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1.
《Journal of Cardiovascular Computed Tomography》2023,17(4):248-253
IntroductionThe clinical implications of a widespread adoption of guideline recommendations for patients with stable chest pain and low pretest probability (PTP) of obstructive coronary artery disease (CAD) remain unclear. We aimed to assess the results of three different testing strategies in this subgroup of patients: A) defer testing; B) perform coronary artery calcium score (CACS), withholding further testing if CACS = 0 and proceeding to coronary computed tomography angiography (CCTA) if CACS>0; C) perform CCTA in all.MethodsTwo-center cross-sectional study assessing 1328 symptomatic patients undergoing CACS and CCTA for suspected CAD. PTP was calculated based on age, sex and symptom typicality. Obstructive CAD was defined as any luminal stenosis ≥50% on CCTA.ResultsThe prevalence of obstructive CAD was 8.6% (n = 114). In the 786 patients (56.8%) with CACS = 0, 8.5% (n = 67) had some degree of CAD [1.9% (n = 15) obstructive, and 6.6% (n = 52) nonobstructive]. Among those with CACS>0 (n = 542), 18.3% (n = 99) had obstructive CAD. The number of patients needed to scan (NNS) to identify one patient with obstructive CAD was 13 for strategy B vs. A, and 91 for strategy C vs. B.ConclusionsUsing CACS as gatekeeper would decrease CCTA use by more than 50%, at the cost of missing obstructive CAD in one in 100 patients. These findings may help inform decisions on testing, which will ultimately depend on the willingness to accept some diagnostic uncertainty. 相似文献
2.
Edward Hulten MD MPH Todd C. Villines MD Michael K. Cheezum MD Daniel S. Berman MD Allison Dunning MSc Stephan Achenbach MD Mouaz Al-Mallah MD Matthew J. Budoff MD Filippo Cademartiri MD PhD Tracy Q. Callister MD Hyuk-Jae Chang MD PhD Victor Y. Cheng MD Kavitha Chinnaiyan MD Benjamin J. W. Chow MD Ricardo C. Cury MD Augustin Delago MD Gudrun Feuchtner MD Martin Hadamitzky MD Jörg Hausleiter MD Philipp A. Kaufmann MD Yong-Jin Kim MD Jonathon Leipsic MD Fay Y. Lin MD Erica Maffei MD Fabian Plank MD Gilbert L. Raff MD Leslee J. Shaw PhD James K. Min MD 《Journal of nuclear cardiology》2014,21(1):29-37
Background
Short-term risk scores, such as the Framingham risk score (FRS), frequently classify younger patients as low risk despite the presence of uncontrolled cardiovascular risk factors. Among patients with low FRS, estimation of lifetime risk is associated with significant differences in coronary arterial calcium scores (CACS); however, the relationship of lifetime risk to coronary atherosclerosis on coronary CT angiography (CCTA) and prognosis has not been studied.Methods and Results
We evaluated asymptomatic 20-60-year-old patients without diabetes or known coronary artery disease (CAD) within an international CT registry who underwent ≥64-slice CCTA. Patients with low FRS (<10%) were stratified as low (<39%) or high (≥39%) lifetime CAD risk, and compared for the presence and severity of CAD and prognosis for death, myocardial infarction, and late coronary revascularization (>90 days post CCTA). 1,863 patients of mean age of 47 years were included, with 48% of the low FRS patients at high lifetime risk. Median follow-up was 2.0 years. Comparing low-to-high lifetime risk, respectively, the prevalence of any CAD was 32% vs 41% (P < .001) and ≥50% stenosis was 7.4% vs 9.6% (P = .09). For those with CAD, subjects at low vs high lifetime risk had lower CACS (median 12 [IQR 0-94] vs 38 [IQR 0.05-144], P = .02) and less purely calcified plaque, 35% vs 45% (P < .001). Prognosis did not differ due to low number of events.Conclusion
Assessment of lifetime risk among patients at low FRS identified those with the increase in CAD prevalence and severity and a higher proportion of calcified plaque. 相似文献3.
《Journal of Cardiovascular Computed Tomography》2023,17(2):138-143
AimLow socioeconomic-position (SEP) is associated with increased prevalence of cardiovascular disease. Whether this is caused by earlier development of atherosclerotic calcifications is not well understood. This study aimed to investigate the association between SEP and coronary artery calcium score (CACS) in a population presenting with symptoms suggestive of obstructive coronary artery disease.MethodsWe included 50,561 patients (mean age 57 ± 11, 53% women) from a national registry undergoing coronary computed tomography angiography (CTA) from 2008 to 2019. CACS was used as outcome in categories; 1–399 and ≥ 400 in regression analyses. SEP was obtained from central registries and defined as mean personal income and length of education.ResultsThe number of risk factors were negatively associated with income and education among both men and women. The adjusted OR of having a CACS≥400 was 1.67(1.50–1.86) among women with <10 years of education compared to >13 years. For men the corresponding OR was 1.03(0.91–1.16).For women with low income the adjusted OR of CACS ≥400 was 2.29(1.96–2.69) using high income as a reference. For men the corresponding OR was 1.13(0.99–1.29).ConclusionIn patients referred for coronary CTA we found an increased level of risk factors among men and women with short education and low income. Among women with longer education and a higher income we demonstrated a lower CACS compared to other women and men. Socioeconomic differences seem to affect the development of CACS beyond what can be explained by traditional risk factors. Part of the observed result may be due to referral bias.ClinicalTrials.gov identifierNone. 相似文献
4.
Filippo Cademartiri Erica Maffei Alessandro Palumbo Sara Seitun Chiara Martini Carlo Tedeschi Ludovico La Grutta Massimo Midiri Annick C. Weustink Nico R. Mollet Gabriel P. Krestin 《European radiology》2010,20(4):846-854
Objectives
The aim of the study was to compare the coronary artery calcium score (CACS) and computed tomography coronary angiography (CTCA) for the assessment of non-obstructive/obstructive coronary artery disease (CAD) in high-risk asymptomatic subjects.Methods
Two hundred and thirteen consecutive asymptomatic subjects (113 male; mean age 53.6?±?12.4 years) with more than one risk factor and an inconclusive or unfeasible non-invasive stress test result underwent CACS and CTCA in an outpatient setting. All patients underwent conventional coronary angiography (CAG). Data from CACS (threshold for positive image: Agatston score 1/100/1,000) and CTCA were compared with CAG regarding the degree of CAD (non-obstructive/obstructive; </≥50% lumen reduction).Results
The mean calcium score was 151?±?403 and the prevalence of obstructive CAD was 17% (8% one-vessel and 10% two-vessel disease). Per-patient sensitivity, specificity, positive and negative predictive values of CACS were: 97%, 75%, 45%, and 100%, respectively (Agatston?≥1); 73%, 90%, 60%, and 94%, respectively (Agatston?≥100); 30%, 98%, 79%, and 87%, respectively (Agatston?≥1,000). Per-patient values for CTCA were 100%, 98%, 97%, and 100%, respectively (p?<?0.05). CTCA detected 65% prevalence of all CAD (48% non-obstructive), while CACS detected 37% prevalence of all CAD (21% non-obstructive) (p?<?0.05).Conclusion
CACS proved inadequate for the detection of obstructive and non-obstructive CAD compared with CTCA. CTCA has a high diagnostic accuracy for the detection of non-obstructive and obstructive CAD in high-risk asymptomatic patients with inconclusive or unfeasible stress test results. 相似文献5.
Riemer H. J. A. Slart Rene A. Tio Felix Zijlstra Rudi A. Dierckx 《European journal of nuclear medicine and molecular imaging》2009,36(11):1829-1834
Treatment strategy in patients with suspected coronary artery disease (CAD) is driven by symptomatology in combination with
diagnostic evaluation of the extent and/or severity of atherosclerosis in the coronary arteries and ischemia in the myocardium,
i.e., the anatomic and functional correlates of CAD. Whereas multislice row computed tomography (MSCT) has the advantage of
detecting coronary atherosclerosis at its earliest stages, thereby allowing initiation of appropriate therapeutic measures
well before development of obstructive CAD, myocardial perfusion imaging (MPI) SPECT can clarify the hemodynamic consequences
of the anatomic findings on MSCT based on a functional assessment of myocardial blood flow. There is a lack of correlation
between coronary artery calcium (CAC), coronary artery stenosis, and MPI SPECT. Therefore CAC scoring and stress MPI should
be thus considered complementary approaches rather than exclusionary in the evaluation of the patient at risk for CAD. The
integration of anatomic and functional information may provide additional information for the clinician by the improved risk
stratification and diagnostic accuracy of integrated techniques. The majority of previous studies are based on a sequential
flowchart, starting with either SPECT or CAC scoring that finally directs the therapeutic strategy. Patients at low risk for
CAD can be selected for primary prevention, and patients at high risk for CAD can be directly selected for coronary angiography
(CAG). The remaining group of patients at intermediate risk for CAD can be substratified into lower- and higher-risk categories
based on the presence or absence of stress-induced ischemia on MPI SPECT and CAC scoring. An integration of SPECT and CAC
as a starting point for CAD detection in symptomatic patients at intermediate risk for CAD may facilitate a tailored diagnostic
as well as therapeutic approach. Finally, using SPECT/CT, MPI SPECT, and CAC findings may be completed with CT angiography.
The development of SPECT/CT hybrid systems is therefore of important value for the nuclear cardiology armamentarium. This
editorial commentary outlines a diagnostic pathway of integrated SPECT/CT for CAD assessment in symptomatic patients at intermediate
risk for CAD. 相似文献
6.
Gabija Pundziute Joanne D. Schuijf J. Wouter Jukema Hildo J. Lamb Albert de Roos Ernst E. van der Wall Jeroen J. Bax 《Journal of nuclear cardiology》2007,14(1):36-43
Background The impact of the coronary calcium score on the diagnostic accuracy of multislice computed tomography (MSCT) to detect obstructive
coronary stenoses remains controversial.
Methods and Results We examined 41 patients (mean Agatston score, 340 ± 530 [range, 0–2546]) with coronary artery disease with 16-slice MSCT and
60 patients (mean Agatston score, 446 ± 877 [range, 0–6264]) with 64-slice MSCT. MSCT scans were analyzed with invasive coronary
angiography (CA) as the standard of reference. Lesions with luminal narrowing of 50% or greater were considered obstructive.
In total, 9% and 2% of uninterpretable segments were excluded from analysis in patients examined with 16- and 64-slice MSCT,
respectively. On a segment basis, the percentage of false-negative segments in the groups with Agatston scores of 0 to 100,
101 to 400, and greater than 400 with 16-slice MSCT were 0%, 5.3%, and 2.9% (P ± .0005), respectively; other comparisons of
false-positive and false-negative segments were not significant. The sensitivity and specificity on a vessel and patient basis
with 16- and 64-slice MSCT were not significantly different in different calcium score groups.
Conclusions A slight impact of coronary calcium was observed on the diagnostic accuracy of 16-slice MSCT CA on a segment basis, with no
significant impact on a vessel and patient basis. No significant impact of coronary calcium was observed on the diagnostic
accuracy of 64-slice MSCT CA on a segment, vessel, or patient basis.
G.P. is financially supported by the Training Fellowship of the European Society of Cardiology and the Huygens Scholarship,
The Netherlands. J.D.S. is financially supported by the Netherlands Heart Foundation, The Hague, The Netherlands (grant No.
2002B105). 相似文献
7.
Anoeshka S. Dharampal Stella L. Papadopoulou Alexia Rossi Annick C. Weustink Nico R. A. Mollet W. Bob Meijboom Lisan A. Neefjes Koen Nieman Eric Boersma Pim J. de Feijter Gabriel P. Krestin 《European radiology》2012,22(11):2415-2423
Objectives
To investigate the diagnostic accuracy of CT coronary angiography (CTCA) in women at low to intermediate pre-test probability of coronary artery disease (CAD) compared with men.Methods
In this retrospective study we included symptomatic patients with low to intermediate risk who underwent both invasive coronary angiography and CTCA. Exclusion criteria were previous revascularisation or myocardial infarction. The pre-test probability of CAD was estimated using the Duke risk score. Thresholds of less than 30?% and 30–90?% were used for determining low and intermediate risk, respectively. The diagnostic accuracy of CTCA in detecting obstructive CAD (≥50?% lumen diameter narrowing) was calculated on patient level. P?<?0.05 was considered significant.Results
A total of 570 patients (46?% women [262/570]) were included and stratified as low (women 73?% [80/109]) and intermediate risk (women 39?% [182/461]). Sensitivity, specificity, PPV and NPV were not significantly different in and between women and men at low and intermediate risk. For women vs. men at low risk they were 97?% vs. 100?%, 79?% vs. 90?%, 80?% vs. 80?% and 97?% vs. 100?%, respectively. For intermediate risk they were 99?% vs. 99?%, 72?% vs. 83?%, 88?% vs. 93?% and 98?% vs. 99?%, respectively.Conclusion
CTCA has similar diagnostic accuracy in women and men at low and intermediate risk.Key Points
? Coronary artery disease (CAD) is increasingly investigated by computed tomography angiography (CTCA). ? CAD detection or exclusion by CTCA is not different between sexes. ? CTCA diagnostic accuracy was similar between low and intermediate risk sex-specific-groups. ? CTCA rarely misses obstructive CAD in low–intermediate risk women and men. ? CAD yield by invasive coronary angiography after positive CTCA is similar between sex-risk-specific groups. 相似文献8.
Hideya Yamamoto Yasuki Kihara Shinichiro Fujimoto Hiroyuki Daida Kazuhiro Kobuke Yoshitaka Iwanaga Shunichi Miyazaki Tomohiro Kawasaki Takashi Fujii Sachio Kuribayashi 《Journal of Cardiovascular Computed Tomography》2021,15(2):148-153
BackgroundWhether coronary plaque characteristics assessed in coronary computed tomography angiography (CCTA) in association with the coronary artery calcium score (CACS) have predictive value for coronary events is unclear. We aimed to examine the predictive value of the CACS and plaque characteristics for the occurrence of coronary events.MethodsAmong 2802 patients who were analyzed in the PREDICT registry, 2083 with suspected coronary artery disease (CAD) were studied using post hoc analysis. High-risk plaques were defined as having ≥2 adverse characteristics, such as low computed tomographic attenuation, positive remodeling, spotty calcification, and napkin-ring sign. An adjudicative composite of coronary events (cardiac death, nonfatal acute coronary syndrome, and coronary revascularization ≥3 months after indexed CCTA) were analyzed.ResultsSeventy-three (3.5%) patients had coronary events and 313 (15.0%) had high-risk plaques. Multivariate Cox proportional hazard analysis showed that high-risk plaques remained an independent predictor of coronary events (adjusted hazard ratio [HR] 1.95, 95% confidence interval [CI] 1.13–3.34, P ?= ?0.0154), as well as the log-transformed CACS (adjusted HR 1.24, 95% CI 1.11–1.39, P ?= ?0.0002) and the presence of obstructive stenosis (adjusted HR 5.63, 95% CI 3.22–10.12, P 0.0001). In subgroup analyses, high-risk plaques were independently predictive only in the low CACS class (<100).ConclusionThis study shows that assessment of adverse features by coronary plaque imaging independently predicts coronary events in patients with suspected CAD and a low CACS. Our findings suggest that the clinical value of high-risk plaques to CACS and stenosis assessment appears marginal. 相似文献
9.
Leslee J. Shaw Allen Taylor Paolo Raggi Daniel S. Berman 《Journal of nuclear cardiology》2006,13(2):156-162
Conclusions CACS is highly predictive of major CVD events, independent of traditional risk factors including the FRS, body mass index,
family history of premature CVD, and high-sensitivity C-reactive protein.36 A synthesis of available prognostic evidence reveals
that patients with an intermediate FRS and a high-risk CAC score are at CVD risk-equivalent status with annual event rates
of 2% or higher. This evidence is consistent with a multimarker approach for risk assessment that includes compounding novel
and traditional risk factors to identify higher-risk subsets of patients. Another example of compounding risk is the combination
of CT and SPECT markers. In those patients with high-risk subclinical disease, the frequency of inducible ischemia with SPECT
is substantially increased. Nearly one quarter of patients with a high-risk CAC score will have ischemia on SPECT imaging.
Thus it is anticipated that upcoming appropriateness criteria and guidelines may be more supportive of the use of CACS as
a screening tool for risk assessment indications in asymptomatic individuals37,38 and that this evidence may translate into
reimbursement for subclinical disease screening.39 It is hoped that strategies aimed at the detection of subclinical atherosclerosis
may result in further reductions in CVD mortality rates, saving thousands of lives and reducing the economic burden of obstructive
coronary disease. 相似文献
10.
《Journal of Cardiovascular Computed Tomography》2018,12(2):118-124
BackgroundTo investigate the incremental prognostic value of low-attenuation plaque volume (LAPV) from coronary CT angiography datasets.MethodsQuantification of LAPV was performed using dedicated software equipped with an adaptive plaque tissue algorithm in 1577 patients with suspected CAD. A combination of death and acute coronary syndrome was defined as primary endpoint. To assess the incremental prognostic value of LAPV, parameters were added to a baseline model including clinical risk and obstructive coronary artery disease (CAD), a baseline model including clinical risk and calcium scoring (CACS) and a baseline model including clinical risk and segment involvement score (SIS).ResultsPatients were followed for 5.5 years either by telephone contact, mail or clinical visits. The primary endpoint occurred in 30 patients. Quantified LAPV provided incremental prognostic information beyond clinical risk and obstructive CAD (c-index 0.701 vs. 0.767, p < .001), clinical risk and CACS (c-index 0.722 vs. 0.771, p < .01) and clinical risk and SIS (c-index 0.735 vs. 0.771, p < .01. A combined approach using quantified LAPV and clinical risk significantly improved the stratification of patients into different risk categories compared to clinical risk alone (categorical net reclassification index 0.69 with 95% CI 0.27 and 0.96, p < .001). The combined approach classified 846 (53.6%) patients as low risk (annual event rate 0.04%), 439 (27.8%) patients as intermediate risk (annual event rate 0.5%) and 292 (18.5%) patients as high risk (annual event rate 0.99%).ConclusionQuantification of LAPV provides incremental prognostic information beyond established CT risk patterns and permits improved stratification of patients into different risk categories. 相似文献
11.
Maffei E Seitun S Palumbo A Martini C Emiliano E Cuttone A Aldrovandi A Malagò R La Grutta L Midiri M Tedeschi C De Rosa R Catalano O Weustink A Mollet N Cademartiri F 《La Radiologia medica》2011,116(8):1188-1202
Purpose
Our aim was to determine the prognostic value of computed tomography coronary angiography (CTCA), coronary artery calcium scoring (CACS) and Morise clinical score in patients with known or suspected coronary artery disease (CAD).Materials and methods
A total of 722 patients (480 men; 62.7±10.9 years) who were referred for further cardiac evaluation underwent CACS and contrast-enhanced CTCA to evaluate the presence and severity of CAD. Of these, 511 (71%) patients were without previous history of CAD. Patients were stratified according to the Morise clinical score (low, intermediate, high), to CACS (0?C10, 11?C100, 101?C400, 401?C1,000, >1,000) and to CTCA (absence of CAD, nonsignificant CAD, obstructive CAD). Patients were followed up for the occurrence of major events: cardiac death, nonfatal myocardial infarction, unstable angina and revascularisation.Results
Significant CAD (>50% luminal narrowing) was detected in 260 (36%) patients; nonsignificant CAD (<50% luminal narrowing) in 250 (35%) and absence of CAD in 212 (29%). During a mean follow-up of 20±4 months, 116 events (21 hard) occurred. In patients with normal coronary arteries on CTCA, the major event rate was 0% vs. 1.7% in patients with nonsignificant CAD and 7.3% in patients with significant CAD (p<0.0001). Three hard events (14%) occurred in patients with CACS??100 and two (9.5%) in patients with intermediate Morise score; one revascularisation was observed in a patient with low Morise score. At multivariate analysis, diabetes, obstructive CAD and CACS >1,000 were significant predictors of events (p<0.05).Conclusions
An excellent prognosis was noted in patients with a normal CTCA (0% event rate). CACS ??100 and low-intermediate Morise score did not exclude the possibility of events at follow-up. 相似文献12.
《Journal of Cardiovascular Computed Tomography》2018,12(2):131-138
BackgroundHIV-infected individuals are at increased risk for both sarcopenia and cardiovascular disease. Whether an association between low muscle mass and subclinical coronary artery disease (CAD) exists, and if it is modified by HIV serostatus, are unknown.MethodsWe performed cross-sectional analysis of 513 male MACS participants (72% HIV-infected) who underwent mid-thigh computed tomography (CT) and non-contrast cardiac CT for coronary artery calcium (CAC) during 2010–2013. Of these, 379 also underwent coronary CT angiography for non-calcified coronary plaque (NCP) and obstructive coronary stenosis ≥50%. Multivariable-adjusted Poisson regression was used to estimate prevalence risk ratios of associations between low muscle mass (<20th percentile of the HIV-uninfected individuals in the sample) and CAC, NCP and obstructive stenosis.ResultsThe prevalence of low thigh muscle mass was similar by HIV serostatus (20%). There was no association of low muscle mass with CAC or NCP. However, low thigh muscle mass was significantly associated with a 2.5-fold higher prevalence of obstructive coronary stenosis, after adjustment for demographics and traditional CAD risk factors [PR 2.46 (95% CI 1.51, 4.01)]. This association remained significant after adjustment for adiposity, inflammation, and physical activity. There was no significant interaction by HIV serostatus (p-interaction = 0.90).ConclusionsIn this exploratory analysis, low thigh muscle mass was significantly associated with subclinical obstructive coronary stenosis. Additional studies involving larger sample sizes and prospective analyses are needed to confirm the potential utility of measuring mid-thigh muscle mass for identifying individuals at increased risk for obstructive CAD who might benefit from more aggressive risk factor management. 相似文献
13.
《Scandinavian journal of medicine & science in sports》2018,28(3):1036-1047
Sudden cardiac death (SCD ) is a devastating event in athletes. Screening efforts that were first directed at athletes younger than 35 years are now focusing on the rapidly growing group of older sportspersons. Athletes aged ≥35 years have a 10‐fold increased risk of exercise‐related cardiac arrest, mostly due to coronary artery disease (CAD ). Although cardiac imaging is pivotal in identifying CAD , the role of imaging modalities in screening asymptomatic older sportspersons remains unclear. We performed a scoping review to identify the role of cardiac imaging to detect CAD in older sportspersons and to identify gaps in the existing literature. We searched MEDLINE , EMBASE and the Cochrane library for studies reporting data on cardiac imaging of CAD in sportspersons ≥35 years. The systematic search yielded 1737 articles, and 14 were included in this scoping review. Imaging modalities included two echocardiography, one unenhanced computed tomography (CT ) for coronary artery calcium scoring (CACS ), three CACS and contrast‐enhanced CT angiography (CCTA ), two CACS and cardiac magnetic resonance (CMR ), one CCTA with CMR and echocardiography, two CCTA , two CMR , and one myocardial perfusion imaging article. The low number of relevant articles and the selection bias introduced by studying specific groups, like veteran marathon runners, indicate the need for future research. Cardiac CT (CACS and CCTA ) probably has the highest potential for pre‐participation screening, with high diagnostic value to detect CAD and low radiation dose. However, currently there is insufficient evidence for incorporating routine cardiac imaging in the pre‐participation screening of asymptomatic sportspersons over 35 years. 相似文献
14.
《Journal of Cardiovascular Computed Tomography》2022,16(5):454-459
BackgroundExisting pathways for investigating coronary artery disease (CAD) in individuals undertaking high-hazard employment are currently guided by coronary artery calcium scoring (CACS) or coronary CT angiography (CTA). The optimal pathway has not been established.AimTo compare the diagnostic outcome and occupational recommendations from two differing investigative pathways for the investigation of CAD in a cohort of high-hazard employees.MethodsWe collected CACS and coronary CTA data from three clinics across two Hospitals on 200 consecutive individuals employed in high-hazard occupations to confirm/exclude occupationally significant CAD. High-hazard occupations were grouped into civil/military pilots and aircraft controllers (n ?= ?106); non-pilot aircrew (NPA) (n ?= ?26); and ground-based (military) personnel (GBP) (n ?= ?52). Demographics, referral indications and recommended occupational outcomes between pathways were compared between groups.ResultsThe CACS pathway led to more than double the number of individuals being returned to partial or full employment, compared with the coronary CTA pathway (OR 2.10, [95%CI 1.54–2.85], P ?< ?0.001). This effect was seen in all sub-groups.Of the 177 subjects that would have been returned to full employment using CACS, 21 (11.9%) would have been occupationally restricted on the basis of significant non-calcified plaque disease using coronary CTA (11.4% pilots/controllers; 19.2% non-pilot aircrew, and 7.7% ground-based personnel).ConclusionUsing CACS to determine the presence of occupational CAD risks returning individuals to roles with occupationally significant CAD that may lead to an unacceptably high likelihood of an incapacitating/distracting acute coronary event. Coronary CTA appears to be a more reliable, non-invasive imaging modality for confirming or excluding occupationally significant CAD in high-hazard employees. 相似文献
15.
Husmann L Schepis T Scheffel H Gaemperli O Leschka S Valenta I Koepfli P Desbiolles L Stolzmann P Marincek B Alkadhi H Kaufmann PA 《Academic radiology》2008,15(4):452-461
RATIONALE AND OBJECTIVES: The aim of this study was to compare the diagnostic accuracy of 64-slice computed tomographic coronary angiography (CTCA) in groups of patients with low, intermediate, and high risk for coronary artery disease (CAD) events. MATERIALS AND METHODS: The institutional review board approved this study; written informed consent was obtained from all patients. Eighty-eight consecutive patients with suspected CAD (40 women; mean age, 64.3 +/- 9.4 years; range, 39-82) underwent CTCA, calcium scoring, and invasive coronary angiography and were grouped according to their Framingham 10-year risk for hard coronary events into low (<10%), intermediate (10%-20%), and high (>20%) risk categories. Significant stenoses (luminal diameter narrowing > or =50%) were assessed on an intention-to-diagnose-basis; no coronary segment was excluded and nonevaluative segments were rated false positive. To determine differences between groups, Kruskal-Wallis tests were performed for individually determined values of diagnostic performance. RESULTS: Per-patient sensitivity, specificity, negative predictive, and positive predictive values were 90.0%, 79.2%, 95.0%, and 64.3%, respectively, with low (n = 34), 87.5%, 92.3%, 85.7%, and 93.3%, respectively, with intermediate (n = 29), and 100%, 75.0%, 100%, and 89.5%, respectively, with high risk (n = 25), with a trend toward higher positive predictive value (P = .07). Per-segment negative predictive value was lower with high pretest probability (P < .01). Mean calcium-score units were 90, 220, and 312 (P = .23), and the prevalence of CAD was 29.4%, 55.2%, and 68.0% (P < .01) with low, intermediate, and high risk. CONCLUSION: Sensitivity and specificity of CTCA are not influenced by the prevalence of CAD, whereas the negative predictive value is lower and the positive predictive value tends to be higher in patients with a high prevalence of CAD. 相似文献
16.
目的 探讨CT冠状动脉成像(CTCA)与钙化积分(CACS)对可疑冠心病患者预后的预测价值.方法 对150例可疑冠心病患者行前瞻性分析.所有患者均接受320排动态容积CT扫描,分析CTCA以及CACS结果,分析并对照CTCA以及CACS判断患者预后的价值.结果 85例患者CTCA发现非阻塞性冠状动脉病变(管腔狭窄≤50%),38例患者发现阻塞性冠状动脉病变(管腔狭窄>50%),27例患者冠状动脉未发现异常.54例患者钙化积分在0~10之间,47例患者钙化积分在11~400之间,49例患者钙化积分大于400.冠状动脉狭窄程度、斑块的类型及钙化积分大小均为患者终点事件发生的危险因素(OR=5.254,95% CI=2.095-13.176,P<0.001; OR=6.877,95%CI=1.372-14.033,P<0.001;OR=2.976,95%CI=1.437-6.614,P=0.003).冠状动脉狭窄程度、斑块类型对患者预后有显著影响(OR=3.725,95%CI=1.379-10.062,P=0.007;OR=4.283,95%CI=1.992-12.254,P=0.002).结论 CTCA和CACS对可疑冠心病患者预后有较高的预测价值,CTCA对患者的预后的预测价值优于CACS. 相似文献
17.
Arthur J. H. A. Scholte Joanne D. Schuijf Antje V. Kharagjitsingh Petra Dibbets-Schneider Marcel P. Stokkel J. Wouter Jukema Ernst E. van der Wall Jeroen J. Bax Frans J. T. Wackers 《Journal of nuclear cardiology》2008,15(4):1401-509
Background. We sought to assess prospectively the evidence for silent coronary artery disease (CAD) in asymptomatic patients with type
2 diabetes mellitus by stress single-photon emission computed tomography (SPECT) myocardial perfusion imaging, coronary artery
calcium (CAC) scoring, and multislice computed tomographic (MSCT) coronary angiography.
Methods. One hundred asymptomatic patients (aged 30 to 72 years) with type 2 diabetes mellitus and one or more risk factors for CAD
were prospectively recruited from an outpatient diabetes clinic. All patients underwent adenosine technetium-99m sestamibi
SPECT imaging, CAC scoring, and 64-slice MSCT coronary angiography.
Results. Twenty-three patients (23%) had abnormal stress SPECT imaging, consistent with inducible myocardial ischemia, whereas 60
patients (60%) had positive CAC scoring (18 patients [18%] with significant CAC >401), and 70 patients (70%) had abnormal
MSCT coronary angiography (24 patients [24%] with significant, ≥50% stenosis). Of 77 patients with normal SPECT, 44 had a
positive CAC score (10 patients [13%] >401), and 54 showed CAD on MSCT angiography (16 patients [21%] with ≥50% stenosis).
Of 23 patients with an abnormal SPECT, 16 patients had a positive CAC score (8 patients [35%] >401), and 16 patients had CAD
on MSCT angiography (8 patients [35%] with ≥50% stenosis). Overall, 17 patients (17%) had more than 2 significantly abnormal
diagnostic test results, and 5 patients had three tests with significantly abnormal results.
Conclusions. In this cohort of asymptomatic patients with type 2 diabetes mellitus, different modalities visualized different aspects
of silent coronary atherosclerosis. Anatomic evidence of coronary atherosclerosis (CAC and MSCT) occurred more frequently
than functional evidence (stress SPECT). However, clinically significant manifestations of CAD were observed in about one-quarter
to one-fifth of patients by each modality, either separately or combined. The relative prognostic value of each modality needs
to be determined by a follow-up of this cohort.
This work was supported by an unrestricted grant from BMS Medical Imaging. In addition, J.J.B. has received research grants
from GE Healthcare. 相似文献
18.
Aortic atherosclerosis detected with electron-beam CT as a predictor of obstructive coronary artery disease 总被引:4,自引:0,他引:4
RATIONALE AND OBJECTIVES: Several studies have demonstrated an association between coronary and aortic atherosclerosis. Aortic atherosclerosis is easily quantified by means of electron-beam computed tomography (CT). The aim of this study was to evaluate the usefulness of measurement of aortic atherosclerosis with electron-beam CT as an independent predictor of obstructive coronary artery disease (CAD). MATERIALS AND METHODS: Ninety-seven patients (67 men, 30 women; mean age, 61 years +/- 12) were enrolled and underwent electron-beam CT with and without contrast material. Coronary artery calcification was quantified with nonenhanced electron-beam CT by means of Agatston score. CAD was defined as luminal narrowing of the coronary artery by at least 70%, as measured with electron-beam angiography. Aortic atherosclerosis was quantified by measuring raised lesions of the aortic wall (plaque) and wall thickening (volume and thickness) in the midportion of the descending thoracic aorta (10 contiguous sections), as depicted at contrast material-enhanced CT angiography. RESULTS: Aortic plaque and calcification were detected only in patients who were at least 58 years old. The presence of aortic plaque was predictive of obstructive CAD, independent of coronary artery calcification. The sensitivity of aortic plaque (raised lesions) for obstructive CAD was 89% in patients at least 58 years old, and the specificity was 63%. Aortic calcification had a sensitivity of 56% and a specificity of 72% for diagnosis of obstructive CAD. CONCLUSION: This study demonstrated that aortic plaque detected with contrast-enhanced electron-beam CT was a more consistent predictor of obstructive CAD than other independent aortic variables. Aortic calcification depicted on nonenhanced CT images was highly specific for obstructive CAD. 相似文献
19.
Christian?Tesche Carlo?N.?De Cecco Andrew?Stubenrauch Brian?E.?Jacobs Akos?Varga-Szemes Sheldon?E.?Litwin B. Devon?Ball Moritz?Baquet David?Jochheim Ullrich?Ebersberger Richard?R.?Bayernd Ellen?Hoffmann Daniel?H.?Steinberg U. Joseph?Schoepf 《La Radiologia medica》2017,122(2):113-120
Objective
To evaluate the correlation between aortic root calcification (ARC) markers and coronary artery calcification (CAC) derived from coronary artery calcium scoring (CACS) and their ability to predict obstructive coronary artery disease (CAD).Methods
We retrospectively analyzed 189 patients (47% male, age 60.3 ± 11.1 years) with an intermediate probability of CAD who underwent clinically indicated CACS and coronary CT angiography (CCTA). ARC markers [aortic root calcium score (ARCS) and volume (ARCV)] were calculated and compared to CAC markers: coronary artery calcium score (CACS), volume (CACV), and mass (CACM). CCTA datasets were visually evaluated for significant CAD (stenosis ≥ 50%) and the ability of ARC markers to predict obstructive CAD was assessed.Results
ARCS (mean 67.7 ± 189.5) and ARCV (mean 67.3 ± 184.7) showed significant differences between patients with and without CAC (109.4 ± 238.6 vs 9.42 ± 31.4, p < 0.0001; 108.5 ± 232.4 vs 9.9 ± 30.5, p < 0.0001). A strong correlation was found for ARCS and ARCV with CACS, CACM, and CACV (all p < 0.0001). In a multivariate analysis, ARCS (OR 1.09, p = 0.033) and ARCV (OR 1.12, p = 0.046) were independent markers for CAC. Using a receiver-operating characteristics analysis, the AUC to detect severe CAC was 0.71 (p < 0.0001) and 0.71 (p < 0.0001) for ARCS and ARCV, respectively. ARCS (0.67, p < 0.0001) and ARCV (0.68, p < 0.0001) showed discriminatory power for predicting obstructive CAD, yielding sensitivities 61 and 78% and specificities of 62 and 80%, respectively.Conclusion
ARC markers are associated with and independently predict the presence of CAC and obstructive CAD. Further testing is required in patients with severe ARC and significant CAD in order to reliably obtain these markers from thoracic-CT or X-ray for proper risk classification.20.
John H. Shin MD Hemlata K. Pokharna PhD Kim A. Williams MD Rupa Mehta MD R. Parker Ward MD 《Journal of nuclear cardiology》2009,16(4):590-596
Background Recent evidence suggests that combining supine and prone acquisitions during stress-gated SPECT myocardial perfusion imaging
(MPS) improves detection of obstructive coronary artery disease (CAD), though the additional imaging time required may not
be feasible in routine clinical practice. MPS with prone-only acquisitions is occasionally performed in many laboratories,
though little is known about the ability of modern MPS with prone-only acquisitions to detect obstructive CAD. Our goal was
to assess the ability of MPS with prone-only acquisitions to detect obstructive CAD as determined by coronary angiography.
Methods and Results We studied 386 patients referred for MPS with either recent coronary angiography or a low pretest likelihood of coronary artery
disease. All rest and stress images were obtained exclusively in the prone position. The sensitivity of prone-only MPS was
88% for detecting ≥50% coronary artery stenosis and 92% for detecting ≥70% coronary artery stenosis as determined by coronary
angiography. Normalcy rate for prone-only MPS in patients with low probability for CAD was 95%, and normalcy rates did not
significantly differ among coronary artery distributions.
Conclusions The findings of this study suggest that MPS using prone-only acquisitions is a reasonable diagnostic option for the detection
of ischemia due to obstructive coronary artery disease. 相似文献