Prognostic Value of Subclinical Coronary Artery Disease in Atrial Fibrillation Patients Identified by Coronary Computed Tomography Angiography

Nous, Fay; Budde, Ricardo P.J.; Dijkman, Eva D. van; Musters, Paul; Nieman, Koen; Galema, Tjebbe W.

doi:10.1016/j.amjcard.2020.03.050

Cited by 13 publications

(11 citation statements)

References 29 publications

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“…reported similar, 41% obstructive CAD cases among 150 patients with atrial fibrillation [ 21 ]. In a recent study involving 94 patients, only 26% had obstructive CAD on coronary CTA [ 13 ]. In our current study, the most widely used definition of CAD, as 50% equal or more of luminal stenosis was applied.…”

Section: Discussionmentioning

confidence: 99%

High incidence of newly diagnosed obstructive coronary artery disease regardless of chest pain detected on pre-procedural cardiac computed tomography angiography in patients undergoing atrial fibrillation ablation

Herczeg

Simon

Szegedi

et al. 2022

Coronary Artery Disease

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Background Cardiac computed tomography (CT) is often performed before catheter ablation of atrial fibrillation to map atrial and pulmonary anatomy. Incident coronary artery disease (CAD) may also be diagnosed during cardiac CT angiography (CTA). Our aim was to assess whether coronary CTA might be able to identify a significant proportion of patients with obstructive CAD prior to their catheter ablation procedure event, even in asymptomatic patients. Methods Consecutive patients undergoing pre-ablation coronary CTA for atrial fibrillation between 2013 and 2020 were retrospectively selected. Patients with previously diagnosed CAD were excluded. Obstructive CAD was defined as ≥50% luminal stenosis. We analyzed the relationship between obstructive CAD, any chest pain, and traditional risk factors. Results Overall, 2321 patients [median age 63.0 (54.4–69.2), 1052/2321 (45.3%) female] underwent coronary CTA and 488/2321 (21.0%) were diagnosed with obstructive CAD. There was no difference regarding the rate of obstructive CAD in patients with any chest pain compared to patients without any chest pain [91/404 (22.5%) vs. 397/1917 (20.7%), P = 0.416, respectively). The following parameters were associated with obstructive CAD: age > 65 years [odds ratio (OR) = 2.51; 95% confidence interval (CI), 2.02–3.13; P < 0.001), male sex (OR = 1.59; 95% CI, 1.28–1.98; P < 0.001), hypertension (OR = 1.40; 95% CI, 1.08–1.81; P = 0.012), diabetes (OR = 1.50; 95% CI, 1.13–1.99; P = 0.006), dyslipidaemia (OR = 1.33; 95% CI, 1.07–1.66; P = 0.011) and history of smoking (OR = 1.34; 95% CI, 1.07–1.68; P = 0.011). Conclusions The high prevalence of obstructive CAD even in patients without chest pain highlights the importance of additional coronary artery diagnostics in patients undergoing left atrial CTA awaiting catheter ablation for atrial fibrillation. These patients regardless of chest pain thus may require further risk modification to decrease their potential ischemic and thromboembolic risk.

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Section: Discussionmentioning

confidence: 99%

High incidence of newly diagnosed obstructive coronary artery disease regardless of chest pain detected on pre-procedural cardiac computed tomography angiography in patients undergoing atrial fibrillation ablation

Herczeg

Simon

Szegedi

et al. 2022

Coronary Artery Disease

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“…Nous et al 4 reported 26% of patients with obstructive CAD in CCTA and 29% of the patients with CAD underwent coronary revascularisation. This is moderately higher than in our study, where 20.3% underwent coronary intervention (45 of 222 patients with CAD in CCTA underwent PCI and two received CABG).…”

Section: Discussionmentioning

confidence: 99%

“… 8 9 Yet, these studies were conducted in comparably small and preselected study populations at a priori elevated risk for CAD. Recently, Nous et al 4 reported the prognostic value of CCTA in identifying CAD in a small AF patient cohort, emphasising the benefit of CCTA in long term clinical follow-up, but lacking short-term clinical consequences. 4 Also, none of the published trials used cardiac catheterisation to further evaluate CAD in pathological CCTA.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic role of coronary CT angiography in paroxysmal or first diagnosed atrial fibrillation

Rottländer

Saal²,

Degen³

et al. 2021

Open Heart

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ObjectivesThe presence of coronary artery disease (CAD) in patients hospitalised with paroxysmal or first diagnosed atrial fibrillation (AF) has major implications for antithrombotic therapy and cardiovascular event rate. Coronary CT angiography (CCTA) is a feasible tool to identify patients with concealed CAD. We aimed to evaluate the diagnostic role of early CCTA in patients hospitalised with paroxysmal or first diagnosed AF.MethodsIn a 5-year single-centre retrospective analysis, 566 patients with paroxysmal or first diagnosed AF who underwent CCTA were enrolled to investigate the presence of CAD.ResultsIn patients with paroxysmal or first diagnosed AF, CCTA revealed CAD (coronary artery stenosis ≥50%) in 39.2%. Cardiac catheterisation was performed in 31.6%, confirming CAD in 13.1% of all patients. In 8.0% percutaneous coronary intervention and in 0.5% coronary artery bypass grafting was performed. In patients with paroxysmal or first diagnosed AF: (1) angina pectoris per se does not predict CAD; (2) multivariable regression analysis revealed age, male sex and diabetes as risk factors for CAD in AF; (3) Framingham Risk Score for coronary heart disease and CHA2DS2-VASc-Score were relevant risk scores of CAD and (4) the classification of Coronary Artery Calcium score reference values according to the Multi-Ethnic Study of Atherosclerosis was a predictor of CAD.ConclusionPatients with paroxysmal or first diagnosed AF are at risk for CAD, while CCTA is a feasible diagnostic tool for CAD. We recommend to integrate CT calcium scoring and CCTA into the diagnostic workup of patients with new-onset or paroxysmal AF.

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“…Пациенты с ФП и обструктивной ИБС получали другое лечение и имели худший прогноз, чем пациенты без обструктивной ИБС. КТ сердца может улучшить стратификацию сердечно-сосудистого риска у пациентов с ФП [51].…”

Section: принятые сокращенияunclassified

Possibilities of computed and magnetic resonance imaging of the heart in patients with atrial fibrillation

Galyautdinov

Ibragimova²,

Galeeva

2023

Kazan Med J

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Computed and magnetic resonance imaging of the heart has been widely used in recent years in patients with atrial fibrillation. They are used to determine the morphology of the heart, the presence of intracardiac thrombi, quantify the structures of the heart, thrombosis of intracardiac devices, determine tactics for surgical interventions, and other purposes. These methods of instrumental diagnostics can be used as an alternative to transesophageal echocardiography, which has a number of limitations and disadvantages compared to computed tomography and magnetic resonance imaging. Computed and magnetic resonance imaging of the heart are used to avoid invasiveness in the study of the heart, to improve the accuracy of measuring heart structures, to reduce the number of diagnostic methods used before various surgical interventions in patients with atrial fibrillation, and also, according to epidemic indications, as part of the prevention of the spread of coronavirus infection. In addition, magnetic resonance imaging allows to avoid radiation exposure to the patient. The review presents the results of studies, meta-analyses of pooled samples, as well as a description of the clinical possibilities of computed and magnetic resonance imaging of the heart in patients with atrial fibrillation. Publications on the use of these methods for visualization of thrombi in the left atrium and its appendage, in pulmonary vein ablation and occlusion of the left atrial appendage, as well as data on visualization of the residual flow around the occlusive device and thrombosis of intracardiac devices are presented. According to the results of a literature review, computed tomography and magnetic resonance imaging of the heart have similar or higher imaging capabilities compared to transesophageal echocardiography, as well as some advantages over it, primarily the non-invasiveness of the procedure. The works demonstrating the possibilities of computed tomography of the heart for the diagnosis of coronary heart disease in patients with atrial fibrillation are presented. In preparing the review, the literature search method in PubMed databases for the period 20132022 was used.

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Prognostic Value of Subclinical Coronary Artery Disease in Atrial Fibrillation Patients Identified by Coronary Computed Tomography Angiography

Cited by 13 publications

References 29 publications

High incidence of newly diagnosed obstructive coronary artery disease regardless of chest pain detected on pre-procedural cardiac computed tomography angiography in patients undergoing atrial fibrillation ablation

High incidence of newly diagnosed obstructive coronary artery disease regardless of chest pain detected on pre-procedural cardiac computed tomography angiography in patients undergoing atrial fibrillation ablation

Diagnostic role of coronary CT angiography in paroxysmal or first diagnosed atrial fibrillation

Possibilities of computed and magnetic resonance imaging of the heart in patients with atrial fibrillation

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Prognostic Value of Subclinical Coronary Artery Disease in Atrial Fibrillation Patients Identified by Coronary Computed Tomography Angiography

Cited by 13 publications

References 29 publications

High incidence of newly diagnosed obstructive coronary artery disease regardless of chest pain detected on pre-procedural cardiac computed tomography angiography in patients undergoing atrial fibrillation ablation

High incidence of newly diagnosed obstructive coronary artery disease regardless of chest pain detected on pre-procedural cardiac computed tomography angiography in patients undergoing atrial fibrillation ablation

Diagnostic role of coronary CT angiography in paroxysmal or first diagnosed atrial fibrillation

Possibilities of computed and magnetic resonance imaging of the heart in patients with ­atrial fibrillation

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Possibilities of computed and magnetic resonance imaging of the heart in patients with atrial fibrillation