Repository logo

Browsing by Author "Dunning, A"

Now showing 1 - 4 of 4
  • 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
  • Long-Term Prognostic Impact of CT-Leaman Score in Patients with Non-Obstructive CAD: Results from the COronary CT Angiography EvaluatioN For Clinical Outcomes InteRnational Multicenter (CONFIRM) Study
    Publication . Andreini, D; Pontone, G; Mushtaq, S; Gransar, H; Conte, E; Bartorelli, AL; Pepi, M; Opolski, M; Ó Hartaigh, B; Berman, D; Budoff, M; Achenbach, S; Al-Mallah, M; Cademartiri, Fi; Callister, T; Chang, HJ; Chinnaiyan, K; Chow, B; Cury, R; Delago, A; Hadamitzky, M; Hausleiter, J; Feuchtner, G; Kim, YJ; Kaufmann, PA; Leipsic, J; Lin, FY; Maffei, E; Raff, G; Shaw, LJ; Villines, TC; Dunning, A; Marques, H; Rubinshtein, R; Hindoyan, N; Gomez, M; Min, JK
    BACKGROUND: Non-obstructive coronary artery disease (CAD) identified by coronary computed tomography angiography (CCTA) demonstrated prognostic value. CT-adapted Leaman score (CT-LeSc) showed to improve the prognostic stratification. Aim of the study was to evaluate the capability of CT-LeSc to assess long-term prognosis of patients with non-obstructive (CAD). METHODS: From 17 centers, we enrolled 2402 patients without prior CAD history who underwent CCTA that showed non-obstructive CAD and provided complete information on plaque composition. Patients were divided into a group without CAD and a group with non-obstructive CAD (<50% stenosis). Segment-involvement score (SIS) and CT-LeSc were calculated. Outcomes were non-fatal myocardial infarction (MI) and the combined end-point of MI and all-cause mortality. RESULTS: Patient mean age was 56±12years. At follow-up (mean 59.8±13.9months), 183 events occurred (53 MI, 99 all-cause deaths and 31 late revascularizations). CT-LeSc was the only multivariate predictor of MI (HRs 2.84 and 2.98 in two models with Framingham and risk factors, respectively) and of MI plus all-cause mortality (HR 2.48 and 1.94 in two models with Framingham and risk factors, respectively). This was confirmed by a net reclassification analysis confirming that the CT-LeSc was able to correctly reclassify a significant proportion of patients (cNRI 0.28 and 0.23 for MI and MI plus all-cause mortality, respectively) vs. baseline model, whereas SIS did not. CONCLUSION: CT-LeSc is an independent predictor of major acute cardiac events, improving prognostic stratification of patients with non-obstructive CAD.
    2017-03-15Journal 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
  • Prognostic Value of Age Adjusted Segment Involvement Score As Measured by Coronary Computed Tomography: a Potential Marker of Vascular Age
    Publication . Ayoub, C; Kritharides, L; Yam, Y; Chen, L; Hossain, A; Achenbach, S; Al-Mallah, M; Andreini, D; Berman, D; Budoff, M; Cademartiri, F; Callister, T; Chang, HJ; Chinnaiyan, K; Cury, R; Delago, A; Dunning, A; Feuchtner, G; Gomez, M; Gransar, H; Hadamitzky, M; Hausleiter, J; Hindoyan, N; Kaufmann, P; Kim, YJ; Leipsic, J; Maffei, E; Marques, H; Pontone, G; Raff, G; Rubinshtein, R; Shaw, L; Villines, T; Min, J; Chow, B
    Extent of coronary atherosclerotic disease (CAD) burden on coronary computed tomography angiography (CCTA) as measured by segment involvement score (SIS) has a prognostic value. We sought to investigate the incremental prognostic value of 'age adjusted SIS' (aSIS), which may be a marker of premature atherosclerosis and vascular age. Consecutive patients were prospectively enrolled into the CONFIRM (Coronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicentre) multinational observational study. Patients were followed for the outcome of all-cause death. aSIS was calculated on CCTA for each patient, and its incremental prognostic value was evaluated. A total of 22,211 patients [mean age 58.5 ± 12.7 years, 55.8% male) with a median follow-up of 27.3 months (IQR 17.8, 35.4)] were identified. After adjustment for clinical factors and presence of obstructive CAD, higher aSIS was associated with increased death on multivariable analysis, with hazard ratio (HR) 2.40 (1.83-3.16, p < 0.001), C-statistic 0.723 (0.700-0.756), net reclassification improvement (NRI) 0.36 (0.26-0.47, p < 0.001), and relative integrated discrimination improvement (IDI) 0.33 (p = 0.009). aSIS had HR 3.48 (2.33-5.18, p < 0.001) for mortality in those without obstructive CAD, compared to HR 1.79 (1.25-2.58, p = 0.02) in those with obstructive CAD. In conclusion, aSIS has an incremental prognostic value to traditional risk factors and obstructive CAD, and may enhance CCTA risk stratification.
    2018-11Journal article Open access Show more