaker patients with known or suspected CAD. A possible reason is that adenosine stress perfusion for ischemia detection in CMR has not been studied in patients with cardiac conduction disease requiring pacemaker therapy. Other than under resting conditions it is unclear whether MR safe pacing modes (paused pacing or asynchronous mode) can be applied safely because the effect of adenosine on heart rate is not precisely known in this entity of patients. We investigate for the first time feasibility and safety of adenosine stress CMR in pacemaker patients in clinical routine and evaluate a pacing protocol that considers heart rate changes under adenosine.MethodsWe retrospectively analyzed CMR scans of 24 consecutive patients with MR conditional pacemakers (mean age 72.1 ± 11.0 years) who underwent CMR in clinical routine for the evaluation of known or suspected CAD. MR protocol included cine imaging, adenosine stress perfusion and late gadolinium enhancement.ResultsPacemaker indications were sinus node dysfunction (n = 18) and second or third degree AV block (n = 6). Under a pacing protocol intended to avoid competitive pacing on the one hand and bradycardia due to AV block on the other no arrhythmia occurred. Pacemaker stimulation was paused to prevent competitive pacing in sinus node dysfunction with resting heart rate >45 bpm. Sympatho-excitatory effect of adenosine led to a significant acceleration of heart rate by 12.3 ± 8.3 bpm (p < 0.001), no bradycardia occurred. On the contrary in AV block heart rate remained constant; asynchronous pacing above resting heart rate did not interfere with intrinsic rhythm.ConclusionAdenosine stress CMR appears to be feasible and safe in patients with MR conditional pacemakers. Heart rate response to adenosine has to be considered for the choice of pacing modes during CMR.

0074: The stress test as a diagnostic toolfor coronary artery disease in hypertensive patients

In hypertensive patients, there are multiplecauses of error in the diagnosis of coronary artery disease: The objective of this study was to evaluate the sensitivity of the positive electrical criteria in the stress test in diagnosing coronary artery disease within the hypertensive patients. 120 hypertensive patients with positive stress test underwent coronary angiography. 33 % of patients had significant coronary lesions and 67% had normal coronary angiography. Two groups of patients were identified: group A (77 patients) withST segment depression in DII, DIII, aVF and V6 with maximal effort and group B (43 patients) with a ST segment depression in DII, DIII, aVF and/or V4, V5, V6 with maximal effort. In group A, 65 patients (84.4%) had normal coronary angiography. In group B, 31 patients (72%) had significant coronary lesions. In a subgroup of 46 patients in group A with persistent ST segment depression in V4 to V6 and recovering for 4 to 6 minutes, 93% of coronary angiograms were normal. In another subgroup of 19 patients in group B with persistent ST segment depressionin V4 to V6 and recovering for 4 to 8 minutes, 16 patients (86%) had significant lesions on coronary angiograms. hypertensive patients with stress test showing ST segment depression in DII, DIII, aVF and/or V4, V5, V6 on maximum effort and persisting for 4-8 minutes recovering have a high probability of significant coronary artery disease.

149 Relationship Between Coronary Artery Calcification (CAC) and Carotid Atherosclerosis in Asymptomatic Diabetes: A Prospective Study

BackgroundCarotid intima media thickness (CIMT) has been used as a risk stratification tool for coronary artery disease (CAD). However, there is insufficient prospective data regarding carotid plaque (CP) and severity...

The relation of location-specific epicardial adipose tissue thickness and obstructive coronary artery disease: systemic review and meta-analysis of observational studies.

BackgroundThere is growing evidence about the importance of epicardial adiposity on cardiometabolic risk. However, the relation of location-specific epicardial adipose tissue (EAT) thickness to coronary atherosclerotic burden is still unclear.MethodsThis meta-analysis was used to study the relations between location-specific EAT thickness and obstructive coronary artery disease (CAD). A systemic literature search to identify eligible studies that met the inclusion criteria from the beginning until January 2014 was made. We conducted the meta-analysis of all included 10 published studies. Pre-specified subgroup analyses were performed according to ethnicity, body mass index, diagnostic tools for CAD, and measurement tool if presence of high heterogeneity between studies. Potential publication bias was also assessed.ResultsWe identified ten observed studies with a total of 1625 subjects for planned comparison. With regard to the association between obstructive CAD and location-specific EAT thickness at the right ventricular free wall, caution is warranted. The pooled estimate showed that location-specific EAT thickness at the right ventricular free wall was significantly higher in the CAD group than non-CAD group (standardized mean difference (SMD): 0.70 mm, 95% CI: 0.26-1.13, P = 0.002), although heterogeneity was high (I2 = 93%). It should be clear that only the result of echocardiography-based studies showed a significant association (SMD: 0.98 mm, 95% CI: 0.43-1.53, P = 0.0005), and the result of all included CT-based studies showed a non-significant association (SMD: 0.06 mm, 95% CI: -0.12-0.25, P = 0.50). In the subgroup analysis, the “diagnostic tools for CAD” or “measurement tool of EAT thickness” are potential major sources of heterogeneity between studies. With regard to location-specific EAT thickness at the left atrioventricular (AV) groove, it was significantly higher in the CAD group than non-CAD group (SMD: 0.74 mm, 95% CI: 0.55-0.92, P <0.00001; I2 = 0%).ConclusionOur meta-analysis suggests that significantly elevated location-specific EAT thickness at the left AV groove is associated with obstructive CAD. Based on the current evidence, the location-specific EAT thickness at the left AV groove appears to be a good predictor in obstructive CAD, especially in Asian populations. Furthermore well-designed studies are warranted because of the current limited number of studies.

MicroRNA--a new diagnostic tool in coronary artery disease and myocardial infarction

Coronary artery disease remain one of the leading causes of mortality in the world, indicating the need for innovative therapies and diagnosis for heart disease. MicroRNAs (miRNAs) have recently emerged as one of the central players in regulating gene expression which implicatate in normal cardiac development and many pathological process of the cardiovascular system, including cardiac arrhythmia, heart failure, cardiac fibrosis, coronary artery disease and myocardial infarction. iRNA are small noncoding RNAs 18-23 nucleotides in length that regulate expression of target genes through sequence-specific hybridization to the 3' untranslated region of messenger RNAs and block translation. miRNAs are not only found intracellularly, but also detectable outside cells, including various body fluids (i.e. serum, plasma, saliva, urine). This review will highlight recent findings in the regulation of miRNA biogenesis and secretion, modulation of the cardiovascular pathological process in CAD and AMI and the potential as non-invasive biomarkers for cardiac ischemia.

Screening for coronary artery disease after mediastinal irradiation in Hodgkin lymphoma survivors: phase II study of indication and acceptance

Cardiovascular diseases are the most common nonmalignant cause of death in Hodgkin lymphoma (HL) survivors, especially after mediastinal irradiation. We investigated the role of computed tomographic coronary angiography (CTA) as a screening tool for coronary artery disease (CAD) in asymptomatic HL survivors, and related CTA findings to exercise testing and subsequent interventions. Patients were eligible for this phase II study if at least 10 years disease-free and treated with mediastinal radiotherapy. Screening consisted of electrocardiogram, exercise testing and CTA. Primary end point was significant CAD (stenosis >50%) on CTA. CTA screening was considered to be indicated for testing in a larger population if ≥6 of 50 CTA scanned patients (12%) would need revascularization. Screening was evaluated with a questionnaire before and after screening. Fifty-two patients were included, and 48 patients underwent CTA. Median age was 47 years, time since HL diagnosis 21 years. There were 45 evaluable scans. Significant CAD on CTA was found in 20% (N = 9), significantly increased compared with the 7% expected abnormalities (P = 0.01, 95% confidence interval 8.3% to 31.7%). In 11% (N = 5), significant stenosis was confirmed at coronary angiography, and revascularization was carried out. Additionally, two patients were treated with optimal medical therapy. Ninety percent of patients were content with screening, regardless whether the CTA showed abnormalities. Prevalence of significant CAD among HL survivors is high, while asymptomatic even in the presence of life-threatening CAD. This might justify screening by CTA in asymptomatic HL survivors who had mediastinal radiotherapy, but needs to be evaluated in a larger cohort. The trial protocol was approved by the Ethics Committee of the LUMC and registered with ClinicalTrials.gov, NCT01271127.