The Experts below are selected from a list of 2622 Experts worldwide ranked by ideXlab platform
Olivier Devuyst - One of the best experts on this subject based on the ideXlab platform.
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progression of coronary artery calcification and thoracic aorta calcification in kidney transplant recipients
American Journal of Kidney Diseases, 2012Co-Authors: Celine Marechal, Emmanuel Coche, Eric Goffin, Anca Dragean, Georg Schlieper, Pauline Nguyen, Jurgen Floege, Nada Kanaan, Olivier DevuystAbstract:BACKGROUND: Vascular calcification independently predicts cardiovascular disease, the major cause of death in kidney transplant recipients (KTRs). Longitudinal studies of vascular calcification in KTRs are few and small and have short follow-up. We assessed the evolution of coronary artery (CAC) and thoracic aorta calcification and their determinants in a cohort of prevalent KTRs. STUDY DESIGN: Longitudinal. SETTING & PARTICIPANTS: The Agatston Score of coronary arteries and thoracic aorta was measured by 16-slice spiral computed tomography in 281 KTRs. PREDICTORS: Demographic, clinical, and biochemical parameters were recorded simultaneously. OUTCOMES & MEASUREMENTS: The Agatston Score was measured again 3.5 or more years later. RESULTS: Repeated analyzable computed tomographic scans were available for 197 (70%) KTRs after 4.40 ± 0.28 years; they were not available for the rest of patients because of death (n = 40), atrial fibrillation (n = 1), other arrhythmias (n = 4), refusal (n = 35), or technical problems precluding confident calcium scoring (n = 4). CAC and aorta calcification Scores increased significantly (by a median of 11% and 4% per year, respectively) during follow-up. By multivariable linear regression, higher baseline CAC Score, history of cardiovascular event, use of a statin, and lower 25-hydroxyvitamin D(3) level were independent determinants of CAC progression. Independent determinants of aorta calcification progression were higher baseline aorta calcification Score, higher pulse pressure, use of a statin, older age, higher serum phosphate level, use of aspirin, and male sex. Significant regression of CAC or aorta calcification was not observed in this cohort. LIMITATIONS: Cohort of prevalent KTRs with potential survival bias; few patients with diabetes and nonwhites, limiting the generalizability of results. CONCLUSION: In contrast to previous small short-term studies, we show that vascular calcification progression is substantial within 4 years in prevalent KTRs and is associated with several traditional and nontraditional cardiovascular risk factors, some of which are modifiable.
Daniel S. Berman - One of the best experts on this subject based on the ideXlab platform.
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Medical Imaging: Image Processing - Automated coronary artery calcium scoring from non-contrast CT using a patient-specific algorithm
Medical Imaging 2015: Image Processing, 2015Co-Authors: Xiaowei Ding, Daniel S. Berman, Piotr J. Slomka, Mariana Diaz-zamudio, Guido Germano, Demetri Terzopoulos, Damini DeyAbstract:Non-contrast cardiac CT is used worldwide to assess coronary artery calcium (CAC), a subclinical marker of coronary atherosclerosis. Manual quantification of regional CAC Scores includes identifying candidate regions, followed by thresholding and connected component labeling. We aimed to develop and validate a fully-automated, algorithm for both overall and regional measurement of CAC Scores from non-contrast CT using a hybrid multi-atlas registration, active contours and knowledge-based region separation algorithm. A co-registered segmented CT atlas was created from manually segmented non-contrast CT data from 10 patients (5 men, 5 women) and stored offline. For each patient scan, the heart region, left ventricle, right ventricle, ascending aorta and aortic root are located by multi-atlas registration followed by active contours refinement. Regional coronary artery territories (left anterior descending artery, left circumflex artery and right coronary artery) are separated using a knowledge-based region separation algorithm. Calcifications from these coronary artery territories are detected by region growing at each lesion. Global and regional Agatston Scores and volume Scores were calculated in 50 patients. Agatston Scores and volume Scores calculated by the algorithm and the expert showed excellent correlation (Agatston Score: r = 0.97, p < 0.0001, volume Score: r = 0.97, p < 0.0001) with no significant differences by comparison of individual data points (Agatston Score: p = 0.30, volume Score: p = 0.33). The total time was
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All-cause mortality in asymptomatic persons with extensive Agatston Scores above 1000
Journal of cardiovascular computed tomography, 2014Co-Authors: Jaideep Patel, Michael J. Blaha, John W. Mcevoy, Sadia Qadir, Rajesh Tota-maharaj, Leslee J. Shaw, John A. Rumberger, Tracy Q. Callister, Daniel S. Berman, James K. MinAbstract:Abstract Background Risk assessment in the extensive calcified plaque phenotype has been limited by small sample size. Objective We studied all-cause mortality rates among asymptomatic patients with markedly elevated Agatston Scores > 1000. Methods We studied a clinical cohort of 44,052 asymptomatic patients referred for coronary calcium scans. Mean follow-up was 5.6 years (range, 1–13 years). All-cause mortality rates were calculated after stratifying by Agatston Score (0, 1–1000, 1001–1500, 1500–2000, and >2000). A multivariable Cox regression model adjusting for self-reported traditional risk factors was created to assess the relative mortality hazard of Agatston Scores 1001 to 1500, 1501 to 2000, and >2000. With the use of post-estimation modeling, we assessed for the presence of an upper threshold of risk with high Agatston Scores. Results A total of 1593 patients (4% of total population) had Agatston Score > 1000. There was a continuous graded decrease in estimated 10-year survival across increasing Agatston Score, continuing when Agatston Score > 1000 (Agatston Score 1001–1500, 78%; Agatston Score 1501–2000, 74%; Agatston Score > 2000, 51%). After multivariable adjustment, Agatston Scores 1001 to 1500, 1501 to 2000, and >2000 were associated with an 8.05-, 7.45-, and 13.26-fold greater mortality risk, respectively, than for Agatston Score of 0. Compared with Agatston Score 1001 to 1500, Agatston Score 1501 to 2000 had a similar all-cause mortality risk, whereas Agatston Score > 2000 had an increased relative risk (Agatston Score 1501–2000: hazard ratio [HR], 1.01 [95% CI, 0.67–1.51]; Agatston Score > 2000: HR, 1.79 [95% CI, 1.30–2.46]). Graphical assessment of the predicted survival model suggests no upper threshold for risk associated with calcified plaque in coronary arteries. Conclusion Increasing calcified plaque in coronary arteries continues to predict a graded decrease in survival among patients with extensive Agatston Score > 1000 with no apparent upper threshold.
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Agreement of Visual Estimation of Coronary Artery Calcium From Low-Dose CT Attenuation Correction Scans in Hybrid PET/CT and SPECT/CT With Standard Agatston Score
Journal of the American College of Cardiology, 2010Co-Authors: Andrew J. Einstein, Lynne L. Johnson, Sabahat Bokhari, Jessica Son, Randall C. Thompson, Timothy M. Bateman, Sean W. Hayes, Daniel S. BermanAbstract:Objectives We sought to evaluate the accuracy and reproducibility of visual estimation of coronary artery calcium (CAC) from computed tomography attenuation correction (CTAC) scans performed for hybrid positron emission tomography (PET)/computed tomography (CT) and single-photon emission computed tomography (SPECT)/CT myocardial perfusion imaging (MPI). Background At the time of MPI, hybrid systems obtain a low-dose, non-electrocardiogram (ECG)-gated CT scan that is used to perform attenuation correction. Utility of this CTAC scan in estimating actual CAC as measured by Agatston Score (AS) on standard ECG-gated scans has not been previously studied. Methods A total of 492 patients, from 3 centers, receiving both MPI with CTAC and a standard CAC scan were studied. At each site, experienced readers blinded to AS reviewed CTAC images, visually estimating CAC on a 6-level scale: classifying patients as estimated AS of 0, 1 to 9, 10 to 99, 100 to 300, 400 to 999, or ≥1,000. Agreement between visually estimated coronary artery calcium (VECAC) on CTAC and AS, measured standardly and converted to the same scale, was evaluated, as was inter-reader agreement. Results Although CTAC images are low dose and nongated, a high degree of association was observed between VECAC and AS, with 63% of VECACs in the same category as the AS category and 93% within 1 category. Weighted kappa was 0.89 (95% confidence interval: 0.88 to 0.91, p Conclusions CAC can be visually assessed from low-dose CTAC scans with high agreement with AS. CTAC scans should be routinely assessed for VECAC.
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agreement of visual estimation of coronary artery calcium from low dose ct attenuation correction scans in hybrid pet ct and spect ct with standard Agatston Score
Journal of the American College of Cardiology, 2010Co-Authors: Andrew J. Einstein, Lynne L. Johnson, Sabahat Bokhari, Jessica Son, Randall C. Thompson, Timothy M. Bateman, Sean W. Hayes, Daniel S. BermanAbstract:Objectives We sought to evaluate the accuracy and reproducibility of visual estimation of coronary artery calcium (CAC) from computed tomography attenuation correction (CTAC) scans performed for hybrid positron emission tomography (PET)/computed tomography (CT) and single-photon emission computed tomography (SPECT)/CT myocardial perfusion imaging (MPI). Background At the time of MPI, hybrid systems obtain a low-dose, non-electrocardiogram (ECG)-gated CT scan that is used to perform attenuation correction. Utility of this CTAC scan in estimating actual CAC as measured by Agatston Score (AS) on standard ECG-gated scans has not been previously studied. Methods A total of 492 patients, from 3 centers, receiving both MPI with CTAC and a standard CAC scan were studied. At each site, experienced readers blinded to AS reviewed CTAC images, visually estimating CAC on a 6-level scale: classifying patients as estimated AS of 0, 1 to 9, 10 to 99, 100 to 300, 400 to 999, or ≥1,000. Agreement between visually estimated coronary artery calcium (VECAC) on CTAC and AS, measured standardly and converted to the same scale, was evaluated, as was inter-reader agreement. Results Although CTAC images are low dose and nongated, a high degree of association was observed between VECAC and AS, with 63% of VECACs in the same category as the AS category and 93% within 1 category. Weighted kappa was 0.89 (95% confidence interval: 0.88 to 0.91, p Conclusions CAC can be visually assessed from low-dose CTAC scans with high agreement with AS. CTAC scans should be routinely assessed for VECAC.
J.p. Riveline - One of the best experts on this subject based on the ideXlab platform.
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Cardiac troponin I and BNP for predicting zero Agatston Score in patients with diabetes mellitus
European Heart Journal - Cardiovascular Imaging, 2021Co-Authors: T Pezel, J.g Dillinger, Guillaume Bonnet, T Vidal Trecan, A Asselin, Georgios Sideris, Damien Logeart, Stéphane Manzo-silberman, J.f. Gautier, J.p. RivelineAbstract:Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND Coronary artery calcifications (CAC) scoring assessed by the Agatston Score has shown an excellent prognostic value in large studies, particularly in diabetic patients, with a very low rate of cardiovascular events in patients with a zero Agatston Score. Moreover, recent studies have suggested that high-sensitive cardiac troponin I (hs-cTnI) and brain natriuretic peptide (BNP) may be useful for detecting subclinical atherosclerosis, especially in diabetic patients. However, the link between hs-cTnI/BNP and the Agatston Score has not been investigated in this population. PURPOSE The aim of this study was to investigate if hs-cTnI and BNP can bring additional value to predict zero Agatston Score in patients with diabetes mellitus in addition to usual risk factors. METHODS Between 2015 and 2019, CAC Score was prospectively performed in consecutive patients with diabetes mellitus with high cardiovascular risk. Patients with symptoms or known coronary artery disease were excluded. Within 24h from CT exam, peripheral blood samples were taken to measure hs-cTnI and BNP. The relationship between serum hs-cTnI/BNP concentrations and zero Agatston Score was evaluated using univariate and multivariate binomial models. 77 variables have been used to build the model. The implication of hs-cTnI and BNP in this multivariate model was evaluated using nested models associated with Chi-squared test of independence. RESULTS A total of 844 patients with diabetes were enrolled (61 ± 7 years, 57% men, mean diabetes duration 18 years). In this population, 294 (35%) had a zero Agatston Score, 253 (30%) an Agatston Score from 1 to 100, 161 (19%) from 101 to 400, and 136 (16%) higher than 400. In univariate analysis, hs-cTnI and BNP concentrations were associated with a zero Agatston Score (respectively OR, 2.63 [95% CI, 1.51-5.01]; p < 0.001 and OR, 1.09 [95% CI, 1.01-1.22]; p = 0.03). In multivariate analysis, hs-cTnI and BNP concentrations were associated with a zero Agatston Score (respectively OR, 2.38 [95% CI, 1.51-4.76]; p = 0.009 and OR, 1.18 [95% CI, 1.07-1.32]; p = 0.001). Among the 77 variables, the multivariate model including age, gender, smoking, dyslipidaemia, duration of the diabetes, arterial hypertension, presence of diabetic neuropathy, hs-cTnI and BNP concentrations, significantly discriminated the zero Agatston Score (AUC = 0.81; p < 0.001). The most discriminant threshold was ≤ 3ng/l for hs-cTnI and <17ng/l for BNP. In nested models, both hs-cTnI and BNP brought information to this multivariate model to predict a zero Agatston Score (respectively p = 0.003 and p < 0.001 to the Chi-squared test). Moreover, removing hs-cTnI and BNP from the model results in a significant reduction in model performance (AUC = 0.79; p = 0.004). CONCLUSIONS Cardiac biomarkers hs-cTnI and BNP are associated with a zero Agatston Score, which is correlated with a very low risk of cardiovascular events in asymptomatic patients with diabetes mellitus. Abstract Figure. ROC curve to predict zero Agatston Score
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Cardiac Troponin I and BNP for Predicting Zero Agatston Score in Patients with Diabetes Mellitus
Archives of Cardiovascular Diseases Supplements, 2021Co-Authors: T Pezel, J.g Dillinger, Guillaume Bonnet, T Vidal Trecan, A Asselin, Georgios Sideris, Damien Logeart, Stéphane Manzo-silberman, J.f. Gautier, J.p. RivelineAbstract:Background Coronary artery calcifications (CAC) scoring assessed by the Agatston Score has shown an excellent prognostic value in large studies and particularly in diabetic patients, with a very low rate of cardiovascular events in patients with a zero Agatston Score. Moreover, recent studies have suggested that high-sensitive cardiac troponin I (hs-cTnI) and brain natriuretic peptide (BNP) may be useful for detecting subclinical atherosclerosis. However, the link between hs-cTnI/BNP and the Agatston Score has not been investigated in patients with diabetes. Purpose The aim of this study was to investigate if hs-cTnI and BNP can bring additional value to predict zero Agatston Score in patients with diabetes mellitus in addition to usual risk factors. Methods Between 2015 and 2019, CAC Score was prospectively performed in consecutive patients with diabetes mellitus. Patients with symptoms, known coronary artery disease or history of atrial fibrillation were excluded. Within 24 h from CT examination, peripheral blood samples were taken to measure hs-cTnI and BNP. The relationship between serum hs-cTnI/BNP concentrations and zero Agatston Score was assessed using univariate and multivariate binomial models. The implication of hs-cTnI and BNP in this multivariate model was evaluated using nested models associated with Chi2 test of independence. Results A total of 844 patients with diabetes were enrolled (61 ± 7years, 57% men, mean duration of diabetes 18years). In this population, 294(35%) had a zero Agatston Score, 253(30%) an Agatston Score from 1 to 100, 161(19%) from 101 to 400, and 136(16%) higher than 400. In univariate analysis, hs-cTnI and BNP concentrations were associated with zero Agatston Score (respectively OR, 2.63 [95%CI, 1.51-5.01]; P Fig. 1 ). The most discriminant threshold was ≤ 3 ng/l for hs-cTnI and Conclusion Cardiac biomarkers hs-cTnI and BNP are associated with zero Agatston Score, which is correlated with a very low risk of cardiovascular events, in asymptomatic patients with diabetes mellitus.
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Abstract 13887: Cardiac Troponin I and Bnp for Predicting Zero Agatston Score in Patients With Diabetes Mellitus
Circulation, 2020Co-Authors: T Pezel, J.g Dillinger, Guillaume Bonnet, T Vidal Trecan, A Asselin, Georgios Sideris, Damien Logeart, Stéphane Manzo-silberman, J.f. Gautier, J.p. RivelineAbstract:Introduction: Coronary artery calcifications (CAC) Agatston Score has shown an excellent prognostic value and particularly in diabetic patients, with a very low rate of cardiovascular (CV) events i...
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Cardiac troponin I and BNP for predicting zero Agatston Score in patients with diabetes mellitus
European Heart Journal, 2020Co-Authors: T Pezel, J.g Dillinger, Guillaume Bonnet, T Vidal Trecan, A Asselin, Georgios Sideris, Damien Logeart, Stéphane Manzo-silberman, J.f. Gautier, J.p. RivelineAbstract:Abstract Background Coronary artery calcifications (CAC) scoring assessed by the Agatston Score has shown an excellent prognostic value in large studies, particularly in diabetic patients, with a very low rate of cardiovascular events in patients with a zero Agatston Score. Moreover, recent studies have suggested that high-sensitive cardiac troponin I (hs-cTnI) and brain natriuretic peptide (BNP) may be useful for detecting subclinical atherosclerosis, especially in diabetic patients. However, the link between hs-cTnI/BNP and the Agatston Score has not been investigated in this population. Purpose The aim of this study was to investigate if hs-cTnI and BNP can bring additional value to predict zero Agatston Score in patients with diabetes mellitus in addition to usual risk factors. Material Between 2015 and 2019, CAC Score was prospectively performed in consecutive patients with diabetes mellitus with high cardiovascular risk. Patients with symptoms or known coronary artery disease were excluded. Within 24h from CT exam, peripheral blood samples were taken to measure hs-cTnI and BNP. The relationship between serum hs-cTnI/BNP concentrations and zero Agatston Score was evaluated using univariate and multivariate binomial models. 77 variables have been used to build the model. The implication of hs-cTnI and BNP in this multivariate model was evaluated using nested models associated with Chi-squared test of independence. Results A total of 844 patients with diabetes were enrolled (61±7 years, 57% men, mean diabetes duration 18 years). In this population, 294 (35%) had a zero Agatston Score, 253 (30%) an Agatston Score from 1 to 100, 161 (19%) from 101 to 400, and 136 (16%) higher than 400. In univariate analysis, hs-cTnI and BNP concentrations were associated with a zero Agatston Score (respectively OR, 2.63 [95% CI, 1.51–5.01]; p<0.001 and OR, 1.09 [95% CI, 1.01–1.22]; p=0.03). In multivariate analysis, hs-cTnI and BNP concentrations were associated with a zero Agatston Score (respectively OR, 2.38 [95% CI, 1.51–4.76]; p=0.009 and OR, 1.18 [95% CI, 1.07–1.32]; p=0.001). Among the 77 variables, the multivariate model including age, gender, smoking, dyslipidaemia, duration of the diabetes, arterial hypertension, presence of diabetic neuropathy, hs-cTnI and BNP concentrations, significantly discriminated the zero Agatston Score (AUC = 0.81; p<0.001). The most discriminant threshold was ≤3ng/l for hs-cTnI and <17ng/l for BNP. In nested models, both hs-cTnI and BNP brought information to this multivariate model to predict a zero Agatston Score (respectively p=0.003 and p<0.001 to the Chi-squared test). Moreover, removing hs-cTnI and BNP from the model results in a significant reduction in model performance (AUC = 0.79; p=0.004). Conclusions Cardiac biomarkers hs-cTnI and BNP are associated with a zero Agatston Score, which is correlated with a very low risk of cardiovascular events in asymptomatic patients with diabetes mellitus. ROC curve to predict zero Agatston Score Funding Acknowledgement Type of funding source: None
Carlo N. De Cecco - One of the best experts on this subject based on the ideXlab platform.
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Automatic coronary calcium scoring in chest CT using a deep neural network in direct comparison with non-contrast cardiac CT: A validation study.
European journal of radiology, 2020Co-Authors: Marly Van Assen, Simon S. Martin, Akos Varga-szemes, Saikiran Rapaka, Serkan Çimen, Puneet Sharma, Pooyan Sahbaee, Carlo N. De Cecco, Rozemarjin Vliegenthart, Tyler J. LeonardAbstract:PURPOSE To evaluate deep-learning based calcium quantification on Chest CT scans compared with manual evaluation, and to enable interpretation in terms of the traditional Agatston Score on dedicated Cardiac CT. METHODS Automated calcium quantification was performed using a combination of deep-learning convolution neural networks with a ResNet-architecture for image features and a fully connected neural network for spatial coordinate features. Calcifications were identified automatically, after which the algorithm automatically excluded all non-coronary calcifications using coronary probability maps and aortic segmentation. The algorithm was first trained on cardiac-CTs and refined on non-triggered chest-CTs. This study used on 95 patients (cohort 1), who underwent both dedicated calcium scoring and chest-CT acquisitions using the Agatston Score as reference standard and 168 patients (cohort 2) who underwent chest-CT only using qualitative expert assessment for external validation. Results from the deep-learning model were compared to Agatston-Scores(cardiac-CTs) and manually determined calcium volumes(chest-CTs) and risk classifications. RESULTS In cohort 1, the Agatston Score and AI determined calcium volume shows high correlation with a correlation coefficient of 0.921(p
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Influence of Coronary Calcium on Diagnostic Performance of Machine Learning CT-FFR: Results From MACHINE Registry.
JACC. Cardiovascular imaging, 2019Co-Authors: Christian Tesche, Carlo N. De Cecco, Moritz H. Albrecht, Katharina Otani, Adriaan Coenen, Jakob De Geer, Mariusz Kruk, Young-hak Kim, Stefan Baumann, Matthias RenkerAbstract:Abstract Objectives This study was conducted to investigate the influence of coronary artery calcium (CAC) Score on the diagnostic performance of machine-learning–based coronary computed tomography (CT) angiography (cCTA)–derived fractional flow reserve (CT-FFR). Background CT-FFR is used reliably to detect lesion-specific ischemia. Novel CT-FFR algorithms using machine-learning artificial intelligence techniques perform fast and require less complex computational fluid dynamics. Yet, influence of CAC Score on diagnostic performance of the machine-learning approach has not been investigated. Methods Four hundred eighty-two vessels from 314 patients (62.3 ± 9.3 years, 77% male) who underwent cCTA followed by invasive FFR were investigated from the MACHINE (Machine Learning based CT Angiography derived FFR: a Multi-center Registry) registry data. CAC Scores were quantified using the Agatston convention. The diagnostic performance of CT-FFR to detect lesion-specific ischemia was assessed across all Agatston Score categories (CAC 0, >0 to Results The diagnostic accuracy of CT-FFR versus invasive FFR was superior to cCTA alone on a per-vessel level (78% vs. 60%) and per patient level (83% vs. 73%) across all Agatston Score categories. No statistically significant differences in the diagnostic accuracy, sensitivity, or specificity of CT-FFR were observed across the categories. CT-FFR showed good discriminatory power in vessels with high Agatston Scores (CAC ≥ 400) and high performance in low-to-intermediate Agatston Scores (CAC >0 to 0 to Conclusions Machine-learning–based CT-FFR showed superior diagnostic performance over cCTA alone in CAC with a significant difference in the performance of CT-FFR as calcium burden/Agatston calcium Score increased. (Machine Learning Based CT Angiography Derived FFR: a Multicenter, Registry [MACHINE] NCT02805621).
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High-pitch low-voltage CT coronary artery calcium scoring with tin filtration: accuracy and radiation dose reduction.
European radiology, 2018Co-Authors: Georg Apfaltrer, Carlo N. De Cecco, U. Joseph Schoepf, Taylor M. Duguay, Moritz H. Albrecht, Domenico De Santis, John W. Nance, Paul Apfaltrer, Marwen Eid, Chelsea EasonAbstract:To investigate diagnostic accuracy and radiation dose of high-pitch CT coronary artery calcium scoring (CACS) with tin filtration (Sn100kVp) versus standard 120kVp high-pitch acquisition. 78 patients (58% male, 61.5±9.1 years) were prospectively enrolled. Subjects underwent clinical 120kVp high-pitch CACS using third-generation dual-source CT followed by additional high-pitch Sn100kVp acquisition. Agatston Scores, calcium volume Scores, Agatston Score categories, percentile-based risk categorization and radiation metrics were compared. 61/78 patients showed coronary calcifications. Median Agatston Scores were 34.9 [0.7–197.1] and 41.7 [0.7–207.2] and calcium volume Scores were 34.1 [0.7–218.0] for Sn100kVp and 35.7 [1.1–221.0] for 120kVp acquisitions, respectively (both p
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CT coronary calcium scoring with tin filtration using iterative beam-hardening calcium correction reconstruction
European journal of radiology, 2017Co-Authors: Christian Tesche, Akos Varga-szemes, Carlo N. De Cecco, U. Joseph Schoepf, Taylor M. Duguay, Moritz H. Albrecht, Domenico De Santis, Virginia W. Lesslie, Ullrich Ebersberger, Richard R. BayerAbstract:Abstract Objectives To investigate the diagnostic accuracy of CT coronary artery calcium scoring (CACS) with tin pre-filtration (Sn100 kVp) using iterative beam-hardening correction (IBHC) calcium material reconstruction compared to the standard 120 kVp acquisition. Background Third generation dual-source CT (DSCT) CACS with Sn100 kVp acquisition allows significant dose reduction. However, the Sn100 kVp spectrum is harder with lower contrast compared to 120kVp, resulting in lower calcium Score values. Sn100 kVp spectral correction using IBHC-based calcium material reconstruction may restore comparable calcium values. Methods Image data of 62 patients (56% male, age 63.9 ± 9.2years) who underwent a clinically-indicated CACS acquisition using the standard 120 kVp protocol and an additional Sn100 kVp CACS scan as part of a research study were retrospectively analyzed. Datasets of the Sn100 kVp scans were reconstructed using a dedicated spectral IBHC CACS reconstruction to restore the spectral response of 120 kVp spectra. Agatston Scores were derived from 120 kVp and IBHC reconstructed Sn100 kVp studies. Pearson’s correlation coefficient was assessed and Agatston Score categories and percentile-based risk categorization were compared. Results Median Agatston Scores derived from IBHC Sn100 kVp scans and 120 kVp acquisition were 31.7 and 34.1, respectively (p = 0.057). Pearson‘s correlation coefficient showed excellent correlation between the acquisitions (r = 0.99, p Conclusion Low voltage CACS with tin filtration using a dedicated IBHC CACS material reconstruction algorithm shows excellent correlation and agreement with the standard 120 kVp acquisition regarding Agatston Score and cardiac risk categorization, while radiation dose is significantly reduced by 75% to the level of a chest x-ray.
T Pezel - One of the best experts on this subject based on the ideXlab platform.
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Cardiac troponin I and BNP for predicting zero Agatston Score in patients with diabetes mellitus
European Heart Journal - Cardiovascular Imaging, 2021Co-Authors: T Pezel, J.g Dillinger, Guillaume Bonnet, T Vidal Trecan, A Asselin, Georgios Sideris, Damien Logeart, Stéphane Manzo-silberman, J.f. Gautier, J.p. RivelineAbstract:Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND Coronary artery calcifications (CAC) scoring assessed by the Agatston Score has shown an excellent prognostic value in large studies, particularly in diabetic patients, with a very low rate of cardiovascular events in patients with a zero Agatston Score. Moreover, recent studies have suggested that high-sensitive cardiac troponin I (hs-cTnI) and brain natriuretic peptide (BNP) may be useful for detecting subclinical atherosclerosis, especially in diabetic patients. However, the link between hs-cTnI/BNP and the Agatston Score has not been investigated in this population. PURPOSE The aim of this study was to investigate if hs-cTnI and BNP can bring additional value to predict zero Agatston Score in patients with diabetes mellitus in addition to usual risk factors. METHODS Between 2015 and 2019, CAC Score was prospectively performed in consecutive patients with diabetes mellitus with high cardiovascular risk. Patients with symptoms or known coronary artery disease were excluded. Within 24h from CT exam, peripheral blood samples were taken to measure hs-cTnI and BNP. The relationship between serum hs-cTnI/BNP concentrations and zero Agatston Score was evaluated using univariate and multivariate binomial models. 77 variables have been used to build the model. The implication of hs-cTnI and BNP in this multivariate model was evaluated using nested models associated with Chi-squared test of independence. RESULTS A total of 844 patients with diabetes were enrolled (61 ± 7 years, 57% men, mean diabetes duration 18 years). In this population, 294 (35%) had a zero Agatston Score, 253 (30%) an Agatston Score from 1 to 100, 161 (19%) from 101 to 400, and 136 (16%) higher than 400. In univariate analysis, hs-cTnI and BNP concentrations were associated with a zero Agatston Score (respectively OR, 2.63 [95% CI, 1.51-5.01]; p < 0.001 and OR, 1.09 [95% CI, 1.01-1.22]; p = 0.03). In multivariate analysis, hs-cTnI and BNP concentrations were associated with a zero Agatston Score (respectively OR, 2.38 [95% CI, 1.51-4.76]; p = 0.009 and OR, 1.18 [95% CI, 1.07-1.32]; p = 0.001). Among the 77 variables, the multivariate model including age, gender, smoking, dyslipidaemia, duration of the diabetes, arterial hypertension, presence of diabetic neuropathy, hs-cTnI and BNP concentrations, significantly discriminated the zero Agatston Score (AUC = 0.81; p < 0.001). The most discriminant threshold was ≤ 3ng/l for hs-cTnI and <17ng/l for BNP. In nested models, both hs-cTnI and BNP brought information to this multivariate model to predict a zero Agatston Score (respectively p = 0.003 and p < 0.001 to the Chi-squared test). Moreover, removing hs-cTnI and BNP from the model results in a significant reduction in model performance (AUC = 0.79; p = 0.004). CONCLUSIONS Cardiac biomarkers hs-cTnI and BNP are associated with a zero Agatston Score, which is correlated with a very low risk of cardiovascular events in asymptomatic patients with diabetes mellitus. Abstract Figure. ROC curve to predict zero Agatston Score
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Cardiac Troponin I and BNP for Predicting Zero Agatston Score in Patients with Diabetes Mellitus
Archives of Cardiovascular Diseases Supplements, 2021Co-Authors: T Pezel, J.g Dillinger, Guillaume Bonnet, T Vidal Trecan, A Asselin, Georgios Sideris, Damien Logeart, Stéphane Manzo-silberman, J.f. Gautier, J.p. RivelineAbstract:Background Coronary artery calcifications (CAC) scoring assessed by the Agatston Score has shown an excellent prognostic value in large studies and particularly in diabetic patients, with a very low rate of cardiovascular events in patients with a zero Agatston Score. Moreover, recent studies have suggested that high-sensitive cardiac troponin I (hs-cTnI) and brain natriuretic peptide (BNP) may be useful for detecting subclinical atherosclerosis. However, the link between hs-cTnI/BNP and the Agatston Score has not been investigated in patients with diabetes. Purpose The aim of this study was to investigate if hs-cTnI and BNP can bring additional value to predict zero Agatston Score in patients with diabetes mellitus in addition to usual risk factors. Methods Between 2015 and 2019, CAC Score was prospectively performed in consecutive patients with diabetes mellitus. Patients with symptoms, known coronary artery disease or history of atrial fibrillation were excluded. Within 24 h from CT examination, peripheral blood samples were taken to measure hs-cTnI and BNP. The relationship between serum hs-cTnI/BNP concentrations and zero Agatston Score was assessed using univariate and multivariate binomial models. The implication of hs-cTnI and BNP in this multivariate model was evaluated using nested models associated with Chi2 test of independence. Results A total of 844 patients with diabetes were enrolled (61 ± 7years, 57% men, mean duration of diabetes 18years). In this population, 294(35%) had a zero Agatston Score, 253(30%) an Agatston Score from 1 to 100, 161(19%) from 101 to 400, and 136(16%) higher than 400. In univariate analysis, hs-cTnI and BNP concentrations were associated with zero Agatston Score (respectively OR, 2.63 [95%CI, 1.51-5.01]; P Fig. 1 ). The most discriminant threshold was ≤ 3 ng/l for hs-cTnI and Conclusion Cardiac biomarkers hs-cTnI and BNP are associated with zero Agatston Score, which is correlated with a very low risk of cardiovascular events, in asymptomatic patients with diabetes mellitus.
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Abstract 13887: Cardiac Troponin I and Bnp for Predicting Zero Agatston Score in Patients With Diabetes Mellitus
Circulation, 2020Co-Authors: T Pezel, J.g Dillinger, Guillaume Bonnet, T Vidal Trecan, A Asselin, Georgios Sideris, Damien Logeart, Stéphane Manzo-silberman, J.f. Gautier, J.p. RivelineAbstract:Introduction: Coronary artery calcifications (CAC) Agatston Score has shown an excellent prognostic value and particularly in diabetic patients, with a very low rate of cardiovascular (CV) events i...
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Cardiac troponin I and BNP for predicting zero Agatston Score in patients with diabetes mellitus
European Heart Journal, 2020Co-Authors: T Pezel, J.g Dillinger, Guillaume Bonnet, T Vidal Trecan, A Asselin, Georgios Sideris, Damien Logeart, Stéphane Manzo-silberman, J.f. Gautier, J.p. RivelineAbstract:Abstract Background Coronary artery calcifications (CAC) scoring assessed by the Agatston Score has shown an excellent prognostic value in large studies, particularly in diabetic patients, with a very low rate of cardiovascular events in patients with a zero Agatston Score. Moreover, recent studies have suggested that high-sensitive cardiac troponin I (hs-cTnI) and brain natriuretic peptide (BNP) may be useful for detecting subclinical atherosclerosis, especially in diabetic patients. However, the link between hs-cTnI/BNP and the Agatston Score has not been investigated in this population. Purpose The aim of this study was to investigate if hs-cTnI and BNP can bring additional value to predict zero Agatston Score in patients with diabetes mellitus in addition to usual risk factors. Material Between 2015 and 2019, CAC Score was prospectively performed in consecutive patients with diabetes mellitus with high cardiovascular risk. Patients with symptoms or known coronary artery disease were excluded. Within 24h from CT exam, peripheral blood samples were taken to measure hs-cTnI and BNP. The relationship between serum hs-cTnI/BNP concentrations and zero Agatston Score was evaluated using univariate and multivariate binomial models. 77 variables have been used to build the model. The implication of hs-cTnI and BNP in this multivariate model was evaluated using nested models associated with Chi-squared test of independence. Results A total of 844 patients with diabetes were enrolled (61±7 years, 57% men, mean diabetes duration 18 years). In this population, 294 (35%) had a zero Agatston Score, 253 (30%) an Agatston Score from 1 to 100, 161 (19%) from 101 to 400, and 136 (16%) higher than 400. In univariate analysis, hs-cTnI and BNP concentrations were associated with a zero Agatston Score (respectively OR, 2.63 [95% CI, 1.51–5.01]; p<0.001 and OR, 1.09 [95% CI, 1.01–1.22]; p=0.03). In multivariate analysis, hs-cTnI and BNP concentrations were associated with a zero Agatston Score (respectively OR, 2.38 [95% CI, 1.51–4.76]; p=0.009 and OR, 1.18 [95% CI, 1.07–1.32]; p=0.001). Among the 77 variables, the multivariate model including age, gender, smoking, dyslipidaemia, duration of the diabetes, arterial hypertension, presence of diabetic neuropathy, hs-cTnI and BNP concentrations, significantly discriminated the zero Agatston Score (AUC = 0.81; p<0.001). The most discriminant threshold was ≤3ng/l for hs-cTnI and <17ng/l for BNP. In nested models, both hs-cTnI and BNP brought information to this multivariate model to predict a zero Agatston Score (respectively p=0.003 and p<0.001 to the Chi-squared test). Moreover, removing hs-cTnI and BNP from the model results in a significant reduction in model performance (AUC = 0.79; p=0.004). Conclusions Cardiac biomarkers hs-cTnI and BNP are associated with a zero Agatston Score, which is correlated with a very low risk of cardiovascular events in asymptomatic patients with diabetes mellitus. ROC curve to predict zero Agatston Score Funding Acknowledgement Type of funding source: None
