Pick Topic
Review Topic
List Experts
Examine Expert
Save Expert
  Site Guide ··   
Coronary Artery Disease: HELP
Articles by Mohamed Marwan
Based on 33 articles published since 2008
||||

Between 2008 and 2019, M. Marwan wrote the following 33 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Guideline SCCT guidelines for the performance and acquisition of coronary computed tomographic angiography: A report of the society of Cardiovascular Computed Tomography Guidelines Committee: Endorsed by the North American Society for Cardiovascular Imaging (NASCI). 2016

Abbara, Suhny / Blanke, Philipp / Maroules, Christopher D / Cheezum, Michael / Choi, Andrew D / Han, B Kelly / Marwan, Mohamed / Naoum, Chris / Norgaard, Bjarne L / Rubinshtein, Ronen / Schoenhagen, Paul / Villines, Todd / Leipsic, Jonathon. ·University of Texas Southwestern Medical Center, Dallas, TX, United States. Electronic address: Suhny.Abbara@UTSouthwestern.edu. · Department of Radiology and Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada. · University of Texas Southwestern Medical Center, Dallas, TX, United States. · Cardiology Service Ft. Belvoir Community Hospital, Ft. Belvoir, VA, United States. · Division of Cardiology and Department of Radiology, The George Washington University School of Medicine, Washington DC, United States. · Minneapolis Heart Institute and Children's Heart Clinic, Minneapolis, MN, United States. · Cardiology Department, University Hospital, Erlangen, Germany. · Concord Hospital, The University of Sydney, Sydney, Australia. · Department of Cardiology B, Aarhus University Hospital-Skejby, Aarhus N, Denmark. · Lady Davis Carmel Medical Center & Rappaport School of Medicine- Technion- IIT, Haifa, Israel. · Cardiovascular Imaging, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, United States. · Walter Reed National Military Medical Center, Bethesda, MD, United States. ·J Cardiovasc Comput Tomogr · Pubmed #27780758.

ABSTRACT: In response to recent technological advancements in acquisition techniques as well as a growing body of evidence regarding the optimal performance of coronary computed tomography angiography (coronary CTA), the Society of Cardiovascular Computed Tomography Guidelines Committee has produced this update to its previously established 2009 "Guidelines for the Performance of Coronary CTA" (1). The purpose of this document is to provide standards meant to ensure reliable practice methods and quality outcomes based on the best available data in order to improve the diagnostic care of patients. Society of Cardiovascular Computed Tomography Guidelines for the Interpretation is published separately (2). The Society of Cardiovascular Computed Tomography Guidelines Committee ensures compliance with all existing standards for the declaration of conflict of interest by all authors and reviewers for the purpose ofclarity and transparency.

2 Clinical Trial Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease: the NXT trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps). 2014

Nørgaard, Bjarne L / Leipsic, Jonathon / Gaur, Sara / Seneviratne, Sujith / Ko, Brian S / Ito, Hiroshi / Jensen, Jesper M / Mauri, Laura / De Bruyne, Bernard / Bezerra, Hiram / Osawa, Kazuhiro / Marwan, Mohamed / Naber, Christoph / Erglis, Andrejs / Park, Seung-Jung / Christiansen, Evald H / Kaltoft, Anne / Lassen, Jens F / Bøtker, Hans Erik / Achenbach, Stephan / Anonymous4700783. ·Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark. Electronic address: bnorgaard@dadlnet.dk. · Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. · Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark. · MonashHeart, Monash Medical Center and Monash University, Victoria, Australia. · Department of Cardiology, Okayama University Hospital, Okayama, Japan. · Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts. · Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium. · Department of Cardiology, Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio. · Department of Cardiology, Erlangen University Hospital, Erlangen, Germany. · Department of Cardiology and Angiology, Elisabeth-Krankenhaus Essen, Essen, Germany. · Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia. · Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea. ·J Am Coll Cardiol · Pubmed #24486266.

ABSTRACT: OBJECTIVES: The goal of this study was to determine the diagnostic performance of noninvasive fractional flow reserve (FFR) derived from standard acquired coronary computed tomography angiography (CTA) datasets (FFR(CT)) for the diagnosis of myocardial ischemia in patients with suspected stable coronary artery disease (CAD). BACKGROUND: FFR measured during invasive coronary angiography (ICA) is the gold standard for lesion-specific coronary revascularization decisions in patients with stable CAD. The potential for FFR(CT) to noninvasively identify ischemia in patients with suspected CAD has not been sufficiently investigated. METHODS: This prospective multicenter trial included 254 patients scheduled to undergo clinically indicated ICA for suspected CAD. Coronary CTA was performed before ICA. Evaluation of stenosis (>50% lumen reduction) in coronary CTA was performed by local investigators and in ICA by an independent core laboratory. FFR(CT) was calculated and interpreted in a blinded fashion by an independent core laboratory. Results were compared with invasively measured FFR, with ischemia defined as FFR(CT) or FFR ≤0.80. RESULTS: The area under the receiver-operating characteristic curve for FFR(CT) was 0.90 (95% confidence interval [CI]: 0.87 to 0.94) versus 0.81 (95% CI: 0.76 to 0.87) for coronary CTA (p = 0.0008). Per-patient sensitivity and specificity (95% CI) to identify myocardial ischemia were 86% (95% CI: 77% to 92%) and 79% (95% CI: 72% to 84%) for FFR(CT) versus 94% (86 to 97) and 34% (95% CI: 27% to 41%) for coronary CTA, and 64% (95% CI: 53% to 74%) and 83% (95% CI: 77% to 88%) for ICA, respectively. In patients (n = 235) with intermediate stenosis (95% CI: 30% to 70%), the diagnostic accuracy of FFR(CT) remained high. CONCLUSIONS: FFR(CT) provides high diagnostic accuracy and discrimination for the diagnosis of hemodynamically significant CAD with invasive FFR as the reference standard. When compared with anatomic testing by using coronary CTA, FFR(CT) led to a marked increase in specificity. (HeartFlowNXT-HeartFlow Analysis of Coronary Blood Flow Using Coronary CT Angiography [HFNXT]; NCT01757678).

3 Article Coronary computed tomography angiography (CCTA) in patients with suspected stable coronary artery disease (CAD): diagnostic impact and clinical consequences in the German Cardiac CT Registry depending on stress test results. 2019

Barth, Sebastian / Marwan, Mohamed / Hausleiter, Jörg / Moshage, Werner / Korosoglou, Grigorios / Leber, Alexander / Schmermund, Axel / Gohlke, Helmut / Bruder, Oliver / Dill, Thorsten / Schröder, Stephen / Kerber, Sebastian / Hamm, Karsten / Gietzen, Frank / Schneider, Steffen / Senges, Jochen / Achenbach, Stephan. ·Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Salzburger Leite 1, 97616, Bad Neustadt/Saale, Germany. sebastian.barth@kardiologie-bad-neustadt.de. · Department of Cardiology, Friedrich-Alexander-Universität, Erlangen-Nürnberg, Erlangen, Germany. · Munich and German Heart Center Munich, Ludwig-Maximilians-Universität, Munich, Germany. · Klinikum Traunstein, Traunstein, Germany. · Department of Cardiology & Vascular Medicine, GRN Hospital Weinheim, Weinheim, Germany. · Klinik für Kardiologie und Intensivmedizin, Klinikum Bogenhausen, Munich, Germany. · Cardioangiologisches Centrum Bethanien, Frankfurt, Germany. · Klinische Kardiologie II, Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany. · Department of Cardiology and Angiology, Contilia Heart and Vascular Center, Elisabeth Hospital Essen, Essen, Germany. · Department of Internal Medicine, Krankenhaus Benrath, Düsseldorf, Germany. · Klinik am Eichert, Göppingen, Germany. · Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Salzburger Leite 1, 97616, Bad Neustadt/Saale, Germany. · Institute for Myocardial Infarction Research, Ludwigshafen, Germany. ·Int J Cardiovasc Imaging · Pubmed #30456460.

ABSTRACT: To evaluate diagnostic impact of clinical use of coronary computed tomography angiography (CCTA) in patients with suspected stable coronary artery disease (CAD) and its consequences in daily practice for patient management, depending on stress test results in daily practice. Between 2009 and 2014 of a total population of 1352 patients of the German Cardiac Computed Tomography (CT) Registry who had previously undergone stress tests, CCTA visualizations were carried out on the coronary arteries with suspected stable CAD. Patients were divided into three groups according to stress test results: Group 1 with inconclusive (n = 178, 13.2%), Group 2 with ischemia in stress test (n = 372, 27.5%) and Group 3 without ischemia in stress test (n = 802, 59.3%). The test of preference was the stress electrocardiogram (ECG), which was performed more frequently in patients without ischemia in stress test as compared to those with ischemia (96.3% vs. 93.0%, p = 0.015). The incidence of detected obstructive CAD was lower in patients with suggested ischemia in stress test as compared to patients with inconclusive results (14.1% vs. 21.1%, p = 0.037). There was no difference in the incidence of an obstructive CAD in patients with and without ischemia in stress test (14.1% vs. 15.8%, p = 0.440). CCTA is a reliable, non-invasive option for ruling-out obstructive CAD irrespective of the stress test result.

4 Article Non-invasive detection of coronary inflammation using computed tomography and prediction of residual cardiovascular risk (the CRISP CT study): a post-hoc analysis of prospective outcome data. 2018

Oikonomou, Evangelos K / Marwan, Mohamed / Desai, Milind Y / Mancio, Jennifer / Alashi, Alaa / Hutt Centeno, Erika / Thomas, Sheena / Herdman, Laura / Kotanidis, Christos P / Thomas, Katharine E / Griffin, Brian P / Flamm, Scott D / Antonopoulos, Alexios S / Shirodaria, Cheerag / Sabharwal, Nikant / Deanfield, John / Neubauer, Stefan / Hopewell, Jemma C / Channon, Keith M / Achenbach, Stephan / Antoniades, Charalambos. ·Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK. · Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany. · Cleveland Clinic Heart and Vascular Institute, Cleveland, OH, USA. · Cardiology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Caristo Diagnostics, Oxford, UK. · Cardiology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. · University College London Institute of Cardiovascular Science, London, UK. · Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK; Oxford Centre of Research Excellence, British Heart Foundation, Oxford, UK; Oxford Biomedical Research Centre, National Institute of Health Research, Oxford, UK. · Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK. · Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK; Oxford Centre of Research Excellence, British Heart Foundation, Oxford, UK; Oxford Biomedical Research Centre, National Institute of Health Research, Oxford, UK. Electronic address: antoniad@well.ox.ac.uk. ·Lancet · Pubmed #30170852.

ABSTRACT: BACKGROUND: Coronary artery inflammation inhibits adipogenesis in adjacent perivascular fat. A novel imaging biomarker-the perivascular fat attenuation index (FAI)-captures coronary inflammation by mapping spatial changes of perivascular fat attenuation on coronary computed tomography angiography (CTA). However, the ability of the perivascular FAI to predict clinical outcomes is unknown. METHODS: In the Cardiovascular RISk Prediction using Computed Tomography (CRISP-CT) study, we did a post-hoc analysis of outcome data gathered prospectively from two independent cohorts of consecutive patients undergoing coronary CTA in Erlangen, Germany (derivation cohort) and Cleveland, OH, USA (validation cohort). Perivascular fat attenuation mapping was done around the three major coronary arteries-the proximal right coronary artery, the left anterior descending artery, and the left circumflex artery. We assessed the prognostic value of perivascular fat attenuation mapping for all-cause and cardiac mortality in Cox regression models, adjusted for age, sex, cardiovascular risk factors, tube voltage, modified Duke coronary artery disease index, and number of coronary CTA-derived high-risk plaque features. FINDINGS: Between 2005 and 2009, 1872 participants in the derivation cohort underwent coronary CTA (median age 62 years [range 17-89]). Between 2008 and 2016, 2040 patients in the validation cohort had coronary CTA (median age 53 years [range 19-87]). Median follow-up was 72 months (range 51-109) in the derivation cohort and 54 months (range 4-105) in the validation cohort. In both cohorts, high perivascular FAI values around the proximal right coronary artery and left anterior descending artery (but not around the left circumflex artery) were predictive of all-cause and cardiac mortality and correlated strongly with each other. Therefore, the perivascular FAI measured around the right coronary artery was used as a representative biomarker of global coronary inflammation (for prediction of cardiac mortality, hazard ratio [HR] 2·15, 95% CI 1·33-3·48; p=0·0017 in the derivation cohort, and 2·06, 1·50-2·83; p<0·0001 in the validation cohort). The optimum cutoff for the perivascular FAI, above which there is a steep increase in cardiac mortality, was ascertained as -70·1 Hounsfield units (HU) or higher in the derivation cohort (HR 9·04, 95% CI 3·35-24·40; p<0·0001 for cardiac mortality; 2·55, 1·65-3·92; p<0·0001 for all-cause mortality). This cutoff was confirmed in the validation cohort (HR 5·62, 95% CI 2·90-10·88; p<0·0001 for cardiac mortality; 3·69, 2·26-6·02; p<0·0001 for all-cause mortality). Perivascular FAI improved risk discrimination in both cohorts, leading to significant reclassification for all-cause and cardiac mortality. INTERPRETATION: The perivascular FAI enhances cardiac risk prediction and restratification over and above current state-of-the-art assessment in coronary CTA by providing a quantitative measure of coronary inflammation. High perivascular FAI values (cutoff ≥-70·1 HU) are an indicator of increased cardiac mortality and, therefore, could guide early targeted primary prevention and intensive secondary prevention in patients. FUNDING: British Heart Foundation, and the National Institute of Health Research Oxford Biomedical Research Centre.

5 Article Comparison of invasively measured FFR with FFR derived from coronary CT angiography for detection of lesion-specific ischemia: Results from a PC-based prototype algorithm. 2018

Röther, Jens / Moshage, Maximilian / Dey, Damini / Schwemmer, Chris / Tröbs, Monique / Blachutzik, Florian / Achenbach, Stephan / Schlundt, Christian / Marwan, Mohamed. ·Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany. Electronic address: jens.roether@uk-erlangen.de. · Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany. · Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, USA. · Computed Tomography - Research & Development, Siemens Healthineers, Forchheim, Germany. ·J Cardiovasc Comput Tomogr · Pubmed #29409717.

ABSTRACT: BACKGROUND: We evaluated the diagnostic accuracy of a novel prototype for on-site determination of CT-based FFR (cFFR) on a standard personal computer (PC) compared to invasively measured FFR in patients with suspected coronary artery disease. METHODS: A total of 91 vessels in 71 patients (mean age 65 ± 9 years) in whom coronary CT angiography had been performed due to suspicion of coronary artery disease, and who subsequently underwent invasive coronary angiography with FFR measurement were analyzed. For both cFFR and FFR, a threshold of ≤0.80 was used to indicate a hemodynamically relevant stenosis. The mean time needed to calculate cFFR was 12.4 ± 3.4 min. A very close correlation between cFFR and FFR could be shown (r = 0.85; p < 0.0001) with Bland-Altman analysis showing moderate agreement between FFR and cFFR with mild systematic overestimation of FFR values in CT (mean difference 0.0049, 95% limits of agreement ±2SD -0.007 to 0.008). Compared to FFR, the sensitivity of cFFR to detect hemodynamically significant lesions was 91% (19/21, 95% CI: 70%-99%), specificity was 96% (67/70, 95% CI: 88%-99%), positive predictive value 86% (95% CI: 65%-97%) and negative predictive value was 97% (95% CI: 90%-100%) with an accuracy of 93%. CONCLUSION: cFFR obtained using an on-site algorithm implemented on a standard PC shows high diagnostic accuracy to detect lesions causing ischemia as compared to FFR. Importantly, the time needed for analysis is short which may be useful for improving clinical workflow.

6 Article Epicardial adipose tissue density and volume are related to subclinical atherosclerosis, inflammation and major adverse cardiac events in asymptomatic subjects. 2018

Goeller, Markus / Achenbach, Stephan / Marwan, Mohamed / Doris, Mhairi K / Cadet, Sebastien / Commandeur, Frederic / Chen, Xi / Slomka, Piotr J / Gransar, Heidi / Cao, J Jane / Wong, Nathan D / Albrecht, Moritz H / Rozanski, Alan / Tamarappoo, Balaji K / Berman, Daniel S / Dey, Damini. ·Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Internal Medicine 2, University of Erlangen, Erlangen, Germany. Electronic address: Markus.Goeller@uk-erlangen.de. · Department of Internal Medicine 2, University of Erlangen, Erlangen, Germany. Electronic address: Stephan.Achenbach@uk-erlangen.de. · Department of Internal Medicine 2, University of Erlangen, Erlangen, Germany. Electronic address: Mohamed.Marwan@uk-erlangen.de. · Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Electronic address: Mhairi.Doris@cshs.org. · Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Electronic address: Sebastien.Cadet@cshs.org. · Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Electronic address: Frederic.Commandeur@cshs.org. · Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Electronic address: Xi.Chen@cshs.org. · Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Electronic address: Piotr.Slomka@cshs.org. · Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Electronic address: Heidi.Gransar@cshs.org. · Department of Cardiology, St Francis Hospital, New York, NY, USA. Electronic address: Jane.Cao@chsli.org. · Department of Medicine, University of California at Irvine, Irvine, USA. Electronic address: ndwong@uci.edu. · Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA. Electronic address: MoritzAlbrecht@gmx.net. · Division of Cardiology, Mount Sinai St Lukes Hospital, New York, NY, USA. Electronic address: ar77md@gmail.com. · Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Electronic address: Balaji.Tamarappoo@cshs.org. · Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Electronic address: Daniel.Berman@cshs.org. · Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Electronic address: damini.dey@cshs.org. ·J Cardiovasc Comput Tomogr · Pubmed #29233634.

ABSTRACT: BACKGROUND: We investigated whether epicardial adipose tissue (EAT) volume and density are related to early atherosclerosis, plaque inflammation and major adverse cardiac events (MACE, cardiac death and myocardial infarction) in asymptomatic subjects. METHODS: EAT volume and density were quantified from non-contrast cardiac CT in 456 asymptomatic individuals (age 60.3 ± 8.3; 68% with CCS>0) from the prospective EISNER trial. EAT volume and density were examined in relation to coronary calcium score (CCS), inflammatory biomarkers and MACE. RESULTS: EAT volume was higher and EAT density lower in subjects with coronary calcium compared to subjects without [89 vs 74 cm CONCLUSION: EAT volume was higher and density lower in subjects with coronary calcium compared to subjects with CCS = 0, with similar EAT volume in CCS<100 and CCS≥100. Lower EAT density and increased EAT volume were associated with coronary calcification, serum levels of plaque inflammatory markers and MACE, suggesting that dysfunctional EAT may be linked to early plaque formation and inflammation.

7 Article Influence of irregular heart rhythm on radiation exposure, image quality and diagnostic impact of cardiac computed tomography angiography in 4,339 patients. Data from the German Cardiac Computed Tomography Registry. 2018

Korosoglou, Grigorios / Marwan, Mohamed / Giusca, Sorin / Schmermund, Axel / Schneider, Steffen / Bruder, Oliver / Hausleiter, Jörg / Schroeder, Stephen / Leber, Alexander / Limbourg, Tobias / Gitsioudis, Gitsios / Rixe, Johannes / Zahn, Ralf / Katus, Hugo A / Achenbach, Stephan / Senges, Jochen. ·Department of Cardiology and Vascular Medicine, GRN Hospital Weinheim, Weinheim, Germany.. Electronic address: Grigorios.Korosoglou@grn.de. · Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nuernberg, Erlangen, Germany. · Department of Cardiology and Vascular Medicine, GRN Hospital Weinheim, Weinheim, Germany. · Cardiovascular Center Bethanien (CCB), Frankfurt Am Main, Germany. · Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany. · Elisabeth Hospital, Essen, Germany. · Department of Cardiology, Ludwig-Maximilian's University, Munich, Germany. · Department of Cardiology and Pneumology, Alb Fils Clinics, Geislingen, Germany. · Munich Heart Alliance, Isar Herzzentrum, Munich, Germany. · Department of Cardiology, University of Giessen, Giessen, Germany. · Department of Cardiology, Ludwigshafen, Germany. · Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany. ·J Cardiovasc Comput Tomogr · Pubmed #29195843.

ABSTRACT: BACKGROUND: Coronary computed tomography angiography (coronary CTA) provides non-invasive evaluation of the coronary arteries with high precision for the detection of significant coronary artery disease (CAD). AIM: To investigate whether irregular heart rhythm including atrial fibrillation and premature beats during data acquisition influences (i) radiation and contrast media exposure, (ii) number of non-evaluable coronary segments and (iii) diagnostic impact of coronary CTA. METHODS: Twelve tertiary care centers with ≥64 slice CT scanners and ≥5 years of experience with cardiovascular imaging participated in this registry. Between 2009 and 2014, 4339 examinations were analysed in patients who underwent clinically indicated coronary CTA for suspected CAD. Clinical and epidemiologic data were gathered from all patients. In addition, clinical presentation, heart rate and rhythm during the scan, Agatston score, radiation and contrast media exposure and the diagnostic impact of coronary CTA were systematically analysed. RESULTS: Of 4339 patients in total, 260 (6.0%) had irregular heart rhythm, whereas the remaining 4079 (94.0%) had stable sinus rhythm. Patients with irregular heart rhythm were older (63.2 ± 12.5yrs versus 58.6 ± 11.4yrs. p < 0.001), exhibited a higher rate of pathologic stress tests before CTA (37.1% versus 26.1%, p < 0.01) and higher heart rates during CTA compared to those with sinus rhythm (62.5 ± 11.6bpm versus 58.9 ± 8.5bpm, p < 0.001). Both contrast media exposure and radiation exposure were significantly higher in patients with irregular heart rhythm (90 mL (95%CI = 80-110 mL) versus 80 mL (95%CI = 70-90 mL) and 6.2 mSv (95%CI = 2.5-11.7) versus 3.3 mSv (95%CI = 1.7-6.9), p < 0.001 for both). Coronary CTA excluded significant CAD less frequently in patients with irregular heart rhythm (32.9% versus 44.8%, p < 0.001). This was attributed to the higher rate of examinations with at least one non-diagnostic coronary segment in patients with irregular heart rhythm (10.8% versus 4.6%, p < 0.001). Subsequent invasive angiography could be avoided in 47.2% of patients with irregular heart rhythm compared to 52.9% of patients with sinus rhythm (p = NS), whereas downstream stress testing was recommended in 3.2% of patients with irregular heart rhythm versus 4.0% of patients with sinus rhythm (p = NS). CONCLUSION: A significant number of patients scheduled for coronary CTA have irregular heart rhythm in a real-world clinical setting. In such patients, heart rate during coronary CTA is higher, possibly resulting in (i) higher radiation and contrast agent exposure and (ii) more frequent coronary CTA examinations with at least one non-diagnostic coronary artery segment. However, this does not seem to lead to increased downstream stress testing or subsequent invasive procedures.

8 Article Declining radiation dose of coronary computed tomography angiography: German cardiac CT registry experience 2009-2014. 2017

Schmermund, Axel / Marwan, Mohamed / Hausleiter, Jörg / Barth, Sebastian / Bruder, Oliver / Kerber, Sebastian / Korosoglou, Grigorius / Leber, Alexander / Moshage, Werner / Schröder, Stephen / Schneider, Steffen / Senges, Jochen / Achenbach, Stephan. ·Cardioangiologisches Centrum Bethanien, CCB, Im Prüfling 23, 60389, Frankfurt Am Main, Germany. a.schmermund@ccb.de. · Friedrich-Alexander-Universität Erlangen, Erlangen, Germany. · Medizinische Klinik und Poliklinik I, LMU Klinikum der Universität München, Munich, Germany. · Herz- und Gefäß-Klinik, Rhön-Klinikum Bad Neustadt an der Saale, Bad Neustadt an Der Saale, Germany. · Klinik für Kardiologie und Angiologie, Contilia Herz- und Gefäßzentrum, Elisabeth-Krankenhaus Essen, Essen, Germany. · Medizinische Klinik (Krehl-Klinik) und Klinik für Kardiologie, Angiologie und Pneumologie (Innere Medizin III), Universitätsklinikum Heidelberg, Heidelberg, Germany. · Kardiologie und Angiologie, GRN-Klinik Weinheim, Weinheim, Germany. · Isar Herz Zentrum München, Munich, Germany. · Kardiologie Klinikum Traunstein, Traunstein, Germany. · Klinik für Kardiologie, Pneumologie und Angiologie mit Schlaganfallstation, Internistische Sportmedizin, Alb Fils Klinik am Eichert, Göppingen, Germany. · Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany. ·Clin Res Cardiol · Pubmed #28725938.

ABSTRACT: BACKGROUND: Coronary computed tomography angiography (CTA) is increasingly used as a test to rule out coronary artery disease (CAD) in patients with a low to intermediate pre-test probability of the disease. We used the database of the German CT registry, collected between 2009 and 2014 in a broad patient population, to analyze contemporary radiation dose associated with coronary CTA in clinical practice. PATIENTS AND METHODS: The prospective observational registry included a total of 7061 patients ≥18 years, referred to 12 participating centers for a clinically indicated cardiac CT examination. All centers were cardiology units well experienced in CTA and used multi-slice CT scanners with at least 64 rows. Coronary CTA was performed in a subset of 5001 patients, 59.6 ± 11.8 years, body mass index (BMI) 26.9 ± 4.5 kg/m RESULTS: BMI and proportion of female patients remained stable over time, and mean heart rate decreased from 60.3 ± 9.0 to 58.5 ± 9.3 bpm from the first to the last time period (p < 0.001). Overall, the mean effective dose of coronary CTA was 3.6 mSv (Q1 1.8 mSv, Q3 7.4 mSv). Within the three time periods, it declined from 5.6 (2.7, 8.6) mSv during the first to 4.8 (2.1, 8.2) mSv during the second and 2.5 (1.3, 4.6) mSv during the last time period (p < 0.001). Paralleling the decline in radiation dose over time, the proportion of prospectively ECG-triggered examinations increased (68, 79, 83%; p < 0.001), and the proportion of examinations with retrospective gating and no tube current modulation decreased (5.3, 4.0, 1.6%; p < 0.001). Tube current (mAs) and voltage (kV) both decreased over time. In multivariable analysis, besides earlier time period, further independent predictors of an increased radiation dose were older age, higher heart rate, and higher BMI as well as the technical factors higher mAs, higher kV, and retrospective gating. At three sites, CT scanners with improved technology were installed during the last time period. CONCLUSIONS: In current clinical practice among German cardiology units with specific expertise in cross-sectional cardiovascular imaging, overall radiation dose of coronary CTA was comparably low. Over time, a decline in radiation dose was demonstrated, probably due to a combination of improvements in data acquisition protocols and patient preparation as well as installation of new CT scanners with advanced technology.

9 Article Influence of Cardiovascular Risk Factors on the Prevalence of Coronary Atherosclerosis in Patients with Angiographically Normal Coronary Arteries. 2017

Bittner, Daniel O / Klinghammer, Lutz / Marwan, Mohamed / Schmid, Jasmin / Layritz, Christian / Hoffmann, Udo / Achenbach, Stephan / Pflederer, Tobias. ·Department of Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany; Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: daniel.bittner@uk-erlangen.de. · Department of Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany. · Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. ·Acad Radiol · Pubmed #28169140.

ABSTRACT: RATIONALE AND OBJECTIVES: Cardiovascular (CV) disease is predominately influenced by CV risk factors and coronary computed tomography angiography (CTA) is capable of detecting early-stage coronary artery disease. We sought to determine the influence of CV risk factors on the prevalence of nonobstructive atherosclerosis in patients with normal-appearing coronary arteries in invasive coronary angiography (ICA). MATERIALS AND METHODS: In this retrospective analysis, we included 60 consecutive symptomatic patients, having undergone ICA and coronary CTA. Coronary dual source CTA was performed using electrocardiogram-triggered retrospective gated image acquisition at 40%-70% of RR interval (tube voltage 100-120 kV, tube current time product 320-440 mAs, 60 mL contrast, and flow rate 6 mL/s). RESULTS: Out of 60 patients (32 men, mean age 61 ± 11 years) with a normal coronary artery appearance in ICA, 45 (75%) patients showed atherosclerotic plaque in CTA. Plaque was present in 14 of 60 (23%) left main, 41 of 60 (68%) left anterior descending, 21 of 60 (35%) circumflex coronary arteries, and 24 of 60 (40%) right coronary arteries. More than 15% of all coronary artery segments showed detectable plaques. Interobserver agreement ranged from good to very good on a per-patient, per-vessel, and per-segment level. Patients with presence of plaque were significantly older (P = 0.005) and showed higher incidence of arterial hypertension (P = 0.019) as compared to individuals without coronary plaque in dual source computed tomography. CONCLUSIONS: The prevalence of coronary atherosclerosis by CTA is substantial in symptomatic patients with normal invasive coronary angiogram. Hypertension and older age significantly influence the prevalence of atherosclerotic plaque and highlight the importance of risk-modifying therapy.

10 Article Fractional flow reserve derived from coronary computed tomography angiography: diagnostic performance in hypertensive and diabetic patients. 2017

Eftekhari, Ashkan / Min, James / Achenbach, Stephan / Marwan, Mohamed / Budoff, Matthew / Leipsic, Jonathon / Gaur, Sara / Jensen, Jesper Møller / Ko, Brian S / Christiansen, Evald Høj / Kaltoft, Anne / Bøtker, Hans Erik / Jensen, Jens Flensted / Nørgaard, Bjarne Linde. ·Department of Cardiology, Aarhus University Hospital, Skejby, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark. · Weill Cornell Medical College, Dalio Institute of Cardiovascular Imagaing, New York-Presbyterian Hospital, New York, NY, USA. · Department of Cardiology, University of Erlangen, Erlangen, Germany. · Department of Medicine, Los Angeles Biomedical Research Center, Torrance, CA, USA. · Division of Cardiology, Department of Radiology, St. Paul's Hospital, Vancouver, BC, Canada. ·Eur Heart J Cardiovasc Imaging · Pubmed #28013282.

ABSTRACT: Aims: Fractional flow reserve (FFR) derived from coronary computed tomography (FFRCT) has high diagnostic performance in stable coronary artery disease (CAD). The diagnostic performance of FFRCT in patients with hypertension (HTN) and diabetes (DM), who are at risk of microvascular impairment, is not known. Methods and results: We analysed the diagnostic performance of FFRCT, in patients (vessels) with DM (n = 16), HTN (n = 186), DM + HTN (n = 58) vs. controls (n = 107) with or with suspected CAD. Patients (vessels) were further divided according to left ventricular mass index (LVMI) tertiles. Reference standard was invasively measured FFR ≤0.80. Per-patient diagnostic accuracy (95% CI) in control patients was 71.7% (61.6-81.8) vs. 79.3 (74.0-85.0) (P = 0.12), 75.0% (47.6-92.7) (P = 0.52), and 75.9% (62.8-86.1) (P = 0.39) in patients with HTN, DM, and HTM + DM, respectively. There was no difference in discrimination of ischaemia by FFRCT between groups. On a per-vessel level, there was no significant difference in diagnostic performance or discrimination of ischaemia by FFRCT between groups. There was a decline in both per-patient and -vessel diagnostic specificity of FFRCT in the upper LVMI tertile when compared with lower tertiles; however, discrimination of ischaemia by FFRCT was unaltered across LVMI tertiles. Conclusion: The diagnostic performance of FFRCT is independent of the presence of HTN and DM. FFRCT is a robust method in a broad stable CAD population, including patients at high risk for microvascular disease.

11 Article Optical coherence tomography: influence of contrast concentration on image quality and diagnostic confidence. 2017

Blachutzik, Florian / Achenbach, Stephan / Nef, Holger / Hamm, Christian / Dörr, Oliver / Boeder, Niklas / Marwan, Mohamed / Tröbs, Monique / Schneider, Reinhard / Röther, Jens / Schlundt, Christian. ·Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany. florian.blachutzik@uk-erlangen.de. · Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany. · Department of Cardiology, University Hospital Giessen, Giessen, Germany. ·Heart Vessels · Pubmed #27830336.

ABSTRACT: OCT requires intracoronary injection of contrast agent to remove blood from the coronary lumen during data acquisition, which is a possible limitation of this method. Aim of this study was to analyze the influence of iodine concentration on image quality and diagnostic certainty of optical coherence tomography (OCT). OCT sequences acquired using contrast agent with a reduced concentration of 150 mg iodine/ml and a standard concentration of 350 mg iodine/ml were analyzed. Cross-sectional images with a spacing of 10 mm were evaluated regarding image quality and diagnostic confidence. A total of 67 OCT sequences acquired in 24 patients were analyzed. 31 sequences were acquired using contrast agent with a concentration of 150 mg iodine/ml and 36 sequences with a concentration of 350 mg iodine/ml. The percentage of remaining blood streaks in the cross sections was significantly lower for 350 mg iodine/ml compared to 150 mg iodine/ml (19 ± 21 vs. 34 ± 26%, p = 0.013). Contrast with 350 mg iodine/ml showed a significantly higher percentage of completely flushed pullback length as compared to 150 mg iodine/ml (78 ± 24 vs. 58 ± 27%, p = 0.004). Diagnostic certainty was significantly higher for 350 mg iodine/ml than for 150 mg iodine/ml (Likert scale average 1.4 ± 0.7 vs. 2.1 ± 1.2, p < 0.001; Likert scale: 1 = absolutely confident, 2 = confident with slight doubts, 3 = doubtful/not confident, 4 = non-diagnostic). Regarding image quality and diagnostic certainty, contrast agent with a concentration of 350 mg iodine/ml is superior to 150 mg iodine/ml.

12 Article Influence of the coronary calcium score on the ability to rule out coronary artery stenoses by coronary CT angiography in patients with suspected coronary artery disease. 2016

Schuhbaeck, Annika / Schmid, Jasmin / Zimmer, Thomas / Muschiol, Gerd / Hell, Michaela M / Marwan, Mohamed / Achenbach, Stephan. ·Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany. Electronic address: annika.schuhbaeck@uk-erlangen.de. · Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany. ·J Cardiovasc Comput Tomogr · Pubmed #27461528.

ABSTRACT: BACKGROUND: Recent guidelines for the workup of patients with chest pain and suspected coronary artery disease include coronary computed tomography angiography (CTA). However, its diagnostic value may be limited in patients with severe coronary calcification. OBJECTIVE: We investigated the relationship between the extent of coronary calcium and the ability of coronary CTA to rule out significant stenoses in a series of consecutive patients with suspected coronary artery disease. METHODS: 2614 consecutive patients with suspected coronary artery disease in whom coronary calcium scoring and coronary CTA had been performed by Dual Source CT were analyzed. The ability of coronary CTA to rule out coronary artery stenoses (fully evaluable coronary arteries and absence of any luminal stenosis >75%) was analyzed relative to the coronary calcium score. RESULTS: The median coronary calcium score was 12, with calcium present in 60.5% of all patients. Coronary CTA ruled out stenoses in 82% of patients, while in 18% of patients at least one stenosis was found or could not be excluded. The threshold above which coronary CTA permitted to rule out stenoses in less than 50% of patients was an "Agatston Score" of 287. This threshold was significantly lower for male patients (213 vs. 330), for patients with a heart rate >65 beats/min (157 vs. 317) and for patients with a body mass index ≥25 kg/m(2) (208 vs. 392). The evaluability of coronary arteries decreased with increasing amounts of calcium and differed significantly between heart rates ≤65 beats/min and >65 beats/min (p < 0.0001). CONCLUSION: In the largest patient series evaluated so far, we identified an "Agatston Score" of 287 to represent a threshold above which coronary CTA permits to rule out coronary artery stenoses in less than 50% of cases.

13 Article White Matter Lesions, Carotid and Coronary Atherosclerosis in Late-Onset Depression and Healthy Controls. 2016

Devantier, Torben Albert / Nørgaard, Bjarne Linde / Poulsen, Mikael Kjær / Garde, Ellen / Øvrehus, Kristian Altern / Marwan, Mohamed / Achenbach, Stephan / Dey, Damini / Sørensen, Leif Hougaard / Videbech, Poul. ·Department for Depression and Anxiety, Q, Aarhus University Hospital, Risskov, Denmark. Electronic address: torbdeva@rm.dk. · Department of Cardiology, Aarhus University Hospital, Skejby, Denmark. · Department of Cardiology, Odense University Hospital, Odense, Denmark. · Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital, Hvidovre, Denmark. · Department of Internal Medicine II, University of Erlangen, Erlangen, Germany. · Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA. · Department of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark. · Psychiatric Centre Glostrup, Copenhagen, Denmark. ·Psychosomatics · Pubmed #27036850.

ABSTRACT: BACKGROUND: Cerebral white matter lesions (WMLs) are more common in individuals with late-onset or late-life depression. It has been proposed that carotid atherosclerosis may predispose to WMLs by inducing cerebral hypoperfusion. This hemodynamic effect of carotid atherosclerosis could be important for the formation of WMLs in depression. METHODS: The case-control study included 29 patients with late-onset major depressive disorder and 27 controls matched for sex, age, and tobacco use. WML volume, carotid intima-media thickness, and coronary plaque volume were assessed using magnetic resonance imaging, ultrasound scan, and coronary computed tomography (CT) angiography, respectively. RESULTS: The mean age for the total sample was 59.7 ± 4.7 years. There was no difference in carotid intima-media thickness between patients and controls (p = 0.164), whereas a higher WML volume in the patients was found (p = 0.051). In both patients and controls, WML volume was associated with carotid but not with coronary atherosclerosis. In adjusted multiple linear regression, a 0.1mm increase in averaged carotid intima-media thickness was associated with a 52% (95% CI: 8.4-112, p = 0.032) increase in WML volume. The association between carotid intima-media thickness and WML volume was, however, similar in patients and controls. CONCLUSIONS: In older persons aged between 50 and 70 years, WMLs do not seem to be a part of generalized atherosclerotic disease, but seem to be dependent on atherosclerosis in the carotid arteries. Carotid atherosclerosis, however, could not explain the higher WML load observed in the depressed patients, and thus, studies are needed to establish the mechanisms linking depression and WMLs.

14 Article Reproducibility of semi-automatic coronary plaque quantification in coronary CT angiography with sub-mSv radiation dose. 2016

Øvrehus, Kristian Altern / Schuhbaeck, Annika / Marwan, Mohamed / Achenbach, Stephan / Nørgaard, Bjarne Linde / Bøtker, Hans Erik / Dey, Damini. ·Aarhus University Hospital, Department of Cardiology, Denmark; Lillebaelt Hospital Vejle, Department of Cardiology, Denmark; Odense University Hospital, Department of Cardiology, Denmark. Electronic address: kristianovrehus@hotmail.com. · Erlangen University Hospital, Germany. · Cedars Sinai Medical Center, Los Angeles, USA. ·J Cardiovasc Comput Tomogr · Pubmed #26712694.

ABSTRACT: INTRODUCTION: Coronary computed tomographic angiography (CTA) can characterize coronary atherosclerotic plaque components as calcified and non-calcified. Quantitative measurements of coronary plaque burden by coronary CTA may play a role in serial studies to determine disease progression or response to medical therapies. The reproducibility from repeated assessment of such quantitative measurements from low-radiation dose coronary CTA has not been previously assessed. PURPOSE: To evaluate the interscan, interobserver and intraobserver reproducibility for coronary plaque volume assessment using semi-automatic plaque analyses algorithm in low radiation dose coronary CTA. METHODS: In 50 consecutive patients undergoing two 128-slice dual source CT scans within 12 days with a mean radiation dose of 0.7 mSv per coronary CTA, the interscan, interobserver and intraobserver reproducibility of coronary plaque assessment using validated software (AutoPlaq) were evaluated. RESULTS: Interscan, interobserver and intraobserver agreement for non-calcified and calcified plaque volumes were excellent (Spearman rho 0.87-0.99). Interscan mean percentage difference in non-calcified and calcified plaque volumes were 0.1% (p = 0.8) and 1.9% (p = 0.19) with limits of agreement of ±11% and ±48.5%; per inter- and intraobserver mean percentage differences were 0.1% (p = 0.25) and 0.3% (p = 0.001), and 0.3% (p = 0.33) and 0.4% (p = 0.59) with limits of agreement of ±7% and ±32.9%, and ±6.6% and ±32.1%, respectively. CONCLUSION: A semi-automatic plaque assessment algorithm in repeated low radiation dose coronary CTA allows for high reproducibility of coronary plaque characterization and quantification measures.

15 Article CT-based analysis of pericoronary adipose tissue density: Relation to cardiovascular risk factors and epicardial adipose tissue volume. 2016

Hell, Michaela M / Achenbach, Stephan / Schuhbaeck, Annika / Klinghammer, Lutz / May, Matthias S / Marwan, Mohamed. ·Department of Cardiology, University of Erlangen, Ulmenweg 18, 91054 Erlangen, Germany. Electronic address: michaela.hell@uk-erlangen.de. · Department of Cardiology, University of Erlangen, Ulmenweg 18, 91054 Erlangen, Germany. · Department of Radiology, University of Erlangen, Maximiliansplatz 1, 91054 Erlangen, Germany. ·J Cardiovasc Comput Tomogr · Pubmed #26256553.

ABSTRACT: BACKGROUND: Pericoronary adipose tissue (PCAT) can promote atherosclerosis. Metabolically active and inactive PCAT may display different CT densities. However, CT density could be influenced by partial volume effects and image interpolation. OBJECTIVE: To investigate whether PCAT density values in CT displays differences that are larger than those attributable to interpolation and partial volume effects, which would manifest themselves through the relationship between PCAT density and distance from the contrast-enhanced coronary lumen. METHODS: PCAT density analysis was performed (417 non-atherosclerotic segments, 63 patients) using dual-source CT with a threshold-based measurement method. Changes in PCAT density values depending on distance from the contrast-enhanced coronary lumen and the influence of cardiovascular risk profile were analyzed. RESULTS: Mean PCAT density was -78.1 ± 5.6 HU. PCAT density decreased from proximal to distal segments in the LAD (-78.0 ± 7.3 vs. -82.4 ± 7.7 HU; p < 0.001). PCAT density was higher close to the lumen compared to more peripheral locations (-76.0 ± 6.7 vs. -78.5 ± 5.4 HU; p < 0.001). Decreasing PCAT density was significantly associated with higher epicardial adipose tissue (EAT) volume and body mass index. There was a trend of lower PCAT values with a family history of coronary artery disease. CONCLUSION: CT-measured attenuation of PCAT is influenced by EAT volume and body mass index. A decrease of PCAT attenuation with increasing distance from the vessel and from proximal to distal segments may suggest variations in CT density of PCAT due to partial volume effects and image interpolation rather than solely due to differences in tissue composition or metabolic activity.

16 Article Association of systemic inflammation with epicardial fat and coronary artery calcification. 2015

Gauss, Sören / Klinghammer, Lutz / Steinhoff, Alina / Raaz-Schrauder, Dorette / Marwan, Mohamed / Achenbach, Stephan / Garlichs, Christoph D. ·Department of Cardiology, University of Erlangen, Ulmenweg 18, 91054, Erlangen, Germany, soeren.gauss@uk-erlangen.de. ·Inflamm Res · Pubmed #25763815.

ABSTRACT: BACKGROUND: Increased epicardial fat volume (EFV) has been shown to be associated with coronary atherosclerosis. While it is postulated to be an independent risk factor, a possible mechanism is local or systemic inflammation. We analyzed the relationship between coronary atherosclerosis, quantified by coronary calcium in CT, epicardial fat volume and systemic inflammation. METHODS: Using non-enhanced dual-source CT, we quantified epicardial fat volume (EFV) and coronary artery calcium (CAC) in 391 patients who underwent coronary computed tomography for suspected coronary artery disease. In addition to traditional risk factors, serum markers of systemic inflammation were measured (IL-1α, IL-2, IL-4, IL-6, IL-7, IL-8, IL-10,IL-12, IL-13, IL-15, IL-17, IFN-γ, TNF-α, hs-CRP, GM-CS, G-CSF, MCP-1, MIP-1, Eotaxin and IP-10). In 94 patients follow-up data were obtained after 1.9 ± 0.5 years. RESULTS: The 391 patients had a mean age of 60 ± 10 years, and 69 % were males. Mean EFV was 116 ± 50 mL. Median CAC was 12 (IQR 0; 152). CAC and EFV showed a significant correlation (ρ = 0.37; P < 0.001). EFV and CAC were significantly correlated with the traditional risk factors like age, male gender, diabetes, smoking and hypertension. With regard to biomarkers, CAC was significantly associated (negatively) to G-CSF and IL-13. EFV (median binned) was significantly associated (positively) with IP-10 (P = 0.002) and MCP-1 (ρ = 0.037). In follow-up, EFV showed a mean annualized progression of 6 mL (IQR 3; 9) (P < 0.001); CAC progressed by a mean of six Agatston Units (IQR 0; 30). The progression of CAC was significantly correlated with the extent of EFV (P < 0.001) while there was no significant correlation between progression of EFV or CAC with systemic inflammation markers. CONCLUSION: Epicardial fat volume and the baseline extent as well as progression of coronary atherosclerosis-measured by the calcium score-are significantly correlated. While both baseline EFV and CAC displayed significant correlations with systemic inflammation markers, biomarkers were not predictive of the progression of CAC or EFV.

17 Article Prospectively ECG-triggered high-pitch coronary angiography with third-generation dual-source CT at 70 kVp tube voltage: feasibility, image quality, radiation dose, and effect of iterative reconstruction. 2014

Hell, Michaela M / Bittner, Daniel / Schuhbaeck, Annika / Muschiol, Gerd / Brand, Michael / Lell, Michael / Uder, Michael / Achenbach, Stephan / Marwan, Mohamed. ·Department of Cardiology, University of Erlangen, Erlangen, Germany. Electronic address: michaela.hell@uk-erlangen.de. · Department of Cardiology, University of Erlangen, Erlangen, Germany. · Department of Radiology, University of Erlangen, Erlangen, Germany. ·J Cardiovasc Comput Tomogr · Pubmed #25439789.

ABSTRACT: BACKGROUND: Low tube voltage reduces radiation exposure in coronary CT angiography (CTA). Using 70 kVp tube potential has so far not been possible because CT systems were unable to provide sufficiently high tube current with low voltage. OBJECTIVE: We evaluated feasibility, image quality (IQ), and radiation dose of coronary CTA using a third-generation dual-source CT system capable of producing 450 mAs tube current at 70 kVp tube voltage. METHODS: Coronary CTA was performed in 26 consecutive patients with suspected coronary artery disease, selected for body weight <100 kg and heart rate <60 beats/min. High-pitch spiral acquisition was used. Filtered back projection (FBP) and iterative reconstruction (IR) algorithms were applied. IQ was assessed using a 4-point rating scale (1 = excellent, 4 = nondiagnostic) and objective parameters. RESULTS: Mean age was 62 ± 9 years (46% males; mean body mass index, 27.7 ± 3.8 kg/m(2); mean heart rate, 54 ± 5 beats/min). Mean dose-length product was 20.6 ± 1.9 mGy × cm; mean estimated effective radiation dose was 0.3 ± 0.03 mSv. Diagnostic IQ was found in 365 of 367 (FBP) and 366 of 367 (IR) segments (P nonsignificant). IQ was rated "excellent" in 53% (FBP) and 86% (IR) segments (P = .001) and "nondiagnostic" in 2 (FBP) and 1 segment (IR) (P nonsignificant). Mean IQ score was lesser in FBP vs IR (1.5 ± 0.4 vs 1.1 ± 0.2; P < .001). Image noise was lower in IR vs FBP (60 ± 10 HU vs 74 ± 8 HU; P < .001). CONCLUSION: In patients <100 kg and with a regular heart rate <60 beats/min, third-generation dual-source CT using high-pitch spiral acquisition and 70 kVp tube voltage is feasible and provides both robust IQ and very low radiation exposure.

18 Article Comparison of quantitative atherosclerotic plaque burden from coronary CT angiography in patients with first acute coronary syndrome and stable coronary artery disease. 2014

Dey, Damini / Achenbach, Stephan / Schuhbaeck, Annika / Pflederer, Tobias / Nakazato, Ryo / Slomka, Piotr J / Berman, Daniel S / Marwan, Mohamed. ·Department of Biomedical Sciences, Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Taper Building, Room A238, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA. Electronic address: Damini.Dey@cshs.org. · Department of Internal Medicine 2, University of Erlangen, Erlangen, Germany. · Department of Imaging and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA. · Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA. ·J Cardiovasc Comput Tomogr · Pubmed #25301042.

ABSTRACT: BACKGROUND: Coronary CTA allows characterization of non-calcified and calcified plaque and identification of high-risk plaque features. OBJECTIVE: We aimed to quantitatively characterize and compare coronary plaque burden from CTA in patients with a first acute coronary syndrome (ACS) and controls with stable coronary artery disease. MATERIALS AND METHODS: We retrospectively analyzed consecutive patients with non-ST-segment elevation myocardial infarction (NSTEMI) or unstable angina with a first ACS, who underwent CTA as part of their initial workup before invasive coronary angiography and age- and gender-matched controls with stable chest pain; controls also underwent CTA with subsequent invasive angiography (total n = 28). Culprit arteries were identified in ACS patients. Coronary arteries were analyzed by automated software to quantify calcified plaque (CP), noncalcified plaque (NCP), and low-density NCP (LD-NCP, attenuation <30 Hounsfield units) volumes, and corresponding burden (plaque volume × 100%/vessel volume), stenosis, remodeling index, contrast density difference (maximum percent difference in attenuation/cross-sectional area from proximal cross-section), and plaque length. RESULTS: ACS patients had fewer lesions (median, 1), with higher total NCP and LD-NCP burdens (NCP: 57.4% vs 41.5%; LD-NCP: 12.5% vs 8%; P ≤ .04), higher maximal stenoses (85.6% vs 53.0%; P = .003) and contrast density differences (46.1 vs 16.3%; P < .006). Per-patient CP burden was not different between ACS and controls. NCP and LD-NCP plaque burden was higher in culprit vs nonculprit arteries (NCP: 57.8% vs 9.5%; LD-NCP: 8.4% vs 0.6%; P ≤ .0003); CP was not significantly different. Culprit arteries had increased plaque lengths, remodeling indices, stenoses, and contrast density differences (46.1% vs 10.9%; P ≤ .001). CONCLUSION: Noninvasive quantitative coronary artery analysis identified several differences for ACS, both on per-patient and per-vessel basis, including increased NCP, LD-NCP burden, and contrast density difference.

19 Article Epicardial fat and coronary artery calcification in patients on long-term hemodialysis. 2014

Gauβ, Soeren / Klinghammer, Lutz / Jahn, Daniela / Schuhbäck, Annika / Achenbach, Stephan / Marwan, Mohamed. ·From the Department of Cardiology, University of Erlangen, Erlangen, Germany. ·J Comput Assist Tomogr · Pubmed #24879458.

ABSTRACT: INTRODUCTION: Recent studies have shown a significant correlation between increased epicardial fat volume (EFV) and mortality, coronary artery disease events, and measures of coronary atherosclerotic burden, for example, coronary calcium. Patients with chronic kidney disease on hemodialysis have an increased prevalence of coronary atherosclerosis and coronary calcium. The mechanisms underlying both may differ from patients with normal kidney function. Only limited data are available on the relationship between epicardial fat and coronary calcium in these patients. METHODS: Ninety-three consecutive patients (62 men and 31 women; mean age, 55 ± 11 years) with chronic kidney failure on regular hemodialysis underwent computed tomography for coronary calcium scoring as well as assessment of cardiovascular risk factors. Calcium scoring was performed using a low-dose, prospectively ECG-triggered high pitch spiral acquisition protocol (dual-source computed tomography, 280-millisecond (ms) rotation, 2 × 128 × 0.6-mm collimation, 120-kV tube voltage, 80-mA·s tube current). Cross-sectional images were reconstructed with 3.0-mm thickness, 1.5-mm increment, and a medium sharp reconstruction kernel (B35f). Agatston score and EVF were analyzed in a semiautomatic fashion using dedicated software. RESULTS: The mean duration of dialysis was 5.7 years. Of all patients, 93% had arterial hypertension, 66% had hyperlipidemia, 30% were diabetic, and 49.5% were current or prior smokers. The mean body mass index (BMI) was 27 ± 4 kg/m. The mean EFV was 162 ± 80 mL, and the mean coronary artery calcification (CAC) was 765 ± 1391 Agatston units (AU). In univariable and multivariable analysis, EFV was significantly correlated to BMI (P < 0.05) and age (P = 0.021), but not to CAC (P = 0.106). In subanalysis for values binned by median, we also found a significant correlation between EFV (binned) and smoking (P = 0.49) as well as a significant correlation between EFV (binned) and CAC for 46 patients younger than 55 years (median age). CONCLUSION: The epicardial fat volume in patients with chronic kidney disease and on hemodialysis is significantly correlated to BMI, age, and smoking but, with the exception of younger patients, not to the coronary calcium score. Our data suggest that in this special patient cohort, other mechanisms might influence the genesis of coronary calcification.

20 Article Coronary plaque volume and composition assessed by computed tomography angiography in patients with late-onset major depression. 2014

Devantier, Torben Albert / Nørgaard, Bjarne Linde / Øvrehus, Kristian Altern / Marwan, Mohamed / Poulsen, Mikael Kjær / Achenbach, Stephan / Dey, Damini / Videbech, Poul. ·Centre for Psychiatric Research, Aarhus University Hospital, Risskov, Denmark. Electronic address: torbdeva@rm.dk. · Department of Cardiology, Aarhus University Hospital, Skejby, Denmark. · Department of Cardiology, Odense University Hospital, Odense, Denmark. · Department of Internal Medicine II, University of Erlangen, Erlangen, Germany. · Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA. · Centre for Psychiatric Research, Aarhus University Hospital, Risskov, Denmark. ·Psychosomatics · Pubmed #24360626.

ABSTRACT: BACKGROUND: Depression is a stronger predictor for the onset of or death from clinical coronary artery disease than traditional cardiovascular risk factors. The association between depression and coronary artery disease has previously been investigated in non-contrast enhanced computed tomography studies with conflicting results. The aim of this study was to further elucidate the depression-coronary artery disease relation by use of coronary computed tomography angiography. METHODS: The calcified and noncalcified coronary plaque volumes were determined by semiautomatic volumetric quantification in 28 patients with late-onset major depression and 27 controls. The calcified plaque proportion, i.e., the calcified plaque volume divided by the total plaque volume, was used to assess the plaque composition. RESULTS: There was no statistically significant difference in the total (p = 0.48), calcified (p = 0.15), and noncalcified (p = 0.62) plaque volume between patients and controls, and the total plaque volume did not predict depression, odds ratio = 1.001 [95% confidence interval: 0.999-1.003; p = 0.23]. However, the calcified plaque proportion was twice as high in patients compared with controls (14% vs. 7%, p = 0.044). Correspondingly, having depression was associated with an increased calcified plaque proportion of 11.3 [95% confidence interval: 2.63-20.1; p = 0.012] percentage points after adjustment for demographics and cardiovascular risk factors. CONCLUSION: The proportion of the total coronary plaque volume that was calcified was significantly higher in patients with late-onset major depression than in controls, indicating a difference in plaque composition.

21 Article Current status of cardiac CT for the detection of myocardial ischemia. 2013

Schuhbäck, A / Marwan, M / Cury, R C / Achenbach, S. ·Department of Cardiology, University of Erlangen, Ulmenweg 18, Erlangen, Germany. annika.schuhbaeck@uk-erlangen.de ·Herz · Pubmed #23588608.

ABSTRACT: Stress and rest myocardial perfusion imaging using computed tomography (CT) can be accurately and safely performed. CT angiography allows for the anatomic visualization of coronary lesions and the components of atherosclerotic plaque, whereas according to currently available data, CT perfusion imaging improves the diagnostic accuracy for detecting ischemic lesions. However, the radiation exposure and contrast load that are involved cannot be neglected. Owing to the limited number of trials that have been published so far, and the fact that they used a wide variety of image acquisition and stress protocols, a standard acquisition protocol for CT perfusion imaging still needs to be found and evaluated in larger multicenter trials. Therefore, CT perfusion imaging, as opposed to other modalities such as magnetic resonance perfusion, SPECT, or positron emission tomography, cannot yet be regarded as clinical routine, but may be considered in patients with contraindications for other imaging modalities.

22 Article Very low-dose coronary artery calcium scanning with high-pitch spiral acquisition mode: comparison between 120-kV and 100-kV tube voltage protocols. 2013

Marwan, Mohamed / Mettin, Carina / Pflederer, Tobias / Seltmann, Martin / Schuhbäck, Annika / Muschiol, Gerd / Ropers, Dieter / Daniel, Werner G / Achenbach, Stephan. ·Department of Cardiology, University of Erlangen, Ulmenweg 18, 91054 Erlangen, Germany. mohamedmarwan@yahoo.com ·J Cardiovasc Comput Tomogr · Pubmed #23333186.

ABSTRACT: BACKGROUND: Effective radiation dose from a single coronary artery calcification CT scan can range from 0.8 to 10.5 mSv, depending on the protocol. Reducing the effective radiation dose to reasonable levels without affecting diagnostic image quality can result in substantial dose reduction in CT. OBJECTIVES: We prospectively compared tube voltages of 120 and 100 kV in a low-dose CT acquisition protocol for measuring coronary artery calcified plaque with prospectively electrocardiogram (ECG)-triggered high-pitch spiral acquisition. METHODS: In 150 consecutive patients, measurement of coronary artery calcified plaque was performed with prospectively ECG-triggered high-pitch spiral acquisition. Imaging was first done with tube voltage of 120 kV voltage and subsequently repeated with 100 kV and otherwise unchanged parameters. CT was performed with a dual-source CT system with 280 milliseconds of rotation time, 2 × 128 slices, pitch of 3.4, triggered at 60% of the R-R interval. Tube current for both protocols was set at 80 mAs. With the use of a medium sharp reconstruction kernel (Siemens B35f), cross-sectional images were reconstructed with 3.0-mm slice thickness and 1.5-mm increment. Agatston scores were determined per patient for both scan settings by 2 independent readers with the use of a standard threshold of 130 HU for calcium detection. In addition, the Agatston score was calculated with a previously proposed threshold of 147 HU for 100-kV acquisitions. RESULTS: Mean image noise was 20 ± 5 and 27 ± 7 for 120 and 100 kV, respectively (P < 0.0001). Mean dose length product was 24 ± 6 cm · cGy for the 120-kV protocol and 14 ± 4 cm · cGy for the 100-kV protocol, corresponding to average estimated effective doses of 0.3 and 0.2 mSv (P < 0.0001). Five patients were excluded from the analysis. In the remaining 145 patients, using the standard tube voltage of 120 kV, any coronary calcium was detected in 76 identical patients by both observers. In 75 of these patients, calcium was also identified by both observers in 100-kV data sets, whereas 1 patient was scored negative by 1 reader and was assigned an Agatston score of 0.7 (threshold, 130 HU) and 0.2 (threshold, 147 HU) by the other. Interobserver disagreement for assigning a patient a zero Agatston score was the same for both scan settings (each 4 patients). The mean Agatston scores for 120-kV and 100-kV (threshold, 147 HU) scans were 105 ± 245 (range, 0-1865) and 116 ± 261 (range, 0-1917), respectively (P < 0.0001). Bland-Altman analysis indicated a systematic overestimation of the Agatston score with tube voltage of 100 kV and threshold of 147 HU (mean difference, 11; 95% limits of agreement, 62 to -40). Similar results were observed for coronary calcium volume scores. CONCLUSION: High-pitch spiral acquisition allows coronary calcium scoring with effective doses below 0.5 mSv. The use of 100-kV tube voltage further reduces effective radiation dose compared with the standard of 120 kV; however, it leads to significant overestimation of the Agatston score when the standard threshold of 130 HU is used. Adjusting the threshold to 147 HU leads to a better agreement compared with standard 120 kV protocols yet with a remaining systematic bias toward overestimation of the Agatston score. For high-pitch spiral acquisition mode, effective radiation dose reduction when using a 100-kV setting is minimal compared with the standard 120-kV setting and may be considered nonsignificant in a clinical setting.

23 Article Interobserver agreement for the detection of atherosclerotic plaque in coronary CT angiography: comparison of two low-dose image acquisition protocols with standard retrospectively ECG-gated reconstruction. 2012

Schuhbäck, Annika / Marwan, Mohamed / Gauss, Sören / Muschiol, Gerd / Ropers, Dieter / Schneider, Christian / Lell, Michael / Rixe, Johannes / Hamm, Christian / Daniel, Werner G / Achenbach, Stephan. ·Department of Cardiology, University of Giessen, Giessen, Germany. ·Eur Radiol · Pubmed #22661076.

ABSTRACT: BACKGROUND: We compared the interobserver variability concerning the detection of calcified and non-calcified plaque in two different low-dose and standard retrospectively gated protocols for coronary CTA. METHODS: 150 patients with low heart rates and less than 100 kg body weight were randomised and examined by contrast-enhanced dual-source CT coronary angiography (100 kV, 320 mAs). 50 patients were examined with prospectively ECG-triggered axial acquisition, 50 patients with prospectively ECG-triggered high pitch spiral acquisition, and 50 patients using spiral acquisition with retrospective ECG gating. Two investigators independently analysed the datasets concerning the presence of calcified and non-calcified plaque on a per-segment level. RESULTS: Mean effective dose was 1.4 ± 0.2 mSv for axial, 0.8 ± 0.07 mSv for high-pitch spiral, and 5.3 ± 2.6 mSV for standard spiral acquisition (P < 0.0001). In axial acquisition, interobserver agreement concerning the presence of atherosclerotic plaque was achieved in 650/749 coronary segments (86.8%). In high-pitch spiral acquisition, agreement was achieved in 664/748 segments (88.8%, n.s.). In standard spiral acquisition, agreement was achieved in 672/738 segments (91.0%, P < 0.0001). Interobserver agreement was significantly higher for calcified than for non-calcified plaque in all data acquisition modes. CONCLUSION: Low-dose coronary CT angiography permits the detection of coronary atherosclerotic plaque with good interobserver agreement. KEY POINTS: • Low-dose CT protocols permit coronary plaque detection with good interobserver agreement. • Image noise is a major predictor of interobserver variability. • Interobserver agreement is significantly higher for calcified than for non-calcified plaque.

24 Article Reproducibility of coronary plaque detection and characterization using low radiation dose coronary computed tomographic angiography in patients with intermediate likelihood of coronary artery disease (ReSCAN study). 2012

Øvrehus, Kristian Altern / Marwan, Mohamed / Bøtker, Hans Erik / Achenbach, Stephan / Nørgaard, Bjarne Linde. ·Department of Cardiology, Lillebealt Hospital-Vejle, Kabbeltoft 25, 7100, Vejle, Denmark. kristianovrehus@hotmail.com ·Int J Cardiovasc Imaging · Pubmed #21626043.

ABSTRACT: The purpose of this study is to evaluate the interscan, interobserver and intraobserver agreement for coronary plaque detection, and characterization using low radiation dose high-pitch spiral acquisition coronary CT angiography (CTA). Two experienced observers independently evaluated coronary CTA datasets from 50 consecutive patients undergoing two 128-slice dual source CT scans within 12 days. Mean (±SD) estimated radiation exposure was 1.5 ± 0.2 mSv per scan. Observers recorded the presence and characterization of coronary plaques as non-calcified or calcified. A "segment involvement score" (SIS) was computed by summing the numbers of segments with any coronary plaque per patient. Reproducibility was assessed using kappa (κ) statistics, paired t test and Bland-Altman analyses. Interscan, interobserver, and intraobserver agreement (κ-values) for detection of any or calcified plaques were 83-94% (κ-values 0.57-0.85), and 67-84% (0.31-0.67) for non-calcified plaques on a patient level. No significant difference was observed in mean interscan or interobserver SIS. Mean (95% CI) intraobserver SIS difference was -0.88 (-1.25; -0.51), P < 0.001, with limits of agreement from -4.7 to 2.9. Low radiation dose high-pitch coronary CTA permits detection of any or calcified plaques with high interscan, interobserver, intraobserver agreement. However, variability for the detection of non-calcified plaque is substantial.

25 Article Assessment of coronary artery remodelling by dual-source CT: a head-to-head comparison with intravascular ultrasound. 2011

Gauss, Sören / Achenbach, Stephan / Pflederer, Tobias / Schuhbäck, Annika / Daniel, Werner G / Marwan, Mohamed. ·Department of Cardiology, University of Erlangen, Erlangen, Germany, UK. ·Heart · Pubmed #21478387.

ABSTRACT: BACKGROUND: While it is widely assumed that coronary CT angiography permits detection and quantification of 'positive remodelling' of coronary atherosclerotic lesions, there is a paucity of data comparing CT with established reference methods. OBJECTIVE: To assess the accuracy of dual-source CT for detecting positive versus absent or negative coronary artery remodelling of coronary atherosclerotic lesions as compared with intravascular ultrasound (IVUS). METHODS: The datasets were evaluated of 38 patients referred for invasive coronary angiography and in whom an IVUS study of one coronary vessel was performed. Coronary CT angiography was performed within 24 h before invasive coronary angiography. Using dual-source CT (Siemens Healthcare, Forchheim, Germany), a contrast-enhanced volume dataset was acquired (120 kV, 400 mA/rot, collimation 2×64×0.6 mm, 60-80 ml contrast agent, intravenous). IVUS was performed using a 40 MHz IVUS catheter (Atlantis, Boston Scientific Corporation, Natick, Massachusetts, USA) and motorised pullback at 0.5 mm/s. 48 corresponding non-calcified and partially calcified plaques within the coronary artery system were identified in both CT and IVUS using bifurcation points as fiducial markers. In CT datasets, multiplanar reconstructions orthogonal to the centre line of the coronary artery were rendered and cross-sectional vessel area was measured at the site of maximal narrowing as well as at a reference segment proximal to the lesion for each of the 48 plaques. The remodelling index (RI) was calculated by dividing the vessel area at the site of maximal narrowing by the area of the reference segment. Corresponding vessel areas and RIs were also determined in IVUS. RESULTS: CT classified 41 plaques as positively remodelled (RI≥1.05) and seven as having either absent or negative remodelling (RI<1.05). In IVUS 29 plaques demonstrated positive remodelling, while 19 did not. Mean cross-sectional vessel areas measured by CT at the lesion and at the reference segment were 19±5 mm(2) and 17± 5 mm(2), respectively, versus 18±5 mm(2) and 17±5 mm(2) for IVUS (mean difference 1±2 mm(2) and -0.2±1 mm(2), p<0.0001 and 0.8, respectively). The mean RI in CT was significantly larger than in IVUS (1.2±0.2 vs 1.1±0.2, p<0.0001). Correlation between CT and IVUS was higher for vessel area measurements (r>0.9, p<0.0001) than for remodelling indices (r=0.7, p<0.0001) with Bland-Altman analysis showing a systematic overestimation of vessel areas and RI in CT. Interobserver agreement was moderate for CT and IVUS measurements. Receiver operating characteristic curve analysis showed that a RI of 1.1 in CT identified positively remodelled plaques in IVUS with a sensitivity of 83% and a specificity of 78% (area under the curve=0.8, 95% CI 0.7 to 1.0). Using the standard cut-off point of 1.05 to identify positively remodelled plaques in CT resulted in a sensitivity of 100%, and a specificity of 45%. CONCLUSION: Coronary CT angiography allows analysis of coronary artery remodelling. The degree of positive remodelling is typically overestimated by CT. A threshold of 1.1 for the RI may be optimal to classify plaques as 'positively remodelled' in coronary CT angiography.

Next