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European Heart Journal Jul 2023The impact of long-term endurance sport participation (on top of a healthy lifestyle) on coronary atherosclerosis and acute cardiac events remains controversial. (Observational Study)
Observational Study
AIMS
The impact of long-term endurance sport participation (on top of a healthy lifestyle) on coronary atherosclerosis and acute cardiac events remains controversial.
METHODS AND RESULTS
The Master@Heart study is a well-balanced prospective observational cohort study. Overall, 191 lifelong master endurance athletes, 191 late-onset athletes (endurance sports initiation after 30 years of age), and 176 healthy non-athletes, all male with a low cardiovascular risk profile, were included. Peak oxygen uptake quantified fitness. The primary endpoint was the prevalence of coronary plaques (calcified, mixed, and non-calcified) on computed tomography coronary angiography. Analyses were corrected for multiple cardiovascular risk factors. The median age was 55 (50-60) years in all groups. Lifelong and late-onset athletes had higher peak oxygen uptake than non-athletes [159 (143-177) vs. 155 (138-169) vs. 122 (108-138) % predicted]. Lifelong endurance sports was associated with having ≥1 coronary plaque [odds ratio (OR) 1.86, 95% confidence interval (CI) 1.17-2.94], ≥ 1 proximal plaque (OR 1.96, 95% CI 1.24-3.11), ≥ 1 calcified plaques (OR 1.58, 95% CI 1.01-2.49), ≥ 1 calcified proximal plaque (OR 2.07, 95% CI 1.28-3.35), ≥ 1 non-calcified plaque (OR 1.95, 95% CI 1.12-3.40), ≥ 1 non-calcified proximal plaque (OR 2.80, 95% CI 1.39-5.65), and ≥1 mixed plaque (OR 1.78, 95% CI 1.06-2.99) as compared to a healthy non-athletic lifestyle.
CONCLUSION
Lifelong endurance sport participation is not associated with a more favourable coronary plaque composition compared to a healthy lifestyle. Lifelong endurance athletes had more coronary plaques, including more non-calcified plaques in proximal segments, than fit and healthy individuals with a similarly low cardiovascular risk profile. Longitudinal research is needed to reconcile these findings with the risk of cardiovascular events at the higher end of the endurance exercise spectrum.
Topics: Humans; Male; Middle Aged; Coronary Artery Disease; Prospective Studies; Plaque, Atherosclerotic; Tomography, X-Ray Computed; Computed Tomography Angiography; Oxygen; Coronary Angiography; Risk Factors
PubMed: 36881712
DOI: 10.1093/eurheartj/ehad152 -
The British Journal of Radiology Dec 2023CT of the heart, in particular ECG-controlled coronary CT angiography (cCTA), has become clinical routine due to rapid technical progress with ever new generations of CT... (Review)
Review
CT of the heart, in particular ECG-controlled coronary CT angiography (cCTA), has become clinical routine due to rapid technical progress with ever new generations of CT equipment. Recently, CT scanners with photon-counting detectors (PCD) have been introduced which have the potential to address some of the remaining challenges for cardiac CT, such as limited spatial resolution and lack of high-quality spectral data. In this review article, we briefly discuss the technical principles of photon-counting detector CT, and we give an overview on how the improved spatial resolution of photon-counting detector CT and the routine availability of spectral data can benefit cardiac applications. We focus on coronary artery calcium scoring, cCTA, and on the evaluation of the myocardium.
Topics: Humans; Phantoms, Imaging; Tomography, X-Ray Computed; Heart; Coronary Angiography; Computed Tomography Angiography; Photons
PubMed: 37750856
DOI: 10.1259/bjr.20230407 -
La Tunisie Medicale Jun 2023The conventional radial approach (CRA), the gold standard approach for percutaneous coronary interventions (PCI), is associated with the risk of radial artery occlusion... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
The conventional radial approach (CRA), the gold standard approach for percutaneous coronary interventions (PCI), is associated with the risk of radial artery occlusion (RAO). The distal radial approach (DRA) is an effective alternative with fewer complications.
AIM
To evaluate the efficacy in terms of puncture success and safety by RAO rate of the DRA in elective PCI in Tunisian patients.
METHODS
It was a randomized controlled non-inferiority trial including patients hospitalized for elective PCI. The protocol was previously published (Tunis Med 2022; 100(3): 192-202). The primary endpoints were puncture success and RAO rate at 30 days.
RESULTS
Overall, 250 patients were included and the groups were comparable. The preprocedural examination of the radial pulse and the Barbeau test were similar. The majority of PCIs were coronary angiography (82%). In ITT, respectively in CRA versus DRA, puncture success rates were similar (97.6% versus 96.8%; p≤0.500). RAO rates were similar (2.4% versus 3.2%; p≤0.500). Crossovers were similar. PCI through DRA lasted longer but was not more irradiating, however it required more contrast. Overall bleeding and vascular complications were similar.
CONCLUSION
This study demonstrated the non-inferiority of DRA compared to CRA for elective PCIs in a Tunisian population regarding puncture success and RAO rate at 30 days. Multicenter trials including urgent PCI with systematic ultrasound screening for RAO are needed.
Topics: Humans; Percutaneous Coronary Intervention; Coronary Angiography; Ultrasonography; Hemorrhage; Arterial Occlusive Diseases; Treatment Outcome
PubMed: 38372550
DOI: No ID Found -
JACC. Cardiovascular Imaging Nov 2023The interplay between coronary hemodynamics and plaque characteristics remains poorly understood.
BACKGROUND
The interplay between coronary hemodynamics and plaque characteristics remains poorly understood.
OBJECTIVES
The aim of this study was to compare atherosclerotic plaque phenotypes between focal and diffuse coronary artery disease (CAD) defined by coronary hemodynamics.
METHODS
This multicenter, prospective, single-arm study was conducted in 5 countries. Patients with functionally significant lesions based on an invasive fractional flow reserve ≤0.80 were included. Plaque analysis was performed by using coronary computed tomography angiography and optical coherence tomography. CAD patterns were assessed using motorized fractional flow reserve pullbacks and quantified by pullback pressure gradient (PPG). Focal and diffuse CAD was defined according to the median PPG value.
RESULTS
A total of 117 patients (120 vessels) were included. The median PPG was 0.66 (IQR: 0.54-0.75). According to coronary computed tomography angiography analysis, plaque burden was higher in patients with focal CAD (87% ± 8% focal vs 82% ± 10% diffuse; P = 0.003). Calcifications were significantly more prevalent in patients with diffuse CAD (Agatston score per vessel: 51 [IQR: 11-204] focal vs 158 [IQR: 52-341] diffuse; P = 0.024). According to optical coherence tomography analysis, patients with focal CAD had a significantly higher prevalence of circumferential lipid-rich plaque (37% focal vs 4% diffuse; P = 0.001) and thin-cap fibroatheroma (TCFA) (47% focal vs 10% diffuse; P = 0.002). Focal disease defined by PPG predicted the presence of TCFA with an area under the curve of 0.73 (95% CI: 0.58-0.87).
CONCLUSIONS
Atherosclerotic plaque phenotypes associate with intracoronary hemodynamics. Focal CAD had a higher plaque burden and was predominantly lipid-rich with a high prevalence of TCFA, whereas calcifications were more prevalent in diffuse CAD. (Precise Percutaneous Coronary Intervention Plan [P3]; NCT03782688).
Topics: Humans; Coronary Artery Disease; Plaque, Atherosclerotic; Prospective Studies; Coronary Angiography; Fractional Flow Reserve, Myocardial; Predictive Value of Tests; Phenotype; Lipids
PubMed: 37480908
DOI: 10.1016/j.jcmg.2023.05.018 -
Internal Medicine (Tokyo, Japan) Jun 2023
Topics: Humans; Coronary Artery Disease; Arrhythmias, Cardiac; Electrocardiography; Coronary Stenosis; Coronary Angiography
PubMed: 36351575
DOI: 10.2169/internalmedicine.0342-22 -
Current Cardiology Reports Dec 2023The study aims to describe methods for detecting subclinical coronary artery disease (CAD) and their potential implications in asymptomatic patients with diabetes. (Review)
Review
PURPOSE OF REVIEW
The study aims to describe methods for detecting subclinical coronary artery disease (CAD) and their potential implications in asymptomatic patients with diabetes.
RECENT FINDINGS
Imaging tools can assess non-invasively the presence and severity of CAD, based on myocardial ischemia, coronary artery calcium score, and coronary computed tomography coronary angiography. Subclinical CAD is common in the general population ageing 50 to 64 years with any coronary atherosclerosis present in 42.1% and obstructive CAD in 5.2%. In patients with diabetes, an even higher prevalence has been noted. The presence of myocardial ischemia, obstructive CAD, and the extent of coronary atherosclerosis provide powerful risk stratification regarding the risk of cardiovascular events. However, randomized trials evaluating systematic screening in the general population or patients with diabetes have demonstrated only moderate impact on management and no significant impact on patient outcomes. Despite providing improved risk stratification, systematic screening of CAD is not recommended in patients with diabetes.
Topics: Humans; Coronary Artery Disease; Coronary Angiography; Diabetes Mellitus; Myocardial Ischemia; Tomography, X-Ray Computed; Risk Factors
PubMed: 37982936
DOI: 10.1007/s11886-023-01999-z -
Circulation Oct 2023Patients with previous coronary artery bypass grafting often require invasive coronary angiography (ICA). However, for these patients, the procedure is technically more... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Patients with previous coronary artery bypass grafting often require invasive coronary angiography (ICA). However, for these patients, the procedure is technically more challenging and has a higher risk of complications. Observational studies suggest that computed tomography cardiac angiography (CTCA) may facilitate ICA in this group, but this has not been tested in a randomized controlled trial.
METHODS
This study was a single-center, open-label randomized controlled trial assessing the benefit of adjunctive CTCA in patients with previous coronary artery bypass grafting referred for ICA. Patients were randomized 1:1 to undergo CTCA before ICA or ICA alone. The co-primary end points were procedural duration of the ICA (defined as the interval between local anesthesia administration for obtaining vascular access and removal of the last catheter), patient satisfaction after ICA using a validated questionnaire, and the incidence of contrast-induced nephropathy. Linear regression was used for procedural duration and patient satisfaction score; contrast-induced nephropathy was analyzed using logistic regression. We applied the Bonferroni correction, with <0.017 considered significant and 98.33% CIs presented. Secondary end points included incidence of procedural complications and 1-year major adverse cardiac events.
RESULTS
Over 3 years, 688 patients were randomized with a median follow-up of 1.0 years. The mean age was 69.8±10.4 years, 108 (15.7%) were women, 402 (58.4%) were White, and there was a high burden of comorbidity (85.3% hypertension and 53.8% diabetes). The median time from coronary artery bypass grafting to angiography was 12.0 years, and there were a median of 3 (interquartile range, 2 to 3) grafts per participant. Procedure duration of the ICA was significantly shorter in the CTCA+ICA group (CTCA+ICA, 18.6±9.5 minutes versus ICA alone, 39.5±16.9 minutes [98.33% CI, -23.5 to -18.4]; <0.001), alongside improved mean ICA satisfaction scores (1=very good to 5=very poor; -1.1 difference [98.33% CI, -1.2 to -0.9]; <0.001), and reduced incidence of contrast-induced nephropathy (3.4% versus 27.9%; odds ratio, 0.09 [98.33% CI, 0.04-0.2]; <0.001). Procedural complications (2.3% versus 10.8%; odds ratio, 0.2 [95% CI, 0.1-0.4]; <0.001) and 1-year major adverse cardiac events (16.0% versus 29.4%; hazard ratio, 0.4 [95% CI, 0.3-0.6]; <0.001) were also lower in the CTCA+ICA group.
CONCLUSIONS
For patients with previous coronary artery bypass grafting, CTCA before ICA leads to reductions in procedure time and contrast-induced nephropathy, with improved patient satisfaction. CTCA before ICA should be considered in this group of patients.
REGISTRATION
URL: https://www.
CLINICALTRIALS
gov; Unique identifier: NCT03736018.
Topics: Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Computed Tomography Angiography; Coronary Angiography; Coronary Artery Disease; Coronary Artery Bypass
PubMed: 37772419
DOI: 10.1161/CIRCULATIONAHA.123.064465 -
European Heart Journal May 2024Clinical risk scores based on traditional risk factors of atherosclerosis correlate imprecisely to an individual's complex pathophysiological predisposition to... (Review)
Review
Clinical risk scores based on traditional risk factors of atherosclerosis correlate imprecisely to an individual's complex pathophysiological predisposition to atherosclerosis and provide limited accuracy for predicting major adverse cardiovascular events (MACE). Over the past two decades, computed tomography scanners and techniques for coronary computed tomography angiography (CCTA) analysis have substantially improved, enabling more precise atherosclerotic plaque quantification and characterization. The accuracy of CCTA for quantifying stenosis and atherosclerosis has been validated in numerous multicentre studies and has shown consistent incremental prognostic value for MACE over the clinical risk spectrum in different populations. Serial CCTA studies have advanced our understanding of vascular biology and atherosclerotic disease progression. The direct disease visualization of CCTA has the potential to be used synergistically with indirect markers of risk to significantly improve prevention of MACE, pending large-scale randomized evaluation.
Topics: Humans; Computed Tomography Angiography; Coronary Artery Disease; Risk Assessment; Coronary Angiography; Plaque, Atherosclerotic; Heart Disease Risk Factors; Prognosis; Coronary Stenosis
PubMed: 38606889
DOI: 10.1093/eurheartj/ehae190 -
RoFo : Fortschritte Auf Dem Gebiete Der... Mar 2024
Topics: Coronary Angiography; Radiography; Radiology; Computed Tomography Angiography; Insurance, Health
PubMed: 38382507
DOI: 10.1055/a-2226-5089 -
European Radiology Aug 2023In patients with suspected coronary artery disease (CAD), dynamic myocardial computed tomography perfusion (CTP) imaging combined with coronary CT angiography (CTA) has... (Review)
Review
In patients with suspected coronary artery disease (CAD), dynamic myocardial computed tomography perfusion (CTP) imaging combined with coronary CT angiography (CTA) has become a comprehensive diagnostic examination technique resulting in both anatomical and quantitative functional information on myocardial blood flow, and the presence and grading of stenosis. Recently, CTP imaging has been proven to have good diagnostic accuracy for detecting myocardial ischemia, comparable to stress magnetic resonance imaging and positron emission tomography perfusion, while being superior to single photon emission computed tomography. Dynamic CTP accompanied by coronary CTA can serve as a gatekeeper for invasive workup, as it reduces unnecessary diagnostic invasive coronary angiography. Dynamic CTP also has good prognostic value for the prediction of major adverse cardiovascular events. In this article, we will provide an overview of dynamic CTP, including the basics of coronary blood flow physiology, applications and technical aspects including protocols, image acquisition and reconstruction, future perspectives, and scientific challenges. KEY POINTS: • Stress dynamic myocardial CT perfusion combined with coronary CTA is a comprehensive diagnostic examination technique resulting in both anatomical and quantitative functional information. • Dynamic CTP imaging has good diagnostic accuracy for detecting myocardial ischemia comparable to stress MRI and PET perfusion. • Dynamic CTP accompanied by coronary CTA may serve as a gatekeeper for invasive workup and can guide treatment in obstructive coronary artery disease.
Topics: Humans; Coronary Artery Disease; Predictive Value of Tests; Coronary Angiography; Tomography, X-Ray Computed; Myocardial Ischemia; Computed Tomography Angiography; Myocardial Perfusion Imaging; Coronary Stenosis; Fractional Flow Reserve, Myocardial
PubMed: 36997751
DOI: 10.1007/s00330-023-09550-y