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Prognostic implications of coronary CT angiography-derived quantitative markers for the prediction of major adverse cardiac events.
J Cardiovasc Comput Tomogr. 2016 Nov - Dec; 10(6):458-465.JC

Abstract

OBJECTIVE

To evaluate quantitative markers derived from coronary CT angiography (coronary CTA) for the prediction of major adverse cardiac events (MACE).

MATERIALS AND METHODS

Pooled data from two centers in the US and Europe were retrospectively analyzed. Forty-six patients (65.5 ± 8.1 years, 62% male) with suspected coronary artery disease (CAD) who had undergone dual-source CCTA and had experienced MACE within 12 months were included and compared to a Framingham risk score matched cohort (n = 46) without MACE. Various quantitative markers derived from coronary CTA were compared between both groups: Total plaque volume (TPV), calcified and non-calcified plaque volumes (CPV and NCPV), plaque burden (%), remodeling index, lesion length, presence of Napkin-ring sign, segment involvement score (SIS), and segment stenosis score (SSS). Discriminatory power of these markers for predicting MACE was assessed.

RESULTS

Patients with MACE had significantly more obstructive CAD with higher plaque burden, SSS, and SIS (all p < 0.05) compared to controls. MACE-related lesions showed higher median TPV (122.6 mm3 vs. 76.3 mm3), NCPV (67.3 mm3 vs. 56.1 mm3), plaque burden (66.3% vs. 44.9%), greater lesion length (23.1 mm vs. 19.2 mm), and higher prevalence of Napkin-ring sign (63% vs. 32%) (all p < 0.05). On multivariable analysis, odds ratios (OR) for MACE on a per-patient level were 1.07 for plaque burden (p = 0.0002) and 1.13 for SSS (p = 0.049). On a per-lesion basis OR for lesion length was 1.05 (p = 0.042), 1.03 for plaque burden (p = 0.018), 1.28 for remodeling index (p = 0.026), and 1.68 for the Napkin-ring sign (p = 0.031). At receiver operating characteristics analysis a combination of markers (Framingham risk score + Napkin-ring sign + lesion length + remodeling index) showed the highest predictive value for MACE (AUC 0.92, p = 0.013).

CONCLUSION

Coronary CTA-derived markers portend predictive value for MACE on a per-patient (plaque burden and SSS) and per-lesion level (lesion length, plaque burden, remodeling index, and Napkin-ring sign). A combination of markers added to the Framingham risk score has the highest predictive power.

Authors+Show Affiliations

Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany.Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany.Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA; Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Department of Cardiology, People's Liberation Army General Hospital, Beijing, China.Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.Institute of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Germany.Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany.Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany.Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA. Electronic address: schoepf@musc.edu.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

27522574

Citation

Tesche, Christian, et al. "Prognostic Implications of Coronary CT Angiography-derived Quantitative Markers for the Prediction of Major Adverse Cardiac Events." Journal of Cardiovascular Computed Tomography, vol. 10, no. 6, 2016, pp. 458-465.
Tesche C, Plank F, De Cecco CN, et al. Prognostic implications of coronary CT angiography-derived quantitative markers for the prediction of major adverse cardiac events. J Cardiovasc Comput Tomogr. 2016;10(6):458-465.
Tesche, C., Plank, F., De Cecco, C. N., Duguay, T. M., Albrecht, M. H., Varga-Szemes, A., Bayer, R. R., Yang, J., Jacks, I. L., Gramer, B. M., Ebersberger, U., Hoffmann, E., Chiaramida, S. A., Feuchtner, G., & Schoepf, U. J. (2016). Prognostic implications of coronary CT angiography-derived quantitative markers for the prediction of major adverse cardiac events. Journal of Cardiovascular Computed Tomography, 10(6), 458-465. https://doi.org/10.1016/j.jcct.2016.08.003
Tesche C, et al. Prognostic Implications of Coronary CT Angiography-derived Quantitative Markers for the Prediction of Major Adverse Cardiac Events. J Cardiovasc Comput Tomogr. 2016 Nov - Dec;10(6):458-465. PubMed PMID: 27522574.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prognostic implications of coronary CT angiography-derived quantitative markers for the prediction of major adverse cardiac events. AU - Tesche,Christian, AU - Plank,Fabian, AU - De Cecco,Carlo N, AU - Duguay,Taylor M, AU - Albrecht,Moritz H, AU - Varga-Szemes,Akos, AU - Bayer,Richard R,Nd AU - Yang,Junjie, AU - Jacks,Isaac L, AU - Gramer,Bettina M, AU - Ebersberger,Ullrich, AU - Hoffmann,Ellen, AU - Chiaramida,Salvatore A, AU - Feuchtner,Gudrun, AU - Schoepf,U Joseph, Y1 - 2016/08/05/ PY - 2016/07/15/received PY - 2016/07/29/revised PY - 2016/08/03/accepted PY - 2016/8/16/pubmed PY - 2017/4/25/medline PY - 2016/8/15/entrez KW - Coronary artery disease KW - Coronary computed tomography angiography KW - Plaque characterization KW - Prognosis SP - 458 EP - 465 JF - Journal of cardiovascular computed tomography JO - J Cardiovasc Comput Tomogr VL - 10 IS - 6 N2 - OBJECTIVE: To evaluate quantitative markers derived from coronary CT angiography (coronary CTA) for the prediction of major adverse cardiac events (MACE). MATERIALS AND METHODS: Pooled data from two centers in the US and Europe were retrospectively analyzed. Forty-six patients (65.5 ± 8.1 years, 62% male) with suspected coronary artery disease (CAD) who had undergone dual-source CCTA and had experienced MACE within 12 months were included and compared to a Framingham risk score matched cohort (n = 46) without MACE. Various quantitative markers derived from coronary CTA were compared between both groups: Total plaque volume (TPV), calcified and non-calcified plaque volumes (CPV and NCPV), plaque burden (%), remodeling index, lesion length, presence of Napkin-ring sign, segment involvement score (SIS), and segment stenosis score (SSS). Discriminatory power of these markers for predicting MACE was assessed. RESULTS: Patients with MACE had significantly more obstructive CAD with higher plaque burden, SSS, and SIS (all p < 0.05) compared to controls. MACE-related lesions showed higher median TPV (122.6 mm3 vs. 76.3 mm3), NCPV (67.3 mm3 vs. 56.1 mm3), plaque burden (66.3% vs. 44.9%), greater lesion length (23.1 mm vs. 19.2 mm), and higher prevalence of Napkin-ring sign (63% vs. 32%) (all p < 0.05). On multivariable analysis, odds ratios (OR) for MACE on a per-patient level were 1.07 for plaque burden (p = 0.0002) and 1.13 for SSS (p = 0.049). On a per-lesion basis OR for lesion length was 1.05 (p = 0.042), 1.03 for plaque burden (p = 0.018), 1.28 for remodeling index (p = 0.026), and 1.68 for the Napkin-ring sign (p = 0.031). At receiver operating characteristics analysis a combination of markers (Framingham risk score + Napkin-ring sign + lesion length + remodeling index) showed the highest predictive value for MACE (AUC 0.92, p = 0.013). CONCLUSION: Coronary CTA-derived markers portend predictive value for MACE on a per-patient (plaque burden and SSS) and per-lesion level (lesion length, plaque burden, remodeling index, and Napkin-ring sign). A combination of markers added to the Framingham risk score has the highest predictive power. SN - 1876-861X UR - https://www.unboundmedicine.com/medline/citation/27522574/Prognostic_implications_of_coronary_CT_angiography_derived_quantitative_markers_for_the_prediction_of_major_adverse_cardiac_events_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1934-5925(16)30184-8 DB - PRIME DP - Unbound Medicine ER -