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Roxana Djaberi, Joanne D Schuijf,
Eelco J de Koning,
D Champa Wijewickrama,
Alberto M Pereira,
Johannes W Smit,
Lucia J Kroft,
Albert de Roos,
Jeroen J Bax,
Ton J Rabelink,
J Wouter Jukema
[show abstract]
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ABSTRACT: Purpose: In diabetes, generalised microvascular disease and coronary artery disease (CAD) are likely to occur in parallel. We used a sidestream dark field (SDF) handheld imaging device to determine the relation between the labial microcirculation parameters and CAD in asymptomatic patients with diabetes.Methods: SDF imaging was validated for assessment of labial capillary density and tortuosity. Thereafter, mean labial capillary density and tortuosity were evaluated and compared in non-diabetic controls, and in asymptomatic patients with type 1 and type 2 diabetes. In diabetic patients, mean capillary density and tortuosity were compared according to the presence of CAD.Results: Both type 1 and type 2 diabetes were associated with increased capillary density and tortuosity. In diabetes, mean capillary density was an independent predictor of elevated coronary artery calcium (CAC) (p = 0.03) and obstructive CAD on computed tomography angiography (p = 0.01). Using a cut-off mean capillary density of 24.9 (per 0.63 mm(2)) the negative predictive value was 84% and 89% for elevated CAC and obstructive CAD. Likewise, capillary tortuosity was an independent predictor of increased CAC (p = 0.01) and obstructive CAD (p = 0.04).Conclusion: Assessment of labial microcirculation parameters using SDF imaging is feasible and conveys the potential to estimate vascular morbidity in patients with diabetes, at bedside.
Diabetes & Vascular Disease Research 05/2012; · 2.12 Impact Factor
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Fleur R de Graaf,
Joëlla E van Velzen,
Stephanie M de Boer,
Jacob M van Werkhoven,
Lucia J Kroft,
Albert de Roos,
Allard Sieders,
Greetje J de Grooth,
J Wouter Jukema, Joanne D Schuijf,
Jeroen J Bax,
Martin J Schalij,
Ernst E van der Wall
[show abstract]
[hide abstract]
ABSTRACT: To determine the rate of subsequent invasive coronary angiography (ICA) and revascularization in relation to computed tomography coronary angiography (CTA) results. In addition, independent determinants of subsequent ICA and revascularization were evaluated. CTA studies were performed using a 64-row (n = 413) or 320-row (n = 224) multidetector scanner. The presence and severity of CAD were determined on CTA. Following CTA, patients were followed up for 1 year for the occurrence of ICA and revascularization. A total of 637 patients (296 male, 56 ± 12 years) were enrolled and 578 CTA investigations were available for analysis. In patients with significant CAD on CTA, subsequent ICA rate was 76 %. Among patients with non-significant CAD on CTA, subsequent ICA rate was 20 % and among patients with normal CTA results, subsequent ICA rate was 5.7 % (p < 0.001). Of patients with significant CAD on CTA, revascularization rate was 47 %, as compared to a revascularization rate of 0.6 % in patients with non-significant CAD on CTA and no revascularizations in patients with a normal CTA results (p < 0.001). Significant CAD on CTA and significant three-vessel or left main disease on CTA were identified as the strongest independent predictors of ICA and revascularization. CTA results are strong and independent determinants of subsequent ICA and revascularization. Consequently, CTA has the potential to serve as a gatekeeper for ICA to identify patients who are most likely to benefit from revascularization and exclude patients who can safely avoid ICA.
The international journal of cardiovascular imaging 05/2012; · 2.15 Impact Factor
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Heart (British Cardiac Society) 05/2012; 98(9):743-54. · 4.22 Impact Factor
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Caroline E Veltman,
Fleur R de Graaf, Joanne D Schuijf,
Jacob M van Werkhoven,
J Wouter Jukema,
Philipp A Kaufmann,
Aju P Pazhenkottil,
Lucia J Kroft,
Eric Boersma,
Jeroen J Bax,
Martin J Schalij,
Ernst E van der Wall
[show abstract]
[hide abstract]
ABSTRACT: Limited information is available regarding the relationship between coronary vessel dominance and prognosis. Therefore, the purpose of this study was to determine the prognostic value of coronary vessel dominance in relation to significant coronary artery disease (CAD) in patients referred for computed tomography coronary angiography (CTA).
The study population consisted of 1425 patients (869 men, 57 ± 12 years) referred for CTA. To evaluate the impact of vessel dominance and significant CAD on CTA on outcome, patients were followed during a median period of 24 months for the occurrence of non-fatal myocardial infarction and all-cause mortality. The presence of a left dominant system was identified as a significant predictor for non-fatal myocardial infarction and all-cause mortality (HR: 3.20; 95% CI: 1.67-6.13, P < 0.001) and had incremental value over baseline risk factors and severity of CAD on CTA. In addition, in the subgroup of patients with significant CAD on CTA, patients with a left dominant system had a worse outcome compared with patients with a right dominant system (cumulative event rates: 9.5% and 35% at 3-year follow-up for a right and left dominant coronary artery system, respectively, log-rank P < 0.001).
The presence of a left dominant system was identified as an independent predictor of non-fatal myocardial infarction and all-cause mortality, especially in patients with significant CAD on CTA. Therefore, the assessment of coronary vessel dominance on CTA may further enhance risk stratification beyond the assessment of significant CAD on CTA.
European Heart Journal 03/2012; 33(11):1367-77. · 10.48 Impact Factor
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[show abstract]
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ABSTRACT: Previous angiographic studies have shown that almost two-thirds of vulnerable plaques are located in non-obstructive lesions. Possibly, the maximum necrotic core (Max NC) area is not always identical to the site of most severe stenosis. Therefore, the purpose of this study was to evaluate the potential difference in location between the maximum necrotic core area and the site of most severe narrowing as assessed by virtual histology intravascular ultrasound (VH IVUS). Overall, 77 patients (139 vessels) underwent VH IVUS. The Max NC site was defined as the cross section with the largest necrotic core area per vessel. The site of most severe narrowing was defined as the minimum lumen area (MLA). Per vessel, the distance from both the Max NC site and MLA site to the origo of the coronary artery was evaluated. In addition, the presence of a virtual histology-thin cap fibroatheroma (VH-TCFA) was assessed. The mean difference (mm) between the MLA site and Max NC site was 10.8 ± 20.6 mm (p < 0.001). Interestingly, the Max NC site was located at the MLA site in seven vessels (5%) and proximally to the MLA site in 92 vessels (66%). Importantly, a higher percentage of VH-TCFA was demonstrated at the Max NC site as compared to the MLA site (24 vs. 9%, p < 0.001). In conclusion, the present findings demonstrate that the Max NC area is rarely at the site of most severe narrowing. Most often, the Max NC area is located proximal to the site of most severe narrowing.
Heart and Vessels 02/2012; · 2.05 Impact Factor
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Mark J Boogers,
Alexander Broersen,
Joëlla E van Velzen,
Fleur R de Graaf,
Heba M El-Naggar,
Pieter H Kitslaar,
Jouke Dijkstra,
Victoria Delgado,
Eric Boersma,
Albert de Roos, Joanne D Schuijf,
Martin J Schalij,
Johan H C Reiber,
Jeroen J Bax,
J Wouter Jukema
[show abstract]
[hide abstract]
ABSTRACT: Previous studies have used semi-automated approaches for coronary plaque quantification on multi-detector row computed tomography (CT), while an automated quantitative approach using a dedicated registration algorithm is currently lacking. Accordingly, the study aimed to demonstrate the feasibility and accuracy of automated coronary plaque quantification on cardiac CT using dedicated software with a novel 3D coregistration algorithm of CT and intravascular ultrasound (IVUS) data sets.
Patients who had undergone CT and IVUS were enrolled. Automated lumen and vessel wall contour detection was performed for both imaging modalities. Dedicated automated quantitative software (QCT) with a unique registration algorithm was used to fuse a complete IVUS run with a CT angiography volume using true anatomical markers. At the level of the minimal lumen area (MLA), percentage lumen area stenosis, plaque burden, and degree of remodelling were obtained on CT. Additionally, mean plaque burden was assessed for the whole coronary plaque. At the identical level within the coronary artery, the same variables were derived from IVUS. Fifty-one patients (40 men, 58 ± 11 years, 103 coronary arteries) with 146 lesions were evaluated. Quantitative computed tomography and IVUS showed good correlation for MLA (n = 146, r = 0.75, P < 0.001). At the level of the MLA, both techniques were well-correlated for lumen area stenosis (n = 146, r = 0.79, P < 0.001) and plaque burden (n = 146, r = 0.70, P < 0.001). Mean plaque burden (n = 146, r = 0.64, P < 0.001) and remodelling index (n = 146, r = 0.56, P < 0.001) showed significant correlations between QCT and IVUS.
Automated quantification of coronary plaque on CT is feasible using dedicated quantitative software with a novel 3D registration algorithm.
European Heart Journal 01/2012; 33(8):1007-16. · 10.48 Impact Factor
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[show abstract]
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ABSTRACT: Identification of patients at risk of future coronary artery disease (CAD) events traditionally relies on scoring tools that take demographic and clinical characteristics into account (e.g., the Framingham risk score in the United States and the Heart Score in Europe). Although these scoring tools have been shown to have a good predictive value, they may still fail to recognize a proportion of patients with coronary atherosclerosis at risk for future CAD events. In order to improve risk stratification, direct visualization of subclinical atherosclerosis has been advocated. Electron-beam computed tomography and multislice computed tomography provide a direct estimation of coronary calcium, a marker of coronary atherosclerosis. A large amount of data is available supporting the clinical value of the noninvasive assessment of coronary artery calcium score (CACS) with these techniques and its incremental prognostic information over traditional risk stratification. Aim of this review is to provide an overview of the literature regarding the prognostic value of CACS assessment. In addition, potential other applications of CACS assessment as well as the limitations of the technique are discussed.
Cardiovascular Therapeutics 12/2011; 29(6):e43-53. · 2.35 Impact Factor
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[show abstract]
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ABSTRACT: Data regarding the distribution of vulnerable lesions in the coronary arteries are scarce. The aim was to evaluate the frequency and distribution of culprit lesions in patients with ST-segment elevation acute myocardial infarction. In addition, the location of culprit lesions was related to infarct size.
Consecutive patients (N=1533, mean age 61±12 years) were evaluated. All patients were treated with primary percutaneous coronary intervention and underwent two-dimensional echocardiography less than 48 h after admission.
The majority of the culprit lesions were located in the left anterior descending coronary artery (LAD, 45%), followed by the right coronary artery (RCA, 38%), and left circumflex coronary artery (LCX, 14%). Subanalysis demonstrated that patients with a culprit lesion in the LAD and LCX had significantly higher-peak cardiac enzymes compared with patients with culprit lesions in the RCA. In addition, patients with proximal LAD and LCX lesions had significantly worse left ventricular function compared with patients with mid or distal lesions.
Plaque rupture resulting in acute myocardial infarction is more likely to occur in the proximal parts of the LAD and RCA. In addition, the location of culprit lesions was related to infarct size. Therefore, knowledge of the distribution of vulnerable lesions is important for identifying patients at risk for acute coronary events.
Coronary artery disease 09/2011; 22(8):533-6. · 1.56 Impact Factor
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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
[show abstract]
[hide abstract]
ABSTRACT: 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.
Heart (British Cardiac Society) 09/2011; 98(3):232-7. · 4.22 Impact Factor
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Cornelis J Roos,
Roxana Djaberi, Joanne D Schuijf,
Eelco J de Koning,
Ton J Rabelink,
Jan W Smit,
Alberto M Pereira,
Imad Al Younis,
Bernies van der Hiel,
Arthur J Scholte,
Jeroen J Bax,
J Wouter Jukema
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ABSTRACT: Vascular stiffness may potentially be used as a screening tool to identify asymptomatic patients with diabetes with abnormal myocardial perfusion. The purpose of this study was therefore to determine the association between vascular stiffness, measured in term of pulse wave velocity (PWV) and augmentation index (AIx), and abnormal myocardial perfusion imaging (MPI) in asymptomatic patients with diabetes.
Prospectively, 160 asymptomatic patients with diabetes (mean age 51 years, 87 men) underwent MPI with adenosine stress. The summed stress score (SSS) was determined in each patient according to a 17-segment and five-point score. Abnormal MPI (SSS ≥ 3) was classified as moderate (SSS 3-7) or severe (SSS ≥ 8) MPI defects. Using applanation tonometry, the carotid-femoral PWV and the radial AIx corrected to 75 beats per minute were determined noninvasively.
MPI was abnormal in 61 patients (38%), with severe MPI defects in 22 patients (14%). Mean PWV increased with deteriorating MPI from 8.4 ± 2.2 m/s in normal MPI to 9.0 ± 2.2 m/s in moderate MPI defects (p = 0.11) and to 11.1 ± 2.5 m/s in severe MPI defects (p < 0.01). Likewise, mean AIx increased from 18.4 ± 13.4% to 19.4 ± 10.7% (p = 0.66) and to 25.4 ± 9.0% (p = 0.03). After adjustment for age and other risk factors, PWV remained a significant predictor of severe MPI defects (p = 0.01, OR 1.50, 95% CI 1.11-2.00), whereas AIx was no longer significant (p = 0.20).
Vascular stiffness measured by PWV is associated with severe MPI defects in asymptomatic patients with diabetes.
European Journal of Nuclear Medicine 08/2011; 38(11):2050-7. · 4.53 Impact Factor
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See Hooi Ewe,
Arnold C T Ng, Joanne D Schuijf,
Frank van der Kley,
Andrea Colli,
Meindert Palmen,
Arend de Weger,
Nina Ajmone Marsan,
Eduard R Holman,
Albert de Roos,
Martin J Schalij,
Jeroen J Bax,
Victoria Delgado
[show abstract]
[hide abstract]
ABSTRACT: Location of aortic valve calcium (AVC) can be better visualized on contrast-enhanced multidetector row computed tomography. The present evaluation examined whether AVC severity and its location could influence paravalvular aortic regurgitation (AR) after transcatheter aortic valve implantation. A total of 79 patients (age 80 ± 7 years, 49% men) with preprocedural multidetector row computed tomography were included. Volumetric AVC quantification and its location were assessed. Transesophageal echocardiography was performed to assess the presence and site of AR after transcatheter aortic valve implantation. Receiver operating characteristic curves were generated to evaluate the usefulness of AVC in determining paravalvular AR at a specific site. Postprocedural AR of grade 1 or more was observed in 63 patients. In most patients (n = 56, 71%), AR was of paravalvular origin. Calcium at the aortic wall of each valve cusp had the largest area under the curve (0.93, p <0.001) in predicting paravalvular AR at the aortic wall site compared to calcium at the valvular edge or body (area under the curve 0.58 and 0.67, respectively). Calcium at the valvular commissure was better than calcium at the valvular edge (area under the curve 0.94 vs 0.71) in predicting paravavular AR originating from the corresponding commissure. In conclusion, contrast-enhanced multidetector row computed tomography can be performed to quantify AVC. Both AVC severity and its exact location are important in determining paravalvular AR after transcatheter aortic valve implantation.
The American journal of cardiology 08/2011; 108(10):1470-7. · 3.58 Impact Factor
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Arnold C T Ng,
Kai-Hang Yiu,
See Hooi Ewe,
Frank van der Kley,
Matteo Bertini,
Arend de Weger,
Albert de Roos,
Dominic Y Leung, Joanne D Schuijf,
Martin J Schalij,
Jeroen J Bax,
Victoria Delgado
[show abstract]
[hide abstract]
ABSTRACT: Evaluate changes in aortic annular dimensions in relation to severe aortic stenosis (AS) and left ventricular (LV) dysfunction.
Mean aortic annular diameters and geometries were compared between 90 severe AS patients and 111 controls by multi-detector row computed tomography (MDCT). All severe AS patients were also dichotomized into two groups based on the presence of preserved (≥ 50%) or impaired (<50%) LV ejection fraction (EF). The influence of LV geometry and function on changes in aortic annular dimensions was examined. Patients with severe AS had similar aortic annular dimensions and geometries compared with controls even after correcting for baseline differences in age and body surface area (BSA). However, severe AS patients with LV dysfunction (LVEF <50%) had significantly larger mean aortic annular diameter (26.4 ± 1.9 vs. 24.5 ± 2.1 mm, P < 0.001) compared with patients with preserved LVEF. The presence of LV dysfunction, male gender, and larger BSA were independent determinants of a larger aortic annulus on MDCT.
In severe AS patients, the presence of LV dysfunction, not the presence of severe AS, was an independent determinant of a larger aortic annular diameter.
European Heart Journal 07/2011; 32(22):2806-13. · 10.48 Impact Factor
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Kai Hang Yiu,
Fleur R de Graaf, Joanne D Schuijf,
Jacob M van Werkhoven,
Joella E van Velzen,
Mark J Boogers,
Cornelis J Roos,
Mihály K de Bie,
Aju Pazhenkottil,
Lucia J Kroft,
Eric Boersma,
Bernhard Herzog,
Albert de Roos,
Philipp A Kaufmann,
Jeroen J Bax,
J Wouter Jukema
[show abstract]
[hide abstract]
ABSTRACT: Chronic kidney disease (CKD) is associated with cardiovascular (CV) events caused by advanced atherosclerosis. Computed tomographic coronary angiography (CTA) can accurately diagnose coronary artery disease (CAD) and predict CV outcomes. The aim of the present study was to evaluate whether moderate CKD provides prognostic information for CV events in patients undergoing CTA. In total 885 patients with suspected CAD underwent CTA and were stratified to moderate CKD (85 patients) or no CKD (770 patients) based on a cut-off estimated glomerular filtration rate of 60 ml/min/1.73 m(2). After 896 days of follow-up, 42 patients developed CV events. Annualized CV event rates were 1.2% in patients with no CKD and no CAD, 2.5% in patients with moderate CKD alone, 2.5% in patients with obstructive CAD alone, and 3.7% in those with moderate CKD and obstructive CAD. Multivariate models demonstrated that moderate CKD (hazard ratio 2.39, confidence interval 1.09 to 5.21, p = 0.03) and obstructive CAD (hazard ratio 2.76, confidence interval 1.40 to 5.44, p <0.01) were independent predictors of CV events. Importantly, moderate CKD provided incremental prognostic information in addition to clinical characteristics and obstructive CAD (chi-square 49.4, p = 0.04). In conclusion, moderate CKD was associated with CV events and provided incremental prognostic information.
The American journal of cardiology 07/2011; 108(7):968-72. · 3.58 Impact Factor
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Joëlla E van Velzen,
Fleur R de Graaf,
Michiel A de Graaf, Joanne D Schuijf,
Lucia J Kroft,
Albert de Roos,
Johan H C Reiber,
Jeroen J Bax,
J Wouter Jukema,
Eric Boersma,
Martin J Schalij,
Ernst E van der Wall
[show abstract]
[hide abstract]
ABSTRACT: The purpose of the study was to systematically compare calcification patterns in plaques on computed tomography angiography (CTA) with plaque characteristics on intravascular ultrasound with radiofrequency backscatter analysis (IVUS-VH).
In total, 108 patients underwent CTA and IVUS-VH. On CTA, calcification patterns in plaques were classified as non-calcified, spotty or dense calcifications. Plaques with spotty calcifications were differentiated into small spotty (<1 mm), intermediate spotty (1-3 mm) and large spotty calcifications (≥3 mm). Plaque characteristics deemed more high-risk on IVUS-VH were defined by % necrotic core (NC) and presence of thin cap fibroatheroma (TCFA). Overall, 300 plaques were identified both on CTA and IVUS-VH. % NC core was significantly higher in plaques with small spotty calcifications as compared to non-calcified plaques (20% vs 13%, P = .006). In addition, there was a trend for a higher % NC in plaques with small spotty calcifications than in plaques with intermediate spotty calcifications (20% vs 14%, P = .053). Plaques with small spotty calcifications had the highest % TCFA as compared to large spotty and dense calcifications (31% vs 9% and 31% vs 6%, P < .05).
Plaques with small spotty calcifications on CTA were related to plaque characteristics deemed more high-risk on IVUS-VH. Therefore, CTA may be valuable in the assessment of the vulnerable plaque.
Journal of Nuclear Cardiology 07/2011; 18(5):893-903. · 2.67 Impact Factor
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Fleur R de Graaf,
Joëlla E van Velzen,
Agnieszka J Witkowska, Joanne D Schuijf,
Noortje van der Bijl,
Lucia J Kroft,
Albert de Roos,
Johan H C Reiber,
Jeroen J Bax,
Greetje J de Grooth,
J Wouter Jukema,
Ernst E van der Wall
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the diagnostic performance of 320-slice computed tomography coronary angiography (CTA) in the evaluation of patients with prior coronary artery bypass grafting (CABG). Invasive coronary angiography (ICA) served as the standard of reference, using a quantitative approach.
CTA studies were performed using CT equipment with 320 detector-rows, each 0.5 mm wide, and a gantry rotation time of 0.35 s. All grafts, recipient and nongrafted vessels were deemed interpretable or uninterpretable. The presence of significant (≥50%) stenosis and occlusion were determined on vessel and patient basis. Results were compared to ICA using quantitative coronary angiography.
A total of 40 patients (28 men, 76 ± 15 years), with 89 grafts, were included in the study. On a graft analysis, the sensitivity, specificity, positive and negative predictive values in the evaluation of significant stenosis were 96%, 92%, 83% and 98% respectively. The diagnostic accuracy for the assessment of recipient and nongrafted vessels was 89% and 80%, respectively. The diagnostic accuracy for the assessment of graft, recipient and nongrafted vessel occlusion was 96%, 92% and 100%, respectively.
320-slice CTA allows accurate non-invasive assessment of significant graft, recipient vessel and nongrafted vessel stenosis in patients with prior CABG.
European Radiology 07/2011; 21(11):2285-96. · 3.22 Impact Factor
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Joëlla E van Velzen,
Fleur R de Graaf,
J Wouter Jukema,
Greetje J de Grooth,
Gabija Pundziute,
Lucia J Kroft,
Albert de Roos,
Johan H C Reiber,
Jeroen J Bax,
Martin J Schalij, Joanne D Schuijf,
Ernst E van der Wall
[show abstract]
[hide abstract]
ABSTRACT: A considerable number of patients with an acute coronary syndrome (ACS) who present with a 0 or low calcium score (CS) still demonstrate coronary artery disease (CAD) and significant stenosis. The aim of the present study was to evaluate the relation between the CS and the degree and character of atherosclerosis in patients with suspected ACS versus patients with stable CAD obtained by computed tomography angiography and virtual histology intravascular ultrasound (VH IVUS). Overall 112 patients were studied, 53 with ACS and 59 with stable CAD. Calcium scoring and computed tomography angiography were performed and followed by VH IVUS. On computed tomography angiography each segment was evaluated for plaque and classified as noncalcified, mixed, or calcified. Vulnerable plaque characteristics on VH IVUS were defined by percent necrotic core and presence of thin-cap fibroatheroma. If the CS was 0, patients with ACS had a higher mean number of plaques (5.0 ± 2.0 vs 2.0 ± 1.9, p <0.05) and noncalcified plaques (4.6 ± 3.5 vs 1.3 ± 1.9, p <0.05) on computed tomography angiography than those with stable CAD. If the CS was 0, VH IVUS demonstrated that patients with ACS had a larger amount of necrotic core area (0.58 ± 0.73 vs 0.22 ± 0.43 mm(2), p <0.05) and a higher mean number of thin-cap fibroatheromas (0.6 ± 0.7 vs 0.1 ± 0.3, p <0.05) than patients with stable CAD. In conclusion, even in the presence of a 0 CS, patients with ACS have increased plaque burden and increased vulnerability compared to patients with stable CAD. Therefore, absence of coronary calcification does not exclude the presence of clinically relevant and potentially vulnerable atherosclerotic plaque burden in patients with ACS.
The American journal of cardiology 06/2011; 108(5):658-64. · 3.58 Impact Factor
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Eleanore S J Kröner,
Joella E van Velzen,
Mark J Boogers,
Hans-Marc J Siebelink,
Martin J Schalij,
Lucia J Kroft,
Albert de Roos,
Ernst E van der Wall,
J Wouter Jukema,
Johan H C Reiber, Joanne D Schuijf,
Jeroen J Bax
[show abstract]
[hide abstract]
ABSTRACT: Coronary computed tomographic angiography allows direct evaluation of the vessel wall and thus positive remodeling, which is a marker of vulnerability. The purpose of this study was to assess the association between positive remodeling on computed tomography angiogram (CTA) and vulnerable plaque characteristics on virtual histologic intravascular ultrasound (VH IVUS) images. Forty-five patients (78% men, 58 ± 11 years old) underwent computed tomographic angiography followed by VH IVUS. On CTA, the remodeling index was determined for each lesion by a blinded observer using quantitative analysis. Positive remodeling was defined based on a remodeling index ≥1.0. Percent necrotic core and presence of thin-capped fibroatheroma (TCFA) were used as markers for plaque vulnerability on VH IVUS images. Ninety-nine atherosclerotic plaques were evaluated, of which 37 lesions (37.4%) were identified as having positive remodeling on CTA. Higher levels of plaque vulnerability were identified in lesions with positive remodeling compared to lesions without positive remodeling. Percent necrotic core was significantly higher in lesions with positive remodeling (15.7 ± 7.8%) compared to lesions without this characteristic (10.2 ± 7.2%, p <0.001). Furthermore, significantly more TCFA lesions were identified in positively remodeled lesions (n = 16, 43.2%) than in lesions without positive remodeling (n = 3, 4.8%, p <0.001). In conclusion, lesions with positive remodeling on CTA are associated with increased levels of plaque vulnerability on VH IVUS images including a higher percent necrotic core and a higher prevalence of TCFA. Thus evaluation of remodeling on CTA may provide a valuable marker for plaque vulnerability.
The American journal of cardiology 06/2011; 107(12):1725-9. · 3.58 Impact Factor
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Tessa S S Genders,
Ewout W Steyerberg,
Hatem Alkadhi,
Sebastian Leschka,
Lotus Desbiolles,
Koen Nieman,
Tjebbe W Galema,
W Bob Meijboom,
Nico R Mollet,
Pim J de Feyter, [......],
Juhani Knuuti,
Sami Kajander,
Carlos A G van Mieghem,
Matthijs F L Meijs,
Maarten J Cramer,
Deepa Gopalan,
Gudrun Feuchtner,
Guy Friedrich,
Gabriel P Krestin,
M G Myriam Hunink
[show abstract]
[hide abstract]
ABSTRACT: The aim was to validate, update, and extend the Diamond-Forrester model for estimating the probability of obstructive coronary artery disease (CAD) in a contemporary cohort.
Prospectively collected data from 14 hospitals on patients with chest pain without a history of CAD and referred for conventional coronary angiography (CCA) were used. Primary outcome was obstructive CAD, defined as ≥ 50% stenosis in one or more vessels on CCA. The validity of the Diamond-Forrester model was assessed using calibration plots, calibration-in-the-large, and recalibration in logistic regression. The model was subsequently updated and extended by revising the predictive value of age, sex, and type of chest pain. Diagnostic performance was assessed by calculating the area under the receiver operating characteristic curve (c-statistic) and reclassification was determined. We included 2260 patients, of whom 1319 had obstructive CAD on CCA. Validation demonstrated an overestimation of the CAD probability, especially in women. The updated and extended models demonstrated a c-statistic of 0.79 (95% CI 0.77-0.81) and 0.82 (95% CI 0.80-0.84), respectively. Sixteen per cent of men and 64% of women were correctly reclassified. The predicted probability of obstructive CAD ranged from 10% for 50-year-old females with non-specific chest pain to 91% for 80-year-old males with typical chest pain. Predictions varied across hospitals due to differences in disease prevalence.
Our results suggest that the Diamond-Forrester model overestimates the probability of CAD especially in women. We updated the predictive effects of age, sex, type of chest pain, and hospital setting which improved model performance and we extended it to include patients of 70 years and older.
European Heart Journal 03/2011; 32(11):1316-30. · 10.48 Impact Factor
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Mark J Boogers,
Jacob M van Werkhoven, Joanne D Schuijf,
Victoria Delgado,
Heba M El-Naggar,
Eric Boersma,
Gaetano Nucifora,
Rob J van der Geest,
Bernard P Paelinck,
Lucia J Kroft,
Johan H C Reiber,
Albert de Roos,
Jeroen J Bax,
Hildo J Lamb
[show abstract]
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ABSTRACT: This study aimed to demonstrate the feasibility of multidetector row computed tomography (CT) for assessment of diastolic function in comparison with 2-dimensional (2D) echocardiography using tissue Doppler imaging (TDI).
Diastolic left ventricular (LV) function plays an important role in patients with cardiovascular disease. 2D echocardiography using TDI has been used most commonly to evaluate diastolic LV function. Although the role of cardiac CT imaging for evaluation of coronary atherosclerosis has been explored extensively, its feasibility to evaluate diastolic function has not been studied.
Patients who had undergone 64-multidetector row CT and 2D echocardiography with TDI were enrolled. Diastolic function was evaluated using early (E) and late (A) transmitral peak velocity (cm/s) and peak mitral septal tissue velocity (Ea; cm/s). Peak transmitral velocity (cm/s) was calculated by dividing peak diastolic transmitral flow (ml/s) by the corresponding mitral valve area (cm(2)). Mitral septal tissue velocity was calculated from changes in LV length per cardiac phase. Subsequently, the estimation of LV filling pressures (E/Ea) was determined.
Seventy patients (46 men; mean age 55 ± 11 years) who had undergone cardiac CT and 2D echocardiography with TDI were included. Good correlations were observed between cardiac CT and 2D echocardiography for assessment of E (r = 0.73; p < 0.01), E/A (r = 0.87; p < 0.01), Ea (r = 0.82; p < 0.01), and E/Ea (r = 0.81; p < 0.01). Moreover, a good diagnostic accuracy (79%) was found for detection of diastolic dysfunction using cardiac CT. Finally, the study showed a low intraobserver and interobserver variability for assessment of diastolic function on cardiac CT.
Cardiac CT imaging showed good correlations for transmitral velocity, mitral septal tissue velocity, and estimation of LV filling pressures when compared with 2D echocardiography. Additionally, cardiac CT and 2D echocardiography were comparable for assessment of diastolic dysfunction. Accordingly, cardiac CT may provide information on diastolic dysfunction.
JACC. Cardiovascular imaging 03/2011; 4(3):246-56. · 14.29 Impact Factor
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Victoria Delgado,
Arnold C T Ng, Joanne D Schuijf,
Frank van der Kley,
Miriam Shanks,
Laurens F Tops,
Nico R L van de Veire,
Albert de Roos,
Lucia J M Kroft,
Martin J Schalij,
Jeroen J Bax
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ABSTRACT: Accurate aortic root measurements and evaluation of spatial relationships with coronary ostia are crucial in preoperative transcatheter aortic valve implantation assessments. Standardization of measurements may increase intraobserver and interobserver reproducibility to promote procedural success rate and reduce the frequency of procedurally related complications. This study evaluated the accuracy and reproducibility of a novel automated multidetector row computed tomography (MDCT) imaging postprocessing software, 3mensio Valves (version 4.1.sp1, Medical Imaging BV, Bilthoven, The Netherlands), in the assessment of patients with severe aortic stenosis candidates for transcatheter aortic valve implantation.
Ninety patients with aortic valve disease were evaluated with 64-row and 320-row MDCT. Aortic valve annular size, aortic root dimensions, and height of the coronary ostia relative to the aortic valve annular plane were measured with the 3mensio Valves software. The measurements were compared with those obtained manually by the Vitrea2 software (Vital Images, Minneapolis, MN).
Assessment of aortic valve annulus and aortic root dimensions were feasible in all the patients using the automated 3mensio Valves software. There were excellent agreements with minimal bias between automated and manual MDCT measurements as demonstrated by Bland-Altman analysis and intraclass correlation coefficients ranging from 0.97 to 0.99. The automated 3mensio Valves software had better interobserver reproducibility and required less image postprocessing time than manual assessment.
Novel automated MDCT postprocessing imaging software (3mensio Valves) permits reliable, reproducible, and automated assessments of the aortic root dimensions and spatial relations with the surrounding structures. This has important clinical implications for preoperative assessments of patients undergoing transcatheter aortic valve implantation.
The Annals of thoracic surgery 03/2011; 91(3):716-23. · 3.74 Impact Factor
