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ABSTRACT: Diastolic dysfunction (DD) in heart failure is associated with increased myocardial cytosolic calcium and calcium-efflux through the sodium-calcium exchanger depends on the sodium gradient. Beta-3-adrenoceptor (ß3-AR) agonists lower cytosolic sodium and have reversed organ congestion. Accordingly, ß3-AR agonists might improve diastolic function, which we aimed to assess. In a first-in-man, randomized, double-blinded trial, we assigned 70 patients with HF with reduced ejection fraction, New York Heart Association II-III, and left ventricular ejection fraction <40% to receive the ß3-AR agonist mirabegron (300 mg/day) or placebo for 6 months, in addition to recommended heart failure therapy. We performed echocardiography and cardiac computed tomography and measured N-terminal probrain natriuretic peptide at baseline and follow-up. DD was graded per multiple renowned algorithms. Baseline and follow-up data were available in 57 patients (59 ± 11 years, 88% male, 49% ischemic heart disease). No clinically significant changes in diastolic measurements were found within or between the groups by echocardiography (E/e' placebo: 13 ± 7 to 13 ± 5, P = 0.21 vs. mirabegron: 12 ± 6 to 13 ± 8, P = 0.74, between-group follow-up difference 0.2 [95% CI, -3 to 4], P = 0.89) or cardiac computed tomography (left atrial volume index: between-group follow-up difference 9 mL/m 2 [95% CI, -3 to 19], P = 0.15). DD gradings did not change within or between the groups following 2 algorithms ( P = 0.72, P = 0.75). N-terminal probrain natriuretic peptide remained unchanged in both the groups ( P = 0.74, P = 0.64). In patients with HF with reduced ejection fraction, no changes were identified in diastolic measurements, gradings or biomarker after ß3-AR stimulation compared with placebo. The findings add to the previous literature questioning the role of impaired Na + -Ca 2+ -mediated calcium export as a major culprit in DD. NCT01876433.
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Acetanilidas , Agonistas de Receptores Adrenérgicos beta 3 , Insuficiencia Cardíaca , Tiazoles , Función Ventricular Izquierda , Humanos , Masculino , Femenino , Persona de Mediana Edad , Agonistas de Receptores Adrenérgicos beta 3/uso terapéutico , Agonistas de Receptores Adrenérgicos beta 3/efectos adversos , Agonistas de Receptores Adrenérgicos beta 3/farmacología , Anciano , Método Doble Ciego , Tiazoles/uso terapéutico , Tiazoles/administración & dosificación , Tiazoles/farmacología , Tiazoles/efectos adversos , Acetanilidas/uso terapéutico , Acetanilidas/efectos adversos , Acetanilidas/farmacología , Insuficiencia Cardíaca/tratamiento farmacológico , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/metabolismo , Insuficiencia Cardíaca/diagnóstico por imagen , Resultado del Tratamiento , Función Ventricular Izquierda/efectos de los fármacos , Diástole/efectos de los fármacos , Enfermedad Crónica , Volumen Sistólico/efectos de los fármacos , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Factores de Tiempo , EcocardiografíaRESUMEN
BACKGROUND: Coronary atherosclerosis may develop at an early age and remain latent for many years. OBJECTIVE: To define characteristics of subclinical coronary atherosclerosis associated with the development of myocardial infarction. DESIGN: Prospective observational cohort study. SETTING: Copenhagen General Population Study, Denmark. PARTICIPANTS: 9533 asymptomatic persons aged 40 years or older without known ischemic heart disease. MEASUREMENTS: Subclinical coronary atherosclerosis was assessed with coronary computed tomography angiography conducted blinded to treatment and outcomes. Coronary atherosclerosis was characterized according to luminal obstruction (nonobstructive or obstructive [≥50% luminal stenosis]) and extent (nonextensive or extensive [one third or more of the coronary tree]). The primary outcome was myocardial infarction, and the secondary outcome was a composite of death or myocardial infarction. RESULTS: A total of 5114 (54%) persons had no subclinical coronary atherosclerosis, 3483 (36%) had nonobstructive disease, and 936 (10%) had obstructive disease. Within a median follow-up of 3.5 years (range, 0.1 to 8.9 years), 193 persons died and 71 had myocardial infarction. The risk for myocardial infarction was increased in persons with obstructive (adjusted relative risk, 9.19 [95% CI, 4.49 to 18.11]) and extensive (7.65 [CI, 3.53 to 16.57]) disease. The highest risk for myocardial infarction was noted in persons with obstructive-extensive subclinical coronary atherosclerosis (adjusted relative risk, 12.48 [CI, 5.50 to 28.12]) or obstructive-nonextensive (adjusted relative risk, 8.28 [CI, 3.75 to 18.32]). The risk for the composite end point of death or myocardial infarction was increased in persons with extensive disease, regardless of degree of obstruction-for example, nonobstructive-extensive (adjusted relative risk, 2.70 [CI, 1.72 to 4.25]) and obstructive-extensive (adjusted relative risk, 3.15 [CI, 2.05 to 4.83]). LIMITATION: Mostly White persons were studied. CONCLUSION: In asymptomatic persons, subclinical, obstructive coronary atherosclerosis is associated with a more than 8-fold elevated risk for myocardial infarction. PRIMARY FUNDING SOURCE: AP Møller og Hustru Chastine Mc-Kinney Møllers Fond.
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Enfermedad de la Arteria Coronaria , Infarto del Miocardio , Humanos , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/epidemiología , Estudios Prospectivos , Angiografía Coronaria , Infarto del Miocardio/epidemiología , Infarto del Miocardio/complicaciones , Pronóstico , Dinamarca/epidemiología , Factores de RiesgoRESUMEN
BACKGROUND: Non-invasive computed tomography (CT)-derived fractional flow reserve (FFRCT) is computed from standard coronary CT angiography (CTA) datasets and provides accurate vessel-specific ischaemia assessment of coronary artery disease (CAD). To date, the technique and its diagnostic performance has not been verified in the Australian clinical context. The aim of this study was to describe and compare the diagnostic performance of FFRCT and CTA for the detection of vessel-specific ischaemia as determined by invasive fractional flow reserve (FFR) in the Australian patient population. METHODS: One-hundred-and-nine patients (219 vessels) referred for clinically mandated invasive angiography were retrospectively assessed. Each patient underwent research mandated CTA and FFRCT within 3 months of invasive angiography and invasive FFR assessment. Independent core laboratory assessments were made to determine visual CTA stenosis, FFRCT and invasive FFR values. FFRCT values were matched with the corresponding invasive FFR measurement taken at the given wire position. Visual CTA stenosis ≥50%, FFRCT values ≤0.8 and invasive FFR values ≤0.8 were considered significant for ischaemia. RESULTS: Per vessel accuracy, sensitivity, specificity, positive predictive value and negative predictive value of FFRCT were 80.4%, 80.0%, 80.6%, 64.9% and 90.0% respectively. Corresponding values for CTA were 75.1%, 87.1%, 69.2%, 58.1% and 91.7% respectively. In receiver operating characteristic curve analysis, FFRCT demonstrated superior area under the curve (AUC) compared with CTA in both per vessel (0.87 vs 0.77, p=0.004) and per patient analysis (0.86 vs 0.74, p=0.011). Per vessel AUC of combined CTA and FFRCT was superior to CTA alone (0.89 vs 0.77, p<0.0001). CONCLUSION: In this cohort of Australian patients, the diagnostic performance of FFRCT was found to be comparable to existing international literature, with demonstrated improvement in performance compared with CTA alone for the detection of vessel-specific ischaemia.
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Enfermedad de la Arteria Coronaria , Estenosis Coronaria , Reserva del Flujo Fraccional Miocárdico , Australia , Constricción Patológica , Angiografía Coronaria/métodos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Vasos Coronarios/diagnóstico por imagen , Humanos , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X/métodosRESUMEN
OBJECTIVE: To implement detailed EU cardiac computed tomography angiography (CCTA) quality criteria in the multicentre DISCHARGE trial (FP72007-2013, EC-GA 603266), we reviewed image quality and adherence to CCTA protocol and to the recommendations of invasive coronary angiography (ICA) in a pilot study. MATERIALS AND METHODS: From every clinical centre, imaging datasets of three patients per arm were assessed for adherence to the inclusion/exclusion criteria of the pilot study, predefined standards for the CCTA protocol and ICA recommendations, image quality and non-diagnostic (NDX) rate. These parameters were compared via multinomial regression and ANOVA. If a site did not reach the minimum quality level, additional datasets had to be sent before entering into the final accepted database (FADB). RESULTS: We analysed 226 cases (150 CCTA/76 ICA). The inclusion/exclusion criteria were not met by 6 of the 226 (2.7%) datasets. The predefined standard was not met by 13 of 76 ICA datasets (17.1%). This percentage decreased between the initial CCTA database and the FADB (multinomial regression, 53 of 70 vs 17 of 75 [76%] vs [23%]). The signal-to-noise ratio and contrast-to-noise ratio of the FADB did not improve significantly (ANOVA, p = 0.20; p = 0.09). The CTA NDX rate was reduced, but not significantly (initial CCTA database 15 of 70 [21.4%]) and FADB 9 of 75 [12%]; p = 0.13). CONCLUSION: We were able to increase conformity to the inclusion/exclusion criteria and CCTA protocol, improve image quality and decrease the CCTA NDX rate by implementing EU CCTA quality criteria and ICA recommendations. KEY POINTS: ⢠Failure to meet protocol adherence in cardiac CTA was high in the pilot study (77.6%). ⢠Image quality varies between sites and can be improved by feedback given by the core lab. ⢠Conformance with new EU cardiac CT quality criteria might render cardiac CTA findings more consistent and comparable.
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Angiografía por Tomografía Computarizada/métodos , Angiografía Coronaria/métodos , Enfermedad de la Arteria Coronaria/diagnóstico , Vasos Coronarios/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Reproducibilidad de los ResultadosRESUMEN
The original version of this article, published on 16 December 2019, unfortunately contained two mistakes.
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PURPOSE OF REVIEW: To review methodological and logistical aspects of CT myocardial perfusion, current clinical evidence and possible future directions, with specific focus on use in patients with coronary artery disease (CAD). RECENT FINDINGS: CT myocardial perfusion imaging may be performed as an add-on to standard coronary CT angiography (CCTA), to identify regions of myocardial hypoperfusion, at rest and during adenosine stress. The principle of measurement is well-validated in animal experimental models, and CT myocardial perfusion imaging has a high degree of concordance with already clinically available perfusion imaging methods. Combining CCTA and CT myocardial perfusion imaging increases the diagnostic accuracy to identify patients with CAD associated with ischemia. In patients suspected of CAD, CCTA frequently detects coronary atherosclerotic lesions, in which revascularization could be clinically beneficial. CT myocardial perfusion imaging may be helpful to identify coronary lesions associated with myocardial ischemia, and thus potentially suitable for coronary intervention.
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Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Isquemia Miocárdica/diagnóstico por imagen , Imagen de Perfusión Miocárdica/métodos , Tomografía Computarizada por Rayos X/métodos , Adenosina , Angiografía por Tomografía Computarizada , Angiografía Coronaria , Prueba de Esfuerzo , Humanos , VasodilatadoresRESUMEN
AIMS: Patients admitted with chest pain are a diagnostic challenge because the majority does not have coronary artery disease (CAD). Assessment of CAD with coronary computed tomography angiography (CCTA) is safe, cost-effective, and accurate, albeit with a modest specificity. Stress myocardial computed tomography perfusion (CTP) has been shown to increase the specificity when added to CCTA, without lowering the sensitivity. This article describes the design of a randomized controlled trial, CATCH-2, comparing a clinical diagnostic management strategy of CCTA alone against CCTA in combination with CTP. METHODS: Patients with acute-onset chest pain older than 50 years and with at least one cardiovascular risk factor for CAD are being prospectively enrolled to this study from 6 different clinical sites since October 2013. A total of 600 patients will be included. Patients are randomized 1:1 to clinical management based on CCTA or on CCTA in combination with CTP, determining the need for further testing with invasive coronary angiography including measurement of the fractional flow reserve in vessels with coronary artery lesions. Patients are scanned with a 320-row multidetector computed tomography scanner. Decisions to revascularize the patients are taken by the invasive cardiologist independently of the study allocation. The primary end point is the frequency of revascularization. Secondary end points of clinical outcome are also recorded. DISCUSSION: The CATCH-2 will determine whether CCTA in combination with CTP is diagnostically superior to CCTA alone in the management of patients with acute-onset chest pain.
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Dolor en el Pecho/diagnóstico por imagen , Angiografía por Tomografía Computarizada , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Tomografía Computarizada Multidetector , Imagen de Perfusión Miocárdica , Dolor en el Pecho/etiología , Enfermedad de la Arteria Coronaria/complicaciones , Manejo de la Enfermedad , Humanos , Procesamiento de Imagen Asistido por Computador , Imagenología Tridimensional , Sensibilidad y Especificidad , Calcificación Vascular/diagnóstico por imagenRESUMEN
OBJECTIVES: In the recently updated clinical guidelines from the European Society of Cardiology on the management of stable coronary artery disease (CAD), the updated Diamond Forrester score has been included as a pretest probability (PTP) score to select patients for further diagnostic testing. We investigated the validity of the new guidelines in a population of patients with acute-onset chest pain. METHODS: We examined 527 consecutive patients with either an exercise-ECG stress test or single-photon emission computed tomography, and subsequently coronary computed tomography angiography (CCTA). We compared the diagnostic accuracy of PTP and stress testing assessed by the area under the receiver operating characteristic curve (AUC) to identify significant CAD, defined as at least 1 coronary artery branch with >70% diameter stenosis identified by CCTA. RESULTS: The diagnostic accuracy of PTP was significantly higher than the stress test (AUC 0.80 vs. 0.69; p = 0.009), but the diagnostic accuracy of the combination of PTP and a stress test did not significantly increase when compared to PTP alone (AUC 0.86 vs. 0.80; p = 0.06). CONCLUSIONS: PTP using the updated Diamond and Forrester Score is a very useful tool in risk-stratifying patients with acute-onset chest pain at a low-to-intermediate risk of having CAD. Adding a stress test to PTP does not appear to offer significant diagnostic benefit.
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Dolor en el Pecho/diagnóstico , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Estenosis Coronaria/diagnóstico por imagen , Vasos Coronarios/diagnóstico por imagen , Prueba de Esfuerzo , Tomografía Computarizada de Emisión de Fotón Único , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Angiografía Coronaria , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Valor Predictivo de las Pruebas , Curva ROC , Medición de Riesgo , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND: Left atrial volume (LAV) estimation with 3D echocardiography has been shown to be more accurate than 2D volume calculation. However, little is known about the possible effect of respiratory movements on the accuracy of the measurement. METHODS: 100 consecutive patients admitted with chest pain were examined with 3D echocardiography and LAV was quantified during inspiratory breath hold, expiratory breath hold and during free breathing. RESULTS: Of the 100 patients, only 65 had an echocardiographic window that allowed for 3D echocardiography in the entire respiratory cycle. Mean atrial end diastolic volume was 45.4 ± 14.5 during inspiratory breath hold, 46.4 ± 14.8 during expiratory breath hold and 45.6 ± 14.3 during free respiration. Mean end systolic volume was 17.6 ± 7.8 during inspiratory breath hold, 18.8 ± 8.0 during expiratory breath hold and 18.3 ± 8.0 during free respiration. No significant differences were seen in any of the measured parameters. CONCLUSIONS: The present study adds to the feasibility of 3D LAV quantitation. LAV estimation by 3D echocardiography may be performed during either end-expiratory or end-inspiratory breath-hold without any significant difference in the calculated volume. Also, the LAV estimation may be performed during free breathing.
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Artefactos , Ecocardiografía Tridimensional/métodos , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/fisiopatología , Interpretación de Imagen Asistida por Computador/métodos , Mecánica Respiratoria , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Aumento de la Imagen/métodos , Imagenología Tridimensional/métodos , Masculino , Persona de Mediana Edad , Movimiento (Física) , Tamaño de los Órganos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Adulto JovenRESUMEN
A pseudoaneurysm of the native sinus of Valsalva compressing a coronary artery is extremely rare. Herein, the case is reported of infective endocarditis with a pseudoaneurysm of the sinus of Valsalva compressing the right coronary artery as the primary diagnostic finding, and its successful treatment. It is suggested that patients with suspected pseudoaneurysms of the sinus of Valsalva should undergo cardiac computed tomographic angiography for diagnosis of this condition.
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Aneurisma Falso/etiología , Aneurisma de la Aorta/etiología , Válvula Aórtica , Estenosis Coronaria/etiología , Endocarditis Bacteriana/complicaciones , Seno Aórtico , Infecciones Estafilocócicas/complicaciones , Aneurisma Falso/diagnóstico , Aneurisma Falso/microbiología , Aneurisma Falso/terapia , Antibacterianos/uso terapéutico , Aneurisma de la Aorta/diagnóstico , Aneurisma de la Aorta/microbiología , Aneurisma de la Aorta/terapia , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/microbiología , Válvula Aórtica/cirugía , Aortografía/métodos , Angiografía Coronaria/métodos , Estenosis Coronaria/diagnóstico , Estenosis Coronaria/terapia , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/terapia , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Masculino , Seno Aórtico/diagnóstico por imagen , Seno Aórtico/microbiología , Seno Aórtico/cirugía , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/terapia , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Adulto JovenRESUMEN
Background: An anomalous origin of the right coronary artery from pulmonary artery (ARCAPA) is a very rare coronary anomaly. Case summary: A 56-year-old man, presenting haemodynamically unstable due to very rapid atrial fibrillation, was found to have ARCAPA by coronary computed tomography angiography. He had normal left ventricular ejection fraction and without reversible ischaemia on an adenosine stress rubidium positron emission tomography. He was treated solely with betablockers and has been well since. Discussion: Numerous case reports on ARCAPA have previously been published, but no previous reports have found rapid atrial fibrillation to be the primary symptom of presentation. Current evidence level concerning the treatment is low; nevertheless, surgical intervention should always be considered to prevent sudden cardiac death. The patient in this case was offered surgical intervention but declined.
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AIMS: The role of atherosclerosis in the pathogenesis of aortic enlargement is uncertain. We aimed to evaluate the relationship between the diameters of the ascending, descending and abdominal aorta, and coronary artery calcification. METHODS AND RESULTS: Individuals in the Copenhagen General Population Study underwent thoracic and abdominal computed tomography. Maximal aortic diameters were measured in each aortic segment and coronary artery calcium scores (CACS) were calculated. Participants were stratified into five predefined groups according to CACSs and compared to aortic dimensions. The relation between aortic diameter and CACS was adjusted for risk factors for aortic dilatation in a multivariable model. A total of 2678 eligible individuals were included. In all segments of the aorta, aortic diameter was associated to CACSs, with mean increases in aortic diameters ranging from 0.7 to 3.5 mm in individuals with calcified coronary arteries compared to non-calcified subjects (P-value < 0.001). After correction for risk factors, individuals with CACS above 400 had larger ascending, descending and abdominal aortic diameter than the non-calcified reference group (P-value < 0.01). CONCLUSION: Enlarged thoracic and abdominal aortic vascular segments are associated with co-existing coronary artery calcification in the general population.
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Enfermedades de la Aorta , Enfermedad de la Arteria Coronaria , Calcificación Vascular , Aorta Abdominal/diagnóstico por imagen , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/epidemiología , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/epidemiología , Humanos , Factores de Riesgo , Calcificación Vascular/diagnóstico por imagen , Calcificación Vascular/epidemiologíaRESUMEN
BACKGROUND: Dynamic myocardial CT perfusion (CTP) has emerged as a potential strategy to combine anatomical and functional evaluation in a single modality. However, this method results in a high radiation dose. METHODS: Dynamic CTP was performed in 56 patients with suspected or known ischemic heart disease of whom 48 had complete CT-data. Datasets with reduced sampling rate of 2- and 3 RR-intervals (2RR and 3RR) were constructed post hoc. Myocardial blood flow (MBF) estimates from the 2RR and 3RR datasets were compared with estimates based on the full dataset (1RR) using the two one-sided test of equivalence for paired samples. RESULTS: Significant equivalence was found for rest MBFLV (p â< â0.001), stress MBFLV (p â< â0.001) and for the CFRLV (p â= â0.005) when comparing 2RR blood flow estimates with the results based on the 1RR dataset. The 2RR reconstruction protocol led to an estimated reduction in radiation dose of 35.4 â± â3.8%. CONCLUSION: MBF can be quantitated with dynamic CTP using a sampling strategy of one volume for every second heartbeat. This strategy could lead to a significant reduction in radiation dose.
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Enfermedad de la Arteria Coronaria , Imagen de Perfusión Miocárdica , Angiografía por Tomografía Computarizada , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Humanos , Perfusión , Valor Predictivo de las Pruebas , Dosis de Radiación , Tomografía Computarizada por Rayos XRESUMEN
Computed tomography derived fractional flow reserve (FFRCT) and computed tomography stress myocardial perfusion imaging (CTP) are techniques to assess haemodynamic significance of coronary stenosis. To compare the diagnostic performance of FFRCT and static rest/stress CTP in detecting fractional flow reserve (FFR) defined haemodynamically-significant stenosis (FFR ≤ 0.8). Fifty-one patients (96 vessels) with suspected coronary artery disease from a single institution planned for elective invasive-angiography prospectively underwent research indicated 320-detector-CT-coronary-angiography (CTA) and adenosine-stress CTP and invasive FFR. Analyses were performed in separate core-laboratories for FFRCT and CTP blinded to FFR results. Myocardial perfusion was assessed visually and semi-quantitatively by transmural perfusion ratio (TPR). Invasive FFR ≤ 0.8 was present in 33% of vessels and 49% of patients. FFRCT, visual CTP and TPR analysis was feasible in 96%, 92% and 92% of patients respectively. Overall per-vessel sensitivity, specificity and diagnostic accuracy for FFRCT were 81%, 85%, 84%, for visual CTP were 50%, 89%, 75% and for TPR were 69%, 48%, 56% respectively. Receiver-operating-characteristics curve analysis demonstrated larger per vessel area-under-curve (AUC) for FFRCT (0.89) compared with visual CTP (0.70; p < 0.001), TPR (0.58; p < 0.001) and CTA (0.70; p = 0.0007); AUC for CTA + FFRCT (0.91) was higher than CTA + visual CTP (0.77, p = 0.008) and CTA + TPR (0.74, p < 0.001). Per-patient AUC for FFRCT (0.90) was higher than visual CTP (0.69; p = 0.0016), TPR (0.56; p < 0.0001) and CTA (0.68; p = 0.001). Based on this selected cohort of patients FFRCT is superior to visually and semi-quantitatively assessed static rest/stress CTP in detecting haemodynamically-significant coronary stenosis as determined on invasive FFR.
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Angiografía por Tomografía Computarizada , Angiografía Coronaria/métodos , Estenosis Coronaria/diagnóstico por imagen , Vasos Coronarios/diagnóstico por imagen , Reserva del Flujo Fraccional Miocárdico , Hemodinámica , Tomografía Computarizada Multidetector , Imagen de Perfusión Miocárdica/métodos , Adenosina/administración & dosificación , Anciano , Estenosis Coronaria/fisiopatología , Vasos Coronarios/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Reproducibilidad de los Resultados , Índice de Severidad de la Enfermedad , Vasodilatadores/administración & dosificaciónRESUMEN
BACKGROUND: The association between low bone mineral density (BMD) and the presence of coronary artery calcium (CAC) as a marker of atherosclerosis is unclear. The aim of this study was to assess the potential relationship between volumetric thoracic bone mineral density and coronary calcification in a large population of men and women. METHODS: Participants from the Copenhagen General Population Study underwent multidetector computed tomography. Volumetric thoracic BMD and CAC were assessed in the same scan. CAC was measured using calibrated mass score (cMS). cMS was dichotomized as cMSâ¯=â¯0 or cMSâ¯>â¯0. The association between BMD and cMS was analyzed using multiple logistic regression in men, premenopausal and postmenopausal women. The model was adjusted for age, BMI, hypertension, hypercholesterolemia, diabetes, known cardiovascular disease and smoking. RESULTS: Of 2548 eligible participants, 1163 men and 1385 women, mean age 61⯱â¯10 were included in the study. Mean BMD was 138⯱â¯46â¯mg/cm3 for men and 151⯱â¯49â¯mg/cm3 women. In 696 men (67%) and 537 women (41%) cMS was found to be above zero. For men, a decrease in BMD of 100â¯mg/cm3 was associated to an odds ratio of 1.49 for cMSâ¯>â¯0 (95% confidence interval: 1.04-2.13, Pâ¯=â¯0.03). In postmenopausal women, a decrease in BMD of 100â¯mg/cm3 was associated to an odds ratio of 1.47 for MSâ¯>â¯0 (95% confidence interval: 1.04-2.08, Pâ¯=â¯0.03). For premenopausal women, no significant association was found between BMD and cMS (odds ratioâ¯=â¯0.74, 95% confidence interval: 0.36-1.52, Pâ¯=â¯0.4). CONCLUSION: Bone mineral density and coronary calcification are inversely related in both men and postmenopausal women, supporting the hypothesis that a direct relation between bone loss and development of atherosclerosis exists irrespective of gender.
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Aterosclerosis/fisiopatología , Densidad Ósea/fisiología , Enfermedad de la Arteria Coronaria/fisiopatología , Anciano , Aterosclerosis/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Calcificación Vascular/diagnóstico por imagen , Calcificación Vascular/fisiopatologíaRESUMEN
INTRODUCTION: Survival in patients with cyanotic congenital heart disease (CCHD) has improved dramatically. The result is an ageing population with risk of acquired heart disease. Previous small uncontrolled studies suggested that these patients are protected against the development of atherosclerosis. To test this hypothesis, we sought to determine the prevalence of subclinical atherosclerosis in a larger population of patients with CCHD. METHOD: We compared the prevalence of subclinical atherosclerosis in adult CCHD patients from Denmark, Sweden, Norway and Australia, with that in age-, sex-, smoking status-, and body mass index matched controls. Coronary artery atherosclerosis was assessed on computed tomography with coronary artery calcification (CAC) score. Subclinical atherosclerosis was defined by CAC-scoreâ¯>â¯0. Carotid artery atherosclerosis was evaluated using ultrasound by measuring carotid plaque thickness (cPT-max) and carotid intima media thickness (CIMT). Lipid status was evaluated as an important atherosclerotic risk factor. RESULTS: Seventy-four patients with CCHD (57% women, median age 49.5â¯years) and 74 matched controls (57% women, median age 50.0â¯years) were included. There were no differences between the groups in: CAC-scoreâ¯>â¯0 (21% vs. 19%, respectively; pâ¯=â¯0.8), carotid plaques (19% vs. 9%, respectively; pâ¯=â¯0.1), cPT-max (2.3â¯mm vs. 2.8â¯mm, respectively; pâ¯=â¯0.1) or CIMT (0.61â¯mm vs. 0.61â¯mm, respectively; pâ¯=â¯0.98). And further no significant differences in lipoprotein concentrations measured by ultracentrifugation. CONCLUSION: Young adults with CCHD have similar cardiovascular risk factor profiles and measures of subclinical atherosclerosis, compared with controls. Given their increasing life expectancies, athero-preventive strategies should be an important part of their clinical management.
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Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Cianosis/diagnóstico por imagen , Cardiopatías Congénitas/diagnóstico por imagen , Adulto , Anciano , Enfermedades de las Arterias Carótidas/epidemiología , Enfermedad de la Arteria Coronaria/epidemiología , Cianosis/epidemiología , Femenino , Cardiopatías Congénitas/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Adulto JovenRESUMEN
AIMS: Accurate assessment of aortic dimensions can be achieved using contrast-enhanced computed tomography. The aim of this study was to define normal values and determinants of aortic dimensions throughout multiple key anatomical landmarks of the aorta in healthy individuals from the Copenhagen General Population Study. METHODS AND RESULTS: The study group consisted of 902 healthy subjects selected from 3000 adults undergoing cardiovascular thoracic and abdominal computed tomography-angiography (CTA), where systematic measurements of aortic dimensions were performed retrospectively. Individuals included were without any of the following predefined cardiovascular risk factors: (i) self-reported angina pectoris; (ii) hypertension; (iii) hypercholesterolaemia; (iv) taking cardiovascular prescribed medication including diuretics, statins, or aspirin; (v) overweight (defined as body mass index ≥30 kg/m2); (vi) diabetes mellitus (self-reported or blood glucose >8 mmol/L); and (vii) chronic obstructive pulmonary disease. Maximal aortic diameters were measured at seven aortic regions: sinuses of Valsalva, sinotubular junction, ascending aorta, mid-descending aorta, abdominal aorta at the diaphragm, abdominal aorta at the coeliac trunk, and infrarenal abdominal aorta. Median age was 52 years, and 396 (40%) were men. Men had significantly larger aortic diameters at all levels compared with women (P < 0.001). Multivariable analysis revealed that sex, age, and body surface area were associated with increasing aortic dimensions. CONCLUSION: Normal values of maximal aortic dimensions at key aortic anatomical locations by contrast-enhanced CTA have been defined. Age, sex, and body surface area were significantly associated with these measures at all levels of aorta. Aortic dimensions follow an almost identical pattern throughout the vessel regardless of sex.
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Aorta/anatomía & histología , Aorta/diagnóstico por imagen , Tomografía Computarizada Multidetector/métodos , Adulto , Puntos Anatómicos de Referencia , Medios de Contraste , Estudios Transversales , Dinamarca , Femenino , Humanos , Masculino , Persona de Mediana Edad , Interpretación de Imagen Radiográfica Asistida por Computador , Valores de Referencia , Estudios Retrospectivos , Encuestas y Cuestionarios , Ácidos TriyodobenzoicosRESUMEN
Aims: Left ventricular (LV) regional hypertrophy in the form of LV asymmetry is a common finding in patients with aortic valve stenosis. The aim of this study was to test the hypothesis that LV asymmetry predicts future symptomatic status and indication for aortic valve replacement (AVR) in patients with asymptomatic aortic valve stenosis. Methods and results: In total, 114 patients with asymptomatic aortic valve stenosis (peak velocity > 2.5 m/s assessed by echocardiographic screening and LV ejection fraction > 50%) were enrolled in the study. LV asymmetry and LV geometry was assessed by multi-detector computed tomography according to previous definitions. Follow-up was conducted using electronic health records. Event-free survival was assessed using Cox proportional hazards models. Patients were followed for a median of 2.2 years (interquartile range 1.6-3.6). Indication for AVR occurred in 46 patients (40%). Patients with LV asymmetry had more than 3 times the risk of AVR (hazard ratio: 3.16; 95% CI: 1.77-5.66; P < 0.001) compared with patients with no LV asymmetry. Multivariate Cox analysis revealed that LV asymmetry was a predictor of future need of AVR (hazard ratio: 3.10; 95% CI: 1.44-6.65; P = 0.004), independent of LV geometry, jet velocity, valvular calcification, and pro-BNP. Conclusions: LV asymmetry is an independent predictor of future need for AVR in patients with asymptomatic aortic valve stenosis. It has incremental prognostic value to LV geometry and may provide a useful method of risk stratification.
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Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/epidemiología , Hipertrofia Ventricular Izquierda/diagnóstico por imagen , Hipertrofia Ventricular Izquierda/epidemiología , Anciano , Anciano de 80 o más Años , Estenosis de la Válvula Aórtica/fisiopatología , Enfermedades Asintomáticas , Causas de Muerte , Estudios de Cohortes , Comorbilidad , Dinamarca , Ecocardiografía/métodos , Femenino , Hospitales Universitarios , Humanos , Hipertrofia Ventricular Izquierda/fisiopatología , Masculino , Persona de Mediana Edad , Monitoreo Fisiológico , Tomografía Computarizada Multidetector/métodos , Análisis Multivariante , Valor Predictivo de las Pruebas , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Medición de Riesgo , Análisis de SupervivenciaRESUMEN
Aims: To compare the diagnostic performance of a reduced-order computed tomography-derived fractional flow reserve (CT-FFR) technique derived from luminal deformation and static CT stress myocardial perfusion (CTP). Methods and results: Forty-six patients (84 vessels) with suspected coronary artery disease from a single institution planned for elective coronary angiography prospectively underwent research indicated invasive fractional flow reserve (FFR) and 320-detector CT coronary angiography (CTA) and static CTP. Analyses were performed in separate blinded core laboratories for CT-FFR and CTP. CT-FFR was derived using a reduced-order model with dedicated software on a standard desktop computer. CTP was assessed visually and quantitatively by transmural perfusion ratio (TPR). Invasive FFR was significant in 33% (28/84) of vessels. Overall per-vessel sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for CT-FFR were 81%, 84%, 71%, 90%, and 83%, respectively, those of visual CTP were 54%, 92%, 79%, 77%, and 78%, respectively, and TPR were 64%, 48%, 42%, 70%, and 54%, respectively. Per-vessel receiver operator curve analysis demonstrated a significantly larger area under the curve (AUC) for CT-FFR (0.89) with that for visual CTP (0.72; P = 0.016), TPR (0.55; P < 0.0001), and CTA (0.76; P = 0.04). The addition of CT-FFR to CTA provided superior improvement in performance (AUC 0.93; P < 0.0001) compared with CTA alone, a combination of CTA with visual CTP (AUC 0.82; P = 0.007) and CTA with TPR (AUC 0.78; P = 0.0006). Conclusion: Based on this selected cohort of patients, a reduced-order CT-FFR technique is superior to visual and quantitatively assessed static CTP in detecting haemodynamically significant coronary stenosis as assessed by invasive FFR.
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Angiografía por Tomografía Computarizada , Estenosis Coronaria/diagnóstico por imagen , Estenosis Coronaria/fisiopatología , Reserva del Flujo Fraccional Miocárdico , Imagen de Perfusión Miocárdica/métodos , Anciano , Simulación por Computador , Angiografía Coronaria , Estenosis Coronaria/diagnóstico , Prueba de Esfuerzo , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Persona de Mediana Edad , Modelos CardiovascularesRESUMEN
OBJECTIVES: The authors sought to perform a randomized controlled trial to evaluate the clinical efficacy of combined examination with coronary computed tomography angiography (CTA) and computed tomography perfusion imaging (CTP) compared to coronary CTA alone. BACKGROUND: Stress myocardial CTP may increase diagnostic specificity when added to coronary CTA in patients suspected of having ischemic heart disease. METHODS: Patients recently hospitalized for acute-onset chest pain, who had acute coronary syndrome had been ruled out by normal electrocardiograms, normal troponin levels, and relief of symptoms, and who had a clinical indication for outpatient noninvasive testing, were screened for inclusion in the CATCH-2 (CArdiac cT in the treatment of acute CHest pain 2) trial (NCT02014311). Patients were randomized 1:1 to examination with coronary CTA or coronary CTA+CTP. The primary endpoint was the frequency of coronary revascularization among patients referred for invasive coronary angiography (ICA) based on index computed tomography evaluation. Secondary endpoints were invasive procedural complications at index-related ICA, post-index cardiac death, hospital admittance because of recurrence of chest pain, unstable angina pectoris, or acute myocardial infarction, ICA, and revascularization. RESULTS: Among 300 patients allocated to the coronary CTA+CTP group, 41 (14%) were referred for ICA compared with 89 (30%) allocated to coronary CTA (p < 0.0001). The primary endpoint occurred in 50% of coronary CTA+CTP patients versus 48% of invasively examined patients (p = 0.85). The total number of revascularizations was significantly lower in the coronary CTA+CTP group compared to the coronary CTA group (n = 20 [7%] vs. n = 42 [14%]; p = 0.0045). At median follow-up of 1.5 years, the occurrence of secondary endpoints was similar in the 2 groups. CONCLUSIONS: A post-discharge diagnostic strategy of coronary CTA+CTP safely reduces the need for invasive examination and treatment in patients suspected of having ischemic heart disease. (CArdiac cT in the treatment of acute CHest pain 2-Myocardial CT Perfusion [CATCH2]; NCT02014311).