Publications by authors named "Leslee Shaw"
Background: The relationship between the extent and severity of stress-induced ischemia and the extent and severity of anatomic coronary artery disease (CAD) in patients with obstructive CAD is multifactorial and includes the intensity of stress achieved, type of testing used, presence and extent of prior infarction, collateral blood flow, plaque characteristics, microvascular disease, coronary vasomotor tone, and genetic factors. Among chronic coronary disease participants with site-determined moderate or severe ischemia, we investigated associations between ischemia severity on stress testing and the extent of CAD on coronary computed tomography angiography.
Methods: Clinically indicated stress testing included nuclear imaging, echocardiography, cardiac magnetic resonance imaging, or nonimaging exercise tolerance test.
Coronary computed tomography angiography (CCTA) allows the assessment of the presence and severity of obstructive and nonobstructive atherosclerotic coronary artery disease. With software developments incorporating artificial intelligence-based automated image analysis along with improved spatial resolution of CT scanners, volumetric measurements of atherosclerotic plaque, detection of high-risk plaque features, and delineation of pericoronary adipose tissue density can now be readily and accurately evaluated for a given at-risk patient. Many of these expanded diagnostic measures have been shown to be prognostically useful for prediction of major adverse cardiac events.
View Article and Find Full Text PDFBackground: Transient ischemic dilation (TID) of the left ventricular (LV) cavity is considered a high-risk marker in patients with abnormal single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). Stress image acquisition with rubidium-82 (Rb) PET occurs at peak stress compared to 30-60 minutes post-stress with SPECT. We aimed to evaluate the prognostic value of TID in patients undergoing Rb PET MPI.
View Article and Find Full Text PDFBackground: There is increasing interest in predicting heart failure (HF), a major cause of morbidity and mortality with a significant financial burden. The role of coronary artery calcium (CAC), an accessible and inexpensive test, in predicting long-term HF mortality among asymptomatic adults remains unknown. We aimed to determine whether CAC burden is associated with HF-related mortality in the CAC Consortium.
View Article and Find Full Text PDFBackground: The comparison of coronary computed tomography angiography plaques and perivascular adipose tissue (PVAT) between patients with acute myocardial infarction (AMI) posttreatment and patients with stable coronary artery disease is poorly understood. Our objective was to evaluate the differences in coronary computed tomography angiography-quantified plaque and PVAT characteristics in patients post-AMI and identify signs of residual inflammation.
Methods And Results: We analyzed 205 patients (age, 59.
Article Synopsis
- The study evaluates the recovery of cardiac diagnostic procedures in Italy one year after the COVID-19 outbreak, focusing on procedure volumes, practices, and staff well-being.
- A global survey revealed a 72% drop in cardiac diagnostic procedures in April 2020 compared to March 2019, with only a slight recovery (3% increase) by April 2021, though some specific tests showed increased volumes.
- Many healthcare centers adopted measures like physical distancing and COVID-19 screening, but 25% of physicians reported high psychological stress levels, highlighting ongoing challenges within the healthcare system.
Evolving Approaches for Diagnostic Testing in Suspected Coronary Artery Disease.
JACC Cardiovasc Imaging
October 2024
A new business paradigm to make coronary CT angiography (CCTA) accessible to all.
J Cardiovasc Comput Tomogr
September 2024
Recently, the Centers for Medicare and Medicaid proposed a classification change that, if enacted, could double reimbursement for coronary CT angiography (CCTA) in the U.S. [1].
View Article and Find Full Text PDFBackground: Compared to normal high-density lipoprotein (HDL) cholesterol values, very high HDL cholesterol is associated with a higher incidence of mortality and atherosclerotic cardiovascular disease (ASCVD). As such, clinical risk stratification among persons with very high HDL cholesterol is challenging.
Objectives: Among persons with very high HDL cholesterol, the purpose was to determine the prevalence of coronary artery calcium (CAC) and compare the association between traditional risk factors vs CAC for all-cause mortality and ASCVD.
Background: The value of physiological ischemia versus anatomic severity of disease for prognosis and management of patients with stable coronary artery disease (CAD) is widely debated.
Methods: A total of 1764 patients who had rest-stress cadmium-zinc-telluride single-photon emission computed tomography myocardial perfusion imaging and angiography (invasive or computed tomography) were prospectively enrolled and followed for cardiac death/nonfatal myocardial infarction. The CAD prognostic index (CADPI) was used to quantify the extent and severity of angiographic disease.
Artificial Intelligence and Machine Learning for Cardiovascular Computed Tomography (CCT): A White Paper of the Society of Cardiovascular Computed Tomography (SCCT).
J Cardiovasc Comput Tomogr
August 2024
Cardiac computed tomography (CCT) is often used synonymously with coronary CT angiography (CCTA) and coronary artery calcium scoring (CACS), but also encompasses the use of CT for the assessment of structural, valvular, and congenital heart disease, and other cardiovascular pathology. This paper looks at the role of cardiac CT in the context of value-based care and predominantly focuses on the role of cardiac CT in the assessment of coronary artery disease (CAD), as this is where most of the clinical use and evidence of value can be found. Critical questions as to the defining of quality health care using cardiac CT are highllighted and the wider use of CT for the assessment of non-coronary disease is commented on towards the end of the manuscript but does not yet have the same level of health economic and value-based evidence.
View Article and Find Full Text PDFRecent studies have demonstrated that coronary plaque burden carries greater prognostic value in predicting adverse atherosclerotic cardiovascular disease outcomes than myocardial ischemia, thereby challenging the existing paradigm. Advances in plaque quantification through both noncontrast and contrast-enhanced computed tomography (CT) methods have led to earlier and more cost-effective detection of coronary disease compared with traditional stress testing. The 2 principal techniques of noninvasive coronary plaque quantification assessment are coronary artery calcium scoring by noncontrast CT and coronary CT angiography, both of which correlate with disease burden on invasive angiography.
View Article and Find Full Text PDFObjective: Epicardial adipose tissue (EAT) is implicated in the pathogenesis and progression of coronary artery disease (CAD). Limited data exists on the interplay between EAT and atherosclerosis in young individuals. Our study aims to explore the relationship between EAT and CAD in a young cohort.
View Article and Find Full Text PDFArticle Synopsis
- The study aimed to evaluate the effectiveness of coronary computed tomography angiography (CCTA) in assessing the risk of cardiovascular events through atherosclerotic plaque analysis in patients with ischemia.
- Using quantitative computed tomography (AI-QCT), researchers analyzed plaque characteristics and examined their relationship to cardiovascular death or myocardial infarction over an average follow-up of 3.3 years.
- Results showed that total plaque volume was the strongest predictor of adverse outcomes, and incorporating AI-QCT data improved predictive models beyond traditional risk factors.
Article Synopsis
- - The study evaluated how various cardiometabolic risk factors, such as metabolic syndrome and individual factors like high fasting glucose and low HDL cholesterol, impact the progression of coronary plaque and the likelihood of major cardiovascular events in patients with stable coronary artery disease.
- - In a cohort of 1,200 patients followed over several years, 28% experienced rapid coronary plaque progression, identified primarily through increased atheroma volume, which indicates worsening arterial health.
- - The findings suggest that a combination of risk factors, particularly high blood sugar and blood pressure, significantly forecast both plaque progression and serious cardiovascular incidents, highlighting the importance of monitoring these factors in at-risk patients.
Article Synopsis
- - Preeclampsia is a major pregnancy complication that significantly increases the risk of cardiovascular disease (CVD) for both mothers and infants, especially among Black women.
- - Early preeclampsia, occurring before 34 weeks of gestation, leads to systemic vascular issues that can cause lasting heart damage and pose long-term risks for heart failure (HF).
- - It’s important for women who experienced early or severe preeclampsia to receive careful monitoring after pregnancy to manage chronic hypertension and decrease the risks of CVD and HF.
Background: Most pretest probability (PTP) tools for obstructive coronary artery disease (CAD) were Western -developed. The most appropriate PTP models and the contribution of coronary artery calcium score (CACS) in Asian populations remain unknown. In a mixed Asian cohort, we compare 5 PTP models: local assessment of the heart (LAH), CAD Consortium (CAD2), risk factor-weighted clinical likelihood, the American Heart Association/American College of Cardiology and the European Society of Cardiology PTP and 3 extended versions of these models that incorporated CACS: LAH, CAD2, and the CACS-clinical likelihood.
View Article and Find Full Text PDFArticle Synopsis
- A study was conducted to improve the prediction of which coronary artery lesions could lead to acute coronary syndrome (ACS) by integrating artificial intelligence (AI) with traditional methods.
- The research focused on patients who had undergone coronary CT angiography (CTA) before experiencing an ACS event, analyzing both culprit (problematic) and nonculprit lesions.
- The new model incorporating AI features showed significantly better predictability for identifying high-risk lesions compared to standard methods, suggesting that AI can enhance cardiac risk assessment.
Article Synopsis
- - The COVID-19 pandemic significantly disrupted cardiovascular testing in Latin America (LATAM), with a study finding a 21% decrease in procedure volumes from pre-pandemic levels in April 2021, contrasting with zero change in the rest of the world.
- - Central America and Mexico experienced the largest reductions in procedures (47%), while healthcare centers in LATAM reported more staff layoffs and salary cuts than those in other regions.
- - The study highlighted the lasting effects of the pandemic on cardiovascular care and emphasized the need for mental health support for healthcare workers in LATAM, as nearly 50% reported excessive psychological stress.
Objective: To compare baseline characteristics of participants in the Women's IschemiA TRial to Reduce Events In Non-ObstRuctive CAD (WARRIOR) trial by qualification by Coronary Computed Tomography Angiography (CCTA) or Invasive Coronary Angiography (ICA).
Methods: The WARRIOR trial (NCT03417388) is an ongoing multicenter, prospective, randomized, blinded outcome evaluation of intensive medical therapy vs. usual care in women with suspected Ischemia and No Obstructive Coronary Artery Disease (INOCA) identified by either CCTA or ICA on the outcome of major adverse cardiovascular events (MACE).