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Aims: This study aims to investigate the association between left ventricular diastolic dysfunction (LVDD) and epicardial adipose tissue (EAT) accumulation in patients with chronic coronary syndrome (CCS) and preserved left ventricular ejection fraction (LVEF). Methods and results: The study included 314 patients with preserved LVEF who underwent coronary computed tomographic angiography (CCTA) and thoracic tissue Doppler echocardiography (TTDE). The EAT volume was measured using CCTA. LVDD was categorized into three groups: absent LVDD, undetermined LVDD, and LVDD. Multivariate logistic regression analysis was performed to assess the association between the clinical parameters, TTDE and CCTA findings, and LVDD. Patients (mean age: 66 ± 13 years; 52% men) were divided into LVDD present (30 patients, 9.6%), LVDD absent (219 patients, 69.7%), and LVDD undetermined (65 patients, 20.7%) groups. CCTA showed that patients with LVDD had a significantly higher coronary artery calcium (CAC) score and % plaque volume (%PV) than those without LVDD, whereas the prevalence of obstructive coronary artery disease was comparable between the groups. The EAT volume index correlated with each LVDD diagnostic component, except for tricuspid regurgitation velocity. A multivariate model showed that age [odds ratio (OR), 1.13; P < 0.001] and EAT volume index (OR, 1.02; P = 0.038) were independently associated with LVDD, even after adjusting for left ventricular mass index (OR, 1.05; P = 0.005). There was no significant association between the CAC score and %PV or LVDD. Conclusion: This study demonstrated that EAT volume index and left ventricular mass index were robust predictors of LVDD; however, there was no independent association between coronary atherosclerotic disease burden and LVDD.

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BACKGROUND: Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) supplementation lower triglyceride levels. The impact on epicardial adipose tissue volume (EATV), which is associated with cardiovascular events, is unclear. OBJECTIVE: To determine if triglyceride reduction with EPA+DHA supplementation decreases EATV and whether EATV affects coronary plaque. METHODS: 139 subjects with coronary artery disease on statins were randomized to 3.36 g EPA+DHA daily or none (control) for 30 months. EATV, coronary plaque volumes and coronary artery calcium score were measured with coronary computed tomographic angiography. RESULTS: Change in triglyceride level correlated with change in EATV (r=0.236; p=0.006). Despite a 6.7% triglyceride reduction (p=0.021) with EPA+DHA supplementation compared to no change in control (between group p=0.034); both groups had similar reductions in EATV possibly due to statin treatment. EATV above the median (>115.6 cm3) was the only determinant of baseline coronary fatty plaque volume (ß=2.4, p=0.010). After multivariate adjustment, waist circumference, a surrogate of abdominal visceral adiposity, was the only determinant of baseline EATV (OR:1.093; 95% CI:1.003-1.192, p=0.042). Moreover, increase in waist circumference was the only predictor of an increase in EATV at 30 months (ß=0.320, p=0.018). CONCLUSIONS: EATV is associated with higher coronary fatty plaque volume and is regulated by waist circumference but not EPA+DHA supplementation at 30-month follow-up in CAD patients on statin treatment. The direct correlation between waist circumference and EATV suggests that maintaining a healthy weight may limit EATV and coronary fatty plaque volume, potentially leading to a decrease in cardiovascular events. Two sentence summary Subjects with clinical CAD on statin treatment randomized to EPA+DHA had similar reductions in epicardial adipose tissue volume (EATV) compared to control, despite a significant reduction in triglyceride level in the EPA+DHA group. Higher EATV was linked to greater fatty, rupture-prone plaques, boosting the risk of MI, and change in waist circumference was the only predictor of an increase in EATV at 30-month follow-up.

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Background: Artificial Intelligence Plaque Analysis (AI-QCPA, HeartFlow) provides, from a CCTA, quantitative plaque burden information including total plaque and plaque subtype volumes. We sought to evaluate the clinical utility of AI-QCPA in clinical decision making. Methods: One hundred cases were reviewed by 3 highly experienced practicing cardiologists who are SCCT level 3 CCTA readers. Patients had varying levels of calcium (median CACS: 99.5) and CAD-RADS scores. Initial management plan for each case was a majority decision based upon patient demographics, clinical history, and CCTA report. AI-QCPA was then provided for each patient, and the plan was reconsidered. The primary endpoint was the reclassification rate (RR). In a secondary analysis of 40 cases, the above process was repeated but the initial plan was based upon review of the actual CCTA images. Results: RR following AI-QCPA review was 66% (66/100) of cases (95% CI, 56.72%-75.28%). RR ranged from 47% in cases with CACS 0 to 96% in cases with CACS >400, and from 40% in CAD-RADS 1 cases to 94% in CAD-RADS 4 cases. RR was higher in cases with coronary stenoses ≥50% (89.5%) vs cases with stenoses <50% (51.6%). RR was 39% in cases with LDL <70 mg/dL vs 70% in LDL ≥70 mg/dL. Following review of the CCTA images rather than the CCTA report, the RR was 50% (95% CI of 34.51% - 65.49%). The primary reclassification effect was to intensify preventative medical therapy. Conclusions: Adding AI-QCPA to CCTA alone leads to a change in clinical care in two-thirds of patients.

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Background: The noninvasive computed tomography angiography-derived fractional flow reserve (CT-FFR) can be used to diagnose coronary ischemia. With advancements in associated software, the diagnostic capability of CT-FFR may have evolved. This study evaluates the effectiveness of a novel deep learning-based software in predicting coronary ischemia through CT-FFR. Methods: In this prospective study, 138 subjects with suspected or confirmed coronary artery disease were assessed. Following indication of 30%-90% stenosis on coronary computed tomography (CT) angiography, participants underwent invasive coronary angiography and fractional flow reserve (FFR) measurement. The diagnostic performance of the CT-FFR was determined using the FFR as the reference standard. Results: With a threshold of 0.80, the CT-FFR displayed an impressive diagnostic accuracy, sensitivity, specificity, area under the receiver operating characteristic curve (AUC), positive predictive value (PPV), and negative predictive value (NPV) of 97.1%, 96.2%, 97.7%, 0.98, 96.2%, and 97.7%, respectively. At a 0.75 threshold, the CT-FFR showed a diagnostic accuracy, sensitivity, specificity, AUC, PPV, and NPV of 84.1%, 78.8%, 85.7%, 0.95, 63.4%, and 92.8%, respectively. The Bland-Altman analysis revealed a direct correlation between the CT-FFR and FFR (p < 0.001), without systematic differences (p = 0.085). Conclusions: The CT-FFR, empowered by novel deep learning software, demonstrates a strong correlation with the FFR, offering high clinical diagnostic accuracy for coronary ischemia. The results underline the potential of modern computational approaches in enhancing noninvasive coronary assessment.

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BACKGROUND AND AIMS: Coronary computed tomographic angiography (CCTA) is pivotal in diagnosing coronary artery disease (CAD). We explored the link between CAD severity and two biomarkers, Pan-Immune Inflammation Value (PIV) and Atherogenic Index of Plasma (AIP), in stable CAD patients. METHODS AND RESULTS: A retrospective observational study of 409 CCTA patients with stable angina pectoris. Logistic regression identified predictors of severe CAD, stratified by CAD-RADS score. Receiver Operating Characteristic (ROC) curves evaluated predictive performance. PIV and AIP were significant predictors of severe CAD (PIV: OR 1.002, 95% CI: 1.000-1.004, p < 0.021; AIP: OR 0.963, 95% CI: 0.934-0.993, p < 0.04). AUC values for predicting severe CAD were 0.563 (p < 0.001) for PIV and 0.625 (p < 0.05) for AIP. Combined with age, AUC improved to 0.662 (p < 0.02). CONCLUSIONS: PIV and AIP were associated with severe CAD, with AIP demonstrating superior predictive capability. Incorporating AIP into risk assessment could enhance CAD prediction, offering a cost-effective and accessible method for identifying individuals at high risk of coronary atherosclerosis.

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Biomarcadores , Angiografía por Tomografía Computarizada , Angiografía Coronaria , Enfermedad de la Arteria Coronaria , Valor Predictivo de las Pruebas , Índice de Severidad de la Enfermedad , Humanos , Masculino , Femenino , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/sangre , Enfermedad de la Arteria Coronaria/inmunología , Enfermedad de la Arteria Coronaria/diagnóstico , Estudios Retrospectivos , Persona de Mediana Edad , Anciano , Biomarcadores/sangre , Mediadores de Inflamación/sangre , Medición de Riesgo , Angina Estable/diagnóstico por imagen , Angina Estable/sangre , Angina Estable/diagnóstico , Angina Estable/inmunología , Pronóstico , Inflamación/sangre , Inflamación/diagnóstico , Inflamación/diagnóstico por imagen , Factores de Riesgo , Vasos Coronarios/diagnóstico por imagen , Área Bajo la Curva

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Background: Pericoronary adipose tissue (PCAT) is a sensor of vascular inflammation. Elevated PCAT attenuation values indicate the presence of coronary inflammation in patients. However, it is unclear which clinical characteristics are associated with increased PCAT attenuation values in patients without coronary heart disease (CHD). The study aims to investigate the relationship between increased PCAT attenuation values and clinical characteristics of patients without CHD. Methods: We recruited 785 eligible patients without CHD who underwent coronary computed tomographic angiography (CCTA). Clinical data were recorded for each patient, and PCAT attenuation values for the left anterior descending branch (LADPCAT), left circumflex branch (LCXPCAT), and right coronary artery (RCAPCAT) were quantified by CCTA using fully automated software. Univariate and multivariate analyses were performed to identify the associations between different clinical characteristics and elevated LADPCAT, LCXPCAT, and RCAPCAT. Results: Univariate analysis showed body mass index (BMI) to be positively associated with LADPCAT (rs=0.109), LCXPCAT (rs=0.076), and RCAPCAT (rs=0.083). Moreover, the duration of smoking, and drinking was positively associated with LADPCAT (rs=0.099, 0.165). Hyperlipidemia was positively associated with LADPCAT (rs=0.089) and RCAPCAT (rs=0.334), while statin use was negatively associated with RCAPCAT (rs=-0.145). Multivariate analysis showed that the significant determinants of LADPCAT were BMI (ß=0.359, P=0.001), duration of smoking (ß=2.612, P=0.002), drinking (ß=4.106, P<0.001), and hyperlipidemia (ß=1.664, P=0.027). LCXPCAT was associated with BMI (ß=0.218, P=0.024), while RCAPCAT was associated with hyperlipidemia (ß=6.110, P<0.001) and statin use (ß=-3.338, P<0.001). Conclusions: In patients without CHD, the PCAT attenuation values measured using CCTA were associated with various clinical characteristics. LADPCAT was associated with BMI, smoking duration, drinking, and hyperlipidemia. On the other hand, LCXPCAT was associated with BMI, while RCAPCAT was associated with hyperlipidemia and statin use.

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Background: Coronary artery disease (CAD) is the leading cause of mortality worldwide. Recent advances in deep learning technology promise better diagnosis of CAD and improve assessment of CAD plaque buildup. The purpose of this study is to assess the performance of a deep learning algorithm in detecting and classifying coronary atherosclerotic plaques in coronary computed tomographic angiography (CCTA) images. Methods: Between January 2019 and September 2020, CCTA images of 669 consecutive patients with suspected CAD from Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine were included in this study. There were 106 patients included in the retrospective plaque detection analysis, which was evaluated by a deep learning algorithm and four independent physicians with varying clinical experience. Additionally, 563 patients were included in the analysis for plaque classification using the deep learning algorithm, and their results were compared with those of expert radiologists. Plaques were categorized as absent, calcified, non-calcified, or mixed. Results: The deep learning algorithm exhibited higher sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy {92% [95% confidence interval (CI): 89.5-94.1%], 87% (95% CI: 84.2-88.5%), 79% (95% CI: 76.1-82.4%), 95% (95% CI: 93.4-96.3%), and 89% (95% CI: 86.9-90.0%)} compared to physicians with ≤5 years of clinical experience in CAD diagnosis for the detection of coronary plaques. The algorithm's overall sensitivity, specificity, PPV, NPV, accuracy, and Cohen's kappa for plaque classification were 94% (95% CI: 92.3-94.7%), 90% (95% CI: 88.8-90.3%), 70% (95% CI: 68.3-72.1%), 98% (95% CI: 97.8-98.5%), 90% (95% CI: 89.8-91.1%) and 0.74 (95% CI: 0.70-0.78), indicating strong performance. Conclusions: The deep learning algorithm has demonstrated reliable and accurate detection and classification of coronary atherosclerotic plaques in CCTA images. It holds the potential to enhance the diagnostic capabilities of junior radiologists and junior intervention cardiologists in the CAD diagnosis, as well as to streamline the triage of patients with acute coronary symptoms.

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OBJECTIVES: This study aimed to investigate the diagnostic performance of computed tomography (CT) fractional flow reserve (CT-FFR) derived from standard images (STD) and images processed via first-generation (SnapShot Freeze, SSF1) and second-generation (SnapShot Freeze 2, SSF2) motion correction algorithms. METHODS: 151 patients who underwent coronary CT angiography (CCTA) and invasive coronary angiography (ICA)/FFR within 3 months were retrospectively included. CCTA images were reconstructed using an iterative reconstruction technique and then further processed through SSF1 and SSF2 algorithms. All images were divided into three groups: STD, SSF1, and SSF2. Obstructive stenosis was defined as a diameter stenosis of ≥ 50 % in the left main artery or ≥ 70 % in other epicardial vessels. Stenosis with an FFR of ≤ 0.8 or a diameter stenosis of ≥ 90 % (as revealed via ICA) was considered ischemic. In patients with multiple lesions, the lesion with lowest CT-FFR was used for patient-level analysis. RESULTS: The overall quality score in SSF2 group (median = 3.67) was markedly higher than that in STD (median = 3) and SSF1 (median = 3) groups (P < 0.001). The best correlation (r = 0.652, P < 0.001) and consistency (mean difference = 0.04) between the CT-FFR and FFR values were observed in the SSF2 group. At the per-lesion level, CT-FFRSSF2 outperformed CT-FFRSSF1 in diagnosing ischemic lesions (area under the curve = 0.887 vs. 0.795, P < 0.001). At the per-patient level, the SSF2 group also demonstrated the highest diagnostic performance. CONCLUSION: The SSF2 algorithm significantly improved CCTA image quality and enhanced its diagnostic performance for evaluating stenosis severity and CT-FFR calculations.

Asunto(s)

Algoritmos , Angiografía por Tomografía Computarizada , Angiografía Coronaria , Estenosis Coronaria , Reserva del Flujo Fraccional Miocárdico , Humanos , Reserva del Flujo Fraccional Miocárdico/fisiología , Femenino , Masculino , Angiografía por Tomografía Computarizada/métodos , Persona de Mediana Edad , Estudios Retrospectivos , Angiografía Coronaria/métodos , Estenosis Coronaria/diagnóstico por imagen , Estenosis Coronaria/fisiopatología , Anciano , Reproducibilidad de los Resultados , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Sensibilidad y Especificidad , Movimiento (Física)

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BACKGROUND: Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital coronary anomaly with the potential to cause adverse cardiac events. However, there is limited data on the association between AAOCA and coronary artery disease (CAD). Therefore, the aim of this study is to determine the prevalence and symptoms of patients with AAOCA, as well as investigate the correlation between AAOCA and CAD in a population referred for coronary computed tomographic angiography (CTA). METHODS AND RESULTS: All consecutive patients who underwent CTA from 2010 to 2021 were included. Characteristics, symptoms, coronary related adverse events and CTA information were reviewed by medical records. Separate multivariable cumulative logistic regressions were performed, using the stenosis severity in each of the four coronaries as individual responses and as a combined patient clustered response. Finally, we identified 207 adult patients with AAOCA, the prevalence of AAOCA is 0.23% (207/90,501). Moreover, this study found no significant association between AAOCA and CAD. AAOCA did not contribute to higher rates of hospitalization or adverse cardiac events, including calcification. CONCLUSION: AAOCA is a rare congenital disease that is not associated with increased presence of obstructive CAD in adults.

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Angiografía por Tomografía Computarizada , Angiografía Coronaria , Enfermedad de la Arteria Coronaria , Anomalías de los Vasos Coronarios , Valor Predictivo de las Pruebas , Humanos , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Anomalías de los Vasos Coronarios/epidemiología , Prevalencia , Masculino , Femenino , Persona de Mediana Edad , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/epidemiología , Anciano , Estudios Retrospectivos , Adulto , Factores de Riesgo , Medición de Riesgo , Índice de Severidad de la Enfermedad

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BACKGROUND: Myocardial bridge (MB) is a common coronary anomaly characterized by a tunneled course through the myocardium. Coronary computed tomography angiography (CCTA) can identify MB. The impact of MB detected by CCTA on coronary physiological parameters before and after percutaneous coronary intervention (PCI) is unknown.Methods and Results: We investigated 141 consecutive patients who underwent pre-PCI CCTA and fractional flow reserve (FFR)-guided elective PCI for de novo single proximal lesions in the left anterior descending artery (LAD). We compared clinical demographics and physiological parameters between patients with and without CCTA-defined MB. MB was identified in 46 (32.6%) patients using pre-PCI CCTA. The prevalence of diabetes was higher among patients with MB. Median post-PCI FFR values were significantly lower among patients with than without MB (0.82 [interquartile range 0.79-0.85] vs. 0.85 [interquartile range 0.82-0.89]; P=0.003), whereas pre-PCI FFR values were similar between the 2 groups. Multivariable linear regression analysis revealed that the presence of MB and greater left ventricular mass volume in the LAD territory were independently associated with lower post-PCI FFR values. Multivariable logistic regression analysis also revealed that the presence of MB and lower pre-PCI FFR values were independent predictors of post-PCI FFR values ≤0.80. CONCLUSIONS: CCTA-defined MB independently predicted both lower post-PCI FFR as a continuous variable and ischemic FFR as a categorical variable in patients undergoing elective PCI for LAD.

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Introduction: The correlation between non-alcoholic fatty liver disease (NAFLD) and cardiovascular disease is well established. Aim: The objective of this study was to assess the short-term associations of the non-alcoholic fatty liver disease fibrosis score (NFS) with various outcomes, including mortality, severe coronary artery disease, myocardial infarction, and the need for coronary angiography, among patients who underwent coronary computed tomographic angiography (CCTA). Material and methods: In this study, we assessed 499 patients who underwent 640-slice CCTA and evaluated their liver fibrosis using the NFS. The NFS takes into account factors such as age, body mass index, impaired fasting glycemia or diabetes mellitus, aspartate aminotransferase/alanine aminotransferase ratio, platelets, and albumin. Our primary focus was myocardial infarction, the need for coronary angiography, and death. Additionally, we examined the association between NFS and severe coronary artery disease. Results: Patients with a higher NFS had a greater number of coronary angiography procedures and higher Agatston score (p < 0.001), with NFS and Agatston score emerging as independent predictors of severe coronary artery disease and the primary endpoint. An NFS value above -0.92 could predict the primary endpoint with 61% sensitivity and 63% specificity, while an NFS value above -0.88 could predict severe coronary artery disease with 62% sensitivity and 65% specificity. To analyze primary endpoints, the Kaplan-Meier method was used for survival analysis, with NFS groups compared using the log-rank test. During the follow-up period, patients with higher NFS were exposed to primary outcomes at an earlier period (p = 0.009). Conclusions: NFS is an effective predictor of major cardiovascular events such as death, myocardial infarction, severe coronary artery disease, and the need for coronary angiography. These findings underscore the importance of NFS as a valuable tool for risk assessment and early intervention in patients with suspected or confirmed coronary artery disease.

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There are unique advantages and disadvantages to functional versus anatomic testing in the work-up of patients who present with symptoms suggestive of obstructive coronary artery disease. Evaluation of these individuals starts with an assessment of pre-test probability, which guides subsequent testing decisions. The choice between anatomic and functional testing depends on this pre-test probability. In general, anatomic testing has particular utility among younger individuals and women; while functional testing can be helpful to rule-in ischemia and guide revascularization decisions. Ultimately, selection of the most appropriate test should be individualized to the patient and clinical scenario.

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Enfermedad de la Arteria Coronaria , Isquemia Miocárdica , Humanos , Femenino , Enfermedad de la Arteria Coronaria/diagnóstico , Angiografía Coronaria , Isquemia Miocárdica/diagnóstico , Prueba de Esfuerzo

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BACKGROUND: Coronary computed tomography angiography stenosis score (CCTA-SS) is a proposed diagnosis score that considers the plaque characteristics, myocardial function, and the diameter reduction rate of the lesions. This study aimed to evaluate the diagnostic performance of the CCTA-SS in seeking coronary artery disease (CAD). METHODS: The 228 patients with suspected CAD who underwent CCTA and invasive coronary angiography (ICA) procedures were under examination. The diagnostic performance was evaluated with the receiver operating curve (ROC) for CCTA-SS in detecting CAD (defined as a diameter reduction of ≥ 50%) and severe CAD (defined as a diameter reduction of ≥ 70%). RESULTS: The area under ROC (AUC) of CCTA-SS was 0.909 (95% CI: 0.864-0.943), which was significantly higher than that of CCTA (AUC: 0.826; 95% CI: 0.771-0.873; P = 0.0352) in diagnosing of CAD with a threshold of 50%. The optimal cutoff point of CCTA-SS was 51% with a sensitivity of 90.66%, specificity of 95.65%, positive predictive value of 98.80%, negative predictive value of 72.13%, and accuracy of 91.67%, whereas the optimal cutoff point of CCTA was 55%, and the corresponding values were 87.36%, 93.48%, 98.15%, 65.15%, and 88.60%, respectively. With a threshold of 70%, the performance of CCTA-SS with an AUC of 0.927 (95% CI: 0.885-0.957) was significantly higher than that of CCTA with an AUC of 0.521 (95% CI: 0.454-0.587) (P < 0.0001). CONCLUSIONS: CCTA-SS significantly improved the diagnostic accuracy of coronary stenosis, including CAD and severe CAD, compared with CCTA.

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Enfermedad de la Arteria Coronaria , Estenosis Coronaria , Humanos , Angiografía por Tomografía Computarizada/métodos , Constricción Patológica , Estenosis Coronaria/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Angiografía Coronaria/métodos , Valor Predictivo de las Pruebas

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To describe the updated coronary computed tomographic angiography (CCTA)-based coronary artery bypass graft (CABG) anatomic SYNTAX Score (aSS) and assess its utility and reproducibility for assessing the completeness of revascularization after CABG. The CCTA-CABG aSS is a visual assessment using CCTA post-CABG which quantifies the failure in effectively grafting stenotic coronary segments, and therefore assesses the completeness of surgical revascularization. It is calculated by subtracting the aSS of successfully anastomosed coronary segments from the aSS of the native coronary tree. The inter-observer reproducibility of the CCTA-CABG aSS was evaluated in 45 consecutive patients with three-vessel disease with or without left main disease who underwent a CCTA 30 days (± 7 days) after CABG. The CCTA-CABG aSS was evaluated in 45 consecutive patients with 117 bypass grafts and 152 anastomoses. The median native coronary aSS was 35.0 [interquartile range (IQR) 27.0-41.0], whilst the median CCTA-CABG aSS was 13.0 (IQR 9.0-20.5). The inter-observer level of agreement for the native coronary aSS and the CCTA-CABG aSS were both substantial with respective Kappas of 0.67 and 0.61. The CCTA-CABG aSS was feasible in all patients who underwent CABG for complex coronary artery disease with substantial inter-observer reproducibility, and therefore can be used to quantify the completeness of revascularization after CABG.

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Enfermedad de la Arteria Coronaria , Intervención Coronaria Percutánea , Humanos , Angiografía Coronaria/métodos , Reproducibilidad de los Resultados , Valor Predictivo de las Pruebas , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/cirugía , Puente de Arteria Coronaria/efectos adversos , Intervención Coronaria Percutánea/métodos , Resultado del Tratamiento

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BACKGROUND: The clinical value of high-risk coronary plaque characteristics (CPCs) to inform intensified medical therapy or revascularization of non-flow-limiting lesions remains uncertain. OBJECTIVES: The authors performed a systematic review and meta-analysis to study the prognostic impact of CPCs on patient-level and lesion-level major cardiovascular adverse events (MACE). METHODS: Thirty studies (21 retrospective, 9 prospective) with 30,369 patients evaluating the association of CPCs with MACE were included. CPCs included high plaque burden, low minimal lumen area, thin cap fibroatheroma, high lipid core burden index, low-attenuation plaque, spotty calcification, napkin ring sign, and positive remodeling. RESULTS: CPCs were evaluated with the use of intracoronary modalities in 9 studies (optical coherence tomography in 4 studies, intravascular ultrasound imaging in 3 studies, and near-infrared spectroscopy intravascular ultrasound imaging in 2 studies) and by means of coronary computed tomographic angiography in 21 studies. CPCs significantly predicted patient-level and lesion-level MACE in both unadjusted and adjusted analyses. For most CPCs, accuracy for MACE was modest to good at the patient level and moderate to good at the lesion level. Plaques with more than 1 CPC had the highest accuracy for lesion-level MACE (AUC: 0.87). Because the prevalence of CPCs among plaques was low, estimated positive predictive values for lesion-level MACE were modest. Results were mostly consistent across imaging modalities and clinical presentations, and in studies with prevailing hard outcomes. CONCLUSIONS: Characterization of CPCs identifies high-risk atherosclerotic plaques that place lesions and patients at risk for future MACE, albeit with modest sensitivity and positive predictive value (Coronary Plaque Characteristics Associated With Major Adverse Cardiovascular Events Among Atherosclerotic Patients and Lesions; CRD42021251810).

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Enfermedad de la Arteria Coronaria , Placa Aterosclerótica , Humanos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/terapia , Enfermedad de la Arteria Coronaria/complicaciones , Angiografía Coronaria/métodos , Estudios Retrospectivos , Estudios Prospectivos , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/patología , Valor Predictivo de las Pruebas , Ultrasonografía Intervencional

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Background Residual risk of cardiovascular events and plaque progression remains despite reduction in low-density lipoprotein cholesterol. Factors contributing to residual risk remain unclear. The authors examined the role of eicosapentaenoic acid and docosahexaenoic acid in coronary plaque regression and its predictors. Methods and Results A total of 240 patients with stable coronary artery disease were randomized to eicosapentaenoic acid plus docosahexaenoic acid (3.36 g/d) or none for 30 months. Patients were stratified by regression or progression of coronary fatty plaque measured by coronary computed tomographic angiography. Cardiac events were ascertained. The mean±SD age was 63.0±7.7 years, mean low-density lipoprotein cholesterol level was <2.07 mmol/L, and median triglyceride level was <1.38 mmol/L. Regressors had a 14.9% reduction in triglycerides that correlated with fatty plaque regression (r=0.135; P=0.036). Compared with regressors, progressors had higher cardiac events (5% vs 22.3%, respectively; P<0.001) and a 2.89-fold increased risk of cardiac events (95% CI, 1.1-8.0; P=0.034). Baseline non-high-density lipoprotein cholesterol level <2.59 mmol/L (100 mg/dL) and systolic blood pressure <125 mm Hg were significant independent predictors of fatty plaque regression. Normotensive patients taking eicosapentaenoic acid plus docosahexaenoic acid had regression of noncalcified coronary plaque that correlated with triglyceride reduction (r=0.35; P=0.034) and a significant decrease in neutrophil/lymphocyte ratio. In contrast, hypertensive patients had no change in noncalcified coronary plaque or neutrophil/lymphocyte ratio. Conclusions Triglyceride reduction, systolic blood pressure <125 mm Hg, and non-high-density lipoprotein cholesterol <2.59 mmol/L were associated with coronary plaque regression and reduced cardiac events. Normotensive patients had greater benefit than hypertensive patients potentially due to lower levels of inflammation. Future studies should examine the role of inflammation in plaque regression. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01624727.

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Enfermedad de la Arteria Coronaria , Humanos , Persona de Mediana Edad , Anciano , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Presión Sanguínea , Ácidos Docosahexaenoicos , Ácido Eicosapentaenoico/uso terapéutico , LDL-Colesterol , Inflamación , Placa Amiloide , Triglicéridos

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BACKGROUND: Treatment of chronic total occlusion (CTO) by percutaneous coronary intervention (PCI) is associated with the difficulty of guidewire manipulation through the occluded segment, particularly when there is hard tissue due to calcification. The purpose of this randomised controlled trial is to determine whether improved planning of CTO-PCI using coronary computed tomographic angiography (CCTA) (versus conventional angiography) increases success rates of wire crossing in ≤ 60 min in difficult cases. METHODS: This is a randomised controlled open-label multi-centre trial in a superiority framework with 1:1 allocation ratio. Participants (n = 130) will be randomised into two groups: the study group who will receive standard of care with the addition of preoperative coronary computed tomographic angiography (CT group), and the control group that will receive standard of care (angiography group). The primary endpoint will be the rate of successful wire crossing in ≤ 60 min in complex CTO (J-CTO ≥ 2). Wire crossing will be considered successful if TIMI flow 3 is restored and residual stenosis is < 30%. The safety endpoint will be mortality due to the intervention or major adverse cardiac events (MACE). Secondary endpoints are success rates at any time; total time of PCI; time of wire crossing; rate of PCI complications; radiation levels during PCI; volume of iodine contrast medium administered; and cost of the PCI. DISCUSSION: This randomised trial will provide insight into whether pre-procedural CCTA as opposed to conventional angiography for planning of CTO-PCI yield higher success rates of wire crossing in ≤ 60 min. Potential benefits of CCTA include shorter successful procedure times of CTO-PCI leading to less irradiation and contrast medium with lower complication rates. TRIAL REGISTRATION: Clinical Trials.gov NCT04549896. Registered on December 21, 2021.

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Intervención Coronaria Percutánea , Enfermedades Vasculares , Humanos , Intervención Coronaria Percutánea/efectos adversos , Tomografía Computarizada por Rayos X , Angiografía por Tomografía Computarizada , Medios de Contraste , Constricción Patológica , Ensayos Clínicos Controlados Aleatorios como Asunto , Estudios Multicéntricos como Asunto

RESUMEN

An anomalous origin of the right coronary artery from the opposite sinus of Valsalva with an intramural course (R-ACAOS-IM) may cause sudden cardiac death in children and adolescents. However, the natural history and management of patients in whom this anomaly is detected later during adulthood remains uncertain. The goals of this study were to assess the impact of an R-ACAOS-IM on the clinical outcomes in an adult population and to determine if adult patients with this anomaly who do not have significant coronary artery disease (CAD) can be managed safely without surgical intervention. A database review identified patients aged >35 years with anomalous coronary arteries diagnosed by cardiac catheterization or coronary computed tomography angiography. The outcomes of patients with R-ACAOS-IM were compared with patients with anomalous left circumflex coronary arteries with retroaortic course (LCx-RA) (an anomaly not associated with ischemic events). The primary outcome was all-cause mortality. The study population consisted of 185 patients aged 59 ± 12 years. Clinical characteristics were similar in the R-ACAOS-IM (n = 88) and LCx-RA (n = 97) groups. At a follow-up of 6.6 ± 4.5 years, there was no difference in mortality (hazard ratio 0.64, 95% confidence interval 0.32 to 1.28, p = 0.20) when adjusted for gender, age, and CAD. A subgroup analysis of 88 patients with no obstructive CAD managed nonoperatively found no difference between the LCx and R-ACAOS-IM groups in mortality (hazard ratio 2.45, 95% confidence interval 0.45 to 13.40, p = 0.30). There was no significant difference between the 2 groups in the composite outcome of death, nonfatal myocardial infarction, or survived cardiac arrest. The outcome of adult patients who have anomalous R-ACAOS-IM are similar to patients who have anomalous LCx-RA with a known benign course. In conclusion, these results suggest that most patients who survive this anomaly into adulthood may be managed conservatively without intervention.

Asunto(s)

Enfermedad de la Arteria Coronaria , Anomalías de los Vasos Coronarios , Seno Aórtico , Niño , Adolescente , Humanos , Adulto , Seno Aórtico/diagnóstico por imagen , Seno Aórtico/anomalías , Estudios Retrospectivos , Angiografía Coronaria/métodos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/cirugía , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Anomalías de los Vasos Coronarios/complicaciones

RESUMEN

Introduction: Coronary computed tomographic angiography (CCTA) is a highly diagnostically accurate non-invasive imaging method for a thorough evaluation of atherosclerotic plaques. Many CCTA-based imaging investigations concentrate on bifurcation lesions. Aim: To determine whether intraprocedural side branch (SB) obstruction during the percutaneous coronary intervention (PCI) of lesions involving bifurcations might be predicted by preprocedural CCTA. Material and methods: This retrospective observational study was conducted on 200 stentable bifurcation lesions of 200 coronary artery disease patients with the SB ≥ 2 mm in diameter. All patients were planned for elective bifurcation PCI after undergoing CCTA for quantitative plaque characterization of both the main vessel and SB to obtain the CT bifurcation score. Then, angiography-based bifurcations were classified using both the Medina classification and the RESOLVE score before PCI of the bifurcation lesions. Most of the cases were managed by the provisional technique. Results: The CT bifurcation score was substantially higher in patients with SB occlusion (p < 0.001) with 80% sensitivity and 60% specificity at a cut-off point of 3. There was a borderline significant relation between the Medina score and SB occlusion in the studied cases (p = 0.05) with 60% sensitivity and 40% specificity. The RESOLVE score was unexpectedly an insignificant predictor of SB occlusion (p = 0.25) in our study, with 40% sensitivity and 50% specificity. Conclusions: Intraprocedural SB occlusion can be predicted by a comprehensive CCTA evaluation. The CT bifurcation score, a novel and simple points scoring system based on six CCTA parameters, outperformed current angiographic classification or scoring systems for predicting SB occlusion.