Results: Univariate analysis showed left atrial volume, the incidence of spontaneous echo contras... more Results: Univariate analysis showed left atrial volume, the incidence of spontaneous echo contrast, male and hypertension were significantly lower and the incidence of paroxysmal AF and chicken wing type were significantly higher in high LAAV group. Multivariate analysis revealed that chicken wing type was an independent predictor for high LAAV (table). Multivariate analysis for predicting high LAAV group Odds Ratio 95% CI P Value Male 0.42 0.14-1.23 0.115 Paroxysmal atrial fibrillation 1.32 0.48-3.63 0.593 Hyper tension 0.51 0.21-1.26 0.147 Left atrial volume (cm 3 ) 0.99 0.98-1.00 0.156 Spontaneous echo contrast 0.42 0.13-1.34 0.142 Chicken wing type 4.19 1.59-11.09 0.004 Conclusions: The morphology of LAA determined by CCT, chicken wing or nonchicken wing type, can become a new
creased end diastolic left ventricular diameter and disappearance of aortic regurgitation. The ha... more creased end diastolic left ventricular diameter and disappearance of aortic regurgitation. The haemolysis ceased and clinical status improved. 4 months later, the patient again developed severe haemolysis leading to global heart failure without AI. Thrombosis in the device was suspected and emergency cardiac transplantation was undertaken. During the procedure, after cardiectomy, the aortic valve was checked (figure) and found totally closed and watertight when submitted to the water test; the aortic leaflets disappeared under layers of fibrosis. The Amplatzer was complety endothelialized on both the aortic and the ventricular side without thrombus apposition or obstruction of ostial coronary arteries. The left ventricular output chamber was free without anomaly of mitral valve motion. Trans-catheter closure of the native aortic valve with an Amplatzer occluder can offer an easy way to treat new-onset severe AI on LVAD patients.
Os métodos não invasivos de imagem cardíaca têm-se revelado de extrema importância no âmbito da d... more Os métodos não invasivos de imagem cardíaca têm-se revelado de extrema importância no âmbito da doença isquémica crónica, não só a nível do diagnóstico/ exclusão, como na determinação da sua repercussão funcional, estratificação do risco e avaliação da viabilidade miocárdica. O seu valor incremental em relação aos scores clínicos na estratificação do risco, tem sido uma mais valia na decisão clínica, quer na selecção de doentes para cateterismo, quer suplementando as informações angiográficas no que concerne à computed tomography and cardiac magnetic resonance, in the range of chronic ischemic disease. Each technique will be approached separately and in comparison with the remainder, in what concerns its diagnostic and prognostic value, weaknesses, cost effectiveness and availability. Crucial in the current practice, will be the analysis of safety issues, especially those related to radiation exposure. Finally, it is presented a conceptual approach to the patient with suspected or known coronary artery disease, in terms of the selection of noninvasive imaging tests, for diagnosis, risk stratification and prognosis assessment. It was taken into account the patients characteristics, symptoms and therefore pretest likehood of disease (Bayes Theorem), the cost effectiveness of each modality, current availability and safety, always with the purpose of guiding clinical decisions.
Background Health-related quality of life (HRQoL) is impaired in patients with stable angina but ... more Background Health-related quality of life (HRQoL) is impaired in patients with stable angina but patients often present with other forms of chest pain. The aim of this study was to compare the pre-diagnostic HRQoL in patients with suspected coronary artery disease (CAD) according to angina type, gender, and presence of obstructive CAD. Methods From the pilot study for the European DISCHARGE trial, we analysed data from 24 sites including 1263 patients (45.9% women, 61.1 ± 11.3 years) who were clinically referred for invasive coronary angiography (ICA; 617 patients) or coronary computed tomography angiography (CTA; 646 patients). Prior to the procedures, patients completed HRQoL questionnaires: the Short Form (SF)-12v2, the EuroQoL (EQ-5D-3 L) and the Hospital Anxiety and Depression Scale. Results Fifty-five percent of ICA and 35% of CTA patients had typical angina, 23 and 33% had atypical angina, 18 and 28% had non-anginal chest discomfort and 5 and 5% had other chest discomfort, re...
BACKGROUND In the diagnosis of obstructive coronary artery disease (CAD), computed tomography (CT... more BACKGROUND In the diagnosis of obstructive coronary artery disease (CAD), computed tomography (CT) is an accurate, noninvasive alternative to invasive coronary angiography (ICA). However, the comparative effectiveness of CT and ICA in the management of CAD to reduce the frequency of major adverse cardiovascular events is uncertain. METHODS We conducted a pragmatic, randomized trial comparing CT with ICA as initial diagnostic imaging strategies for guiding the treatment of patients with stable chest pain who had an intermediate pretest probability of obstructive CAD and were referred for ICA at one of 26 European centers. The primary outcome was major adverse cardiovascular events (cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke) over 3.5 years. Key secondary outcomes were procedurerelated complications and angina pectoris. RESULTS Among 3561 patients (56.2% of whom were women), follow-up was complete for 3523 (98.9%). Major adverse cardiovascular events occurred in 38 of 1808 patients (2.1%) in the CT group and in 52 of 1753 (3.0%) in the ICA group (hazard ratio, 0.70; 95% confidence interval [CI], 0.46 to 1.07; P = 0.10). Major procedure-related complications occurred in 9 patients (0.5%) in the CT group and in 33 (1.9%) in the ICA group (hazard ratio, 0.26; 95% CI, 0.13 to 0.55). Angina during the final 4 weeks of follow-up was reported in 8.8% of the patients in the CT group and in 7.5% of those in the ICA group (odds ratio, 1.17; 95% CI, 0.92 to 1.48). CONCLUSIONS Among patients referred for ICA because of stable chest pain and intermediate pretest probability of CAD, the risk of major adverse cardiovascular events was similar in the CT group and the ICA group. The frequency of major procedurerelated complications was lower with an initial CT strategy. (Funded by the European Union Seventh Framework Program and others; DISCHARGE ClinicalTrials .gov number, NCT02400229.
Echocardiography-a Journal of Cardiovascular Ultrasound and Allied Techniques, Feb 4, 2018
A 56-year-old woman was referred to the cardiology outpatient clinic complaining of atypical ches... more A 56-year-old woman was referred to the cardiology outpatient clinic complaining of atypical chest pain. Her physical examination was unremarkable. The chest radiograph (Figure 1) depicted flattening and elongation of the left heart border (Snoopy sign), right heart border superimposed on the spine and a radiolucent band.
Introduction and objectives: In severe aortic stenosis (AS), the impact of aortic valve replaceme... more Introduction and objectives: In severe aortic stenosis (AS), the impact of aortic valve replacement (AVR) on left ventricular (LV) systolic function assessed by strain and measured by echocardiography or cardiac magnetic resonance (CMR) has been controversial. We aimed to investigate LV systolic myocardial function changes six months after AVR using global longitudinal (GLS), circumferential (GCS) and radial (GRS) strain derived from CMR imaging. Methods: We included 39 severe AS patients (69.3±7.8 years; 61.5% male) with preserved LV ejection fraction (LVEF) who were recruited as part of the EPICHEART study and underwent successful AVR (aortic valvular area: 0.8 cm 2 (IQR: 0.2) pre-to 1.8 cm 2 (IQR:0.5) post-AVR). Structural and functional parameters were assessed at baseline and six months after AVR, including LV GRS, GCS and GLS analysis by CMR, using cine short-axial and two-, three-, and four-chamber long-axial view. Comparison between baseline and postoperative LV remodeling was performed using Student t-test and Wilcoxon test. Results: At six-month follow-up, LV mass, end-diastolic and end-systolic volumes, stroke volume, cardiac output, lateral E/e', tricuspid annular plane systolic excursion, right ventricular (RV) S wave velocity, GLS [-15.6% (IQR: 4.39) to-13.7% (IQR: 4.62)] and GCS [-17.8±3.58% to-16.1±2.94%] reduced significantly, while LVEF and GRS remained unchanged and lateral e' velocity increased.
hancement imaging were performed on a 1.5 T MR system scan. The extent of myocardial edema was as... more hancement imaging were performed on a 1.5 T MR system scan. The extent of myocardial edema was assessed quantitatively using semi-automated detection, where myocardial regions that had signal intensity (SI) above a threshold of twice the mean signal intensity of skeletal muscle were considered to be edematous, and expressed as the percentage of global left ventricular (LV) mass. Quantitative analysis of myocardial deformation included the assessment of radial, longitudinal, and circumferential peak systolic strain values, rotation and twist of the left ventricle (LV). Results: Compared to baseline, end-diastolic volumes, stroke volumes and right ventricular ejection fraction significantly decreased post-race (P<0.05), whereas LV ejection fraction remained unchanged. Global myocardial edema significantly increased after the competition (3.9±3.8% LV mass pre-exertion vs. 10.5±6% LV mass post-exertion, P=0.004), with relative apical sparing distribution (P<0.001) (Figure), matched by a post-exercise reduction of radial peak systolic strain values confined to basal segments. Apical rotation and twist significantly increased postexercise (P<0.05). Myocardial edema pre-and post-race Conclusions: Intense exercise in master triathletes is associated with a transient reduction in right ventricular systolic function, regional increase in myocardial edema, and reduction of radial peak systolic strain, with a peculiar relative "apical sparing" pattern.
Quadricuspid aortic valve (QAV) is a rare abnormality, which may cause aortic regurgitation (AR) ... more Quadricuspid aortic valve (QAV) is a rare abnormality, which may cause aortic regurgitation (AR) requiring surgical intervention in some patients. The characteristics associated with aortic valve functional degeneration in patients with QAV are still unknown. The aim of this study is to describe QAV prevalence, characterize the disease by multimodality imaging, evaluate predictors of severe AR, and assess mid-term prognosis.
Introduction: There is a well-established association between atrial fibrillation (AF) and corona... more Introduction: There is a well-established association between atrial fibrillation (AF) and coronary artery disease. Coronary artery calcium score (CACS) is a helpful tool to refine cardiovascular (CV) risk stratification and inform on the best strategies for primary CV prevention. This study aims to evaluate the impact of opportunistic screening with CACS on risk stratification and decision of preventive therapies, in patients with AF. Methods: Cross-sectional study including patients with AF or atrial flutter undergoing cardiac computed tomography for ablation procedure planning, from 2017 to 2019. Baseline clinical and demographical data were collected. CACS was assessed in patients without coronary artery disease using the Agatston method. Results: A total of 474 patients were included (93% with AF, mean age of 58 ± 10 years, 62% male). CACS &gt;0 was present in 254 (54%) patients. According to CACS and the Society of Cardiovascular Computed Tomography recommendations, 25% of the patients would be candidates for statin therapy and 17% would be candidates for changes in the current statin intensity; in 11 patients (8%), acetylsalicylic acid would be recommended. Conclusion: In our study, more than half of the patients undergoing cardiac computed tomography before AF catheter ablation had CACS above zero. Our findings suggest that an opportunistic evaluation of CACS at the time of ablation can be an important tool to improve CV risk stratification, with important clinical and therapeutic implications.
Funding Acknowledgements: Type of funding sources: None. Introduction: Patients with atrial fibri... more Funding Acknowledgements: Type of funding sources: None. Introduction: Patients with atrial fibrillation (AF) referred for catheter ablation routinely undergo cardiac computed tomography (CCT) for procedure planning. An opportunistic evaluation of coronary artery calcium score (CACS) can be an important tool to improve clinical care. It is already known that CACS is associated with a high risk of AF development, particularly if values are above 100, but few data are available regarding the impact of CACS in AF recurrence after ablation. Purpose: To assess the impact of CACS on atrial fibrillation recurrence following catheter ablation. Methods: Retrospective, single-centre cohort study of consecutive patients with AF undergoing CCT for ablation procedure planning, from 2017 to 2019. Baseline clinical and demographical data were collected. Patients with known history of coronary artery disease (CAD) and moderate to severe valvular heart disease were excluded. CACS was assessed using the Agatston method. Recurrence was defined as any documented episode of AF, atrial flutter or atrial tachycardia after 3 months from procedure. Patients were stratified in CACS<100 and CACS≥100. Explorative analysis incorporated Kaplan-Meier survival curves and Cox regression. Results: A total of 354 patients were included, with a mean age of 56 ± 12 years, 66% male and 21% with persistent AF. More than half of the patients had a CACS>0 (n=185, 52%) and 63 patients (18%) had a CACS≥100. Patients with CACS≥100 were older (63 ± 7 vs 54 ± 12 years, p<0.001), had higher prevalence of hypertension (68% vs 43%, p<0.001) and diabetes mellitus (21% vs 10%, p=0.012) and higher left atrial volume (39 ± 9 vs 35 ± 9 ml/m2, p=0.018). After a median observation time of 34 months (IQR 24-43), 117 patients (33%) had AF recurrence. CACS≥100 was associated with increased risk of AF recurrence (unadjusted Cox regression: hazard ratio [HR] 1.85; 95% confidence interval [CI], 1.23-2.79, p=0.003) (Fig. 1). After covariate adjustment (age, gender, hypertension, diabetes mellitus, obesity, thyroid disease, AF type and left atria enlargement) CACS≥100 remained an independent predictor of the risk of AF recurrence (HR, 1.68; 95% CI, 1.05-2.70, p=0.03) as well as persistent AF (HR, 1.91; 95% CI, 1.23-3.00, p=0.004) (Fig. 2). Conclusion: In patients with AF undergoing catheter ablation, without previous history of CAD, a CACS≥100 was independently associated with a 68% increase in the risk of AF recurrence.
The presence of thoracic aortic calcification (TAC) has been shown to increase the risk of cardio... more The presence of thoracic aortic calcification (TAC) has been shown to increase the risk of cardiovascular and cerebrovascular events. Few studies have evaluated the relationship between CT measured by computed tomography (CT) before cardiac surgery and clinical outcomes, and the relationship is still unclear. This study aimed to analyse the impact on clinical outcomes of the presence of TAC in patients undergoing cardiac surgery. A retrospective unicentre analysis of patients undergoing a noncontrast CT prior to cardiac surgery was performed. TAC was quantified using a volume-rendering method. The percentiles of TAC volume (TACV) were used to determine the relative standing. Demographic data, risk factors and clinical outcomes were comparable between groups. A P-value &lt; 0.05 is statistically significant. The mean TACV was 2.45 ± 2.79 cm3, and the median and 75th percentiles were 1.45 and 4.06 cm3, respectively. Of the total of 121 patients, 26 (21.5%) had high TACV. Table 1 shows the baseline demographic and risk factors. There was no significant difference in risk factors and personal history between groups except for age (P-value = 0.02), hypertension (P-value = 0.04) and coronary artery disease (P-value &lt; 0.01). Regarding clinical outcomes, there was no significant difference in clinical outcomes except for acute kidney failure (P-value = 0.04), which was not significant in multivariate analysis. In conclusion, aortic calcification is a recurrent finding, to which there seems to be a contribution from hypertension-related vascular damage, especially in older ones. In patients undergoing cardiac surgery, TACV appears not to be related to clinical outcomes in multivariate analysis. However, large-scale studies are needed to confirm these results.
Results: Univariate analysis showed left atrial volume, the incidence of spontaneous echo contras... more Results: Univariate analysis showed left atrial volume, the incidence of spontaneous echo contrast, male and hypertension were significantly lower and the incidence of paroxysmal AF and chicken wing type were significantly higher in high LAAV group. Multivariate analysis revealed that chicken wing type was an independent predictor for high LAAV (table). Multivariate analysis for predicting high LAAV group Odds Ratio 95% CI P Value Male 0.42 0.14-1.23 0.115 Paroxysmal atrial fibrillation 1.32 0.48-3.63 0.593 Hyper tension 0.51 0.21-1.26 0.147 Left atrial volume (cm 3 ) 0.99 0.98-1.00 0.156 Spontaneous echo contrast 0.42 0.13-1.34 0.142 Chicken wing type 4.19 1.59-11.09 0.004 Conclusions: The morphology of LAA determined by CCT, chicken wing or nonchicken wing type, can become a new
creased end diastolic left ventricular diameter and disappearance of aortic regurgitation. The ha... more creased end diastolic left ventricular diameter and disappearance of aortic regurgitation. The haemolysis ceased and clinical status improved. 4 months later, the patient again developed severe haemolysis leading to global heart failure without AI. Thrombosis in the device was suspected and emergency cardiac transplantation was undertaken. During the procedure, after cardiectomy, the aortic valve was checked (figure) and found totally closed and watertight when submitted to the water test; the aortic leaflets disappeared under layers of fibrosis. The Amplatzer was complety endothelialized on both the aortic and the ventricular side without thrombus apposition or obstruction of ostial coronary arteries. The left ventricular output chamber was free without anomaly of mitral valve motion. Trans-catheter closure of the native aortic valve with an Amplatzer occluder can offer an easy way to treat new-onset severe AI on LVAD patients.
Os métodos não invasivos de imagem cardíaca têm-se revelado de extrema importância no âmbito da d... more Os métodos não invasivos de imagem cardíaca têm-se revelado de extrema importância no âmbito da doença isquémica crónica, não só a nível do diagnóstico/ exclusão, como na determinação da sua repercussão funcional, estratificação do risco e avaliação da viabilidade miocárdica. O seu valor incremental em relação aos scores clínicos na estratificação do risco, tem sido uma mais valia na decisão clínica, quer na selecção de doentes para cateterismo, quer suplementando as informações angiográficas no que concerne à computed tomography and cardiac magnetic resonance, in the range of chronic ischemic disease. Each technique will be approached separately and in comparison with the remainder, in what concerns its diagnostic and prognostic value, weaknesses, cost effectiveness and availability. Crucial in the current practice, will be the analysis of safety issues, especially those related to radiation exposure. Finally, it is presented a conceptual approach to the patient with suspected or known coronary artery disease, in terms of the selection of noninvasive imaging tests, for diagnosis, risk stratification and prognosis assessment. It was taken into account the patients characteristics, symptoms and therefore pretest likehood of disease (Bayes Theorem), the cost effectiveness of each modality, current availability and safety, always with the purpose of guiding clinical decisions.
Background Health-related quality of life (HRQoL) is impaired in patients with stable angina but ... more Background Health-related quality of life (HRQoL) is impaired in patients with stable angina but patients often present with other forms of chest pain. The aim of this study was to compare the pre-diagnostic HRQoL in patients with suspected coronary artery disease (CAD) according to angina type, gender, and presence of obstructive CAD. Methods From the pilot study for the European DISCHARGE trial, we analysed data from 24 sites including 1263 patients (45.9% women, 61.1 ± 11.3 years) who were clinically referred for invasive coronary angiography (ICA; 617 patients) or coronary computed tomography angiography (CTA; 646 patients). Prior to the procedures, patients completed HRQoL questionnaires: the Short Form (SF)-12v2, the EuroQoL (EQ-5D-3 L) and the Hospital Anxiety and Depression Scale. Results Fifty-five percent of ICA and 35% of CTA patients had typical angina, 23 and 33% had atypical angina, 18 and 28% had non-anginal chest discomfort and 5 and 5% had other chest discomfort, re...
BACKGROUND In the diagnosis of obstructive coronary artery disease (CAD), computed tomography (CT... more BACKGROUND In the diagnosis of obstructive coronary artery disease (CAD), computed tomography (CT) is an accurate, noninvasive alternative to invasive coronary angiography (ICA). However, the comparative effectiveness of CT and ICA in the management of CAD to reduce the frequency of major adverse cardiovascular events is uncertain. METHODS We conducted a pragmatic, randomized trial comparing CT with ICA as initial diagnostic imaging strategies for guiding the treatment of patients with stable chest pain who had an intermediate pretest probability of obstructive CAD and were referred for ICA at one of 26 European centers. The primary outcome was major adverse cardiovascular events (cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke) over 3.5 years. Key secondary outcomes were procedurerelated complications and angina pectoris. RESULTS Among 3561 patients (56.2% of whom were women), follow-up was complete for 3523 (98.9%). Major adverse cardiovascular events occurred in 38 of 1808 patients (2.1%) in the CT group and in 52 of 1753 (3.0%) in the ICA group (hazard ratio, 0.70; 95% confidence interval [CI], 0.46 to 1.07; P = 0.10). Major procedure-related complications occurred in 9 patients (0.5%) in the CT group and in 33 (1.9%) in the ICA group (hazard ratio, 0.26; 95% CI, 0.13 to 0.55). Angina during the final 4 weeks of follow-up was reported in 8.8% of the patients in the CT group and in 7.5% of those in the ICA group (odds ratio, 1.17; 95% CI, 0.92 to 1.48). CONCLUSIONS Among patients referred for ICA because of stable chest pain and intermediate pretest probability of CAD, the risk of major adverse cardiovascular events was similar in the CT group and the ICA group. The frequency of major procedurerelated complications was lower with an initial CT strategy. (Funded by the European Union Seventh Framework Program and others; DISCHARGE ClinicalTrials .gov number, NCT02400229.
Echocardiography-a Journal of Cardiovascular Ultrasound and Allied Techniques, Feb 4, 2018
A 56-year-old woman was referred to the cardiology outpatient clinic complaining of atypical ches... more A 56-year-old woman was referred to the cardiology outpatient clinic complaining of atypical chest pain. Her physical examination was unremarkable. The chest radiograph (Figure 1) depicted flattening and elongation of the left heart border (Snoopy sign), right heart border superimposed on the spine and a radiolucent band.
Introduction and objectives: In severe aortic stenosis (AS), the impact of aortic valve replaceme... more Introduction and objectives: In severe aortic stenosis (AS), the impact of aortic valve replacement (AVR) on left ventricular (LV) systolic function assessed by strain and measured by echocardiography or cardiac magnetic resonance (CMR) has been controversial. We aimed to investigate LV systolic myocardial function changes six months after AVR using global longitudinal (GLS), circumferential (GCS) and radial (GRS) strain derived from CMR imaging. Methods: We included 39 severe AS patients (69.3±7.8 years; 61.5% male) with preserved LV ejection fraction (LVEF) who were recruited as part of the EPICHEART study and underwent successful AVR (aortic valvular area: 0.8 cm 2 (IQR: 0.2) pre-to 1.8 cm 2 (IQR:0.5) post-AVR). Structural and functional parameters were assessed at baseline and six months after AVR, including LV GRS, GCS and GLS analysis by CMR, using cine short-axial and two-, three-, and four-chamber long-axial view. Comparison between baseline and postoperative LV remodeling was performed using Student t-test and Wilcoxon test. Results: At six-month follow-up, LV mass, end-diastolic and end-systolic volumes, stroke volume, cardiac output, lateral E/e', tricuspid annular plane systolic excursion, right ventricular (RV) S wave velocity, GLS [-15.6% (IQR: 4.39) to-13.7% (IQR: 4.62)] and GCS [-17.8±3.58% to-16.1±2.94%] reduced significantly, while LVEF and GRS remained unchanged and lateral e' velocity increased.
hancement imaging were performed on a 1.5 T MR system scan. The extent of myocardial edema was as... more hancement imaging were performed on a 1.5 T MR system scan. The extent of myocardial edema was assessed quantitatively using semi-automated detection, where myocardial regions that had signal intensity (SI) above a threshold of twice the mean signal intensity of skeletal muscle were considered to be edematous, and expressed as the percentage of global left ventricular (LV) mass. Quantitative analysis of myocardial deformation included the assessment of radial, longitudinal, and circumferential peak systolic strain values, rotation and twist of the left ventricle (LV). Results: Compared to baseline, end-diastolic volumes, stroke volumes and right ventricular ejection fraction significantly decreased post-race (P<0.05), whereas LV ejection fraction remained unchanged. Global myocardial edema significantly increased after the competition (3.9±3.8% LV mass pre-exertion vs. 10.5±6% LV mass post-exertion, P=0.004), with relative apical sparing distribution (P<0.001) (Figure), matched by a post-exercise reduction of radial peak systolic strain values confined to basal segments. Apical rotation and twist significantly increased postexercise (P<0.05). Myocardial edema pre-and post-race Conclusions: Intense exercise in master triathletes is associated with a transient reduction in right ventricular systolic function, regional increase in myocardial edema, and reduction of radial peak systolic strain, with a peculiar relative "apical sparing" pattern.
Quadricuspid aortic valve (QAV) is a rare abnormality, which may cause aortic regurgitation (AR) ... more Quadricuspid aortic valve (QAV) is a rare abnormality, which may cause aortic regurgitation (AR) requiring surgical intervention in some patients. The characteristics associated with aortic valve functional degeneration in patients with QAV are still unknown. The aim of this study is to describe QAV prevalence, characterize the disease by multimodality imaging, evaluate predictors of severe AR, and assess mid-term prognosis.
Introduction: There is a well-established association between atrial fibrillation (AF) and corona... more Introduction: There is a well-established association between atrial fibrillation (AF) and coronary artery disease. Coronary artery calcium score (CACS) is a helpful tool to refine cardiovascular (CV) risk stratification and inform on the best strategies for primary CV prevention. This study aims to evaluate the impact of opportunistic screening with CACS on risk stratification and decision of preventive therapies, in patients with AF. Methods: Cross-sectional study including patients with AF or atrial flutter undergoing cardiac computed tomography for ablation procedure planning, from 2017 to 2019. Baseline clinical and demographical data were collected. CACS was assessed in patients without coronary artery disease using the Agatston method. Results: A total of 474 patients were included (93% with AF, mean age of 58 ± 10 years, 62% male). CACS &gt;0 was present in 254 (54%) patients. According to CACS and the Society of Cardiovascular Computed Tomography recommendations, 25% of the patients would be candidates for statin therapy and 17% would be candidates for changes in the current statin intensity; in 11 patients (8%), acetylsalicylic acid would be recommended. Conclusion: In our study, more than half of the patients undergoing cardiac computed tomography before AF catheter ablation had CACS above zero. Our findings suggest that an opportunistic evaluation of CACS at the time of ablation can be an important tool to improve CV risk stratification, with important clinical and therapeutic implications.
Funding Acknowledgements: Type of funding sources: None. Introduction: Patients with atrial fibri... more Funding Acknowledgements: Type of funding sources: None. Introduction: Patients with atrial fibrillation (AF) referred for catheter ablation routinely undergo cardiac computed tomography (CCT) for procedure planning. An opportunistic evaluation of coronary artery calcium score (CACS) can be an important tool to improve clinical care. It is already known that CACS is associated with a high risk of AF development, particularly if values are above 100, but few data are available regarding the impact of CACS in AF recurrence after ablation. Purpose: To assess the impact of CACS on atrial fibrillation recurrence following catheter ablation. Methods: Retrospective, single-centre cohort study of consecutive patients with AF undergoing CCT for ablation procedure planning, from 2017 to 2019. Baseline clinical and demographical data were collected. Patients with known history of coronary artery disease (CAD) and moderate to severe valvular heart disease were excluded. CACS was assessed using the Agatston method. Recurrence was defined as any documented episode of AF, atrial flutter or atrial tachycardia after 3 months from procedure. Patients were stratified in CACS<100 and CACS≥100. Explorative analysis incorporated Kaplan-Meier survival curves and Cox regression. Results: A total of 354 patients were included, with a mean age of 56 ± 12 years, 66% male and 21% with persistent AF. More than half of the patients had a CACS>0 (n=185, 52%) and 63 patients (18%) had a CACS≥100. Patients with CACS≥100 were older (63 ± 7 vs 54 ± 12 years, p<0.001), had higher prevalence of hypertension (68% vs 43%, p<0.001) and diabetes mellitus (21% vs 10%, p=0.012) and higher left atrial volume (39 ± 9 vs 35 ± 9 ml/m2, p=0.018). After a median observation time of 34 months (IQR 24-43), 117 patients (33%) had AF recurrence. CACS≥100 was associated with increased risk of AF recurrence (unadjusted Cox regression: hazard ratio [HR] 1.85; 95% confidence interval [CI], 1.23-2.79, p=0.003) (Fig. 1). After covariate adjustment (age, gender, hypertension, diabetes mellitus, obesity, thyroid disease, AF type and left atria enlargement) CACS≥100 remained an independent predictor of the risk of AF recurrence (HR, 1.68; 95% CI, 1.05-2.70, p=0.03) as well as persistent AF (HR, 1.91; 95% CI, 1.23-3.00, p=0.004) (Fig. 2). Conclusion: In patients with AF undergoing catheter ablation, without previous history of CAD, a CACS≥100 was independently associated with a 68% increase in the risk of AF recurrence.
The presence of thoracic aortic calcification (TAC) has been shown to increase the risk of cardio... more The presence of thoracic aortic calcification (TAC) has been shown to increase the risk of cardiovascular and cerebrovascular events. Few studies have evaluated the relationship between CT measured by computed tomography (CT) before cardiac surgery and clinical outcomes, and the relationship is still unclear. This study aimed to analyse the impact on clinical outcomes of the presence of TAC in patients undergoing cardiac surgery. A retrospective unicentre analysis of patients undergoing a noncontrast CT prior to cardiac surgery was performed. TAC was quantified using a volume-rendering method. The percentiles of TAC volume (TACV) were used to determine the relative standing. Demographic data, risk factors and clinical outcomes were comparable between groups. A P-value &lt; 0.05 is statistically significant. The mean TACV was 2.45 ± 2.79 cm3, and the median and 75th percentiles were 1.45 and 4.06 cm3, respectively. Of the total of 121 patients, 26 (21.5%) had high TACV. Table 1 shows the baseline demographic and risk factors. There was no significant difference in risk factors and personal history between groups except for age (P-value = 0.02), hypertension (P-value = 0.04) and coronary artery disease (P-value &lt; 0.01). Regarding clinical outcomes, there was no significant difference in clinical outcomes except for acute kidney failure (P-value = 0.04), which was not significant in multivariate analysis. In conclusion, aortic calcification is a recurrent finding, to which there seems to be a contribution from hypertension-related vascular damage, especially in older ones. In patients undergoing cardiac surgery, TACV appears not to be related to clinical outcomes in multivariate analysis. However, large-scale studies are needed to confirm these results.
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