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Browsing by Author "Callister, TQ"

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  • Impact of Age and Sex on Left Ventricular Function Determined by Coronary Computed Tomographic Angiography: Results From the Prospective Multicentre CONFIRM Study
    Publication . Gebhard, C; Buechel, RR; Stähli, BE; Gransar, H; Achenbach, S; Berman, DS; Budoff, MJ; Callister, TQ; Chow, B; Dunning, A; Al-Mallah, MH; Cademartiri, F; Chinnaiyan, K; Rubinshtein, R; Pinto Marques, H; DeLago, A; Villines, TC; Hadamitzky, M; Hausleiter, J; Shaw, LJ; Cury, RC; Feuchtner, G; Kim, YJ; Maffei, E; Raff, G; Pontone, G; Andreini, D; Chang, HJ; Leipsic, J; Min, JK; Kaufmann, PA
    BACKGROUND: Left ventricular (LV) volumetric and functional parameters measured with cardiac computed tomography (cardiac CT) augment risk prediction and discrimination for future mortality. Gender- and age-specific standard values for LV dimensions and systolic function obtained by 64-slice cardiac CT are lacking. METHODS AND RESULTS: 1155 patients from the Coronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter registry (54.5% males, mean age 53.1 ± 12.4 years, range: 18-92 years) without known coronary artery disease (CAD), structural heart disease, diabetes, or hypertension who underwent cardiac CT for various indications were categorized according to age and sex. A cardiac CT data acquisition protocol was used that allowed volumetric measuring of LV function. Image interpretation was performed at each site. Patients with significant CAD (>50% stenosis) on cardiac CT were excluded from the analysis. Overall, mean left ventricular ejection fraction (LVEF) was higher in women when compared with men (66.6 ± 7.7% vs. 64.6 ± 8.1%, P < 0.001). This gender-difference in overall LVEF was caused by a significantly higher LVEF in women ≥70 years when compared with men ≥70 years (69.95 ± 8.89% vs. 65.50 ± 9.42%, P = 0.004). Accordingly, a significant increase in LVEF was observed with age (P = 0.005 for males and P < 0.001 for females), which was more pronounced in females (5.21%) than in males (2.6%). LV end-diastolic volume decreased in females from 122.48 ± 27.87 (<40 years) to 95.56 ± 23.17 (>70 years; P < 0.001) and in males from 155.22 ± 35.07 (<40 years) to 130.26 ± 27.18 (>70 years; P < 0.001). CONCLUSION: Our findings indicate that the LV undergoes a lifelong remodelling and highlight the need for age and gender adjusted reference values.
    2017-09-01Journal article Open access Show more
  • Predictive Value of Age- and Sex-Specific Nomograms of Global Plaque Burden on Coronary Computed Tomography Angiography for Major Cardiac Events
    Publication . Naoum, C; Berman, D; Ahmadi, A; Blanke, P; Gransar, H; Narula, J; Shaw, LJ; Kritharides, L; Achenbach, S; Al-Mallah, M; Andreini, D; Budoff, MJ; Cademartiri, F; Callister, TQ; Chang, HJ; Chinnaiyan, K; Chow, B; Cury, R; DeLago, A; Dunning, A; Feuchtner, G; Hadamitzky, M; Hausleiter, J; Kaufmann, PA; Kim, YJ; Maffei, E; Marquez, H; Pontone, G; Raff, G; Rubinshtein, R; Villines, TC; Min, J; Leipsic, J
    Background: Age-adjusted coronary artery disease (CAD) burden identified on coronary computed tomography angiography predicts major adverse cardiovascular event (MACE) risk; however, it seldom contributes to clinical decision making because of a lack of nomographic data. We aimed to develop clinically pragmatic age- and sex-specific nomograms of CAD burden using coronary computed tomography angiography and to validate their prognostic use. Methods and results: Patients prospectively enrolled in phase I of the CONFIRM registry (Coronary CT Angiography Evaluation for Clinical Outcomes) were included (derivation cohort: n=21,132; 46% female) to develop CAD nomograms based on age-sex percentiles of segment involvement score (SIS) at each year of life (40-79 years). The relationship between SIS age-sex percentiles (SIS%) and MACE (all-cause death, myocardial infarction, unstable angina, and late revascularization) was tested in a nonoverlapping validation cohort (phase II, CONFIRM registry; n=3030, 44% female) by stratifying patients into 3 SIS% groups (≤50th, 51-75th, and >75th) and comparing annualized MACE rates and time to MACE using multivariable Cox proportional hazards models adjusting for Framingham risk and chest pain typicality. Age-sex percentiles were well fitted to second-order polynomial curves (men: R2=0.86±0.12; women: R2=0.86±0.14). Using the nomograms, there were 1576, 965, and 489 patients, respectively, in the ≤50th, 51-75th, and >75th SIS% groups. Annualized event rates were higher among patients with greater CAD burden (2.1% [95% confidence interval: 1.7%-2.7%], 3.9% [95% confidence interval: 3.0%-5.1%], and 7.2% [95% confidence interval: 5.4%-9.6%] in ≤50th, 51-75th, and >75th SIS% groups, respectively; P<0.001). Adjusted MACE risk was significantly increased among patients in SIS% groups above the median compared with patients below the median (hazard ratio [95% confidence interval]: 1.9 [1.3-2.8] for 51-75th SIS% group and 3.4 [2.3-5.0] for >75th SIS% group; P<0.01 for both). Conclusions: We have developed clinically pragmatic age- and sex-specific nomograms of CAD prevalence using coronary computed tomography angiography findings. Global plaque burden measured using SIS% is predictive of cardiac events independent of traditional risk assessment.
    2017-03Journal article Open access Show more