Implication of coronary CT angiography combined with four-dimensional speckle tracking echocardiography for predicting major adverse cardiac events

  • Xiaohua Yin
  • Rong Xu
  • Yingchun Wang
  • Tao Cheng
  • Hui Zhou
Original Paper


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.


Coronary 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 ( for its linguistic assistance during the preparation of this manuscript.


The study received a research grant from Shanghai Municipal Commission of Health and Family Planning for Scientific Research projects in China (Grant No. 201440598) and Shanghai Municipal Science and Technology Commission guidance project in China (Grant No. 134119b2300).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of RadiologyJiading Central HospitalShanghaiPeople’s Republic of China
  2. 2.Department of UltrasoundJiading Central HospitalShanghaiPeople’s Republic of China

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