Incremental prognostic utility of coronary CT angiography for asymptomatic patients based upon extent and severity of coronary artery calcium: results from the COronary CT Angiography EvaluatioN For Clinical Outcomes InteRnational Multicenter (CONFIRM) Study

Cho, Iksung; Chang, Hyuk Jae; Hartaigh, Bríain ó; Shin, Sanghoon; Sung, Ji Min; Lin, Fay Y.; Achenbach, Stephan; Heo, Ran; Berman, Daniel S.; Budoff, Matthew J.; Callister, Tracy Q.; Al-Mallah, Mouaz; Cademartiri, Filippo; Chinnaiyan, Kavitha M.; Chow, Benjamin J.W.; Dunning, Allison; Delago, Augustin; Villines, Todd C.; Hadamitzky, Martin; Hausleiter, Jöerg; Leipsic, Jonathon; Shaw, Leslee J.; Kaufmann, Philipp A.; Cury, Ricardo C.; Feuchtner, Gudrun; Kim, Yong Jin; Maffei, Erica; Raff, Gilbert; Pontone, Gianluca; Andreini, Daniele; Min, James K.

doi:10.1093/eurheartj/ehu358

Cited by 111 publications

(66 citation statements)

References 47 publications

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“…An advanced burden of subclinical atherosclerosis in the coronary arteries is an independent marker of ASCVD risk in the general population [71][72][73] . There is evidence from robust prospective studies that advanced coronary artery calcification detected by cardiac computed tomography, defined mainly as a coronary calcium score >100 Agatston units, identifies individuals at high relative and absolute risk of coronary heart disease events and mortality 72,74 .…”

Section: Advanced Subclinical Coronary Atherosclerosis Burdenmentioning

confidence: 99%

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Defining severe familial hypercholesterolaemia and the implications for clinical management: a consensus statement from the International Atherosclerosis Society Severe Familial Hypercholesterolemia Panel

Santos

Gidding

Hegele

et al. 2016

The Lancet Diabetes & Endocrinology

343

222

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Familial hypercholesterolaemia is common in individuals who had a myocardial infarction at a young age. As many as one in 200 people could have heterozygous familial hypercholesterolaemia, and up to one in 300 000 individuals could be homozygous. The phenotypes of heterozygous and homozygous familial hypercholesterolaemia overlap considerably; the response to treatment is also heterogeneous. In this Review, we aim to define a phenotype for severe familial hypercholesterolaemia and identify people at highest risk for cardiovascular disease, based on the concentration of LDL cholesterol in blood and individuals' responsiveness to conventional lipid-lowering treatment. We assess the importance of molecular characterisation and define the role of other cardiovascular risk factors and advanced subclinical coronary atherosclerosis in risk stratification. Individuals with severe familial hypercholesterolaemia might benefit in particular from early and more aggressive cholesterol-lowering treatment (eg, with PCSK9 inhibitors). In addition to better tailored therapy, more precise characterisation of individuals with severe familial hypercholesterolaemia could improve resource use

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Section: Advanced Subclinical Coronary Atherosclerosis Burdenmentioning

confidence: 99%

“…The presence of obstructive (>50% luminal obstruction) in one vessel or nonobstructive coronary plaques in at least two vessels detected by cardiac computed tomography angiography also represent independent markers of death and myocardial infarction 73,[76][77][78] .…”

Section: Advanced Subclinical Coronary Atherosclerosis Burdenmentioning

confidence: 99%

Defining severe familial hypercholesterolaemia and the implications for clinical management: a consensus statement from the International Atherosclerosis Society Severe Familial Hypercholesterolemia Panel

Santos

Gidding

Hegele

et al. 2016

The Lancet Diabetes & Endocrinology

343

222

View full text Add to dashboard Cite

show abstract

“…19 Continuous normally distributed variables are reported as mean ± SD and were compared using Student's t-test or Wilcoxon rank-sum test as appropriate for 2-group comparisons, or using 1-way ANOVA or Kruskal-Wallis test as appropriate for >2-group comparisons. Comparison of categorical variables was performed using the Pearson chi-squared test and categorical variables are reported as counts with proportions.…”

Section: Discussionmentioning

confidence: 99%

Incremental Benefit of Coronary Artery Calcium Score Above Traditional Risk Factors for All-Cause Mortality in Asymptomatic Korean Adults

Han

Hartaigh

Gransar

et al. 2015

Circ J

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“…22,23 These findings, which may be able to be depicted more clearly by positron emission tomography with fluorine 18-fluorodeoxyglucose or cardiac magnetic resonance imaging compared to coronary CT imaging, [21][22][23][24] are likely to be a more immediate or short-term risk indicator of adverse outcomes. On the other hand, Cho et al 25 recently showed incremental prognostic values of the assessment of atherosclerotic plaque burden and lumen narrowing by coronary CT angiography in asymptomatic patients with moderate coronary calcification defined as calcium score ranging from 101 to 400 during a 24-month period. The prognostic efficacy, however, is likely to be attenuated ironically in patients with lower or higher coronary calcification probably due to false positive or negative results in the presence of severe calcification and/or motion artifacts.…”

Section: See Related Article Pp 1253-1262mentioning

confidence: 99%

A multifunctional CT technology: Reality or illusion for patient risk assessment?

Nakata

2017

Journal of Nuclear Cardiology

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A high-speed, multi-slice coronary computed tomography (CT) imaging has emerged as a promising or clinically available multifunctional technique for the assessment of myocardial ischemia, viability, ischemia-induced cardiac dysfunction, and coronary atherosclerotic alterations in patients with suspected or known coronary artery disease. Despite several technical issues remain to be resolved, cardiac CT imaging will have a reality as a multifunctional modality for guiding physicians in better decision-making for favorable clinical outcomes in patients with suspected coronary artery disease, provided that this imaging technology can contribute to characterization and localization of high-risk coronary atherosclerosis in combination with the quantitative evaluation of functional myocardial ischemia.Key Words: Myocardial ischemia AE stree myocardial perfusion imaging AE coronary artery disease AE cardiac CT See related article, pp. 1253-1262Several non-invasive modalities have emerged as promising or clinically available multifunctional techniques for the assessment of myocardial ischemia, ischemic burden size, ischemia-induced left ventricular dysfunction, myocardial viability, and high-risk coronary plaque, all of which are definitively related to unfavorable clinical outcomes in patients with suspected or known coronary artery disease. Among them, recent remarkable advances in high-speed, multi-slice computed tomography (CT) in cardiac imaging enable to evaluate not only coronary arteriosclerosis, including luminal narrowing, vulnerable plaque, and atherosclerotic remodeling, but also functional ischemia by the measurement of coronary flow reserve with or without a vasodilator agent. A wide-spread use and easy access to coronary CT at cardiology practice contributes to identifying cryptogenic coronary arteriosclerosis and vulnerable coronary plaque. On the other hand, anatomical approach to coronary artery disease tends to overestimate coronary luminal narrowing, which is not necessarily the hallmark of significant coronary artery disease or future cardiac event risks, 1-3 and sometimes results in unnecessary or ineffective selection of invasive diagnostic or therapeutic strategy. [4][5][6][7][8][9][10] In this context, cardiac CT technology as a multifunctional modality is still challenging and in progress. In this issue of J Nucl Cardiol, van Rosendael et al 11 investigated the association between atherosclerotic coronary morphology and functional ischemia both of which were estimated on the same day using a sequential CT imaging protocol together with an adenosine stress approach in 84 of 115 consecutive patients with new onset chest pain referred from the outpatient clinic. Authors demonstrated a limited but positive correlation between CT angiographic stenosis and adenosine-induced CT perfusion abnormality. Besides the small, single-center study and the limited number of ischemic lesions, there are several issues to be recognized in this study before these results can be put into clinical perspective.

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Incremental prognostic utility of coronary CT angiography for asymptomatic patients based upon extent and severity of coronary artery calcium: results from the COronary CT Angiography EvaluatioN For Clinical Outcomes InteRnational Multicenter (CONFIRM) Study

Abstract: Coronary CT angiography provides incremental prognostic utility for prediction of mortality and non-fatal myocardial infarction for asymptomatic individuals with moderately high CACS, but not for lower or higher CACS.

Cited by 111 publications

References 47 publications

Defining severe familial hypercholesterolaemia and the implications for clinical management: a consensus statement from the International Atherosclerosis Society Severe Familial Hypercholesterolemia Panel

Defining severe familial hypercholesterolaemia and the implications for clinical management: a consensus statement from the International Atherosclerosis Society Severe Familial Hypercholesterolemia Panel

Incremental Benefit of Coronary Artery Calcium Score Above Traditional Risk Factors for All-Cause Mortality in Asymptomatic Korean Adults

A multifunctional CT technology: Reality or illusion for patient risk assessment?

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