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1.
Practical instructions for using drugs in CT and MR cardiac imaging.
Rovere, G, Meduri, A, Savino, G, Flammia, FC, Lo Piccolo, F, Carafa, MRP, Larici, AR, Natale, L, Merlino, B, Marano, R
La Radiologia medica. 2021;(3):356-364
Abstract
The progressive increase in numbers of noninvasive cardiac imaging examinations broadens the spectrum of knowledge radiologists are expected to acquire in the management of drugs during CT coronary angiography (CTCA) and cardiac MR (CMR) to improve image quality for optimal visualization and assessment of the coronary arteries and adequate MR functional analysis. Aim of this review is to provide an overview on different class of drugs (nitrate, beta-blockers, ivabradine, anxiolytic, adenosine, dobutamine, atropine, dipyridamole and regadenoson) that can be used in CTCA and CMR, illustrating their main indications, contraindications, efficacy, mechanism of action, metabolism, safety, side effects or complications, and providing advices in their use.
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2.
Coronary Calcium Risk Score and Cardiovascular Risk.
Lehker, A, Mukherjee, D
Current vascular pharmacology. 2021;(3):280-284
Abstract
The association between the presence of coronary artery calcium (CAC) and the risk of coronary artery disease (CAD) has been appreciated for decades. In this review, we critically appraise the role of CAC based on computerized tomography in contemporary risk stratification. Available evidence suggests that the measurement of CAC is a useful modality in many patients for more precise risk stratification and prognostic determination. Whether newer CAC score incorporating extra coronary calcification will add incremental value, especially for stroke and other non-coronary vascular outcomes, needs a prospective study.
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3.
Society of Cardiovascular Computed Tomography / North American Society of Cardiovascular Imaging - Expert Consensus Document on Coronary CT Imaging of Atherosclerotic Plaque.
Shaw, LJ, Blankstein, R, Bax, JJ, Ferencik, M, Bittencourt, MS, Min, JK, Berman, DS, Leipsic, J, Villines, TC, Dey, D, et al
Journal of cardiovascular computed tomography. 2021;(2):93-109
Abstract
Coronary computed tomographic angiography (CCTA) provides a wealth of clinically meaningful information beyond anatomic stenosis alone, including the presence or absence of nonobstructive atherosclerosis and high-risk plaque features as precursors for incident coronary events. There is, however, no uniform agreement on how to identify and quantify these features or their use in evidence-based clinical decision-making. This statement from the Society of Cardiovascular Computed Tomography and North American Society of Cardiovascular Imaging addresses this gap and provides a comprehensive review of the available evidence on imaging of coronary atherosclerosis. In this statement, we provide standardized definitions for high-risk plaque (HRP) features and distill the evidence on the effectiveness of risk stratification into usable practice points. This statement outlines how this information should be communicated to referring physicians and patients by identifying critical elements to include in a structured CCTA report - the presence and severity of atherosclerotic plaque (descriptive statements, CAD-RADS™ categories), the segment involvement score, HRP features (e.g., low attenuation plaque, positive remodeling), and the coronary artery calcium score (when performed). Rigorous documentation of atherosclerosis on CCTA provides a vital opportunity to make recommendations for preventive care and to initiate and guide an effective care strategy for at-risk patients.
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4.
Coronary Artery Calcium: Where Do We Stand After Over 3 Decades?
Grundy, SM, Stone, NJ
The American journal of medicine. 2021;(9):1091-1095
Abstract
In 2018, cardiovascular society cholesterol guidelines recommended the use of coronary artery calcium to guide statin therapy in patients 40-79 years of age who are at intermediate risk by multiple risk factor equations (ie, estimated 10-year risk for atherosclerotic disease of 7.5%-19.9% but in whom statin benefit is uncertain). Many such patients have no coronary calcium and remain at <5% risk over the next decade; hence, statin therapy can be delayed until a repeat calcium scan is conducted. Exceptions include patients with severe hypercholesterolemia, diabetes, and a strong family history of atherosclerotic disease. If coronary calcium equals 1-99 Agatston units, the 10-year risk is borderline (5% to <7.5%) and statin therapy is optional pending a repeat scan. If coronary calcium equals 100-299 Agatston units, the patient is clearly statin eligible (7.5% to <20% 10-year risk). And finally, if coronary calcium is ≥300 Agatston units, a patient is at high risk and is a candidate for high-intensity statins. Risk factor analysis combined judiciously with coronary calcium scanning offers the strongest evidence-based approach to use of statins in primary prevention.
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5.
Ischemia and outcome prediction by cardiac CT based machine learning.
Brandt, V, Emrich, T, Schoepf, UJ, Dargis, DM, Bayer, RR, De Cecco, CN, Tesche, C
The international journal of cardiovascular imaging. 2020;(12):2429-2439
Abstract
Cardiac CT using non-enhanced coronary artery calcium scoring (CACS) and coronary CT angiography (cCTA) has been proven to provide excellent evaluation of coronary artery disease (CAD) combining anatomical and morphological assessment of CAD for cardiovascular risk stratification and therapeutic decision-making, in addition to providing prognostic value for the occurrence of adverse cardiac outcome. In recent years, artificial intelligence (AI) and, in particular, the application of machine learning (ML) algorithms, have been promoted in cardiovascular CT imaging for improved decision pathways, risk stratification, and outcome prediction in a more objective, reproducible, and rational manner. AI is based on computer science and mathematics that are based on big data, high performance computational infrastructure, and applied algorithms. The application of ML in daily routine clinical practice may hold potential to improve imaging workflow and to promote better outcome prediction and more effective decision-making in patient management. Moreover, CT represents a field wherein ML may be particularly useful, such as CACS and cCTA. Thus, the purpose of this review is to give a short overview about the contemporary state of ML based algorithms in cardiac CT, as well as to provide clinicians with currently available scientific data on clinical validation and implementation of these algorithms for the prediction of ischemia-specific CAD and cardiovascular outcome.
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6.
Artificial Intelligence in Coronary Computed Tomography Angiography: From Anatomy to Prognosis.
Muscogiuri, G, Van Assen, M, Tesche, C, De Cecco, CN, Chiesa, M, Scafuri, S, Guglielmo, M, Baggiano, A, Fusini, L, Guaricci, AI, et al
BioMed research international. 2020;:6649410
Abstract
Cardiac computed tomography angiography (CCTA) is widely used as a diagnostic tool for evaluation of coronary artery disease (CAD). Despite the excellent capability to rule-out CAD, CCTA may overestimate the degree of stenosis; furthermore, CCTA analysis can be time consuming, often requiring advanced postprocessing techniques. In consideration of the most recent ESC guidelines on CAD management, which will likely increase CCTA volume over the next years, new tools are necessary to shorten reporting time and improve the accuracy for the detection of ischemia-inducing coronary lesions. The application of artificial intelligence (AI) may provide a helpful tool in CCTA, improving the evaluation and quantification of coronary stenosis, plaque characterization, and assessment of myocardial ischemia. Furthermore, in comparison with existing risk scores, machine-learning algorithms can better predict the outcome utilizing both imaging findings and clinical parameters. Medical AI is moving from the research field to daily clinical practice, and with the increasing number of CCTA examinations, AI will be extensively utilized in cardiac imaging. This review is aimed at illustrating the state of the art in AI-based CCTA applications and future clinical scenarios.
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7.
Coronary artery calcium: A technical argument for a new scoring method.
Willemink, MJ, van der Werf, NR, Nieman, K, Greuter, MJW, Koweek, LM, Fleischmann, D
Journal of cardiovascular computed tomography. 2019;(6):347-352
Abstract
Coronary artery calcium (CAC) is a strong predictor for future cardiovascular events. Traditionally CAC has been quantified using the Agatston score, which was developed in the late 1980s for electron beam tomography (EBT). While EBT has been completely replaced by modern multiple-detector row CT technology, the traditional CAC scoring method by Agatston remains in use, although the literature indicates suboptimal reproducibility and subjects being incorrectly classified. The traditional Agatston scoring method counteracts the technical advances of CT technology, and prevents the use of thinner sections, obtained at lower tube voltage and overall decreased radiation exposure that has become available to other CT applications. Moreover, recent studies have shown that not only the total amount of CAC, but also its density and distribution in the coronary arterial tree may be of prognostic value. Acquisition and reconstruction techniques thus need to be adapted for modern CT technology and optimized for CAC quantification. In this review we describe the technical limitations of the Agatston score followed by our suggestions for developing a new and more robust CAC quantification method.
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8.
Intracoronary Lithotripsy for the Treatment of Calcified Plaque.
Yeoh, J, Hill, J
Interventional cardiology clinics. 2019;(4):411-424
Abstract
Intravascular lithotripsy facilitates percutaneous coronary intervention of lesions with severe calcification by using high-pressure ultrasonic energy. It is the newest adjunctive tool for calcium modification and is showing promise as its users gather more experience and it becomes readily available worldwide. This article reviews intravascular lithotripsy technology, the evidence in the literature, and the advantages and disadvantages compared with other forms of calcium modification, and discusses its role in specific subsets of coronary lesions. It concludes with a discussion about the future direction of research involving this new technology as its role within percutaneous cardiac procedures becomes more defined.
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9.
Cardiovascular Risk Heterogeneity in Adults with Diabetes: Selective Use of Coronary Artery Calcium in Statin Use Decision-making.
Sarkar, S, Orimoloye, OA, Nass, CM, Blumenthal, RS, Martin, SS
Journal of general internal medicine. 2019;(11):2643-2647
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Abstract
Current American College of Cardiology/American Heart Association and American Diabetes Association guidelines recommend statin therapy for all patients with diabetes between the ages of 40 and 75, including those without cardiovascular disease (CVD). While diabetes is a major CVD risk factor, not all patients with diabetes have an equal risk of CVD. Thus, a more risk-based approach warrants consideration when recommending statin therapy for the primary prevention of CVD. Coronary artery calcium (CAC) is a noninvasive imaging modality that can help risk stratify patients with diabetes for future CVD events. CAC has been extensively studied in large cohorts such as the Multi-Ethnic Study of Atherosclerosis and found to outperform other novel risk stratification tools including carotid intima-media thickness. Moreover, a CAC score of 0 has been shown to be useful in downgrading the estimated risk of a CVD event in patients with diabetes and an intermediate Pooled Cohort Equation score. As clinicians weigh the recommendation for a lifelong therapy and the problem of statin nonadherence and patients weigh concerns about adverse effects of statins, the decision to initiate statin therapy in patients with diabetes is ideally a shared one between patients and providers, and CAC could facilitate this discussion.
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10.
Coronary risk assessment using traditional risk factors with CT coronary artery calcium scoring in clinical practice.
Kerut, EK, Hall, ME, Turner, MC, McMullan, MR
Echocardiography (Mount Kisco, N.Y.). 2018;(8):1216-1222
Abstract
As coronary artery calcium (CAC) is atherosclerosis and not just a marker of cardiovascular (CV) disease, measurement of a patient's coronary artery calcium score (CACS) is a strong predictor of risk. Clinically performed in asymptomatic patients, the CACS, along with several CV risk factors, namely age, sex, ethnicity, diabetes, tobacco use, family history, cholesterol level, blood pressure, and use of cholesterol or hypertensive medications, provide a predictive model of 10 year risk for CV events. A smartphone "App" makes this quick to obtain and use. This helps the clinician in making recommendations for both lifestyle changes and statin therapy. Those patients in which the most benefit occur from measurement of a CACS are those at an intermediate CV risk. Measurement of the CACS has become an integral part of the clinician's assessment of a patient's CV risk and for guiding preventative therapies.