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Coronary Artery Disease: HELP
Articles by Arthur J. H. A. Scholte
Based on 46 articles published since 2008
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Between 2008 and 2019, A. Scholte wrote the following 46 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Editorial Cardiac risk assessment in asymptomatic diabetes: combining [corrected] different imaging modalities and surrogate markers? 2011

Scholte, Arthur J H A. · ·J Nucl Cardiol · Pubmed #21448761.

ABSTRACT: -- No abstract --

2 Editorial Positron emission tomography; viable tool in patients pre-CABG? 2010

van der Wall, E E / Siebelink, H M / Scholte, A J / Bax, J J. · ·Int J Cardiovasc Imaging · Pubmed #20358291.

ABSTRACT: -- No abstract --

3 Review Function and anatomy: SPECT-MPI and MSCT coronary angiography. 2010

Scholte, Arthur J H A / Roos, Cornelis J / van Werkhoven, Jacob M. ·Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. a.j.h.a.scholte@lumc.nl ·EuroIntervention · Pubmed #20542836.

ABSTRACT: For the diagnosis of coronary artery disease (CAD), non-invasive cardiac imaging is indispensable. Myocardial perfusion imaging (MPI) by single photon emission computed tomography (SPECT) investigates the pathophysiological consequences of luminal obstructive CAD, while multislice computed tomography coronary angiography (CTA) indicates the presence, extent and location of coronary atherosclerosis. The integration of CTA and SPECT data may provide important information which may be useful for patient management. In this manuscript the value of both techniques will be described. In addition, the feasibility and potential value of combined anatomic and functional imaging will be discussed.

4 Clinical Trial Screening for coronary artery disease after mediastinal irradiation in Hodgkin lymphoma survivors: phase II study of indication and acceptance†. 2014

Daniëls, L A / Krol, A D G / de Graaf, M A / Scholte, A J H A / Van't Veer, M B / Putter, H / de Roos, A / Schalij, M J / Creutzberg, C L. ·Department of Clinical Oncology l.a.daniels@lumc.nl. · Department of Clinical Oncology. · Department of Cardiology The Interuniversity Cardiology Institute of The Netherlands, Utrecht, The Netherlands. · Department of Cardiology. · Department of Hematology. · Department of Medical Statistics and Bio-informatics. · Radiology, Leiden University Medical Center, Leiden. ·Ann Oncol · Pubmed #24692582.

ABSTRACT: BACKGROUND: Cardiovascular diseases are the most common nonmalignant cause of death in Hodgkin lymphoma (HL) survivors, especially after mediastinal irradiation. We investigated the role of computed tomographic coronary angiography (CTA) as a screening tool for coronary artery disease (CAD) in asymptomatic HL survivors, and related CTA findings to exercise testing and subsequent interventions. PATIENTS AND METHODS: Patients were eligible for this phase II study if at least 10 years disease-free and treated with mediastinal radiotherapy. Screening consisted of electrocardiogram, exercise testing and CTA. Primary end point was significant CAD (stenosis >50%) on CTA. CTA screening was considered to be indicated for testing in a larger population if ≥6 of 50 CTA scanned patients (12%) would need revascularization. Screening was evaluated with a questionnaire before and after screening. RESULTS: Fifty-two patients were included, and 48 patients underwent CTA. Median age was 47 years, time since HL diagnosis 21 years. There were 45 evaluable scans. Significant CAD on CTA was found in 20% (N = 9), significantly increased compared with the 7% expected abnormalities (P = 0.01, 95% confidence interval 8.3% to 31.7%). In 11% (N = 5), significant stenosis was confirmed at coronary angiography, and revascularization was carried out. Additionally, two patients were treated with optimal medical therapy. Ninety percent of patients were content with screening, regardless whether the CTA showed abnormalities. CONCLUSIONS: Prevalence of significant CAD among HL survivors is high, while asymptomatic even in the presence of life-threatening CAD. This might justify screening by CTA in asymptomatic HL survivors who had mediastinal radiotherapy, but needs to be evaluated in a larger cohort. The trial protocol was approved by the Ethics Committee of the LUMC and registered with ClinicalTrials.gov, NCT01271127.

5 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 / Anonymous721272. ·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.

6 Article Noninvasive CT-based hemodynamic assessment of coronary lesions derived from fast computational analysis: a comparison against fractional flow reserve. 2019

Siogkas, Panagiotis K / Anagnostopoulos, Constantinos D / Liga, Riccardo / Exarchos, Themis P / Sakellarios, Antonis I / Rigas, George / Scholte, Arthur J H A / Papafaklis, M I / Loggitsi, Dimitra / Pelosi, Gualtiero / Parodi, Oberdan / Maaniitty, Teemu / Michalis, Lampros K / Knuuti, Juhani / Neglia, Danilo / Fotiadis, Dimitrios I. ·Unit of Medical Technology and Intelligent Information Systems, Dept. of Materials Science and Engineering, University of Ioannina, Ioannina, Greece. · Center for Experimental Surgery, Clinical and Translational Research, Biomedical Research Foundation, Academy of Athens, 4 Soranou Ephessiou St., 115 27, Athens, Greece. cdanagnostopoulos@bioacademy.gr. · Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy. · Department of Nuclear Medicine, University Hospital Zurich, Zürich, Switzerland. · Biomedical Research Institute - FORTH, GR 45110 Ioannina, Ioannina, Greece. · Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. · Michaelideion Cardiac Center, Dept. of Cardiology in Medical School, University of Ioannina, 451 10, Ioannina, Greece. · CT & MRI Department Hygeia-Mitera Hospitals, Athens, Greece. · Fondazione Toscana G. Monasterio and CNR Institute of Clinical Physiology, Pisa, Italy. · Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland. ·Eur Radiol · Pubmed #30324382.

ABSTRACT: OBJECTIVES: Application of computational fluid dynamics (CFD) to three-dimensional CTCA datasets has been shown to provide accurate assessment of the hemodynamic significance of a coronary lesion. We aim to test the feasibility of calculating a novel CTCA-based virtual functional assessment index (vFAI) of coronary stenoses > 30% and ≤ 90% by using an automated in-house-developed software and to evaluate its efficacy as compared to the invasively measured fractional flow reserve (FFR). METHODS AND RESULTS: In 63 patients with chest pain symptoms and intermediate (20-90%) pre-test likelihood of coronary artery disease undergoing CTCA and invasive coronary angiography with FFR measurement, vFAI calculations were performed after 3D reconstruction of the coronary vessels and flow simulations using the finite element method. A total of 74 vessels were analyzed. Mean CTCA processing time was 25(± 10) min. There was a strong correlation between vFAI and FFR, (R = 0.93, p < 0.001) and a very good agreement between the two parameters by the Bland-Altman method of analysis. The mean difference of measurements from the two methods was 0.03 (SD = 0.033), indicating a small systematic overestimation of the FFR by vFAI. Using a receiver-operating characteristic curve analysis, the optimal vFAI cutoff value for identifying an FFR threshold of ≤ 0.8 was ≤ 0.82 (95% CI 0.81 to 0.88). CONCLUSIONS: vFAI can be effectively derived from the application of computational fluid dynamics to three-dimensional CTCA datasets. In patients with coronary stenosis severity > 30% and ≤ 90%, vFAI performs well against FFR and may efficiently distinguish between hemodynamically significant from non-significant lesions. KEY POINTS: Virtual functional assessment index (vFAI) can be effectively derived from 3D CTCA datasets. In patients with coronary stenoses severity > 30% and ≤ 90%, vFAI performs well against FFR. vFAI may efficiently distinguish between functionally significant from non-significant lesions.

7 Article Diagnostic accuracy of semi-automatic quantitative metrics as an alternative to expert reading of CT myocardial perfusion in the CORE320 study. 2018

Ostovaneh, Mohammad R / Vavere, Andrea L / Mehra, Vishal C / Kofoed, Klaus F / Matheson, Matthew B / Arbab-Zadeh, Armin / Fujisawa, Yasuko / Schuijf, Joanne D / Rochitte, Carlos E / Scholte, Arthur J / Kitagawa, Kakuya / Dewey, Marc / Cox, Christopher / DiCarli, Marcelo F / George, Richard T / Lima, Joao A C. ·Devision of Cardiology, Johns Hopkins Hospital and School of Medicine Baltimore, MD, USA. · Rigshospitalet, University of Copenhagen, Denmark. · Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. · Toshiba Medical Systems Corporation, Japan. · Toshiba Medical Systems Europe B.V., Zoetermeer, The Netherlands. · InCor Heart Institute, University of Sao Paulo Medical School, Brazil. · Leiden University Medical Center, Leiden, The Netherlands. · Mie University Hospital, Tsu, Japan. · Charité Medical School, Humboldt, Berlin, Germany. · Brigham and Women's Hospital, Harvard University, Boston, MA, USA. · Devision of Cardiology, Johns Hopkins Hospital and School of Medicine Baltimore, MD, USA. Electronic address: jlima@jhmi.edu. ·J Cardiovasc Comput Tomogr · Pubmed #29730016.

ABSTRACT: AIMS: To determine the diagnostic accuracy of semi-automatic quantitative metrics compared to expert reading for interpretation of computed tomography perfusion (CTP) imaging. METHODS: The CORE320 multicenter diagnostic accuracy clinical study enrolled patients between 45 and 85 years of age who were clinically referred for invasive coronary angiography (ICA). Computed tomography angiography (CTA), CTP, single photon emission computed tomography (SPECT), and ICA images were interpreted manually in blinded core laboratories by two experienced readers. Additionally, eight quantitative CTP metrics as continuous values were computed semi-automatically from myocardial and blood attenuation and were combined using logistic regression to derive a final quantitative CTP metric score. For the reference standard, hemodynamically significant coronary artery disease (CAD) was defined as a quantitative ICA stenosis of 50% or greater and a corresponding perfusion defect by SPECT. Diagnostic accuracy was determined by area under the receiver operating characteristic curve (AUC). RESULTS: Of the total 377 included patients, 66% were male, median age was 62 (IQR: 56, 68) years, and 27% had prior myocardial infarction. In patient based analysis, the AUC (95% CI) for combined CTA-CTP expert reading and combined CTA-CTP semi-automatic quantitative metrics was 0.87(0.84-0.91) and 0.86 (0.83-0.9), respectively. In vessel based analyses the AUC's were 0.85 (0.82-0.88) and 0.84 (0.81-0.87), respectively. No significant difference in AUC was found between combined CTA-CTP expert reading and CTA-CTP semi-automatic quantitative metrics in patient based or vessel based analyses(p > 0.05 for all). CONCLUSION: Combined CTA-CTP semi-automatic quantitative metrics is as accurate as CTA-CTP expert reading to detect hemodynamically significant CAD.

8 Article Gender-Specific Differences in All-Cause Mortality Between Incomplete and Complete Revascularization in Patients With ST-Elevation Myocardial Infarction and Multi-Vessel Coronary Artery Disease. 2018

Dimitriu-Leen, Aukelien C / Hermans, Maaike P J / van Rosendael, Alexander R / van Zwet, Erik W / van der Hoeven, Bas L / Bax, Jeroen J / Scholte, Arthur J H A. ·Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. · Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands. · Department of Medical Statistics and Bio-informatics, Leiden University Medical Center, Leiden, The Netherlands. · Department of Cardiology, Medical Center Haaglanden, The Hague, The Netherlands. · Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: a.j.h.a.scholte@lumc.nl. ·Am J Cardiol · Pubmed #29361286.

ABSTRACT: The best revascularization strategy (complete vs incomplete revascularization) in patients with ST-elevation myocardial infarction (STEMI) is still debated. The interaction between gender and revascularization strategy in patients with STEMI on all-cause mortality is uncertain. The aim of the present study was to evaluate gender-specific difference in all-cause mortality between incomplete and complete revascularization in patients with STEMI and multi-vessel coronary artery disease. The study population consisted of 375 men and 115 women with a first STEMI and multi-vessel coronary artery disease without cardiogenic shock at admission or left main stenosis. The 30-day and 5-year all-cause mortality was examined in patients categorized according to gender and revascularization strategy (incomplete and complete revascularization). Within the first 30 days, men and women with incomplete revascularization were associated with higher mortality rates compared with men with complete revascularization. However, the gender-strategy interaction variable was not independently associated with 30-day mortality after STEMI when corrected for baseline characteristics and angiographic features. Within the survivors of the first 30 days, men with incomplete revascularization (compared with men with complete revascularization) were independently associated with all-cause mortality during 5 years of follow-up (hazard ratios 3.07, 95% confidence interval 1.24;7.61, p = 0.016). In contrast, women with incomplete revascularization were not independently associated with 5-year all-cause mortality (hazard ratios 0.60, 95% confidence interval 0.14;2.51, p = 0.48). In conclusion, no gender-strategy differences occurred in all-cause mortality within 30 days after STEMI. However, in the survivors of the first 30 days, incomplete revascularization in men was independently associated with all-cause mortality during 5-year follow-up, but this was not the case in women.

9 Article Different manifestation of irradiation induced coronary artery disease detected with coronary computed tomography compared with matched non-irradiated controls. 2017

van Rosendael, Alexander R / Daniëls, Laurien A / Dimitriu-Leen, Aukelien C / Smit, Jeff M / van Rosendael, Philippe J / Schalij, Martin J / Bax, Jeroen J / Scholte, Arthur J H A. ·Department of Cardiology, Leiden University Medical Center, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands. · Department of Radiotherapy, Leiden University Medical Center, The Netherlands. · Department of Cardiology, Leiden University Medical Center, The Netherlands. · Department of Cardiology, Leiden University Medical Center, The Netherlands. Electronic address: a.j.h.a.scholte@lumc.nl. ·Radiother Oncol · Pubmed #28987749.

ABSTRACT: BACKGROUND AND PURPOSE: Patients who received chest irradiation for treatment of a malignancy are at increased risk for the development of coronary artery atherosclerosis. Little is known about the anatomical coronary artery plaque characteristics of irradiation induced coronary artery disease (CAD). This study aimed to evaluate potential differences in the presence, extent, severity, composition and location of CAD in patients treated with mediastinal irradiation compared with non-irradiated controls matched on age, gender and cardiovascular risk factors. MATERIAL AND METHODS: Seventy-nine asymptomatic Hodgkin and non-Hodgkin lymphoma survivors, all treated with mediastinal irradiation with or without chemotherapy, who underwent coronary computed tomography angiography (CTA) to exclude or detect CAD were included. Patients were 1:3 matched with non-irradiated controls (n=237) for age, gender, diabetes, hypertension, hypercholesterolemia, family history of CAD and currently smoking. Mean age at cancer diagnosis was 26±9years and age at the time of coronary CTA was 45±11years. RESULTS: More patients had an abnormal CTA (defined as any coronary artery atherosclerosis): 59% vs. 36% (P<0.001) and significantly more patients had two vessel CAD: 10% vs. 6% and three vessel/left main CAD: 24% vs. 9% compared with controls (overall P<0.001). The maximum stenosis severity among patients was less often <30% (53% vs. 68%) and more often >70% (7% vs. 0%) (overall P=0.001). Patients had more coronary artery plaques in proximal coronary artery segments: left main (17% vs. 6%, P=0.004), proximal left anterior descending artery (30% vs. 16%, P=0.004), proximal right coronary artery (25% vs 10%, P<0.001) and proximal left circumflex artery (14% vs 6%, P=0.022), whereas the number of plaques in non-proximal segments did not differ between groups. CONCLUSIONS: Hodgkin and non-Hodgkin lymphoma survivors treated with mediastinal irradiation with or without chemotherapy showed a higher presence, greater severity, larger extent and more proximally located CAD compared with age, gender and risk factor matched non-irradiated controls. These findings represent features of higher risk CAD and may explain the worse cardiovascular outcome after chest irradiation.

10 Article Automatic identification of coronary tree anatomy in coronary computed tomography angiography. 2017

Cao, Qing / Broersen, Alexander / de Graaf, Michiel A / Kitslaar, Pieter H / Yang, Guanyu / Scholte, Arthur J / Lelieveldt, Boudewijn P F / Reiber, Johan H C / Dijkstra, Jouke. ·Division of Image Processing, Department of Radiology, C2S, Leiden University Medical Center, PO Box 9600, Albinusdreef 2, 2300 RC, Leiden, The Netherlands. · Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. · Medis Medical Imaging Systems BV, Leiden, The Netherlands. · Laboratory of Image Science and Technology, Southeast University, Nanjing, China. · Division of Image Processing, Department of Radiology, C2S, Leiden University Medical Center, PO Box 9600, Albinusdreef 2, 2300 RC, Leiden, The Netherlands. j.dijkstra@lumc.nl. ·Int J Cardiovasc Imaging · Pubmed #28647774.

ABSTRACT: An automatic coronary artery tree labeling algorithm is described to identify the anatomical segments of the extracted centerlines from coronary computed tomography angiography (CCTA) images. This method will facilitate the automatic lesion reporting and risk stratification of cardiovascular disease. Three-dimensional (3D) models for both right dominant (RD) and left dominant (LD) coronary circulations were built. All labels in the model were matched with their possible candidates in the extracted tree to find the optimal labeling result. In total, 83 CCTA datasets with 1149 segments were included in the testing of the algorithm. The results of the automatic labeling were compared with those by two experts. In all cases, the proximal parts of main branches including LM were labeled correctly. The automatic labeling algorithm was able to identify and assign labels to 89.2% RD and 83.6% LD coronary tree segments in comparison with the agreements of the two experts (97.6% RD, 87.6% LD). The average precision of start and end points of segments was 92.0% for RD and 90.7% for LD in comparison with the manual identification by two experts while average differences in experts is 1.0% in RD and 2.2% in LD cases. All cases got similar clinical risk scores as the two experts. The presented fully automatic labeling algorithm can identify and assign labels to the extracted coronary centerlines for both RD and LD circulations.

11 Article Accuracy and reproducibility of fast fractional flow reserve computation from invasive coronary angiography. 2017

van Rosendael, A R / Koning, G / Dimitriu-Leen, A C / Smit, J M / Montero-Cabezas, J M / van der Kley, F / Jukema, J W / Reiber, J H C / Bax, J J / Scholte, A J H A. ·Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Postal zone 2300 RC, 2333 ZA, Leiden, The Netherlands. · Medis Medical Imaging Systems B.V., Leiden, The Netherlands. · Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. · Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Postal zone 2300 RC, 2333 ZA, Leiden, The Netherlands. a.j.h.a.scholte@lumc.nl. ·Int J Cardiovasc Imaging · Pubmed #28642995.

ABSTRACT: Fractional flow reserve (FFR) guided percutaneous coronary intervention (PCI) is associated with favourable outcome compared with revascularization based on angiographic stenosis severity alone. The feasibility of the new image-based quantitative flow ratio (QFR) assessed from 3D quantitative coronary angiography (QCA) and thrombolysis in myocardial infarction (TIMI) frame count using three different flow models has been reported recently. The aim of the current study was to assess the accuracy, and in particular, the reproducibility of these three QFR techniques when compared with invasive FFR. QFR was derived (1) from adenosine induced hyperaemic coronary angiography images (adenosine-flow QFR [aQFR]), (2) from non-hyperemic images (contrast-flow QFR [cQFR]) and (3) using a fixed empiric hyperaemic flow [fixed-flow QFR (fQFR)]. The three QFR values were calculated in 17 patients who prospectively underwent invasive FFR measurement in 20 vessels. Two independent observers performed the QFR analyses. Mean difference, standard deviation and 95% limits of agreement (LOA) between invasive FFR and aQFR, cQFR and fQFR for observer 1 were: 0.01 ± 0.04 (95% LOA: -0.07; 0.10), 0.01 ± 0.05 (95% LOA: -0.08; 0.10), 0.01 ± 0.04 (95% LOA: -0.06; 0.08) and for observer 2: 0.00 ± 0.03 (95% LOA: -0.06; 0.07), -0.01 ± 0.03 (95% LOA: -0.07; 0.05), 0.00 ± 0.03 (95% LOA: -0.06; 0.05). Values between the 2 observers were (to assess reproducibility) for aQFR: 0.01 ± 0.04 (95% LOA: -0.07; 0.09), for cQFR: 0.02 ± 0.04 (95% LOA: -0.06; 0.09) and for fQFR: 0.01 ± 0.05 (95% LOA: -0.07; 0.10). In a small number of patients we showed good accuracy of three QFR techniques (aQFR, cQFR and fQFR) to predict invasive FFR. Furthermore, good inter-observer agreement of the QFR values was observed between two independent observers.

12 Article Coronary computed tomography angiography derived risk score in predicting cardiac events. 2017

Uusitalo, Valtteri / Kamperidis, Vasileios / de Graaf, Michiel A / Maaniitty, Teemu / Stenström, Iida / Broersen, Alexander / Dijkstra, Jouke / Scholte, Arthur J / Saraste, Antti / Bax, Jeroen J / Knuuti, Juhani. ·Turku PET Center, University of Turku, Turku, Finland; Department of Clinical Physiology and Nuclear Medicine, HUS Medical Imaging Center, Helsinki University Hospital, Helsinki, Finland. Electronic address: valtteri.uusitalo@utu.fi. · Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. · Turku PET Center, University of Turku, Turku, Finland. · Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. · Turku PET Center, University of Turku, Turku, Finland; Department of Cardiology, University of Turku, Turku, Finland. · Turku PET Center, University of Turku, Turku, Finland; Department of Clinical Physiology, Nuclear Medicine and PET, University of Turku, Turku, Finland. ·J Cardiovasc Comput Tomogr · Pubmed #28476505.

ABSTRACT: BACKGROUND: We evaluated the prognostic value of an integrated atherosclerosis risk score combining the markers of coronary plaque burden, location and composition as assessed by computed tomography angiography (CTA). METHODS: 922 consecutive patients underwent CTA for suspected coronary artery disease (CAD). Patients without atherosclerosis (n = 261) and in whom quantitative CTA analysis was not feasible due to image quality, step-artefacts or technical factors related to image acquisition or data storage (n = 153) were excluded. Thus, final study group consisted of 508 patients aged 63 ± 9 years. Coronary plaque location, severity and composition for each coronary segment were identified using automated CTA quantification software and integrated in a single CTA score (0-42). Adverse events (AE) including death, myocardial infarction (MI) and unstable angina (UA) were obtained from the national healthcare statistics. RESULTS: There were a total of 20 (4%) AE during a median follow-up of 3.6 years (9 deaths, 5 MI and 6 UA). The CTA risk score was divided into tertiles: 0-6.7, 6.8-14.8 and > 14.8, respectively. All MI (n = 5) and most of the other AE occurred in the highest risk score tertile (3 vs. 3 vs. 14, p = 0.002). After correction for age and gender, the CTA risk score remained independently associated with AE. CONCLUSIONS: Comprehensive CTA risk score integrating the location, burden and composition of coronary atherosclerosis predicts future cardiac events in patients with suspected CAD.

13 Article Prognostic Value of Combined CT Angiography and Myocardial Perfusion Imaging versus Invasive Coronary Angiography and Nuclear Stress Perfusion Imaging in the Prediction of Major Adverse Cardiovascular Events: The CORE320 Multicenter Study. 2017

Chen, Marcus Y / Rochitte, Carlos E / Arbab-Zadeh, Armin / Dewey, Marc / George, Richard T / Miller, Julie M / Niinuma, Hiroyuki / Yoshioka, Kunihiro / Kitagawa, Kakuya / Sakuma, Hajime / Laham, Roger / Vavere, Andrea L / Cerci, Rodrigo J / Mehra, Vishal C / Nomura, Cesar / Kofoed, Klaus F / Jinzaki, Masahiro / Kuribayashi, Sachio / Scholte, Arthur J / Laule, Michael / Tan, Swee Yaw / Hoe, John / Paul, Narinder / Rybicki, Frank J / Brinker, Jeffrey A / Arai, Andrew E / Matheson, Matthew B / Cox, Christopher / Clouse, Melvin E / Di Carli, Marcelo F / Lima, João A C. ·From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.) · InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.) · Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.) · Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.) · Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.) · Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.) · Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.) · Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.) · and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.) · From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.) · Keio University School of Medicine, Tokyo, Japan (M.J., S.K.) · Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.) · Department of Cardiology, National Heart Centre, Singapore (S.Y.T.) · Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.) · Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.) · Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.) · Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.) · and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.). ·Radiology · Pubmed #28290782.

ABSTRACT: Purpose To compare the prognostic importance (time to major adverse cardiovascular event [MACE]) of combined computed tomography (CT) angiography and CT myocardial stress perfusion imaging with that of combined invasive coronary angiography (ICA) and stress single photon emission CT myocardial perfusion imaging. Materials and Methods This study was approved by all institutional review boards, and written informed consent was obtained. Between November 2009 and July 2011, 381 participants clinically referred for ICA and aged 45-85 years were enrolled in the Combined Noninvasive Coronary Angiography and Myocardial Perfusion Imaging Using 320-Detector Row Computed Tomography (CORE320) prospective multicenter diagnostic study. All images were analyzed in blinded independent core laboratories, and a panel of physicians adjudicated all adverse events. MACE was defined as revascularization (>30 days after index ICA), myocardial infarction, or cardiac death; hospitalization for chest pain or congestive heart failure; or arrhythmia. Late MACE was defined similarly, except for patients who underwent revascularization within the first 182 days after ICA, who were excluded. Comparisons of 2-year survival (time to MACE) used standard Kaplan-Meier curves and restricted mean survival times bootstrapped with 2000 replicates. Results An MACE (49 revascularizations, five myocardial infarctions, one cardiac death, nine hospitalizations for chest pain or congestive heart failure, and one arrhythmia) occurred in 51 of 379 patients (13.5%). The 2-year MACE-free rates for combined CT angiography and CT perfusion findings were 94% negative for coronary artery disease (CAD) versus 82% positive for CAD and were similar to combined ICA and single photon emission CT findings (93% negative for CAD vs 77% positive for CAD, P < .001 for both). Event-free rates for CT angiography and CT perfusion versus ICA and single photon emission CT for either positive or negative results were not significantly different for MACE or late MACE (P > .05 for all). The area under the receiver operating characteristic curve (AUC) for combined CT angiography and CT perfusion (AUC = 68; 95% confidence interval [CI]: 62, 75) was similar (P = .36) to that for combined ICA and single photon emission CT (AUC = 71; 95% CI: 65, 79) in the identification of MACE at 2-year follow-up. Conclusion Combined CT angiography and CT perfusion enables similar prediction of 2-year MACE, late MACE, and event-free survival similar to that enabled by ICA and single photon emission CT.

14 Article Prevalence by Computed Tomographic Angiography of Coronary Plaques in South Asian and White Patients With Type 2 Diabetes Mellitus at Low and High Risk Using Four Cardiovascular Risk Scores (UKPDS, FRS, ASCVD, and JBS3). 2017

Gobardhan, Sanjay N / Dimitriu-Leen, Aukelien C / van Rosendael, Alexander R / van Zwet, Erik W / Roos, Cornelis J / Oemrawsingh, Pranobe V / Kharagjitsingh, Aan V / Jukema, J Wouter / Delgado, Victoria / Schalij, Martin J / Bax, Jeroen J / Scholte, Arthur J H A. ·Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. · Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; The Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands. · Department of Medical statistics, Leiden University Medical Center, Leiden, The Netherlands. · Department of Cardiology, Medical Spectrum Twente, Enschede, The Netherlands. · Department of Cardiology, Medical Center Haaglanden, The Hague, The Netherlands. · Department of Internal Medicine, Medical Center Haaglanden, The Hague, The Netherlands; Department of Internal Medicine and Endocrinology, Leiden University Medical Center, Leiden, The Netherlands. · Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: a.j.h.a.scholte@lumc.nl. ·Am J Cardiol · Pubmed #28024655.

ABSTRACT: The aim of this study was to explore the association between various cardiovascular (CV) risk scores and coronary atherosclerotic burden on coronary computed tomography angiography (CTA) in South Asians with type 2 diabetes mellitus and matched whites. Asymptomatic type 2 diabetic South Asians and whites were matched for age, gender, body mass index, hypertension, and hypercholesterolemia. Ten-year CV risk was estimated using different risk scores (United Kingdom Prospective Diabetes Study [UKPDS], Framingham Risk Score [FRS], AtheroSclerotic CardioVascular Disease [ASCVD], and Joint British Societies for the prevention of CVD [JBS3]) and categorized into low- and high-risk groups. The presence of coronary artery calcium (CAC) and obstructive coronary artery disease (CAD; ≥50% stenosis) was assessed using coronary CTA. Finally, the relation between coronary atherosclerosis on CTA and the low- and high-risk groups was compared. UKPDS, FRS, and ASCVD showed no differences in estimated CV risk between 159 South Asians and 159 matched whites. JBS3 showed a significant greater absolute CV risk in South Asians (18.4% vs 14.2%, p <0.01). Higher presence of CAC score >0 (69% vs 55%, p <0.05) and obstructive CAD (39% vs 27%, p <0.05) was observed in South Asians. South Asians categorized as high risk, using UKPDS, FRS, and ASCVD, showed more CAC and CAD compared than whites. JBS3 showed no differences. In conclusion, asymptomatic South Asians with type 2 diabetes mellitus more frequently showed CAC and obstructive CAD than matched whites in the population categorized as high-risk patients using UKPDS, FRS, and ASCVD as risk estimators. However, JBS3 seems to correlate best to CAC and CAD in both ethnicity groups compared with the other risk scores.

15 Article Segmental quantitative myocardial perfusion with PET for the detection of significant coronary artery disease in patients with stable angina. 2016

Berti, Valentina / Sciagrà, Roberto / Neglia, Danilo / Pietilä, Mikko / Scholte, Arthur J / Nekolla, Stephan / Rouzet, François / Pupi, Alberto / Knuuti, Juhani. ·Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", Nuclear Medicine Unit, University of Florence, Largo Brambilla 3, 50134, Florence, FI, Italy. valentina.berti@unifi.it. · Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", Nuclear Medicine Unit, University of Florence, Largo Brambilla 3, 50134, Florence, FI, Italy. · Institute of Clinical Physiology, CNR, Pisa, Italy. · Heart Center and Turku PET Center University of Turku and Turku University Hospital, Turku, Finland. · Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. · Nuklearmedizinische Klinik, Technische University of Munich, Munich, Germany. · Department of Nuclear Medicine, Bichat University Hospital, University Paris Diderot, Paris, France. ·Eur J Nucl Med Mol Imaging · Pubmed #26993310.

ABSTRACT: PURPOSE: The goal of this study is to determine the technical accuracy of segmental perfusion parameters assessed with quantitative cardiac PET imaging in the evaluation of coronary artery disease (CAD) in patients with stable angina. METHODS: A cohort of patients who participated in the EVINCI protocol underwent an evaluation of coronary anatomy by invasive coronary angiography (ICA) and/or coronary computed tomography angiography (CCTA) and PET myocardial perfusion imaging with H2 (15)O, (13)NH3 or (82)Rb. PET studies were analyzed by two independent observers blinded to clinical and instrumental data, and classified as positive or negative for significant CAD using only segmental perfusion measurements and cut-off values from literature. RESULTS: On a per-patient basis, the overall inter-observer agreement on PET results was 90 % (kappa = 0.79), indicating substantial agreement. On a per-vessel basis, the inter-observer agreement on PET results was 88 % (kappa = 0.74) in the RCA territory, 94 % (kappa = 0.84) in the LAD territory and 94 % (kappa = 0.85) in the LCX territory. Segmental PET measurements correctly identified 85 % of the patients, resulting in a global sensitivity of 86 %, a specificity of 84 %, a positive predictive value (PPV) of 69 % and a negative predictive value (NPV) of 93 %. In vessel-based analyses, quantitative perfusion parameters had a sensitivity, specificity, PPV and NPV of 92 %, 82 %, 42 % and 99 %, respectively, for the detection of significant coronary stenoses in all major coronary arteries. CONCLUSIONS: The assessment of absolute myocardial perfusion parameters measured at a segment level lead to reliable and accurate identification of patients with significant coronary stenosis at ICA and/or CCTA.

16 Article Multicentre multi-device hybrid imaging study of coronary artery disease: results from the EValuation of INtegrated Cardiac Imaging for the Detection and Characterization of Ischaemic Heart Disease (EVINCI) hybrid imaging population. 2016

Liga, Riccardo / Vontobel, Jan / Rovai, Daniele / Marinelli, Martina / Caselli, Chiara / Pietila, Mikko / Teresinska, Anna / Aguadé-Bruix, Santiago / Pizzi, Maria Nazarena / Todiere, Giancarlo / Gimelli, Alessia / Chiappino, Dante / Marraccini, Paolo / Schroeder, Stephen / Drosch, Tanja / Poddighe, Rosa / Casolo, Giancarlo / Anagnostopoulos, Constantinos / Pugliese, Francesca / Rouzet, Francois / Le Guludec, Dominique / Cappelli, Francesco / Valente, Serafina / Gensini, Gian Franco / Zawaideh, Camilla / Capitanio, Selene / Sambuceti, Gianmario / Marsico, Fabio / Filardi, Pasquale Perrone / Fernández-Golfín, Covadonga / Rincón, Luis M / Graner, Frank P / de Graaf, Michiel A / Stehli, Julia / Reyes, Eliana / Nkomo, Sandy / Mäki, Maija / Lorenzoni, Valentina / Turchetti, Giuseppe / Carpeggiani, Clara / Puzzuoli, Stefano / Mangione, Maurizio / Marcheschi, Paolo / Giannessi, Daniela / Nekolla, Stephan / Lombardi, Massimo / Sicari, Rosa / Scholte, Arthur J H A / Zamorano, José L / Underwood, S Richard / Knuuti, Juhani / Kaufmann, Philipp A / Neglia, Danilo / Gaemperli, Oliver / Anonymous460862. ·Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland. · Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland. · Institute of Clinical Physiology, CNR, Pisa, Italy. · Heart Center and Turku PET Center, University of Turku, Turku University Hospital, Turku, Finland. · Department of Nuclear Medicine, Institute of Cardiology, Warsaw, Poland. · Department of Nuclear Medicine, University Hospital Val d'Hebron, Institut Catala de la Salut, Barcelona, Spain. · Cardiothoracic Department, Fondazione Toscana G. Monasterio, Pisa, Italy. · Imaging Department, Fondazione Toscana G. Monasterio, Pisa, Italy. · Department of Cardiology, Alb-Fils-Kliniken, Göppingen, Germany. · Emergency Department, Cardiology, Ospedale della Versilia, Lido di Camaiore, Italy. · Center for Experimental Surgery, Clinical and Translational Research, Biomedical Research Foundation, Academy of Athens, Athens, Greece Centre for Advanced Cardiovascular Imaging, National Institute for Health Research Cardiovascular Biomedical Research Unit at Barts, William Harvey Research Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UK. · Centre for Advanced Cardiovascular Imaging, National Institute for Health Research Cardiovascular Biomedical Research Unit at Barts, William Harvey Research Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UK. · Department of Nuclear Medicine, Bichat University Hospital, Département Hospitalo-Universitaire FIRE, Assistance Publique-Hôpitaux de Paris, University Paris Diderot, Paris, France. · Cardiothoracic and Vascular Department, Azienda Ospedaliera Universitaria Careggi, Florence, Italy. · Cardiothoracic and Vascular Department, Azienda Ospedaliera Universitaria Careggi, Florence, Italy Don Carlo Gnocchi Foundation, IRCCS, Florence, Italy. · Department of Health Science and Internal Medicine, IRCCS Hospital San Martino, National Institute for Cancer Research and University of Genoa, Genoa, Italy. · Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy. · Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Spain. · Department of Nuclear Medicine, Klinikum Rechts der Isar der Technischen Universität München, Muenchen, Germany. · Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. · Biomedical Research Unit, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK. · Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy. · Technology Department, Fondazione Toscana G. Monasterio, Pisa, Italy. · Institute of Clinical Physiology, CNR, Pisa, Italy Cardiothoracic Department, Fondazione Toscana G. Monasterio, Pisa, Italy. · Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland oliver.gaemperli@usz.ch. ·Eur Heart J Cardiovasc Imaging · Pubmed #26992419.

ABSTRACT: AIMS: Hybrid imaging provides a non-invasive assessment of coronary anatomy and myocardial perfusion. We sought to evaluate the added clinical value of hybrid imaging in a multi-centre multi-vendor setting. METHODS AND RESULTS: Fourteen centres enrolled 252 patients with stable angina and intermediate (20-90%) pre-test likelihood of coronary artery disease (CAD) who underwent myocardial perfusion scintigraphy (MPS), CT coronary angiography (CTCA), and quantitative coronary angiography (QCA) with fractional flow reserve (FFR). Hybrid MPS/CTCA images were obtained by 3D image fusion. Blinded core-lab analyses were performed for CTCA, MPS, QCA and hybrid datasets. Hemodynamically significant CAD was ruled-in non-invasively in the presence of a matched finding (myocardial perfusion defect co-localized with stenosed coronary artery) and ruled-out with normal findings (both CTCA and MPS normal). Overall prevalence of significant CAD on QCA (>70% stenosis or 30-70% with FFR≤0.80) was 37%. Of 1004 pathological myocardial segments on MPS, 246 (25%) were reclassified from their standard coronary distribution to another territory by hybrid imaging. In this respect, in 45/252 (18%) patients, hybrid imaging reassigned an entire perfusion defect to another coronary territory, changing the final diagnosis in 42% of the cases. Hybrid imaging allowed non-invasive CAD rule-out in 41%, and rule-in in 24% of patients, with a negative and positive predictive value of 88% and 87%, respectively. CONCLUSION: In patients at intermediate risk of CAD, hybrid imaging allows non-invasive co-localization of myocardial perfusion defects and subtending coronary arteries, impacting clinical decision-making in almost one every five subjects.

17 Article Effect of Coronary Atherosclerosis and Myocardial Ischemia on Plasma Levels of High-Sensitivity Troponin T and NT-proBNP in Patients With Stable Angina. 2016

Caselli, Chiara / Prontera, Concetta / Liga, Riccardo / De Graaf, Michiel A / Gaemperli, Oliver / Lorenzoni, Valentina / Ragusa, Rosetta / Marinelli, Martina / Del Ry, Silvia / Rovai, Daniele / Giannessi, Daniela / Aguade-Bruix, Santiago / Clemente, Alberto / Bax, Jeroen J / Lombardi, Massimo / Sicari, Rosa / Zamorano, José / Scholte, Arthur J / Kaufmann, Philipp A / Knuuti, Juhani / Underwood, S Richard / Clerico, Aldo / Neglia, Danilo. ·From the CNR, Institute of Clinical Physiology, Pisa, Italy (C.C., M.M., S.D.R., D.R., D.G., R.S., D.N.) · Fondazione Toscana G. Monasterio, Pisa, Italy (C.P., A.C., M.L., A.C., D.N.) · Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Italy (R.L.) · Leiden University Medical Center, Leiden, The Netherlands (M.A.D.G., J.J.B., A.J.S.) · University Hospital Zurich, Zurich, Switzerland (O.G., P.A.K.) · Scuola Superiore Sant'Anna, Pisa, Italy (V.L., R.R., A.C.) · Hospital Universitario Vall d'Hebron, Barcelona, Spain (S.A.-B.) · University Alcala, Hospital Ramón y Cajal, Madrid, Spain (J.Z.) · University of Turku and Turku University Hospital, Turku, Finland (J.K.) · and Imperial College London, United Kingdom (S.R.U.). ·Arterioscler Thromb Vasc Biol · Pubmed #26868212.

ABSTRACT: OBJECTIVE: Circulating levels of high-sensitivity cardiac troponin T (hs-cTnT) and N terminal pro brain natriuretic peptide (NT-proBNP) are predictors of prognosis in patients with coronary artery disease (CAD). We aimed at evaluating the effect of coronary atherosclerosis and myocardial ischemia on cardiac release of hs-cTnT and NT-proBNP in patients with suspected CAD. APPROACH AND RESULTS: Hs-cTnT and NT-proBNP were measured in 378 patients (60.1±0.5 years, 229 males) with stable angina and unknown CAD enrolled in the Evaluation of Integrated Cardiac Imaging (EVINCI) study. All patients underwent stress imaging to detect myocardial ischemia and coronary computed tomographic angiography to assess the presence and characteristics of CAD. An individual computed tomographic angiography score was calculated combining extent, severity, composition, and location of plaques. In the whole population, the median (25-75 percentiles) value of plasma hs-cTnT was 6.17 (4.2-9.1) ng/L and of NT-proBNP was 61.66 (31.2-132.6) ng/L. In a multivariate model, computed tomographic angiography score was an independent predictor of the plasma hs-cTnT (coefficient 0.06, SE 0.02; P=0.0089), whereas ischemia was a predictor of NT-proBNP (coefficient 0.38, SE 0.12; P=0.0015). Hs-cTnT concentrations were significantly increased in patients with CAD with or without myocardial ischemia (P<0.005), whereas only patients with CAD and ischemia showed significantly higher levels of NT-proBNP (P<0.001). CONCLUSIONS: In patients with stable angina, the presence and extent of coronary atherosclerosis is related with circulating levels of hs-cTnT, also in the absence of ischemia, suggesting an ischemia-independent mechanism of hs-cTnT release. Obstructive CAD causing myocardial ischemia is associated with increased levels of NT-proBNP.

18 Article Coronary anatomy as related to bicuspid aortic valve morphology. 2016

Koenraadt, Wilke M C / Tokmaji, George / DeRuiter, Marco C / Vliegen, Hubert W / Scholte, Arthur J H A / Siebelink, Hans Marc J / Gittenberger-de Groot, Adriana C / de Graaf, Michiel A / Wolterbeek, Ron / Mulder, Barbara J / Bouma, Berto J / Schalij, Martin J / Jongbloed, Monique R M. ·Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. · Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands. · Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, The Netherlands. · Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands. · Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, The Netherlands. ·Heart · Pubmed #26864668.

ABSTRACT: OBJECTIVE: Variable coronary anatomy has been described in patients with bicuspid aortic valves (BAVs). This was never specified to BAV morphology, and prognostic relevance of coronary vessel dominance in this patient group is unclear. The purpose of this study was to evaluate valve morphology in relation to coronary artery anatomy and outcome in patients with isolated BAV and with associated aortic coarctation (CoA). METHODS: Coronary anatomy was evaluated in 186 patients with BAV (141 men (79%), 51±14 years) by CT and invasive coronary angiography. Correlation of coronary anatomy was made with BAV morphology and coronary events. RESULTS: Strictly bicuspid valves (without raphe) with left-right cusp fusion (type 1B) had more left dominant coronary systems compared with BAVs with left-right cusp fusion with a raphe (type 1A) (48% vs. 26%, p=0.047) and showed more separate ostia (28% vs. 9%, p=0.016). Type 1B BAVs had more coronary artery disease than patients with type 1A BAV (36% vs. 19%, p=0.047). More left dominance was seen in BAV patients with CoA than in patients without (65% vs. 24%, p<0.05). CONCLUSIONS: The incidence of a left dominant coronary artery system and separate ostia was significantly related to BAVs with left-right fusion without a raphe (type 1B). These patients more often had significant coronary artery disease. In patients with BAV and CoA, left dominancy is more common.

19 Article Value of Coronary Computed Tomography Angiography in Tailoring Aspirin Therapy for Primary Prevention of Atherosclerotic Events in Patients at High Risk With Diabetes Mellitus. 2016

Dimitriu-Leen, Aukelien C / Scholte, Arthur J H A / van Rosendael, Alexander R / van den Hoogen, Inge J / Kharagjitsingh, Aantje V / Wolterbeek, Ron / Knuuti, Juhani / Kroft, Lucia J M / Delgado, Victoria / Jukema, J Wouter / de Graaf, Michiel A / Bax, Jeroen J. ·Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: a.c.dimitriu-leen@lumc.nl. · Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. · Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands. · Department of Internal Medicine, Medical Center Haaglanden, The Hague, The Netherlands; Division of Endocrinology, Department of Medicine, Leiden University Medical Center, The Netherlands. · Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands. · Turku Positron Emission Tomography Centre, Turku University Hospital, University of Turku, Turku, Finland. · Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. ·Am J Cardiol · Pubmed #26803383.

ABSTRACT: Aspirin use for primary prevention in patients at high risk with diabetes mellitus (DM) is often recommended under the assumption that most patients with DM have coronary artery disease (CAD). However, not all patients may have CAD. The present study evaluated, in 425 patients at high risk with DM (without chest pain syndrome or a history of cardiac disease), the prevalence of CAD on coronary computed tomography angiography (CTA). Moreover, the association between the presence and number of traditional cardiovascular (CV) risk factors and CAD (on coronary CTA) was evaluated. The median coronary artery calcium score was 29 (interquartile range 0 to 298). On coronary CTA, 116 patients (27%) had no CAD (defined as <30% stenosis). Of the 309 patients (73%) with any CAD (≥30% stenosis), 35% had obstructive CAD (≥50% stenosis). The number of traditional CV risk factors was not associated with the presence of any CAD (≥30% stenosis; p = 0.18) or obstructive CAD (≥50% stenosis; p = 0.13). Hypertension was the only traditional CV risk factor associated with a higher frequency of any CAD (≥30% stenosis; odds ratio = 2.21, 95% CI 1.43 to 3.41, p <0.001) and obstructive CAD (≥50% stenosis; odds ratio 2.03, 95% CI 1.33 to 3.11, p = 0.001). In conclusion, in patients at high risk with DM without chest pain syndrome, any CAD was ruled out by coronary CTA in 27%, whereas 65% of the patients did not have obstructive CAD. The number of CV risk factors was not associated with the presence of CAD. Hypertension was the only traditional CV risk factor that was associated with a higher frequency of CAD. These observations support potential use of coronary CTA to tailor aspirin therapy in patients at high risk with DM.

20 Article Prognostic Value of Coronary Computed Tomography Imaging in Patients at High Risk Without Symptoms of Coronary Artery Disease. 2016

Dedic, Admir / Ten Kate, Gert-Jan R / Roos, Cornelis J / Neefjes, Lisan A / de Graaf, Michiel A / Spronk, Angela / Delgado, Victoria / van Lennep, Jeanine E Roeters / Moelker, Adriaan / Ouhlous, Mohamed / Scholte, Arthur J H A / Boersma, Eric / Sijbrands, Eric J G / Nieman, Koen / Bax, Jeroen J / de Feijter, Pim J. ·Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands. Electronic address: a.dedic@erasmusmc.nl. · Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands. · Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands; Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. · Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. · Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands. · Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands. · Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands. · Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands. ·Am J Cardiol · Pubmed #26754124.

ABSTRACT: At present, traditional risk factors are used to guide cardiovascular management of asymptomatic subjects. Intensified surveillance may be warranted in those identified as high risk of developing cardiovascular disease (CVD). This study aims to determine the prognostic value of coronary computed tomography (CT) angiography (CCTA) next to the coronary artery calcium score (CACS) in patients at high CVD risk without symptoms suspect for coronary artery disease (CAD). A total of 665 patients at high risk (mean age 56 ± 9 years, 417 men), having at least one important CVD risk factor (diabetes mellitus, familial hypercholesterolemia, peripheral artery disease, or severe hypertension) or a calculated European systematic coronary risk evaluation of >10% were included from outpatient clinics at 2 academic centers. Follow-up was performed for the occurrence of adverse events including all-cause mortality, nonfatal myocardial infarction, unstable angina, or coronary revascularization. During a median follow-up of 3.0 (interquartile range 1.3 to 4.1) years, adverse events occurred in 40 subjects (6.0%). By multivariate analysis, adjusted for age, gender, and CACS, obstructive CAD on CCTA (≥50% luminal stenosis) was a significant predictor of adverse events (hazard ratio 5.9 [CI 1.3 to 26.1]). Addition of CCTA to age, gender, plus CACS, increased the C statistic from 0.81 to 0.84 and resulted in a total net reclassification index of 0.19 (p <0.01). In conclusion, CCTA has incremental prognostic value and risk reclassification benefit beyond CACS in patients without CAD symptoms but with high risk of developing CVD.

21 Article Enhanced characterization of calcified areas in intravascular ultrasound virtual histology images by quantification of the acoustic shadow: validation against computed tomography coronary angiography. 2016

Broersen, Alexander / de Graaf, Michiel A / Eggermont, Jeroen / Wolterbeek, Ron / Kitslaar, Pieter H / Dijkstra, Jouke / Bax, Jeroen J / Reiber, Johan H C / Scholte, Arthur J. ·Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. a.broersen@lumc.nl. · Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Postal zone 2300 RC, 2333 ZA, Leiden, The Netherlands. · The Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands. · Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. · Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands. · Medis Medical Imaging Systems bv, Leiden, The Netherlands. ·Int J Cardiovasc Imaging · Pubmed #26667446.

ABSTRACT: We enhance intravascular ultrasound virtual histology (VH) tissue characterization by fully automatic quantification of the acoustic shadow behind calcified plaque. VH is unable to characterize atherosclerosis located behind calcifications. In this study, the quantified acoustic shadows are considered calcified to approximate the real dense calcium (DC) plaque volume. In total, 57 patients with 108 coronary lesions were included. A novel post-processing step is applied on the VH images to quantify the acoustic shadow and enhance the VH results. The VH and enhanced VH results are compared to quantitative computed tomography angiography (QTA) plaque characterization as reference standard. The correlation of the plaque types between enhanced VH and QTA differs significantly from the correlation with unenhanced VH. For DC, the correlation improved from 0.733 to 0.818. Instead of an underestimation of DC in VH with a bias of 8.5 mm(3), there was a smaller overestimation of 1.1 mm(3) in the enhanced VH. Although tissue characterization within the acoustic shadow in VH is difficult, the novel algorithm improved the DC tissue characterization. This algorithm contributes to accurate assessment of calcium on VH and could be applied in clinical studies.

22 Article One-stop-shop cardiac CT: 3D fusion of CT coronary anatomy and myocardial perfusion for guiding revascularization in complex multivessel disease. 2016

van Rosendael, Alexander R / Dimitriu-Leen, Aukelien C / Montero-Cabezas, José M / Bax, Jeroen J / Kroft, Lucia J / Scholte, Arthur J H A. ·Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. a.r.rosendael@lumc.nl. · The Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands. a.r.rosendael@lumc.nl. · Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. · Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. ·J Nucl Cardiol · Pubmed #26631174.

ABSTRACT: -- No abstract --

23 Article Prognostic value of coronary computed tomography angiography in diabetic patients without chest pain syndrome. 2016

van den Hoogen, Inge J / de Graaf, Michiel A / Roos, Cornelis J / Leen, Aukelien C / Kharagjitsingh, Aan V / Wolterbeek, Ron / Kroft, Lucia J / Wouter Jukema, J / Bax, Jeroen J / Scholte, Arthur J. ·Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Postal zone 2300 RC, 2333 ZA, Leiden, The Netherlands. · Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Postal zone 2300 RC, 2333 ZA, Leiden, The Netherlands. M.A.de_Graaf@lumc.nl. · The Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands. M.A.de_Graaf@lumc.nl. · The Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands. · Department of Internal Medicine, Westeinde Hospital, The Hague, The Netherlands. · Department of Medical Statistics and Bio-informatics, Leiden University Medical Center, Leiden, The Netherlands. · Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. · Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Postal zone 2300 RC, 2333 ZA, Leiden, The Netherlands. a.j.h.a.scholte@lumc.nl. ·J Nucl Cardiol · Pubmed #26156098.

ABSTRACT: AIMS: Diabetic patients with coronary artery disease (CAD) are often free of chest pain syndrome. A useful modality for non-invasive assessment of CAD is coronary computed tomography angiography (CTA). However, the prognostic value of CAD on coronary CTA in diabetic patients without chest pain syndrome is relatively unknown. Therefore, the aim was to investigate the long-term prognostic value of coronary CTA in a large population diabetic patients without chest pain syndrome. METHODS: Between 2005 and 2013, 525 diabetic patients without chest pain syndrome were prospectively included to undergo coronary artery calcium (CAC)-scoring followed by coronary CTA. During follow-up, the composite endpoint of all-cause mortality, non-fatal myocardial infarction (MI), and late revascularization (>90 days) was registered. RESULTS: In total, CAC-scoring was performed in 410 patients and coronary CTA in 444 patients (431 interpretable). After median follow-up of 5.0 (IQR 2.7-6.5) years, the composite endpoint occurred in 65 (14%) patients. Coronary CTA demonstrated a high prevalence of CAD (85%), mostly non-obstructive CAD (51%). Furthermore, patients with a normal CTA had an excellent prognosis (event-rate 3%). An incremental increase in event-rate was observed with increasing CAC-risk category or coronary stenosis severity. Finally, obstructive (50-70%) or severe CAD (>70%) was independently predictive of events (HR 11.10 [2.52;48.79] (P = .001), HR 15.16 [3.01;76.36] (P = .001)). Obstructive (50-70%) or severe CAD (>70%) provided increased value over baseline risk factors. CONCLUSION: Coronary CTA provided prognostic value in diabetic patients without chest pain syndrome. Most importantly, the prognosis of patients with a normal CTA was excellent.

24 Article EANM procedural guidelines for radionuclide myocardial perfusion imaging with SPECT and SPECT/CT: 2015 revision. 2015

Verberne, Hein J / Acampa, Wanda / Anagnostopoulos, Constantinos / Ballinger, Jim / Bengel, Frank / De Bondt, Pieter / Buechel, Ronny R / Cuocolo, Alberto / van Eck-Smit, Berthe L F / Flotats, Albert / Hacker, Marcus / Hindorf, Cecilia / Kaufmann, Philip A / Lindner, Oliver / Ljungberg, Michael / Lonsdale, Markus / Manrique, Alain / Minarik, David / Scholte, Arthur J H A / Slart, Riemer H J A / Trägårdh, Elin / de Wit, Tim C / Hesse, Birger / Anonymous920840. ·Department of Nuclear Medicine, F2-238, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. h.j.verberne@amc.uva.nl. · Institute of Biostructures and Bioimaging, National Council of Research, Naples, Italy. · Center for Experimental Surgery, Clinical and Translational Research, Biomedical Research Foundation, Academy of Athens, Athens, Greece. · Department of Nuclear Medicine, Guy's Hospital - Guy's & St Thomas' Trust Foundation, London, UK. · Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany. · Department of Nuclear Medicine, OLV Hospital, Aalst, Belgium. · Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland. · Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy. · Department of Nuclear Medicine, F2-238, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. · Nuclear Medicine Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain. · Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria. · Department of Radiation Physics, Skåne University Hospital, Lund, Sweden. · Heart and Diabetes Center North Rhine-Westphalia, Institute for Radiology, Nuclear Medicine and Molecular Imaging, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany. · Department of Medical Radiation Physics, Lund University, Lund, Sweden. · Department of Clinical Physiology and Nuclear Medicine, Bispebjerg Hospital, Copenhagen, Denmark. · Department of Nuclear Medicine, Service Commun Investigations chez l'Homme, GIP Cyceron, Caen University Hospital, Caen, France. · Radiation Physics, Skåne University Hospital, Malmö, Sweden. · Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. · Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. · Clinical Physiology and Nuclear Medicine, Skåne University Hospital and Lund University, Malmö, Sweden. · Department of Clinical Physiology and Nuclear Medicine & PET, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark. ·Eur J Nucl Med Mol Imaging · Pubmed #26290421.

ABSTRACT: Since the publication of the European Association of Nuclear Medicine (EANM) procedural guidelines for radionuclide myocardial perfusion imaging (MPI) in 2005, many small and some larger steps of progress have been made, improving MPI procedures. In this paper, the major changes from the updated 2015 procedural guidelines are highlighted, focusing on the important changes related to new instrumentation with improved image information and the possibility to reduce radiation exposure, which is further discussed in relation to the recent developments of new International Commission on Radiological Protection (ICRP) models. Introduction of the selective coronary vasodilator regadenoson and the use of coronary CT-contrast agents for hybrid imaging with SPECT/CT angiography are other important areas for nuclear cardiology that were not included in the previous guidelines. A large number of minor changes have been described in more detail in the fully revised version available at the EANM home page: http://eanm.org/publications/guidelines/2015_07_EANM_FINAL_myocardial_perfusion_guideline.pdf .

25 Article HDL cholesterol, leptin and interleukin-6 predict high risk coronary anatomy assessed by CT angiography in patients with stable chest pain. 2015

Caselli, Chiara / De Graaf, Michiel A / Lorenzoni, Valentina / Rovai, Daniele / Marinelli, Martina / Del Ry, Silvia / Giannessi, Daniela / Bax, Jeroen J / Neglia, Danilo / Scholte, Arthur J. ·CNR, Institute of Clinical Physiology, Pisa, Italy. Electronic address: chiara.caselli@ifc.cnr.it. · Leiden University Medical Center, Leiden, The Netherlands. · Scuola Superiore Sant'Anna, Pisa, Italy. · CNR, Institute of Clinical Physiology, Pisa, Italy. · CNR, Institute of Clinical Physiology, Pisa, Italy; Fondazione Toscana G. Monasterio, Pisa, Italy. ·Atherosclerosis · Pubmed #25966440.

ABSTRACT: OBJECTIVES: Coronary computed tomography angiography (CTA) describes several features of coronary plaques, i.e. location, severity, and composition. Integrated CTA scores are able to identify individual patterns of higher risk. We sought to test whether circulating biomarkers related with metabolism and inflammation could predict high risk coronary anatomy at CTA in patients with stable chest pain. METHODS: We evaluated a panel of 17 biomarkers in 429 patients (60.3 ± 0.4 years, 268 males) with stable chest pain who underwent coronary CTA having been enrolled in the Evaluation of Integrated Cardiac Imaging (EVINCI) study. The individual CTA risk score was calculated combining plaque extent, severity, composition, and location. The presence and distribution of non-calcified, mixed and calcified plaques were analyzed in each patient. RESULTS: After adjustment for age, sex and medical treatment, high-density lipoprotein (HDL) cholesterol, leptin, and interleukin-6 (IL-6) were independent predictors of CTA risk score at multivariate analysis (P = 0.050, 0.002, and 0.007, respectively). Integrating these biomarkers with common clinical variables, a model was developed which showed a better discriminating ability than the Framingham Risk Score and the Euro-SCORE in identifying the patients with higher CTA risk score (area under the receiver-operating characteristics curve = 0.81, 0.63 and 0.71, respectively, P < 0.001). These three biomarkers were significantly altered in patients with mixed or non-calcified plaques. CONCLUSIONS: In patients with stable chest pain, low HDL cholesterol, low leptin and high IL-6 are independent predictors of high risk coronary anatomy as defined by an integrated CTA risk score.

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