Journal of Cardiovascular Computed Tomography最新文献

英文中文

Predicting mortality after transcatheter aortic valve replacement using AI-based fully automated left atrioventricular coupling index 利用基于人工智能的全自动左房室耦合指数预测经导管主动脉瓣置换术后的死亡率。

IF 5.5 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Computed Tomography

Pub Date : 2025-03-01 DOI: 10.1016/j.jcct.2024.12.082

Emese Zsarnoczay , Akos Varga-Szemes , U. Joseph Schoepf , Saikiran Rapaka , Daniel Pinos , Gilberto J. Aquino , Nicola Fink , Milan Vecsey-Nagy , Giuseppe Tremamunno , Dmitrij Kravchenko , Muhammad Taha Hagar , Nicholas S. Amoroso , Daniel H. Steinberg , Athira Jacob , Jim O’Doherty , Puneet Sharma , Pal Maurovich-Horvat , Tilman Emrich

Background

This study aimed to determine whether artificial intelligence (AI)–based automated assessment of left atrioventricular coupling index (LACI) can provide incremental value above other traditional risk factors for predicting mortality among patients with severe aortic stenosis (AS) undergoing coronary CT angiography (CCTA) before transcatheter aortic valve replacement (TAVR).

Methods

This retrospective study evaluated patients with severe AS who underwent CCTA examination before TAVR between September 2014 and December 2020. An AI-prototype software fully automatically calculated left atrial and left ventricular end-diastolic volumes and LACI was defined by the ratio between them. Uni- and multivariate Cox proportional hazard methods were used to identify the predictors of mortality in models adjusting for relevant significant parameters and Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) score.

Results

A total of 656 patients (77 years [IQR, 71–84 years]; 387 [59.0 %] male) were included in the final cohort. The all-cause mortality rate was 21.6 % over a median follow-up time of 24 (10–40) months. When adjusting for clinical confounders, LACI ≥43.7 % independently predicted mortality (adjusted HR, 1.52, [95 % CI: 1.03, 2.22]; p = 0.032). After adjusting for the STS-PROM score in a separate model, LACI ≥43.7 % remained an independent prognostic parameter (adjusted HR, 1.47, [95 % CI: 1.03–2.08]; p = 0.031). In a sub-analysis of patients with preserved left ventricular ejection fraction, LACI remained a significant predictor (adjusted HR, 1.72 [95 % CI: 1.02, 2.89]; p = 0.042).

Conclusions

AI-based fully automated assessment of LACI can be used independently to predict mortality in patients undergoing TAVR, including those with preserved LVEF.

背景：本研究旨在确定基于人工智能（AI）的左房室耦合指数（LACI）自动评估是否可以为严重主动脉狭窄（AS）患者在经导管主动脉瓣置换术（TAVR）前行冠状动脉CT血管造影（CCTA）预测死亡率提供高于其他传统危险因素的增量价值。方法：本回顾性研究评估了2014年9月至2020年12月在TAVR前接受CCTA检查的严重AS患者。ai原型软件全自动计算左心房和左心室舒张末期容积，并通过它们之间的比值定义LACI。采用单因素和多因素Cox比例风险法，在调整相关显著参数和胸外科学会预测死亡风险（STS-PROM）评分的模型中确定死亡率的预测因素。结果：共656例患者(77岁[IQR， 71-84岁]；387例（59.0%）男性被纳入最终队列。全因死亡率为21.6%，中位随访时间24（10-40）个月。当调整临床混杂因素时，LACI≥43.7%独立预测死亡率(调整后HR为1.52,[95% CI: 1.03, 2.22]；p = 0.032)。在单独模型中调整STS-PROM评分后，LACI≥43.7%仍然是一个独立的预后参数(调整后HR为1.47,[95% CI: 1.03-2.08]；p = 0.031)。在保留左室射血分数的患者的亚分析中，LACI仍然是一个重要的预测因子(调整后HR， 1.72 [95% CI: 1.02, 2.89]；p = 0.042)。结论：基于人工智能的LACI全自动评估可独立用于预测TAVR患者的死亡率，包括保留LVEF的患者。

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引用次数: 0

Association between symptom characteristics and disease severity in patients suspected of coronary artery disease

IF 5.5 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Computed Tomography

Pub Date : 2025-03-01 DOI: 10.1016/j.jcct.2025.01.004

Oliver Buchhave Pedersen , Laust Dupont Rasmussen , Louise Nissen , June Anita Ejlersen , Jesper Mortensen , Lars Christian Gormsen , Ashkan Eftekhari , Jelmer Westra , Evald Høj Christiansen , Daniel B. Mark , Morten Bøttcher , Pamela S. Douglas , Simon Winther

Background

Discrepancies often exist between patient-reported symptoms and diagnostic test findings in patients with suspected obstructive coronary artery disease (CAD).

Objectives

To quantify the association between patient-reported symptoms and the diagnosis of severe stenosis in patients with suspected obstructive CAD.

Methods

Two large-scale cohorts of patients with new-onset symptoms suggestive of obstructive CAD were evaluated. Chest discomfort was assessed by typicality, location, type, exertional/stress factors, and relief with rest/nitroglycerine. Patients underwent non-invasive diagnostic testing (coronary computed tomographic angiography (CCTA) or functional testing), followed by test-result-driven invasive coronary angiography (ICA). Severe stenosis was defined as ≥70 % diameter stenosis on ICA. Sensitivity analyses included CCTA stenosis, functional abnormalities, and revascularization.

Results

Of 14,410 patients, 2093 (14.5 %) were referred for ICA, and 765 (5.3 %) were diagnosed with severe stenosis. Patients with typical angina (n = 224) had higher odds of being diagnosed with severe stenosis on ICA (OR and 95 % CIs: 2.84 [2.40–3.34]) than those with atypical or non-anginal symptoms. In patients diagnosed with severe stenosis on ICA, those with exertional/stress factors (n = 418; OR [95 % CI]: 2.50 [2.16–2.90]) and relief with rest/nitroglycerine (n = 318, 2.28; [1.96–2.65]) had higher odds compared to those without. Patients reporting pressure or burning pain had higher odds of severe stenosis. Associations were consistent across sex and age groups, and sensitivity references.

Conclusions

Exertional/stress-related chest discomfort and relief with rest/nitroglycerine increased the odds of severe stenosis in patients with suspected CAD undergoing test-result-driven ICA, while location and type of chest pain were less associated, with no differences across sex or age groups.

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引用次数: 0

Very severe aortic valve stenosis: Diagnostic value of computed tomography aortic valve calcium scoring 非常严重主动脉瓣狭窄：计算机断层扫描主动脉瓣钙评分的诊断价值。

IF 5.5 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Computed Tomography

Pub Date : 2025-03-01 DOI: 10.1016/j.jcct.2024.11.004

Matthias Hammerer , Christoph Knapitsch , Nikolaos Schörghofer , Michael Lichtenauer , Moritz Mirna , Erika Prinz , Wilfried Wintersteller , Klaus Hergan , Uta C. Hoppe , Bernhard Scharinger , Elke Boxhammer

Background

(A) Very severe aortic valve stenosis (VSAS; Vmax ≥ 5 m/s, MPG ≥60 mmHg) is a critical condition with unfavorable clinical outcomes. Guidelines regard VSAS as one criterion for considering valve replacement in asymptomatic patients. (B) Guidelines recommend the use of aortic valve calcium (AVC) scoring as a parameter to differentiate between moderate and severe aortic valve stenosis (SAS). The aim of our study is to propose AVC thresholds for the discrimination between SAS and VSAS.

Methods

Data of patients from a single center who underwent transcatheter aortic valve implantation (n = 523) were retrospectively analyzed. Patients with concordant AS (n = 430) were divided into SAS (n = 344) and VSAS (n = 86) groups and compared in terms of absolute AVC and indexed AVC (body surface area; aortic valve annulus area).

Results

Mean AVC was significantly higher in men (m) than in women (w), and significantly higher in VSAS than in SAS (m: SAS 3572.0 AU; VSAS 5465.0 AU; w: SAS 2252.5 AU; VSAS 3064.5 AU; all p < 0,001). ROC curve analyses showed AVC to be a predictor of VSAS in both sexes (m: AUC 0.794; p < 0.001; w: AUC 0.725; p < 0.001), with optimal cut-off values of 3706.5 AU (m) and 2374.5 (w). Some indexed AVC had a slightly, but not relevantly, better predictive value.

Conclusion

The proposed AVC thresholds – approximately 3700 AU (m) and 2400 AU (w) - showed significant predictive power to differentiate SAS from VSAS in the study cohort.

背景：(A)非常严重的主动脉瓣狭窄（VSAS）；Vmax≥5 m/s, MPG≥60 mmHg)是临床预后不良的危重情况。指南将VSAS作为无症状患者考虑瓣膜置换术的一个标准。(B)指南推荐使用主动脉瓣钙（AVC）评分作为区分中度和重度主动脉瓣狭窄（SAS）的参数。本研究的目的是提出AVC阈值来区分SAS和VSAS。方法：回顾性分析单个中心523例经导管主动脉瓣植入术患者的资料。将430例和谐型AS患者分为SAS组（n = 344）和VSAS组（n = 86），比较绝对AVC和指数AVC(体表面积；主动脉瓣环面积)。结果：男性平均AVC (m)显著高于女性(w)， VSAS显著高于SAS (m: SAS 3572.0 AU；Vsas 5465.0 au；w: SAS 2252.5 AU；Vsas 3064.5 au；结论：建议的AVC阈值-大约3700 AU (m)和2400 AU (w) -在研究队列中显示出区分SAS和VSAS的显著预测能力。

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引用次数: 0

Impact of diabetes mellitus on coronary artery plaque characteristics and outcomes in the SCOT-HEART trial 苏格兰-心脏试验中糖尿病对冠状动脉斑块特征和结果的影响

IF 5.5 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Computed Tomography

Pub Date : 2025-03-01 DOI: 10.1016/j.jcct.2024.12.083

Zuzanna M. Gebert , Jacek Kwiecinski , Jonathan R. Weir-McCall , Philip D. Adamson , Nicholas L. Mills , Giles Roditi , Edwin J.R. van Beek , Edward D. Nicol , Daniel S. Berman , Piotr J. Slomka , Marc R. Dweck , Damini Dey , David E. Newby , Michelle C. Williams

Background

Diabetes mellitus is an established cardiovascular risk factor. We assessed the impact of diabetes mellitus on quantitative plaque and long-term outcomes in patients with and without diabetes mellitus in the Scottish COmputed Tomography of the HEART (SCOT-HEART) trial.

Methods

Coronary artery calcium (CAC) was assessed on non-contrast computed tomography (CT). Coronary stenoses, visually assessed adverse plaque characteristics and quantitative plaque burdens (calcified, non-calcified, low attenuation and total, Autoplaque 2.5) were assessed on coronary CT angiography. Multivariable and survival analyses were performed.

Results

Images of 1769 patients were assessed (56 % male, 58 ± 9 years). Diabetes mellitus was present in 196 (11 %) patients. Patients with diabetes mellitus had higher 10-year cardiovascular risk score (29 [interquartile range 21, 40] versus 15 [9, 21] %, p < 0.001) and CAC score (71 [1, 447] versus 17 [0, 209] Agatston units, p < 0.001), but were not more likely to have obstructive disease or visually assessed adverse plaque characteristics. Patients with diabetes mellitus had higher quantitatively assessed calcified, non-calcified, low attenuation and total plaque burdens. After adjustment for age and sex, diabetes mellitus was an independent predictor of calcified plaque burden (p = 0.009), but not the other plaque types. During 8.7 [IQR 8, 9.6] years follow-up, diabetes mellitus was associated with an increased risk of fatal or non-fatal myocardial infarction, adjusted for age and sex (hazard ratio 1.85, 95 % confidence interval 1.09 to 3.17, p = 0.024).

Conclusion

Diabetes mellitus was an independent predictor of quantitatively assessed plaque burden, particularly calcified plaque, and was associated with an increased risk of myocardial infarction.

背景：糖尿病是一种确定的心血管危险因素。我们在苏格兰心脏计算机断层扫描（SCOT-HEART）试验中评估了糖尿病对糖尿病患者和非糖尿病患者定量斑块和长期预后的影响。方法：采用非对比计算机断层扫描（CT）评价冠状动脉钙（CAC）。冠状动脉CT血管造影评估冠状动脉狭窄、目测不良斑块特征和定量斑块负担（钙化、非钙化、低衰减和总数、Autoplaque 2.5）。进行多变量分析和生存分析。结果：1769例患者的图像被评估（56%男性，58±9岁）。196例（11%）患者有糖尿病。糖尿病患者的10年心血管风险评分更高(29[四分位数范围21,40]比15 [9,21]%，p结论：糖尿病是定量评估斑块负担的独立预测因子，特别是钙化斑块，并与心肌梗死风险增加相关。

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引用次数: 0

Assessing the feasibility and accuracy of an on-site prototype workstation in assessing CT derived fractional flow reserve in severe aortic stenosis 评估现场原型工作站在评估 CT 导出的重度主动脉瓣狭窄患者血流储备分数方面的可行性和准确性。

IF 5.5 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Computed Tomography

Pub Date : 2025-03-01 DOI: 10.1016/j.jcct.2024.10.015

Harsh V. Thakkar, Sean Tan, Jasmine Chan, Abdul R. Ihdayhid, Michael Michail, Adam J. Brown, Brian Ko

引用次数: 0

Clinical impact of CCT-FFR as first-strategy in patients with symptomatic stable coronary artery disease: A systematic review and meta-analysis

IF 5.5 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Computed Tomography

Pub Date : 2025-03-01 DOI: 10.1016/j.jcct.2025.02.006

Gianluca Di Pietro , Riccardo Improta , Ovidio De Filippo , Francesco Bruno , Lucia Ilaria Birtolo , Emanuele Bruno , Nicola Galea , Marco Francone , Marc Dewey , Fabrizio D'Ascenzo , Massimo Mancone

Aims: Despite the promising results, the clinical implications of the CCT-FFR is already debated. This metanalysis aimed to determine the potential benefits of incorporating FFRCT into stable CAD management.

Methods: After searching for studies comparing outcomes of patients with suspected stable CAD who underwent CCT-FFR as a first strategy versus non-urgent cardiovascular testing after a clinical judgment, we calculated odds ratios (ORs) and 95 % confidence intervals (CIs) using a random-effects or fixed-effects meta-analysis model depending on heterogeneity significance.

Results: 5 studies (3 RCTs and 2 observational studies) globally encompassing 5282 patients (CCT-FFR = 2604 patients, Control Group = 2678 patients) were included in the quantitative analysis. The rates of ICA overall (OR 1.57, 95%CI 1.36–1.81, p value < 0.001) and those without obstructive CAD (OR 6.63, 95%CI 4.79–9.16, p value < 0.001) were reduced in the CCTAFFR group, as compared to the control group. Moreover, CCT-FFR patients underwent coronary revascularization more frequently than patients in the control arm (OR 0.48,CI 0.38–0.62, p value < 0.001). There was no significance difference between the two strategies in terms of 1 year MACE (OR 1.11,CI 0.86–1.44, p value 0.42), nonfatal MI (OR 0.73, CI 0.41–1.33, p value 0.31), all-cause mortality (OR 1.29,CI 0.47–3.54, p value 0.63) and unplanned revascularization for angina (OR 0.99, 95%CI 0.65–1.49, p value 0.95).

Conclusions: In conclusion, in the management of stable CAD, the use of CCT-FFR was associated with lower overall rates of ICA but higher rates of coronary revascularization with comparable 1-year clinical impact.

{"title":"Clinical impact of CCT-FFR as first-strategy in patients with symptomatic stable coronary artery disease: A systematic review and meta-analysis","authors":"Gianluca Di Pietro , Riccardo Improta , Ovidio De Filippo , Francesco Bruno , Lucia Ilaria Birtolo , Emanuele Bruno , Nicola Galea , Marco Francone , Marc Dewey , Fabrizio D'Ascenzo , Massimo Mancone","doi":"10.1016/j.jcct.2025.02.006","DOIUrl":"10.1016/j.jcct.2025.02.006","url":null,"abstract":"<div><div>Aims: Despite the promising results, the clinical implications of the CCT-FFR is already debated. This metanalysis aimed to determine the potential benefits of incorporating FFRCT into stable CAD management.</div><div>Methods: After searching for studies comparing outcomes of patients with suspected stable CAD who underwent CCT-FFR as a first strategy versus non-urgent cardiovascular testing after a clinical judgment, we calculated odds ratios (ORs) and 95 % confidence intervals (CIs) using a random-effects or fixed-effects meta-analysis model depending on heterogeneity significance.</div><div>Results: 5 studies (3 RCTs and 2 observational studies) globally encompassing 5282 patients (CCT-FFR = 2604 patients, Control Group = 2678 patients) were included in the quantitative analysis. The rates of ICA overall (OR 1.57, 95%CI 1.36–1.81, p value < 0.001) and those without obstructive CAD (OR 6.63, 95%CI 4.79–9.16, p value < 0.001) were reduced in the CCTAFFR group, as compared to the control group. Moreover, CCT-FFR patients underwent coronary revascularization more frequently than patients in the control arm (OR 0.48,CI 0.38–0.62, p value < 0.001). There was no significance difference between the two strategies in terms of 1 year MACE (OR 1.11,CI 0.86–1.44, p value 0.42), nonfatal MI (OR 0.73, CI 0.41–1.33, p value 0.31), all-cause mortality (OR 1.29,CI 0.47–3.54, p value 0.63) and unplanned revascularization for angina (OR 0.99, 95%CI 0.65–1.49, p value 0.95).</div><div>Conclusions: In conclusion, in the management of stable CAD, the use of CCT-FFR was associated with lower overall rates of ICA but higher rates of coronary revascularization with comparable 1-year clinical impact.</div></div>","PeriodicalId":49039,"journal":{"name":"Journal of Cardiovascular Computed Tomography","volume":"19 2","pages":"Pages 174-182"},"PeriodicalIF":5.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143569174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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IF 5.5 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Computed Tomography

Pub Date : 2025-03-01 DOI: 10.1016/S1934-5925(25)00065-6

引用次数: 0

Spring, renewal, and growth in the SCCT

IF 5.5 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Computed Tomography

Pub Date : 2025-03-01 DOI: 10.1016/j.jcct.2025.04.001

Maros Ferencik (President, Society of Cardiovascular Computed Tomography)

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JCCT PULSE_BW_FP

IF 5.5 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Computed Tomography

Pub Date : 2025-03-01 DOI: 10.1016/S1934-5925(25)00076-0

引用次数: 0

Cardiac hydatid cyst causing coronary arterial compression 心脏水瘤囊肿导致冠状动脉受压。

IF 5.5 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Computed Tomography

Pub Date : 2025-03-01 DOI: 10.1016/j.jcct.2024.09.006

Nataraju Komallama Girish , Damandeep Singh , Niraj Nirmal Pandey , Aprateem Mukherjee , Rakesh Yadav , Priya Jagia

引用次数: 0

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