Computed Tomographic Perfusion Improves Diagnostic Power of Coronary Computed Tomographic Angiography in Women

Penagaluri, Ashritha; Higgins, Angela; Vavere, Andrea L.; Miller, Julie M.; Arbab‐Zadeh, Armin; Betoko, Aisha; Steveson, Chloe; Zimmermann, Elke; Cox, Christopher; Rochitte, Carlos Eduardo; Dewey, Marc; Kofoed, Klaus F.; Niinuma, Hiroyuki; Carli, Marcelo F. Di; Lima, João A.C.; Chen, Marcus Y

doi:10.1161/circimaging.116.005189

Cited by 18 publications

(5 citation statements)

References 35 publications

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“…Te assessment of coronary stenosis may exhibit some diferences between CAG and CCTA. Tis variation depends on factors such as the patient population, operator experience, and technological nuances [27,28]. We need to carefully consider these factors for a more accurate evaluation of coronary artery health.…”

Section: Discussionmentioning

confidence: 99%

Relationship between Coronary Artery Calcium Score and Coronary Stenosis

Chen,

Zhao,

Cai

et al. 2023

Cardiology Research and Practice

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Background. The coronary artery calcium score (CACS) is commonly employed to quantify the degree of calcification in coronary atherosclerosis. Indeed, increased coronary stenosis severity is associated with a progressive increase in CACS. Objectives. This study sought to explore the association between CACS and coronary stenosis of ≥50% and ≥70%. Methods. We conducted a retrospective analysis of patient data collected between July 1, 2017, and March 3, 2022, at Jiangmen Central Hospital. A total of 208 patients, presenting with both symptomatic and asymptomatic manifestations and suspected coronary artery disease (CAD), were included. Statistical analyses included ROC curve assessments, subgroup analyses based on age, and comparisons of CACS values against the presence of coronary stenosis ≥50% and ≥70%. Results. Ultimately, 208 patients were included, with a median age of 65.0 years and a median CACS of 115.7 (interquartile range: 13.7–369.4). A CACS threshold of ≥1300 demonstrated a specificity of 100% for coronary stenosis of ≥50%. Notably, the percentage of patients with obstructive CAD showing CACS = 0 was significantly higher in those under 65 years (15.1%) compared to patients over 65 years (3.8%) ( P = 0.005 ). The inflection point, at which the risk probability for coronary stenosis of ≥50% shifted from being a protective factor to a risk factor, was observed when CACS fell within the range of 63.3 to 66.0. Conclusion. CACS demonstrates good performance for the detection of coronary artery stenosis.

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Section: Discussionmentioning

confidence: 99%

Relationship between Coronary Artery Calcium Score and Coronary Stenosis

Chen,

Zhao,

Cai

et al. 2023

Cardiology Research and Practice

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“…A combination of coronary computed tomographic angiography (CTA) and perfusion (CTP) imaging is more powerful in diagnosing flow-limiting stenosis than CTA or CTP alone. Also, CTP is superior to CTA in females [15].…”

Section: Diagnosismentioning

confidence: 90%

Correlation of Coronary Artery Disease and Left Ventricular Hypertrophy

Khalid¹,

Padda²,

Ismail³

et al. 2021

Cureus

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Ischemic heart disease (IHD) is the leading cause of death worldwide, and it is defined as an imbalance between myocardial oxygen supply and demand. Coronary artery disease (CAD) and left ventricular hypertrophy (LVH) are two common causes of IHD that independently result in myocardial ischemia. CAD decreases myocardial blood and oxygen supply whereas LVH increases myocardial oxygen demand. The coexistence of both CAD and LVH results in a significant increase in oxygen demand while simultaneously lowering oxygen supply.Since hypertension is a shared predisposing condition for both CAD and LVH, the left ventricular (LV) mass on noninvasive echocardiography can reflect on the severity of coronary artery stenosis. In clinical practice, it can help physicians decide whether to perform invasive cardiac catheterization to visualize the extent of the coronary block. Although, both CAD and LVH are directly proportional to mortality risk, the addition of eccentric LVH can further increase morbidity and mortality due to myocardial infarction. Therefore, the latest management of both the acute and chronic phases of CAD places an increased emphasis on controlling the predisposing factors to prevent or reverse LVH. For example, angiotensin-converting enzyme inhibitors and diuretics reduce LV mass by lowering the cardiac preload and afterload. This article aims to investigate the deleterious effects of the collaboration between CAD and LVH, establish a causal relationship, and explore the new prevention and management strategies.

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“…While some studies report similar accuracy of CTCA in detecting CAD in women and men, other studies have reported less sensitivity (54%-56% vs 85%-89%) and specificity (75% vs. 90%) in detecting CAD affecting distal coronary segments or side branches likely due to women having smaller epicardial arteries compared with men. [42][43][44] The PROMISE trial randomized patients with symptoms suggestive of stable CAD to either functional or anatomic testing. 45 There was no difference in clinical events between groups or by sex.…”

Section: Obstructive Cadmentioning

confidence: 99%

Approach to Imaging Ischemia in Women

Parwani

Mohammad

Liberman

et al. 2023

Journal of Thoracic Imaging

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Approach to imaging ischemia in women Coronary artery disease in women tends to have a worse short-and long-term prognosis relative to men and remains the leading cause of mortality worldwide. Both clinical symptoms and diagnostic approach remain challenging in women due to lesser likelihood of women presenting with classic anginal symptoms on one hand and underperformance of conventional exercise treadmill testing in women on the other. Moreover, a higher proportion of women with signs and symptoms suggestive of ischemia are more likely to have nonobstructive coronary artery disease (CAD) that requires additional imaging and therapeutic considerations. New imaging techniques such as coronary computed tomography (CT) angiography, CT myocardial perfusion imaging, CT functional flow reserve assessment, and cardiac magnetic resonance imaging carry substantially better sensitivity and specificity for the detection of ischemia and coronary artery disease in women. Familiarity with various clinical subtypes of ischemic heart disease in women and with the major advantages and disadvantages of advanced imaging tests to ensure the decision to select one modality over another is one of the keys to successful diagnosis of CAD in women. This review compares the 2 major types of ischemic heart disease in womenobstructive and nonobstructive, while focusing on sex-specific elements of its pathophysiology.

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Computed Tomographic Perfusion Improves Diagnostic Power of Coronary Computed Tomographic Angiography in Women

Cited by 18 publications

References 35 publications

Relationship between Coronary Artery Calcium Score and Coronary Stenosis

Relationship between Coronary Artery Calcium Score and Coronary Stenosis

Correlation of Coronary Artery Disease and Left Ventricular Hypertrophy

Approach to Imaging Ischemia in Women

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