TY - JOUR
T1 - Normalized Subendocardial Myocardial Attenuation on Coronary Computed Tomography Angiography Predicts Postoperative Adverse Cardiovascular Events
T2 - Coronary CTA VISION Substudy
AU - Walpot, Jeroen
AU - Massalha, Samia
AU - Jayasinghe, Pranisha
AU - Sadaf, Madiha
AU - Clarkin, Owen
AU - Godkin, Laura
AU - Sharma, Ashwin
AU - Ratnayake, Indeevari
AU - Godkin, Kara
AU - Jia, Kateleen
AU - Hossain, Alomgir
AU - Crean, Andrew M.
AU - Chan, Matthew
AU - Butler, Craig
AU - Tandon, Vikas
AU - Nagele, Peter
AU - Woodard, Pamela K.
AU - Mrkobrada, Marko
AU - Szczeklik, Wojciech
AU - Aziz, Yang Faridah Abdul
AU - Biccard, Bruce
AU - Devereaux, P. J.
AU - Sheth, Tej
AU - Chow, Benjamin J.W.
N1 - Funding Information:
Dr Chow receives research support from CV Diagnostix and AusculSciences, Siemens Healthineers, and educational support from TeraRecon Inc. He has equity interest in General Electric. Dr Nagele reports receiving research grants and other research support from Roche Diagnostics (Indianapolis, IN); and research grants and other research support from Abbott Diagnostics (Abbott Park, IL). Dr Woodard is the Hugh Monroe Professor of Radiology. She receives research support from the National Institutes of Health, Siemens Medical Systems, Roche Diagnostics, Lilly, and is a consultant for Medtronic. The other authors report no conflicts.
Funding Information:
Coronary CTA VISION was funded by the Canadian Institute of Health Research (CIHR). This substudy did not receive additional funding.
Publisher Copyright:
© 2020 American Heart Association, Inc.
PY - 2022/1/1
Y1 - 2022/1/1
N2 - Background: Abnormalities in computed tomography myocardial perfusion has been associated with coronary artery disease and major adverse cardiovascular events (MACE). We sought to investigate if subendocardial attenuation using coronary computed tomography angiography predicts MACE 30 days postelective noncardiac surgery. Methods: Using a 17-segment model, coronary computed tomography angiography images were analyzed for subendocardial and transmural attenuation and the corresponding blood pool. The segment with the lowest subendocardial attenuation and transmural attenuation were normalized to the segment with the highest subendocardial and transmural attenuation, respectively (SUBnormalized, and TRANSnormalized, respectively). We evaluated the independent and incremental value of myocardial attenuation to predict the composite of cardiovascular death or nonfatal myocardial infarction. Results: Of a total of 995 coronary CTA VISION (Coronary Computed Tomographic Angiography and Vascular Events in Noncardiac Surgery Patients Cohort Evaluation Study) patients, 735 had available images and complete data for these analyses. Among these patients, 60 had MACE. Based on Revised Cardiovascular Risk Index, 257, 302, 138, and 38 patients had scores of 0, 1, 2, and ≥3, respectively. On coronary computed tomography angiography, 75 patients had normal coronary arteries, 297 patients had nonobstructive coronary artery disease, 264 patients had obstructive disease, and 99 patients had extensive obstructive coronary artery disease. SUBnormalizedwas an independent and incremental predictor of events in the model that included Revised Cardiovascular Risk Index and coronary artery disease severity. Compared with patients in the highest tertile of SUBnormalized, patients in the second and first tertiles had an increased hazards ratio for events (2.23 [95% CI, 1.091-4.551] and 2.36 [95% CI, 1.16-4.81], respectively). TRANSnormalized, as a continuous variable, was also found to be a predictor of MACE (P=0.027). Conclusions: Our study demonstrates that SUBnormalizedand TRANSnormalizedare independent and incremental predictors of MACE 30 days after elective noncardiac surgery. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01635309.
AB - Background: Abnormalities in computed tomography myocardial perfusion has been associated with coronary artery disease and major adverse cardiovascular events (MACE). We sought to investigate if subendocardial attenuation using coronary computed tomography angiography predicts MACE 30 days postelective noncardiac surgery. Methods: Using a 17-segment model, coronary computed tomography angiography images were analyzed for subendocardial and transmural attenuation and the corresponding blood pool. The segment with the lowest subendocardial attenuation and transmural attenuation were normalized to the segment with the highest subendocardial and transmural attenuation, respectively (SUBnormalized, and TRANSnormalized, respectively). We evaluated the independent and incremental value of myocardial attenuation to predict the composite of cardiovascular death or nonfatal myocardial infarction. Results: Of a total of 995 coronary CTA VISION (Coronary Computed Tomographic Angiography and Vascular Events in Noncardiac Surgery Patients Cohort Evaluation Study) patients, 735 had available images and complete data for these analyses. Among these patients, 60 had MACE. Based on Revised Cardiovascular Risk Index, 257, 302, 138, and 38 patients had scores of 0, 1, 2, and ≥3, respectively. On coronary computed tomography angiography, 75 patients had normal coronary arteries, 297 patients had nonobstructive coronary artery disease, 264 patients had obstructive disease, and 99 patients had extensive obstructive coronary artery disease. SUBnormalizedwas an independent and incremental predictor of events in the model that included Revised Cardiovascular Risk Index and coronary artery disease severity. Compared with patients in the highest tertile of SUBnormalized, patients in the second and first tertiles had an increased hazards ratio for events (2.23 [95% CI, 1.091-4.551] and 2.36 [95% CI, 1.16-4.81], respectively). TRANSnormalized, as a continuous variable, was also found to be a predictor of MACE (P=0.027). Conclusions: Our study demonstrates that SUBnormalizedand TRANSnormalizedare independent and incremental predictors of MACE 30 days after elective noncardiac surgery. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01635309.
KW - angiography
KW - computed tomography
KW - coronary artery disease
KW - myocardial infarction
KW - perfusion
UR - http://www.scopus.com/inward/record.url?scp=85123664644&partnerID=8YFLogxK
U2 - 10.1161/CIRCIMAGING.121.012654
DO - 10.1161/CIRCIMAGING.121.012654
M3 - Article
C2 - 35041449
AN - SCOPUS:85123664644
SN - 1941-9651
VL - 15
SP - E012654
JO - Circulation: Cardiovascular Imaging
JF - Circulation: Cardiovascular Imaging
IS - 1
ER -