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Coronary Artery Disease: HELP
Articles by Pal Maurovich-Horvat
Based on 68 articles published since 2010
(Why 68 articles?)
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Between 2010 and 2020, Pâl Maurovich-Horvat wrote the following 68 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3
1 Editorial 2 Steps Forward, 1 Step Back. 2019

Maurovich-Horvat, Pál. ·MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary. Electronic address: p.maurovich-horvat@cirg.hu. ·JACC Cardiovasc Imaging · Pubmed #30660528.

ABSTRACT: -- No abstract --

2 Editorial Myocardial computed tomography perfusion: a synergy of form and function. 2018

Szilveszter, Bálint / Maurovich-Horvat, Pál. ·Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary. ·Eur Heart J Cardiovasc Imaging · Pubmed #30256917.

ABSTRACT: -- No abstract --

3 Editorial The left main stem: The barometer of coronary artery disease severity? 2018

Maurovich-Horvat, Pál. ·MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary. Electronic address: p.maurovich-horvat@cirg.hu. ·J Cardiovasc Comput Tomogr · Pubmed #29759893.

ABSTRACT: -- No abstract --

4 Review Advanced atherosclerosis imaging by CT: Radiomics, machine learning and deep learning. 2019

Kolossváry, Márton / De Cecco, Carlo N / Feuchtner, Gudrun / Maurovich-Horvat, Pál. ·Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary. Electronic address: marton.kolossvary@cirg.hu. · Division of Cardiothoracic Imaging, Department of Radiology and Imaging Science, Emory University, Atlanta, GA, USA. · Department of Radiology, Innsbruck Medical University, Innsbruck, Austria. · Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary. ·J Cardiovasc Comput Tomogr · Pubmed #31029649.

ABSTRACT: In the last decade, technical advances in the field of medical imaging significantly improved and broadened the application of coronary CT angiography (CCTA) for the non-invasive assessment of coronary artery disease. Recently, similar breakthroughs are happening in the post-processing, analysis and interpretation of radiological images. Technologies such as radiomics allow to extract significantly more information from scans than what human visual assessment is capable of. This allows the precision phenotyping of diseases based on medical images. The increased amount of information can then be analyzed using novel data analytic techniques such as machine learning (ML) and deep learning (DL), which utilize the power of big data to build predictive models, which seek to mimic human intelligence, artificially. Thanks to big data availability and increased computational power, these novel analytic methods are outperforming conventional statistical techniques. In this current overview we describe the basics of radiomics, ML and DL, highlighting similarities, differences, limitations and potential pitfalls of these techniques. In addition, we provide a brief overview of recently published results on the applications of the aforementioned techniques for the non-invasive assessment of coronary atherosclerosis using CCTA.

5 Review The year 2017 in the European Heart Journal-Cardiovascular Imaging: Part I. 2018

Popescu, Bogdan A / Petersen, Steffen E / Maurovich-Horvat, Pál / Haugaa, Kristina H / Donal, Erwan / Maurer, Gerald / Edvardsen, Thor. ·Department of Cardiology, University of Medicine and Pharmacy "Carol Davila"-Euroecolab, Emergency Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Sos. Fundeni 258, Sector 2, Bucharest, Romania. · William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, UK. · Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK. · MTA-SE Cardiovascular Imaging Research Group (CIRG), Heart and Vascular Center, Semmelweis University, Varosmajor u.68, Budapest, Hungary. · Department of Cardiology, Centre of Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, NO-0027 Oslo, Norway. · Institute for Clinical Medicine, University of Oslo, Sognsvannsveien 20, NO-0027 Oslo, Norway. · Cardiology and CIC-IT1414, CHU Rennes, Rennes, France and LTSI INSERM 1099, University Rennes-1, Rennes, France. · Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Spitalgasse 23, Wien, Austria. ·Eur Heart J Cardiovasc Imaging · Pubmed #30085023.

ABSTRACT: The European Heart Journal - Cardiovascular Imaging was launched in 2012. It has gained an impressive impact factor of 8.336 during its first 6 years and is now established as one of the top 10 cardiovascular journals in the world and the most important cardiovascular imaging journal in Europe. The most important studies published in the journal in 2017 will be highlighted in two reports. Part I will focus on studies about myocardial function, coronary artery disease and myocardial ischaemia, and emerging techniques and applications in cardiovascular imaging, whereas Part II will focus on valvular heart disease, heart failure, cardiomyopathies, and congenital heart disease.

6 Review CAD-RADS - a new clinical decision support tool for coronary computed tomography angiography. 2018

Foldyna, Borek / Szilveszter, Bálint / Scholtz, Jan-Erik / Banerji, Dahlia / Maurovich-Horvat, Pál / Hoffmann, Udo. ·Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA. bfoldyna@mgh.harvard.edu. · Department of Diagnostic and Interventional Radiology, University of Leipzig - Heart Center, Leipzig, Germany. bfoldyna@mgh.harvard.edu. · MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary. · Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA. ·Eur Radiol · Pubmed #29116390.

ABSTRACT: Coronary computed tomography angiography (CTA) has been established as an accurate method to non-invasively assess coronary artery disease (CAD). The proposed 'Coronary Artery Disease Reporting and Data System' (CAD-RADS) may enable standardised reporting of the broad spectrum of coronary CTA findings related to the presence, extent and composition of coronary atherosclerosis. The CAD-RADS classification is a comprehensive tool for summarising findings on a per-patient-basis dependent on the highest-grade coronary artery lesion, ranging from CAD-RADS 0 (absence of CAD) to CAD-RADS 5 (total occlusion of a coronary artery). In addition, it provides suggestions for clinical management for each classification, including further testing and therapeutic options. Despite some limitations, CAD-RADS may facilitate improved communication between imagers and patient caregivers. As such, CAD-RADS may enable a more efficient use of coronary CTA leading to more accurate utilisation of invasive coronary angiograms. Furthermore, widespread use of CAD-RADS may facilitate registry-based research of diagnostic and prognostic aspects of CTA. KEY POINTS: • CAD-RADS is a tool for standardising coronary CTA reports. • CAD-RADS includes clinical treatment recommendations based on CTA findings. • CAD-RADS has the potential to reduce variability of CTA reports.

7 Review Plaque imaging with CT-a comprehensive review on coronary CT angiography based risk assessment. 2017

Kolossváry, Márton / Szilveszter, Bálint / Merkely, Béla / Maurovich-Horvat, Pál. ·MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary. ·Cardiovasc Diagn Ther · Pubmed #29255692.

ABSTRACT: CT based technologies have evolved considerably in recent years. Coronary CT angiography (CTA) provides robust assessment of coronary artery disease (CAD). Early coronary CTA imaging-as a gate-keeper of invasive angiography-has focused on the presence of obstructive stenosis. Coronary CTA is currently the only non-invasive imaging modality for the evaluation of non-obstructive CAD, which has been shown to contribute to adverse cardiac events. Importantly, improved spatial resolution of CT scanners and novel image reconstruction algorithms enable the quantification and characterization of atherosclerotic plaques. State-of-the-art CT imaging can therefore reliably assess the extent of CAD and differentiate between various plaque features. Recent studies have demonstrated the incremental prognostic value of adverse plaque features over luminal stenosis. Comprehensive coronary plaque assessment holds potential to significantly improve individual risk assessment incorporating adverse plaque characteristics, the extent and severity of atherosclerotic plaque burden. As a result, several coronary CTA based composite risk scores have been proposed recently to determine patients at high risk for adverse events. Coronary CTA became a promising modality for the evaluation of functional significance of coronary lesions using CT derived fractional flow reserve (FFR-CT) and/or rest/dynamic myocardial CT perfusion. This could lead to substantial reduction in unnecessary invasive catheterization procedures and provide information on ischemic burden of CAD. Discordance between the degree of stenosis and ischemia has been recognized in clinical landmark trials using invasive FFR. Both lesion stenosis and composition are possibly related to myocardial ischemia. The evaluation of lesion-specific ischemia using combined functional and morphological plaque information could ultimately improve the diagnostic performance of CTA and thus patient care. In this review we aimed to summarize current evidence on comprehensive coronary artery plaque assessment using coronary CTA.

8 Review Prognostic Value of Coronary Computed Tomography Angiography in Patients With Diabetes: A Meta-analysis. 2016

Celeng, Csilla / Maurovich-Horvat, Pál / Ghoshhajra, Brian B / Merkely, Béla / Leiner, Tim / Takx, Richard A P. ·MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary. · Cardiac MR PET CT Program, Division of Cardiovascular Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA. · Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands. · Cardiac MR PET CT Program, Division of Cardiovascular Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands r.a.p.takx@umcutrecht.nl. ·Diabetes Care · Pubmed #27330128.

ABSTRACT: OBJECTIVE: The usefulness of coronary computed tomography angiography (CTA) for the evaluation of coronary artery disease (CAD) in patients with diabetes is ambiguous. We therefore performed a meta-analysis of studies reporting event rates and hazard ratios (HR) to determine the prognostic value of CTA in this patient population. RESEARCH DESIGN AND METHODS: We searched PubMed and Embase up to November 2015. Study subjects' characteristics, events (all-cause mortality or cardiac death, nonfatal myocardial infarction, unstable angina pectoris, stroke, revascularization), and events excluding revascularization were collected. We calculated the prevalence of obstructive and nonobstructive CAD on CTA, annualized event rates, and pooled unadjusted and adjusted HR using a generic inverse random model. RESULTS: Eight studies were eligible for inclusion into this meta-analysis, with 6,225 participants (56% male; weighted age, 61 years) with a follow-up period ranging from 20 to 66 months. The prevalence of obstructive CAD, nonobstructive CAD, and no CAD was 38%, 36%, and 25%, respectively. The annualized event rate was 17.1% for obstructive CAD, 4.5% for nonobstructive CAD, and 0.1% for no CAD. Obstructive and nonobstructive CAD were associated with an increased HR of 5.4 and 4.2, respectively. A higher HR for obstructive CAD was observed in studies including revascularization compared with those that did not (7.3 vs. 3.7, P = 0.124). CONCLUSIONS: CTA in patients with diabetes allows for safely ruling out future events, and the detection of CAD could allow for the identification of high-risk patients in whom aggressive risk factor modification, medical surveillance, or elective revascularization could potentially improve survival.

9 Review Non-invasive and invasive imaging of vulnerable coronary plaque. 2016

Celeng, Csilla / Takx, Richard A P / Ferencik, Maros / Maurovich-Horvat, Pál. ·MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary. · Cardiac MR PET CT Program, Division of Cardiovascular Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands. · Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR. · MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary. Electronic address: p.maurovich-horvat@cirg.hu. ·Trends Cardiovasc Med · Pubmed #27079893.

ABSTRACT: Vulnerable plaque is characterized by a large necrotic core and an overlying thin fibrous cap. Non-invasive imaging modalities such as computed tomography angiography (CTA) and magnetic resonance imaging (MRI) allow for the assessment of morphological plaque characteristics, while positron emission tomography (PET) enables the detection of metabolic activity within the atherosclerotic lesions. Invasive imaging modalities such as intravascular ultrasound (IVUS), optical-coherence tomography (OCT), and intravascular MRI (IV-MRI) display plaques at a high spatial resolution. Near-infrared spectroscopy (NIRS) allows for the detection of chemical components of atherosclerotic plaques. In this review, we describe state-of-the-art non-invasive and invasive imaging modalities and stress the combination of their advantages to identify vulnerable plaque features.

10 Review Plaque assessment by coronary CT. 2016

Szilveszter, Bálint / Celeng, Csilla / Maurovich-Horvat, Pál. ·MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Varosmajor st, Budapest, 1122, Hungary. · MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Varosmajor st, Budapest, 1122, Hungary. p.maurovich-horvat@cirg.hu. ·Int J Cardiovasc Imaging · Pubmed #26280890.

ABSTRACT: Coronary CT angiography (CTA) has emerged as a highly reliable and non-invasive modality for the exclusion of coronary artery disease. Recent technological advancements in coronary CTA imaging allow for robust qualitative and quantitative assessment of atherosclerotic plaques. Furthermore, CTA is a promising modality for functional evaluation of coronary lesions. Individual plaque features, the extent and severity of atherosclerotic plaque burden were proposed to improve cardiovascular risk stratification. It has been suggested that total atherosclerotic plaque burden is a stronger predictor of coronary events than total ischemia burden. The quest to noninvasively detect individual vulnerable plaques still remains. In the current review we sought to summarize state-of-the-art coronary artery plaque assessment by CTA.

11 Review Comprehensive plaque assessment by coronary CT angiography. 2014

Maurovich-Horvat, Pál / Ferencik, Maros / Voros, Szilard / Merkely, Béla / Hoffmann, Udo. ·MTA-SE Lendület Cardiovascular Imaging Research Group, Heart and Vascular Centre, Semmelweis University, 68 Varosmajor ut, 1025 Budapest, Hungary. · Cardiac MR PET CT Program, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA 02114. USA. · Stony Brook University, 101 Nicolls Road, Stony Brook, NY 11794 USA. ·Nat Rev Cardiol · Pubmed #24755916.

ABSTRACT: Most acute coronary syndromes are caused by sudden luminal thrombosis due to atherosclerotic plaque rupture or erosion. Preventing such an event seems to be the only effective strategy to reduce mortality and morbidity of coronary heart disease. Coronary lesions prone to rupture have a distinct morphology compared with stable plaques, and provide a unique opportunity for noninvasive imaging to identify vulnerable plaques before they lead to clinical events. The submillimeter spatial resolution and excellent image quality of modern computed tomography (CT) scanners allow coronary atherosclerotic lesions to be detected, characterized, and quantified. Large plaque volume, low CT attenuation, napkin-ring sign, positive remodelling, and spotty calcification are all associated with a high risk of acute cardiovascular events in patients. Computation fluid dynamics allow the calculation of lesion-specific endothelial shear stress and fractional flow reserve, which add functional information to plaque assessment using CT. The combination of morphologic and functional characteristics of coronary plaques might enable noninvasive detection of vulnerable plaques in the future.

12 Review Complementary value of cardiac FDG PET and CT for the characterization of atherosclerotic disease. 2011

Stolzmann, Paul / Subramanian, Sharath / Abdelbaky, Amr / Maurovich-Horvat, Pál / Scheffel, Hans / Tawakol, Ahmed / Hoffmann, Udo. ·Massachusetts General Hospital, Boston, MA 02114, USA. paul.stolzmann@usz.ch ·Radiographics · Pubmed #21918043.

ABSTRACT: For decades, the identification of significant luminal narrowing has been the hallmark to characterize the presence and extent of coronary artery disease. However, it is now known that characterizations of systemic atherosclerosis burden and inflammation, as well as the local quality of plaque composition and morphology, allow better characterization of coronary artery disease and thus may allow improved prediction of adverse cardiovascular events. Plaque characterized histologically as a thin-cap fibroatheroma (ie, an atheroma with a thin fibrous cap, an underlying lipid-rich necrotic core, and inflammatory activity) has been recognized as representing vulnerable or high-risk plaque. Positron emission tomography (PET) and cardiac computed tomography (CT) are noninvasive modalities that provide metabolic (PET) and morphologic (CT) information about atherosclerotic plaque. PET allows the quantification of the uptake of fluorine 18 fluorodeoxyglucose (FDG) within the arterial wall, which provides a measure of macrophage activity within atheromatous plaque. Coronary CT allows the depiction of plaque morphology and composition. Thus, integrated imaging with PET and CT (PET/CT) permits coregistration of FDG activity with the presence and morphology of plaque and may lead to improved characterization of vulnerable plaque or vulnerable patients, or both. This review details the methods and principles of cardiac FDG PET and coronary CT and provides an overview of the research, with an emphasis on the identification and characterization of vulnerable plaque.

13 Clinical Trial Association of ischemic stroke to coronary artery disease using computed tomography coronary angiography. 2012

Jensen, Jesper K / Medina, Hector M / Nørgaard, Bjarne L / Øvrehus, Kristian A / Jensen, Jesper M / Nielsen, Lene H / Maurovich-Horvat, Pal / Engel, Leif-Christopher / Januzzi, James L / Hoffmann, Udo / Truong, Quynh A. ·Department of Cardiology, Vejle Hospital, Denmark. jesperkjensen@dadlnet.dk ·Int J Cardiol · Pubmed #21543126.

ABSTRACT: BACKGROUND: While patients with coronary artery disease (CAD) and cerebrovascular disease share similar risk factor profiles, data on whether IS can be considered a "CAD equivalent" are limited. We aimed to determine whether ischemic stroke is an independent predictor of CAD by using cardiac computed tomography angiography (CTA). METHODS: We analyzed the CTA in 392 patients with no history of CAD (24 patients with acute IS and 368 patients with acute chest pain). Extent of plaque burden was additionally dichotomized into 0-4 versus >4 segments. RESULTS: Patients with IS had a near 5-fold increase odds of having coronary artery plaque (odds ratio [OR] 4.9, P<0.01) as compared to those without IS. After adjustment for age, gender, and traditional cardiac risk factors, there remained a near 4-fold increase odds for coronary plaque (adjusted OR 3.7, P=0.04). When stratified by extent of plaque, patients with IS had over 18-fold increase odds of having >4 segments of plaque than 0-4 segments as compared to patients without stroke (OR 18.3, P<0.01), which remained significantly associated in adjusted analysis (adjusted OR 12.1, P<0.001). CONCLUSION: Acute IS is independently associated with higher risk and greater extent of CAD compared to patients with acute chest pain at low-to-intermediate risk for acute coronary syndrome.

14 Clinical Trial Influence of pericoronary adipose tissue on local coronary atherosclerosis as assessed by a novel MDCT volumetric method. 2011

Maurovich-Horvat, Pál / Kallianos, Kimberly / Engel, Leif-Christopher / Szymonifka, Jackie / Fox, Caroline S / Hoffmann, Udo / Truong, Quynh A. ·Cardiac MR PET CT Program, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, United States. ·Atherosclerosis · Pubmed #21782176.

ABSTRACT: OBJECTIVE: Pericoronary adipose tissue (PCAT) may create a pro-inflammatory state, contributing to the development of coronary artery disease (CAD). We sought to evaluate the feasibility of a novel volumetric PCAT quantification method using a novel threshold based computed tomography approach. In addition we determined the relation between PCAT volumes and CAD. METHODS: In 51 patients (49.5±5.1 years, 64.8% male) who underwent 64-slice MDCT, we measured threshold-based PCAT volumes using distance and anatomic-based methods. Using the most reproducible method, we performed the proximal 40-mm distance measurement in three groups as stratified by coronary plaque and high-sensitivity C-reactive protein (hs-CRP) levels: Group 1 (presence of coronary plaque, hs-CRP >2.0 mg/L); an intermediate group (Group 2, no plaque, hs-CRP >2.0 mg/L); and Group 3 (no plaque, hs-CRP<1.0 mg/L). We compared PCAT volumes to the presence of coronary plaque on a patient (n=51) and vessel (n=153) basis. On a subsegment basis (n=1224), we compared PCAT volume to the presence of plaque as well as plaque morphology. RESULTS: Distance-based PCAT volume measurements yielded excellent reproducibility with intra-observer intraclass correlation (ICC) of 0.997 and inter-observer ICC of 0.951. On a both a per-patient and per-vessel analysis, adjusted PCAT volume was greater in patients with plaque (Group 1) than without plaque (Groups 2 and 3, p<0.001). No difference in PCAT volume was seen between high and low hs-CRP groups without plaque (p=0.51). Adjusted PCAT volumes were higher in subsegments with plaque as compared without (p<0.001). Additionally, adjusted PCAT volume was greatest in subsegments with mixed plaque followed by non-calcified plaque, calcified plaque, and the lowest volume in segments with no plaque (p<0.001). CONCLUSION: In this proof-of-concept study, threshold based PCAT volume assessment is feasible and highly reproducible. PCAT volume is increased in patients and vessels with coronary plaques. Surrounding vessel subsegments with coronary plaque, particularly mixed plaques, have greatest PCAT volume and highlight the effect of local PCAT in the development of coronary atherosclerosis.

15 Article Health-related qualify of life, angina type and coronary artery disease in patients with stable chest pain. 2020

Rieckmann, Nina / Neumann, Konrad / Feger, Sarah / Ibes, Paolo / Napp, Adriane / Preuß, Daniel / Dreger, Henryk / Feuchtner, Gudrun / Plank, Fabian / Suchánek, Vojtěch / Veselka, Josef / Engstrøm, Thomas / Kofoed, Klaus F / Schröder, Stephen / Zelesny, Thomas / Gutberlet, Matthias / Woinke, Michael / Maurovich-Horvat, Pál / Merkely, Béla / Donnelly, Patrick / Ball, Peter / Dodd, Jonathan D / Hensey, Mark / Loi, Bruno / Saba, Luca / Francone, Marco / Mancone, Massimo / Berzina, Marina / Erglis, Andrejs / Vaitiekiene, Audrone / Zajanckauskiene, Laura / Harań, Tomasz / Suckiel, Malgorzata Ilnicka / Faria, Rita / Gama-Ribeiro, Vasco / Benedek, Imre / Rodean, Ioana / Adjić, Filip / Čemerlić Adjić, Nada / Rodriguez-Palomares, José / Garcia Del Blanco, Bruno / Brooksbank, Katriona / Collison, Damien / Davis, Gershan / Thwaite, Erica / Knuuti, Juhani / Saraste, Antti / Kępka, Cezary / Kruk, Mariusz / Benedek, Theodora / Ratiu, Mihaela / Neskovic, Aleksandar N / Vidakovic, Radosav / Diez, Ignacio / Lecumberri, Iñigo / Fisher, Michael / Ruzsics, Balasz / Hollingworth, William / Gutiérrez-Ibarluzea, Iñaki / Dewey, Marc / Müller-Nordhorn, Jacqueline. ·Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany. nina.rieckmann@charite.de. · Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany. · Institute of Biometry and Clinical Epidemiology and Berlin Institute of Health, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany. · Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany. · Department of Cardiology and Angiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany. · Department of Radiology, Innsbruck Medical University, Innsbruck, Austria. · Department of Internal Medicine III, Cardiology, Innsbruck Medical University, Innsbruck, Austria. · Department of Imaging Methods, Motol University Hospital, Prague, Czech Republic. · Department of Cardiology, Motol University Hospital, Prague, Czech Republic. · Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. · Department of Cardiology, ALB FILS KLINIKEN GmbH, Goeppingen, Germany. · Department of Radiology, ALB FILS KLINIKEN GmbH, Goeppingen, Germany. · Department of Radiology, University of Leipzig Heart Centre, Leipzig, Germany. · Department of Cardiology, University of Leipzig Heart Centre, Leipzig, Germany. · Heart and Vascular Center, Semmelweis University, Budapest, Hungary. · Department of Cardiology, Southeastern Health and Social Care Trust, Belfast, UK. · Department of Radiology, Southeastern Health and Social Care Trust, Belfast, UK. · Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland. · Department of Cardiology, St. Vincent's University Hospital, Dublin, Ireland. · Department of Cardiology, Azienda Ospedaliera Brotzu, Cagliari, CA, Italy. · Department of Radiology, University of Cagliari, Cagliari, CA, Italy. · Department of Radiological, Pathological and Oncological Sciences, Sapienza University of Rome, Rome, Italy. · Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Science, Sapienza University of Rome, Rome, Italy. · Department of Cardiology, Paul Stradins Clinical University Hospital, Riga, Latvia. · Department of Cardiology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania. · Department of Radiology, Wojewodzki Szpital Specjalistyczny We Wroclawiu, Wroclaw, Poland. · Department of Cardiology, Wojewodzki Szpital Specjalistyczny We Wroclawiu, Wroclaw, Poland. · Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/ Espinho, Vila Nova de Gaia, Portugal. · Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center, Tirgu Mures, Romania. · Department of Internal Medicine, University of Medicine and Pharmacy, Tirgu Mures, Romania. · Department of Cardiology, Institute for Cardiovascular Diseases of Vojvodina, Novi Sad, Sremska Kamenica, Serbia. · Faculty of medicine, University of Novi Sad, Novi Sad, Serbia. · Department of Cardiology, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain. · BHF Centre of Research Excellence, Glasgow University, Glasgow, UK. · Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK. · Golden Jubilee National Hospital, Clydebank, UK. · Cardiovascular Medicine, University of Central Lancashire, Preston, UK. · Department of Cardiology, Aintree University Hospital, Liverpool, UK. · Department of Radiology, Aintree University Hospital, Liverpool, UK. · Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland. · Heart Center, Turku University Hospital and University of Turku, Turku, Finland. · The National Institute of Cardiology, Warsaw, Poland. · County Clinical Emergency Hospital, Tirgu Mures, Romania. · Department of Radiology and Medical Imaging, University of Medicine and Pharmacy, Tirgu Mures, Romania. · Clinic of Internal medicine/Interventional cardiology, Clinical Hospital Center Zemun-Belgrade, Belgrade, Serbia. · Faculty of Medicine, University of Belgrade, Belgrade, Serbia. · Department of non-invasive diagnostics, Cardiology Division, Clinical Hospital Center Zemun-Belgrade, Belgrade, Serbia. · Department of Cardiology, Basurto Hospital, Bilbao, Spain. · Department of Radiology, Basurto Hospital, Bilbao, Spain. · Department of Cardiology, Royal Liverpool University Hospital, Liverpool, UK. · Institute for Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, UK. · Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK. · Osteba, Basque Office for Health Technology Assessment, Ministry for Health, Basque Country, Spain. ·Health Qual Life Outcomes · Pubmed #32410687.

ABSTRACT: BACKGROUND: Health-related quality of life (HRQoL) is impaired in patients with stable angina but patients often present with other forms of chest pain. The aim of this study was to compare the pre-diagnostic HRQoL in patients with suspected coronary artery disease (CAD) according to angina type, gender, and presence of obstructive CAD. METHODS: From the pilot study for the European DISCHARGE trial, we analysed data from 24 sites including 1263 patients (45.9% women, 61.1 ± 11.3 years) who were clinically referred for invasive coronary angiography (ICA; 617 patients) or coronary computed tomography angiography (CTA; 646 patients). Prior to the procedures, patients completed HRQoL questionnaires: the Short Form (SF)-12v2, the EuroQoL (EQ-5D-3 L) and the Hospital Anxiety and Depression Scale. RESULTS: Fifty-five percent of ICA and 35% of CTA patients had typical angina, 23 and 33% had atypical angina, 18 and 28% had non-anginal chest discomfort and 5 and 5% had other chest discomfort, respectively. Patients with typical angina had the poorest physical functioning compared to the other angina groups (SF-12 physical component score; 41.2 ± 8.8, 43.3 ± 9.1, 46.2 ± 9.0, 46.4 ± 11.4, respectively, all age and gender-adjusted p < 0.01), and highest anxiety levels (8.3 ± 4.1, 7.5 ± 4.1, 6.5 ± 4.0, 4.7 ± 4.5, respectively, all adjusted p < 0.01). On all other measures, patients with typical or atypical angina had lower HRQoL compared to the two other groups (all adjusted p < 0.05). HRQoL did not differ between patients with and without obstructive CAD while women had worse HRQoL compared with men, irrespective of age and angina type. CONCLUSIONS: Prior to a diagnostic procedure for stable chest pain, HRQoL is associated with chest pain characteristics, but not with obstructive CAD, and is significantly lower in women. TRIAL REGISTRATION: Clinicaltrials.gov, NCT02400229.

16 Article Radiomics versus Visual and Histogram-based Assessment to Identify Atheromatous Lesions at Coronary CT Angiography: An ex Vivo Study. 2019

Kolossváry, Márton / Karády, Júlia / Kikuchi, Yasuka / Ivanov, Alexander / Schlett, Christopher L / Lu, Michael T / Foldyna, Borek / Merkely, Béla / Aerts, Hugo J / Hoffmann, Udo / Maurovich-Horvat, Pál. ·From the MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Varosmajor St, 1122 Budapest, Hungary (M.K., J.K., B.M., P.M.H.) · Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.K., Y.K., A.I., M.T.L., B.F., H.J.A., U.H.) · Center for Cause of Death Investigation, Faculty of Medicine, Hokkaido University, Hokkaido, Japan (Y.K.) · Department for Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Freiburg, Germany (C.L.S.) · and Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (H.J.A.). ·Radiology · Pubmed #31385755.

ABSTRACT: Background Visual and histogram-based assessments of coronary CT angiography have limited accuracy in the identification of advanced lesions. Radiomics-based machine learning (ML) could provide a more accurate tool. Purpose To compare the diagnostic performance of radiomics-based ML with that of visual and histogram-based assessment of ex vivo coronary CT angiography cross sections to identify advanced atherosclerotic lesions defined with histologic examination. Materials and Methods In this prospective study, 21 coronary arteries from seven hearts obtained from male donors (mean age, 52.3 years ± 5.3) were imaged ex vivo with coronary CT angiography between February 23, 2009, and July 31, 2010. From 95 coronary plaques, 611 histologic cross sections were coregistered with coronary CT cross sections. Lesions were considered advanced if early fibroatheroma, late fibroatheroma, or thin-cap atheroma was present. CT cross sections were classified as showing homogeneous, heterogeneous, or napkin-ring sign plaques on the basis of visual assessment. The area of low attenuation (<30 HU) and the average Hounsfield unit were quantified. Radiomic parameters were extracted and used as inputs to ML algorithms. Eight radiomics-based ML models were trained on randomly selected cross sections (training set, 75% of the cross sections) to identify advanced lesions. Visual assessment, histogram-based assessment, and the best ML model were compared on the remaining 25% of the data (validation set) by using the area under the receiver operating characteristic curve (AUC) to identify advanced lesions. Results After excluding sections with no visible plaque (

17 Article Design of CTP-PRO study (impact of stress Cardiac computed Tomography myocardial Perfusion on downstream resources and PROgnosis in patients with suspected or known coronary artery disease: A multicenter international study). 2019

Pontone, Gianluca / De Cecco, Carlo / Baggiano, Andrea / Guaricci, Andrea I / Guglielmo, Marco / Leiner, Tim / Lima, Joao / Maurovich-Horvat, Pál / Muscogiuri, Giuseppe / Nance, John W / Schoepf, U Joseph. ·Centro Cardiologico Monzino, IRCCS, Milan, Italy. Electronic address: gianluca.pontone@ccfm.it. · Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA. · Centro Cardiologico Monzino, IRCCS, Milan, Italy. · Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico, Bari, Italy. · Department of Radiology, Utrecht University Medical Center, Utrecht, the Netherlands. · The Johns Hopkins Hospital, Baltimore, USA. · MTA-SE Cardiovascular Imaging Research Group (CIRG) Heart and Vascular Center, Semmelweis University, Budapest, Hungary. · Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA. ·Int J Cardiol · Pubmed #31230938.

ABSTRACT: BACKGROUND: CT myocardial perfusion imaging (CTP) represents one of the newly developed CT-based techniques but its cost-effectiveness in the clinical pathway is undefined. The aim of the study is to evaluate the usefulness of combined evaluation of coronary anatomy and myocardial perfusion in intermediate to high-risk patients for suspected CAD or with known disease in terms of clinical decision-making, resource utilization and outcomes in a broad variety of geographic areas and patient subgroups. METHODS: CTP-PRO study is a cooperative, international, multicentre, prospective, open-label, randomized controlled study evaluating the cost-effectiveness of a CCTA+CTP strategy (Group A) versus usual care (Group B) in intermediate-high risk patients with suspected or known CAD who undergo clinically indicated diagnostic evaluation. A total sample size of 2000 subjects will be enrolled and followed up for 24 months. The primary endpoint is the reclassification rate of CCTA in group A due to the addition of CTP. The secondary endpoint will be the comparison between groups in terms of non-invasive and invasive downstream testing, prevalence of obstructive CAD at ICA, revascularization, cumulative ED and overall cost during the follow-up at 1- and 2-years. The tertiary endpoint will be the comparison between each group in terms of MACE and cost-effectiveness at 1- and 2-years. CONCLUSIONS: The study will provide information to patients, health care providers and other stakeholders about which strategy could be more effective in the diagnosis of suspected CAD in intermediate to high-risk patients or in the symptomatic patients with known CAD and previous history of revascularization.

18 Article Comprehensive coronary plaque assessment in patients with obstructive sleep apnea. 2019

Bikov, Andras / Kolossváry, Márton / Jermendy, Adam L / Drobni, Zsofia D / Tarnoki, Adam D / Tarnoki, David L / Forgó, Bianka / Kovacs, Daniel T / Losonczy, Gyorgy / Kunos, Laszlo / Voros, Szilard / Merkely, Bela / Maurovich-Horvat, Pal. ·Department of Pulmonology, Semmelweis University, Budapest, Hungary. · Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary. · Department of Radiology, Semmelweis University, Budapest, Hungary. · Global Genomics Group, Atlanta, Georgia, USA. ·J Sleep Res · Pubmed #30724416.

ABSTRACT: Obstructive sleep apnea (OSA) is associated with an increased risk of cardiovascular disease. Previous studies have assessed the relationship between OSA and coronary artery disease (CAD) using coronary artery calcium score (CAC) measurements. However, limited data are available regarding the association of OSA with non-calcified plaque burden. We therefore aimed to assess the relationship between CAD severity as assessed by coronary computed tomography angiography (CTA) and OSA. Forty-one adult subjects (59 ± 9 years, 15 men) underwent a 256-slice coronary CTA, which was followed by a diagnostic attended cardiorespiratory polygraphy (n = 13) or polysomnography (n = 28). Segment involvement score (SIS), segment stenosis score (SSS) and CAC were used to quantify total CAD burden. Correlation analysis was used to assess potential associations between CAD and OSA. Twenty-two patients were diagnosed with OSA. SIS and SSS were elevated in OSA (2.90 ± 2.78 versus 1.79 ± 2.39 and 4.91 ± 5.94 versus 1.79 ± 4.54, OSA versus controls, SIS and SSS respectively, both p < 0.01) and correlated with OSA severity as measured by the apnea-hypopnea index (AHI, r = 0.41 and 0.43, p < 0.01) and oxygen desaturation index (ODI, r = 0.45 and 0.46, p < 0.01). However, no significant correlation was observed between CAC and OSA. Compared to CAC, SIS and SSS provide additional information on coronary plaque burden in OSA, which shows a significant association with OSA.

19 Article Quantitative CT assessment identifies more heart transplanted patients with progressive coronary wall thickening than standard clinical read. 2019

Károlyi, Mihály / Kolossváry, Márton / Bartykowszki, Andrea / Kocsmár, Ildikó / Szilveszter, Bálint / Karády, Júlia / Merkely, Béla / Maurovich-Horvat, Pál. ·MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary. · MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary. Electronic address: p.maurovich.horvat@mail.harvard.edu. ·J Cardiovasc Comput Tomogr · Pubmed #30528167.

ABSTRACT: BACKGROUND: We sought to compare quantitative coronary CT angiography (CTA) assessment versus standard clinical reading to identify heart transplanted (HTX) patients with progressive coronary wall thickening. METHODS: 35 patients (23 males, age 58 [IQR: 50;61] years) underwent 256-slice coronary CTA at one year and two years after HTX to rule out cardiac allograft vasculopathy (CAV). In addition to the standard clinical read, we quantified total vessel wall volume in all coronaries up to 2-mm luminal diameter. Fixed threshold settings were used to assess calcified (>350 HU) and non-calcified vessel wall components with high- (131-350 HU), intermediate- (75-130 HU) and low-attenuation (<75 HU). RESULTS: Total lumen volume did not change between baseline and follow-up studies (p = 0.59). Total vessel wall volume showed significant increase (464 [IQR: 338; 570] vs. 563 [IQR: 345; 717] mm CONCLUSION: Quantitative coronary wall assessment is feasible with coronary CTA in HTX patients. Coronary wall thickening within the first two years after HTX is mainly attributable to non-calcified lesion components and might be an early sign of CAV.

20 Article Effect of image reconstruction algorithms on volumetric and radiomic parameters of coronary plaques. 2019

Kolossváry, Márton / Szilveszter, Bálint / Karády, Júlia / Drobni, Zsófia Dóra / Merkely, Béla / Maurovich-Horvat, Pál. ·Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest Hungary, 68. Varosmajor Street, 1122, Budapest, Hungary. Electronic address: marton.kolossvary@cirg.hu. · Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest Hungary, 68. Varosmajor Street, 1122, Budapest, Hungary. ·J Cardiovasc Comput Tomogr · Pubmed #30447949.

ABSTRACT: BACKGROUND: Volumetric and radiomic analysis of atherosclerotic plaques on coronary CT angiography have been shown to predict high-risk plaque morphology and to predict patient outcomes. However, there is limited information whether image reconstruction algorithms and preprocessing steps (type of binning, number of bins used for discretization) may influence parameter values. METHODS: We retrospectively identified 60 coronary lesions on coronary CT angiography (CTA). All images were reconstructed using filtered back projection (FBP), hybrid (HIR) and model-based (MIR) iterative reconstruction. Plaques were segmented manually on HIR images and copied to FBP and MIR images to ensure identical voxels were analyzed. Overall, 4 volumetric and 169 radiomic parameters were calculated. Intra-class correlation coefficient (ICC) was used to assess reproducibility between image reconstructions, while linear regression analysis was used to assess the effect of preprocessing steps done before calculating radiomic metrics. RESULTS: All volumetric and radiomic metrics had ICC>0.90 except for first-order statistics: mode, harmonic mean, minimum (0.45, 0.76, 0.84; respectively) and gray level co-occurrence (GLCM) parameters: inverse difference sum and sum variance (0.01, 0.04; respectively). Among GLCM parameters 90% were significantly affected by the type of binning and 100% by the number of bins. In case of gray level run length matrix parameters 100% of metrics were affected by both preprocessing steps. CONCLUSIONS: Volumetric and radiomic statistics are robust to image reconstruction algorithms. However, all radiomic variables were affected by preprocessing steps therefore, showing the need for standardization before being implemented into everyday clinical practice.

21 Article Anatomical and Functional Computed Tomography for Diagnosing Hemodynamically Significant Coronary Artery Disease: A Meta-Analysis. 2019

Celeng, Csilla / Leiner, Tim / Maurovich-Horvat, Pál / Merkely, Béla / de Jong, Pim / Dankbaar, Jan W / van Es, Hendrik W / Ghoshhajra, Brian B / Hoffmann, Udo / Takx, Richard A P. ·Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands. Electronic address: c.celeng@umcutrecht.nl. · Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands. · MTA-SE Cardiovascular Imaging Research Group Heart and Vascular Center, Semmelweis University, Budapest, Hungary. · Department of Radiology, St. Antonius Hospital, Nieuwegein, the Netherlands. · Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. · Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Radiology, St. Antonius Hospital, Nieuwegein, the Netherlands; Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. ·JACC Cardiovasc Imaging · Pubmed #30219398.

ABSTRACT: OBJECTIVES: This meta-analysis determined the diagnostic performance of coronary computed tomography (CT) angiography (CTA), CT myocardial perfusion (CTP), fractional flow reserve CT (FFR BACKGROUND: CTA provides excellent anatomic, albeit limited functional information for the evaluation of CAD. Recently, various functional CT techniques emerged to assess the hemodynamic consequences of CAD. METHODS: This meta-analysis was performed in adherence to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, EMBASE, and Web of Science were searched from inception until September 7, 2017. Bayesian random effects analysis was used to compute pooled sensitivity, specificity, and the summary receiver-operating characteristic curve of the index tests and compare them with the FFR as a reference standard. Analyses were performed on vessel and patient levels. Because CTA has excellent sensitivity, specificity was considered most relevant. Individual FFR RESULTS: Overall, 54 articles and 5,330 patients were included. At vessel level, pooled specificity of CTP (0.86; 95% confidence interval [CI]: 0.76 to 0.93), FFR CONCLUSIONS: CTP and FFR

22 Article Coronary Computed Tomography Angiography-Specific Definitions of High-Risk Plaque Features Improve Detection of Acute Coronary Syndrome. 2018

Bittner, Daniel O / Mayrhofer, Thomas / Puchner, Stefan B / Lu, Michael T / Maurovich-Horvat, Pal / Ghemigian, Khristine / Kitslaar, Pieter H / Broersen, Alexander / Bamberg, Fabian / Truong, Quynh A / Schlett, Christopher L / Hoffmann, Udo / Ferencik, Maros. ·Department of Radiology (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.). · Cardiac MR PET CT Program (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.). · Massachusetts General Hospital and Harvard Medical School, Boston. Department of Cardiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), University Hospital Erlangen, Germany (D.O.B.). · School of Business Studies, Stralsund University of Applied Sciences, Germany (T.M.). · Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Austria (S.B.P.). · MTA-SE Lendület Cardiovascular Imaging Research Group, Heart and Vascular Centre, Semmelweis University, Budapest, Hungary (P.M.-H.). · Division of Image Processing, Department of Radiology, Leiden University Medical Center, the Netherlands (P.H.K., A.B.). · Medis Medical Imaging Systems B.V, Leiden, the Netherlands (P.H.K.). · Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College (Q.A.T.). · Department of Radiology, University of Tuebingen, Germany (F.B.). ·Circ Cardiovasc Imaging · Pubmed #30354493.

ABSTRACT: Background High-risk plaque (HRP) features as detected by coronary computed tomography angiography (CTA) predict acute coronary syndrome (ACS). We sought to determine whether coronary CTA-specific definitions of HRP improve discrimination of patients with ACS as compared with definitions from intravascular ultrasound (IVUS). Methods and Results In patients with suspected ACS, randomized to coronary CTA in the ROMICAT II (Rule Out Myocardial Infarction/Ischemia Using Computer Assisted Tomography II) trial, we retrospectively performed semiautomated quantitative analysis of HRP (including remodeling index, plaque burden as derived by plaque area, low computed tomography attenuation plaque volume) and degree of luminal stenosis and analyzed the performance of traditional IVUS thresholds to detect ACS. Furthermore, we derived CTA-specific thresholds in patients with ACS to detect culprit lesions and applied those to all patients to calculate the discriminatory ability to detect ACS in comparison to IVUS thresholds. Of 472 patients, 255 patients (56±7.8 years; 63% men) had coronary plaque. In 32 patients (6.8%) with ACS, culprit plaques (n=35) differed from nonculprit plaques (n=172) with significantly greater values for all HRP features except minimal luminal area (significantly lower; all P<0.01). IVUS definitions showed good performance while minimal luminal area (odds ratio: 6.82; P=0.014) and plaque burden (odds ratio: 5.71; P=0.008) were independently associated with ACS but not remodeling index (odds ratio: 0.78; P=0.673). Optimized CTA-specific thresholds for plaque burden (area under the curve: 0.832 versus 0.676) and degree of stenosis (area under the curve: 0.826 versus 0.721) showed significantly higher diagnostic performance for ACS as compared with IVUS-based thresholds (all P<0.05) with borderline significance for minimal luminal area (area under the curve: 0.817 versus 0.742; P=0.066). Conclusions CTA-specific definitions of HRP features may improve the discrimination of patients with ACS as compared with IVUS-based definitions. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT01084239.

23 Article Reduction in radiation exposure in cardiovascular computed tomography imaging: results from the PROspective multicenter registry on radiaTion dose Estimates of cardiac CT angIOgraphy iN daily practice in 2017 (PROTECTION VI). 2018

Stocker, Thomas J / Deseive, Simon / Leipsic, Jonathon / Hadamitzky, Martin / Chen, Marcus Y / Rubinshtein, Ronen / Heckner, Mathias / Bax, Jeroen J / Fang, Xiang-Ming / Grove, Erik Lerkevang / Lesser, John / Maurovich-Horvat, Pál / Otton, James / Shin, Sanghoon / Pontone, Gianluca / Marques, Hugo / Chow, Benjamin / Nomura, Cesar H / Tabbalat, Ramzi / Schmermund, Axel / Kang, Joon-Won / Naoum, Christopher / Atkins, Melany / Martuscelli, Eugenio / Massberg, Steffen / Hausleiter, Jörg / Anonymous3971115. ·Medizinische Klinik und Poliklinik I, Ludwig Maximilians-Universität, Munich, Germany. · DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany. · University of British Columbia, Vancouver, Canada. · Deutsches Herzzentrum, Munich, Germany. · National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, USA. · Lady Davis Carmel Medical Center, Haifa, Israel. · Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. · Wuxi People's Hospital, Wuxi, China. · Aarhus University Hospital, Aarhus, Denmark. · Minneapolis Heart Institute at Abbott Northwestern Hosptial, Minneapolis, USA. · Heart and Vascular Center, Budapest, Hungary. · Spectrum Radiology Liverpool, Sydney, Australia. · National Health Insurance Service Ilsan Hospital, Goyang-si, South Korea. · Centro Cardiologico Monzino, University of Milan, Milan, Italy. · UNICA (cardiovascular CT and MRI Unit), Hospital da Luz, Lisboa, Portugal. · University of Ottawa Heart Institute, Ottawa, Canada. · Heart Institute-InCor, Sao Paulo, Brazil. · Khalidi Hospital & Medical Center, Amman, Jordan. · Cardioangiologisches Centrum Bethanien (CCB), Frankfurt, Germany. · Asan Medical Center, Seoul, South Korea. · Macquarie University Hospital, Sydney, Australia. · Fairfax Radiological Consultants, Fairfax, USA. · Policlinico di Tor Vergata, Rome, Italy. ·Eur Heart J · Pubmed #30165629.

ABSTRACT: Aims: Advances of cardiac computed tomography angiography (CTA) have been developed for dose reduction, but their efficacy in clinical practice is largely unknown. This study was designed to evaluate radiation dose exposure and utilization of dose-saving strategies for contrast-enhanced cardiac CTA in daily practice. Methods and results: Sixty one hospitals from 32 countries prospectively enrolled 4502 patients undergoing cardiac CTA during one calendar month in 2017. Computed tomography angiography scan data and images were analysed in a central core lab and compared with a similar dose survey performed in 2007. Linear regression analysis was performed to identify independent predictors associated with dose. The most frequent indication for cardiac CTA was the evaluation of coronary artery disease in 89% of patients. The median dose-length product (DLP) of coronary CTA was 195 mGy*cm (interquartile range 110-338 mGy*cm). When compared with 2007, the DLP was reduced by 78% (P < 0.001) without an increase in non-diagnostic coronary CTAs (1.7% in 2007 vs. 1.9% in 2017 surveys, P = 0.55). A 37-fold variability in median DLP was observed between the hospitals with lowest and highest DLP (range of median DLP 57-2090 mGy*cm). Independent predictors for radiation dose of coronary CTA were: body weight, heart rate, sinus rhythm, tube voltage, iterative image reconstruction, and the selection of scan protocols. Conclusion: This large international radiation dose survey demonstrates considerable reduction of radiation exposure in coronary CTA during the last decade. However, the large inter-site variability in radiation exposure underlines the need for further site-specific training and adaptation of contemporary cardiac scan protocols.

24 Article High-Risk Plaque Regression and Stabilization: Hybrid Noninvasive Morphological and Hemodynamic Assessment. 2018

Giannopoulos, Andreas A / Mitsouras, Dimitrios / Bartykowszki, Andrea / Merkely, Béla / Chatzizisis, Yiannis S / Buechel, Ronny R / Kaufmann, Philipp A / Gaemperli, Oliver / Maurovich-Horvat, Pál. ·Cardiac Imaging, Nuclear Medicine Department, University Hospital Zurich, Switzerland (A.A.G., R.R.B., P.A.K., O.G.). · Applied Imaging Science Laboratory, Radiology Department, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (D.M.). · The University of Ottawa Medical School, ON, Canada (D.M.). · MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (A.B., B.M., P.M.-H.). · Cardiovascular Biology and Biomechanics Laboratory, Cardiovascular Division, University of Nebraska Medical Center, Omaha (Y.S.C.). · MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary (A.B., B.M., P.M.-H.) p.maurovich.horvat@mail.harvard.edu. ·Circ Cardiovasc Imaging · Pubmed #29970381.

ABSTRACT: -- No abstract --

25 Article Differences in the association of total versus local coronary artery calcium with acute coronary syndrome and culprit lesions in patients with acute chest pain: The coronary calcium paradox. 2018

Puchner, Stefan B / Mayrhofer, Thomas / Park, Jakob / Lu, Michael T / Liu, Ting / Maurovich-Horvat, Pal / Ghemigian, Khristine / Bittner, Daniel O / Fleg, Jerome L / Udelson, James E / Truong, Quynh A / Hoffmann, Udo / Ferencik, Maros. ·Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria. · Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; School of Business Studies, Stralsund University of Applied Sciences, Stralsund, Germany. · Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. · Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, China. · MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Centre, Semmelweis University, Budapest, Hungary. · Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Cardiology, University Hospital Erlangen, Germany. · Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, USA. · Division of Cardiology and the Cardio-Vascular Center, Tufts Medical Center, Boston, MA, USA. · Department of Radiology and Division of Cardiology, Weill Cornell Medical College, New York, NY, USA. · Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA. Electronic address: ferencik@ohsu.edu. ·Atherosclerosis · Pubmed #29703635.

ABSTRACT: BACKGROUND AND AIMS: Total coronary artery calcium (CAC) burden is associated with an increased cardiovascular risk, while local CAC may represent stable plaques. We determined differences in relationship of total CAC with acute coronary syndrome (ACS) and local CAC with culprit lesions in patients with suspected ACS. METHODS: We performed computed tomography (CT) for CAC and CT angiography to assess the presence of significant stenosis and high-risk plaque (positive remodeling, low CT attenuation, napkin-ring sign, spotty calcium) in 37 patients with ACS and 223 controls. Total and segmental Agatston scores were measured. Culprit lesions were assessed in subjects with ACS. RESULTS: Patients (n = 260) with vs. without ACS had higher total CAC score (median 229, 25 CONCLUSIONS: Total CAC burden was associated with ACS but segmental CAC was not associated with culprit lesions. Our findings suggest that total but not local CAC is a marker of ACS risk and support the hypothesis that extensive local CAC is a marker of plaque stability.

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