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Coronary Artery Disease: HELP
Articles by Arthur J. H. A. Scholte
Based on 50 articles published since 2010
(Why 50 articles?)
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Between 2010 and 2020, A. Scholte wrote the following 50 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 Impact of Clinical Characteristics and Statins on Coronary Plaque Progression by Serial Computed Tomography Angiography. 2020

Smit, Jeff M / van Rosendael, Alexander R / El Mahdiui, Mohammed / Neglia, Danilo / Knuuti, Juhani / Saraste, Antti / Buechel, Ronny R / Teresinska, Anna / Pizzi, Maria N / Roque, Albert / Poddighe, Rosa / Mertens, Bart J / Caselli, Chiara / Rocchiccioli, Silvia / Parodi, Oberdan / Pelosi, Gualtiero / Scholte, Arthur J. ·Department of Cardiology, Leiden University Medical Center, The Netherlands (J.M.S., A.R.v.R., M.E.M., A.J.S.). · Fondazione Toscana Gabriele Monasterio, Pisa, Italy (D.N.). · Heart Center and PET Centre, Turku University Hospital, University of Turku, Finland (J.K., A.S.). · Department of Nuclear Medicine, Cardiac Imaging, University Hospital and University of Zurich, Switzerland (R.R.B.). · Instytut Kardiologii im. Prymasa Tysiąclecia Stefana Kardynała Wyszyńskiego, ul. Alpejska, Warszawa, Poland (A.T.). · Department of Cardiology (M.N.P.). · Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain (A.R.). · ASL12 U.O.C. Cardiologia, Viareggio, Italy (R.P.). · Department of Medical Statistics, Leiden University Medical Center, The Netherlands (B.J.M.). · Institute of Clinical Physiology CNR, Pisa, Italy (C.C., S.R., G.P.). · Institute of Information Science and Technologies CNR, Pisa, Italy (O.P.). ·Circ Cardiovasc Imaging · Pubmed #32160786.

ABSTRACT: Background Progression of coronary artery disease using serial coronary computed tomography angiography (CTA) is of clinical interest. Our primary aim was to prospectively assess the impact of clinical characteristics and statin use on quantitatively assessed coronary plaque progression in a low-risk study population during long-term follow-up. Methods Patients who previously underwent coronary CTA for suspected coronary artery disease were prospectively included to undergo follow-up coronary CTA. The primary end point was coronary artery disease progression, defined as the absolute annual increase in total, calcified, and noncalcified plaque volume by quantitative CTA analysis. Results In total, 202 patients underwent serial coronary CTA with a mean interscan period of 6.2±1.4 years. On a per-plaque basis, increasing age (β=0.070;

6 Article Anatomical and functional coronary imaging to predict long-term outcome in patients with suspected coronary artery disease: the EVINCI-outcome study. 2019

Neglia, Danilo / Liga, Riccardo / Caselli, Chiara / Carpeggiani, Clara / Lorenzoni, Valentina / Sicari, Rosa / Lombardi, Massimo / Gaemperli, Oliver / Kaufmann, Philipp A / Scholte, Arthur J H A / Underwood, S Richard / Knuuti, Juhani / Anonymous4171010. ·Cardiovascular Department, Fondazione Toscana G. Monasterio, Via G. Moruzzi 1, Pisa, Italy. · CNR, Institute of Clinical Physiology, Via G. Moruzzi 1, Pisa, Italy. · Sant'Anna School of Advanced Studies, Piazza Martiri della Libertà, 33, Pisa, Italy. · Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Via Roma, 67, Pisa, Italy. · Multimodality Cardiac Imaging Section, I.R.C.C.S. Policlinico San Donato, Piazza Edmondo Malan, 2, San Donato Milanese, Milano, Italy. · Cardiology, HeartClinic Hirslanden, Witellikerstrasse 40, Zürich, Switzerland. · Cardiac Imaging, Nuclear Medicine Department, University Hospital Zürich, Rämistrasse 100, Zürich, Switzerland. · Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Albinusdreef 2, RC, Leiden, The Netherlands. · Department of Non-Invasive Cardiac Imaging, Royal Brompton Hospital and Harefield Hospital, 250 King's Rd, Chelsea, London SW3 5UE, UK. · PET Center, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, Turku, Finland. ·Eur Heart J Cardiovasc Imaging · Pubmed #31701136.

ABSTRACT: AIMS: To investigate the prognostic relevance of coronary anatomy, coronary function, and early revascularization in patients with stable coronary artery disease (CAD). METHODS AND RESULTS: From March 2009 to June 2012, 430 patients with suspected CAD (61 ± 9 years, 62% men) underwent coronary anatomical imaging by computed tomography coronary angiography (CTCA) and coronary functional imaging followed by invasive coronary angiography (ICA) if at least one non-invasive test was abnormal. Obstructive CAD was documented by ICA in 119 patients and 90 were revascularized within 90 days of enrolment. Core laboratory analysis showed that 134 patients had obstructive CAD by CTCA (>50% stenosis in major coronary vessels) and 79 significant ischaemia by functional imaging [>10% left ventricular (LV) myocardium]. Over mean follow-up of 4.4 years, major adverse events (AEs) (all-cause death, non-fatal myocardial infarction, or hospital admission for unstable angina or heart failure) or AEs plus late revascularization (LR) occurred in 40 (9.3%) and 58 (13.5%) patients, respectively. Obstructive CAD at CTCA was the only independent imaging predictor of AEs [hazard ratio (HR) 3.2, 95% confidence interval (CI) 1.10-9.30; P = 0.033] and AEs plus LR (HR 4.3, 95% CI 1.56-11.81; P = 0.005). Patients with CAD in whom early revascularization was performed in the presence of ischaemia and deferred in its absence had fewer AEs, similar to patients without CAD (HR 2.0, 95% CI 0.71-5.51; P = 0.195). CONCLUSION: Obstructive CAD imaged by CTCA is an independent predictor of clinical outcome. Early management of CAD targeted to the combined anatomical and functional disease phenotype improves clinical outcome.

7 Article Association of PCSK9 plasma levels with metabolic patterns and coronary atherosclerosis in patients with stable angina. 2019

Caselli, Chiara / Del Turco, Serena / Ragusa, Rosetta / Lorenzoni, Valentina / De Graaf, Michiel / Basta, Giuseppina / Scholte, Arthur / De Caterina, Raffaele / Neglia, Danilo. ·CNR, Institute of Clinical Physiology, Via Moruzzi 1, 56100, Pisa, Italy. chiara.caselli@ifc.cnr.it. · CNR, Institute of Clinical Physiology, Via Moruzzi 1, 56100, Pisa, Italy. · Scuola Superiore Sant'Anna, Pisa, Italy. · Leiden University Medical Center, Leiden, The Netherlands. · Institute of Cardiology, University of Pisa, Pisa, Italy. · Fondazione Toscana G. Monasterio, Pisa, Italy. ·Cardiovasc Diabetol · Pubmed #31672148.

ABSTRACT: OBJECTIVE: Aim of this study was to evaluate the relationship of plasma PCSK9 with metabolic and inflammatory profile and coronary atherosclerotic burden in patients with suspected CAD enrolled in the EVINCI study. METHODS: PCSK9 was measured in 539 patients (60.3 ± 8.6 years, 256 males) with symptoms of CAD characterized by risk factors, bio-humoral profiles, and treatment. N = 412 patients underwent coronary computed tomography angiography (CTA) to assess the presence and characteristics of coronary atherosclerosis. A CTA score, combining extent, severity, composition, and location of plaques was computed. RESULTS: Patients were divided according to PCSK9 quartiles: I (< 136 ng/mL), II-III (136-266 ng/mL), and IV quartile (> 266 ng/mL). Compared with patients in quartile IV, patients in quartile I had a higher prevalence of the metabolic syndrome and higher values of body mass index. LDL- and HDL-cholesterol were significantly lower in patients in the quartile I than in those in quartile IV. Coronary CTA documented normal vessels in 30% and obstructive CAD in 35% of cases without differences among PCSK9 quartiles. Compared with patients with the highest levels, patients with the lowest PCSK9 levels had a higher CTA score mainly due to higher number of mixed non-obstructive coronary plaques. At multivariable analysis including clinical, medications, and lipid variables, PCSK9 was an independent predictor of the CTA score (coefficient - 0.129, SE 0.03, P < 0.0001), together with age, male gender, statins, interleukin-6, and leptin. CONCLUSION: In patients with stable CAD, low PCSK9 plasma levels are associated with a particular metabolic phenotype (low HDL cholesterol, the metabolic syndrome, obesity, insulin resistance and diabetes) and diffuse non-obstructive coronary atherosclerosis. Trial registration ClinicalTrials.gov NCT00979199. Registered September 17, 2009.

8 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.

9 Article Coronary Calcium Characteristics as Predictors of Major Adverse Cardiac Events in Symptomatic Patients: Insights From the CORE 320 Multinational Study. 2019

Lo-Kioeng-Shioe, Mallory S / Vavere, Andrea L / Arbab-Zadeh, Armin / Schuijf, Joanne D / Rochitte, Carlos E / Chen, Marcus Y / Rief, Matthias / Kofoed, Klaus F / Clouse, Melvin E / Scholte, Arthur J / Miller, Julie M / Betoko, Aisha / Blaha, Michael J / Cox, Christopher / Deckers, Jaap W / Lima, Joao A C. ·1 Department of Cardiology Johns Hopkins Hospital and School of Medicine Baltimore MD. · 2 Department of Cardiology Erasmus Medical Center Erasmus University Rotterdam Rotterdam the Netherlands. · 3 Toshiba Medical Systems Europe BV Zoetermeer the Netherlands. · 4 Department of Cardiology InCor Heart Lung and Blood Institute University of Sao Paulo Medical School Sao Paulo Brazil. · 5 National Heart Lung and Blood Institute National Institutes of Health Bethesda MD. · 6 Department of Radiology Charité Medical School Humboldt Berlin, Germany. · 7 Department of Cardiology Heart Center University of Copenhagen Copenhagen Denmark. · 8 Department of Cardiology Beth Israel Deaconess Medical Center Harvard University Boston MA. · 9 Department of Cardiology Leiden University Medical Center Leiden the Netherlands. · 10 Johns Hopkins Bloomberg School of Public Health Baltimore MD. ·J Am Heart Assoc · Pubmed #30879377.

ABSTRACT: Background The predictive value of coronary artery calcium ( CAC ) has been widely studied; however, little is known about specific characteristics of CAC that are most predictive. We aimed to determine the independent associations of Agatston score, CAC volume, CAC area, CAC mass, and CAC density score with major adverse cardiac events in patients with suspected coronary artery disease. Methods and Results A total of 379 symptomatic participants, aged 45 to 85 years, referred for invasive coronary angiography, who underwent coronary calcium scanning and computed tomography angiography as part of the CORE 320 (Combined Noninvasive Coronary Angiography and Myocardial Perfusion Imaging Using 320 Detector Computed Tomography) study, were included. Agatston score, CAC volume, area, mass, and density were computed on noncontrast images. Stenosis measurements were made on contrast-enhanced images. The primary outcome of 2-year major adverse cardiac events (30 revascularizations [>182 days of index catheterization], 5 myocardial infarctions, 1 cardiac death, 9 hospitalizations, and 1 arrhythmia) occurred in 32 patients (8.4%). Associations were estimated using multivariable proportional means models. Median age was 62 (interquartile range, 56-68) years, 34% were women, and 56% were white. In separate models, the Agatston, volume, and density scores were all significantly associated with higher risk of major adverse cardiac events after adjustment for age, sex, race, and statin use; density was the strongest predictor in all CAC models. CAC density did not provide incremental value over Agatston score after adjustment for diameter stenosis, age, sex, and race. Conclusions In symptomatic patients, CAC density was the strongest independent predictor of major adverse cardiac events among CAC scores, but it did not provide incremental value beyond the Agatston score after adjustment for diameter stenosis.

10 Article Superior Risk Stratification With Coronary Computed Tomography Angiography Using a Comprehensive Atherosclerotic Risk Score. 2019

van Rosendael, Alexander R / Shaw, Leslee J / Xie, Joe X / Dimitriu-Leen, Aukelien C / Smit, Jeff M / Scholte, Arthur J / van Werkhoven, Jacob M / Callister, Tracy Q / DeLago, Augustin / Berman, Daniel S / Hadamitzky, Martin / Hausleiter, Jeorg / Al-Mallah, Mouaz H / Budoff, Matthew J / Kaufmann, Philipp A / Raff, Gilbert / Chinnaiyan, Kavitha / Cademartiri, Filippo / Maffei, Erica / Villines, Todd C / Kim, Yong-Jin / Feuchtner, Gudrun / Lin, Fay Y / Jones, Erica C / Pontone, Gianluca / Andreini, Daniele / Marques, Hugo / Rubinshtein, Ronen / Achenbach, Stephan / Dunning, Allison / Gomez, Millie / Hindoyan, Niree / Gransar, Heidi / Leipsic, Jonathon / Narula, Jagat / Min, James K / Bax, Jeroen J. ·Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York. · Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia. · Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands. · Tennessee Heart and Vascular Institute, Hendersonville, Tennessee. · Capitol Cardiology Associates, Albany, New York. · Department of Imaging, Cedars Sinai Medical Center, Los Angeles, California. · Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany. · King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King AbdulAziz Cardiac Center, Ministry of National Guard, Health Affairs, Riyadh, Saudi Arabia. · Department of Medicine, Harbor UCLA Medical Center, Los Angeles, California. · University Hospital, Zurich, Switzerland. · William Beaumont Hospital, Royal Oaks, Michigan. · Cardiovascular Imaging Center, IRCCS SDN, Naples, Italy. · Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy. · Department of Medicine, Walter Reed National Military Medical Center, Bethesda. · Seoul National University Hospital, Seoul, South Korea. · Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria. · Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York. · Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy. · UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal. · Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. · Department of Medicine, University of Erlangen, Erlangen, Germany. · Duke Clinical Research Institute, Durham, North Carolina. · Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada. · Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York. · Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: j.j.bax@lumc.nl. ·JACC Cardiovasc Imaging · Pubmed #30660516.

ABSTRACT: OBJECTIVES: This study was designed to assess the prognostic value of a new comprehensive coronary computed tomography angiography (CTA) score compared with the stenosis severity component of the Coronary Artery Disease-Reporting and Data System (CAD-RADS). BACKGROUND: Current risk assessment with coronary CTA is mainly focused on maximal stenosis severity. Integration of plaque extent, location, and composition in a comprehensive model may improve risk stratification. METHODS: A total of 2,134 patients with suspected but without known CAD were included. The predictive value of the comprehensive CTA score (ranging from 0 to 42 and divided into 3 groups: 0 to 5, 6 to 20, and >20) was compared with the CAD-RADS combined into 3 groups (0% to 30%, 30% to 70% and ≥70% stenosis). Its predictive performance was internally and externally validated (using the 5-year follow-up dataset of the CONFIRM [Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry], n = 1,971). RESULTS: The mean age of patients was 55 ± 13 years, mean follow-up 3.6 ± 2.8 years, and 130 events (myocardial infarction or death) occurred. The new, comprehensive CTA score showed strong and independent predictive value using the Cox proportional hazard analysis. A model including clinical variables plus comprehensive CTA score showed better discrimination of events compared with a model consisting of clinical variables plus CAD-RADS (0.768 vs. 0.742, p = 0.001). Also, the comprehensive CTA score correctly reclassified a significant proportion of patients compared with the CAD-RADS (net reclassification improvement 12.4%, p < 0.001). Good predictive accuracy was reproduced in the external validation cohort. CONCLUSIONS: The new comprehensive CTA score provides better discrimination and reclassification of events compared with the CAD-RADS score based on stenosis severity only. The score retained similar prognostic accuracy when externally validated. Anatomic risk scores can be improved with the addition of extent, location, and compositional measures of atherosclerotic plaque. (Comprehensive CTA risk score calculator is available at: http://18.224.14.19/calcApp/).

11 Article Characterization of functionally significant coronary artery disease by a coronary computed tomography angiography-based index: a comparison with positron emission tomography. 2019

Anagnostopoulos, Constantinos D / Siogkas, Panagiotis K / Liga, Riccardo / Benetos, Georgios / Maaniitty, Teemu / Sakellarios, Antonis I / Koutagiar, Iosif / Karakitsios, Ioannis / Papafaklis, Michail I / Berti, Valentina / Sciagrà, Roberto / Scholte, Arthur J H A / Michalis, Lampros K / Gaemperli, Oliver / Kaufmann, Philipp A / Pelosi, Gualtiero / Parodi, Oberdan / Knuuti, Juhani / Fotiadis, Dimitrios I / Neglia, Danilo. ·Biomedical Research Foundation of Academy of Athens, 4 Soranou Ephesiou, Athens, Greece. · University of Ioannina, Materials Science and Engineering, Ioannina, Greece. · Biomedical Research Institute, FORTH, Ioannina, Greece. · Institute of Clinical Physiology, National Research Council, Pisa, IT, Italy. · First Department of Cardiology, Hippokration Hospital, National and Kapodistrian University Medical School, Athens, Greece. · Turku PET Centre, Turku, Finland. · University of Ioannina Medical School Ioannina, Greece. · Department of Biomedical, Experimental and Clinical Sciences, Mario Serio, Nuclear Medicine Unit, University of Florence, Largo Brambilla 3, Florence, FI, Italy. · Leiden University Medical Center, Leiden, Netherlands. · University Hospital Zurich, Zurich, Switzerland. · Fondazione Toscana Gabriele Monasterio, Pisa, IT, Italy. ·Eur Heart J Cardiovasc Imaging · Pubmed #30629151.

ABSTRACT: AIMS: To test the hypothesis that virtual functional assessment index (vFAI) is related with regional flow parameters derived by quantitative positron emission tomography (PET) and can be used to assess abnormal vasodilating capability in coronary vessels with stenotic lesions at coronary computed tomography angiography (CCTA). METHODS AND RESULTS: vFAI, stress myocardial blood flow (MBF), and myocardial flow reserve (MFR) were assessed in 78 patients (mean age 62.2 ± 7.7 years) with intermediate pre-test likelihood of coronary artery disease (CAD). Coronary stenoses ≥50% were considered angiographically significant. PET was considered positive for significant CAD, when more than one contiguous segments showed stress MBF ≤2.3 mL/g/min for 15O-water or <1.79 mL/g/min for 13N-ammonia. MFR thresholds were ≤2.5 and ≤2.0, respectively. vFAI was lower in vessels with abnormal stress MBF (0.76 ± 0.10 vs. 0.89 ± 0.07, P < 0.001) or MFR (0.80 ± 0.10 vs. 0.89 ± 0.07, P < 0.001). vFAI had an accuracy of 78.6% and 75% in unmasking abnormal stress MBF and MFR in 15O-water and 82.7% and 71.2% in 13N-ammonia studies, respectively. Addition of vFAI to anatomical CCTA data increased the ability for predicting abnormal stress MBF and MFR in 15O-water studies [AUCccta + vfai = 0.866, 95% confidence interval (CI) 0.783-0.949; P = 0.013 and AUCccta + vfai = 0.737, 95% CI 0.648-0.825; P = 0.007, respectively]. An incremental value was also demonstrated for prediction of stress MBF (AUCccta + vfai = 0.887, 95% CI 0.799-0.974; P = 0.001) in 13N-ammonia studies. A similar trend was recorded for MFR (AUCccta + vfai = 0.780, 95% CI 0.632-0.929; P = 0.13). CONCLUSION: vFAI identifies accurately the presence of impaired vasodilating capability. In combination with anatomical data, vFAI enhances the diagnostic performance of CCTA.

12 Article Referral of patients for fractional flow reserve using quantitative flow ratio. 2019

Smit, Jeff M / Koning, Gerhard / van Rosendael, Alexander R / El Mahdiui, Mohammed / Mertens, Bart J / Schalij, Martin J / Jukema, J Wouter / Delgado, Victoria / Reiber, Johan H C / Bax, Jeroen J / Scholte, Arthur J. ·Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands. · Medis Medical Imaging Systems B.V., Schuttersveld 9, XG Leiden, The Netherlands. · Department of Medical Statistics, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands. · Department of Radiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands. ·Eur Heart J Cardiovasc Imaging · Pubmed #30535361.

ABSTRACT: AIMS: Quantitative flow ratio (QFR) is a recently developed technique to calculate fractional flow reserve (FFR) based on 3D quantitative coronary angiography and computational fluid dynamics, obviating the need for a pressure-wire and hyperaemia induction. QFR might be used to guide patient selection for FFR and subsequent percutaneous coronary intervention (PCI) referral in hospitals not capable to perform FFR and PCI. We aimed to investigate the feasibility to use QFR to appropriately select patients for FFR referral. METHODS AND RESULTS: Patients who underwent invasive coronary angiography in a hospital where FFR and PCI could not be performed and were referred to our hospital for invasive FFR measurement, were included. Angiogram images from the referring hospitals were retrospectively collected for QFR analysis. Based on QFR cut-off values of 0.77 and 0.86, our patient cohort was reclassified to 'no referral' (QFR ≥0.86), referral for 'FFR' (QFR 0.78-0.85), or 'direct PCI' (QFR ≤0.77). In total, 290 patients were included. Overall accuracy of QFR to detect an invasive FFR of ≤0.80 was 86%. Based on a QFR cut-off value of 0.86, a 50% reduction in patient referral for FFR could be obtained, while only 5% of these patients had an invasive FFR of ≤0.80 (thus, these patients were incorrectly reclassified to the 'no referral' group). Furthermore, 22% of the patients that still need to be referred could undergo direct PCI, based on a QFR cut-off value of 0.77. CONCLUSION: QFR is feasible to use for the selection of patients for FFR referral.

13 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.

14 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.

15 Article Applicability and accuracy of pretest probability calculations implemented in the NICE clinical guideline for decision making about imaging in patients with chest pain of recent onset. 2018

Roehle, Robert / Wieske, Viktoria / Schuetz, Georg M / Gueret, Pascal / Andreini, Daniele / Meijboom, Willem Bob / Pontone, Gianluca / Garcia, Mario / Alkadhi, Hatem / Honoris, Lily / Hausleiter, Jörg / Bettencourt, Nuno / Zimmermann, Elke / Leschka, Sebastian / Gerber, Bernhard / Rochitte, Carlos / Schoepf, U Joseph / Shabestari, Abbas Arjmand / Nørgaard, Bjarne / Sato, Akira / Knuuti, Juhani / Meijs, Matthijs F L / Brodoefel, Harald / Jenkins, Shona M M / Øvrehus, Kristian Altern / Diederichsen, Axel Cosmus Pyndt / Hamdan, Ashraf / Halvorsen, Bjørn Arild / Mendoza Rodriguez, Vladimir / Wan, Yung Liang / Rixe, Johannes / Sheikh, Mehraj / Langer, Christoph / Ghostine, Said / Martuscelli, Eugenio / Niinuma, Hiroyuki / Scholte, Arthur / Nikolaou, Konstantin / Ulimoen, Geir / Zhang, Zhaoqi / Mickley, Hans / Nieman, Koen / Kaufmann, Philipp A / Buechel, Ronny Ralf / Herzog, Bernhard A / Clouse, Melvin / Halon, David A / Leipsic, Jonathan / Bush, David / Jakamy, Reda / Sun, Kai / Yang, Lin / Johnson, Thorsten / Laissy, Jean-Pierre / Marcus, Roy / Muraglia, Simone / Tardif, Jean-Claude / Chow, Benjamin / Paul, Narinder / Maintz, David / Hoe, John / de Roos, Albert / Haase, Robert / Laule, Michael / Schlattmann, Peter / Dewey, Marc. ·Department of Radiology, Charité - Universitätsmedizin Berlin Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany. · Cardiology Department, Henri Mondor Hospital, University Paris Est Creteil, Créteil, France. · Centro Cardiologico Monzino, IRCCS, Milan, Italy. · Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy. · IJsselland Ziekenhuis, Capelle a/d IJssel, The Netherlands. · Montefiore, the University Hospital for the Albert Einstein College of Medicine, New York City, NY, USA. · Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland. · Aurora Health Care, Milwaukee, WI, USA. · Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-University of Munich, Munich, Germany. · Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Gaia, Portugal. · Department of Radiology and Nuclear Medicine Kantonsspital St. Gallen, St. Gallen, Switzerland. · Division of Cardiology, Cardiovascular Center, Cliniques Universitaires St. Luc, Institut de Recherche Clinique et Experimentale, Brussels, Belgium. · Heart Institute - InCor - University of São Paulo Medical School, São Paulo, Brazil. · Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA. · Department of Radiology, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. · Department Cardiology B, Aarhus University Hospital Skejby, Aarhus, Denmark. · Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. · Turku University Hospital and University of Turku, Turku, Finland. · Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands. · Department of Radiology, University of Regensburg, Regensburg, Germany. · Glasgow Royal Infirmary and Stobhill Hospital, Glasgow, UK. · Department of Cardiology, Odense University Hospital, Odense, Denmark. · Department of Cardiology Lillebælt Hospital -Vejle, Vejle, Denmark. · Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany. · Heart Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel. · Medical Department, Ostfold Hospital Trust, Fredrikstad, Norway. · National Institute of Cardiology and Cardiovascular, Surgery, Havana, Cuba. · Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan. · Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan. · Medizinische Klinik I (Kardiologie, Angiologie), Universitätsklinikum Giessen und Marburg GmbH, Giessen, Germany. · Department of Radiology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait. · Mubarak Al Kabeer Hospital, Jabriya, Kuwait. · Klinik für Innere Medizin III mit Schwerpunkt Kardiologie und Angiologie, UKSH, Kiel, Germany. · Kardiologische Klinik, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany. · Cardiologie diagnostique et interventionnelle, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France. · Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy. · Department of Medicine, St. Luke's International Hospital, Tokyo, Japan. · Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. · Department of Diagnostic and Interventional Radiology, Eberhard Karls Universität Tübingen, Tübingen, Germany. · Aleris Hospital, Oslo, Norway. · Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China. · Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands. · Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands. · Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland. · Department of Radiology, Beth Israel Deaconess, Harvard University, Boston, MA, USA. · Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel. · Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel. · Department of Radiology and Division of Cardiology UBC, St Paul's Hospital, Vancouver, Canada. · Department of Cardiology, Johns Hopkins University, Baltimore, MD, USA. · Department of Cardiology, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA. · Department of Interventional Cardiology, University Hospital Cochin, Paris, France. · Department of Radiology, Baotou Central Hospital, Baotou Shi, Inner Mongolia Province, China. · Department of Clinical Radiology, Hospital Grosshadern of the University of Munich, Munich, Germany. · Department of Diagnostic Imaging and Interventional Radiology, Bichat University Hospital, Paris, France. · Department of Clinical Radiology, Munich, Ludwig-Maximilians-University of Munich, Munich, Germany. · Cardiology Department, S. Chiara Hospital, Trento, Italy. · Research Center Montreal Heart Institute, Université de Montréal, Montréal, Canada. · University of Ottawa, Heart Institute, Ottawa, Canada. · Joint Department of Medical Imaging, University Health Network, Mount Sinai and Women's College Hospitals, Toronto, Canada. · University of Toronto, Toronto, Canada. · Institute and Polyclinic for Diagnostic Radiology, University of Cologne, Cologne, Germany. · Department of Diagnostic Radiology, Mt Elizabeth Hospital, Singapore, Singapore. · Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. · Department of Cardiology, Charité - Universitätsmedizin Berlin Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany. · Department of Medical Statistics, Informatics and Documentation, University Hospital of Friedrich Schiller University Jena, Jena, Germany. · Department of Radiology, Charité - Universitätsmedizin Berlin Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany. marc.dewey@charite.de. ·Eur Radiol · Pubmed #29556770.

ABSTRACT: OBJECTIVES: To analyse the implementation, applicability and accuracy of the pretest probability calculation provided by NICE clinical guideline 95 for decision making about imaging in patients with chest pain of recent onset. METHODS: The definitions for pretest probability calculation in the original Duke clinical score and the NICE guideline were compared. We also calculated the agreement and disagreement in pretest probability and the resulting imaging and management groups based on individual patient data from the Collaborative Meta-Analysis of Cardiac CT (CoMe-CCT). RESULTS: 4,673 individual patient data from the CoMe-CCT Consortium were analysed. Major differences in definitions in the Duke clinical score and NICE guideline were found for the predictors age and number of risk factors. Pretest probability calculation using guideline criteria was only possible for 30.8 % (1,439/4,673) of patients despite availability of all required data due to ambiguity in guideline definitions for risk factors and age groups. Agreement regarding patient management groups was found in only 70 % (366/523) of patients in whom pretest probability calculation was possible according to both models. CONCLUSIONS: Our results suggest that pretest probability calculation for clinical decision making about cardiac imaging as implemented in the NICE clinical guideline for patients has relevant limitations. KEY POINTS: • Duke clinical score is not implemented correctly in NICE guideline 95. • Pretest probability assessment in NICE guideline 95 is impossible for most patients. • Improved clinical decision making requires accurate pretest probability calculation. • These refinements are essential for appropriate use of cardiac CT.

16 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.

17 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.

18 Article Relationship Between Coronary Contrast-Flow Quantitative Flow Ratio and Myocardial Ischemia Assessed by SPECT MPI. 2017

Smit, Jeff M / Koning, Gerhard / van Rosendael, Alexander R / Dibbets-Schneider, Petra / Mertens, Bart J / Jukema, J Wouter / Delgado, Victoria / Reiber, Johan H C / Bax, Jeroen J / Scholte, Arthur J. ·Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Postal zone 2300 RC, Leiden, ZA, 2333, The Netherlands. · Medis medical imaging systems B.V., Leiden, The Netherlands. · Department of Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands. · Department of Medical Statistics, 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, Leiden, ZA, 2333, The Netherlands. a.j.h.a.scholte@lumc.nl. ·Eur J Nucl Med Mol Imaging · Pubmed #28685228.

ABSTRACT: PURPOSE: A new method has been developed to calculate fractional flow reserve (FFR) from invasive coronary angiography, the so-called "contrast-flow quantitative flow ratio (cQFR)". Recently, cQFR was compared to invasive FFR in intermediate coronary lesions showing an overall diagnostic accuracy of 85%. The purpose of this study was to investigate the relationship between cQFR and myocardial ischemia assessed by single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI). METHODS: Patients who underwent SPECT MPI and coronary angiography within 3 months were included. The cQFR computation was performed offline, using dedicated software. The cQFR computation was based on 3-dimensional quantitative coronary angiography (QCA) and computational fluid dynamics. The standard 17-segment model was used to determine the vascular territories. Myocardial ischemia was defined as a summed difference score ≥2 in a vascular territory. A cQFR of ≤0.80 was considered abnormal. RESULTS: Two hundred and twenty-four coronary arteries were analysed in 85 patients. Overall accuracy of cQFR to detect ischemia on SPECT MPI was 90%. In multivariable analysis, cQFR was independently associated with ischemia on SPECT MPI (OR per 0.01 decrease of cQFR: 1.10; 95% CI 1.04-1.18, p = 0.002), whereas clinical and QCA parameters were not. Furthermore, cQFR showed incremental value for the detection of ischemia compared to clinical and QCA parameters (global chi square 48.7 to 62.6; p <0.001). CONCLUSIONS: A good relationship between cQFR and SPECT MPI was found. cQFR was independently associated with ischemia on SPECT MPI and showed incremental value to detect ischemia compared to clinical and QCA parameters.

19 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.

20 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.

21 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.

22 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.

23 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.

24 Article Relation between quantitative coronary CTA and myocardial ischemia by adenosine stress myocardial CT perfusion. 2017

van Rosendael, Alexander R / Kroft, Lucia J / Broersen, Alexander / Dijkstra, Jouke / van den Hoogen, Inge J / van Zwet, Erik W / Bax, Jeroen J / de Graaf, Michiel A / Scholte, Arthur J. ·Department of Cardiology, Heart and Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, 2300 RC, Leiden, The Netherlands. · The Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands. · Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. · Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. · Department of Medical Statistics and Bio-informatics, Leiden University Medical Center, Leiden, The Netherlands. · Department of Cardiology, Heart and Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, 2300 RC, Leiden, The Netherlands. a.j.h.a.scholte@lumc.nl. ·J Nucl Cardiol · Pubmed #26860110.

ABSTRACT: BACKGROUND: Coronary-computed tomography angiography (CTA) has limited accuracy to predict myocardial ischemia. Besides luminal area stenosis, other coronary plaque morphology and composition parameters may help to assess ischemia. With the integration of coronary CTA and adenosine stress CT myocardial perfusion (CTP), reliable information regarding coronary anatomy and function can be derived in one procedure. This analysis aimed to investigate the association between coronary stenosis severity, plaque composition and morphology and the presence of ischemia measured with adenosine stress myocardial CTP. METHODS AND RESULTS: 84 patients (age, 62 ± 10 years; 48% men) who underwent sequential coronary CTA and adenosine stress myocardial CT perfusion were analyzed. Automated quantification was performed in all coronary lesions (quantitative CTA). Downstream myocardial ischemia was assessed by visual analysis of the rest and stress CTP images and defined as a summed difference score of ≥1. One or more coronary plaques were present in 146 coronary arteries of which 31 (21%) were ischemia-related. Of the lesions with a stenosis percentage <50%, 50%-70%, and >70%, respectively, 9% (6/67), 18% (9/51), and 57% (16/28) demonstrated downstream ischemia. Furthermore, mean plaque burden, plaque volume, lesion length, maximal plaque thickness, and dense calcium volume were significantly higher in ischemia-related lesions, but only stenosis severity (%) (OR 1.06; 95% CI 1.02-1.10; P = .006) and lesion length (mm) (OR 1.26; 95% CI 1.02-1.55; P = .029) were independent correlates. CONCLUSIONS: Increasing stenosis percentage by quantitative CTA is positively correlated to myocardial ischemia measured with adenosine stress myocardial CTP. However, stenosis percentage remains a moderate determinant. Lumen area stenosis and lesion length were independently associated with ischemia, adjusted for coronary plaque volume, mean plaque burden, maximal lesion thickness, and dense calcium volume.

25 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.

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