Filippo Cademartiri

Publications

• 1.45

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  Clinical indications for cardiac computed tomography. From the Working Group of the Cardiac Radiology Section of the Italian Society of Medical Radiology (SIRM).

  E di Cesare, I Carbone, A Carriero, M Centonze, F De Cobelli, R De Rosa, P Di Renzi, A Esposito, R Faletti, R Fattori, [......], L La Grutta, G Ligabue, L Lovato, R Marano, M Midiri, L Natale, A Romagnoli, V Russo, F Sardanelli, F Cademartiri

  La Radiologia medica. 04/2012;

  Cardiac computed tomography (CCT) has grown as a useful means in different clinical contexts. Technological development has progressively extended the indications for CCT while reducing the required radiation dose. Even today there is little documentation from the main international scientific socie... [more] Cardiac computed tomography (CCT) has grown as a useful means in different clinical contexts. Technological development has progressively extended the indications for CCT while reducing the required radiation dose. Even today there is little documentation from the main international scientific societies describing the proper use and clinical indications of CCT; in particular, there are no complete guidelines. This document reflects the position of the Working Group of the Cardiac Radiology Section of the Italian Society of Radiology concerning the indications for CCT.
• 12.54

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  Reply.

  James K Min, Allison Dunning, Fay Y Lin, Stephan Achenbach, Mouaz Al-Mallah, Matthew J Budoff, Filippo Cademartiri, Tracy Q Callister, Hyuk-Jae Chang, Victor Cheng, [......], Benjamin J W Chow, Augustin Delago, Martin Hadamitzky, Joerg Hausleiter, Philipp Kaufmann, Erica Maffei, Gilbert Raff, Leslee J Shaw, Todd Villines, Daniel S Berman

  Journal of the American College of Cardiology. 02/2012; 59(7):701.
• 3.59

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  Left and right ventricle assessment with Cardiac CT: validation study vs. Cardiac MR.

  Erica Maffei, Giancarlo Messalli, Chiara Martini, Koen Nieman, Onofrio Catalano, Alexia Rossi, Sara Seitun, Andrea I Guaricci, Carlo Tedeschi, Nico R Mollet, Filippo Cademartiri

  European radiology. 01/2012;

  OBJECTIVES: To compare Magnetic Resonance (MR) and Computed Tomography (CT) for the assessment of left (LV) and right (RV) ventricular functional parameters. METHODS: Seventy nine patients underwent both Cardiac CT and Cardiac MR. Images were acquired using short axis (SAX) reconstructions for CT an... [more] OBJECTIVES: To compare Magnetic Resonance (MR) and Computed Tomography (CT) for the assessment of left (LV) and right (RV) ventricular functional parameters. METHODS: Seventy nine patients underwent both Cardiac CT and Cardiac MR. Images were acquired using short axis (SAX) reconstructions for CT and 2D cine b-SSFP (balanced-steady state free precession) SAX sequence for MR, and evaluated using dedicated software. RESULTS: CT and MR images showed good agreement: LV EF (Ejection Fraction) (52 ± 14% for CT vs. 52 ± 14% for MR; r = 0.73; p > 0.05); RV EF (47 ± 12% for CT vs. 47 ± 12% for MR; r = 0.74; p > 0.05); LV EDV (End Diastolic Volume) (74 ± 21 ml/m² for CT vs. 76 ± 25 ml/m² for MR; r = 0.59; p > 0.05); RV EDV (84 ± 25 ml/m² for CT vs. 80 ± 23 ml/m² for MR; r = 0.58; p > 0.05); LV ESV (End Systolic Volume)(37 ± 19 ml/m² for CT vs. 38 ± 23 ml/m² for MR; r = 0.76; p > 0.05); RV ESV (46 ± 21 ml/m² for CT vs. 43 ± 18 ml/m² for MR; r = 0.70; p > 0.05). Intra- and inter-observer variability were good, and the performance of CT was maintained for different EF subgroups. CONCLUSIONS: Cardiac CT provides accurate and reproducible LV and RV volume parameters compared with MR, and can be considered as a reliable alternative for patients who are not suitable to undergo MR. KEY POINTS : • Cardiac-CT is able to provide Left and Right Ventricular function. • Cardiac-CT is accurate as MR for LV and RV volume assessment. • Cardiac-CT can provide accurate evaluation of coronary arteries and LV and RV function.
• 1.45

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  MDCT findings of aortic branch artery pseudoaneurysms associated with type B intramural haematoma.

  S Seitun, U G Rossi, F Cademartiri, E Maffei, P Cronin, C Ferro, D M Williams

  La Radiologia medica. 01/2012;

  PURPOSE: The purpose of this study was to evaluate prevalence, morphological characteristics and evolution of aortic branch artery pseudoaneurysms associated with type B aortic intramural haematoma (IMH) using multidetector computed tomography (MDCT). MATERIALS AND METHODS: We enrolled 14 patients (... [more] PURPOSE: The purpose of this study was to evaluate prevalence, morphological characteristics and evolution of aortic branch artery pseudoaneurysms associated with type B aortic intramural haematoma (IMH) using multidetector computed tomography (MDCT). MATERIALS AND METHODS: We enrolled 14 patients (nine men; mean age 64.6±9.6; range 42-75 years) with a diagnosis in the acute phase of type B IMH without evidence of intimal tear. All patients underwent clinical and MDCT follow-up. RESULTS: Twenty-two pseudoaneurysms in six patients (6/14, 43%) were observed at MDCT. In the majority of patients (5/6, 83%) the pseudoaneurysms were multiple and involved the branches of the descending thoracic aorta (14/22, 64%), mainly the intercostal arteries (11/22, 50%). At a mean follow-up of 10.6±8.7 months, 21 pseudoaneurysms showed resolution, reduction or dimensional stability (95%), whereas only one increased in size (5%). CONCLUSIONS: Aortic branch artery pseudoaneurysms associated with IMH may be considered a benign disease, as the majority of cases resolved or did not change in size, with haematoma resorption. However, because a dynamic change in pseudoaneurysms in the acute and subacute phases was frequently observed, close clinical and imaging follow-up is mandatory.
• 6.34

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  Image quality and radiation exposure using different low-dose scan protocols in dual-source CT coronary angiography: randomized study.

  Lisan A Neefjes, Anoeshka S Dharampal, Alexia Rossi, Koen Nieman, Annick C Weustink, Marcel L Dijkshoorn, Gert-Jan R Ten Kate, Admir Dedic, Stella L Papadopoulou, Marcel van Straten, Filippo Cademartiri, Gabriël P Krestin, Pim J de Feyter, Nico R Mollet

  Radiology. 12/2011; 261(3):779-86.

  To compare image quality, radiation dose, and their relationship with heart rate of computed tomographic (CT) coronary angiographic scan protocols by using a 128-section dual-source CT scanner. Institutional review board approved the study; all patients gave informed consent. Two hundred seventy-two... [more] To compare image quality, radiation dose, and their relationship with heart rate of computed tomographic (CT) coronary angiographic scan protocols by using a 128-section dual-source CT scanner. Institutional review board approved the study; all patients gave informed consent. Two hundred seventy-two patients (175 men, 97 women; mean ages, 58 and 59 years, respectively) referred for CT coronary angiography were categorized according to heart rate: less than 65 beats per minute (group A) and 65 beats per minute or greater (group B). Patients were randomized to undergo prospective high-pitch spiral scanning and narrow-window prospective sequential scanning in group A (n = 160) or wide-window prospective sequential scanning and retrospective spiral scanning in group B (n = 112). Image quality was graded (1 = nondiagnostic; 2 = artifacts present, diagnostic; 3 = no artifacts) and compared (Mann-Whitney and Student t tests). In group A, mean image quality grade was significantly lower with high-pitch spiral versus sequential scanning (2.67 ± 0.38 [standard deviation] vs 2.86 ± 0.21; P < .001). In a subpopulation (heart rate, <55 beats per minute), mean image quality grade was similar (2.81 ± 0.30 vs 2.94 ± 0.08; P = .35). In group B, image quality grade was comparable between sequential and retrospective spiral scanning (2.81 ± 0.28 vs 2.80 ± 0.38; P = .54). Mean estimated radiation dose was significantly lower (high-pitch spiral vs sequential scanning) in group A (for 100 kV, 0.81 mSv ± 0.30 vs 2.74 mSv ± 1.14 [P < .001]; for 120 kV, 1.65 mSv ± 0.69 vs 4.21 mSv ± 1.20 [P < .001]) and in group B (sequential vs retrospective spiral scanning) (for 100 kV, 4.07 mSv ± 1.07 vs 5.54 mSv ± 1.76 [P = .02]; for 120 kV, 7.50 mSv ± 1.79 vs 9.83 mSv ± 3.49 [P = .1]). A high-pitch spiral CT coronary angiographic protocol should be applied in patients with regular and low (<55 beats per minute) heart rates; a sequential protocol is preferred in all others.
• 14.82

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  Performance of the traditional age, sex, and angina typicality-based approach for estimating pretest probability of angiographically significant coronary artery disease in patients undergoing coronary computed tomographic angiography: results from the multinational coronary CT angiography evaluation for clinical outcomes: an international multicenter registry (CONFIRM).

  Victor Y Cheng, Daniel S Berman, Alan Rozanski, Allison M Dunning, Stephan Achenbach, Mouaz Al-Mallah, Matthew J Budoff, Filippo Cademartiri, Tracy Q Callister, Hyuk-Jae Chang, [......], Martin Hadamitzky, Jörg Hausleiter, Ronald P Karlsberg, Philipp Kaufmann, Fay Y Lin, Erica Maffei, Gilbert L Raff, Todd C Villines, Leslee J Shaw, James K Min

  Circulation. 11/2011; 124(22):2423-32, 1-8.

  Guidelines for the management of patients with suspected coronary artery disease (CAD) rely on the age, sex, and angina typicality-based pretest probabilities of angiographically significant CAD derived from invasive coronary angiography (guideline probabilities). Reliability of guideline probabilit... [more] Guidelines for the management of patients with suspected coronary artery disease (CAD) rely on the age, sex, and angina typicality-based pretest probabilities of angiographically significant CAD derived from invasive coronary angiography (guideline probabilities). Reliability of guideline probabilities has not been investigated in patients referred to noninvasive CAD testing. We identified 14048 consecutive patients with suspected CAD who underwent coronary computed tomographic angiography. Angina typicality was recorded with the use of accepted criteria. Pretest likelihoods of CAD with ≥ 50 diameter stenosis (CAD50) and ≥ 70 diameter stenosis (CAD70) were calculated from guideline probabilities. Computed tomographic angiography images were evaluated by ≥ 1 expert reader to determine the presence of CAD50 and CAD70. Typical angina was associated with the highest prevalence of CAD50 (40 in men, 19 in women) and CAD70 (27 men, 11 women) compared with other symptom categories (P<0.001 for all). Observed CAD50 and CAD70 prevalences were substantially lower than those predicted by guideline probabilities in the overall population (18 versus 51 for CAD50, 10 versus 42 for CAD70; P<0.001), driven by pronounced differences in patients with atypical angina (15 versus 47 for CAD50, 7 versus 37 for CAD70) and typical angina (29 versus 86 for CAD50, 19 versus 71 for CAD70). Marked overestimation of disease prevalence by guideline probabilities was found at all participating centers and across all sex and age subgroups. In this multinational study of patients referred for coronary computed tomographic angiography, determination of pretest likelihood of angiographically significant CAD by the invasive angiography-based guideline probabilities greatly overestimates the actual prevalence of disease.
• 12.54

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  Prognostic assessment of coronary artery bypass patients with 64-slice computed tomography angiography: anatomical information is incremental to clinical risk prediction.

  Gary R Small, Yeung Yam, Li Chen, Osman Ahmed, Mouaz Al-Mallah, Daniel S Berman, Victor Y Cheng, Kavitha Chinnaiyan, Gilbert Raff, Todd C Villines, [......], Augustin Delago, Allison Dunning, Martin Hadamitzky, Jorg Hausleiter, Philipp Kaufmann, Fay Lin, Erica Maffei, James K Min, Leslee J Shaw, Benjamin J W Chow

  Journal of the American College of Cardiology. 11/2011; 58(23):2389-95.

  We sought to determine the incremental prognostic value of 64 multi-slice coronary computed tomography angiography (CCTA) in coronary artery bypass graft (CABG) patients. Prognostication in CABG patients can be difficult. Anatomical assessment of native coronary artery disease and graft patency migh... [more] We sought to determine the incremental prognostic value of 64 multi-slice coronary computed tomography angiography (CCTA) in coronary artery bypass graft (CABG) patients. Prognostication in CABG patients can be difficult. Anatomical assessment of native coronary artery disease and graft patency might provide useful information, but the utility of CCTA in the assessment of CABG patients is unknown. Six hundred fifty-seven CABG patients with all-cause mortality follow-up were identified from a multicenter CCTA registry, of 10,628 patients from 5 CCTA centers. Clinical risk was profiled with modified logistic and additive EuroSCOREs (European Systems for Cardiac Operative Risk Evaluations). The CCTA defined coronary anatomy. Patients were classified by unprotected coronary territory (UCT) or a summary of native vessel disease and graft patency: the coronary artery protection score (CAPS). Forty-four deaths occurred during a mean follow-up of 20 months. Left ventricular ejection fraction, creatinine, age, severity of native vessel disease, UCT, CAPS, and EuroSCOREs were univariate predictors of mortality (p < 0.001). In multivariate analysis with additive EuroSCORE, UCT (p = 0.004) and CAPS were predictive of events (p < 0.001). In comparison with additive EuroSCORE, CAPS score was associated with a 27% net reclassification index. Coronary computed tomography angiography provides incremental anatomical data to clinical risk assessment to help determine the prognosis of patients after CABG. The CAPS evaluation with CCTA might help identify those patients at highest risk.
• 6.34

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  Relationship and prognostic value of modified coronary artery calcium score, FEV1, and emphysema in lung cancer screening population: the MILD trial.

  Nicola Sverzellati, Filippo Cademartiri, Francesca Bravi, Chiara Martini, Federica A Gira, Erica Maffei, Alfonso Marchianò, Carlo La Vecchia, Massimo De Filippo, Jan-Martin Kuhnigk, Cristina Rossi, Ugo Pastorino

  Radiology. 11/2011; 262(2):460-7.

  To assess the relationship between a modified coronary artery calcium (mCAC) score and both forced expiratory volume in 1 second (FEV1) and pulmonary emphysema and the associations of such factors with all-cause mortality and cardiovascular events (CVEs) in a lung cancer computed tomographic (CT) sc... [more] To assess the relationship between a modified coronary artery calcium (mCAC) score and both forced expiratory volume in 1 second (FEV1) and pulmonary emphysema and the associations of such factors with all-cause mortality and cardiovascular events (CVEs) in a lung cancer computed tomographic (CT) screening trial. In this institutional review board-approved study, both clinical and low-dose CT data were evaluated in a cohort of heavy smokers consecutively recruited by the Multicentric Italian Lung Detection, or MILD, trial. Low-dose CT images were analyzed by using software that allowed quantification of mCAC, mean lung attenuation (MLA), and total extent of emphysema. The correlations between mCAC, percentage predicted FEV1, MLA, and emphysema extent were tested by using the Pearson correlation coefficient. Adjusted multiple logistic regression models were applied to assess the relationships between mCAC, FEV1, MLA, and emphysema extent and all-cause mortality and CVEs. The final study cohort consisted of 1159 smokers. There were no significant correlations between mCAC score and FEV1 (r=-0.03, P=.4), MLA (r=-0.01, P=.7), or emphysema extent (r=0.02, P=.6). An mCAC score greater than 400 was the only factor that was independently associated with both all-cause mortality (odds ratio [OR]: 3.73; 95% confidence interval [CI]: 1.05, 13.32; P=.04) and CVEs (OR: 2.87; 95% CI: 1.13, 7.27; P=.03). mCAC is a better predictor of CVE and all-cause mortality than FEV1 and emphysema extent and may contribute to the identification of high-risk individuals in a lung cancer screening setting.
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  Classification of noncalcified coronary atherosclerotic plaque components on CT coronary angiography: impact of vascular attenuation and density thresholds.

  E Maffei, K Nieman, C Martini, O Catalano, S Seitun, T Arcadi, R Malagò, A Rossi, A Clemente, N R Mollet, F Cademartiri

  La Radiologia medica. 11/2011;

  PURPOSE: The authors assessed the effect of vascular attenuation and density thresholds on the classification of noncalcified plaque by computed tomography coronary angiography (CTCA). MATERIALS AND METHODS: Thirty patients (men 25; age 59±8 years) with stable angina underwent arterial and delayed C... [more] PURPOSE: The authors assessed the effect of vascular attenuation and density thresholds on the classification of noncalcified plaque by computed tomography coronary angiography (CTCA). MATERIALS AND METHODS: Thirty patients (men 25; age 59±8 years) with stable angina underwent arterial and delayed CTCA. At sites of atherosclerotic plaque, attenuation values (HU) were measured within the coronary lumen, noncalcified and calcified plaque material and the surrounding epicardial fat. Based on the measured CT attenuation values, coronary plaques were classified as lipid rich (attenuation value below the threshold) or fibrous (attenuation value above the threshold) using 30-HU, 50-HU and 70-HU density thresholds. RESULTS: One hundred and sixty-seven plaques (117 mixed and 50 noncalcified) were detected and assessed. The attenuation values of mixed plaques were higher than those of exclusively noncalcified plaques in both the arterial (148.3±73.1 HU vs. 106.2±57.9 HU) and delayed (111.4±50.5 HU vs. 64.4±43.4 HU) phases (p<0.01). Using a 50-HU threshold, 12 (7.2%) plaques would be classified as lipid rich on arterial scan compared with 28 (17%) on the delayed-phase scan. Reclassification of these 16 (9.6%) plaques from fibrous to lipid rich involved 4/30 (13%) patients. CONCLUSIONS: Classification of coronary plaques as lipid rich or fibrous based on absolute CT attenuation values is significantly affected by vascular attenuation and density thresholds used for the definition.
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  Diagnostic accuracy of second-generation dual-source computed tomography coronary angiography with iterative reconstructions: a real-world experience.

  E Maffei, C Martini, A Rossi, N Mollet, C Lario, M Castiglione Morelli, A Clemente, G Gentile, T Arcadi, S Seitun, O Catalano, A Aldrovandi, F Cademartiri

  La Radiologia medica. 11/2011;

  PURPOSE: The authors evaluated the diagnostic accuracy of second-generation dual-source (DSCT) computed tomography coronary angiography (CTCA) with iterative reconstructions for detecting obstructive coronary artery disease (CAD). MATERIALS AND METHODS: Between June 2010 and February 2011, we enroll... [more] PURPOSE: The authors evaluated the diagnostic accuracy of second-generation dual-source (DSCT) computed tomography coronary angiography (CTCA) with iterative reconstructions for detecting obstructive coronary artery disease (CAD). MATERIALS AND METHODS: Between June 2010 and February 2011, we enrolled 160 patients (85 men; mean age 61.2±11.6 years) with suspected CAD. All patients underwent CTCA and conventional coronary angiography (CCA). For the CTCA scan (Definition Flash, Siemens), we use prospective tube current modulation and 70-100 ml of iodinated contrast material (Iomeprol 400 mgI/ ml, Bracco). Data sets were reconstructed with iterative reconstruction algorithm (IRIS, Siemens). CTCA and CCA reports were used to evaluate accuracy using the threshold for significant stenosis at ≥50% and ≥70%, respectively. RESULTS: No patient was excluded from the analysis. Heart rate was 64.3±11.9 bpm and radiation dose was 7.2±2.1 mSv. Disease prevalence was 30% (48/160). Sensitivity, specificity and positive and negative predictive values of CTCA in detecting significant stenosis were 90.1%, 93.3%, 53.2% and 99.1% (per segment), 97.5%, 91.2%, 61.4% and 99.6% (per vessel) and 100%, 83%, 71.6% and 100% (per patient), respectively. Positive and negative likelihood ratios at the per-patient level were 5.89 and 0.0, respectively. CONCLUSIONS: CTCA with second-generation DSCT in the real clinical world shows a diagnostic performance comparable with previously reported validation studies. The excellent negative predictive value and likelihood ratio make CTCA a first-line noninvasive method for diagnosing obstructive CAD.
• 12.54

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  Prevalence and severity of coronary artery disease and adverse events among symptomatic patients with coronary artery calcification scores of zero undergoing coronary computed tomography angiography: results from the CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter) registry.

  Todd C Villines, Edward A Hulten, Leslee J Shaw, Manju Goyal, Allison Dunning, Stephan Achenbach, Mouaz Al-Mallah, Daniel S Berman, Matthew J Budoff, Filippo Cademartiri, [......], Kavitha Chinnaiyan, Benjamin J W Chow, Augustin Delago, Martin Hadamitzky, Jörg Hausleiter, Philipp Kaufmann, Fay Y Lin, Erica Maffei, Gilbert L Raff, James K Min

  Journal of the American College of Cardiology. 11/2011; 58(24):2533-40.

  The purpose of this study was to describe the prevalence and severity of coronary artery disease (CAD) in relation to prognosis in symptomatic patients without coronary artery calcification (CAC) undergoing coronary computed tomography angiography (CCTA). The frequency and clinical relevance of CAD ... [more] The purpose of this study was to describe the prevalence and severity of coronary artery disease (CAD) in relation to prognosis in symptomatic patients without coronary artery calcification (CAC) undergoing coronary computed tomography angiography (CCTA). The frequency and clinical relevance of CAD in patients without CAC are unclear. We identified 10,037 symptomatic patients without CAD who underwent concomitant CCTA and CAC scoring. CAD was assessed as <50%, ≥50%, and ≥70% stenosis. All-cause mortality and the composite endpoint of mortality, myocardial infarction, or late coronary revascularization (≥90 days after CCTA) were assessed. Mean age was 57 years, 56% were men, and 51% had a CAC score of 0. Among patients with a CAC score of 0, 84% had no CAD, 13% had nonobstructive stenosis, and 3.5% had ≥50% stenosis (1.4% had ≥70% stenosis) on CCTA. A CAC score >0 had a sensitivity, specificity, and negative and positive predictive values for stenosis ≥50% of 89%, 59%, 96%, and 29%, respectively. During a median of 2.1 years, there was no difference in mortality among patients with a CAC score of 0 irrespective of obstructive CAD. Among 8,907 patients with follow-up for the composite endpoint, 3.9% with a CAC score of 0 and ≥50% stenosis experienced an event (hazard ratio: 5.7; 95% confidence interval: 2.5 to 13.1; p < 0.001) compared with 0.8% of patients with a CAC score of 0 and no obstructive CAD. Receiver-operator characteristic curve analysis demonstrated that the CAC score did not add incremental prognostic information compared with CAD extent on CCTA for the composite endpoint (CCTA area under the curve = 0.825; CAC + CCTA area under the curve = 0.826; p = 0.84). In symptomatic patients with a CAC score of 0, obstructive CAD is possible and is associated with increased cardiovascular events. CAC scoring did not add incremental prognostic information to CCTA.
• 5.39

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  Age- and gender-specific differences in the prognostic value of CT coronary angiography.

  Kai Hang Yiu, Fleur R de Graaf, Joanne D Schuijf, Jacob M van Werkhoven, Nina Ajmone Marsan, Caroline E Veltman, Albert de Roos, Aju Pazhenkottil, Lucia J Kroft, Eric Boersma, Bernhard Herzog, Melissa Leung, Erica Maffei, Dominic Y Leung, Philipp A Kaufmann, Filippo Cademartiri, Jeroen J Bax, J Wouter Jukema

  Heart (British Cardiac Society). 09/2011; 98(3):232-7.

  To evaluate the potential age- and gender-specific differences in the incidence and prognostic value of coronary artery disease (CAD) in patients undergoing CT coronary angiography (CTA). In this multicentre prospective registry study, 2432 patients (mean age 57 ± 12, 56% male) underwent CTA for sus... [more] To evaluate the potential age- and gender-specific differences in the incidence and prognostic value of coronary artery disease (CAD) in patients undergoing CT coronary angiography (CTA). In this multicentre prospective registry study, 2432 patients (mean age 57 ± 12, 56% male) underwent CTA for suspected CAD. Patients were stratified into four groups according to age <60 or ≥60 years and, male or female gender. A composite end point of cardiac death and non-fatal myocardial infarction. CTA results were normal in 991 (41%) patients, showed non-significant CAD in 761 (31%) patients and significant CAD in the remaining 680 (28%) patients. During follow-up (median 819 days, 25-75th centile 482-1142) a cardiovascular event occurred in 59 (2.4%) patients. The annualised event rate was 1.1% in the total population (men=1.3% and women=0.9%). In patients aged <60 years, the annualised event rate of male and female patients was 0.6% and 0.5%, respectively. Among patients aged ≥60 years the annualised event rate was 1.9% in male and 1.1% in female patients. Observations on CTA predicted events in male patients, both age <60 and ≥60 years and in female patients age ≥60 years (log-rank test in all groups, p<0.01). However, CTA provided limited prognostic value in female patients aged <60 years (log-rank test, p=0.45). After age and gender stratification, CTA findings were shown to be of limited predictive value in female patients aged <60 years as compared with male patients at any age and female patients aged ≥60 years.
• 1.45

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  Coronary plaque burden in patients with stable and unstable coronary artery disease using multislice CT coronary angiography.

  N Mollet, E Maffei, C Martini, A Weustink, C van Mieghem, T Baks, E McFadden, P de Feyter, O Catalano, S Seitun, G Krestin, F Cademartiri

  La Radiologia medica. 09/2011; 116(8):1174-87.

  We evaluated the multislice computed tomography (MSCT) coronary plaque burden in patients with stable and unstable angina pectoris. Twenty-one patients with stable and 20 with unstable angina pectoris scheduled for conventional coronary angiography (CCA) underwent MSCT-CA using a 64-slice scanner of... [more] We evaluated the multislice computed tomography (MSCT) coronary plaque burden in patients with stable and unstable angina pectoris. Twenty-one patients with stable and 20 with unstable angina pectoris scheduled for conventional coronary angiography (CCA) underwent MSCT-CA using a 64-slice scanner offering a fast rotation time (330 ms) and higher X-ray tube output (900 mAs). To determine the MSCT coronary plaque burden, we assessed the extent (number of diseased segments), size (small or large), type (calcific, noncalcific, mixed) of plaque, its anatomic distribution and angiographic appearance in all available ≥2-mm segments. In a subset of 15 (seven stable, eight unstable) patients, the detection and classification of coronary plaques by MSCT was verified by intracoronary ultrasound (ICUS). Sensitivity and specificity of MSCT compared with ICUS to detect significant plaques (defined as ≥1-mm plaque thickness on ICUS) was 83% and 87%. Overall, 473 segments were examined, resulting in 11.6±1.5 segments per patient. Plaques were present in 62% of segments and classified as large in 47% of diseased segments. Thirty-two percent were noncalcific, 25% calcific and 43% mixed. Plaques were most frequently located in the proximal and mid segments. Plaque was found in 33% of segments classified as normal on CCA. Unstable patients had significantly more noncalcific plaques when compared with stable patients (45% vs. 21%, p<0.05). MSCT-CA provides important information regarding the coronary plaque burden in patients with stable and unstable angina.
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  Prognostic value of Morise clinical score, calcium score and computed tomography coronary angiography in patients with suspected or known coronary artery disease.

  E Maffei, S Seitun, A Palumbo, C Martini, E Emiliano, A Cuttone, A Aldrovandi, R Malagò, L La Grutta, M Midiri, C Tedeschi, R De Rosa, O Catalano, A Weustink, N Mollet, F Cademartiri

  La Radiologia medica. 09/2011; 116(8):1188-202.

  Our aim was to determine the prognostic value of computed tomography coronary angiography (CTCA), coronary artery calcium scoring (CACS) and Morise clinical score in patients with known or suspected coronary artery disease (CAD). A total of 722 patients (480 men; 62.7±10.9 years) who were referred f... [more] Our aim was to determine the prognostic value of computed tomography coronary angiography (CTCA), coronary artery calcium scoring (CACS) and Morise clinical score in patients with known or suspected coronary artery disease (CAD). A total of 722 patients (480 men; 62.7±10.9 years) who were referred for further cardiac evaluation underwent CACS and contrast-enhanced CTCA to evaluate the presence and severity of CAD. Of these, 511 (71%) patients were without previous history of CAD. Patients were stratified according to the Morise clinical score (low, intermediate, high), to CACS (0-10, 11-100, 101-400, 401-1,000, >1,000) and to CTCA (absence of CAD, nonsignificant CAD, obstructive CAD). Patients were followed up for the occurrence of major events: cardiac death, nonfatal myocardial infarction, unstable angina and revascularisation. Significant CAD (>50% luminal narrowing) was detected in 260 (36%) patients; nonsignificant CAD (<50% luminal narrowing) in 250 (35%) and absence of CAD in 212 (29%). During a mean follow-up of 20±4 months, 116 events (21 hard) occurred. In patients with normal coronary arteries on CTCA, the major event rate was 0% vs. 1.7% in patients with nonsignificant CAD and 7.3% in patients with significant CAD (p<0.0001). Three hard events (14%) occurred in patients with CACS≤100 and two (9.5%) in patients with intermediate Morise score; one revascularisation was observed in a patient with low Morise score. At multivariate analysis, diabetes, obstructive CAD and CACS >1,000 were significant predictors of events (p<0.05). An excellent prognosis was noted in patients with a normal CTCA (0% event rate). CACS ≤100 and low-intermediate Morise score did not exclude the possibility of events at follow-up.
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  Computed tomography coronary angiography in asymptomatic patients.

  E Maffei, A Palumbo, C Martini, C Tedeschi, T Arcadi, L La Grutta, R Malagò, A C Weustink, N R Mollet, R De Rosa, O Catalano, I Salamone, A Blandino, M Midiri, F Cademartiri

  La Radiologia medica. 09/2011; 116(8):1161-73.

  This study assessed the accuracy of computed tomography coronary angiography (CT-CA) for detecting significant coronary artery disease (CAD; ≥50% lumen reduction) in intermediate/high-risk asymptomatic patients. A total of 183 consecutive asymptomatic individuals (92 men; mean age 54±11 years) with ... [more] This study assessed the accuracy of computed tomography coronary angiography (CT-CA) for detecting significant coronary artery disease (CAD; ≥50% lumen reduction) in intermediate/high-risk asymptomatic patients. A total of 183 consecutive asymptomatic individuals (92 men; mean age 54±11 years) with more than one major risk factor (obesity, hypertension, diabetes, hypercholesterolaemia, family history, smoking) and an inconclusive or nonfeasible noninvasive stress test result (stress electrocardiography, stress echocardiography, nuclear stress scintigraphy) underwent CT-CA in an outpatient setting. All patients underwent conventional coronary angiography (CAG) within 4 weeks. Data from CT-CA were compared with CAG regarding the presence of significant CAD (≥50% lumen reduction). Mean calcium score was 177±432, mean heart rate during the CT-CA scan was 58±8 bpm and the prevalence (per-patient) of obstructive CAD was 19%. CT-CA showed single-vessel CAD in 9% of patients, two-vessel CAD in 9% and three-vessel CAD in 0%. Per-patient sensitivity, specificity, positive predictive value and negative predictive value of CT-CA were 100% (90-100), 98% (96-99), 97% (85-99), 100% (97-100), respectively. Positive and negative likelihood ratios were 151 and 0, respectively. CT-CA is an excellent noninvasive imaging modality for excluding significant CAD in intermediate/ high-risk asymptomatic patients with inconclusive or nonfeasible noninvasive stress test.
• 12.54

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  Age- and sex-related differences in all-cause mortality risk based on coronary computed tomography angiography findings results from the International Multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) of 23,854 patients without known coronary artery disease.

  James K Min, Allison Dunning, Fay Y Lin, Stephan Achenbach, Mouaz Al-Mallah, Matthew J Budoff, Filippo Cademartiri, Tracy Q Callister, Hyuk-Jae Chang, Victor Cheng, [......], Benjamin J W Chow, Augustin Delago, Martin Hadamitzky, Joerg Hausleiter, Philipp Kaufmann, Erica Maffei, Gilbert Raff, Leslee J Shaw, Todd Villines, Daniel S Berman

  Journal of the American College of Cardiology. 08/2011; 58(8):849-60.

  We examined mortality in relation to coronary artery disease (CAD) as assessed by ≥64-detector row coronary computed tomography angiography (CCTA). Although CCTA has demonstrated high diagnostic performance for detection and exclusion of obstructive CAD, the prognostic findings of CAD by CCTA have n... [more] We examined mortality in relation to coronary artery disease (CAD) as assessed by ≥64-detector row coronary computed tomography angiography (CCTA). Although CCTA has demonstrated high diagnostic performance for detection and exclusion of obstructive CAD, the prognostic findings of CAD by CCTA have not, to date, been examined for age- and sex-specific outcomes. We evaluated a consecutive cohort of 24,775 patients undergoing ≥64-detector row CCTA between 2005 and 2009 without known CAD who met inclusion criteria. In these patients, CAD by CCTA was defined as none (0% stenosis), mild (1% to 49% stenosis), moderate (50% to 69% stenosis), or severe (≥70% stenosis). CAD severity was judged on a per-patient, per-vessel, and per-segment basis. Time to mortality was estimated using multivariable Cox proportional hazards models. At a 2.3 ± 1.1-year follow-up, 404 deaths had occurred. In risk-adjusted analysis, both per-patient obstructive (hazard ratio [HR]: 2.60; 95% confidence interval [CI]: 1.94 to 3.49; p < 0.0001) and nonobstructive (HR: 1.60; 95% CI: 1.18 to 2.16; p = 0.002) CAD conferred increased risk of mortality compared with patients without evident CAD. Incident mortality was associated with a dose-response relationship to the number of coronary vessels exhibiting obstructive CAD, with increasing risk observed for nonobstructive (HR: 1.62; 95% CI: 1.20 to 2.19; p = 0.002), obstructive 1-vessel (HR: 2.00; 95% CI: 1.43 to 2.82; p < 0.0001), 2-vessel (HR: 2.92; 95% CI: 2.00 to 4.25; p < 0.0001), or 3-vessel or left main (HR: 3.70; 95% CI: 2.58 to 5.29; p < 0.0001) CAD. Importantly, the absence of CAD by CCTA was associated with a low rate of incident death (annualized death rate: 0.28%). When stratified by age <65 years versus ≥65 years, younger patients experienced higher hazards for death for 2-vessel (HR: 4.00; 95% CI: 2.16 to 7.40; p < 0.0001 vs. HR: 2.46; 95% CI: 1.51 to 4.02; p = 0.0003) and 3-vessel (HR: 6.19; 95% CI: 3.43 to 11.2; p < 0.0001 vs. HR: 3.10; 95% CI: 1.95 to 4.92; p < 0.0001) CAD. The relative hazard for 3-vessel CAD (HR: 4.21; 95% CI: 2.47 to 7.18; p < 0.0001 vs. HR: 3.27; 95% CI: 1.96 to 5.45; p < 0.0001) was higher for women as compared with men. Among individuals without known CAD, nonobstructive and obstructive CAD by CCTA are associated with higher rates of mortality, with risk profiles differing for age and sex. Importantly, absence of CAD is associated with a very favorable prognosis.
• 1.45

  Impact points

  Role of cardiac MRI in evaluating patients with Anderson-Fabry disease: assessing cardiac effects of long-term enzyme replacement therapy.

  G Messalli, M Imbriaco, G Avitabile, R Russo, D Iodice, L Spinelli, S Dellegrottaglie, F Cademartiri, M Salvatore, A Pisani

  La Radiologia medica. 07/2011; 117(1):19-28.

  PURPOSE: Anderson-Fabry disease is a multisystemic disorder of lipid metabolism secondary to X-chromosome alterations and is frequently associated with cardiac manifestations such as left ventricular (LV) hypertrophy, gradually leading to an alteration in cardiac performance. The purpose of this stu... [more] PURPOSE: Anderson-Fabry disease is a multisystemic disorder of lipid metabolism secondary to X-chromosome alterations and is frequently associated with cardiac manifestations such as left ventricular (LV) hypertrophy, gradually leading to an alteration in cardiac performance. The purpose of this study was to monitor, using magnetic resonance imaging (MRI), any changes produced by enzyme replacement therapy with agalsidase beta at the cardiac level in patients with Anderson-Fabry disease. MATERIALS AND METHODS: Sixteen (ten men, six women) patients with genetically confirmed Anderson-Fabry disease underwent cardiac MRI before starting enzyme replacement therapy (baseline study) and after 48 months of treatment with agalsidase beta at the dose of 1 mg/kg (follow-up study). RESULTS: After 48 months of treatment, a significant reduction in LV mass and wall thickness was observed: 187±59 g vs. 149±44 g, and 16±3 mm vs. 13±3 mm, respectively. A significant reduction in T2 relaxation time was noted at the level of the interventricular septum (81±3 ms vs. 67±7 ms), at the apical level (80±8 ms vs. 63±6 ms) and at the level of the lateral wall (82±8 ms vs. 63±10 ms) (p<0.05). No significant variation was observed in ejection fraction between the two studies (65±3% vs. 64±2%; p>0.05) (mean bias 1.0); however, an improvement was noted in the New York Heart Association (NYHA) class of the majority of patients (12/16) (p<0.05). CONCLUSIONS: In patients with Anderson-Fabry disease undergoing enzyme replacement therapy with agalsidase beta, MRI documented a significant reduction in myocardial T2 relaxation time, a significant decrease in maximal myocardial thickness and in total LV mass. MRI did not reveal significant improvements in LV global systolic function; however, improvement in NYHA functional class was noted, consistent with improved diastolic function.
• 1.78

  Impact points

  Incremental prognostic value of cardiac computed tomography in coronary artery disease using CONFIRM: COroNary computed tomography angiography evaluation for clinical outcomes: an InteRnational Multicenter registry.

  Benjamin J W Chow, Gary Small, Yeung Yam, Li Chen, Stephan Achenbach, Mouaz Al-Mallah, Daniel S Berman, Matthew J Budoff, Filippo Cademartiri, Tracy Q Callister, [......], Allison Dunning, Martin Hadamitzky, Jörg Hausleiter, Philipp Kaufmann, Fay Lin, Erica Maffei, Gilbert L Raff, Leslee J Shaw, Todd C Villines, James K Min

  Circulation. Cardiovascular imaging. 07/2011; 4(5):463-72.

  Large multicenter studies validating the prognostic value of coronary computed tomographic angiography (CCTA) and left ventricular ejection fraction (LVEF) are lacking. We sought to confirm the independent and incremental prognostic value of coronary artery disease (CAD) severity measured using 64-s... [more] Large multicenter studies validating the prognostic value of coronary computed tomographic angiography (CCTA) and left ventricular ejection fraction (LVEF) are lacking. We sought to confirm the independent and incremental prognostic value of coronary artery disease (CAD) severity measured using 64-slice CCTA over LVEF and clinical variables. A large international multicenter registry (CONFIRM Registry) was queried, and CCTA patients with LVEF data on CCTA were screened. Patients with a history of myocardial infarction, coronary revascularization, or cardiac transplantation were excluded. The National Cholesterol Education Program-Adult Treatment Panel III risk was calculated for each patient, and CCTA was evaluated for CAD severity (normal, nonobstructive, non-high-risk, or high-risk CAD) and LVEF <50%. Patients were followed for an end point of all-cause mortality; 27 125 patients underwent CCTA at 12 participating centers, with a total of 14 064 patients meeting the analysis criteria. Follow-up was available for 13 966 (99.3%) patients (mean follow-up of 22.5 months; 95% confidence interval, 22.3 to 22.7 months). All-cause mortality (271 deaths) occurred in 0.65% of patients without coronary atherosclerosis, 1.99% of patients with nonobstructive CAD, 2.90% of patients with non-high-risk CAD, and 4.95% for patients with high-risk CAD. Multivariable analysis confirmed that LVEF <50% (hazard ratio, 2.74; 95% confidence interval, 2.12 to 3.51) and CAD severity (hazard ratio,1.58; 95% confidence interval, 1.42 to 1.76) were predictors of all-cause mortality, and CAD severity had incremental value over LVEF and clinical variables. Our results demonstrate that CCTA measures of CAD severity and LVEF have independent prognostic value. Incorporation of CAD severity provides incremental value for predicting all-cause death over routine clinical predictors and LVEF in patients with suspected obstructive CAD.
• 1.45

  Impact points

  Diagnostic accuracy of 64-slice computed tomography coronary angiography in a large population of patients without revascularisation: registry data in NSTEMI acute coronary syndrome and influence of gender and risk factors.

  E Maffei, C Martini, C Tedeschi, P Spagnolo, A Zuccarelli, T Arcadi, A Guaricci, S Seitun, A C Weustink, N R Mollet, F Cademartiri

  La Radiologia medica. 06/2011; 116(7):1014-26.

  This study sought to evaluate the diagnostic accuracy of computed tomography coronary angiography (CTCA) for detecting significant coronary artery stenosis (≥50% lumen reduction) compared with conventional coronary angiography (CAG) in non-ST-elevation myocardial infarction-acute coronary syndrome (... [more] This study sought to evaluate the diagnostic accuracy of computed tomography coronary angiography (CTCA) for detecting significant coronary artery stenosis (≥50% lumen reduction) compared with conventional coronary angiography (CAG) in non-ST-elevation myocardial infarction-acute coronary syndrome (NSTEMI-ACS) and in subgroups selected by gender and number of risk factors (RF). We selected from a population of 1,500 patients in a multicentre registry with NSTEMI-ACS who had undergone CTCA and CAG, (n=237; 187 men, mean age 63±10 years). Diagnostic accuracy and likelihood ratios (LR) of CTCA were assessed against CAG in the total population and subgroups (men, women: 0 RF = absence of RF, 1-2 RF = presence of one or two RF, >2 RF = presence of more than two RF). The prevalence of obstructive disease was 53%. In the per-patient analysis, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of CTCA were 100% (men 100%; women 100%; 0 RF 100%; 1-2 RF 100%; >2 RF 100%), 95% (men 98%; women 50%; 0 RF NA% (NA, not assessable); 1-2 RF 96%; >2 RF 96%), 95% (men 98%; women 91%; 0 RF 91%; 1-2 RF 96%; >2 RF 96%), 100% (men 100%; women 100%; 0 RF NV%; 1-2 RF 100%; >2 RF 100%), respectively. The per-segment analysis showed a reduction in PPV (ranging between 56% and 67%). The per-patient LR+ ranged between 18 and 27, whereas LR-were always 0. We observed no significant differences in diagnostic accuracy between subgroups. CTCA is a reliable diagnostic modality with high sensitivity and NPV in NSTEMI-ACS patients who are not candidates for early revascularisation, regardless of gender and number of risk factors.
• 1.45

  Impact points

  Computed tomography coronary angiography in the selection of outlier patients: a feasibility report.

  E Maffei, C Martini, S Seitun, T Arcadi, C Tedeschi, A Guaricci, R Malagò, G Tarantini, A Aldrovandi, F Cademartiri

  La Radiologia medica. 06/2011;

  PURPOSE: This study evaluated criteria, presence and distribution of outlier patients by means of computed tomography coronary angiography (CTCA) in a large institutional database. MATERIAL AND METHODS: From a population of 2,881 consecutive patients (1,842 men, mean age 62±13 years) in sinus rhythm... [more] PURPOSE: This study evaluated criteria, presence and distribution of outlier patients by means of computed tomography coronary angiography (CTCA) in a large institutional database. MATERIAL AND METHODS: From a population of 2,881 consecutive patients (1,842 men, mean age 62±13 years) in sinus rhythm who underwent CTCA, we extracted data on patients with suspected coronary artery disease (CAD). We selected patient outliers in the fifth and sixth decades of life with the following criteria: ≥3 risk factors and absence of CAD, zero to one risk factors and ≥5 diseased coronary segments. Diabetes was excluded from risk factors because of the different impact on CAD. RESULTS: The patient population consisted of 2,432 individuals with suspected CAD (1,495 men, age 62±13 years). The prevalence of obstructive CAD (≥50% lumen reduction at CTCA) was 36% (863/2,432). Patients with normal coronary arteries accounted for 34% of the total (837/2,432; 431 men, age 55±14 years). Of these, 210 were in the fifth and 231 in the 6th decade (men 196, women 245); those with ≥3 risk factors accounted for 4.2% of the total (102/2,432; men 42, women 60). Patients with ≥5 diseased coronary segments accounted for 28% of the total (686/2,432; 510 men, age 68±10 years). Of these, 115 were in the fifth and 270 in the sixth decade (men 309, women 76); those with zero to one risk factors accounted for 3.0% (73/2,432; men 66, women 7). CONCLUSIONS: CTCA is a reliable noninvasive diagnostic modality that can be used to identify outlier patients. This will enable dedicated trials aimed at characterising biomarkers and genomics of protective and nonprotective factors against CAD and its complications.