Publications by authors named "Heidi Gransar"
Prognostic value of left ventricular mass measured on coronary computed tomography angiography.
J Cardiovasc Comput Tomogr
November 2024
Background: Left ventricular (LV) mass is a well-established prognostic indicator for cardiovascular risk. Measurement of LV mass on coronary computed tomography angiography (CCTA) is considered optional. We aimed to assess for associations between LV mass measured on CCTA with all-cause mortality (ACM) risk and to determine age- and sex-specific distributions.
View Article and Find Full Text PDFBackground: There has been an increasing call for employing ultrashort exercise activity questionnaires as a clinical "vital sign". To-date, this has not been applied to patients undergoing cardiac stress testing.
Methods: We evaluated 1136 patients who completed a one-item exercise questionnaire before undergoing stress SPECT myocardial perfusion imaging (MPI).
Article Synopsis
- Coronary computed tomography angiography (CCTA) is used to evaluate cardiovascular risk by quantifying coronary plaque, and deep learning technology helps automate this process.
- A study involving 2803 patients analyzed how age and sex affect coronary plaque volume and its relation to the risk of myocardial infarction, showing that plaque volume increases with age and is typically higher in men.
- Patients with coronary plaque in the ≥75th percentile were found to have a significantly higher risk of myocardial infarction compared to those below the 50th percentile, suggesting that deep learning-based plaque measurements can effectively predict cardiac events.
Article Synopsis
- More people from different ethnic backgrounds are getting stress tests, but most coronary artery calcium (CAC) scans are done on White patients.
- Since 1991, the number of Black and Hispanic patients getting stress tests has increased, but not for CAC scans, which are mainly paid for by White patients.
- There is a need to make CAC scans more accessible for ethnic and racial minorities to ensure everyone gets equal healthcare.
Article Synopsis
- The study evaluated the impact of self-reported exercise activity on mortality risk in 9,772 patients undergoing coronary computed tomography angiography (CCTA) between 2007 and 2020.
- Results showed that higher levels of exercise were linked to lower mortality rates, with those reporting no exercise having a threefold higher risk of death compared to those with high activity.
- The findings suggest that physical activity is a significant predictor of survival, regardless of the severity of coronary stenosis indicated by CCTA.
Article Synopsis
- The study examines the effectiveness of using automated deep learning techniques to analyze vessel-specific coronary artery calcification (CAC) for better prognostic assessments of heart health in patients.
- A large dataset comprised of electrocardiogram-gated and attenuation-corrected CT scans was used to evaluate the accuracy of this analysis, showing strong agreement with expert assessments across various artery segments.
- The findings indicate that significant CAC levels, especially in the left main/left anterior descending artery, correlate with a higher risk of major adverse cardiovascular events, suggesting that vessel-specific assessment can enhance risk stratification in cardiovascular health.
Background: Despite its potential benefits, the utilization of stress-only protocol in clinical practice has been limited. We report utilizing stress-first single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI).
Methods: We assessed 12,472 patients who were referred for SPECT-MPI between 2013 and 2020.
Article Synopsis
- Myocardial creep refers to the movement of the heart from its original position during stress PET imaging, potentially affecting blood flow measurements, highlighting the need for motion correction for accurate results.
- In a study involving over 4,000 patients, downward myocardial creep was found to significantly correlate with lower all-cause mortality rates and improved prediction of outcomes compared to standard imaging metrics.
- The research indicates that integrating downward creep measurements into PET-MPI models enhances risk assessment for patients, underlining its clinical importance despite limited effects from movement in other directions.
Article Synopsis
- SPECT-MPI was used in about two-thirds of cases, while PET-MPI was more common among older patients with higher cardiac risk factors.
- The PET-MPI group had a higher annualized mortality rate, even after matching for similar clinical backgrounds.
- Key predictors of mortality differed between the groups: exercise ability for SPECT-MPI patients and myocardial flow reserve (MFR) for PET-MPI patients.
Background: Since typical angina has become less frequent, it is unclear if this symptom still has prognostic significance.
Methods: We evaluated 38,383 patients undergoing stress/rest SPECT myocardial perfusion imaging followed for a median of 10.9 years.
Background: The Diamond-Forrester model was used extensively to predict obstructive coronary artery disease (CAD) but overestimates probability in current populations. Coronary artery calcium (CAC) is a useful marker of CAD, which is not routinely integrated with other features. We derived simple likelihood tables, integrating CAC with age, sex, and cardiac chest pain to predict obstructive CAD.
View Article and Find Full Text PDFObjective: To assess the frequency, change in prevalence, and prognostic significance of dyspnea among contemporary patients referred for cardiac stress testing.
Patients And Methods: We evaluated the prevalence of dyspnea and its relationship to all-cause mortality among 33,564 patients undergoing stress/rest SPECT-MPI between January 1, 2002 and December 31, 2017. Dyspnea was assessed as a single-item question.
Background: While coronary artery calcium (CAC) can now be evaluated by multiple imaging modalities, there is presently scant study regarding how CAC scores may vary among populations of varying clinical risk.
Methods: We evaluated the distribution of CAC scores among three patient groups: 18,941 referred for CAC scanning, 5101 referred for diagnostic coronary CT angiography (CCTA), and 3307 referred for diagnostic positron emission tomography (PET) myocardial perfusion imaging (MPI). We assessed the relationship between CAC score and myocardial ischemia, obstructive coronary artery disease (CAD), and all-cause mortality across imaging modalities.
Article Synopsis
- This study investigates the independent prognostic value of phase variables, specifically stress phase entropy, in predicting mortality compared to traditional PET-MPI variables like myocardial flow reserve (MFR).
- In a cohort of nearly 4,000 patients, those with abnormal stress phase entropy had a significantly higher annual mortality rate, indicating that it can effectively stratify risk regardless of MFR status.
- The findings suggest that integrating stress phase entropy into PET-MPI assessments enhances the predictive accuracy for all-cause mortality, beyond what standard measures provide.
Objective: To evaluate temporal trends in the prevalence of typical angina and its clinical correlates among patients referred for stress/rest SPECT myocardial perfusion imaging (MPI).
Patients And Methods: We evaluated the prevalence of chest pain symptoms and their relationship to inducible myocardial ischemia among 61,717 patients undergoing stress/rest SPECT-MPI between January 2, 1991 and December 31, 2017. We also assessed the relationship between chest pain symptom and angiographic findings among 6,579 patients undergoing coronary CT angiography between 2011 and 2017.
Background: Extracellular volume (ECV) is a quantitative measure of extracellular compartment expansion, and an increase in ECV is a marker of myocardial fibrosis. Although cardiac magnetic resonance (CMR) is considered the standard imaging tool for ECV quantification, cardiac computed tomography (CT) has also been used for ECV assessment.
Objectives: The aim of this meta-analysis was to evaluate the correlation and agreement in the quantification of myocardial ECV by CT and CMR.
Background: Elevated coronary artery calcium (CAC) scores in subjects without prior atherosclerotic cardiovascular disease (ASCVD) have been shown to be associated with increased cardiovascular risk.
Objectives: The authors sought to determine at what level individuals with elevated CAC scores who have not had an ASCVD event should be treated as aggressively for cardiovascular risk factors as patients who have already survived an ASCVD event.
Methods: The authors performed a cohort study comparing event rates of patients with established ASVCD to event rates in persons with no history of ASCVD and known calcium scores to ascertain at what level elevated CAC scores equate to risk associated with existing ASCVD.
Evaluation of California Non-Comprehensive Death File Against National Death Index.
Dialogues Health
December 2022
The National Death Index (NDI) by the Centers for Disease Control and Prevention and Death Master File (DMF) by Social Security Administration are the two most broadly utilized data files for mortality outcomes in clinical research. NDI's high costs and the elimination of protected death records from California in DMF calls for alternative death files. The recently emerged California Non-Comprehensive Death File (CNDF) serves as an alternative source for vital statistics.
View Article and Find Full Text PDFThe journal of cardiovascular computed tomography: A year in review: 2022.
J Cardiovasc Comput Tomogr
May 2023
This review aims to summarize key articles published in the Journal of Cardiovascular Computed Tomography (JCCT) in 2022, focusing on those that had the most scientific and educational impact. The JCCT continues to expand; the number of submissions, published manuscripts, cited articles, article downloads, social media presence, and impact factor continues to grow. The articles selected by the Editorial Board of the JCCT in this review highlight the role of cardiovascular computed tomography (CCT) to detect subclinical atherosclerosis, assess the functional relevance of stenoses, and plan invasive coronary and valve procedures.
View Article and Find Full Text PDFBackground: Absence of subclinical atherosclerosis is considered safe to defer statin therapy in general population. However, impact of statins on atherosclerotic cardiovascular disease in patients with diabetes stratified by coronary artery calcium (CAC) scores and extent of non-obstructive CAD on coronary computed tomography angiography (CCTA) has not been evaluated.
Methods: CONFIRM (Coronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multi-center Registry) study enrolled consecutive adults 18 years of age between 2005 and 2009 who underwent 64-detector row CCTA for suspected CAD.
Background: Prognostic significance of non-obstructive left main (LM) disease was recently reported. However, the influence of diabetes mellitus (DM) on event rates in patients with and without non-obstructive LM disease is not well-known.
Methods: We evaluated 27,252 patients undergoing coronary computed tomographic angiography from the COroNary CT Angiography Evaluation For Clinical Outcomes: An InteRnational Multicenter (CONFIRM) Registry.
Background: Assessment of coronary artery calcium (CAC) by computed tomographic (CT) imaging provides an accurate measure of atherosclerotic burden. CAC is also visible in computed tomographic attenuation correction (CTAC) scans, always acquired with cardiac positron emission tomographic (PET) imaging.
Objectives: The aim of this study was to develop a deep-learning (DL) model capable of fully automated CAC definition from PET CTAC scans.
Aim: Some observational studies have observed a lower, rather than higher, mortality rate in association with hypercholesterolemia during follow-up of patients after cardiac stress testing. We aim to assess the relationship of hypercholesterolemia and other CAD risk factors to mortality across a wide spectrum of patients referred for various cardiac tests.
Methods And Results: We identified four cardiac cohorts: 64,357 patients undergoing coronary artery calcium (CAC) scanning, 10,814 patients undergoing coronary CT angiography (CCTA), 31,411 patients without known CAD undergoing stress/rest single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), and 5051 patients with known CAD undergoing stress/rest SPECT-MPI.