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1.
Neurol India ; 69(4): 916-922, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34507412

RESUMO

Background: Coronary artery disease (CAD) and ischemic stroke share the same risk factors. Objective: The aim of the study was to explore the prevalence and predictors of concomitant CAD in acute ischemic stroke patients. Methods: One hundred and five patients (64.3 ± 15.0 years, 61 male) presenting with acute ischemic stroke documented by neuroimaging were consecutively included. All patients were carefully evaluated to determine their cardiovascular disease risk scores. The patients who had been previously shown to have ≥50% stenosis in at least one of the major coronary arteries by coronary angiography were grouped as CAD patients. Results: Of the 105 stroke patients, 27 patients had documented concomitant CAD. The stroke patients with CAD had higher cardiovascular risk scores and troponin I levels and carotid plaques were more prevalent. ROC analysis determined cut-off values as ≥22% for Framingham Heart Study Risk Score, ≥0.05 ng/mL for Troponin I, and ≥0.80 mm for carotid artery intima-media thickness to predict concomitant CAD. During 6 months of follow-up, among the 78 stroke patients without documented CAD, 16 patients had experienced major cardiovascular events including myocardial infarction, recurrent stroke, or cardiovascular death. These patients had higher Framingham Heart Study Risk Score and high-sensitive C reactive protein levels. Conclusion: Our study suggests stroke patients with higher Framingham Heart Study Risk Score and troponin I levels and carotid plaques be further investigated for the presence of concomitant CAD.


Assuntos
Isquemia Encefálica , Doença da Artéria Coronariana , AVC Isquêmico , Acidente Vascular Cerebral , Isquemia Encefálica/complicações , Isquemia Encefálica/epidemiologia , Espessura Intima-Media Carotídea , Angiografia Coronária , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Humanos , Masculino , Prognóstico , Fatores de Risco , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/epidemiologia
2.
J Assoc Physicians India ; 69(8): 11-12, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34472803

RESUMO

BACKGROUND: Family history of premature coronary artery disease as a risk factor in first degree relatives has been well established by various studies. This study aims at identification and assessment of the presence of risk factors in asymptomatic siblings of patients with documented premature coronary artery disease. Prevalence of Systemic Hypertension in siblings (both male and female) of patients with premature coronary artery disease (males <45yrs, females <55yrs, confirmed by coronary angiography) was analysed. Other risk factor prevalence estimation was also done which included, dyslipidaemia, diabetes mellitus, tobacco use, alcohol intake, obesity, passive smoke exposure, diet and exercise. The study also estimated the percentage of sibling awareness regarding the risk factors for cardiovascular disease. MATERIALS AND METHODS: This was a cross sectional study where all patients (both In and Out patient), visiting Amrita Institute of Medical Sciences, Kochi and diagnosed as having angiographically proven Premature Coronary Artery Disease from December 2014 to June 2016 were identified and risk factor screening was done for both male and female siblings of any age of these patients. Laboratory tests included fasting blood sugar and fasting lipid profile were analysed after sample collection. RESULTS: 47.6% of male siblings and 35.7% of female siblings were found to be hypertensive, 17.3% of the male siblings and 18.7% of the female siblings were found to have abnormal levels of LDL cholesterol, 22.7% of male siblings and female siblings were found to have abnormal fasting plasma sugar levels, 30.5% of male siblings and 20% of male siblings were found to be overweight. 19.1% of male siblings and 21.4% of female siblings were found to be obese. Only 18.1% of male siblings and 5.7% of female siblings performed any kind of exercise on a regular basis. Among male siblings, 21.9% of male siblings were currently using tobacco in some form. Among non-smokers in both sexes, as many as 36% were exposed to some form of passive smoke. Almost half of the male siblings (49.5%) consumed alcohol containing beverages on a regular basis. CONCLUSIONS: Previously undetected risk factors were found to be highly prevalent among the studied siblings. Significant number of siblings were was found to be hypertensive and in addition some had elevated fasting blood sugar levels. Other modifiable risk factors like obesity, alcohol consumption, tobacco use, passive smoking and lack of exercise were also found to be widely prevalent. An important aspect that the study highlighted is the widespread lack of awareness in the study population about risk factors for disease.


Assuntos
Doença da Artéria Coronariana , Irmãos , LDL-Colesterol , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Fatores de Risco
3.
Saudi Med J ; 42(8): 895-902, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34344814

RESUMO

OBJECTIVES: To determine the clinical and coronary angiographic characteristics of patients with coronary artery disease (CAD) and the patterns and determinants of CAD treatment in Kingdom of Saudi Arabia (KSA). METHODS: We conducted a cross-sectional study including 242 patients at 3 hospitals in KSA between June 2018 and June 2019. We included all patients aged ≥18 years diagnosed with CAD on angiography. We carried out a multinomial logistic regression to ascertain the determinants of treatment patterns and treatment modalities. Covariates for this multivariate analysis were selected based on univariate regressions. RESULTS: The study population had a mean ± standard deviation of 58.3 ± 11.8 years, and 66.1% were male. The most frequent cardiovascular risk factor was diabetes (58.7%). Lesions involving the left anterior descending were reported among 68.6%, left circumflex among 51.2%, and right coronary arteries (RCA) among 48.8% of our patients. The most common treatment was the best medical therapy (lifestyle modifications and medical management), prescribed to 69.8% of patients. Patients aged ≤60 years with the left main disease or disease of the ramus had a higher likelihood of undergoing coronary artery bypass grafting (CABG). Contrarily, patients with RCA lesions were more likely to undergo a percutaneous coronary intervention (PCI). CONCLUSION: Patient age and anatomical localization of coronary atherosclerotic lesions were the main determinants of treatment with CABG or PCI.


Assuntos
Doença da Artéria Coronariana , Intervenção Coronária Percutânea , Adolescente , Adulto , Ponte de Artéria Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/terapia , Estudos Transversais , Humanos , Masculino , Fatores de Risco , Arábia Saudita/epidemiologia , Resultado do Tratamento
4.
J Forensic Leg Med ; 82: 102227, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34403966

RESUMO

About two-thirds of sudden deaths are sudden cardiac deaths (SCD), and ischemic heart disease (IHD) accounts for 60% of these. Although an autopsy needs to be performed to prove SCD, the forensic autopsy rate is very low in Japan. To diagnose the cause of death, postmortem computed tomography (PMCT) is often performed. Because coronary artery calcification (CAC) is a risk factor in cardiac diseases such as IHD and its severity can be evaluated with CT, we examined its ability to diagnose SCD. We collected 104 autopsy cases with CT scans. On the basis of the autopsy report, we separated the cases into two groups: SCD suspected as the cause of death and SCD not suspected. We calculated each CAC severity with the Agatston score from the CT images. Cases with Agatston scores of more than 400 were labeled as severe. The relationship between SCD and CAC severity was confirmed with Fisher's exact test (p < 0.05). The sensitivity and specificity of CAC severity for SCD were 20.3% and 97.5%, respectively, and the positive likelihood ratio was 8.1. Severe CAC can increase the probability of SCD. In cases in which only PMCT can be performed, this finding can be helpful for diagnosing SCD.


Assuntos
Calcinose/diagnóstico por imagem , Doença da Artéria Coronariana/diagnóstico por imagem , Morte Súbita Cardíaca/etiologia , Artropatias/diagnóstico por imagem , Doenças Vasculares/diagnóstico por imagem , Adulto , Idoso , Autopsia , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X
5.
Pol Merkur Lekarski ; 49(292): 278-282, 2021 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-34464368

RESUMO

Epidemiological data on serum vitamin D levels in the population of Polish patients with angiographically confirmed coronary artery disease are limited. AIM: The aim of the study was to prospectively assess the concentrations of vitamin D in a group of patients from the Cardiological Department in Bielanski Hospital in Warsaw referred for coronary angiography due to suspected coronary artery disease. MATERIALS AND METHODS: The study included a total of 1,043 qualified patients (374 women and 669 men, age: 66,9±11,0 years) who underwent coronary angiography between the years of 2013 and 2017. Plasma 25(OH)D concentrations were assessed by electrochemiluminescence. RESULTS: The median 25(OH)D concentration in the study group was 15.2 ng/ml (range: 4.0 - 55.0 ng/ml). Optimal 25(OH)D concentrations (ie., equal to or greater than 30 ng/ml) were found in 64 patients (6%). Severe deficiencies (less than 10 ng/ml) were found in 229 patients (22%). Moderate deficiencies (concentration equal to or greater than 10 ng/ml and less than 20 ng/ml) and mild deficiencies (concentration equal to or greater than 20 ng/ml and less than 30 ng/ml) were observed in 525 (50%) and 225 patients (22%), respectively. CONCLUSIONS: Vitamin D deficiency was found in 94% of residents of central Poland with angiographically confirmed coronary artery disease. 22% of patients had a severe vitamin D deficiency. Due to the documented effects of vitamin D on the cardiovascular system and the fact that cardiovascular disease (including coronary artery disease) is still the most common cause of death in developed countries, prophylactic and therapeutic strategies should be considered to combat 25(OH)D deficiency in this group of Polish patients.


Assuntos
Doença da Artéria Coronariana , Deficiência de Vitamina D , Idoso , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polônia/epidemiologia , Vitamina D , Deficiência de Vitamina D/epidemiologia
6.
Pan Afr Med J ; 38: 362, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34367441

RESUMO

Introduction: atherosclerosis could be a sequela of long-term activation of cell-mediated immunity as the case of latent tuberculosis infection. Atherosclerosis is the main pathological event in ischemic heart disease. The present study aimed to assess the prevalence of Latent tuberculosis infection (LTBI) among patients with ischemic heart disease (IHD) and to detect the association between both diseases. Methods: this cross-sectional study included 98 patients with a history of previously diagnosed ischemic heart disease who did a multi-detector computed tomography coronary angiogram (MDCTCA). Detailed clinical examination and investigations as chest X-ray and sputum examination were done for those with positive QuantiFERON-TB Gold test (QFT) to exclude active tuberculosis (TB). Participants having positive QFT results but with no evidence of active TB were considered as LTBI positive. Results: the prevalence of LTBI in patients with IHD was 19.3% as only nineteen of the ninety-eight patients were diagnosed with latent tuberculosis infection using the QuantiFERON serum test. Eighty-four percent (84.2%) of patients with LTBI had coronary artery atherosclerosis (CAA) compared to only 55.6% in patients without LTBI with a statistically significant difference. In multivariable analysis, Diabetes Mellitus (DM) (AOR 0.179, 95% C.I.: 0.03-0.967), and LTBI (AOR 1.024, 95% C.I.: 1.002-1.736) were significantly associated with coronary artery atherosclerosis (p=0.0001, and p= 0.003 respectively). Conclusion: the prevalence of latent tuberculosis infection among patients with ischemic heart diseases is high. Among different factors that are already well known to precipitate ischemic heart disease, latent tuberculosis should be considered.


Assuntos
Doença da Artéria Coronariana/epidemiologia , Tuberculose Latente/epidemiologia , Isquemia Miocárdica/epidemiologia , Adulto , Idoso , Angiografia por Tomografia Computadorizada , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/etiologia , Estudos Transversais , Feminino , Humanos , Tuberculose Latente/diagnóstico , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Isquemia Miocárdica/diagnóstico por imagem , Isquemia Miocárdica/etiologia , Prevalência , Fatores de Risco , Arábia Saudita
7.
Medicina (Kaunas) ; 57(8)2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34441013

RESUMO

Background and Objectives: There are limited data on the association between severity of non-alcoholic fatty liver disease (NAFLD) and coronary artery calcification. This study investigated sonographic diagnosed NAFLD and coronary artery calcium score (CAC) as detected by cardiac multidetector computed tomography in general populations. Materials and Methods: A total of 545 patients were enrolled in this study. NAFLD was diagnosed by ultrasonography examination and CAC score were evaluated by cardiac multidetector computed tomography. The association between NAFLD and artery calcium score stage was determined by logistic regression analysis and Spearman correlation coefficient analysis. Results: Of all the participants, 437 (80.2%) had ultrasonography-diagnosed NAFLD and 242 (44%) had coronary artery calcification (CAC > 0). After adjustment for cardiovascular risk factors, the risk of developing coronary artery calcification was 1.36-fold greater in the patients with different severity of NAFLD compared to those without NAFLD (OR = 1.36, 95% CI = 1.07-1.77, p = 0.016). The highest OR for separate coronary artery calcification was 1.98 (OR = 1.98, 95% CI = 1.37-2.87, p < 0.001) in the left main artery, and the risk was still 1.71-fold greater after adjustments (OR = 1.71, 95% CI = 1.16-2.54, p = 0.007). Conclusions: This cross-sectional study demonstrated that the severity of NAFLD was associated with the presence of significant coronary artery calcification, especially in the left main coronary artery, suggesting increasing the cardiovascular risk.


Assuntos
Doença da Artéria Coronariana , Hepatopatia Gordurosa não Alcoólica , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/etiologia , Estudos Transversais , Humanos , Hepatopatia Gordurosa não Alcoólica/complicações , Hepatopatia Gordurosa não Alcoólica/diagnóstico por imagem , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Fatores de Risco , Ultrassonografia
8.
J Appl Clin Med Phys ; 22(9): 307-312, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34375023

RESUMO

OBJECTIVES: The area detector 320-row CT scanner, which can cover the whole heart in one rotation, can aid in reducing radiation exposure during electrocardiography (ECG)-gated coronary CT angiography (CCTA). Recently, researchers have proposed dose-modulated dynamic CCTA with a 320-row scanner for the detection of functional myocardial ischemia. In the present study, we compared and validated the radiation dose of this method with that of the standard CCTA method and the latest diagnostic reference levels (DRLs). MATERIALS AND METHODS: The study included a total of 164 consecutive patients with suspected or known coronary artery disease (CAD) who underwent CCTA with a 320-row scanner. The patients were randomly divided into dynamic and standard CCTA groups, and the CT dose index (CTDIvol) and dose length product (DLP) calculated by the CT system were compared between the two protocols and with the latest DRL. RESULTS: Standard and dynamic CCTA scans were performed in 77 and 87 patients, respectively. CTDIvol was significantly higher for standard CCTA than for dynamic CCTA (41 ± 35 mGy vs. 22 ± 7 mGy, p = 0.0014). DLP was also significantly higher for standard CCTA than for dynamic CCTA (864 ± 702 mGy × cm vs. 434 ± 106 mGy × cm, p < .0001). For standard scans, CTDIvol and DLP exceeded the 2020 DRL in Japan in 16% (12/77) and 17% (13/77) of cases, respectively. In contrast, rates for the dynamic scan were only 1% (1/87) for CTDIvol and 0% (0/87) for DLP. CONCLUSION: The dose of radiation exposure during dynamic CCTA with a 320-row scanner does not exceed that of standard CCTA and is sufficient to meet the latest DRL. Thus, our results suggest that the method is safe from the perspective of radiation exposure.


Assuntos
Angiografia por Tomografia Computadorizada , Doença da Artéria Coronariana , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Humanos , Doses de Radiação , Tomografia Computadorizada por Raios X
9.
Medicine (Baltimore) ; 100(30): e26761, 2021 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-34397720

RESUMO

ABSTRACT: Cystatin C is associated with atherosclerosis, but the relationship between cystatin C and coronary artery calcification (CAC) is uncertain. The purpose of this study was to evaluate the predictive value of cystatin C on the occurrence and severity of CAC.A total of 1447 hospitalized patients with coronary computed tomography angiography were selected in this study. According to the CAC score (CACS), patients were divided into calcification group (with CAC, n = 749) and control group (without CAC, n = 698). The calcification group was further divided into low calcification group (CACS < 100, n = 407), medium calcification group (CACS 100-400, n = 203), and high calcification group (CACS≥400, n = 139).Patients with CAC had higher cystatin C level than those in control group (P < .05). With the increase of calcification score, the cystatin C level showed an upward trend. The cystatin C level in the high calcification group was significantly higher than those in the low and medium calcification group (P < .05). ROC curve analysis showed that cystatin C had a high predictive value for the occurrence of CAC [area under the curve 0.640, 95% confidence interval (95% CI) 0.591-0.690, cut-off value 0.945 mg/L, sensitivity 0.683, specificity 0.558, P < .05] and severe CAC (area under the curve 0.638, 95% CI 0.550-0.762, cut-off value 0.965 mg/L, sensitivity 0.865, specificity 0.398, P < .05). Multivariate logistic regression analysis showed that cystatin C was an independent predictor of severe CAC (AOR 3.748, 95% CI 1.138-10.044, P < .05).Cystatin C was significantly associated with the occurrence and severity of CAC, suggesting that cystatin C had the potential as a predictor of CAC.


Assuntos
Calcinose/sangue , Doença da Artéria Coronariana/sangue , Cistatina C/sangue , Idoso , Calcinose/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Doença da Artéria Coronariana/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Estudos Retrospectivos
11.
J Int Med Res ; 49(8): 3000605211033177, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34382462

RESUMO

Contrast-induced nephropathy (CIN) is the impairment of kidney function defined as a serum creatinine increase of 25% or 44 µmol/L compared with baseline, usually occurring 24 to 48 hours after the use of intravenous contrast. Important risk factors for CIN include female sex, advanced age (>65 years), type 2 diabetes (T2D), kidney disease, advanced heart failure, and intravascular volume depletion. We herein present a male patient with T2D, moderately reduced renal function, no albuminuria, and a positive echocardiography stress test. He underwent percutaneous coronary intervention (PCI), and two drug-eluting stents (in the left anterior descending coronary artery) and three bare-metal stents (in the right coronary artery) were implanted. Despite adequate rehydration (0.9% intravenous NaCl with 8.4% sodium bicarbonate) before and after the procedures, he developed irreversible kidney injury after coronary angiography and PCI. This case report demonstrates the unpredictable clinical course of CIN. Patients with T2D are at high risk for the occurrence of CIN, so careful clinical assessment is recommended with global renal functional reserve evaluation.


Assuntos
Doença da Artéria Coronariana , Diabetes Mellitus Tipo 2 , Nefropatias , Intervenção Coronária Percutânea , Idoso , Meios de Contraste/efeitos adversos , Angiografia Coronária , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Creatinina , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Feminino , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco
12.
Nan Fang Yi Ke Da Xue Xue Bao ; 41(7): 988-994, 2021 Jul 20.
Artigo em Chinês | MEDLINE | ID: mdl-34308847

RESUMO

OBJECTIVE: To investigate the combined value of coronary computed tomography angiography (CCTA) indicators and perivascular fat attenuation index (FAI) in predicting hemodynamically significant coronary artery disease. METHODS: We retrospectively analyzed the data of patients undergoing CCTA in Chinese PLA General Hospital from 2017 to 2019, who were also examined for fractional flow reserve (FFR) with invasive coronary angiography within one month before inclusion. The CCTA indicators at the vascular level were measured, including plaque distribution, coronary artery calcification score, lesion length, maximum diameter stenosis, maximum area stenosis (MAS), total plaque burden (TPB), perivascular FAI, and CT-FFR based on machine learning. Lesion-specific hemodynamically significant coronary artery disease was diagnosed for an invasive FFR≤0.8. RESULTS: A total of 99 patients with 124 involved coronary arteries were included in this analysis. At the vascular level, according to the results of invasive FFR, coronary artery calcification score, maximum diameter stenosis, MAS and the total plaque burden were significantly higher in patents with a FFR≤0.8 than in those with a FFR>0.8; the perivascular FAI (P < 0.01) and CT-FFR (P < 0.01) also differed significantly between the two groups. The AUC of MAS combined with perivascular FAI was 0.818, which was not significantly different from that of CT-FFR (P=0.076). CONCLUSION: The combination of MAS and perivascular FAI has good diagnostic performance in predicting hemodynamically significant coronary stenosis, which is comparable with that of CT-FFR.


Assuntos
Doença da Artéria Coronariana , Estenose Coronária , Reserva Fracionada de Fluxo Miocárdico , Tecido Adiposo , Constrição Patológica , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Humanos , Valor Preditivo dos Testes , Estudos Retrospectivos , Índice de Gravidade de Doença
13.
J Card Surg ; 36(10): 3892-3897, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34216393

RESUMO

We present here a case of a symptomatic chest injury with a nail gun causing a delayed occurrence of coronary artery fistula to the left pulmonary artery presenting with unstable angina 4 years after the initial injury, three of which were symptom-free. The patient underwent successful surgical closure of the fistula and removal of the foreign body.


Assuntos
Fístula Artério-Arterial , Doença da Artéria Coronariana , Fístula , Cardiopatias Congênitas , Traumatismos Torácicos , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Humanos , Traumatismos Torácicos/complicações , Traumatismos Torácicos/cirurgia
14.
Eur J Radiol ; 142: 109835, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34237493

RESUMO

OBJECTIVES: To investigate the effect of reader experience, calcification and image quality on the performance of deep learning (DL) powered coronary CT angiography (CCTA) in automatically detecting obstructive coronary artery disease (CAD) with invasive coronary angiography (ICA) as reference standard. METHODS: A total of 165 patients (680 vessels and 1505 segments) were included in this study. Three sessions were performed in order: (1) The artificial intelligence (AI) software automatically processed CCTA images, stenosis degree and processing time were recorded for each case; (2) Six cardiovascular radiologists with different experiences (low/ intermediate/ high experience) independently performed image post-processing and interpretation of CCTA, (3) AI + human reading was performed. Luminal stenosis ≥50% was defined as obstructive CAD in ICA and CCTA. Diagnostic performances of AI, human reading and AI + human reading were evaluated and compared on a per-patient, per-vessel and per-segment basis with ICA as reference standard. The effects of calcification and image quality on the diagnostic performance were also studied. RESULTS: The average post-processing and interpretation times of AI was 2.3 ± 0.6 min per case, reduced by 76%, 72%, 69% compared with low/ intermediate/ high experience readers (all P < 0.001), respectively. On a per-patient, per-vessel and per-segment basis, with ICA as reference method, the AI overall diagnostic sensitivity for detecting obstructive CAD were 90.5%, 81.4%, 72.9%, the specificity was 82.3%, 93.9%, 95.0%, with the corresponding areas under the curve (AUCs) of 0.90, 0.90, 0.87, respectively. Compared to human readers, the diagnostic performance of AI was higher than that of low experience readers (all P < 0.001). The diagnostic performance of AI + human reading was higher than human reading alone, and AI + human readers' ability to correctly reclassify obstructive CAD was also improved, especially for low experience readers (Per-patient, the net reclassification improvement (NRI) = 0.085; per-vessel, NRI = 0.070; and per-segment, NRI = 0.068, all P < 0.001). The diagnostic performance of AI was not significantly affected by calcification and image quality (all P > 0.05). CONCLUSIONS: AI can substantially shorten the post-processing time, while AI + human reading model can significantly improve the diagnostic performance compared with human readers, especially for inexperienced readers, regardless of calcification severity and image quality.


Assuntos
Doença da Artéria Coronariana , Estenose Coronária , Aprendizado Profundo , Inteligência Artificial , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Humanos , Valor Preditivo dos Testes
16.
BMJ Open Respir Res ; 8(1)2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34272254

RESUMO

BACKGROUND: Although several studies have reported an association between atherosclerosis-related diseases and COVID-19, the relationship between COVID-19 severity and atherosclerosis progression remains unclear. The aim of this study is to determine the coronary artery calcium score (CACS) prognostic value in patients with COVID-19 using indices such as deterioration in oxygenation and CT images of the chest. METHODS: This was a single-centre retrospective study of 53 consecutive patients with COVID-19 in Narita who were admitted to our hospital between March 2020 and August 2020. CACS was calculated based on non-gated CT scans of the chest performed on admission day. The patients were divided into the following two groups based on CACS: group 1 (CACS ≥180, n=11) and group 2 (CACS <180, n=42). Following univariate analysis of the main variables, multivariate analysis of variables that may be associated with COVID-19 progression was performed. RESULTS: Multivariable logistic regression analysis of age, sex, smoking history, diabetes, hypertension, dyslipidaemia, number of days from symptom onset to hospitalisation and CACS of ≥180 was performed. It revealed that unlike CACS of <180, CACS of ≥180 is associated with exacerbation of oxygenation or CT images of the chest during hospitalisation (OR: 12.879, 95% CI: 1.399 to 380.401). Furthermore, this model of eight variables showed good calibration (Hosmer-Lemeshow p=0.119). CONCLUSION: CACS may be a prognosis marker of COVID-19 severity. Although coronary artery calcification is not typically assessed in pneumonia cases, it may provide a valuable clinical indicator for predicting severe COVID-19 outcomes.


Assuntos
COVID-19/fisiopatologia , Doença da Artéria Coronariana/diagnóstico por imagem , Calcificação Vascular/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , Doença da Artéria Coronariana/epidemiologia , Diabetes Mellitus/epidemiologia , Progressão da Doença , Dislipidemias/epidemiologia , Feminino , Hospitalização , Humanos , Hipertensão/epidemiologia , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Estudos Retrospectivos , SARS-CoV-2 , Índice de Gravidade de Doença , Fatores Sexuais , Fumar/epidemiologia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Calcificação Vascular/epidemiologia
17.
PLoS One ; 16(7): e0255045, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34288966

RESUMO

PURPOSE: Cardiovascular comorbidity anticipates severe progression of COVID-19 and becomes evident by coronary artery calcification (CAC) on low-dose chest computed tomography (LDCT). The purpose of this study was to predict a patient's obligation of intensive care treatment by evaluating the coronary calcium burden on the initial diagnostic LDCT. METHODS: Eighty-nine consecutive patients with parallel LDCT and positive RT-PCR for SARS-CoV-2 were included from three centers. The primary endpoint was admission to ICU, tracheal intubation, or death in the 22-day follow-up period. CAC burden was represented by the Agatston score. Multivariate logistic regression was modeled for prediction of the primary endpoint by the independent variables "Agatston score > 0", as well as the CT lung involvement score, patient sex, age, clinical predictors of severe COVID-19 progression (history of hypertension, diabetes, prior cardiovascular event, active smoking, or hyperlipidemia), and laboratory parameters (creatinine, C-reactive protein, leucocyte, as well as thrombocyte counts, relative lymphocyte count, d-dimer, and lactate dehydrogenase levels). RESULTS: After excluding multicollinearity, "Agatston score >0" was an independent regressor within multivariate analysis for prediction of the primary endpoint (p<0.01). Further independent regressors were creatinine (p = 0.02) and leucocyte count (p = 0.04). The Agatston score was significantly higher for COVID-19 cases which completed the primary endpoint (64.2 [interquartile range 1.7-409.4] vs. 0 [interquartile range 0-0]). CONCLUSION: CAC scoring on LDCT might help to predict future obligation of intensive care treatment at the day of patient admission to the hospital.


Assuntos
COVID-19/complicações , Calcinose/complicações , Calcinose/diagnóstico por imagem , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Progressão da Doença , Radiografia Torácica , COVID-19/diagnóstico , COVID-19/epidemiologia , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Pandemias , Prognóstico , Doses de Radiação
18.
J Comput Assist Tomogr ; 45(3): 395-402, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34297510

RESUMO

OBJECTIVE: This study aimed to compare the prognostic performance of Coronary Artery Disease (CAD)-Reporting and Data System (CAD-RADS) score with those of clinical risk factors and the extent of CAD classification for predicting major adverse cardiac events in emergency department patients. METHODS: A total of 779 patients with acute chest pain at low to intermediate risk for CAD underwent cardiac computed tomography angiography. The primary end point was early and late major adverse cardiac events. We developed the following models: model 1, clinical risk factors; model 2, clinical risk factors and CAD-RADS scores; model 3, clinical risk factors and extent of CAD. RESULTS: The C-statistics revealed that both CAD-RADS score and CAD extent improved risk stratification over the clinical risk factors (C-index for early events: C-index: 0.901 vs 0.814 and 0.911 vs 0.814; C-index for late events: 0.897 vs 0.808 and 0.905 vs 0.808; all P < 0.05). CONCLUSIONS: The CAD-RADS score had additional risk prediction benefits over clinical risk factors for emergency department patients.


Assuntos
Dor no Peito/etiologia , Doença da Artéria Coronariana/diagnóstico por imagem , Sistemas de Apoio a Decisões Clínicas , Sistemas de Informação em Radiologia , Adulto , Idoso , Doença da Artéria Coronariana/mortalidade , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Medição de Risco , Fatores de Risco , Tomografia Computadorizada por Raios X
19.
Acad Radiol ; 28(7): 972-979, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34217490

RESUMO

RATIONALE AND OBJECTIVES: We aimed to assess relationship between single-click, whole heart radiomics from low-dose computed tomography (LDCT) for lung cancer screening with coronary artery calcification and stenosis. MATERIALS AND METHODS: The institutional review board-approved, retrospective study included all 106 patients (68 men, 38 women, mean age 64 ± 7 years) who underwent both LDCT for lung cancer screening and had calcium scoring and coronary computed tomography angiography in our institution. We recorded the clinical variables including patients' demographics, smoking history, family history, and lipid profiles. Coronary calcium scores and grading of coronary stenosis were recorded from the radiology information system. We calculated the multiethnic scores for atherosclerosis risk scores to obtain 10-year coronary heart disease (MESA 10-Y CHD) risk of cardiovascular disease for all patients. Deidentified LDCT exams were exported to a Radiomics prototype for automatic heart segmentation, and derivation of radiomics. Data were analyzed using multiple logistic regression and kernel Fisher discriminant analyses. RESULTS: Whole heart radiomics were better than the clinical variables for differentiating subjects with different Agatston scores (≤400 and >400) (area under the curve [AUC] 0.92 vs 0.69). Prediction of coronary stenosis and MESA 10-Y CHD risk was better on whole heart radiomics (AUC:0.86-0.87) than with clinical variables (AUC:0.69-0.79). Addition of clinical variables or visual assessment of coronary calcification from LDCT to whole heart radiomics resulted in a modest change in the AUC. CONCLUSION: Single-click, whole heart radiomics obtained from LDCT for lung cancer screening can differentiate patients with different Agatston and MESA risk scores for cardiovascular diseases.


Assuntos
Doença da Artéria Coronariana , Estenose Coronária , Neoplasias Pulmonares , Calcificação Vascular , Idoso , Constrição Patológica , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/epidemiologia , Vasos Coronários , Detecção Precoce de Câncer , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/epidemiologia
20.
Medicina (Kaunas) ; 57(6)2021 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-34200527

RESUMO

The pathophysiology of accelerated atherosclerosis in people living with Human Immunofediciency virus (HIV) is complex. Coronary artery disease (CAD) has become an important cause of mortality in these patients. They often have atypical symptoms, leading to frequently missed diagnoses. We report a case of a 51-year-old male undergoing antiretroviral therapy who was admitted for acute coronary syndrome. He had severe coronary artery disease that involved difficult management.


Assuntos
Síndrome Coronariana Aguda , Doença da Artéria Coronariana , Infecções por HIV , Ponte de Artéria Coronária , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Resultado do Tratamento
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