ObjectivesNo clear recommendations are endorsed by the different scientific societies on the clinical use of repeat coronary computed tomography angiography (CCTA) in patients with non-obstructive... Show moreObjectivesNo clear recommendations are endorsed by the different scientific societies on the clinical use of repeat coronary computed tomography angiography (CCTA) in patients with non-obstructive coronary artery disease (CAD). This study aimed to develop and validate a practical CCTA risk score to predict medium-term disease progression in patients at a low-to-intermediate probability of CAD.MethodsPatients were part of the Progression of AtheRosclerotic PlAque Determined by Computed Tomographic Angiography Imaging (PARADIGM) registry. Specifically, 370 (derivation cohort) and 219 (validation cohort) patients with two repeat, clinically indicated CCTA scans, non-obstructive CAD, and absence of high-risk plaque (≥ 2 high-risk features) at baseline CCTA were included. Disease progression was defined as the new occurrence of ≥ 50% stenosis and/or high-risk plaque at follow-up CCTA.ResultsIn the derivation cohort, 104 (28%) patients experienced disease progression. The median time interval between the two CCTAs was 3.3 years (2.7–4.8). Odds ratios for disease progression derived from multivariable logistic regression were as follows: 4.59 (95% confidence interval: 1.69–12.48) for the number of plaques with spotty calcification, 3.73 (1.46–9.52) for the number of plaques with low attenuation component, 2.71 (1.62–4.50) for 25–49% stenosis severity, 1.47 (1.17–1.84) for the number of bifurcation plaques, and 1.21 (1.02–1.42) for the time between the two CCTAs. The C-statistics of the model were 0.732 (0.676–0.788) and 0.668 (0.583–0.752) in the derivation and validation cohorts, respectively.ConclusionsThe new CCTA-based risk score is a simple and practical tool that can predict mid-term CAD progression in patients with known non-obstructive CAD. Show less
Singh, G.K.; Vollema, E.M.; Stassen, J.; Rosendael, A. van; Gegenava, T.; Kley, F. van der; ... ; Bax, J.J. 2022
Several studies have shown an association between aortic stenosis (AS) and coronary atherosclerosis. This study aimed to evaluate the gender differences in aortic valve calcium (AVC) and coronary... Show moreSeveral studies have shown an association between aortic stenosis (AS) and coronary atherosclerosis. This study aimed to evaluate the gender differences in aortic valve calcium (AVC) and coronary artery calcium (CAC) and the association between CAC and allcause mortality in patients with severe AS. A total of 260 patients (80 +/- 7 years, 39% men) with severe AS who were scheduled for transcatheter aortic valve implantation (TAVI) were included. AVC and CAC before TAVI were assessed by noncontrast cardiac computed tomography. Patients with coronary intervention or aortic valve replacement before cardiac computed tomography were excluded. Standard reference values of CAC score were used to classify the percentile groups and the distribution of AVC was assessed. The primary end point was all-cause mortality. In men, the AVC score was 3,911 Hounsfield units (HUs) (interquartile range [IQR] 2,525 to 5,259) and in women, 2,409 HU (IQR 1,588 to 3,359) (p <0.001). CAC score in men was 824 HU (IQR 328 to 1,855) and in women, 478 HU (IQR 136 to 962) (p <0.001). In men, the AVC score increased along with the CAC score, whereas in women, the AVC score was similar across the CAC percentile groups. During a median follow-up of 1,095 days, 59 patients (23%) died. No significant gender-difference was seen in all-cause mortality for CAC score (p = 0.187). Men with severe AS show higher AVC and CAC scores than women. Although the pattern of CAC distribution was similar between men and women, the AVC score increased along with the CAC score in men; whereas, in women, the AVC score remained similar across the various percentiles. CAC score was not associated with cumulative mortality in patients with severe AS who underwent TAVI. (c) 2022 Published by Elsevier Inc. (Am J Cardiol 2022;182:83-88) Show less
IMPORTANCE Distinct plaque locations and vessel geometric features predispose to altered coronary flow hemodynamics. The association between these lesion-level characteristics assessed by coronary... Show moreIMPORTANCE Distinct plaque locations and vessel geometric features predispose to altered coronary flow hemodynamics. The association between these lesion-level characteristics assessed by coronary computed tomographic angiography (CCTA) and risk of future acute coronary syndrome (ACS) is unknown.OBJECTIVE To examine whether CCTA-derived adverse geometric characteristics (AGCs) of coronary lesions describing location and vessel geometry add to plaque morphology and burden for identifying culprit lesion precursors associated with future ACS.DESIGN, SETTING, AND PARTICIPANTS This substudy of ICONIC (Incident Coronary Syndromes Identified by Computed Tomography), a multicenter nested case-control cohort study, included patients with ACS and a culprit lesion precursor identified on baseline CCTA (n = 116) and propensity score-matched non-ACS controls (n = 116). Data were collected from July 20, 2012, to April 30, 2017, and analyzed from October 1, 2020, to October 31, 2021.EXPOSURES Coronary lesions were evaluated for the following 3 AGCs: (1) distance from the coronary ostium to lesion; (2) location at vessel bifurcations; and (3) vessel tortuosity, defined as the presence of 1 bend of greater than 90 degrees or 3 curves of 45 degrees to 90 degrees using a 3-point angle within the lesion.MAIN OUTCOMES AND MEASURES Association between lesion-level AGCs and risk of future ACS-causing culprit lesions.RESULTS Of 548 lesions, 116 culprit lesion precursors were identified in 116 patients (80 [69.0%] men; mean [SD], age 62.7 [11.5] years). Compared with nonculprit lesions, culprit lesion precursors had a shorter distance from the ostium (median, 35.1 [IQR, 23.6-48.4] mm vs 44.5 [IQR, 28.2-70.8] mm), more frequently localized to bifurcations (85 [73.3%] vs 168 [38.9%]), and had more tortuous vessel segments (5 [4.3%] vs 6 [1.4%]; all P<.05). In multivariable Cox regression analysis, an increasing number of AGCs was associated with a greater risk of future culprit lesions (hazard ratio [HR] for 1 AGC, 2.90 [95% CI, 1.38-6.08]; P=.005; HR for >= 2 AGCs, 6.84 [95% CI, 3.33-14.04]; P<.001). Adverse geometric characteristics provided incremental discriminatory value for culprit lesion precursors when added to a model containing stenosis severity, adverse morphological plaque characteristics, and quantitative plaque characteristics (area under the curve, 0.766 [95% CI, 0.718-0.814] vs 0.733 [95% CI, 0.685-0.782]). In per-patient comparison, patients with ACS had a higher frequency of lesions with adverse plaque characteristics, AGCs, or both compared with control patients (>= 2 adverse plaque characteristics, 70 [60.3%] vs 50 [43.1%]; >= 2 AGCs, 92 [79.3%] vs 60 [51.7%]; >= 2 of both, 37 [31.9%] vs 20 [17.2%]; all P<.05).CONCLUSIONS AND RELEVANCE These findings support the concept that CCTA-derived AGCs capturing lesion location and vessel geometry are associated with risk of future ACS-causing culprit lesions. Adverse geometric characteristics may provide additive prognostic information beyond plaque assessment in CCTA. Show less
OBJECTIVES This study designed and evaluated an end-to-end deep learning solution for cardiac segmentation and quantification.BACKGROUND Segmentation of cardiac structures from coronary computed... Show moreOBJECTIVES This study designed and evaluated an end-to-end deep learning solution for cardiac segmentation and quantification.BACKGROUND Segmentation of cardiac structures from coronary computed tomography angiography (CCTA) images is laborious. We designed an end-to-end deep-learning solution.METHODS Scans were obtained from multicenter registries of 166 patients who underwent clinically indicated CCTA. Left ventricular volume (LVV) and right ventricular volume (RVV), left atrial volume (LAV) and right atrial volume (RAV), and left ventricular myocardial mass (LVM) were manually annotated as ground truth. A U-Net-inspired, deep-learning model was trained, validated, and tested in a 70:20:10 split.RESULTS Mean age was 61.1 +/- 8.4 years, and 49% were women. A combined overall median Dice score of 0.9246 (interquartile range: 0.8870 to 0.9475) was achieved. The median Dice scores for LVV, RVV, LAV, RAV, and LVM were 0.938 (interquartile range: 0.887 to 0.958), 0.927 (interquartile range: 0.916 to 0.946), 0.934 (interquartile range: 0.899 to 0.950), 0.915 (interquartile range: 0.890 to 0.920), and 0.920 (interquartile range: 0.811 to 0.944), respectively. Model prediction correlated and agreed well with manual annotation for LVV (r = 0.98), RVV (r = 0.97), LAV (r = 0.78), RAV (r = 0.97), and LVM (r = 0.94) (p < 0.05 for all). Mean difference and limits of agreement for LVV, RVV, LAV, RAV, and LVM were 1.20 ml (95% CI: -7.12 to 9.51), -0.78 ml (95% CI: -10.08 to 8.52), -3.75 ml (95% CI: -21.53 to 14.03), 0.97 ml (95% CI: -6.14 to 8.09), and 6.41 g (95% CI: -8.71 to 21.52), respectively.CONCLUSIONS A deep-learning model rapidly segmented and quantified cardiac structures. This was done with high accuracy on a pixel level, with good agreement with manual annotation, facilitating its expansion into areas of research and clinical import. (C) 2020 by the American College of Cardiology Foundation. Show less
Gegenava, T.; Bijl, P. van der; Hirasawa, K.; Vollema, E.M.; Rosendael, A. van; Kley, F. van der; ... ; Delgado, V. 2020
BackgroundLeft ventricular (LV) systolic function is a prognostic factorin patients with severe aortic stenosis (AS). Multi-detector row computed tomography (MDCT) data are key in the evaluation... Show moreBackgroundLeft ventricular (LV) systolic function is a prognostic factorin patients with severe aortic stenosis (AS). Multi-detector row computed tomography (MDCT) data are key in the evaluation of patients undergoing transcatheter aortic valve implantation (TAVI) and when acquired retrospectively, LV systolic function can be assessed. Novel software permits assessment of LV global longitudinal strain (GLS) from MDCT data.ObjectivesThe present study investigated the feasibility of feature tracking MDCT-derived LV GLS and its agreement with echocardiographic LV GLS in patients treated with TAVI.MethodsLV GLS was measured on transthoracic echocardiography using speckle tracking analysis and on dynamic MDCT using feature tracking technology. Agreement between the measurements of two different modalities was assessed using Bland-Altman analysis.ResultsA total of 214 patients (51% male, mean age: 80 ± 7 years) were analysed. Mean LV GLS on echocardiography was −13.91 ± 4.32%, whereas mean feature tracking MDCT-derived GLS was −12.46 ± 3.97%. Correlation of measurements between feature tracking MDCT-derived LV GLS and echocardiographic LV GLS demonstrated a large effect size (r = 0.791, p < 0.001). On Bland-Altman analysis, feature tracking MDCT-derived strain analysis underestimated LV GLS compared to echocardiography with a mean difference of 1.44% (95% limits of agreement −3.85% - 6.73%).ConclusionsAssessment of LV GLS on dynamic feature tracking MDCT data is feasible in TAVI patients. Compared to speckle tracking echocardiography, feature tracking MDCT underestimates the value of LV GLS. Show less
Gegenava, T.; Vollema, E.M.; Rosendael, A. van; Abou, R.; Goedemans, L.; Kley, F. van der; ... ; Delgado, V. 2019
Background: After transcatheter aortic valve replacement (TAVR), changes in left ventricular (LV) function are partly influenced by the vascular afterload. The burden of thoracic aorta... Show moreBackground: After transcatheter aortic valve replacement (TAVR), changes in left ventricular (LV) function are partly influenced by the vascular afterload. The burden of thoracic aorta calcification is a component of vascular afterload.Objective: To assess changes in LV systolic function measured with global longitudinal strain (GLS) in relation to the burden of thoracic aorta calcification in patients with severe aortic stenosis treated with TAVR.Results: At baseline, patients within the first tertile of thoracic aorta calcification (0-1,395 Hounsfield Units, HU) had better LV systolic function (LV ejection fraction [LVEF], 47% +/- 9%; and LV GLS, -15% +/- 5%) as compared with the second tertile (1,396-4,634 HU; LVEF, 46% +/- 10%; and LV GLS, -14% +/- 4%), and the third tertile (>4,634 HU; LVEF, 44% +/- 10%; and LV GLS, -12% +/- 4%). During follow-up, patients within tertile 1 of calcification of thoracic aorta achieved significantly better LV systolic function and larger regression of LV mass at 12 months of follow-up than patients within the other tertiles. This pattern was more pronounced in patients with reduced LVEF at baseline.Conclusion: After TAVR, LVEF and GLS improves and LV mass index is reduced significantly at 3-6 and 12 months of follow-up. Patients within the lowest burden of thoracic aorta calcification achieved the best values of LVEF and LV GLS at 1-year follow-up. Show less
Gegenava, T.; Vollema, E.M.; Rosendael, A. van; Abou, R.; Goedemans, L.; Kley, F. van der; ... ; Delgado, V. 2019
Background: After transcatheter aortic valve replacement (TAVR), changes in left ventricular (LV) function are partly influenced by the vascular afterload. The burden of thoracic aorta... Show moreBackground: After transcatheter aortic valve replacement (TAVR), changes in left ventricular (LV) function are partly influenced by the vascular afterload. The burden of thoracic aorta calcification is a component of vascular afterload.Objective: To assess changes in LV systolic function measured with global longitudinal strain (GLS) in relation to the burden of thoracic aorta calcification in patients with severe aortic stenosis treated with TAVR.Methods: Calcification of the thoracic aorta was estimated on noncontrast computed tomography in 210 patients (50% male, 80 ± 7 years) undergoing TAVR. Conventional and speckle-tracking echocardiography were performed at baseline (prior to TAVR) and 3-6 months and 12 months after TAVR. Patients were divided according to tertiles of calcification burden of the thoracic aorta.Results: At baseline, patients within the first tertile of thoracic aorta calcification (0-1,395 Hounsfield Units, HU) had better LV systolic function (LV ejection fraction [LVEF], 47% ± 9%; and LV GLS, -15% ± 5%) as compared with the second tertile (1,396-4,634 HU; LVEF, 46% ± 10%; and LV GLS, -14% ± 4%), and the third tertile (>4,634 HU; LVEF, 44% ± 10%; and LV GLS, -12% ± 4%). During follow-up, patients within tertile 1 of calcification of thoracic aorta achieved significantly better LV systolic function and larger regression of LV mass at 12 months of follow-up than patients within the other tertiles. This pattern was more pronounced in patients with reduced LVEF at baseline.Conclusions: After TAVR, LVEF and GLS improves and LV mass index is reduced significantly at 3-6 and 12 months of follow-up. Patients within the lowest burden of thoracic aorta calcification achieved the best values of LVEF and LV GLS at 1-year follow-up.Keywords: Global longitudinal strain; Left ventricular mass; Thoracic aorta calcification; Transcatheter aortic valve replacement. Show less
Gegeneva, T.; Vollema, E.M.; Abou, R.; Goedemans, L.; Rosendael, A. van; Kley, F. van der; ... ; Delgado, V. 2019
