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Coronary Artery Disease: HELP
Articles by Bjarne Linde Nørgaard
Based on 79 articles published since 2010
(Why 79 articles?)
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Between 2010 and 2020, B. Nørgaard wrote the following 79 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4
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 Editorial Angiography based quantitative flow ratio in coronary artery disease: Mimic of FFR - Ready for clinical use? 2019

Nørgaard, B L / Ko, B. ·Department Cardiology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: bnorgaard@dadlnet.dk. · Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia. ·Int J Cardiol · Pubmed #30612849.

ABSTRACT: -- No abstract --

3 Editorial Coronary CT Angiography to Guide Treatment Decision Making: Lessons From the SYNTAX II Trial. 2018

Nørgaard, Bjarne L / Leipsic, Jonathon / Achenbach, Stephan. ·Department of Cardiology, Aarhus University Hospital, 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, Friedrich-Alexander-University, Erlangen-Nürnberg, Germany. ·J Am Coll Cardiol · Pubmed #29802015.

ABSTRACT: -- No abstract --

4 Editorial From Newton to the Coronaries: Computational Fluid Dynamics Has Entered the Clinical Scene. 2016

Nørgaard, Bjarne L / Leipsic, Jonathon. ·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. ·JACC Cardiovasc Imaging · Pubmed #26897680.

ABSTRACT: -- No abstract --

5 Editorial Coronary CT angiography in clinical practice: experiences from Denmark. 2014

Nørgaard, Bjarne Linde. ·Department of Cardiology B, Aarhus University Hospital Skejby , Aarhus C , Denmark. ·Scand Cardiovasc J · Pubmed #25142798.

ABSTRACT: -- No abstract --

6 Review Current Evidence in Cardiothoracic Imaging: Computed Tomography-derived Fractional Flow Reserve in Stable Chest Pain. 2019

Schwartz, Fides R / Koweek, Lynne M / Nørgaard, Bjarne L. ·Department of Radiology, Duke University Medical Center, Durham, NC. · Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark. ·J Thorac Imaging · Pubmed #30376481.

ABSTRACT: High-accuracy diagnostic imaging is needed to diagnose and manage coronary artery disease as well as to allow risk stratification for future events. Advancements in multidetector computed tomography and image postprocessing allow for routine computed tomography coronary angiography to provide anatomic luminal assessment similar to invasive coronary angiography, and, similarly, computational fractional flow reserve derived from computed tomography facilitates determination of hemodynamically relevant stenosis comparable to invasive fractional flow reserve. In this review article, we describe the diagnostic performance and the potential impact of fractional flow reserve derived from computed tomography in clinical practice.

7 Review Coronary CT Angiography Derived Fractional Flow Reserve: The Game Changer in Noninvasive Testing. 2017

Nørgaard, Bjarne Linde / Jensen, Jesper Møller / Blanke, Philipp / Sand, Niels Peter / Rabbat, Mark / Leipsic, Jonathon. ·Department Cardiology, Aarhus University Hospital, 8200, Aarhus N, Denmark. bnorgaard@dadlnet.dk. · Department Cardiology, Aarhus University Hospital, 8200, Aarhus N, Denmark. · Department of Radiology and Medicine, St. Paul´s Hospital, University of British Columbia, Vancouver, Canada. · Department Cardiology, Hospital of South West Denmark, Esbjerg, and Institute of regional Health Research, University of Southern Denmark, Esbjerg, Denmark. · Medicine and Radiology, Division of Cardiology, Loyola University Chicago, Chicago, Illinois, USA. ·Curr Cardiol Rep · Pubmed #28940026.

ABSTRACT: PURPOSE OF REVIEW: To summarize the scientific basis of CT derived fractional flow reserve (FFR

8 Review Interpreting results of coronary computed tomography angiography-derived fractional flow reserve in clinical practice. 2017

Rabbat, Mark G / Berman, Daniel S / Kern, Morton / Raff, Gilbert / Chinnaiyan, Kavitha / Koweek, Lynne / Shaw, Leslee J / Blanke, Philipp / Scherer, Markus / Jensen, Jesper M / Lesser, John / Nørgaard, Bjarne L / Pontone, Gianluca / De Bruyne, Bernard / Bax, Jeroen J / Leipsic, Jonathon. ·Department of Medicine and Radiology, Division of Cardiology, Loyola University Chicago, Chicago, IL, USA; Edward Hines Jr. Veteran's Affairs Hospital, Hines, IL, USA. Electronic address: mrabbat@lumc.edu. · Cedars-Sinai Medical Center, Department of Imaging, USA. · VA Long Beach HCS, Department of Cardiology, University of California Irvine, USA. · Beaumont Health, Department of Cardiology, USA. · Duke University, Department of Medicine and Radiology, USA. · Emory University, Department of Cardiology, USA. · St. Paul's Hospital & University of British Columbia, Department of Radiology, Canada. · Sanger Heart and Vascular Institute, Department of Cardiology, USA. · Aarhus University Hospital, Department of Cardiology, Denmark. · Minneapolis Heart Institute, USA. · Cardiologico Monzino, Department of Cardiovascular Imaging, Milan, Italy. · OLV Ziekenhuis Aalst, Cardiovascular Center Aalst, Belgium. · Leiden University Medical Center, Department of Cardiology, The Netherlands. ·J Cardiovasc Comput Tomogr · Pubmed #28666784.

ABSTRACT: The application of computational fluid dynamics to coronary computed tomography angiography allows Fractional Flow Reserve (FFR) to be calculated non-invasively (FFR

9 Review Diagnostic performance of cardiac imaging methods to diagnose ischaemia-causing coronary artery disease when directly compared with fractional flow reserve as a reference standard: a meta-analysis. 2017

Danad, Ibrahim / Szymonifka, Jackie / Twisk, Jos W R / Norgaard, Bjarne L / Zarins, Christopher K / Knaapen, Paul / Min, James K. ·Department of Radiology, Weill Cornell Medical College, New York, NY, USA. · Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, New York, NY, USA. · Department of Epidemiology and Biostatistics, VU University Medical Center, VU University, Amsterdam, The Netherlands. · Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark. · Department of Surgery, Stanford University Medical Center, Stanford, CA, USA. · HeartFlow, Inc., Redwood City, CA, USA. · Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands. ·Eur Heart J · Pubmed #27141095.

ABSTRACT: Aims: The aim of this study was to determine the diagnostic performance of single-photon emission computed tomography (SPECT), stress echocardiography (SE), invasive coronary angiography (ICA), coronary computed tomography angiography (CCTA), fractional flow reserve (FFR) derived from CCTA (FFRCT), and cardiac magnetic resonance (MRI) imaging when directly compared with an FFR reference standard. Method and results: PubMed and Web of Knowledge were searched for investigations published between 1 January 2002 and 28 February 2015. Studies performing FFR in at least 75% of coronary vessels for the diagnosis of ischaemic coronary artery disease (CAD) were included. Twenty-three articles reporting on 3788 patients and 5323 vessels were identified. Meta-analysis was performed for pooled sensitivity, specificity, likelihood ratios (LR), diagnostic odds ratio, and summary receiver operating characteristic curves. In contrast to ICA, CCTA, and FFRCT reports, studies evaluating SPECT, SE, and MRI were largely retrospective, single-centre and with generally smaller study samples. On a per-patient basis, the sensitivity of CCTA (90%, 95% CI: 86-93), FFRCT (90%, 95% CI: 85-93), and MRI (90%, 95% CI: 75-97) were higher than for SPECT (70%, 95% CI: 59-80), SE (77%, 95% CI: 61-88), and ICA (69%, 95% CI: 65-75). The highest and lowest per-patient specificity was observed for MRI (94%, 95% CI: 79-99) and for CCTA (39%, 95% CI: 34-44), respectively. Similar specificities were noted for SPECT (78%, 95% CI: 68-87), SE (75%, 95% CI: 63-85), FFRCT (71%, 95% CI: 65-75%), and ICA (67%, 95% CI: 63-71). On a per-vessel basis, the highest sensitivity was for CCTA (pooled sensitivity, 91%: 88-93), MRI (91%: 84-95), and FFRCT (83%, 78-87), with lower sensitivities for ICA (71%, 69-74), and SPECT (57%: 49-64). Per-vessel specificity was highest for MRI (85%, 79-89), FFRCT (78%: 78-81), and SPECT (75%: 69-80), whereas ICA (66%: 64-68) and CCTA (58%: 55-61) yielded a lower specificity. Conclusions: In this meta-analysis comparing cardiac imaging methods directly to FFR, MRI had the highest performance for diagnosis of ischaemia-causing CAD, with lower performance for SPECT and SE. Anatomic methods of CCTA and ICA yielded lower specificity, with functional assessment of coronary atherosclerosis by SE, SPECT, and FFRCT improving accuracy.

10 Review Beyond Stenosis With Fractional Flow Reserve Via Computed Tomography and Advanced Plaque Analyses for the Diagnosis of Lesion-Specific Ischemia. 2016

Cheruvu, Chaitu / Naoum, Christopher / Blanke, Philipp / Norgaard, Bjarne / Leipsic, Jonathon. ·Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada. · Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark. · Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: jleipsic@providencehealth.bc.ca. ·Can J Cardiol · Pubmed #27032888.

ABSTRACT: In the treatment of stable coronary artery disease (CAD), the determination of stenosis severity by invasive coronary angiography (ICA) is a critical procedure, and for borderline lesions, the detection of ischemia through invasive fractional flow reserve (FFR) is the gold standard. With advances in computational fluid dynamics, FFR can now be calculated noninvasively using anatomic data from coronary computed tomographic angiography (CCTA). This technique is known as FFR

11 Review Coronary Computed Tomography Angiography Derived Fractional Flow Reserve and Plaque Stress. 2016

Nørgaard, Bjarne Linde / Leipsic, Jonathon / Koo, Bon-Kwon / Zarins, Christopher K / Jensen, Jesper Møller / Sand, Niels Peter / Taylor, Charles A. ·Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark. · Department of Radiology and Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, Canada. · Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. · Heart Flow, Inc., Redwood City, CA USA ; Department of Surgery, Stanford University, Stanford, CA USA. · Department of Cardiology, Hospital of South West Denmark, Esbjerg, Denmark ; Institute of Regional Health Services Research, University of Southern Denmark, Odense M, Denmark. · Heart Flow, Inc., Redwood City, CA USA ; Department of Bioengineering, Stanford University, Stanford, CA USA. ·Curr Cardiovasc Imaging Rep · Pubmed #26941886.

ABSTRACT: Fractional flow reserve (FFR) measured during invasive coronary angiography is an independent prognosticator in patients with coronary artery disease and the gold standard for decision making in coronary revascularization. The integration of computational fluid dynamics and quantitative anatomic and physiologic modeling now enables simulation of patient-specific hemodynamic parameters including blood velocity, pressure, pressure gradients, and FFR from standard acquired coronary computed tomography (CT) datasets. In this review article, we describe the potential impact on clinical practice and the science behind noninvasive coronary computed tomography (CT) angiography derived fractional flow reserve (FFR

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

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

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

13 Review Fractional flow reserve derived from coronary CT angiography in stable coronary disease: a new standard in non-invasive testing? 2015

Nørgaard, B L / Jensen, J M / Leipsic, J. ·Department of Cardiology B, Aarhus University Hospital Skejby, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark, bnorgaard@dadlnet.dk. ·Eur Radiol · Pubmed #25680721.

ABSTRACT: Fractional flow reserve (FFR) measured during invasive coronary angiography is the gold standard for lesion-specific decisions on coronary revascularization in patients with stable coronary artery disease (CAD). Current guidelines recommend non-invasive functional or anatomic testing as a gatekeeper to the catheterization laboratory. However, the "holy grail" in non-invasive testing of CAD is to establish a single test that quantifies both coronary lesion severity and the associated ischemia. Most evidence to date of such a test is based on the addition of computational analysis of FFR to the anatomic information obtained from standard-acquired coronary CTA data sets at rest (FFRCT). This review summarizes the clinical evidence for the use of FFRCT in stable CAD in context to the diagnostic performance of other non-invasive testing modalities. Key Points • The process of selecting appropriate patients for invasive coronary angiography is inadequate • Invasive fractional flow reserve is the standard for assessing coronary lesion-specific ischemia • Fractional flow reserve may be derived from standard coronary CT angiography (FFR CT ) • FFR CT provides high diagnostic performance in stable coronary artery disease.

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

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

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

15 Clinical Trial CT-based total vessel plaque analyses improves prediction of hemodynamic significance lesions as assessed by fractional flow reserve in patients with stable angina pectoris. 2018

Øvrehus, Kristian A / Gaur, Sara / Leipsic, Jonathon / Jensen, Jesper M / Dey, Damini / Bøtker, Hans E / Ahmadi, Amir / Achenbach, Stephan / Ko, Brian / Nørgaard, Bjarne L. ·Department of Cardiology, Odense University Hospital, Odense, Denmark. Electronic address: kristian.altern.ovrehus@rsyd.dk. · Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. · Department of Radiology, St. Paul's Hospital, Vancouver, BC, Canada. · Cedars-Sinai Medical Center, Los Angeles, CA, USA. · Icahn School of Medicine at Mount Sinai, New York, NY, USA. · Department of Cardiology, Friedrich-Alexander University of Erlangen, Germany. · Monash Heart, Monash Medical Center and Monash University, Victoria, Australia. ·J Cardiovasc Comput Tomogr · Pubmed #29866619.

ABSTRACT: BACKGROUND: Coronary stenosis and plaque evaluation by coronary computed tomography angiography (CTA) may contribute to identify hemodynamically relevant lesions. We evaluated the most stenotic lesion including plaques proximal to it versus a total vessel analyses combined with stenosis for ischemia. METHODS: Patients scheduled for clinically indicated invasive coronary angiography (ICA) for suspected coronary artery disease underwent coronary CTA and ICA including fractional flow reserve (FFR) as part of the NXT trial (clinicaltrials.govNCT01757678). Stenoses were visually graded ≤50%, 51-70%, and >70% on coronary CTA. Semi-automated plaque analyses were performed using a proximal to the FFR pressure sensor location (including the most severe lesion to the coronary ostium) versus a total vessel (vessel diameter ≥2 mm) approach. Coronary stenosis and plaque parameters were evaluated for discrimination of ischemia by logistic regressions and combined models analyzed using receiver operating characteristics (ROC) with invasive FFR≤ 0.80 as reference standard. RESULTS: In 254 patients, mean (±SD) age 64 (±10) years, 64% male, a coronary CTA stenosis >50% was present in 239 (49%) vessels. Invasive FFR was ≤0.80 in 100 (21%) vessels. Coronary stenosis severity and low-density non-calcified plaque (LD-NCP) volume were independent predictors of ischemia in the "proximal" and "total-vessel" analyses. Stenosis severity + total vessel LD-NCP assessment performed better than stenosis severity + proximal LD-NCP evaluation (Area under curve [AUC] (95%CI): 0.83 (0.78-0.87) vs 0.81 (0.76-0.86), p-value = 0.009), whereas stenosis severity + proximal LD-NCP performed better than stenosis alone (AUC (95%CI): 0.81 (0.76-0.86) vs 0.78 (0.73-0.83), p-value = 0.019). CONCLUSION: Adding total vessel high-risk plaque volume to stenosis severity improves discrimination of ischemia in coronary CTA performed in patients with stable angina pectoris.

16 Clinical Trial Integrated prediction of lesion-specific ischaemia from quantitative coronary CT angiography using machine learning: a multicentre study. 2018

Dey, Damini / Gaur, Sara / Ovrehus, Kristian A / Slomka, Piotr J / Betancur, Julian / Goeller, Markus / Hell, Michaela M / Gransar, Heidi / Berman, Daniel S / Achenbach, Stephan / Botker, Hans Erik / Jensen, Jesper Moller / Lassen, Jens Flensted / Norgaard, Bjarne Linde. ·Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Taper building, A238, 8700 Beverly Blvd, Los Angeles, 90048, USA. Damini.Dey@cshs.org. · Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. · Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA. · Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Taper building, A238, 8700 Beverly Blvd, Los Angeles, 90048, USA. · Department of Cardiology, Friedrich-Alexander Universitat Erlangen-Nurnberg, Erlangen, Germany. ·Eur Radiol · Pubmed #29352380.

ABSTRACT: OBJECTIVES: We aimed to investigate if lesion-specific ischaemia by invasive fractional flow reserve (FFR) can be predicted by an integrated machine learning (ML) ischaemia risk score from quantitative plaque measures from coronary computed tomography angiography (CTA). METHODS: In a multicentre trial of 254 patients, CTA and invasive coronary angiography were performed, with FFR in 484 vessels. CTA data sets were analysed by semi-automated software to quantify stenosis and non-calcified (NCP), low-density NCP (LD-NCP, < 30 HU), calcified and total plaque volumes, contrast density difference (CDD, maximum difference in luminal attenuation per unit area) and plaque length. ML integration included automated feature selection and model building from quantitative CTA with a boosted ensemble algorithm, and tenfold stratified cross-validation. RESULTS: Eighty patients had ischaemia by FFR (FFR ≤ 0.80) in 100 vessels. Information gain for predicting ischaemia was highest for CDD (0.172), followed by LD-NCP (0.125), NCP (0.097), and total plaque volumes (0.092). ML exhibited higher area-under-the-curve (0.84) than individual CTA measures, including stenosis (0.76), LD-NCP volume (0.77), total plaque volume (0.74) and pre-test likelihood of coronary artery disease (CAD) (0.63); p < 0.006. CONCLUSIONS: Integrated ML ischaemia risk score improved the prediction of lesion-specific ischaemia by invasive FFR, over stenosis, plaque measures and pre-test likelihood of CAD. KEY POINTS: • Integrated ischaemia risk score improved prediction of ischaemia over quantitative plaque measures • Integrated ischaemia risk score showed higher prediction of ischaemia than standard approach • Contrast density difference had the highest information gain to identify lesion-specific ischaemia.

17 Clinical Trial Effect of the ratio of coronary arterial lumen volume to left ventricle myocardial mass derived from coronary CT angiography on fractional flow reserve. 2017

Taylor, Charles A / Gaur, Sara / Leipsic, Jonathon / Achenbach, Stephan / Berman, Daniel S / Jensen, Jesper M / Dey, Damini / Bøtker, Hans Erik / Kim, Hyun Jin / Khem, Sophie / Wilk, Alan / Zarins, Christopher K / Bezerra, Hiram / Lesser, John / Ko, Brian / Narula, Jagat / Ahmadi, Amir / Øvrehus, Kristian A / St Goar, Fred / De Bruyne, Bernard / Nørgaard, Bjarne L. ·HeartFlow, Inc., Redwood City, CA, USA; Department of Bioengineering, Stanford University, Stanford, CA, USA. Electronic address: ctaylor@heartflow.com. · Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark. · Department of Radiology and Division of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada. · Department of Cardiology, Erlangen, Germany. · Department of Cardiology, Cedars Sinai Hospital, Los Angeles, CA, USA. · HeartFlow, Inc., Redwood City, CA, USA. · Department of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland, Ohio, USA. · Minneapolis Heart Institute, Minneapolis, MN, USA. · Monash Heart, Monash Medical Center and Monash University, Victoria, Australia. · Department of Cardiology, Mount Sinai Hospital, New York, NY, USA. · Department of Cardiology, El Camino Hospital, Mountain View, CA, USA. · Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium. ·J Cardiovasc Comput Tomogr · Pubmed #28789941.

ABSTRACT: BACKGROUND: We hypothesize that in patients with suspected coronary artery disease (CAD), lower values of the ratio of total epicardial coronary arterial lumen volume to left ventricular myocardial mass (V/M) result in lower fractional flow reserve (FFR). METHODS: V/M was computed in 238 patients from the NXT trial who underwent coronary computed tomography angiography (CTA), quantitative coronary angiography (QCA) and FFR measurement in 438 vessels. Nitroglycerin was administered prior to CT, QCA and FFR acquisition. The V/M ratio was quantified on a patient-level from CT image data by segmenting the epicardial coronary arterial lumen volume (V) and the left ventricular myocardial mass (M). Calcified and noncalcified plaque volumes were quantified using semi-automated software. RESULTS: The median value of V/M (18.57 mm CONCLUSIONS: Patients with a low V/M ratio have lower FFR overall and in non-obstructive CAD, independent of plaque measures.

18 Clinical Trial Quality-of-Life and Economic Outcomes of Assessing Fractional Flow Reserve With Computed Tomography Angiography: PLATFORM. 2015

Hlatky, Mark A / De Bruyne, Bernard / Pontone, Gianluca / Patel, Manesh R / Norgaard, Bjarne L / Byrne, Robert A / Curzen, Nick / Purcell, Ian / Gutberlet, Matthias / Rioufol, Gilles / Hink, Ulrich / Schuchlenz, Herwig Walter / Feuchtner, Gudrun / Gilard, Martine / Andreini, Daniele / Jensen, Jesper M / Hadamitzky, Martin / Wilk, Alan / Wang, Furong / Rogers, Campbell / Douglas, Pamela S / Anonymous7530845. ·Department of Health Research and Policy and Department of Medicine, Stanford University School of Medicine, Stanford, California. Electronic address: hlatky@stanford.edu. · Cardiovascular Center Aalst, Aalst, Belgium. · Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy. · Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina. · Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark. · Deutsches Herzzentrum München, Technische Universität München, Munich, Germany. · University Hospital Southampton NHS Trust, Southampton, United Kingdom. · Freeman Hospital, Newcastle upon Tyne, United Kingdom. · University of Leipzig Heart Centre, Leipzig, Germany. · Hospices Civils de Lyon and Laboratoire de Recherche en Cardiovasculaire, Métabolisme, Diabétologie et Nutrition, Institut National de la Santé et de la Recherche Médicale, Lyon, France. · Cardiology Department, Johannes Gutenberg University Hospital, Mainz, Germany. · LKH Graz West, Graz, Austria. · Department of Radiology, Innsbruck Medical University, Innsbruck, Austria. · Department of Cardiology, Cavale Blanche Hospital, Brest, France. · HeartFlow, Inc., Redwood City, California. ·J Am Coll Cardiol · Pubmed #26475205.

ABSTRACT: BACKGROUND: Fractional flow reserve estimated using computed tomography (FFRCT) might improve evaluation of patients with chest pain. OBJECTIVES: The authors sought to determine the effect on cost and quality of life (QOL) of using FFRCT instead of usual care to evaluate stable patients with symptoms suspicious for coronary disease. METHODS: Symptomatic patients without known coronary disease were enrolled into 2 strata based on whether invasive or noninvasive diagnostic testing was planned. In each stratum, consecutive observational cohorts were evaluated with either usual care or FFRCT. The number of diagnostic tests, invasive procedures, hospitalizations, and medications during 90-day follow-up were multiplied by U.S. cost weights and summed to derive total medical costs. Changes in QOL from baseline to 90 days were assessed using the Seattle Angina Questionnaire, the EuroQOL, and a visual analog scale. RESULTS: In the 584 patients, 74% had atypical angina, and the pre-test probability of coronary disease was 49%. In the planned invasive stratum, mean costs were 32% lower among the FFRCT patients than among the usual care patients ($7,343 vs. $10,734 p < 0.0001). In the noninvasive stratum, mean costs were not significantly different between the FFRCT patients and the usual care patients ($2,679 vs. $2,137; p = 0.26). In a sensitivity analysis, when the cost weight of FFRCT was set to 7 times that of computed tomography angiography, the FFRCT group still had lower costs than the usual care group in the invasive testing stratum ($8,619 vs. $ 10,734; p < 0.0001), whereas in the noninvasive testing stratum, when the cost weight of FFRCT was set to one-half that of computed tomography angiography, the FFRCT group had higher costs than the usual care group ($2,766 vs. $2,137; p = 0.02). Each QOL score improved in the overall study population (p < 0.0001). In the noninvasive stratum, QOL scores improved more in FFRCT patients than in usual care patients: Seattle Angina Questionnaire 19.5 versus 11.4, p = 0.003; EuroQOL 0.08 versus 0.03, p = 0.002; and visual analog scale 4.1 versus 2.3, p = 0.82. In the invasive cohort, the improvements in QOL were similar in the FFRCT and usual care patients. CONCLUSIONS: An evaluation strategy based on FFRCT was associated with less resource use and lower costs within 90 days than evaluation with invasive coronary angiography. Evaluation with FFRCT was associated with greater improvement in quality of life than evaluation with usual noninvasive testing. (Prospective Longitudinal Trial of FFRCT: Outcomes and Resource Impacts [PLATFORM]; NCT01943903).

19 Clinical Trial Influence of Coronary Calcification on the Diagnostic Performance of CT Angiography Derived FFR in Coronary Artery Disease: A Substudy of the NXT Trial. 2015

Nørgaard, Bjarne L / Gaur, Sara / Leipsic, Jonathon / Ito, Hiroshi / Miyoshi, Toru / Park, Seung-Jung / Zvaigzne, Ligita / Tzemos, Nikolaos / Jensen, Jesper M / Hansson, Nicolaj / Ko, Brian / Bezerra, Hiram / Christiansen, Evald H / Kaltoft, Anne / Lassen, Jens F / Bøtker, Hans Erik / Achenbach, Stephan. ·Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark. Electronic address: bnorgaard@dadlnet.dk. · Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark. · Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. · Department of Cardiology, Okayama University Hospital, Okayama, Japan. · Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea. · Diagnostic Institute of Radiology, Paul Stradins Clinical University Hospital, Riga, Latvia. · Department of Radiology, Golden Jubilee Hospital, Glasgow, Scotland. · MonashHeart, Monash Medical Center and Monash University, Victoria, Australia. · Department of Cardiology, Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio. · Department of Cardiology, Erlangen University Hospital, Erlangen, Germany. ·JACC Cardiovasc Imaging · Pubmed #26298072.

ABSTRACT: OBJECTIVES: The goal of this study was to examine the diagnostic performance of noninvasive fractional flow reserve (FFR) derived from coronary computed tomography angiography (CTA) (FFRCT) in relation to coronary calcification severity. BACKGROUND: FFRCT has shown promising results in identifying lesion-specific ischemia. The extent to which the severity of coronary calcification affects the diagnostic performance of FFRCT is not known. METHODS: Coronary calcification was assessed by using the Agatston score (AS) in 214 patients suspected of having coronary artery disease who underwent coronary CTA, FFRCT, and FFR (FFR examination was performed in 333 vessels). The diagnostic performance of FFRCT (≤0.80) in identifying vessel-specific ischemia (FFR ≤0.80) was investigated across AS quartiles (Q1 to Q4) and for discrimination of ischemia in patients and vessels with a low-mid AS (Q1 to Q3) versus a high AS (Q4). Coronary CTA stenosis was defined as lumen reduction >50%. RESULTS: Mean ± SD per-patient and per-vessel AS were 302 ± 468 (range 0 to 3,599) and 95 ± 172 (range 0 to 1,703), respectively. There was no statistical difference in diagnostic accuracy, sensitivity, or specificity of FFRCT across AS quartiles. Discrimination of ischemia by FFRCT was high in patients with a high AS (416 to 3,599) and a low-mid AS (0 to 415), with no difference in area under the receiver-operating characteristic curve (AUC) (0.86 [95% confidence interval (CI): 0.76 to 0.96] vs. 0.92 [95% CI: 0.88 to 0.96]) (p = 0.45). Similarly, discrimination of ischemia by FFRCT was high in vessels with a high AS (121 to 1,703) and a low-mid AS (0 to 120) (AUC: 0.91 [95% CI: 0.85 to 0.97] vs. 0.95 [95% CI: 0.91 to 0.98]; p = 0.65). Diagnostic accuracy and specificity of FFRCT were significantly higher than for stenosis assessment in each AS quartile at the per-patient (p < 0.001) and per-vessel (p < 0.05) level with similar sensitivity. In vessels with a high AS, FFRCT exhibited improved discrimination of ischemia compared with coronary CTA alone (AUC: 0.91 vs. 0.71; p = 0.004), whereas on a per-patient level, the difference did not reach statistical significance (AUC: 0.86 vs. 0.72; p = 0.09). CONCLUSIONS: FFRCT provided high and superior diagnostic performance compared with coronary CTA interpretation alone in patients and vessels with a high AS.

20 Clinical Trial Non-invasive computed fractional flow reserve from computed tomography (CT) for diagnosing coronary artery disease – Japanese results from NXT trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps). 2015

Miyoshi, Toru / Osawa, Kazuhiro / Ito, Hiroshi / Kanazawa, Susumu / Kimura, Takeshi / Shiomi, Hiroki / Kuribayashi, Sachio / Jinzaki, Masahiro / Kawamura, Akio / Bezerra, Hiram / Achenbach, Stephan / Nørgaard, Bjarne L. ·Department of Cardiovascular Medicine, Okayama University Hospital, Japan. miyoshit@cc.okayama-u.ac.jp ·Circ J · Pubmed #25452201.

ABSTRACT: BACKGROUND: Recently, a non-invasive method using computational fluid dynamics to calculate vessel-specific fractional flow reserve (FFRCT) from routinely acquired coronary computed tomography angiography (CTA) was described. The Analysis of Coronary Blood Flow Using CT Angiography: Next Steps (NXT) trial, which was a prospective, multicenter trial including 254 patients with suspected coronary artery disease, noted high diagnostic performance of FFRCT compared with invasive FFR. The aim of this post-hoc analysis was to assess the diagnostic performance of non-invasive FFRCT vs. standard stenosis quantification on coronary CTA in the Japanese subset of the NXT trial. METHODS AND RESULTS: A total of 57 Japanese participants were included from Okayama University (n=36), Kyoto University (n=17), and Keio University (n=4) Hospitals. Per-patient diagnostic accuracy of FFRCT(74%; 95% confidence interval [CI]: 60-85%) was higher than for coronary CTA (47%; 95% CI: 34-61%, P<0.001) arising from improved specificity (63% vs. 27%, P<0.001). FFRCT correctly reclassified 53% of patients and 63% of vessels with coronary CTA false positives as true negatives. When patients with Agatston score >1,000 were excluded, per-patient accuracy of FFRCT was 83% with a high specificity of 76%, similar to the overall NXT trial findings. CONCLUSIONS: FFRCT has high diagnostic performance compared with invasive FFR in the Japanese subset of patients in the NXT trial.

21 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 / Anonymous4730783. ·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).

22 Clinical Trial Rationale and design of the HeartFlowNXT (HeartFlow analysis of coronary blood flow using CT angiography: NeXt sTeps) study. 2013

Gaur, Sara / Achenbach, Stephan / Leipsic, Jonathon / Mauri, Laura / Bezerra, Hiram G / Jensen, Jesper Møller / Bøtker, Hans Erik / Lassen, Jens Flensted / Nørgaard, Bjarne Linde. ·Department of Cardiology, Aarhus University Hospital, Brendstrupgaardsvej 100, 8200 Aarhus N, Skejby, Denmark. Electronic address: sargau@rm.dk. ·J Cardiovasc Comput Tomogr · Pubmed #24268114.

ABSTRACT: INTRODUCTION: Coronary CT angiography (CTA) is an established noninvasive method for visualization of coronary artery disease. However, coronary CTA lacks physiological information; thus, it does not permit differentiation of ischemia-causing lesions. Recent advances in computational fluid dynamic techniques applied to standard coronary CTA images allow for computation of fractional flow reserve (FFR), a measure of lesion-specific ischemia. The diagnostic performance of computed FFR (FFRCT) compared with invasively measured FFR is not yet fully established. METHODS/DESIGN: HeartFlowNXT (HeartFlow analysis of coronary blood flow using coronary CT angiography: NeXt sTeps) is a prospective, international, multicenter study designed to evaluate the diagnostic performance of FFRCT for the detection and exclusion of flow-limiting obstructive coronary stenoses, as defined by invasively measured FFR as the reference standard. FFR values ≤ 0.80 will be considered to be ischemia causing. All subjects (N = 270; 10 investigative sites) will undergo coronary CTA (single- or dual-source CT scanners with a minimum of 64 slices) and invasive coronary angiography with FFR. Patients with insufficient quality of coronary CTA will be excluded. Blinded core laboratory interpretation will be performed for FFRCT, invasive coronary angiography, and FFR. Stenosis severity by coronary CTA will be evaluated by the investigative site in addition to a blinded core laboratory interpretation. The primary objective of the study is to determine the diagnostic performance of FFRCT compared with coronary CTA alone to noninvasively determine the presence of hemodynamically significant coronary lesions. The secondary end point comprises assessment of diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of FFRCT.

23 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.

24 Article Risk stratification by assessment of coronary artery disease using coronary computed tomography angiography in diabetes and non-diabetes patients: a study from the Western Denmark Cardiac Computed Tomography Registry. 2019

Olesen, Kevin K W / Riis, Anders H / Nielsen, Lene H / Steffensen, Flemming H / Nørgaard, Bjarne L / Jensen, Jesper M / Poulsen, Per L / Thim, Troels / Bøtker, Hans Erik / Sørensen, Henrik T / Maeng, Michael. ·Department of Cardiology, Aarhus University Hospital, Palle Juel Jensens Boulevard 99, Aarhus, Denmark. · Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Alle 43-45, Aarhus, Denmark. · Department of Cardiology, Lillebaelt Hospital, Beriderbakken 4, Vejle, Denmark. · Departments of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus, Denmark. ·Eur Heart J Cardiovasc Imaging · Pubmed #31220229.

ABSTRACT: AIMS: We examined whether severity of coronary artery disease (CAD) measured by coronary computed tomography angiography can be used to predict rates of myocardial infarction (MI) and death in patients with and without diabetes. METHODS AND RESULTS: A cohort study of consecutive patients (n = 48 731) registered in the Western Denmark Cardiac Computed Tomography Registry from 2008 to 2016. Patients were stratified by diabetes status and CAD severity (no, non-obstructive, or obstructive). Endpoints were MI and death. Event rates per 1000 person-years, unadjusted and adjusted incidence rate ratios were computed. Median follow-up was 3.6 years. Among non-diabetes patients, MI event rates per 1000 person-years were 1.4 for no CAD, 4.1 for non-obstructive CAD, and 9.1 for obstructive CAD. Among diabetes patients, the corresponding rates were 2.1 for no CAD, 4.8 for non-obstructive CAD, and 12.6 for obstructive CAD. Non-diabetes and diabetes patients without CAD had similar low rates of MI [adjusted incidence rate ratio 1.40, 95% confidence interval (CI): 0.71-2.78]. Among diabetes patients, the adjusted risk of MI increased with severity of CAD (no CAD: reference; non-obstructive CAD: adjusted incidence rate ratio 1.71, 95% CI: 0.79-3.68; obstructive CAD: adjusted incidence rate ratio 4.42, 95% CI: 2.14-9.17). Diabetes patients had higher death rates than non-diabetes patients, irrespective of CAD severity. CONCLUSION: In patients without CAD, diabetes patients have a low risk of MI similar to non-diabetes patients. Further, MI rates increase with CAD severity in both diabetes and non-diabetes patients; with diabetes patients with obstructive CAD having the highest risk of MI.

25 Article Diagnosis of obstructive coronary artery disease using computed tomography angiography in patients with stable chest pain depending on clinical probability and in clinically important subgroups: meta-analysis of individual patient data. 2019

Haase, Robert / Schlattmann, Peter / Gueret, Pascal / Andreini, Daniele / Pontone, Gianluca / Alkadhi, Hatem / Hausleiter, Jörg / Garcia, Mario J / Leschka, Sebastian / Meijboom, Willem B / Zimmermann, Elke / Gerber, Bernhard / Schoepf, U Joseph / Shabestari, Abbas A / Nørgaard, Bjarne L / Meijs, Matthijs F L / Sato, Akira / Ovrehus, Kristian A / Diederichsen, Axel C P / Jenkins, Shona M M / Knuuti, Juhani / Hamdan, Ashraf / Halvorsen, Bjørn A / Mendoza-Rodriguez, Vladimir / Rochitte, Carlos E / Rixe, Johannes / Wan, Yung Liang / Langer, Christoph / Bettencourt, Nuno / Martuscelli, Eugenio / Ghostine, Said / Buechel, Ronny R / Nikolaou, Konstantin / Mickley, Hans / Yang, Lin / Zhang, Zhaqoi / Chen, Marcus Y / Halon, David A / Rief, Matthias / Sun, Kai / Hirt-Moch, Beatrice / Niinuma, Hiroyuki / Marcus, Roy P / Muraglia, Simone / Jakamy, Réda / Chow, Benjamin J / Kaufmann, Philipp A / Tardif, Jean-Claude / Nomura, Cesar / Kofoed, Klaus F / Laissy, Jean-Pierre / Arbab-Zadeh, Armin / Kitagawa, Kakuya / Laham, Roger / Jinzaki, Masahiro / Hoe, John / Rybicki, Frank J / Scholte, Arthur / Paul, Narinder / Tan, Swee Y / Yoshioka, Kunihiro / Röhle, Robert / Schuetz, Georg M / Schueler, Sabine / Coenen, Maria H / Wieske, Viktoria / Achenbach, Stephan / Budoff, Matthew J / Laule, Michael / Newby, David E / Dewey, Marc / Anonymous4951133. ·Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany. · Institute of Medical Statistics, Computer Sciences and Data Science, University Hospital of Friedrich Schiller University Jena, Jena, Germany. · Department of Cardiology, Henri Mondor Hospital, University Paris Est Créteil, Créteil, France. · Department of Cardiology and Radiology, Centro Cardiologico Monzino IRCCS, University of Milan, Milan, Italy. · Centro Cardiologico Monzino, IRCCS, Milan, Italy. · Department of Radiology, University Hospital Zurich, Zurich, Switzerland. · Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität München, Munich, Germany. · Department of Cardiology, Montefiore, University Hospital for the Albert Einstein College of Medicine, NY, USA. · Department of Radiology, Kantonsspital St Gallen, St Gallen, Switzerland. · Department of Cardiology, Erasmus University Medical Centre, Rotterdam, Netherlands. · Department of Cardiology, Clinique Universitaire St Luc, Institut de Recherche Clinique et Expérimentale, Brussels, Belgium. · Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA. · Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. · Department of Cardiology, Aarhus Universtity Hostipal, Aarhus, Denmark. · Department of Cardiology, University Medical Centre Utrecht, Utrecht, Netherlands. · Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. · Department of Cardiology, Odense University Hospital, Odense, Denmark. · Department of Cardiology, Glasgow Royal Infirmary and Stobhill Hospital, Glasgow, UK. · Turku University Hospital and University of Turku, Turku, Finland. · Department of Cardiovascular Imaging, Department of Cardiology, Rabin Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. · Medical Department, Ostfold Hospital Trust, Grålum, Norway. · Department of Cardiology, National Institute of Cardiology and Cardiovascular Surgery, Havana, Cuba. · Heart Institute, InCor, University of São Paulo Medical School, São Paulo, Brazil. · Department of Cardiology, Kerckhoff Heart Centre, Bad Nauheim, Germany. · Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Chang Gung Memorial Hospital at Linkou, Taoyaun City, Taiwan. · Heart and Diabetes Center NRW in Bad Oeynhausen, University Clinic of the Ruhr-University Bochum, Bochum, Germany. · Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal. · Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy. · Department of Cardiology, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France. · Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland. · Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany. · Department of Radiology, Beijing Anzhen Hospital, Beijing, China. · National Heart and Blood Institute, National Institutes of Health, Bethesda, MD, USA. · Cardiovascular Clinical Research Unit, Lady Davis Carmel Medical Center, Haifa, Israel. · Department of Radiology, Baotou Central Hospital, Inner Mongolia Province, China. · St Luke's International Hospital, Tokyo, Japan. · Department of Cardiology, S Chiara Hospital, Trento, Italy. · Department of Cardiology, University Hospital Pitié-Salpêtrière, Paris, France. · University of Ottawa, Heart Institute, Ottawa, Ontario, Canada. · Montreal Heart Institute, Université de Montréal, Montréal, Canada. · Albert Einstein Hospital, São Paulo, Brazil. · The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. · Department of Diagnostic Imaging and Interventional Radiology, Bichat University Hospital, Paris, France. · Division of Cardiology, Johns Hopkins Hospital, Johns Hopkins University, Baltimore, MD, USA. · Mie University Hospital, Tsu, Japan. · BIDMC/Harvard Medical School, Department of Cardiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA. · Department of Radiology, Keio University Hospital, Tokyo, Japan. · Department of Radiology, Mount Elizabeth Hospital, Singapore. · Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada. · Department of Cardiology, Leiden University Medical Centre, Leiden, Netherlands. · Department of Medical Imaging, Western University, London, Ontario, Canada. · National Heart Centre, Singapore, Singapore. · Iwate Medical University, Morioka, Japan. · Department of Cardiology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany. · University of California Los Angeles, Los Angeles, CA, USA. · British Heart Foundation, University of Edinburgh, Edinburgh, UK. · Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany dewey@charite.de. ·BMJ · Pubmed #31189617.

ABSTRACT: OBJECTIVE: To determine whether coronary computed tomography angiography (CTA) should be performed in patients with any clinical probability of coronary artery disease (CAD), and whether the diagnostic performance differs between subgroups of patients. DESIGN: Prospectively designed meta-analysis of individual patient data from prospective diagnostic accuracy studies. DATA SOURCES: Medline, Embase, and Web of Science for published studies. Unpublished studies were identified via direct contact with participating investigators. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Prospective diagnostic accuracy studies that compared coronary CTA with coronary angiography as the reference standard, using at least a 50% diameter reduction as a cutoff value for obstructive CAD. All patients needed to have a clinical indication for coronary angiography due to suspected CAD, and both tests had to be performed in all patients. Results had to be provided using 2×2 or 3×2 cross tabulations for the comparison of CTA with coronary angiography. Primary outcomes were the positive and negative predictive values of CTA as a function of clinical pretest probability of obstructive CAD, analysed by a generalised linear mixed model; calculations were performed including and excluding non-diagnostic CTA results. The no-treat/treat threshold model was used to determine the range of appropriate pretest probabilities for CTA. The threshold model was based on obtained post-test probabilities of less than 15% in case of negative CTA and above 50% in case of positive CTA. Sex, angina pectoris type, age, and number of computed tomography detector rows were used as clinical variables to analyse the diagnostic performance in relevant subgroups. RESULTS: Individual patient data from 5332 patients from 65 prospective diagnostic accuracy studies were retrieved. For a pretest probability range of 7-67%, the treat threshold of more than 50% and the no-treat threshold of less than 15% post-test probability were obtained using CTA. At a pretest probability of 7%, the positive predictive value of CTA was 50.9% (95% confidence interval 43.3% to 57.7%) and the negative predictive value of CTA was 97.8% (96.4% to 98.7%); corresponding values at a pretest probability of 67% were 82.7% (78.3% to 86.2%) and 85.0% (80.2% to 88.9%), respectively. The overall sensitivity of CTA was 95.2% (92.6% to 96.9%) and the specificity was 79.2% (74.9% to 82.9%). CTA using more than 64 detector rows was associated with a higher empirical sensitivity than CTA using up to 64 rows (93.4% CONCLUSIONS: In a no-treat/treat threshold model, the diagnosis of obstructive CAD using coronary CTA in patients with stable chest pain was most accurate when the clinical pretest probability was between 7% and 67%. Performance of CTA was not influenced by the angina pectoris type and was slightly higher in men and lower in older patients. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42012002780.

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