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Coronary Artery Disease: HELP
Articles by Dr. Stephan Achenbach
Based on 165 articles published since 2008
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Between 2008 and 2019, S. Achenbach wrote the following 165 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7
1 Guideline Coronary computed tomographic imaging in women: An expert consensus statement from the Society of Cardiovascular Computed Tomography. 2018

Truong, Quynh A / Rinehart, Sarah / Abbara, Suhny / Achenbach, Stephan / Berman, Daniel S / Bullock-Palmer, Renee / Carrascosa, Patricia / Chinnaiyan, Kavitha M / Dey, Damini / Ferencik, Maros / Fuechtner, Gudrun / Hecht, Harvey / Jacobs, Jill E / Lee, Sang-Eun / Leipsic, Jonathan / Lin, Fay / Meave, Aloha / Pugliese, Francesca / Sierra-Galán, Lilia M / Williams, Michelle C / Villines, Todd C / Shaw, Leslee J / Anonymous3891033. ·Weill Cornell Medicine, USA. Electronic address: qat9001@med.cornell.edu. · Piedmont Healthcare, USA. · UT Southwestern Medical Center, USA. · University of Erlangan, Germany. · Cedars-Sinai Medical Center, USA. · Deborah Heart and Lung Center, USA. · Maipu Diagnosis, Argentina. · William Beaumont Hospital, USA. · Oregon Health & Science University, USA. · Medical University of Innsbruck, Austria. · Mount Sinai Health System, USA. · NYU Langone Medical Center, USA. · Severance Hospital, South Korea. · Providence Healthcare, Canada. · Weill Cornell Medicine, USA. · Ignacio Chavez National Institute for Cardiology, Mexico. · William Harvey Research Institute, UK. · American British Cowdray Medical Center, Mexico. · British Heart Foundation, UK. · Uniformed Services University of the Health Sciences F Edward Hebert School of Medicine, USA. ·J Cardiovasc Comput Tomogr · Pubmed #30392926.

ABSTRACT: This expert consensus statement from the Society of Cardiovascular Computed Tomography (SCCT) provides an evidence synthesis on the use of computed tomography (CT) imaging for diagnosis and risk stratification of coronary artery disease in women. From large patient and population cohorts of asymptomatic women, detection of any coronary artery calcium that identifies females with a 10-year atherosclerotic cardiovascular disease risk of >7.5% may more effectively triage women who may benefit from pharmacologic therapy. In addition to accurate detection of obstructive coronary artery disease (CAD), CT angiography (CTA) identifies nonobstructive atherosclerotic plaque extent and composition which is otherwise not detected by alternative stress testing modalities. Moreover, CTA has superior risk stratification when compared to stress testing in symptomatic women with stable chest pain (or equivalent) symptoms. For the evaluation of symptomatic women both in the emergency department and the outpatient setting, there is abundant evidence from large observational registries and multi-center randomized trials, that CT imaging is an effective procedure. Although radiation doses are far less for CT when compared to nuclear imaging, radiation dose reduction strategies should be applied in all women undergoing CT imaging. Effective and appropriate use of CT imaging can provide the means for improved detection of at-risk women and thereby focus preventive management resulting in long-term risk reduction and improved clinical outcomes.

2 Guideline Coronary Artery Disease - Reporting and Data System (CAD-RADS): An Expert Consensus Document of SCCT, ACR and NASCI: Endorsed by the ACC. 2016

Cury, Ricardo C / Abbara, Suhny / Achenbach, Stephan / Agatston, Arthur / Berman, Daniel S / Budoff, Matthew J / Dill, Karin E / Jacobs, Jill E / Maroules, Christopher D / Rubin, Geoffrey D / Rybicki, Frank J / Schoepf, U Joseph / Shaw, Leslee J / Stillman, Arthur E / White, Charles S / Woodard, Pamela K / Leipsic, Jonathon A. · ·JACC Cardiovasc Imaging · Pubmed #27609151.

ABSTRACT: The intent of CAD-RADS - Coronary Artery Disease Reporting and Data System is to create a standardized method to communicate findings of coronary CT angiography (coronary CTA) in order to facilitate decision-making regarding further patient management. The suggested CAD-RADS classification is applied on a per-patient basis and represents the highest-grade coronary artery lesion documented by coronary CTA. It ranges from CAD-RADS 0 (Zero) for the complete absence of stenosis and plaque to CAD-RADS 5 for the presence of at least one totally occluded coronary artery and should always be interpreted in conjunction with the impression found in the report. Specific recommendations are provided for further management of patients with stable or acute chest pain based on the CAD-RADS classification. The main goal of CAD-RADS is to standardize reporting of coronary CTA results and to facilitate communication of test results to referring physicians along with suggestions for subsequent patient management. In addition, CAD-RADS will provide a framework of standardization that may benefit education, research, peer-review and quality assurance with the potential to ultimately result in improved quality of care.

3 Guideline CAD-RADS(TM) Coronary Artery Disease - Reporting and Data System. An expert consensus document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Radiology (ACR) and the North American Society for Cardiovascular Imaging (NASCI). Endorsed by the American College of Cardiology. 2016

Cury, Ricardo C / Abbara, Suhny / Achenbach, Stephan / Agatston, Arthur / Berman, Daniel S / Budoff, Matthew J / Dill, Karin E / Jacobs, Jill E / Maroules, Christopher D / Rubin, Geoffrey D / Rybicki, Frank J / Schoepf, U Joseph / Shaw, Leslee J / Stillman, Arthur E / White, Charles S / Woodard, Pamela K / Leipsic, Jonathon A. ·Miami Cardiac and Vascular Institute, Baptist Hospital of Miami, 8900 N Kendall Drive, Miami, FL, 33176, United States. Electronic address: rcury@baptisthealth.net. · Department of Radiology, 5323 Harry Hines Blvd, Dallas, TX, 75390, United States. Electronic address: Suhny.Abbara@UTSouthwestern.edu. · Friedrich-Alexander-Universität, Erlangen-Nürnberg, Department of Cardiology, Ulmenweg 18, 90154, Erlangen, Germany. Electronic address: Stephan.Achenbach@uk-erlangen.de. · Baptist Health Medical Grp, 1691 Michigan Avenue, Miami, FL, 33139, United States. Electronic address: ArthurSAg@baptisthealth.net. · Cedars-Sinai Med Center, 8700 Beverly Boulevard, Taper Building, Rm 1258, Los Angeles, CA, 90048, United States. Electronic address: bermand@cshs.org. · 1124 W. Carson Street, Torrance, CA, 90502, United States. Electronic address: mbudoff@labiomed.org. · 5841 South Maryland Ave, MC2026, Chicago, IL, 60637, United States. Electronic address: kdill@radiology.bsd.uchicago.edu. · 550 First Avenue, New York, NY, 10016, United States. Electronic address: jill.jacobs@nyumc.org. · Department of Radiology, 5323 Harry Hines Blvd, Dallas, TX, 75390, United States. Electronic address: christopher.maroules@gmail.com. · 2400 Pratt Street, Room 8020, DCRI Box 17969, Durham, NC, 27715, United States. Electronic address: grubin@duke.edu. · The Ottawa Hospital General Campus, 501 Smyth Rd, Ottawa, ON, CA K1H 8L6, Canada. Electronic address: frybicki@toh.on.ca. · 25 Courtenay Dr., Charleston, SC, 29425, United States. Electronic address: schoepf@musc.edu. · 1256 Briarcliff Rd. NE, Rm 529, Atlanta, GA, 30324, United States. Electronic address: lshaw3@emory.edu. · 1364 Clifton Road, NE, Atlanta, GA, 30322, United States. Electronic address: aestill@emory.edu. · University of Maryland, 22 S. Greene St., Baltimore, MD, 21201, United States. Electronic address: cwhite@umm.edu. · Mallinckrodt Instit of Radiology, 510 S Kingshighway Blvd, St. Louis, MO, 63110, United States. Electronic address: woodardp@mir.wustl.edu. · Department of Radiology|St. Paul's Hospital, 2nd Floor, Providence Building, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, United States. Electronic address: jleipsic@providencehealth.bc.ca. ·J Cardiovasc Comput Tomogr · Pubmed #27318587.

ABSTRACT: The intent of CAD-RADS - Coronary Artery Disease Reporting and Data System is to create a standardized method to communicate findings of coronary CT angiography (coronary CTA) in order to facilitate decision-making regarding further patient management. The suggested CAD-RADS classification is applied on a per-patient basis and represents the highest-grade coronary artery lesion documented by coronary CTA. It ranges from CAD-RADS 0 (Zero) for the complete absence of stenosis and plaque to CAD-RADS 5 for the presence of at least one totally occluded coronary artery and should always be interpreted in conjunction with the impression found in the report. Specific recommendations are provided for further management of patients with stable or acute chest pain based on the CAD-RADS classification. The main goal of CAD-RADS is to standardize reporting of coronary CTA results and to facilitate communication of test results to referring physicians along with suggestions for subsequent patient management. In addition, CAD-RADS will provide a framework of standardization that may benefit education, research, peer-review and quality assurance with the potential to ultimately result in improved quality of care.

4 Guideline 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. 2013

Anonymous3190768 / Montalescot, Gilles / Sechtem, Udo / Achenbach, Stephan / Andreotti, Felicita / Arden, Chris / Budaj, Andrzej / Bugiardini, Raffaele / Crea, Filippo / Cuisset, Thomas / Di Mario, Carlo / Ferreira, J Rafael / Gersh, Bernard J / Gitt, Anselm K / Hulot, Jean-Sebastien / Marx, Nikolaus / Opie, Lionel H / Pfisterer, Matthias / Prescott, Eva / Ruschitzka, Frank / Sabaté, Manel / Senior, Roxy / Taggart, David Paul / van der Wall, Ernst E / Vrints, Christiaan J M / Anonymous3200768 / Zamorano, Jose Luis / Achenbach, Stephan / Baumgartner, Helmut / Bax, Jeroen J / Bueno, Héctor / Dean, Veronica / Deaton, Christi / Erol, Cetin / Fagard, Robert / Ferrari, Roberto / Hasdai, David / Hoes, Arno W / Kirchhof, Paulus / Knuuti, Juhani / Kolh, Philippe / Lancellotti, Patrizio / Linhart, Ales / Nihoyannopoulos, Petros / Piepoli, Massimo F / Ponikowski, Piotr / Sirnes, Per Anton / Tamargo, Juan Luis / Tendera, Michal / Torbicki, Adam / Wijns, William / Windecker, Stephan / Anonymous3210768 / Knuuti, Juhani / Valgimigli, Marco / Bueno, Héctor / Claeys, Marc J / Donner-Banzhoff, Norbert / Erol, Cetin / Frank, Herbert / Funck-Brentano, Christian / Gaemperli, Oliver / Gonzalez-Juanatey, José R / Hamilos, Michalis / Hasdai, David / Husted, Steen / James, Stefan K / Kervinen, Kari / Kolh, Philippe / Kristensen, Steen Dalby / Lancellotti, Patrizio / Maggioni, Aldo Pietro / Piepoli, Massimo F / Pries, Axel R / Romeo, Francesco / Rydén, Lars / Simoons, Maarten L / Sirnes, Per Anton / Steg, Ph Gabriel / Timmis, Adam / Wijns, William / Windecker, Stephan / Yildirir, Aylin / Zamorano, Jose Luis. ·The disclosure forms of the authors and reviewers are available on the ESC website www.escardio.org/guidelines. ·Eur Heart J · Pubmed #23996286.

ABSTRACT: -- No abstract --

5 Guideline SCCT guidelines for the interpretation and reporting of coronary computed tomographic angiography. 2009

Raff, Gilbert L / Abidov, Aiden / Achenbach, Stephan / Berman, Daniel S / Boxt, Lawrence M / Budoff, Matthew J / Cheng, Victor / DeFrance, Tony / Hellinger, Jeffrey C / Karlsberg, Ronald P / Anonymous4580623. ·Society of Cardiovascular Computed Tomography, 2400 N Street NW, Washington, DC 20037, USA. GRaff@beaumont.edu ·J Cardiovasc Comput Tomogr · Pubmed #19272853.

ABSTRACT: -- No abstract --

6 Guideline Noninvasive coronary artery imaging: magnetic resonance angiography and multidetector computed tomography angiography: a scientific statement from the american heart association committee on cardiovascular imaging and intervention of the council on cardiovascular radiology and intervention, and the councils on clinical cardiology and cardiovascular disease in the young. 2008

Bluemke, David A / Achenbach, Stephan / Budoff, Matthew / Gerber, Thomas C / Gersh, Bernard / Hillis, L David / Hundley, W Gregory / Manning, Warren J / Printz, Beth Feller / Stuber, Matthias / Woodard, Pamela K. · ·Circulation · Pubmed #18586979.

ABSTRACT: -- No abstract --

7 Editorial How much evidence is in a case report? A road trip of scientific evidence, including skeptics, Ockham's razor, Hume's Fork, and Karl R. Popper. 2015

Achenbach, Stephan / Einstein, Andrew J / Ferencik, Maros. ·Department of Cardiology, University of Erlangen, Ulmenweg 18, 91054 Erlangen, Germany. Electronic address: stephan.achenbach@uk-erlangen.de. · Division of Cardiology, Department of Medicine, Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY, USA; Department of Radiology, Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY, USA. · Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA. ·J Cardiovasc Comput Tomogr · Pubmed #26088377.

ABSTRACT: -- No abstract --

8 Editorial The ethics of publishing medical imaging research. 2013

Achenbach, Stephan / Chandrashekhar, Y / Narula, Jagat. ·Medizinische Klinik I, Universitätsklinikum Gießen und Marburg, Gießen, Germany. · University of Minnesota, Minneapolis, Minnesota, and VA Medical Center, Minneapolis, Minnesota. · Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: jagat.narula@mountsinai.org. ·JACC Cardiovasc Imaging · Pubmed #24332290.

ABSTRACT: -- No abstract --

9 Editorial Anatomy trumps all! 2013

Shaw, Leslee / Achenbach, Stephan / Narula, Jagat. · ·JACC Cardiovasc Imaging · Pubmed #23764103.

ABSTRACT: -- No abstract --

10 Editorial On tests, times, and the test of time... 2012

Achenbach, Stephan / Chandrashekhar, Y / Narula, Jagat. · ·JACC Cardiovasc Imaging · Pubmed #23153924.

ABSTRACT: -- No abstract --

11 Editorial Coronary CT angiography and comparative effectiveness research prognostic value of atherosclerotic disease burden in appropriately indicated clinical examinations. 2011

Schoenhagen, Paul / Hachamovitch, Rory / Achenbach, Stephan. · ·JACC Cardiovasc Imaging · Pubmed #21565736.

ABSTRACT: -- No abstract --

12 Editorial Napkin-ring necrotic cores: defining circumferential extent of necrotic cores in unstable plaques. 2009

Narula, Jagat / Achenbach, Stephan. · ·JACC Cardiovasc Imaging · Pubmed #20083080.

ABSTRACT: -- No abstract --

13 Editorial Computed tomographic angiography and the Atlantic. 2008

Achenbach, Stephan / Chandrashekhar, Y / Narula, Jagat. · ·JACC Cardiovasc Imaging · Pubmed #19356524.

ABSTRACT: -- No abstract --

14 Editorial Assessing the prognostic value of coronary computed tomography angiography. 2008

Achenbach, Stephan. · ·J Am Coll Cardiol · Pubmed #18929246.

ABSTRACT: -- No abstract --

15 Review Noninvasive Fractional Flow Reserve Derived From Coronary CT Angiography: Clinical Data and Scientific Principles. 2015

Min, James K / Taylor, Charles A / Achenbach, Stephan / Koo, Bon Kwon / Leipsic, Jonathon / Nørgaard, Bjarne L / Pijls, Nico J / De Bruyne, Bernard. ·Departments of Radiology and Medicine, Weill Cornell Medical College, New York, New York; Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital, New York, New York. Electronic address: jkm2001@med.cornell.edu. · HeartFlow, Inc., Redwood City, California; Department of Bioengineering, Stanford University, Stanford, California. · Department of Cardiology, Erlangen University Hospital, Erlangen, Germany. · Department of Medicine, Seoul National University Hospital, Seoul, South Korea. · Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. · Department of Medicine, Weill Cornell Medical Center, New York, New York; Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark. · Catharina Hospital, Eindhoven, the Netherlands. · Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium. ·JACC Cardiovasc Imaging · Pubmed #26481846.

ABSTRACT: Fractional flow reserve derived from coronary computed tomography angiography enables noninvasive assessment of the hemodynamic significance of coronary artery lesions and coupling of the anatomic severity of a coronary stenosis with its physiological effects. Since its initial demonstration of feasibility of use in humans in 2011, a significant body of clinical evidence has developed to evaluate the diagnostic performance of coronary computed tomography angiography-derived fractional flow reserve compared with an invasive fractional flow reserve reference standard. The purpose of this paper was to describe the scientific principles and to review the clinical data of this technology recently approved by the U.S. Food and Drug Administration.

16 Review Coronary plaque characterization using CT. 2015

Saremi, Farhood / Achenbach, Stephan. ·1 Department of Radiology, University of Southern California, USC Keck Hospital, 1500 San Pablo St, Los Angeles, CA 90033. ·AJR Am J Roentgenol · Pubmed #25714309.

ABSTRACT: OBJECTIVE. In this article, we review the histopathologic classification of coronary atherosclerotic plaques and describe the possibilities and limitations of CT regarding the evaluation of coronary artery plaques. CONCLUSION. The composition of atherosclerotic plaques in the coronary arteries displays substantial variability and is associated with the likelihood for rupture and downstream ischemic events. Accurate identification and quantification of coronary plaque components on CT is challenging because of the limited temporal, spatial, and contrast resolutions of current scanners. Nonetheless, CT may provide valuable information that has potential for characterization of coronary plaques. For example, the extent of calcification can be determined, lipid-rich lesions can be separated from more fibrous ones, and positive remodeling can be identified.

17 Review Can coronary computed tomography angiography replace invasive angiography? Yes: it is all about finding the right test for the right person at the right time. 2015

Achenbach, Stephan. ·From the Department of Cardiology, University of Erlangen, Erlangen, Germany. stephan.achenbach@uk-erlangen.de. ·Circulation · Pubmed #25623123.

ABSTRACT: -- No abstract --

18 Review The diagnostic accuracy and outcomes after coronary computed tomography angiography vs. conventional functional testing in patients with stable angina pectoris: a systematic review and meta-analysis. 2014

Nielsen, Lene H / Ortner, Nino / Nørgaard, Bjarne L / Achenbach, Stephan / Leipsic, Jonathon / Abdulla, Jawdat. ·Department of Cardiology, Lillebaelt Hospital, Kabbeltoft 25, Vejle 7100, Denmark lenehuche@gmail.com. · Division of Cardiology, Department of Medicine, Glostrup University Hospital, Glostrup, Denmark. · Department of Cardiology B, Aarhus University Hospital Skejby, Aarhus N, Denmark. · Department of Cardiology, University of Erlangen, Erlangen, Germany. · Department of Medical Imaging, St. Paul's Hospital, Vancouver, BC, Canada. ·Eur Heart J Cardiovasc Imaging · Pubmed #24618659.

ABSTRACT: AIMS: To systematically review and perform a meta-analysis of the diagnostic accuracy and post-test outcomes of conventional exercise electrocardiography (XECG) and single-photon emission computed tomography (SPECT) compared with coronary computed tomography angiography (coronary CTA) in patients suspected of stable coronary artery disease (CAD). METHODS AND RESULTS: We systematically searched for studies published from January 2002 to February 2013 examining the diagnostic accuracy (defined as at least ≥50% luminal obstruction on invasive coronary angiography) and outcomes of coronary CTA (≥16 slice) in comparison with XECG and SPECT. The search revealed 11 eligible studies (N = 1575) comparing the diagnostic accuracy and 7 studies (N = 216.603) the outcomes of coronary CTA vs. XECG or/and SPECT. The per-patient sensitivity [95% confidence interval (95% CI)] to identify significant CAD was 98% (93-99%) for coronary CTA vs. 67% (54-78%) (P < 0.001) for XECG and 99% (96-100%) vs. 73% (59-83%) (P = 0.001) for SPECT. The specificity (95% CI) of coronary CTA was 82% (63-93%) vs. 46% (30-64%) (P < 0.001) for XECG and 71% (60-80%) vs. 48% (31-64%) (P = 0.14) for SPECT. The odds ratio (OR) of downstream test utilization (DTU) for coronary CTA vs. XECG/SPECT was 1.38 (1.33-1.43, P < 0.001), for revascularization 2.63 (2.50-2.77, P < 0.001), for non-fatal myocardial infarction 0.53 (0.39-0.72, P < 0.001), and for all-cause mortality 1.01 (0.87-1.18, P = 0.87). CONCLUSION: The up-front diagnostic performance of coronary CTA is higher than of XECG and SPECT. When compared with XECG/SPECT testing, coronary CTA testing is associated with increased DTU and coronary revascularization.

19 Review Non-invasive measurement of coronary plaque from coronary CT angiography and its clinical implications. 2013

Dey, Damini / Schuhbaeck, Annika / Min, James K / Berman, Daniel S / Achenbach, Stephan. ·Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA. deyd@cshs.org ·Expert Rev Cardiovasc Ther · Pubmed #23984930.

ABSTRACT: Coronary CT angiography (CTA) is increasingly used worldwide for direct, non-invasive evaluation of the coronary arteries. Advances in computed tomography (CT) technology over the last decade have enabled such reliable imaging of the coronary arteries. Beyond arterial stenosis, coronary CTA also permits assessment of atherosclerotic plaque (including plaque burden) and coronary artery remodeling, previously only achievable through invasive means. It has been shown that coronary plaque volumes for non-calcified and mixed plaques and the arterial remodeling index, correlate closely with invasive intravascular ultrasound. Several studies have also shown a strong relationship of adverse plaque features imaged by coronary CTA with acute coronary syndrome, all-cause death, major adverse cardiovascular events and myocardial ischemia. The aim of this review is to summarize current methods for quantitative measurement of atherosclerotic plaque features from coronary CTA and to discuss their clinical implications.

20 Review Cardiac computed tomography--evidence, limitations and clinical application. 2012

Hamilton-Craig, Christian R / Friedman, Daniel / Achenbach, Stephan. ·Department of Radiology and Cardiology, Prince Charles Hospital, Australia. chamiltoncraig@gmail.com ·Heart Lung Circ · Pubmed #22024629.

ABSTRACT: Coronary CT angiography and coronary calcium scoring offer a new approach to the diagnosis of coronary artery disease (CAD). They hold significant promise in improving patient outcomes, through identification of atherosclerosis and improved risk assessment. Coronary calcium scoring has proven predictive value concerning the occurrence of future cardiovascular events and outperforms current risk evaluation methods such as the Framingham Risk Score. Coronary CT angiography allows visualisation of the coronary artery lumen, detection of stenoses as well as visualisation of both calcified and non-calcified plaque. The accuracy of coronary CT angiography to detect obstructive coronary artery disease has been established by numerous trials. In particular the negative predictive value of the test approaches 100% in low and intermediate risk groups. Outcomes data demonstrate significant prognostic ability of coronary CT angiography. Modern techniques allow substantial reduction of dose values and radiation exposure of coronary CT angiography has significantly fallen. Coronary CT angiography can be reliably performed with doses similar to the level of annual background radiation, and less than one-third of a Tc Sestamibi scan. Coronary CT angiography has been approved for Medicare reimbursement for specific indications when performed by accredited providers. High quality examinations, experience and careful patient selection and preparation are required to ensure optimal results of coronary CT angiography, and to guide clinical decisions.

21 Review Meta-analysis and systematic review of the long-term predictive value of assessment of coronary atherosclerosis by contrast-enhanced coronary computed tomography angiography. 2011

Bamberg, Fabian / Sommer, Wieland H / Hoffmann, Verena / Achenbach, Stephan / Nikolaou, Konstantin / Conen, David / Reiser, Maximilian F / Hoffmann, Udo / Becker, Christoph R. ·Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany. fbamberg@post.harvard.edu ·J Am Coll Cardiol · Pubmed #21658564.

ABSTRACT: OBJECTIVES: We conducted a systematic review and meta-analysis to determine the predictive value of findings of coronary computed tomography angiography for incident cardiovascular events. BACKGROUND: Initial studies indicate a prognostic value of the technique; however, the level of evidence as well as exact independent risk estimates remain unclear. METHODS: We searched PubMed, EMBASE, and the Cochrane Library through January 2010 for studies that followed up ≥ 100 subjects for ≥ 1 year and reported at ≥ 1 hazard ratio (HR) of interest. Risk estimates for the presence of significant coronary stenosis (primary endpoint; ≥ 50% diameter stenosis), left main coronary artery stenosis, each coronary stenosis, 3-vessel disease, any plaque, per coronary segment containing plaque, and noncalcified plaque were derived in random effect regression analysis, and causes of heterogeneity were determined in meta-regression analysis. RESULTS: We identified 11 eligible articles including 7,335 participants (age 59.1 ± 2.6 years, 62.8% male) with suspected coronary artery disease. The presence of ≥ 1 significant coronary stenosis (9 studies, 3,670 participants, and 252 outcome events [6.8%] with 62% revascularizations) was associated with an annualized event rate of 11.9% (6.4% in studies excluding revascularization). The corresponding HR was 10.74 (98% confidence interval [CI]: 6.37 to 18.11) and 6.15 (95% CI: 3.22 to 11.74) in studies excluding revascularization. Adjustment for coronary calcification did not attenuate the prognostic significance (p = 0.79). The estimated HRs for left main stenosis, presence of plaque, and each coronary segment containing plaque were 6.64 (95% CI: 2.6 to 17.3), 4.51 (95% CI: 2.2 to 9.3), and 1.23 (95% CI: 1.17 to 1.29), respectively. CONCLUSIONS: Presence and extent of coronary artery disease on coronary computed tomography angiography are strong, independent predictors of cardiovascular events despite heterogeneity in endpoints, categorization of computed tomography findings, and study population.

22 Review Current clinical applications of cardiac computed tomography. 2011

Achenbach, Stephan. ·Medizinische Klinik I, Universitätsklinikum Glessen, Klinikstrasse 33, 39352, Giessen, Germany. Stephan.achenbach@innere.med.uni-giessen.de ·J Cardiovasc Transl Res · Pubmed #21505916.

ABSTRACT: Multi-detector row CT allows high-resolution anatomic and functional visualization of the heart. The main current clinical application is non-invasive coronary angiography after intravenous injection of contrast agent. Coronary CT angiography permits the detection of coronary artery stenoses with relatively high accuracy and especially high negative predictive value. It is therefore considered clinically useful to rule out disease and avoid invasive coronary angiography in patients with low to intermediate likelihood of disease and especially with equivocal stress test results. Of lesser clinical relevance, albeit indicated in certain patient subgroups, is the use of cardiac computed tomography for coronary calcium quantification in the context of risk stratification. Finally, the analysis of cardiac morphology and function, including the assessment of valvular disease, is possible by CT. For most of these applications, CT is only indicated if more standard techniques such as echocardiography or cardiac magnetic resonance fail. Correct patient selection as well as sufficient experience and expertise are prerequisites for the beneficial clinical application of coronary CT angiography.

23 Review The year in coronary artery disease. 2010

Achenbach, Stephan / Kramer, Christopher M / Zoghbi, William A / Dilsizian, Vasken. ·Department of Cardiology, University of Erlangen, Erlangen, Germany. stephan.achenbach@uk-erlangen.de ·JACC Cardiovasc Imaging · Pubmed #20947052.

ABSTRACT: Imaging plays a central role in the diagnosis and management of coronary artery disease. Imaging is used for the detection of underlying coronary artery stenoses in patients with stable or chronic chest pain, for the assessment of myocardial scar and viability, for assessing prognosis, or for predicting complications. Echocardiography, nuclear imaging, cardiac magnetic resonance, and-more recently-computed tomography are powerful tools to provide answers to these questions. New technology, new contrast agents, and newly developed imaging protocols widen the applicability and increase accuracy of these imaging modalities, and new clinical studies provide information on their diagnostic potential and their therapeutic as well as prognostic value. The relative strengths and weaknesses of the different imaging modalities influence the selection of the most appropriate imaging approach in different clinical scenarios. This article outlines some of the most important developments of the past 12 months in the field of echocardiography, nuclear imaging, cardiac magnetic resonance, and computed tomography as they pertain to coronary artery disease.

24 Review [Role of cardiac CT-angiography in clinical routine--an update 2010]. 2010

Achenbach, S. ·Medizinische Klinik 2, Universitätsklinikum Erlangen, Erlangen. stephan.achenbach@uk-erlangen.de ·Dtsch Med Wochenschr · Pubmed #20859842.

ABSTRACT: Multi Detector CT, the usage of adequate technology, suitable imaging protocols, sufficient experience and strict patient selection provided, allows visualization of the heart with high temporal and spatial resolution. The main application is coronary CT angiography. Coronary artery stenoses can be detected with high sensitivity and specificity. Especially the high negative predictive value is high, but care has to be taken to avoid false-positive results which occur especially when image quality is degraded. Coronary CT angiography should not be considered a widespread replacement of invasive coronary angiography or even a "screening" procedure, but it can be clinically useful to rule out coronary artery stenoses in selected patients. The detection of coronary artery calcification can be used for risk stratification purposes. Finally, CT also allows evaluation of cardiac morphology and function, but will be used for this only when other modalities, such as echocardiography and MR imaging, have failed or are not applicable.

25 Review Imaging of coronary atherosclerosis by computed tomography. 2010

Achenbach, Stephan / Raggi, Paolo. ·Department of Cardiology, University of Erlangen, Ulmenweg 18, 91054 Erlangen, Germany. ·Eur Heart J · Pubmed #20484566.

ABSTRACT: Modern computed tomography (CT) systems afford sufficient spatial and temporal resolution for imaging of the heart and coronary arteries. The detection of coronary artery calcium (CAC) is relatively straightforward and it is applied to detect and quantify subclinical coronary atherosclerosis even in asymptomatic individuals. A large body of evidence has accumulated that uniformly attests to a high predictive value of CAC for future cardiac events. More complex data acquisition protocols, which require higher spatial and temporal resolution, specific patient preparation, and the intravenous injection of contrast agent, allow to perform coronary CT angiography (CTA). With CTA, the presence of luminal stenoses and, given sufficient image quality, calcified as well as non-calcified atherosclerotic plaque can be visualized. Initial studies have shown that certain plaque characteristics, such as positive remodelling or very low CT attenuation, are associated with plaque vulnerability. So far, the available clinical data are not sufficient to draw specific conclusions as to the risk-benefit ratio of contrast-enhanced coronary CTA for risk prediction, especially for asymptomatic individuals. Hence, CTA is currently not recommended for risk stratification purposes. However, the technology of coronary CTA continues to evolve at a rapid pace and clinical applications for plaque imaging and characterization may become possible in the future.

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