Diagnostic role of coronary CT angiography in paroxysmal or first diagnosed atrial fibrillation

Abstract

ObjectivesThe presence of coronary artery disease (CAD) in patients hospitalised with paroxysmal or first diagnosed atrial fibrillation (AF) has major implications for antithrombotic therapy and cardiovascular event rate. Coronary CT angiography (CCTA) is a feasible tool to identify patients with concealed CAD. We aimed to evaluate the diagnostic role of early CCTA in patients hospitalised with paroxysmal or first diagnosed AF.MethodsIn a 5-year single-centre retrospective analysis, 566 patients with paroxysmal or first diagnosed AF who underwent CCTA were enrolled to investigate the presence of CAD.ResultsIn patients with paroxysmal or first diagnosed AF, CCTA revealed CAD (coronary artery stenosis ≥50%) in 39.2%. Cardiac catheterisation was performed in 31.6%, confirming CAD in 13.1% of all patients. In 8.0% percutaneous coronary intervention and in 0.5% coronary artery bypass grafting was performed. In patients with paroxysmal or first diagnosed AF: (1) angina pectoris per se does not predict CAD; (2) multivariable regression analysis revealed age, male sex and diabetes as risk factors for CAD in AF; (3) Framingham Risk Score for coronary heart disease and CHA2DS2-VASc-Score were relevant risk scores of CAD and (4) the classification of Coronary Artery Calcium score reference values according to the Multi-Ethnic Study of Atherosclerosis was a predictor of CAD.ConclusionPatients with paroxysmal or first diagnosed AF are at risk for CAD, while CCTA is a feasible diagnostic tool for CAD. We recommend to integrate CT calcium scoring and CCTA into the diagnostic workup of patients with new-onset or paroxysmal AF.

Risk of myocardial infarction and ischemic stroke in individuals with first-diagnosed paroxysmal vs. non-paroxysmal atrial fibrillation under anticoagulation

“…A recent retrospective study showed that coronary CT angiography identified underlying coronary artery disease in 39% of individuals with paroxysmal of first-diagnosed AF. 18 In this context, coronary CT angiography is integrated in the diagnostic work-up of individuals with paroxysmal or first-diagnosed AF. 18 In addition, intensive strategies aiming to more efficient control of the atherosclerotic risk factors beyond OAC treatment, which could include lifestyle changes like smoking cessation, exercise and physical activity interventions, adoption of Mediterranean diet, and better weight control, as well as pharmaceutical interventions to control related comorbidities such as diabetes mellitus and dyslipidemia more efficiently.…”

“… 18 In this context, coronary CT angiography is integrated in the diagnostic work-up of individuals with paroxysmal or first-diagnosed AF. 18 In addition, intensive strategies aiming to more efficient control of the atherosclerotic risk factors beyond OAC treatment, which could include lifestyle changes like smoking cessation, exercise and physical activity interventions, adoption of Mediterranean diet, and better weight control, as well as pharmaceutical interventions to control related comorbidities such as diabetes mellitus and dyslipidemia more efficiently. Accordingly, several retrospective studies showed that statin treatment in individuals with AF is associated with reduced risk for cardiovascular events.…”

High incidence of newly diagnosed obstructive coronary artery disease regardless of chest pain detected on pre-procedural cardiac computed tomography angiography in patients undergoing atrial fibrillation ablation

“…In a recent publication, Rottlander et al . conclude that there might be only a weak association between atrial fibrillation patients admitted to the hospital due to chest pain and relevant CAD [ 16 ]. Brown et al .…”

“…Besides male sex, age, diabetes, Framingham score and CHA 2 DS 2 -VASc score proved to be good predictors for CAD in a retrospective analysis of Rottlander et al . involving 566 paroxysmal or newly diagnosed atrial fibrillation patients [ 16 ]. However, according to Chen et al ., CACS was also observed without any conventional cardiovascular risk factors in 58% of the studied 324 patients [ 8 ].…”

Possibilities of computed and magnetic resonance imaging of the heart in patients with ­atrial fibrillation

“…По результатам исследования у пациентов с пароксизмальной или впервые диагностированной ФП КТ-ангиография выявила ИБС (стеноз коронарной артерии ≥50%) в 39,2% случаев. Авторы рекомендуют интегрировать оценку кальцификации при КТ и КТ-ангиографии в диагностическое обследование пациентов с впервые возникшей или пароксизмальной ФП [50].…”