Affective temperaments are documented predictors of psychopathology, but cumulating data suggest their relationship with coronary artery disease (CAD). We aimed to evaluate their role in relation to ...surrogate semiquantitative markers of coronary plaque burden, as assessed by coronary CT angiography (CCTA).BACKGROUNDAffective temperaments are documented predictors of psychopathology, but cumulating data suggest their relationship with coronary artery disease (CAD). We aimed to evaluate their role in relation to surrogate semiquantitative markers of coronary plaque burden, as assessed by coronary CT angiography (CCTA).We included 351 patients who were referred for CCTA due to suspected CAD. All patients completed the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A). The severity and extent of CAD was evaluated by CCTA, applying semiquantitative plaque burden scores, notably Segment Involvement Score (SIS) and Segment Stenosis Score (SSS). Logistic regression analyses were performed to define the predictors of CAD severity and extent.METHODSWe included 351 patients who were referred for CCTA due to suspected CAD. All patients completed the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A). The severity and extent of CAD was evaluated by CCTA, applying semiquantitative plaque burden scores, notably Segment Involvement Score (SIS) and Segment Stenosis Score (SSS). Logistic regression analyses were performed to define the predictors of CAD severity and extent.Regarding the scores evaluated by TEMPS-A that consists of 110 questions, in men, significant inverse association was found between hyperthymic temperament score and SSS (β = -0.143, (95%CI: -0.091 to -0.004), p = 0.034). Compared to the TEMPS-A form, applying the abbreviated version - containing 40 questions - significant relationship between affective temperaments and SSS or SIS was found in case of both sexes. Concerning men, hyperthymic temperament was demonstrated to be independent predictor of both SSS (β = -0.193, (95%CI: -0.224 to -0.048), p = 0.004) and SIS (β = -0.194, (95%CI: -0.202 to -0.038), p = 0.004). Additionally, we proved, that significant positive association between irritable temperament and SSS (β = 0.152, (95%CI: 0.002 to 0.269), p = 0.047) and SIS (β = 0.155, (95%CI: 0.004 to 0.221), p = 0.042) exists among women.RESULTSRegarding the scores evaluated by TEMPS-A that consists of 110 questions, in men, significant inverse association was found between hyperthymic temperament score and SSS (β = -0.143, (95%CI: -0.091 to -0.004), p = 0.034). Compared to the TEMPS-A form, applying the abbreviated version - containing 40 questions - significant relationship between affective temperaments and SSS or SIS was found in case of both sexes. Concerning men, hyperthymic temperament was demonstrated to be independent predictor of both SSS (β = -0.193, (95%CI: -0.224 to -0.048), p = 0.004) and SIS (β = -0.194, (95%CI: -0.202 to -0.038), p = 0.004). Additionally, we proved, that significant positive association between irritable temperament and SSS (β = 0.152, (95%CI: 0.002 to 0.269), p = 0.047) and SIS (β = 0.155, (95%CI: 0.004 to 0.221), p = 0.042) exists among women.Cross-sectional analysis of a single center study with self-reported questionnaires.LIMITATIONSCross-sectional analysis of a single center study with self-reported questionnaires.Assessment of affective temperaments could offer added value in stratifying cardiovascular risk for patients beyond traditional risk factors.CONCLUSIONSAssessment of affective temperaments could offer added value in stratifying cardiovascular risk for patients beyond traditional risk factors.
Abstract
Funding Acknowledgements
Type of funding sources: None.
Aims
To describe the role of coronary CT angiography (CCTA) as the sole available non-invasive diagnostic test for symptomatic ...patients with suspected CAD in a hub center for cardiovascular emergencies in the presence of limited access to hospital facilities during the COVID-19 pandemic.
Methods and Results
From March 9th to April 30th, during the peak of the COVID-19 pandemic, a consecutive cohort of symptomatic patients with high clinical suspicion of CAD and clinical indication to CCTA were enrolled in a hub hospital in Milan, Italy. When obstructive coronary artery disease was detected (>70% diameter stenosis in a proximal coronary segment or >90% stenosis in any coronary segment) patients were referred to invasive coronary angiography (ICA). Clinical follow-up was assessed in patients in whom ICA was considered deferrable.
Overall, 58 consecutive patients were included. Ten (17.2%) symptomatic patients underwent ICA according to CCTA findings, while in 48 (82.8%) patients ICA was deferred. No clinical events were recorded after a mean follow-up of 49.7 ± 16.8 days. In nine out of ten patients referred to ICA, severe coronary artery disease was confirmed and treated accordingly. Changes in medical therapy were significantly more prevalent in patients with vs. those without CAD at CCTA.
Conclusion
We report a potential pivotal role for CCTA in the triage of non-COVID-19 patients with suspected CAD during the SARS-CoV-2 pandemic. CCTA may be helpful for identifying patients who necessitate ICA, ensuring adequate resource utilization during the pandemic.
The prognostic efficacy of a coronary computed tomography angiography (CCTA)-derived myocardial radiomics model in patients with chronic myocardial infarction (MI) is unclear.
In this retrospective ...study, a cohort of 236 patients with chronic MI who underwent both CCTA and cardiac magnetic resonance (CMR) examinations within 30 days were enrolled and randomly divided into training and testing datasets at a ratio of 7:3. The clinical endpoints were major adverse cardiovascular events (MACE), defined as all-cause death, myocardial reinfarction and heart failure hospitalization. The entire three-dimensional left ventricular myocardium on CCTA images was segmented as the volume of interest for the extraction of radiomics features. Five models, namely the clinical model, CMR model, clinical+CMR model, CCTA-radiomics model, and clinical+CCTA-radiomics model, were constructed using multivariate Cox regression. The prognostic performances of these models were evaluated through receiver operating characteristic curve analysis and the index of concordance (C-index).
Fifty-one (20.16%) patients experienced MACE during a median follow-up of 1439.5 days. The predictive performance of the CCTA-radiomics model surpassed that of the clinical model, CMR model, and clinical+CMR model in both the training (area under the curve (AUC) of 0.904 vs. 0.691, 0.764, 0.785; C-index of 0.88 vs. 0.71, 0.75, 0.76, all p values <0.001) and testing (AUC of 0.893 vs. 0.704, 0.851, 0.888; C-index of 0.86 vs. 0.73, 0.85, 0.85, all p values <0.05) datasets.
The CCTA-based myocardial radiomics model is a valuable tool for predicting adverse outcomes in chronic MI, providing incremental value to conventional clinical and CMR parameters.
•The CCTA-based myocardial radiomics model improved adverse outcomes prediction in chronic myocardial infarction (MI) patients.•The predictive value of the CCTA-based myocardial radiomics model outperformed that of the conventional clinical and MR models.•The clinical+CCTA-radiomics model may serve as a widely used method for reliable risk stratification for chronic MI patients.
Carotid Web (CaW) represents an overlooked stroke etiology and has been associated with high recurrence rates and to be amenable to stenting. We evaluated the diagnostic performance of different ...computed tomography angiography (CTA) projections in CaW.
Consecutive patients <65 years-old with symptomatic CaW (n=31), carotid atherosclerosis (n=27), or normal carotids (n=49) diagnosed with a thin-cut CTA were included. Deidentified CTAs were independently reviewed by three readers, who recorded the diagnosis and level of certainty after evaluating the axial plane alone, after adding sagittal/coronal maximum intensity projection (MIP), then after oblique MPR reformats.
There were 93 total CaW, 81 atherosclerosis, and 147 normal carotid reads. With CTA axial projection alone, less CaW cases (44.1 %) were appropriately diagnosed as compared to atherosclerosis (87.7 %; p<0.001) and normal carotid (83 %; p<0.001) cases. Sagittal/coronal MIPS increased the rate of accurate CaW diagnosis (44.1–76.3 %; p<0.001). Inter-rater agreement in CaW detection increased from k= 0.46 (0.35–0.57) using axial to k= 0.80 (0.69–0.91) with sagittal/coronal planes. The axial projection alone had lower sensitivity (44 % vs. 76 %) but similar specificity (95 % vs. 96 %) in CaW detection compared to axial+ sagittal/coronal MIPS. The accuracy in detecting atherosclerosis or normal carotids did not increase after adding sagittal/coronal MIPS and oblique MPRs. The certainty level for CaW diagnosis was lower when compared to atherosclerosis and normal carotids using axial alone (3.0 3.0–4.0 vs. 4.0 3.0–5.0; p<0.001 and 4.0 3.0–5.0; p<0.001) as well as after adding sagittal/coronal MIPS (4.0 3.0–5.0 vs. 5.04.0–5.0; p=0.01 and 4.0 4.0–5.0; p<0.001).
CTA axial plane alone was insufficient for CaW detection. CTA sagittal/coronal MIP reconstructions as well as oblique MPR reformats enhanced the accuracy and confidence related to CaW diagnosis.
•The axial plane of the CT angiogram may be insufficient to diagnose a carotid web.•The inclusion of sagittal and coronal sections may increase the diagnostic performance the carotid web diagnosis.•Oblique multiplanar reconstruction reformatting may increase the reader's confidence in the detection of carotid webs.
Purpose
The thrombus in the false lumen (FL) of aortic dissection (AD) patients is a meaningful indicator to determine aortic remodeling but difficult to measure in clinic. In this study, a novel ...segmentation strategy based on deep learning was proposed to automatically extract the thrombus in the FL in post‐operative computed tomography angiography (CTA) images of AD patients, which provided an efficient and convenient segmentation method with high accuracy.
Methods
A two‐step segmentation strategy was proposed. Each step contained a convolutional neural network (CNN) to segment the aorta and the thrombus, respectively. In the first step, a CNN was used to obtain the binary segmentation mask of the whole aorta. In the second step, another CNN was introduced to segment the thrombus. The results of the first step were used as additional input to the second step to highlight the aorta in the complex background. Moreover, skip connection attention refinement (SAR) modules were designed and added in the second step to improve the segmentation accuracy of the thrombus details by efficiently using the low‐level features.
Results
The proposed method provided accurate thrombus segmentation results (0.903 ± 0.062 in dice score, 0.828 ± 0.092 in Jaccard index, and 2.209 ± 2.945 in 95% Hausdorff distance), which showed improvement compared to the methods without prior information (0.846 ± 0.085 in dice score) and the method without SAR (0.899 ± 0.060 in dice score). Moreover, the proposed method achieved 0.967 ± 0.029 and 0.948 ± 0.041 in dice score of true lumen (TL) and patent FL (PFL) segmentation, respectively, indicating the excellence of the proposed method in the segmentation task of the overall aorta.
Conclusions
A novel CNN‐based segmentation framework was proposed to automatically obtain thrombus segmentation for thrombosed AD in post‐operative CTA images, which provided a useful tool for further application of thrombus‐related indicators in clinical and research application.
Abstract
Aims
Non-invasive assessment of stable chest pain patients is a critical determinant of resource utilization and clinical outcomes. Increasingly coronary computed tomography angiography ...(CCTA) with selective CCTA-derived fractional flow reserve (FFRCT) is being used. The ADVANCE Registry, is a large prospective examination of using a CCTA and FFRCT diagnostic pathway in real-world settings, with the aim of determining the impact of this pathway on decision-making, downstream invasive coronary angiography (ICA), revascularization, and major adverse cardiovascular events (MACE).
Methods and results
A total of 5083 patients with symptoms concerning for coronary artery disease (CAD) and atherosclerosis on CCTA were enrolled at 38 international sites from 15 July 2015 to 20 October 2017. Demographics, symptom status, CCTA and FFRCT findings, treatment plans, and 90 days outcomes were recorded. The primary endpoint of reclassification between core lab CCTA alone and CCTA plus FFRCT-based management plans occurred in 66.9% confidence interval (CI): 64.8–67.6 of patients. Non-obstructive coronary disease was significantly lower in ICA patients with FFRCT ≤0.80 (14.4%) compared to patients with FFRCT >0.80 (43.8%, odds ratio 0.19, CI: 0.15–0.25, P < 0.001). In total, 72.3% of subjects undergoing ICA with FFRCT ≤0.80 were revascularized. No death/myocardial infarction (MI) occurred within 90 days in patients with FFRCT >0.80 (n = 1529), whereas 19 (0.6%) MACE hazard ratio (HR) 19.75, CI: 1.19–326, P = 0.0008 and 14 (0.3%) death/MI (HR 14.68, CI 0.88–246, P = 0.039) occurred in subjects with an FFRCT ≤0.80.
Conclusions
In a large international multicentre population, FFRCT modified treatment recommendation in two-thirds of subjects as compared to CCTA alone, was associated with less negative ICA, predicted revascularization, and identified subjects at low risk of adverse events through 90 days.
The attentive consideration of absorbed dose impact on the breast, a radiosensitive organ, remains pivotal in coronary computed tomography angiography (CCTA). Additionally, the thyroid is subjected ...to scatter radiation during this diagnostic procedure. The primary objective of this study was to comprehensively investigate and quantify the absorbed dose, effective dose, and lifetime attributable risks (LARs) associated with breast and thyroid cancers in the context of CCTA. This investigation enrolled a cohort of 180 patients (90 men and 90 women) who underwent CCTA utilizing three distinct CT scanners: the SOMATOM Definition AS 128 slice (Siemens 128), the Lightspeed VCT 64 Slice (GE 64), and the Brilliance 64 Slice (Philips 64). The precise quantification of absorbed doses to the breast and thyroid was achieved through the utilization of a thermoluminescence dosimeter (TLD). LAR for breast and thyroid cancers was evaluated in accordance with the BEIR VII report. Kruskal–Wallis test was employed to compare the means of absorbed doses and LARs. The average absorbed doses to the breast during CCTA with Siemens 128, GE 64, and Philips 64 scanners were 116.32 ± 39.02, 82.88 ± 18.33, and 84.11 ± 15.18 mGy, respectively (P < 0.05). Correspondingly, the average LAR for breast cancer was found to be 84, 68, and 52 cases per 100,000 persons, respectively. Notably, a significant discrepancy in breast cancer LARs was observed among different age groups (P < 0.05). Regarding thyroid doses with Siemens 128, GE 64, and Philips 64 scanners, average values were 11.82 ± 7.51, 12.20 ± 10.87, and 14.49 ± 5.43 mGy, respectively (P > 0.05). Additionally, the average LAR for thyroid cancer was determined as 0.32, 0.56, and 0.22 cases per 100,000 persons, respectively. Across all age groups, the LAR for thyroid cancer exhibited higher values among women compared to men. However, these differences did not achieve statistical significance (P > 0.05), indicating a need for further investigation. The findings prominently indicated high absorbed doses to the breast in CCTA using protocols investigated in this study (with an average of 93.7 ± 30.26 mGy). Particularly, the LAR for breast cancer was higher among younger women, specifically those aged between 20 and 40 years (249 cases per 100,000). These results underscore the necessity for further justification and optimization of CCTA protocols.
•The absorbed dose to the breast in CCTA utilizing current protocols is high (94 mGy).•The average LAR of breast cancer in CCTA is higher (249 cases per 100,000) for women aged between 20 and 40 years.•The LAR of thyroid cancer in CCTA is higher for women compared to the men but not statistically significant (P > 0.05).•Further justification and optimization of CCTA protocols is needed.
The Use and Efficacy of FFR-CT Mittal, Tarun K.; Hothi, Sandeep S.; Venugopal, Vinod ...
JACC. Cardiovascular imaging,
August 2023, 2023-08-00, Letnik:
16, Številka:
8
Journal Article
Recenzirano
Fractional flow reserve–computed tomography (FFR-CT) is endorsed by UK and U.S. chest pain guidelines, but its clinical effectiveness and cost benefit in real-world practice are unknown.
The purpose ...of this study was to audit the use of FFR-CT in clinical practice against England’s National Institute for Health and Care Excellence guidance and assess its diagnostic accuracy and cost.
A multicenter audit was undertaken covering the 3 years when FFR-CT was centrally funded in England. For coronary computed tomographic angiograms (CCTAs) submitted for FFR-CT analysis, centers provided data on symptoms, CCTA and FFR-CT findings, and subsequent management. Audit standards included using FFR-CT only in patients with stable chest pain and equivocal stenosis (50%-69%). Diagnostic accuracy was evaluated against invasive FFR, when performed. Follow-up for nonfatal myocardial infarction and all-cause mortality was undertaken. The cost of an FFR-CT strategy was compared to alternative stress imaging pathways using cost analysis modeling.
A total of 2,298 CCTAs from 12 centers underwent FFR-CT analysis. Stable chest pain was the main symptom in 77%, and 40% had equivocal stenosis. Positive and negative predictive values of FFR-CT were 49% and 76%, respectively. A total of 46 events (2%) occurred over a mean follow-up period of 17 months; FFR-CT (cutoff: 0.80) was not predictive. The FFR-CT strategy costs £2,102 per patient compared with an average of £1,411 for stress imaging.
In clinical practice, the National Institute for Health and Care Excellence criteria for using FFR-CT were met in three-fourths of patients for symptoms and 40% for stenosis. FFR-CT had a low positive predictive value, making its use potentially more expensive than conventional stress imaging strategies.
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Synopsis
A 73‐year‐old woman with a history of hysterectomy presented with pelvic calcified lesions. Imaging led to laparoscopic surgery, revealing a calcified fibroid after subtotal hysterectomy.
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