Journal of cardiovascular computed tomography最新文献

{"title":"Cost-effectiveness of ultrahigh-resolution photon-counting detector coronary CT angiography for the evaluation of stable chest pain.","authors":"Milán Vecsey-Nagy, Tilman Emrich, Giuseppe Tremamunno, Dmitrij Kravchenko, Muhammad Taha Hagar, Gerald S Laux, U Joseph Schoepf, Jim O'Doherty, Melinda Boussoussou, Bálint Szilveszter, Pál Maurovich-Horvat, Thomas Kroencke, Ismail Mikdat Kabakus, Pal Spruill Suranyi, Akos Varga-Szemes, Josua A Decker","doi":"10.1016/j.jcct.2024.10.011","DOIUrl":"https://doi.org/10.1016/j.jcct.2024.10.011","url":null,"abstract":"<p><strong>Background: </strong>The increased specificity of ultrahigh-resolution (UHR) photon-counting detector (PCD)-CT over energy-integrating detector (EID)-CT for coronary CT angiography (CCTA) could defer unwarranted downstream tests. The objective of the study was to simulate the cost-effectiveness of UHR CCTA in stable chest pain patients with coronary calcifications.</p><p><strong>Methods: </strong>A decision and simulation model was developed using Monte Carlo simulations with 1000 bootstrap resamples to estimate the costs associated with PCD-CT in lieu of EID-CT for CCTA and the referral for subsequent testing. The model was constructed using the diagnostic accuracy metrics of 55 coronary lesions in patients who underwent CCTA on both CT systems and subsequent invasive coronary angiography (ICA). Sensitivity and specificity were defined for each Coronary Artery Disease Reporting and Data System category. The aggregate healthcare expenditures were derived from the hospital billing system.</p><p><strong>Results: </strong>Assuming a projected cohort of 15,000 patients over the lifetime of the PCD-CT, its implementation resulted in a 18.9 ​% reduction in the number of functional follow-up tests (6330.3 ​± ​59.5 vs. 5135.7 ​± ​60.6, p ​< ​0.001), a 6.0 ​% reduction in performed ICAs (1447.7 ​± ​36.2 vs. 1360.2 ​± ​34.7, p ​< ​0.001), and a 9.4 ​% decrease in major procedure-related complications. Over a 10-year expected life expectancy, PCD-CT led to an average cost saving of $794.50 ​± ​18.50 per patient and an overall cost difference of $11,917,500 ​± ​4,350,169.</p><p><strong>Conclusions: </strong>PCD-CT has the potential to reduce the financial burden on healthcare systems and procedure-related complications for stable chest pain patients with coronary calcification when compared to EID-CT.</p>","PeriodicalId":94071,"journal":{"name":"Journal of cardiovascular computed tomography","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142585432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic value of left ventricular mass measured on coronary computed tomography angiography.","authors":"Michael Abiragi, Melanie Chen, Billy Lin, Heidi Gransar, Damini Dey, Piotr Slomka, Sean W Hayes, Louise E Thomson, John D Friedman, Daniel S Berman, Donghee Han","doi":"10.1016/j.jcct.2024.10.010","DOIUrl":"https://doi.org/10.1016/j.jcct.2024.10.010","url":null,"abstract":"<p><strong>Background: </strong>Left ventricular (LV) mass is a well-established prognostic indicator for cardiovascular risk. Measurement of LV mass on coronary computed tomography angiography (CCTA) is considered optional. We aimed to assess for associations between LV mass measured on CCTA with all-cause mortality (ACM) risk and to determine age- and sex-specific distributions.</p><p><strong>Methods: </strong>We evaluated patients without known coronary artery disease (CAD) who underwent CCTA at a single center. We assessed age- and sex-specific distributions (10th, 25th, 50th, 75th, and 90th percentiles) of LV mass index. ACM, the primary endpoint, was recorded over a median period of 5.1 [interquartile range: 1.4-8.4] years. The association between LV mass and mortality risk was assessed using multivariable Cox models adjusted for age, sex, medical history, coronary artery calcium (CAC) score and CCTA stenosis.</p><p><strong>Results: </strong>4187 patients (mean age: 61.9 ​± ​11.7, 63 ​% male) were included. Male sex, African American ethnicity, Hypertension, CAC>400, and smoking were independent predictors of increased LV mass index. During the median 5.1 years of study follow, 265 (6.3 ​%) deaths occurred. Increased LV mass index percentiles were associated with increased risk of ACM. The addition of LV mass index percentiles improved discrimination and reclassification for mortality prediction over a model with age, sex, conventional risk factors, CAC score and CCTA stenosis severity (X² improvement: 22.68, NRI: 28 ​%, both p ​< ​0.001).</p><p><strong>Conclusion: </strong>In a large sample of patients without known CAD who underwent CCTA, increased LV mass index provided independent and incremental prognostic value for all-cause mortality. Assessment of LV mass by CCTA, considering age and gender distribution, can be utilized clinically to identify patients with high myocardial mass.</p>","PeriodicalId":94071,"journal":{"name":"Journal of cardiovascular computed tomography","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of coronary inflammation with plaque vulnerability and fractional flow reserve in coronary artery disease.","authors":"You-Jung Choi, Seokhun Yang, Henry West, Pete Tomlins, Masahiro Hoshino, Tadashi Murai, Doyeon Hwang, Eun-Seok Shin, Joon-Hyung Doh, Chang-Wook Nam, Jianan Wang, Hitoshi Matsuo, Tsunekazu Kakuta, Charalambos Antoniades, Bon-Kwon Koo","doi":"10.1016/j.jcct.2024.10.013","DOIUrl":"https://doi.org/10.1016/j.jcct.2024.10.013","url":null,"abstract":"<p><strong>Background: </strong>The fat attenuation index (FAI) measured using coronary computed tomography angiography (CCTA) enables the direct evaluation of pericoronary adipose tissue composition and vascular inflammation. We aimed to investigate the association of fractional flow reserve (FFR) and plaque vulnerability with coronary inflammation.</p><p><strong>Methods: </strong>Patients with suspected coronary artery disease (CAD) who underwent CCTA and invasive FFR measurements within 90-day were included. A cloud-based medical device, CaRi-Heart, serves as a surrogate tool for evaluating coronary inflammation based on FAI by analyzing CCTA images. The correlations between CCTA-defined plaque characteristics, invasive coronary angiographic and physiologic assessments, and CaRi-Heart risk were analyzed. The primary endpoint was the patient-oriented composite outcome (POCO) consisting of all-cause death, any myocardial infarction, and any revascularization.</p><p><strong>Results: </strong>A total of 564 patients (median age 67.0 years; 75.4 ​% men) were included. There were no significant differences in quantitative and qualitative plaque characteristics or FFR between the high- and low-CaRi-Heart risk groups (i.e., ≥5 ​% and <5 ​%). During the median follow-up of 3.2 years [1.13-4.73 years], CaRi-Heart risk ≥5 ​% was associated with a significantly higher rate of POCO compared to CaRi-Heart risk <5 ​% (0.9 ​% vs. 10.1 ​%, P ​= ​0.037). The CaRi-Heart risk was an independent predictor of POCO as a continuous (adjusted HR 1.016, 95 ​% CI 1.005-0.027, P ​= ​0.004) and categorical variable (CaRi-Heart risk ≥5 ​%, adjusted HR 2.949, 95 ​% CI 1.182-7.360, P ​= ​0.021), regardless of high-risk plaque characteristics and FFR.</p><p><strong>Conclusion: </strong>Coronary inflammation risk assessed using CaRi-Heart risk provides independent prognostic information regardless of plaque vulnerability and physiologic stenosis in patients with CAD.</p>","PeriodicalId":94071,"journal":{"name":"Journal of cardiovascular computed tomography","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronary computed tomography angiography for the diagnosis of significant left main coronary artery disease.","authors":"Carlos M Campos, Hector M Garcia-Garcia","doi":"10.1016/j.jcct.2024.10.012","DOIUrl":"https://doi.org/10.1016/j.jcct.2024.10.012","url":null,"abstract":"","PeriodicalId":94071,"journal":{"name":"Journal of cardiovascular computed tomography","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic performance of fully automatic coronary CT angiography-based quantitative flow ratio.","authors":"Guanyu Li, Tingwen Weng, Pengcheng Sun, Zehang Li, Daixin Ding, Shaofeng Guan, Wenzheng Han, Qian Gan, Ming Li, Lin Qi, Cheng Li, Yang Chen, Liang Zhang, Tianqi Li, Xifeng Chang, Joost Daemen, Xinkai Qu, Shengxian Tu","doi":"10.1016/j.jcct.2024.10.001","DOIUrl":"https://doi.org/10.1016/j.jcct.2024.10.001","url":null,"abstract":"<p><strong>Background: </strong>Murray-law based quantitative flow ratio, namely μFR, was recently validated to compute fractional flow reserve (FFR) from coronary angiographic images in the cath lab. Recently, the μFR algorithm was applied to coronary computed tomography angiography (CCTA) and a semi-automated computed μFR (CT-μFR) showed good accuracy in identifying flow-limiting coronary lesions prior to referral of patients to the cath lab. We aimed to evaluate the diagnostic accuracy of an artificial intelligence-powered method for fully automatic CCTA reconstruction and CT-μFR computation, using cath lab physiology as reference standard.</p><p><strong>Methods: </strong>This was a post-hoc blinded analysis of the prospective CAREER trial (NCT04665817). Patients who underwent CCTA, coronary angiography including FFR within 30 days were included. Cath lab physiology standard for determining hemodynamically significant coronary stenosis was defined as FFR≤0.80, or μFR≤0.80 when FFR was not available.</p><p><strong>Results: </strong>Automatic CCTA reconstruction and CT-μFR computation was successfully achieved in 657 vessels from 242 patients. CT-μFR showed good correlation (r ​= ​0.62, p ​< ​0.001) and agreement (mean difference ​= ​-0.01 ​± ​0.10, p ​< ​0.001) with cath lab physiology standard. Patient-level diagnostic accuracy for CT-μFR to identify patients with hemodynamically significant stenosis was 83.0 ​% (95%CI: 78.3%-87.8 ​%), with sensitivity, specificity, positive and negative predictive value, positive and negative likelihood ratio of 84.2 ​%, 81.9 ​%, 82.1 ​%, 84.0 ​%, 4.7 and 0.2, respectively. Average analysis time for CT-μFR was 1.60 ​± ​0.34 ​min per patient.</p><p><strong>Conclusion: </strong>The fully automatic CT-μFR yielded high feasibility and good diagnostic performance in identifying patients with hemodynamically significant stenosis prior to referral of patients to the cath lab.</p>","PeriodicalId":94071,"journal":{"name":"Journal of cardiovascular computed tomography","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging the distance between non-invasive coronary angiography and in vivo plaque assessment.","authors":"Edoardo Conte, Davide Marchetti, Daniele Andreini","doi":"10.1016/j.jcct.2024.10.008","DOIUrl":"https://doi.org/10.1016/j.jcct.2024.10.008","url":null,"abstract":"","PeriodicalId":94071,"journal":{"name":"Journal of cardiovascular computed tomography","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Specific calcium deposition on pre-procedural CCTA at the time of percutaneous coronary intervention predicts in-stent restenosis in symptomatic patients.","authors":"Rafael Adolf, Insa Krinke, Janina Datz, Salvatore Cassese, Adnan Kastrati, Michael Joner, Heribert Schunkert, Wolfgang Wall, Martin Hadamitzky, Leif-Christopher Engel","doi":"10.1016/j.jcct.2024.09.010","DOIUrl":"https://doi.org/10.1016/j.jcct.2024.09.010","url":null,"abstract":"<p><strong>Purpose: </strong>To characterize preprocedural coronary atherosclerotic lesions derived from CCTA and assess their association with in-stent restenosis (ISR) after percutaneous coronary intervention (PCI).</p><p><strong>Materials and methods: </strong>This retrospective cohort-study included patients who underwent CCTA for suspected coronary artery disease, subsequent index angiography including PCI and surveillance angiography within 6-8 months after the index procedure. We performed a plaque analysis of culprit lesions on CCTA using a dedicated plaque analysis software including assessment of the surrounding pericoronary fat attenuation index (FAI) and compared findings between lesions with and without ISR at surveillance angiography after stenting.</p><p><strong>Results: </strong>Overall 278 coronary lesions in 209 patients were included. Of these lesions, 43 (15.5 ​%) had ISR at surveillance angiography after stenting while 235 (84.5 ​%) did not. Likewise, plaque composition such as volume of calcification [129.8 mm³ (83.3-212.6) vs. 94.4 mm³ (60.4-160.5) p ​= ​0.06] and lipid-rich and fibrous plaque volume [38.4 mm³ (19.4-71.2) vs. 38.0 mm³ (14.0-59.1), p ​= ​0.11 and 50.4 mm³ (26.1-77.6) vs. 42.1 mm³ (31.1-60.3), p ​= ​0.16] between lesion with and without ISR were not statistically significant. However lesions associated with ISR were more eccentric (n ​= ​37, 86.0 ​% versus n ​= ​159, 67,7 ​%; p ​= ​0.03) and more frequently demonstrated calcified portions on opposite sides on the vessel wall on cross-sectional datasets (n ​= ​24, 55.8 ​% versus n ​= ​55, 23.4 ​%, p ​= ​0.001). FAI_lesion was significantly different in lesions with ISR as compared to those without ISR [-76.5 (-80.1 to -73.6) vs. -80.9 (-88.9 to -74.0), p ​= ​0.02]. There was no difference with respect to FAI_RCA between the two groups [-77.4 (-81.9 to -75.6) vs. -78.5 (-86.0 to -71.0), p ​= ​0.41].</p><p><strong>Conclusion: </strong>Coronary lesions associated with ISR at surveillance angiography demonstrated differences in the arrangement of calcified portions as well as an increased lesion-specific pericoronary fat attenuation index at baseline CCTA. This latter finding suggests that perivascular inflammation at baseline may play a major role in the development of in-stent restenosis.</p>","PeriodicalId":94071,"journal":{"name":"Journal of cardiovascular computed tomography","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of an institutional process change adopting end-systolic coronary CTA acquisition and automated dose selection on patient throughput and image quality.","authors":"Nisha Hosadurg, Kara Harrison, Joseph Dan Khoa Nguyen, Patricia Rodriguez Lozano, Christopher M Kramer, Patrick T Norton, Amit R Patel, Todd C Villines","doi":"10.1016/j.jcct.2024.10.003","DOIUrl":"https://doi.org/10.1016/j.jcct.2024.10.003","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Guidelines recommend prospective ECG-triggered mid-diastolic coronary computed tomographic angiography (CCTA) acquisition after achieving optimal heart rate (HR) control in order to optimize scan image quality. With dual-source CCTA, prospective end-systolic acquisition has been shown to be less prone to motion artifacts at higher heart rates and may improve scan and CT laboratory efficiency by allowing CCTA without routine pre-scan beta-blocker (BB) administration.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We implemented an institutional process change in CCTA performance effective January 2023, comprising a transition from prospective ECG-triggered mid-diastolic acquisitions individually supervised by a physician at the scanner to an algorithmic approach predominately utilizing prospective end-systolic acquisition (200-400 ​ms after R peak), employing an automated dose selection algorithm, without BB administration. All scans were performed on a third-generation 192-slice dual-source scanner. We reviewed 300 consecutive CCTAs done pre- and post-process change in Jan 2022 (phase 0), Jan 2023 (phase 1), and in May 2023 (phase 2) after implementation of a process improvement involving more selective utilization of automated tube potential/current algorithms (CARE kV) to optimize image quality. Coronary segmental image quality was assessed by two experienced CCTA readers by consensus using an 18-segment SCCT model on a 5-point Likert scale (1 ​= ​non-interpretable; 2 ​= ​poor; 3 ​= ​acceptable; 4 ​= ​good; 5 ​= ​excellent). Measures of radiation dose, medication administration, and time required for patient scanning were compared. Logistic regression was used to determine factors associated with patient-level reduction in image quality (IQ) and with repeat scans.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Post-process change, there was a significant reduction in the median overall patient appointment [phase 0: 95 (75-125) min vs. phase 1: 68 (52-88) min and phase 2: 72 (59-90) min; P ​&lt; ​0.001] and scan times [phase 0: 13 (10-16) min vs. phase 1: 8 (6-13) min and phase 2: 9 (7-13) min; P ​&lt; ​0.001]. Median IQ score in both post-process change phases was 4 (4-5) compared to a median score of 5 (4-5) pre-process change (P for comparison &lt;0.001). The majority of segments post-process change had \"good\" IQ (Phase 1 segmental IQ scores: 5 ​= ​36.7 ​%, 4 ​= ​46.8 ​%, 3 ​= ​13 ​%, 2 ​= ​2.6 ​%, 1 ​= ​0.9 ​%; Phase 2 segmental IQ scores: 5 ​= ​26 ​%, 4 ​= ​49.7 ​%, 3 ​= ​16.3 ​%, 2 ​= ​6.1 ​%, 1 ​= ​1.9 ​%), whereas pre-process change, the majority of segments had \"excellent\" IQ (Phase 0 segmental IQ scores: 5 ​= ​56 ​%, 4 ​= ​34.3 ​%, 3 ​= ​7.5 ​%, 2 ​= ​1.8 ​%, 1 ​= ​0.4 ​%) There was no significant increase in non-interpretable scans at the patient level. The 22 ​% re-scan rate in phase 1 (vs. 6 ​% in phase 0, P ​= ​.002) improved to 15 ​% in phase 2. While patient related factors of body mass index [adjusted OR obese 2.64, 95 ​% CI 1.12-6.5","PeriodicalId":94071,"journal":{"name":"Journal of cardiovascular computed tomography","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial referral bias in cardiac computed tomography: Differences, disparities or discrimination?","authors":"Benjamin J W Chow, Saad Balamane, Anahita Tavoosi, Lucas Dirienzo, Yeung Yam, Li Chen, Aun Yeong Chong","doi":"10.1016/j.jcct.2024.09.016","DOIUrl":"https://doi.org/10.1016/j.jcct.2024.09.016","url":null,"abstract":"<p><strong>Background: </strong>Disparities exist in medicine and can affect patient care. We sought to understand influences of racial biases in diagnostic testing within a Cardiac CT (CCT) population.</p><p><strong>Methods: </strong>Race of CCT patients, referring physicians and the population in the catchment area were captured between February 2006 and November 2021. The frequency of CCT referrals for each race was indexed to the catchment population.</p><p><strong>Results: </strong>Of 21,241 CCT patients, 17,514 (82.5 ​%) patients were White. The Non-White population was comprised of 467(2.2 ​%) Indigenous, 656(3.1 ​%) Black, 932(4.4 ​%) Asian, 276(1.3 ​%) South Asian, 1100(5.2 ​%) Middle Eastern and 296(1.4 ​%) Latin American races. The catchment population was 907,675, with 619,514 individuals of whom 69.7 ​% identified as White. Compared to the catchment population, there was a disproportionately higher referral rate for Whites than Non-Whites. The referral index for Whites was higher than Non-Whites (1.2 versus 0.6, p ​< ​0.001)). This pattern was consistent across all racial minorities and age categories. A total of 356 physicians (236(66.3 ​%) White, 4(1.2 ​%) Black, 39(12.0 ​%) Asian, 30(9.2 ​%) South Asian, 43(13.2 ​%), Middle Eastern and 4 (1.2 ​%) Latin American) made referrals to CCT. The racial difference in referral patterns was independent of physician race and was independent of their years in practice.</p><p><strong>Conclusions: </strong>Racial differences exist in CCT referrals. These differences are independent of prevalence of disease, physician race or years in practice. This study supports the need to better understand reasons for disparity and strategies to mitigate potential bias.</p>","PeriodicalId":94071,"journal":{"name":"Journal of cardiovascular computed tomography","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic value of systolic left ventricular ejection fraction using prospective ECG-triggered cardiac CT.","authors":"Yoshito Kadoya, Mehmet Onur Omaygenc, Shahin Sean Abtahi, Shankavi Sritharan, Amal Nehmeh, Yeung Yam, Gary R Small, Benjamin Chow","doi":"10.1016/j.jcct.2024.10.006","DOIUrl":"https://doi.org/10.1016/j.jcct.2024.10.006","url":null,"abstract":"<p><strong>Background: </strong>Prospective ECG-triggered cardiac computed tomography (CT) imaging limits the ability to assess left ventricular (LV) ejection fraction (EF). We previously developed a new index derived from LV volume changes over 100 ​ms during systole (LVEF_100msec) as a surrogate of LV function in patients undergoing prospective ECG-triggered cardiac CT. We sought to evaluate the prognostic value of LVEF_100msec.</p><p><strong>Methods: </strong>Patients undergoing prospective systolic ECG-triggered cardiac CT were enrolled between January 2015 and September 2022. Each CT was analyzed for LVEF_100msec. Area under the curve analysis and Cox proportional hazards models were used to define the best LVEF_100msec cut-off and to predict major adverse cardiovascular events (MACE), defined as a composite of all-cause death, cardiac death/arrest, non-fatal myocardial infarction, and stroke.</p><p><strong>Results: </strong>The study enrolled 313 patients (median age ​= ​58 years, male ​= ​52.4 ​%). During a median follow-up of 924 (660-1365) days, 24 (7.7 ​%) patients had MACE. LVEF_100msec was significantly lower in the MACE group compared to the non-MACE group (4.8 ​% vs. 8.3 ​%, p ​= ​0.002). Optimal LVEF_100msec cut-off for predicting MACE was 6.3 ​%. MACE-free survival rate was significantly lower in patients with LVEF_100msec ≤6.3 ​% than those with >6.3 ​% (p ​< ​0.001). LVEF_100msec ≤6.3 ​% was an independent predictor of MACE, with an adjusted hazard ratio of 3.758 (95 ​% CI, 1.543-9.148; p ​= ​0.004). The prognostic value of LVEF_100msec was consistent across the various severities of coronary artery disease.</p><p><strong>Conclusion: </strong>LVEF_100msec was an independent predictor of adverse events. The implementation of LVEF_100msec may improve the prognostic value of prospective ECG-triggered cardiac CT.</p>","PeriodicalId":94071,"journal":{"name":"Journal of cardiovascular computed tomography","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}