Deep learning model to predict exercise stress test results: Optimizing the diagnostic test selection strategy and reduce wastage in suspected coronary artery disease patients.

Background: Cardiac exercise stress testing (EST) offers a non-invasive way in the management of patients with suspected coronary artery disease (CAD). However, up to 30% EST results are either inconclusive or non-diagnostic, which results in significant resource wastage. Our aim was to build machine learning (ML) based models, using patients demographic (age, sex) and pre-test clinical information (reason for performing test, medications, blood pressure, heart rate, and resting electrocardiogram), capable of predicting EST results beforehand including those with inconclusive or non-diagnostic results.

Endomyocardial Fibrosis, Apical Hypertrophy, or Both?

• Endomyocardial fibrosis and apical HCM can coexist. • These conditions can appear similar on TTE. • CMR is a useful tool to distinguish between the 2 conditions.

Quantified coronary plaque characteristics between Caucasian and Morise score-matched South Asian populations.

Low-attenuation plaques (LAPs) are associated with an increased risk of cardiovascular mortality and morbidity. South Asians experience poorer cardiovascular outcomes compared to Caucasian populations. We hypothesised that South Asian population has a higher prevalence of LAP compared to Caucasians and this difference predicts major adverse cardiovascular events.

Point of Care Clinical Risk Score to Improve the Negative Diagnostic Utility of an Agatston Score of Zero: Averting the Need for Coronary Computed Tomography Angiography.

Background: Coronary artery calcification is a marker of underlying atherosclerotic vascular disease. The absence of coronary artery calcification is associated with a low prevalence of obstructive coronary artery disease (CAD), but it cannot be ruled out completely. We sought to develop a clinical tool that can be added to Agatston score of zero to rule out obstructive CAD with high accuracy.

Stress Myocardial Perfusion PET Provides Incremental Risk Prediction in Patients with and Patients without Diabetes.

Purpose: To evaluate the prognostic value of myocardial perfusion PET in patients with and patients without diabetes mellitus.

Materials And Methods: The authors performed a retrospective analysis of prospectively acquired data from a multicenter registry cohort of 7061 patients, including 1966 with diabetes mellitus, who underwent clinically indicated rest-stress rubidium 82 (Rb) myocardial perfusion PET. The mean patient age (±standard deviation) was 63.

Feature selection and transformation by machine learning reduce variable numbers and improve prediction for heart failure readmission or death.

Background: The prediction of readmission or death after a hospital discharge for heart failure (HF) remains a major challenge. Modern healthcare systems, electronic health records, and machine learning (ML) techniques allow us to mine data to select the most significant variables (allowing for reduction in the number of variables) without compromising the performance of models used for prediction of readmission and death. Moreover, ML methods based on transformation of variables may potentially further improve the performance.

Diagnosis of obstructive coronary artery disease using computed tomography angiography in patients with stable chest pain depending on clinical probability and in clinically important subgroups: meta-analysis of individual patient data.

Objective: To determine whether coronary computed tomography angiography (CTA) should be performed in patients with any clinical probability of coronary artery disease (CAD), and whether the diagnostic performance differs between subgroups of patients.

Design: Prospectively designed meta-analysis of individual patient data from prospective diagnostic accuracy studies.

Data Sources: Medline, Embase, and Web of Science for published studies.

Prognostic value of chronic total occlusions detected on coronary computed tomographic angiography.

Objective: Data describing clinical relevance of chronic total occlusion (CTO) identified by coronary CT angiography (CCTA) have not been reported to date. We investigated the prognosis of CTO on CCTA.

Methods: We identified 22 828 patients without prior known coronary artery disease (CAD), who were followed for a median of 26 months.

Positron Emission Tomography and Single-Photon Emission Computed Tomography Imaging in the Diagnosis of Cardiac Implantable Electronic Device Infection: A Systematic Review and Meta-Analysis.

Background: The use of cardiac implantable electronic devices (CIED) is increasing, and their associated infections result in significant morbidity and mortality. The introduction of better cardiac imaging techniques could be useful for diagnosing this condition and guiding therapy. Our objective was to systematically assess the diagnostic accuracy of Fluor-18-fluorodeoxyglucose positron emission tomography and computed tomography, labeled leukocyte scintigraphy (LS), and Gallium-67 citrate scintigraphy for the diagnosis of CIED infection.

Improved 5-year prediction of all-cause mortality by coronary CT angiography applying the CONFIRM score.

Aims: To investigate the long-term performance of the CONFIRM score for prediction of all-cause mortality in a large patient cohort undergoing coronary computed tomography angiography (CCTA).

Methods And Results: Patients with a 5-year follow-up from the international multicentre CONFIRM registry were included. The primary endpoint was all-cause mortality.

Mid-diastolic left ventricular volume and mass: Normal values for coronary computed tomography angiography.

Background: The adoption of prospectively ECG-triggered acquisition coronary computed tomography angiography (CTA) has resulted in the inability to measure left ventricle (LV) end-diastolic volume and LV ejection fraction. However other prognostic measures such as LV mass and LV mid-diastolic volume (LVMDV) can still be assessed. The objective of this study is to establish normal reference values for LVMDV and LV mass.

Quantifying Aortic Valve Calcification using Coronary Computed Tomography Angiography.

Introduction: Aortic valve calcification (AVC) has been associated with major adverse cardiovascular events and all-cause mortality. We sought to develop and validate a method to quantify AVC using coronary CT angiography (CTA).

Methods: Of 59 patients who underwent both non-contrast and contrast enhanced coronary CTA, 25 patients served as the derivation cohort and 34 patients served as the validation cohort.

Long-term prognostic impact of CT-Leaman score in patients with non-obstructive CAD: Results from the COronary CT Angiography EvaluatioN For Clinical Outcomes InteRnational Multicenter (CONFIRM) study.

Background: Non-obstructive coronary artery disease (CAD) identified by coronary computed tomography angiography (CCTA) demonstrated prognostic value. CT-adapted Leaman score (CT-LeSc) showed to improve the prognostic stratification. Aim of the study was to evaluate the capability of CT-LeSc to assess long-term prognosis of patients with non-obstructive (CAD).

Using coronary calcification to exclude an ischemic etiology for cardiomyopathy: A validation study and systematic review.

Background: Preliminary data suggests the absence of coronary artery calcification (CAC) excludes ischemic etiologies of cardiomyopathy. We prospectively validate and perform a systematic review to determine the utility of an Agatston score=0 to exclude the diagnosis of ischemic cardiomyopathy.

Methods And Results: Patients with newly diagnosed LV dysfunction were prospectively enrolled.

Incremental Prognostic Value of Quantified Vulnerable Plaque by Cardiac Computed Tomography: A Pilot Study.

Background: Coronary computed tomography (CT) angiography (CCTA) has the ability to detect, characterize, and quantify atherosclerotic plaques. The aim of our study was to evaluate the prognostic power of CCTA-quantified plaque subtypes.

Materials And Methods: A total of 36 patients with adverse events and 36 Morise score-matched patients who remained event free on follow-up were identified.

Systemic and inflammatory disorders involving the heart: the role of PET imaging.

Cardiac inflammatory disorders, either primarily cardiac or secondary to a systemic process, are associated with significant morbidity and/or mortality. Their diagnosis can be challenging, especially due to significant overlap in their clinical presentation with other cardiac diseases. Recent publications have investigated the potential diagnostic role of positron emission tomography (PET) imaging in these patients.

Long-Term Follow-Up of Outcomes With F-18-Fluorodeoxyglucose Positron Emission Tomography Imaging-Assisted Management of Patients With Severe Left Ventricular Dysfunction Secondary to Coronary Disease.

Background: Whether viability imaging can impact long-term patient outcomes is uncertain. The PARR-2 study (Positron Emission Tomography and Recovery Following Revascularization) showed a nonsignificant trend toward improved outcomes at 1 year using an F-18-fluorodeoxyglucose positron emission tomography (PET)-assisted strategy in patients with suspected ischemic cardiomyopathy. When patients adhered to F-18-fluorodeoxyglucose PET recommendations, outcome benefit was observed.

Impact of a structured referral algorithm on the ability to monitor adherence to appropriate use criteria for transthoracic echocardiography.

Background: Many free-form-text referral requisitions for transthoracic echocardiography (TTE) provide insufficient information to adequately evaluate their adherence to Appropriate Use Criteria (AUC). We developed a structured referral requisition algorithm based on requisition deficiencies identified retrospectively in a derivation cohort of 1303 TTE referrals and evaluated the performance of the algorithm in a consecutive series of cardiology outpatient referrals.

Methods: The validation cohort comprised 286 consecutive TTE outpatient cardiology referrals over a 2-week period.

The role of nuclear cardiac imaging in risk stratification of sudden cardiac death.

Sudden cardiac death (SCD) represents a significant portion of all cardiac deaths. Current guidelines focus mainly on left ventricular ejection fraction (LVEF) as the main criterion for SCD risk stratification and management. However, LVEF alone lacks both sensitivity and specificity in stratifying patients.

Left Atrial Volume Assessed by Coronary Computed Tomography in Mid Ventricular Diastasis Predicts Adverse Events.

Purpose: Previous studies have demonstrated that left atrial (LA) volume has incremental prognostic value in predicting major adverse cardiac events (MACE). However, the predictive ability of LA volume in mid diastasis has not been investigated. We determined the incremental predictive value of LA volume indexed to body surface area (LAVi) measured in mid ventricular diastasis.

Machine learning for prediction of all-cause mortality in patients with suspected coronary artery disease: a 5-year multicentre prospective registry analysis.

Aims: Traditional prognostic risk assessment in patients undergoing non-invasive imaging is based upon a limited selection of clinical and imaging findings. Machine learning (ML) can consider a greater number and complexity of variables. Therefore, we investigated the feasibility and accuracy of ML to predict 5-year all-cause mortality (ACM) in patients undergoing coronary computed tomographic angiography (CCTA), and compared the performance to existing clinical or CCTA metrics.

Impact of Center Experience on Patient Radiation Exposure During Transradial Coronary Angiography and Percutaneous Intervention: A Patient-Level, International, Collaborative, Multi-Center Analysis.

Background: The adoption of the transradial (TR) approach over the traditional transfemoral (TF) approach has been hampered by concerns of increased radiation exposure-a subject of considerable debate within the field. We performed a patient-level, multi-center analysis to definitively address the impact of TR access on radiation exposure.

Methods And Results: Overall, 10 centers were included from 6 countries-Canada (2 centers), United Kingdom (2), Germany (2), Sweden (2), Hungary (1), and The Netherlands (1).

Coronary Artery Disease in French Canadians-Investigation of a Suggested Vulnerable Population.

Background: There is a perception among Canadian physicians that coronary artery disease (CAD) and adverse cardiac events are more common in those of French Canadian heritage. We sought to compare the prevalence of CAD using coronary computed tomographic angiography (CCTA) in French Canadians and non-French white Canadians.

Methods: Consecutive patients were prospectively enrolled in our institutional CCTA registry.

The Prognostic Value of Percentage Total Plaque Score Adjusted to Age.

Background: Total plaque score (TPS) on coronary computed tomography angiography (CCTA) has been validated as a surrogate measure of coronary artery disease (CAD) burden and is prognostic. We propose a novel measure, percentage TPS adjusted to age (%TPS/age), that may reflect vascular age and potentially more rapidly progressive atherosclerosis and evaluate its potential prognostic value.

Methods: %TPS/age was calculated for consecutive patients prospectively enrolled into our institutional CCTA registry and evaluated for primary composite outcome of cardiac death, nonfatal myocardial infarction, and late revascularization.