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

被引:7
作者
Bittner, Daniel O. [1 ,2 ]
Klinghammer, Lutz [1 ]
Marwan, Mohamed [1 ]
Schmid, Jasmin [1 ]
Layritz, Christian [1 ]
Hoffmann, Udo [2 ]
Achenbach, Stephan [1 ]
Pflederer, Tobias [1 ]
机构
[1] Friedrich Alexander Univ Erlangen Nurnberg FAU, Univ Hosp Erlangen, Dept Cardiol, Ulmenweg 18, D-91054 Erlangen, Germany
[2] Harvard Med Sch, Massachusetts Gen Hosp, Cardiac MR PET CT Program, Boston, MA USA
关键词
Cardiovascular risk factors; coronary artery disease; coronary plaque; invasive coronary angiography; computed tomography; COMPUTED TOMOGRAPHIC ANGIOGRAPHY; INTERNATIONAL MULTICENTER REGISTRY; LONG-TERM PROGNOSIS; ALL-CAUSE MORTALITY; ACUTE CHEST-PAIN; CT ANGIOGRAPHY; INTRAVASCULAR ULTRASOUND; CARDIAC EVENTS; DIAGNOSTIC PERFORMANCE; CLINICAL-OUTCOMES;
D O I
10.1016/j.acra.2016.12.005
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
Rationale and Objectives: Cardiovascular (CV) disease is predominately influenced by CV risk factors and coronary computed tomography angiography (CTA) is capable of detecting early-stage coronary artery disease. We sought to determine the influence of CV risk factors on the prevalence of nonobstructive atherosclerosis in patients with normal-appearing coronary arteries in invasive coronary angiography (ICA). Materials and Methods: In this retrospective analysis, we included 60 consecutive symptomatic patients, having undergone ICA and coronary CTA. Coronary dual source CTA was performed using electrocardiogram-triggered retrospective gated image acquisition at 40%-70% of RR interval (tube voltage 100-120 kV, tube current time product 320-440 mAs, 60 mL contrast, and flow rate 6 mUs). Results: Out of 60 patients (32 men, mean age 61 11 years) with a normal coronary artery appearance in ICA, 45 (75%) patients showed atherosclerotic plaque in CTA. Plaque was present in 14 of 60 (23%) left main, 41 of 60 (68%) left anterior descending, 21 of 60 (35%) circumflex coronary arteries, and 24 of 60 (40%) right coronary arteries. More than 15% of all coronary artery segments showed detectable plaques. Interobserver agreement ranged from good to very good on a per-patient, per-vessel, and per-segment level. Patients with presence of plaque were significantly older (P = 0.005) and showed higher incidence of arterial hypertension (P = 0.019) as compared to individuals without coronary plaque in dual source computed tomography. Conclusions: The prevalence of coronary atherosclerosis by CTA is substantial in symptomatic patients with normal invasive coronary angiogram. Hypertension and older age significantly influence the prevalence of atherosclerotic plaque and highlight the importance of risk-modifying therapy. (C) 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
引用
收藏
页码:580 / 586
页数:7
相关论文
共 28 条
[1]   Prognostic value of absence or presence of coronary artery disease determined by 64-slice computed tomography coronary angiography A systematic review and meta-analysis [J].
Abdulla, Jawdat ;
Asferg, Camilla ;
Kofoed, Klaus Fuglsang .
INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING, 2011, 27 (03) :413-420
[2]  
Altman D. G., 1990, Practical Statistics for medical research, DOI DOI 10.1201/9780429258589
[3]   Diagnostic Performance of 64-Multidetector Row Coronary Computed Tomographic Angiography for Evaluation of Coronary Artery Stenosis in Individuals Without Known Coronary Artery Disease [J].
Budoff, Matthew J. ;
Dowe, David ;
Jollis, James G. ;
Gitter, Michael ;
Sutherland, John ;
Halamert, Edward ;
Scherer, Markus ;
Bellinger, Raye ;
Martin, Arthur ;
Benton, Robert ;
Delago, Augustin ;
Min, James K. .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2008, 52 (21) :1724-1732
[4]   Long-term prognosis associated with coronary calcification - Observations from a registry of 25,253 patients [J].
Budoff, Matthew J. ;
Shaw, Leslee J. ;
Liu, Sandy T. ;
Weinstein, Steven R. ;
Mosler, Tristen P. ;
Tseng, Philip H. ;
Flores, Ferdinand R. ;
Callister, Tracy Q. ;
Raggi, Paolo ;
Berman, Daniel S. .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2007, 49 (18) :1860-1870
[5]   Cardiovascular events with absent or minimal coronary calcification: The Multi-Ethnic Study of Atherosclerosis (MESA) [J].
Budoff, Matthew J. ;
McClelland, Robyn L. ;
Nasir, Khurram ;
Greenland, Philip ;
Kronmal, Richard A. ;
Kondos, George T. ;
Shea, Steven ;
Lima, Joao A. C. ;
Blumenthal, Roger S. .
AMERICAN HEART JOURNAL, 2009, 158 (04) :554-561
[6]   Prognostic and Therapeutic Implications of Statin and Aspirin Therapy in Individuals With Nonobstructive Coronary Artery Disease Results From the CONFIRM (Coronary CT Angiography Evaluation For Clinical Outcomes: An International Multicenter Registry) Registry [J].
Chow, Benjamin J. W. ;
Small, Gary ;
Yam, Yeung ;
Chen, Li ;
McPherson, Ruth ;
Achenbach, Stephan ;
Al-Mallah, Mouaz ;
Berman, Daniel S. ;
Budoff, Matthew J. ;
Cademartiri, Filippo ;
Callister, Tracy Q. ;
Chang, Hyuk-Jae ;
Cheng, Victor Y. ;
Chinnaiyan, Kavitha ;
Cury, Ricardo ;
Delago, Augustin ;
Dunning, Allison ;
Feuchtner, Gundrun ;
Hadamitzky, Martin ;
Hausleiter, Joerg ;
Karlsberg, Ronald P. ;
Kaufmann, Philipp A. ;
Kim, Yong-Jin ;
Leipsic, Jonathon ;
LaBounty, Troy ;
Lin, Fay ;
Maffei, Erica ;
Ralf, Gilbert L. ;
Shaw, Leslee J. ;
Villines, Todd C. ;
Min, James K. .
ARTERIOSCLEROSIS THROMBOSIS AND VASCULAR BIOLOGY, 2015, 35 (04) :981-U271
[7]   Coronary calcium as a predictor of coronary events in four racial or ethnic groups [J].
Detrano, Robert ;
Guerci, Alan D. ;
Carr, J. Jeffrey ;
Bild, Diane E. ;
Burke, Gregory ;
Folsom, Aaron R. ;
Liu, Kiang ;
Shea, Steven ;
Szklo, Moyses ;
Bluemke, David A. ;
O'Leary, Daniel H. ;
Tracy, Russell ;
Watson, Karol ;
Wong, Nathan D. ;
Kronmal, Richard A. .
NEW ENGLAND JOURNAL OF MEDICINE, 2008, 358 (13) :1336-1345
[8]   Coronary CT angiography versus intravascular ultrasound for estimation of coronary stenosis and atherosclerotic plaque burden: A meta-analysis [J].
Fischer, Collin ;
Hulten, Edward ;
Belur, Pallavi ;
Smith, Ryan ;
Voros, Szilard ;
Villines, Todd C. .
JOURNAL OF CARDIOVASCULAR COMPUTED TOMOGRAPHY, 2013, 7 (04) :256-266
[9]   Association of cardiac events with coronary artery disease detected by 64-slice or greater coronary CT angiography: A systematic review and meta-analysis [J].
Habib, Phillip J. ;
Green, Jacinta ;
Butterfield, Ryan C. ;
Kuntz, Gretchen M. ;
Murthy, Raguveer ;
Kraemer, Dale F. ;
Percy, Robert F. ;
Miller, Alan B. ;
Strom, Joel A. .
INTERNATIONAL JOURNAL OF CARDIOLOGY, 2013, 169 (02) :112-120
[10]   Prognostic Value of Coronary Computed Tomographic Angiography for Prediction of Cardiac Events in Patients With Suspected Coronary Artery Disease [J].
Hadamitzky, Martin ;
Freissmuth, Barbara ;
Meyer, Tanja ;
Hein, Franziska ;
Kastrati, Adnan ;
Martinoff, Stefan ;
Schoemig, Albert ;
Hausleiter, Joerg .
JACC-CARDIOVASCULAR IMAGING, 2009, 2 (04) :404-411