Implication of coronary CT angiography combined with four-dimensional speckle tracking echocardiography for predicting major adverse cardiac events
- 23 Downloads
Coronary computed tomography angiography (CCTA) can provide abundant information about the anatomy of the coronary artery. However, this modality is limited in evaluation of myocardial function. Four-dimensional speckle tracking echocardiography (4DSTE) is a novel and sensitive technique for quantitative evaluation of myocardial deformation. We estimated the value of these imaging modalities to predict the risk of MACE in 209 patients with suspected coronary artery disease(CAD) after a median follow-up of 727 days. Three models were established: (1) CCTA alone, (2) CCTA combined with 4DSTE, and (3) CCTA combined with 4DSTE and clinical risk factors. Forty-six (22.0%) patients developed MACE. The hazard ratio (HR) of CCTA classification to predict the risk of MACE was greater (HR = 4.86) than for other parameters, including B-type natriuretic peptide (BNP) (HR = 2.44) and left ventricular ejection fraction (LVEF) (HR = 0.40). The area under the curve of models 2 and 3 to predict MACE was significantly greater than that of model 1 (0.92 and 0.93 vs. 0.84, respectively, p < 0.001). We conclude that there is direct relationship between CCTA classification and MACE risk. CCTA combined with 4DSTE can improve the ability of CCTA to predict the risk of MACE. This approach provides cardiologists a noninvasive, objective, and efficient method to predict MACE.
KeywordsCoronary computed tomography angiography Four-dimensional speckle tracking echocardiography Risk factors Major adverse cardiac events Atherosclerotic plaque
The authors would like to thank participants and coordinators in the study, including Dr. Xuedong Shen and Dr. Ben He from Renji Hospital, Medical School of Shanghai Jiao-Tong University in China. We also thank Bracco Sine Pharmaceutical Corp. Ltd. and LetPub (http://www.letpub.com) for its linguistic assistance during the preparation of this manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 2.Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, McQueen M, Budaj A, Pais P, Varigos J, Lisheng L (2004) Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 364:937–952. https://doi.org/10.1016/S0140-6736(04)17018-9 CrossRefPubMedGoogle Scholar
- 4.Correia LC, Garcia G, Kalil F, Ferreira F, Carvalhal M, Oliveira R, Silva A, Vasconcelos I, Henri C, Noya-Rabelo M (2014) Prognostic value of TIMI score versus GRACE score in ST-segment elevation myocardial infarction. Arq Bras Cardiol 103:98–106. https://doi.org/10.5935/abc.20140095 PubMedPubMedCentralGoogle Scholar
- 5.Raposeiras-Roubín S, Abu-Assi E, López-López A, Bouzas-Cruz N, Castiñeira-Busto M, Cambeiro-González C, Álvarez-Álvarez B, Virgós-Lamela A, Varela-Román A, García-Acuña JM, González-Juanatey JR (2015) Risk stratification for the development of heart failure after acute coronary syndrome at the time of hospital discharge: predictive ability of GRACE risk score. J Cardiol 66:224–231. https://doi.org/10.1016/j.jjcc.2014.12.015 CrossRefPubMedGoogle Scholar
- 7.Krittayaphong R, Boonyasirinant T, Saiviroonporn P, Thanapiboonpol P, Nakyen S, Udompunturak S (2008) Correlation between NT-pro BNP grades and left ventricular wall stress, sphericity index and extent of myocardial damage: a magnetic resonance imaging study. J Card Fail 14:687–694. https://doi.org/10.1016/j.cardfail.2008.05.002 CrossRefPubMedGoogle Scholar
- 8.Raja S, Mittal BR, Santhosh S, Bhattacharya A, Rohit MK (2014) Comparison of LVEF assessed by 2D echocardiography, gated blood pool SPECT, 99mTc tetrofosmin gated SPECT, and 18F-FDG gated PET with ERNV in patients with CAD and severe LV dysfunction. Nucl Med Commun 35:1156–1161. https://doi.org/10.1097/MNM.0000000000000182 CrossRefPubMedGoogle Scholar
- 9.Thalji NM, Suri RM, Daly RC, Dearani JA, Burkhart HM, Park SJ, Greason KL, Joyce LD, Stulak JM, Huebner M, Li Z, Frye RL, Schaff HV (2013) Assessment of coronary artery disease risk in 5463 patients undergoing cardiac surgery: when is preoperative coronary angiography necessary? J Thorac Cardiovasc Surg 146:1055–1063. https://doi.org/10.1016/j.jtcvs.2013.06.0461064.e1.CrossRefPubMedGoogle Scholar
- 13.Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, Pennell DJ, Rumberger JA, Ryan T, Verani MS; American Heart Association Writing Group on Myocardial Segmentationand Registration for Cardiac Imaging (2002) Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 105:539–542. https://doi.org/10.1067/mje.2002.123374 CrossRefPubMedGoogle Scholar
- 14.Cantoni V, Green R, Acampa W, Petretta M, Bonaduce D, Salvatore M, Cuocolo A (2016) Long-term prognostic value of stress myocardial perfusion imaging and coronary computed tomography angiography: a meta-analysis. J Nucl Cardiol 23:185–197. https://doi.org/10.1007/s12350-015-0349-3 CrossRefPubMedGoogle Scholar
- 15.Min JK, Dunning A, Lin FY, Achenbach S, Al-Mallah M, Budoff MJ, Cademartiri F, Callister TQ, Chang HJ, Cheng V, Chinnaiyan K, Chow BJ, Delago A, Hadamitzky M, Hausleiter J, Kaufmann P, Maffei E, Raff G, Shaw LJ, Villines T, Berman DS, CONFIRM Investigators (2011) Age- and sex-related differences in all-cause mortality risk based on coronary computed tomography angiography findings. J Am Coll Cardiol 58: 849–860. https://doi.org/10.1016/j.jacc.2011.02.074 CrossRefPubMedGoogle Scholar
- 16.Miller JM, Rochitte CE, Dewey M, Arbab-Zadeh A, Niinuma H, Gottlieb I, Paul N, Clouse ME, Shapiro EP, Hoe J, Lardo AC, Bush DE, de Roos A, Cox C, Brinker J, Lima JA (2008) Diagnostic performance of coronary angiography by 64-Row CT. N Engl J Me 359: 2324–2336. https://doi.org/10.1056/NEJMoa0806576 CrossRefGoogle Scholar
- 17.Abdulla J, Asferg C, Kofoed KF (2011) Prognostic value of absence or presence of coronary artery disease determined by 64-slice computed tomography coronary angiography: a systematic review and meta-analysis. Int J Cardiovasc Imaging 27:413–420. https://doi.org/10.1007/s10554-010-9652-x CrossRefPubMedGoogle Scholar
- 18.Schlett CL, Banerji D, Siegel E, Bamberg F, Lehman SJ, Ferencik M, Brady TJ, Nagurney JT, Hoffmann U, Truong QA (2011) Prognostic value of CT angiography for major adverse cardiac events in patients with acute chest pain from the emergency department: 2-year outcomes of the ROMICAT trial. JACC Cardiovasc Imaging 4:481–491. https://doi.org/10.1016/j.jcmg.2010.12.008 CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Bergerot C, Mewton N, Lacote-Roiron C, Ernande L, Ovize M, Croisille P, Thibault H, Derumeaux G (2014) Influence of microvascular obstruction on regional myocardial deformation in the acute phase of myocardial infarction: a speckle-tracking echocardiography study. J Am Soc Echocardiogr 27:93–100. https://doi.org/10.1016/j.echo.2013.09.011 CrossRefPubMedGoogle Scholar
- 20.Reant P, Barbot L, Touche C, Dijos M, Arsac F, Pillois X, Landelle M, Roudaut R, Lafitte S (2012) Evaluation of global left ventricular systolic function using three-dimensional echocardiography speckle-tracking strain parameters. J Am Soc Echocardiogr 25:68–79. https://doi.org/10.1016/j.echo.2011.10.009 CrossRefPubMedGoogle Scholar