The composition and extent of coronary artery plaque detected by multislice computed tomographic angiography provides incremental prognostic value in patients with suspected coronary artery disease
Multislice computed tomographic coronary angiography (CTCA) provides accurate noninvasive assessment of coronary artery disease (CAD). However, data on the prognostic value of CTCA in patients with suspected CAD are only beginning to emerge. The aim of the study was to assess the prognostic value of CTCA in patients with suspected CAD. Patients (males = 259, females = 235; mean age 58.2 ± 9.8 years) with suspected CAD who underwent 16- or 64-slice CTCA were followed for 1,308 ± 318 days for cardiac death, nonfatal myocaridal infarction (MI) and late (>90 days after CTCA) revascularization. Patient outcomes were related to clinical and CTCA data. Cox proportional-hazards model was applied in stepwise forward fashion to identify outcome predictors. Coronary artery plaque was found in 340 patients. Cardiac events occurred in 40 patients including cardiac death (n = 9), nonfatal MI (n = 8) and late revascularization (n = 23). A multivariable analysis identified the following independent predictors for adverse cardiac events: obstructive plaque in a proximal coronary artery segment (hazard ratio (HR) 2.73; 95% confidence interval (CI): 1.35-5.54; P = 0.005), the number of segments with noncalcified plaque(s) (HR 1.53 per segment; 95%CI: 1.21-1.92; P < 0.001), the number of segments with mixed plaque(s) (HR 1.56 per segment; 95%CI: 1.27-1.92; P < 0.001) and the number of segments with calcified plaque(s) (HR 1.21 per segment; 95%CI: 1.07-1.37; P = 0.002). In patients with suspected CAD, both the extent and composition of atherosclerotic plaque as determined by CTCA are prognostic of subsequent cardiac events.
Available from: Ewa Stepien
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ABSTRACT: We conducted a cross-sectional observation study that included 500 asymptomatic subjects to investigate the relationship between bone metabolism and coronary artery calcification (CAC) in hypertensive conditions. Osteoprotegerin (OPG) and osteopontin (OPN) levels and their associations with hypertension were analyzed to predict CAC in 316 subjects. Multislice computed tomography was used to quantify CAC. Multivariate analysis of variance was used to test the non-interactive effects of hypertension, CAC severity and biomarker levels, and the logistic regression model was applied to predict the risk of CAC. OPG and OPN concentrations were significantly higher in the hypertensive than the normotensive subjects, at 3.0 (2.3-4.0) pmol l(-1) and 51 (21-136) ng ml(-1) vs. 2.4 (2.0-3.0) pmol l(-1) and 41 (13-63) ng ml(-1), respectively. The OPG level, but not OPN level, increased with age (r = 0.29; P = 0.0001). Zero or minimal CAC (<10 Agatston units (AU)) was observed in 63% of the subjects, mild (11-100 AU) in 17%, moderate (101-400 AU) in 12% and severe (401-1000 AU)-to-extensive (>1000 AU) in 8%. In hypertensive subjects, only glomerular filtration rate (GFR) (β = -0.67) and gender (β = 0.52) were significant predictors for CAC (R = 0.68). In normotensive patients, GFR (β = -0.81), gender (β = 0.48) and log-transformed OPG levels (β = 0.15) were significant predictors for CAC. OPG levels were associated with an increased risk of CAC in normotensive subjects only (odds ratio: 3.37; 95% confidence interval (1.63-6.57); P = 0.0002). OPG predicted a premature state of vascular calcification in asymptomatic normotensive individuals, and renal function significantly contributed to this process in both hypertensive and normotensive subjects.
Hypertension Research 01/2012; 35(5):531-8. DOI:10.1038/hr.2011.231 · 2.66 Impact Factor
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ABSTRACT: Computed tomography has undergone rapid developments over the last decades, in particular, the emergence and technological improvements of multislice CT scanners enable satisfactory performance of cardiac CT imaging. Cardiac CT has been widely used in the diagnosis of coronary artery disease, which is the leading cause of death in industrialized countries. Cardiac CT also provides valuable information to predict the extent and prognosis of coronary artery disease. The main disadvantage of cardiac CT imaging is radiation dose, which raises concern in recent years, as there is potential risk of radiation-induced malignancy. This article will provide an overview of the current research status of cardiac CT imaging in the diagnosis of coronary artery disease, highlight the key applications of cardiac CT imaging and briefly discuss future directions of this fast advancing technique.
06/2012; 2(2):98-105. DOI:10.3978/j.issn.2223-4292.2012.05.02
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ABSTRACT: High-sensitivity C-reactive protein (hsCRP) and coronary artery plaque characteristics have been separately evaluated as prognosticators of adverse cardiovascular events; however, their relationship remains unclear. We therefore evaluated the prognostic value of hsCRP in relation to plaque subtypes in predicting adverse cardiovascular outcome in asymptomatic patients without known coronary artery disease.
A total of 4690 asymptomatic patients who underwent coronary computed tomography angiography for screening purposes were included. HsCRP was categorized as <1 mg/L, 1-3 mg/L and >3 mg/L. Cardiovascular events were defined as cardiovascular death, acute coronary syndrome, and stroke.
During follow-up (median 49 months, interquartile range 34-59 months), adverse cardiovascular events were observed in 56 (1.2%) patients. Higher hsCRP was associated with poor outcome in overall patients (OR 2.716, 95% CI 1.512-4.880, p = 0.001 for hsCRP 1-3 mg/L, OR 2.705, 95% CI 1.239-5.908, p = 0.013 for hsCRP > 3 mg/L, hsCRP <1 mg/L as reference). When patients were evaluated according to plaque subtype, hsCRP > 3 mg/L was a significant predictor of poor outcome only in patients with noncalcified plaques (NCP; p = 0.038). After adjusting for Framingham risk and coronary artery calcium score, hsCRP > 3 mg/L was a significant predictor of adverse outcomes in the presence of NCP (p = 0.048) but not in the presence of CP or MCP (p = 0.742).
Elevated hsCRP is a predictor of adverse cardiovascular events in asymptomatic patients with NCP. After adjusting for Framingham risk and coronary artery calcium scores, hsCRP > 3 mgL remained an independent predictor of risk in patients with NCP but not in patients with CP or MCP.
Atherosclerosis 07/2012; 224(1):201-7. DOI:10.1016/j.atherosclerosis.2012.06.061 · 3.99 Impact Factor
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