Small whole heart volume predicts cardiovascular events in patients with stable chest pain: insights from the PROMISE trial
| Autor: | Michael T. Lu, Pamela S. Douglas, Roman Zeleznik, Nandini M. Meyersohn, Hamed Emami, Borek Foldyna, Maros Ferencik, Patricia A. Pellikka, Jan-Erik Scholtz, Thomas Mayrhofer, Daniel O. Bittner, Stefan Puchner, Hugo J.W.L. Aerts, Udo Hoffmann, Parastou Eslami |
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| Přispěvatelé: | Beeldvorming, MUMC+: DA BV Research (9), RS: Carim - B06 Imaging |
| Rok vydání: | 2021 |
| Předmět: |
Male
Chest Pain medicine.medical_specialty Computed Tomography Angiography Cardiac Volume heart failure Coronary Artery Disease Coronary Angiography Chest pain Risk Assessment Article 030218 nuclear medicine & medical imaging Multidetector computed tomography Coronary artery disease 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests Risk Factors Internal medicine medicine Humans Radiology Nuclear Medicine and imaging Prospective Studies cardiovascular diseases Myocardial infarction Coronary disease Framingham Risk Score Unstable angina business.industry General Medicine Prognosis medicine.disease 030220 oncology & carcinogenesis Heart failure Cardiology Female Radiology medicine.symptom Metabolic syndrome business Mace |
| Zdroj: | Eur Radiol European Radiology, 31(8), 6200-6210. Springer, Cham |
| ISSN: | 1432-1084 0938-7994 |
| DOI: | 10.1007/s00330-021-07695-2 |
| Popis: | The size of the heart may predict major cardiovascular events (MACE) in patients with stable chest pain. We aimed to evaluate the prognostic value of 3D whole heart volume (WHV) derived from non-contrast cardiac computed tomography (CT). Among participants randomized to the CT arm of the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE), we used deep learning to extract WHV, defined as the volume of the pericardial sac. We compared the WHV across categories of cardiovascular risk factors and coronary artery disease (CAD) characteristics and determined the association of WHV with MACE (all-cause death, myocardial infarction, unstable angina; median follow-up: 26 months). In the 3798 included patients (60.5 ± 8.2 years; 51.5% women), the WHV was 351.9 ± 57.6 cm3/m2. We found smaller WHV in no- or non-obstructive CAD, women, people with diabetes, sedentary lifestyle, and metabolic syndrome. Larger WHV was found in obstructive CAD, men, and increased atherosclerosis cardiovascular disease (ASCVD) risk score (p < 0.05). In a time-to-event analysis, small WHV was associated with over 4.4-fold risk of MACE (HR (per one standard deviation) = 0.221; 95% CI: 0.068–0.721; p = 0.012) independent of ASCVD risk score and CT-derived CAD characteristics. In patients with non-obstructive CAD, but not in those with no- or obstructive CAD, WHV increased the discriminatory capacity of ASCVD and CT-derived CAD characteristics significantly. Small WHV may represent a novel imaging marker of MACE in stable chest pain. In particular, WHV may improve risk stratification in patients with non-obstructive CAD, a cohort with an unmet need for better risk stratification. • Heart volume is easily assessable from non-contrast cardiac computed tomography. • Small heart volume may be an imaging marker of major adverse cardiac events independent and incremental to traditional cardiovascular risk factors and established CT measures of CAD. • Heart volume may improve cardiovascular risk stratification in patients with non-obstructive CAD. |
| Databáze: | OpenAIRE |
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