Coronary Computed Tomography Angiography From Clinical Uses to Emerging Technologies

Abdelrahman, Khaled M.; Chen, Marcus Y; Dey, Amit; Virmani, Renu; Finn, Aloke V.; Khamis, Ramzi; Choi, Andrew; Min, James K.; Williams, Michelle; Buckler, Andrew J.; Taylor, Charles A.; Rogers, Campbell; Samady, Habib; Antoniades, Charalambos; Shaw, Leslee J.; Budoff, Matthew J.; Hoffmann, Udo; Blankstein, Ron; Narula, Jagat; Mehta, Nehal N.

doi:10.1016/j.jacc.2020.06.076

Cited by 192 publications

(125 citation statements)

References 141 publications

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“…Carotid plaques were assessed in pre-operative CT angiographies using a semi-automated, histology-validated software as previously described (The vascuCAP ® (Elucid Bioimaging Inc., Boston, MA, USA) software) [ 36 , 37 , 38 , 39 , 40 , 41 ]. In brief, reconstructed images were analyzed in a blinded fashion by one observer (EK) to characterize plaque structure and composition (plaque morphology) [ 4 ] creating 3D segmentations with improved resolution and soft tissue plaque component differentiation.…”

Section: Methodsmentioning

confidence: 99%

Proteoglycan 4 Modulates Osteogenic Smooth Muscle Cell Differentiation during Vascular Remodeling and Intimal Calcification

Seime

Akbulut

Liljeqvist

et al. 2021

Cells

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Calcification is a prominent feature of late-stage atherosclerosis, but the mechanisms driving this process are unclear. Using a biobank of carotid endarterectomies, we recently showed that Proteoglycan 4 (PRG4) is a key molecular signature of calcified plaques, expressed in smooth muscle cell (SMC) rich regions. Here, we aimed to unravel the PRG4 role in vascular remodeling and intimal calcification. PRG4 expression in human carotid endarterectomies correlated with calcification assessed by preoperative computed tomographies. PRG4 localized to SMCs in early intimal thickening, while in advanced lesions it was found in the extracellular matrix, surrounding macro‑calcifications. In experimental models, Prg4 was upregulated in SMCs from partially ligated ApoE−/− mice and rat carotid intimal hyperplasia, correlating with osteogenic markers and TGFb1. Furthermore, PRG4 was enriched in cells positive for chondrogenic marker SOX9 and around plaque calcifications in ApoE−/− mice on warfarin. In vitro, PRG4 was induced in SMCs by IFNg, TGFb1 and calcifying medium, while SMC markers were repressed under calcifying conditions. Silencing experiments showed that PRG4 expression was driven by transcription factors SMAD3 and SOX9. Functionally, the addition of recombinant human PRG4 increased ectopic SMC calcification, while arresting cell migration and proliferation. Mechanistically, it suppressed endogenous PRG4, SMAD3 and SOX9, and restored SMC markers’ expression. PRG4 modulates SMC function and osteogenic phenotype during intimal remodeling and macro-calcification in response to TGFb1 signaling, SMAD3 and SOX9 activation. The effects of PRG4 on SMC phenotype and calcification suggest its role in atherosclerotic plaque stability, warranting further investigations.

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Section: Methodsmentioning

confidence: 99%

Proteoglycan 4 Modulates Osteogenic Smooth Muscle Cell Differentiation during Vascular Remodeling and Intimal Calcification

Seime

Akbulut

Liljeqvist

et al. 2021

Cells

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“…The advantage of the multirow spiral is that it allows rapid assessment of the main etiology of acute chest pain and has a high negative predictive value [ 19 ]. In addition to its diagnostic feasibility, the test has other advantages, such as the ability to reduce the number of diagnostic tests, the time of the patient′s examination, and the cost of medical tests [ 20 ]. It provides a cost-effective modality for patients presenting to the emergency department with acute chest pain [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Value of Multislice Spiral CT Cardiothoracic Combined with Angiography in Acute Chest Pain

Yang

2021

Journal of Healthcare Engineering

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Acute chest pain is a common clinical emergency condition with a variety of causes, including acute coronary syndrome, pulmonary embolism, aortic coarctation, and pneumothorax. It is essential for emergency physicians to quickly and accurately understand the cause of acute chest pain. 64-slice spiral CT combined cardiothoracic angiography is an accurate and rapid way to diagnose and differentiate the cause of acute chest pain. 64-slice combined cardiothoracic angiography can accurately and rapidly display the thoracic aorta, both pulmonary arteries, the main trunk of the coronary artery and its major branches, and also provide a comprehensive view of both lungs and mediastinum, which is an effective test for the diagnosis and differential diagnosis of acute chest pain. Based on this, this study further investigated the value of 64-slice spiral CT triplex examination in the diagnosis of acute chest pain. The results showed that 64-slice spiral CT has the advantages of fast scanning speed, high resolution, and advanced postprocessing technology, and combined cardiothoracic angiography can quickly and accurately help emergency physicians analyze the cause of acute chest pain, which plays a very important role in formulating the correct treatment plan in a timely manner. At the same time, with the continuous development of CT technology, the temporal and spatial resolution has improved the quality of CT images, giving us more options to reduce the effective radiation dose and reduce the total amount of contrast, making the 64-row spiral CT cardiothoracic imaging more perfect.

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“…Coronary CTA is a noninvasive method that is widely used for the evaluation of both luminal narrowing and remodeling of CAPs. 4 It also provides additional information about CAP characteristics such as morphology, exact localization, and the involved number of segments with CAPs. Therefore, coronary CTA has several advantages over other noninvasive tests, particularly for predictive utility.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, radiation exposure is still a major drawback for this method with older version CT scanners, but recently some studies reported successful coronary CTA scan with low-dose radiation. 25 However, contrast-induced acute kidney injury (CI-AKI) 4 should be kept in mind before CTA and the clinician should describe the clinical and periprocedural risk factors for CI-AKI and perform a risk assessment for patients receiving contrast media. Contrast-induced acute kidney injury can also affect short-term and long-term outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 However, the risks of CTA such as radiation and contrast-related complications should be kept in mind. 4 Besides only lumenographic data documented by conventional angiography, coronary CTA visualizes the vessel as a whole, including lumen and wall, which provides critical anatomic data about stenosis severity, location(s), and morphologic features of coronary atherosclerotic plaque (CAP). 5,6 As most of the acute coronary syndromes (ACS) and cardiac deaths occur due to the rupture of noncritical CAP, 7 the delineation of CAP characteristics has vital importance.…”

Section: Introductionmentioning

confidence: 99%

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Long-Term Prognostic Value of Coronary Atherosclerotic Plaque Characteristics Assessed by Computerized Tomographic Angiography

et al. 2020

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We aimed to present the long-term prognostic role of coronary computed tomography angiography (CTA) in a cohort of patients with coronary artery disease (CAD) and noncritical stenosis. A total of 1138 patients who underwent coronary CTA for suspected CAD were included in the study. For the categorization of the coronary atherosclerotic plaque (CAP), the coronary system was divided into 16 segments. For each segment, CAPs were categorized as calcified, noncalcified, and mixed. All-cause and cardiovascular (CV) mortality data were collected for prognostic evaluation. Coronary CTA analyses showed that 34.5% of patients had noncalcified CAP, 14.5% of patients had calcified CAP, and 11% of patients had mixed CAP. During a median of 141.5 months follow-up, CV and all-cause mortality was observed in 57 (5%) and 149 (13.1%) patients, respectively. In multivariable Cox regression analysis, calcified CAP morphology and the extent of involved segments were significant predictors of both CV and all-cause mortality. The presence of calcified CAP morphology and the higher number of diseased coronary segments via coronary CTA might help stratify patients at risk for adverse CV outcomes during long-term follow-up. Patients with these features at index coronary CTA may be evaluated more closely with aggressive preventive measures.

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Coronary Computed Tomography Angiography From Clinical Uses to Emerging Technologies

Cited by 192 publications

References 141 publications

Proteoglycan 4 Modulates Osteogenic Smooth Muscle Cell Differentiation during Vascular Remodeling and Intimal Calcification

Proteoglycan 4 Modulates Osteogenic Smooth Muscle Cell Differentiation during Vascular Remodeling and Intimal Calcification

Diagnostic Value of Multislice Spiral CT Cardiothoracic Combined with Angiography in Acute Chest Pain

Long-Term Prognostic Value of Coronary Atherosclerotic Plaque Characteristics Assessed by Computerized Tomographic Angiography

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