Incremental value of stress echocardiography and computed tomography coronary calcium scoring for the diagnosis of coronary artery disease

AlJaroudi, Wael; Mansour, Mohamad Jihad; Chedid, Maroun; Hamoui, Omar; Asmar, Joseph; Mansour, Layal; Chammas, Elie

doi:10.1007/s10554-019-01577-x

Cited by 9 publications

(6 citation statements)

References 27 publications

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“…In another published study, a median CAC score of 238 (interquartile range 238-488) was associated with obstructive CAD. 25 While DD is associated with abnormal CAC, we believe that the current findings Diastolic dysfunction is known to be an independent predictor of cardiovascular outcomes in many cohorts 27 and has incremental prognostic value by risk-stratifying patients with different FRS. 28 Also, worsening of DD over time is an independent predictor of death.…”

Section: Discussionmentioning

confidence: 57%

“…In another published study, a median CAC score of 238 (interquartile range 238‐488) was associated with obstructive CAD . While DD is associated with abnormal CAC, we believe that the current findings have important prognostic implications and may reveal unexpected diagnoses since asymptomatic patients with high‐grade DD and CAC score are at increased risk for subclinical obstructive CAD, which warrants the need for further testing and investigation.…”

Section: Discussionmentioning

confidence: 58%

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Association between left ventricular diastolic dysfunction and subclinical coronary artery calcification

Mansour

Chammas

Hamoui³

et al. 2020

Echocardiography

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Background Assessment of diastolic dysfunction (DD) by echocardiography is an integral part of the evaluation of patients with normal ejection fraction and symptoms suggestive of heart failure. However, many patients with DD are asymptomatic. Computed tomography calcium scoring (CTCS) is often used to assess patients at low‐intermediate risk for coronary artery disease (CAD). The purpose of this study was to evaluate the association of DD with subclinical coronary artery calcification. Methods Consecutive patients presenting for executive checkup who underwent resting transthoracic echocardiography followed by CTCS were retrospectively identified between January 2010 and December 2014. Two‐dimensional and tissue Doppler imaging parameters were analyzed for assessing and grading of DD. Coronary artery calcium (CAC) score was quantified. Results A total of 191 patients (mean age 52 ± 12 years, 17% age ≥65, 20% with diabetes) were included. Of them, 69 (36%) patients had DD. Patients with higher CAC score were older, had more comorbidities, lower e′, and were more likely to have DD. In the multivariate analysis, DD alone, age >65 years, or both were associated with almost threefold increase of subclinical atherosclerosis. After propensity analysis, DD was still associated with increased odds ratio (OR) for subclinical CAC (OR 3.66 [1.54‐8.72], P‐value .03) and similarly for e′ < 10 cm/s. Compared to patients age <65 years and normal diastolic function, those age >65 years or DD had OR 3.49 (1.45‐8.35) (P‐value .005) for subclinical coronary atherosclerosis (CAC > 0), whereas those age >65 and DD had OR 9.30 (2.00‐42) (P‐value .004). Conclusions Our analysis suggests that DD was strongly associated with CAC > 0, particularly among those age <65 years. Assessment of CAC as part of the routine clinical evaluation of patients with normal EF and atypical symptoms without a history of coronary atherosclerotic disease is warranted for further risk stratification.

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 58%

Association between left ventricular diastolic dysfunction and subclinical coronary artery calcification

Mansour

Chammas

Hamoui³

et al. 2020

Echocardiography

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“…A cohort of 302 consecutive outpatients was identified from an internationally recognized executive health program between January 2010 and July 2018 (described previously, 9 – 11 . Patients with abnormal resting left ventricular ejection fraction, prior myocardial infarction, significant valvular disease, left bundle branch block, congenital heart disease, pericarditis, myocarditis, and previous cardiac surgeries, were excluded (n = 18), leaving 284 patients for the final analysis.…”

Section: Methodsmentioning

confidence: 99%

Clinical significance of the hemodynamic gain index in patients undergoing exercise stress testing and coronary computed tomography angiography

Mansour

Chammas²,

Winkler

et al. 2023

BMC Cardiovasc Disord

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Background Many hemodynamic parameters provide limited information regarding obstructive coronary artery disease (CAD) during exercise stress testing particularly when exercise is suboptimal. Hemodynamic gain index (HGI) is a recent sensitive indicator of ischemia and has been associated with increased mortality. This study evaluated the clinical impact of HGI in patients who underwent concomitant exercise stress testing and coronary computed tomography angiography (CCTA). Methods A total of 284 consecutive patients from the executive health program between 2010 and 2018 were identified. Resting and peak heart rate (HR) as well as systolic blood pressure (SBP) measurements were recorded. Framingham risk score (FRS), Duke treadmill score (DTS) and HGI $$(\frac{{{\text{HRpeak}} \times {\text{SBPpeak}} - {\text{HRrest}} \times {\text{SBPrest}}}}{{{\text{HRrest}} \times {\text{SBPrest}}}})$$ ( HRpeak × SBPpeak - HRrest × SBPrest HRrest × SBPrest ) were calculated. The latter was divided into quartiles. CCTA was used as a reference test to detect any CAD. Multivariate analysis and artificial neural network were used to determine the independent predictors of obstructive CAD. Results Mean age was 53 ± 12 years with 83% male. Mean HGI was 1.74 ± 0.67, with cut-off value of severely blunted HGI ≤ 1.25 (Quartile 4). Patients with severely blunted HGI were older, had higher FRS, and worse DTS. Patients with obstructive CAD had lower HGI when compared to those with normal CCTA/non-obstructive CAD (1.36 ± 0.53 vs. 1.77 ± 0.67, P = 0.005), and showed a higher prevalence of severely blunted HGI (44% vs. 22%, P = 0.019). After adjusting for traditional risk factors, HGI remained an independent predictor of obstructive CAD while severely blunted HGI was associated with threefold increased odds of having obstructive CAD (P = 0.05). Using artificial intelligence analysis, severely blunted HGI independently predicted obstructive CAD with an area under the curve of 0.83 and 0.96, and normalized importance of HGI of 100% and 63%, respectively for different models. Conclusions Among patients who underwent concomitant exercise stress testing and CCTA, severely blunted HGI independently predicted obstructive CAD after multivariate adjustment for traditional risk factors.

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“…The providers in turn benefit from these tests, with some under the label of "executive package" offering computed tomography coronary angiography and exercise stress echocardiography for asymptomatic executives on the same day. 35 Similarly, insurance companies do discourage such practices with the potential to increase future premium. This explains in part the continuous increase in healthcare insurance policy prices that nearly triples from 2,196 USD in 1999 to 6,690 USD in 2017.…”

Section: Behaviorsmentioning

confidence: 99%

Reforming Healthcare Practice in View of the Economic Crisis in Lebanon: The Case of Cardiovascular Care

2020

MedJEM

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Since the fall of 2019, Lebanon has been facing an economic crisis that has imposed many challenges on its healthcare system in its entirety. In this review, we propose a methodology to inform healthcare policy and apply it on cardiovascular disease (CVD) healthcare with emphasis on ischemic heart disease (IHD). The main goal of this methodology is reducing unnecessary expenditure while maintaining quality and access. CVD, and particularly IHD, is the most common reason for hospitalizations in Lebanon. Lebanon also has a high density of catheterization labs, higher than countries with higher prevalence of disease. Additionally, we found coronary to be are more expensive in comparison to other countries. To reduce healthcare costs without compromising quality and access we propose solutions targeting healthcare financing, payment for services, healthcare organizations, behaviors of providers, payers, and patients, and above all government regulation.

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Incremental value of stress echocardiography and computed tomography coronary calcium scoring for the diagnosis of coronary artery disease

Cited by 9 publications

References 27 publications

Association between left ventricular diastolic dysfunction and subclinical coronary artery calcification

Association between left ventricular diastolic dysfunction and subclinical coronary artery calcification

Clinical significance of the hemodynamic gain index in patients undergoing exercise stress testing and coronary computed tomography angiography

Reforming Healthcare Practice in View of the Economic Crisis in Lebanon: The Case of Cardiovascular Care

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