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Quantification of coronary atherosclerotic burden with coronary computed tomography angiography: adapted Leaman score in Croatian patients

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Abstract

The aim of the study was to quantify the total coronary atherosclerotic burden in patients with suspected coronary artery disease (CAD) defined by coronary computed tomography adapted Leaman score (CT-LeSc) and to estimate its cut-off level for high coronary atherosclerotic burden. We enrolled 434 consecutive patients referred to coronary computed tomography angiography, of which 261 patients fulfilled the study inclusion criteria. Demographic and clinical characteristics, as well as CAD risk factors were obtained. CAD pre-test probabilities were estimated by the Diamond-Forrester model and Morise score. The coronary atherosclerotic burden was estimated using CT-LeSc. As a cut-off for a high coronary atherosclerotic burden, we used 3rd tercile (Tc3) (CT-LeSc ≥ 5.52). We evaluated the association of clinical characteristics and risk factors with Tc3 in univariate and multivariate analysis. There were 60.9% males and 39.1% females, 81% of patients had above-normal weight, 68.2% hypertension, 54.0% dyslipidemia, 15.3% diabetes mellitus, 12.3% positive smoking history and 11.9% had a family history of CAD. According to the Diamond-Forrester model and Morise score the majority of patients had intermediate risk, 59.7 and 52.8%, followed by the high-risk group, 36.0 and 34.4%, respectively. Age, dyslipidemia, hypertension and pre-test risk scores in the univariate analysis significantly predicted Tc3. In the multivariate analysis, male sex (p = 0.004), dyslipidemia (p = 0.002) and coronary calcium score (< 0.001) were identified as predictors of Tc3. CT-LeSc quantified the total coronary atherosclerotic burden and showed an association of risk factors and pre-test probabilities with Tc3.

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References

  1. Townsend N, Wilson L, Bhatnagar P, Wickramasinghe K, Rayner M, Nichols M (2016) Cardiovascular disease in Europe: epidemiological update 2016. Eur Heart J 37:3232–3245

    Article  PubMed  Google Scholar 

  2. Min JK, Shaw LJ, Berman DS (2010) The present state of coronary computed tomography angiography a process in evolution. J Am Coll Cardiol 55:957–965

    Article  PubMed  Google Scholar 

  3. Min JK, Shaw LJ, Devereux RB, Okin PM, Weinsaft JW, Russo DJ et al (2007) Prognostic value of multidetector coronary computed tomographic angiography for prediction of all-cause mortality. J Am Coll Cardiol 50:1161–1170

    Article  PubMed  Google Scholar 

  4. Leaman DM, Brower RW, Meester GT, Serruys P, van den Brand M (1981) Coronary artery atherosclerosis: severity of the disease, severity of angina pectoris and compromised left ventricular function. Circulation 63:285–299

    Article  CAS  PubMed  Google Scholar 

  5. de Araujo Gonçalves P, Garcia-Garcia HM, Dores H, Carvalho MS, Jerónimo Sousa P, Marques H et al (2013) Coronary computed tomography angiography-adapted Leaman score as a tool to noninvasively quantify total coronary atherosclerotic burden. Int J Cardiovasc Imaging 29:1575–1584

    Article  PubMed  Google Scholar 

  6. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus (1997) Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 20:1183–1197

    Article  Google Scholar 

  7. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M et al (2013) 2013 ESH/ESC guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 34:2159–2219

    Article  PubMed  Google Scholar 

  8. Taylor AJ, Bindeman J, Feuerstein I, Cao F, Brazaitis M, O’Malley PG (2005) Coronary calcium independently predicts incident premature coronary heart disease over measured cardiovascular risk factors: mean three-year outcomes in the Prospective Army Coronary Calcium (PACC) project. J Am Coll Cardiol 46:807–814

    Article  CAS  PubMed  Google Scholar 

  9. Morise AP, Haddad WJ, Beckner D (1997) Development and validation of a clinical score to estimate the probability of coronary artery disease in men and women presenting with suspected coronary disease. Am J Med 102:350–356

    Article  CAS  PubMed  Google Scholar 

  10. Diamond GA, Forrester JS (1979) Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease. N Engl J Med 300:1350–1358

    Article  CAS  PubMed  Google Scholar 

  11. Leschka S, Scheffel H, Desbiolles L, Plass A, Gaemperli O, Valenta I et al (2007) Image quality and reconstruction intervals of dual-source CT coronary angiography: recommendations for ECG-pulsing windowing. Invest Radiol 42:543–549

    Article  PubMed  Google Scholar 

  12. Hausleiter J, Meyer T, Hadamitzky M, Zankl M, Gerein P, Dorrler K et al (2007) Non-invasive coronary computed tomographic angiography for patients with suspected coronary artery disease: the coronary angiography by computed tomography with the use of a submillimeter resolution (CACTUS) trial. Eur Heart J 28:3034–3041

    Article  PubMed  Google Scholar 

  13. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M, Detrano R (1990) Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15:827–832

    Article  CAS  PubMed  Google Scholar 

  14. Carr JJ, Nelson JC, Wong ND, McNitt-Gray M, Arad Y, Jacobs DR et al (2005) Calcified coronary artery plaque measurement with cardiac CT in population-based studies: standardized protocol of multi-ethnic study of atherosclerosis (MESA) and coronary artery risk development in young adults (CARDIA) study. Radiology 234:35–43

    Article  PubMed  Google Scholar 

  15. Bongartz G, Golding SJ, Jurik AG, Leonardi M, van Persijn van Meerten E, Rodriguez R et al (2004) CT quality criteria. European Commission, Luxembourg

    Google Scholar 

  16. Scanlon PJ, Faxon DP, Audet AM, Carabello B, Dehmer GJ, Eagle KA et al (1999) ACC/AHA guidelines for coronary angiography: executive summary and recommendations: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Coronary Angiography) Developed in collaboration with the Society for Cardiac Angiography and Interventions. Circulation 99:2345–2357

    Article  CAS  PubMed  Google Scholar 

  17. Raff GL, Abidov A, Achenbach S, Berman DS, Boxt LM et al (2009) SCCT guidelines for the interpretation and reporting of coronary computed tomographic angiography. J Cardiovasc Comput Tomogr 3:122–136

    Article  PubMed  Google Scholar 

  18. Vrazić H, Sikić J, Lucijanić T, Milosević M, Borić K, Udovicić M et al. (2012) The prevalence of smoking among Croatian hospitalized coronary heart disease patients. Coll Antropol 36(1):229–233

    Article  PubMed  Google Scholar 

  19. Versteylen MO, Joosen IA, Shaw LJ, Narula J, Hofstra L (2011) Comparison of Framingham, PROCAM, SCORE, and Diamond Forrester to predict coronary atherosclerosis and cardiovascular events. J Nucl Cardiol 18:904–911

    Article  PubMed  PubMed Central  Google Scholar 

  20. Morise AP, Jalisi F (2003) Evaluation of pretest and exercise test scores to assess all-cause mortality in unselected patients presenting for exercise testing with symptoms of suspected coronary artery disease. J Am Coll Cardiol 42:842–850

    Article  PubMed  Google Scholar 

  21. Deupree RH, Fields RI, McMahan CA, Strong JP (1973) Atherosclerotic lesions and coronary heart disease. Key relationships in necropsied cases. Lab Invest 28:252–262

    CAS  PubMed  Google Scholar 

  22. Rissanen V (1975) Coronary atherosclerosis in cases of coronary death as compared with that occurring in the population. A study of a medico-legal autopsy series of coronary deaths and violent deaths. Ann Clin Res 7:412–425

    CAS  PubMed  Google Scholar 

  23. Baroldi G, Falzi G, Mariani F (1979) Sudden coronary death. A postmortem study in 208 selected cases compared to 97 “control” subjects. Am Heart J 98:20–31

    Article  CAS  PubMed  Google Scholar 

  24. Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL et al (2016) European guidelines on cardiovascular disease prevention in clinical practice: the sixth joint task force of the European Society of Cardiology and Other Societies on cardiovascular disease prevention in clinical practice (constituted by representatives of 10 societies and by invited experts): developed with the special contribution of the European Association for Cardiovascular Prevention and Rehabilitation (EACPR). Eur J Prev Cardiol 23:NP1–NP96

    Google Scholar 

  25. Hadamitzky M, Meyer T, Hein F et al (2010) Prognostic value of coronary computed tomographic angiography in asymptomatic patients. Am J Cardiol 105:1746–1751

    Article  PubMed  Google Scholar 

  26. Youssef G, Budoff MJ (2012) Coronary artery calcium scoring, what is answered and what questions remain. Cardiovasc Diagn Ther 2:94–105

    PubMed  PubMed Central  Google Scholar 

  27. Hecht HS (2009) Coronary artery calcium: the cup is 96% full. JACC Cardiovasc Imaging 2:1184–1186

    Article  PubMed  Google Scholar 

  28. Sangiorgi G, Rumberger JA, Severson A, Edwards WD, Gregoire J, Fitzpatrick LA et al (1998) Arterial calcification and not lumen stenosis is highly correlated with atherosclerotic plaque burden in humans: a histologic study of 723 coronary artery segments using nondecalcifying methodology. J Am Coll Cardiol 31:126–133

    Article  CAS  PubMed  Google Scholar 

  29. Alluri K, Joshi PH, Henry TS, Blumenthal RS, Nasir K, Blaha MJ (2015) Scoring of coronary artery calcium scans: history, assumptions, current limitations, and future directions. Atherosclerosis 239:109–117

    Article  CAS  PubMed  Google Scholar 

  30. Mushtaq S, De Araujo Gonçalves P, Garcia-Garcia HM, Pontone G, Bartorelli AL, Bertella E et al (2015) Long-term prognostic effect of coronary atherosclerotic burden: validation of the computed tomography-Leaman score. Circ Cardiovasc Imaging 8:e002332

    Article  PubMed  Google Scholar 

  31. Andreini D, Pontone G, Mushtaq S, Gransar H, Conte E, Bartorelli AL et al (2017) Long-term prognostic impact of CT-Leaman score in patients with non-obstructive CAD: results from the coronary CT angiography evaluation for Clinical Outcomes International Multicenter (CONFIRM) study. Int J Cardiol 231:18–25

    Article  PubMed  Google Scholar 

  32. Puchner SB, Liu T, Mayrhofer T, Truong QA, Lee H, Fleg JL et al (2014) High-risk plaque detected on coronary CT angiography predicts acute coronary syndromes independent of significant stenosis in acute chest pain: results from the ROMICAT-II trial. J Am Coll Cardiol 64:684–692

    Article  PubMed  PubMed Central  Google Scholar 

  33. Stone GW, Maehara A, Lansky AJ, de Bruyne B, Cristea E, Mintz GS et al (2011) A prospective natural-history study of coronary atherosclerosis. N Engl J Med 364:226–235

    Article  CAS  PubMed  Google Scholar 

  34. Naya M, Murthy VL, Blankstein R, Sitek A, Hainer J, Foster C et al (2011) Quantitative relationship between the extent and morphology of coronary atherosclerotic plaque and downstream myocardial perfusion. J Am Coll Cardiol 58:1807–1816

    Article  PubMed  PubMed Central  Google Scholar 

  35. Glaser R, Selzer F, Faxon DP, Laskey WK, Cohen HA, Slater J et al (2005) Clinical progression of incidental, asymptomatic lesions discovered during culprit vessel coronary intervention. Circulation 111:143–149

    Article  PubMed  Google Scholar 

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Funding

This study is an investigator initiated project and did not receive any specific grants from funding agencies in the public, commercial or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Radiology, Polyclinic Sunce, Trnjanska cesta 108, 10000, Zagreb, Croatia

    Petar Medakovic & Mladen Jukic

  2. Department of Medical Statistics, Epidemiology and Medical Informatics, School of Public Health Andrija Stampar, University of Zagreb, School of Medicine, Zagreb, Croatia

    Zrinka Biloglav

  3. Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia

    Ivan Padjen

  4. Croatian Institute for Public Health, Zagreb, Croatia

    Ivan Pristas

  5. Ministry of Defence of the Republic of Croatia, Zagreb, Croatia

    Franko Zuvela

  6. Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, Zagreb, Croatia

    Gordana Ivanac & Boris Brkljacic

  7. University of Zagreb, School of Medicine, Zagreb, Croatia

    Ivan Padjen, Gordana Ivanac, Boris Brkljacic, Tena Jukic & Lana Turk

Authors
  1. Petar Medakovic
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  2. Zrinka Biloglav
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  3. Ivan Padjen
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  9. Tena Jukic
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Correspondence to Petar Medakovic.

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The authors declare that they have no conflict of interest.

Ethical approval

The study was conducted according to the Declaration of Helsinki. It was approved by the institutional Ethical Committee.

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Medakovic, P., Biloglav, Z., Padjen, I. et al. Quantification of coronary atherosclerotic burden with coronary computed tomography angiography: adapted Leaman score in Croatian patients. Int J Cardiovasc Imaging 34, 1647–1655 (2018). https://doi.org/10.1007/s10554-018-1376-3

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  • DOI: https://doi.org/10.1007/s10554-018-1376-3

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