Long-term prognostic utility of computed tomography coronary angiography in older populations

Gnanenthiran, S.; Naoum, Christopher; Leipsic, Jonathon; Achenbach, Stephan; Al‐Mallah, Mouaz H.; Andreini, Daniele; Bax, Jeroen J.; Berman, Daniel S.; Budoff, Matthew J.; Cademartiri, Filippo; Callister, Tracy Q.; Chang, Hyuk Jae; Chinnaiyan, Kavitha M.; Chow, Benjamin J.W.; Cury, Ricardo C.; Delago, Augustin; Feuchtner, Gudrun; Hadamitzky, Martin; Hausleiter, Jöerg; Kaufman, P.; Kim, Yong Jin; Maffei, Erica; Marques, Hugo; Gonçalves, Pedro de Araújo; Raff, Gilbert; Rubinshtein, Ronen; Shaw, Leslee J.; Villines, Todd C.; Gransar, Heidi; Lu, Yao; Jones, Edward; Peña, Jessica M.; Lin, Fay Y.; Kritharides, Leonard; Min, James K.

doi:10.1093/ehjci/jez067

Cited by 13 publications

(4 citation statements)

References 19 publications

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“…Then, the individual segment scores of all 16 segments were summed to yield a total score ranging from 0 to 48. The prognostic value of these coronary artery plaque scores has been previously demonstrated in patients with suspected stable CAD without current ACS and validated by independent groups . According to the cutoff proposed by Min et al, patients were separated into groups with SIS or SSS of ≤5 vs >5.…”

Section: Methodsmentioning

confidence: 99%

“…The prognostic value of these coronary artery plaque scores has been previously demonstrated in patients with suspected stable CAD without current ACS 24 and validated by independent groups. [25][26][27] According to the cutoff proposed by Min et al, 24 patients were separated into groups with SIS or SSS of ≤5 vs >5. Finally, a 3-vessel plaque score was calculated as 0 or 1 based on the absence or presence of plaques in the left anterior descending, left circumflex, and right coronary arteries, irrespective of severity.…”

Section: Coronary Computed Tomography Angiographymentioning

confidence: 99%

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Plasma circular RNA hsa_circ_0001445 and coronary artery disease: Performance as a biomarker

et al. 2020

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The role of circular RNAs (circRNAs) as biomarkers remains poorly characterized. Here, we investigated the performance of the circRNA hsa_circ_0001445 as a biomarker of coronary artery disease (CAD) in a real‐world clinical practice setting. Plasma hsa_circ_0001445 was measured in a study population of 200 consecutive patients with suspected stable CAD who had undergone coronary computed tomographic angiography (CTA). Multivariable logistic models were constructed combining conventional risk factors with established biomarkers and hsa_circ_0001445. Model robustness was internally validated by the bootstrap technique. Biomarker accuracy was evaluated using the C‐index. The integrated discrimination improvement (IDI) and net reclassification improvement (NRI) were also calculated. Risk groups were developed via classification tree models. The stability of plasma hsa_circ_0001445 was evaluated under different clinical conditions. hsa_circ_0001445 levels were associated with higher coronary atherosclerosis extent and severity with a 2‐fold increase across tertiles (28.4%‐50.0%). Levels of hsa_circ_0001445 were proportional to coronary atherosclerotic burden, even after comprehensive adjustment for cardiovascular risk factors, medications, and established biomarkers (fully adjusted OR = 0.432 for hsa_circ_0001445 as a continuous variable and fully adjusted OR = 0.277 for hsa_circ_0001445 as a binary variable). The classification of patients was improved with the incorporation of hsa_circ_0001445 into a base clinical model (CM) composed of conventional cardiovascular risk factors, showing an IDI of 0.047 and NRI of 0.482 for hsa_circ_0001445 as a continuous variable and an IDI of 0.056 and NRI of 0.373 for hsa_circ_0001445 as a binary variable. A trend toward higher discrimination capacity was also observed (C‐indexCM = 0.833, C‐indexCM+continuous hsa_circ_0001445 = 0.856 and C‐indexCM+binary hsa_circ_0001445 = 0.855). Detailed analysis of stability showed that hsa_circ_0001445 was present in plasma in a remarkably stable form. In vitro, hsa_circ_0001445 was downregulated in extracellular vesicles secreted by human coronary smooth muscle cells upon exposure to atherogenic conditions. In patients with suspected stable CAD referred for coronary CTA, plasma hsa_circ_0001445 improves the identification of coronary artery atherosclerosis.

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Section: Methodsmentioning

confidence: 99%

Section: Coronary Computed Tomography Angiographymentioning

confidence: 99%

Plasma circular RNA hsa_circ_0001445 and coronary artery disease: Performance as a biomarker

et al. 2020

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“…Authors analysed CCT results according to age and divided the population into two groups: <70 years (n=7,198) and ≥70 years (n=1,786); they found that the segment involvement score (SIS) was predictive of mortality in both groups. The same study showed that CCT findings predicted long-term MACE in both groups (21).…”

Section: Prognostic Insights Of the Confirm Registrymentioning

confidence: 78%

Updated diagnostic & prognostic paradigm for CAD: a narrative review

Toia¹,

Grutta²,

Smeraldi³

et al. 2020

Cardiovasc Diagn Ther

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Cardiovascular diseases are the first cause of death globally; early detection of coronary artery disease (CAD) is a challenge for clinicians and radiologists. Over the past 2 decades there have been several improvements in the methods for the assessment of diagnosis and prognosis in patients with suspected CAD; most of these methods are imaging methods and they operate with high-end technologies. Cardiac computed tomography (CCT) as we know it today was introduced in 1998 and has ever progressed with constant pace. The first decade was the technical validation phase of the method while the second decade was the clinical validation phase. CCT has developed an excellent diagnostic and prognostic value; technological development together with radiation dose reduction, contributed to the widening of its clinical indications.The diagnostic value of CCT is particularly important as a first line in symptomatic patients with suspected obstructive CAD and low-to-intermediate cardiovascular risk. It is a test that should come, whenever possible, in front of functional evaluation because of its very high sensitivity and negative predictive value.The prognostic value of CCt is still investigational, even though it is becoming quite evident that the atherosclerotic phenotype plays a major role in the determination of prognosis, and as consequence, in the individualization of optimal pharmacological therapy, especially in the cohort without significant obstructive CAD. Recently, scientific and practical guidelines have been updated taking into account the role of CCT, which is able to provide a reliable and fast diagnosis with an additional resources optimization. Multiple registries and trials have been developed and will be summarized in this review. Recent guidelines highlighted the role of CCT in diagnosing suspected CAD.

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“…18 Quantifying coronary plaque burden improves risk assessment using both semi-quantitative (SSS, SIS) or quantitative (volumetric) plaque metrics. 19 , 20 Recent studies incorporated the degree of stenosis, plaque morphology, and SSS for the detection of PP. Although quantitative plaque analysis (volumetric change in atheroma burden) is not used routinely in clinical setting, this biomarker has been increasingly utilized for monitoring anti-atherosclerotic drug therapy.…”

Section: Discussionmentioning

confidence: 99%

CAD-RADS may underestimate coronary plaque progression as detected by serial CT angiography

Szilveszter

Vattay

Bossoussou

et al. 2021

European Heart Journal - Cardiovascular Imaging

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Aims We wished to assess whether different clinical definitions of coronary artery disease (CAD) [segment stenosis and involvement score (SSS, SIS), Coronary Artery Disease—Reporting and Data System (CAD-RADS)] affect which patients are considered to progress and which risk factors affect progression. Methods and results We enrolled 115 subsequent patients (60.1 ± 9.6 years, 27% female) who underwent serial coronary computed tomography angiography (CTA) imaging with >1year between the two examinations. CAD was described using SSS, SIS, and CAD-RADS. Linear mixed models were used to investigate the effects of risk factors on the overall amount of CAD and the effect on annual progression rate of different definitions. Coronary plaque burdens were SSS 4.63 ± 4.06 vs. 5.67 ± 5.10, P < 0.001; SIS 3.43 ± 2.53 vs. 3.89 ± 2.65, P < 0.001; CAD-RADS 0:8.7% vs. 0.0% 1:44.3% vs. 40.9%, 2:34.8% vs. 40.9%, 3:7.0% vs. 9.6% 4:3.5% vs. 6.1% 5:1.7% vs. 2.6%, P < 0.001, at baseline and follow-up, respectively. Overall, 53.0%, 29.6%, and 28.7% of patients progressed over time based on SSS, SIS, and CAD-RADS, respectively. Of the patients who progressed based on SSS, only 54% showed changes in CAD-RADS. Smoking and diabetes increased the annual progression rate of SSS by 0.37/year and 0.38/year, respectively (both P < 0.05). Furthermore, each year increase in age raised SSS by 0.12 [confidence interval (CI) 0.05–0.20, P = 0.001] and SIS 0.10 (CI 0.06–0.15, P < 0.001), while female sex was associated with 2.86 lower SSS (CI −4.52 to −1.20, P < 0.001) and 1.68 SIS values (CI −2.65 to −0.77, P = 0.001). Conclusion CAD-RADS could not capture the progression of CAD in almost half of patients with serial CTA. Differences in CAD definitions may lead to significant differences in patients who are considered to progress, and which risk factors are considered to influence progression.

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Long-term prognostic utility of computed tomography coronary angiography in older populations

Cited by 13 publications

References 19 publications

Plasma circular RNA hsa_circ_0001445 and coronary artery disease: Performance as a biomarker

Plasma circular RNA hsa_circ_0001445 and coronary artery disease: Performance as a biomarker

Updated diagnostic & prognostic paradigm for CAD: a narrative review

CAD-RADS may underestimate coronary plaque progression as detected by serial CT angiography

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