The Fallacy of the Power of Zero Villines, Todd C.; Williams, Michelle C.
JACC. Cardiovascular imaging,
June 2022, 2022-Jun, 2022-06-00, 20220601, Letnik:
15, Številka:
6
Journal Article
PET‐MRI of Coronary Artery Disease Whittington, Beth; Dweck, Marc R.; Beek, Edwin J.R. ...
Journal of magnetic resonance imaging,
20/May , Letnik:
57, Številka:
5
Journal Article
Recenzirano
Odprti dostop
Simultaneous positron emission tomography and magnetic resonance imaging (PET‐MRI) combines the anatomical detail and tissue characterization of MRI with the functional information from PET. Within ...the coronary arteries, this hybrid technique can be used to identify biological activity combined with anatomically high‐risk plaque features to better understand the processes underlying coronary atherosclerosis. Furthermore, the downstream effects of coronary artery disease on the myocardium can be characterized by providing information on myocardial perfusion, viability, and function. This review will describe the current capabilities of PET‐MRI in coronary artery disease and discuss the limitations and future directions of this emerging technique.
Level of Evidence
5
Technical Efficacy
Stage 3
Summary
Cancer‐related cognitive impairment (CRCI) is an important clinical problem for cancer patients and survivors. In this review, we summarize studies investigating the occurrence of impaired ...cognition in patients with haematological malignancies. Most published studies focus on survivors of childhood acute lymphoblastic leukaemia and primary central nervous system lymphoma. We also discuss studies conducted in acute myeloid leukaemia, myelodysplastic syndromes, chronic myeloid leukaemia, Hodgkin lymphoma (HL), non‐HL and chronic lymphocytic leukaemia. Although research in this area is still emerging, it appears that a subset of chemotherapy‐treated haematological malignancy survivors experience CRCI. Future research should focus on expanding the literature reviewed here with larger studies appropriately powered to assess cognition via objective and subjective measures in a longitudinal fashion to tease apart the impact of disease and the various forms of cancer treatment.
Lipoprotein(a) Lp(a) is associated with increased risk of myocardial infarction, although the mechanism for this observation remains uncertain.
This study aims to investigate whether Lp(a) is ...associated with adverse plaque progression.
Lp(a) was measured in patients with advanced stable coronary artery disease undergoing coronary computed tomography angiography at baseline and 12 months to assess progression of total, calcific, noncalcific, and low-attenuation plaque (necrotic core) in particular. High Lp(a) was defined as Lp(a) ≥ 70 mg/dL. The relationship of Lp(a) with plaque progression was assessed using linear regression analysis, adjusting for body mass index, segment involvement score, and ASSIGN score (a Scottish cardiovascular risk score comprised of age, sex, smoking, blood pressure, total and high-density lipoprotein HDL-cholesterol, diabetes, rheumatoid arthritis, and deprivation index).
A total of 191 patients (65.9 ± 8.3 years of age; 152 80% male) were included in the analysis, with median Lp(a) values of 100 (range: 82 to 115) mg/dL and 10 (range: 5 to 24) mg/dL in the high and low Lp(a) groups, respectively. At baseline, there was no difference in coronary artery disease severity or plaque burden. Patients with high Lp(a) showed accelerated progression of low-attenuation plaque compared with low Lp(a) patients (26.2 ± 88.4 mm
vs -0.7 ± 50.1 mm
; P = 0.020). Multivariable linear regression analysis confirmed the relation between Lp(a) and low-attenuation plaque volume progression (β = 10.5% increase for each 50 mg/dL Lp(a), 95% CI: 0.7%-20.3%). There was no difference in total, calcific, and noncalcific plaque volume progression.
Among patients with advanced stable coronary artery disease, Lp(a) is associated with accelerated progression of coronary low-attenuation plaque (necrotic core). This may explain the association between Lp(a) and the high residual risk of myocardial infarction, providing support for Lp(a) as a treatment target in atherosclerosis.
Coronary Artery Disease Reporting and Data System (CAD-RADS) was created to standardize reporting system for patients undergoing coronary CT angiography (CCTA) and to guide possible next steps in ...patient management. The goal of this updated 2022 CAD-RADS 2.0 is to improve the initial reporting system for CCTA by considering new technical developments in cardiac CT, including data from recent clinical trials and new clinical guidelines. The updated CAD-RADS classification will follow an established framework of stenosis, plaque burden, and modifiers, which will include assessment of lesion-specific ischemia using CT fractional-flow-reserve (CT-FFR) or myocardial CT perfusion (CTP), when performed. Similar to the method used in the original CAD-RADS version, the determinant for stenosis severity classification will be the most severe coronary artery luminal stenosis on a per-patient basis, ranging from CAD-RADS 0 (zero) for absence of any plaque or stenosis to CAD-RADS 5 indicating the presence of at least one totally occluded coronary artery. Given the increasing data supporting the prognostic relevance of coronary plaque burden, this document will provide various methods to estimate and report total plaque burden. The addition of P1 to P4 descriptors are used to denote increasing categories of plaque burden. The main goal of CAD-RADS, which should always be interpreted together with the impression found in the report, remains to facilitate communication of test results with referring physicians along with suggestions for subsequent patient management. In addition, CAD-RADS will continue to provide a framework of standardization that may benefit education, research, peer-review, artificial intelligence development, clinical trial design, population health and quality assurance with the ultimate goal of improving patient care.
Forget Ischemia: It's All About the Plaque Newby, David E; Williams, Michelle C; Dweck, Marc R
Circulation (New York, N.Y.),
09/2021, Letnik:
144, Številka:
13
Journal Article
Abstract
Background
The capabilities of coronary computed tomography angiography (CCTA) have advanced significantly in the past decade. Its capacity to detect stenotic coronary arteries safely and ...consistently has led to a marked decline in invasive diagnostic angiography. However, CCTA can do much more than identify coronary artery stenoses.
Method
This review discusses applications of CCTA beyond coronary stenosis assessment, focusing in particular on the visual and quantitative analysis of atherosclerotic plaque.
Results
Established signs of visually assessed high-risk plaque on CT include positive remodeling, low-attenuation plaque, spotty calcification, and the napkin-ring sign, which correlate with the histological thin-cap fibroatheroma. Recently, quantification of plaque subtypes has further improved the assessment of coronary plaque on CT. Quantitatively assessed low-attenuation plaque, which correlates with the necrotic core of the thin-cap fibroatheroma, has demonstrated superiority over stenosis severity and coronary calcium score in predicting subsequent myocardial infarction. Current research aims to use radiomic and machine learning methods to further improve our understanding of high-risk atherosclerotic plaque subtypes identified on CCTA.
Conclusion
Despite rapid technological advances in the field of coronary computed tomography angiography, there remains a significant lag in routine clinical practice where use is often limited to lumenography. We summarize some of the most promising techniques that significantly improve the diagnostic and prognostic potential of CCTA.
Key Points:
In addition to its ability to determine severity of luminal stenoses, CCTA provides important prognostic information by evaluating atherosclerotic plaque.
Simple scoring systems such as the segment involved score or the CT-adapted Leaman score can provide more prognostic information on major adverse coronary events compared to traditional risk factors such as presence of hypertension or diabetes.
CT signs of high-risk plaque, including positive remodeling, low-attenuation plaque, spotty calcification, and the napkin-ring sign, are significantly more likely to predict acute coronary syndromes.
Quantitative plaque assessment can provide precise description of volume and burden of plaque subtypes and have been found to predict subsequent myocardial infarction better than cardiovascular risk scores, calcium scoring and severity of coronary artery stenoses.
Machine learning techniques have the potential to automate risk stratification and enhance health economy, even though present clinical applications are limited. In this era of “big data” they are an exciting avenue for future research.
Citation Format
Meah MN, Williams MC. Clinical Relevance of Coronary Computed Tomography Angiography Beyond Coronary Artery Stenosis. Fortschr Röntgenstr 2021; 193: 1162 – 1170
Artificial intelligence (AI) is likely to revolutionize the way medical images are analysed and has the potential to improve the identification and analysis of vulnerable or high-risk atherosclerotic ...plaques in coronary arteries, leading to advances in the treatment of coronary artery disease. However, coronary plaque analysis is challenging owing to cardiac and respiratory motion, as well as the small size of cardiovascular structures. Moreover, the analysis of coronary imaging data is time-consuming, can be performed only by clinicians with dedicated cardiovascular imaging training, and is subject to considerable interreader and intrareader variability. AI has the potential to improve the assessment of images of vulnerable plaque in coronary arteries, but requires robust development, testing and validation. Combining human expertise with AI might facilitate the reliable and valid interpretation of images obtained using CT, MRI, PET, intravascular ultrasonography and optical coherence tomography. In this Roadmap, we review existing evidence on the application of AI to the imaging of vulnerable plaque in coronary arteries and provide consensus recommendations developed by an interdisciplinary group of experts on AI and non-invasive and invasive coronary imaging. We also outline future requirements of AI technology to address bias, uncertainty, explainability and generalizability, which are all essential for the acceptance of AI and its clinical utility in handling the anticipated growing volume of coronary imaging procedures.
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