Cardiac computed tomography for rule-out of ischemic heart disease in patients with new-onset heart failure.

IF 6.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS European Heart Journal - Cardiovascular Imaging Pub Date : 2025-03-14 DOI:10.1093/ehjci/jeaf090

Christina Boesgaard Graversen, Laust Dupont Rasmussen, Jens Sundbøll, Morten Würtz, Kristian Hay Kragholm, Morten Bøttcher, Simon Winther

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引用次数: 0

Abstract

Background: In patients with new-onset heart failure (HF), invasive coronary angiography (ICA) is recommended to rule out coronary artery disease (CAD).

Objective: To investigate the utility of a coronary artery calcium score (CACS) and coronary computed tomography angiography (CCTA) for rule-out of obstructive CAD in patients with new-onset HF.

Methods and results: Patients with new-onset HF referred for cardiac computed tomography (CT) were included (2008-2022). Patients were grouped according to CACS and CCTA findings. Stenosis on CCTA was defined as ≥1 vessel with ≥50% luminal diameter stenosis. Obstructive CAD was defined as ≥1 vessel with ≥50% luminal diameter stenosis at ICA performed within 120 days from cardiac CT. Revascularization procedures within 120 days from cardiac CT were identified.Overall, 3336 patients were eligible. Obstructive CAD was ruled out in 2332/2780 patients (83.8%) with complete cardiac CT. 1032 (30.9%) patients had CACS=0 and 377 (11.3%) patients had CACS≥1000.18.0% of patients had stenosis on CCTA, ranging from 2.8% to 71.7% in patients with CACS=0 and CACS≥1000, respectively.Obstructive CAD at second-line ICA was diagnosed in 11.5% of patients, ranging from 1.2% to 47.2% in patients with CACS=0 and CACS≥1000, respectively. Revascularization was performed in 6.9% of patients, ranging from 0.6% to 26.5% in patients with CACS=0 and CACS≥1000, respectively.

Conclusion: In stable patients with new-onset HF, cardiac CT may be considered as the primary imaging modality to rule out ischemic heart disease, and implementation of a CT-based strategy for ischemia rule-out may substantially reduce the need for invasive examination.

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背景：对于新发心力衰竭（HF）患者，建议进行有创冠状动脉造影（ICA）以排除冠状动脉疾病：目的：研究冠状动脉钙化评分（CACS）和冠状动脉计算机断层扫描（CCTA）对新发心力衰竭（HF）患者排除阻塞性CAD的作用：研究冠状动脉钙化评分（CACS）和冠状动脉计算机断层扫描血管造影（CCTA）对排除新发心力衰竭患者阻塞性冠状动脉疾病的作用：纳入了转诊至心脏计算机断层扫描（CT）的新发高血压患者（2008-2022 年）。根据 CACS 和 CCTA 结果对患者进行分组。CCTA上的血管狭窄定义为管腔直径狭窄≥50%的血管≥1条。阻塞性 CAD 的定义是：在心脏 CT 后 120 天内进行的 ICA 检查中，≥1 根血管的管腔直径狭窄≥50%。符合条件的患者共有 3336 人。2332/2780名患者（83.8%）通过完整的心脏CT检查排除了阻塞性CAD。1032例（30.9%）患者的CACS=0，377例（11.3%）患者的CACS≥1000。18.0%的患者在CCTA检查中发现血管狭窄，CACS=0和CACS≥1000患者的狭窄率分别从2.8%到71.7%不等。11.5%的患者在二线ICA诊断出阻塞性CAD，CACS=0和CACS≥1000患者的阻塞性CAD率分别从1.2%到47.2%不等。6.9%的患者接受了血管重建手术，CACS=0和CACS≥1000的患者接受血管重建手术的比例分别为0.6%至26.5%：结论：对于病情稳定的新发 HF 患者，心脏 CT 可被视为排除缺血性心脏病的主要成像方式，而实施基于 CT 的缺血排除策略可大大减少有创检查的需求。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Heart Journal - Cardiovascular Imaging CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

11.60

自引率

9.70%

发文量

708

审稿时长

4-8 weeks

期刊介绍： European Heart Journal – Cardiovascular Imaging is a monthly international peer reviewed journal dealing with Cardiovascular Imaging. It is an official publication of the European Association of Cardiovascular Imaging, a branch of the European Society of Cardiology. The journal aims to publish the highest quality material, both scientific and clinical from all areas of cardiovascular imaging including echocardiography, magnetic resonance, computed tomography, nuclear and invasive imaging. A range of article types will be considered, including original research, reviews, editorials, image focus, letters and recommendation papers from relevant groups of the European Society of Cardiology. In addition it provides a forum for the exchange of information on all aspects of cardiovascular imaging.