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2. Location-specific prognostic significance of plaque burden, stenosis, and plaque morphology in coronary artery disease.

Author

Jukema, Ruurt A, Maaniitty, Teemu, Nurmohamed, Nick S, Raijmakers, Pieter G, Planken, R Nils, Twisk, Jos, van der Harst, Pim, Cramer, Maarten J, Min, James K, Earls, James P, Knaapen, Paul, Saraste, Antti, Knuuti, Juhani, and Danad, Ibrahim

Abstract

Aims To investigate the location-specific prognostic significance of plaque burden, diameter stenosis, and plaque morphology. Methods and results Patients without a documented cardiac history that underwent coronary computed tomography angiography (CCTA) for suspected coronary artery disease were included. Percentage atheroma volume (PAV), maximum diameter stenosis, and plaque morphology were assessed and classified into proximal, mid, or distal segments of the coronary tree. Major adverse cardiac events (MACE) were defined as death or non-fatal myocardial infarction. Among 2819 patients 267 events (9.5%) occurred during a median follow-up of 6.9 years. When adjusted for traditional risk factors and the presence of PAV in other locations, only proximal PAV was independently associated with MACE. However, PAV of the proximal segments was strongly correlated to PAV localized at the mid (R = 0.76) and distal segments (R = 0.74, P < 0.01 for both). When only adjusted for cardiovascular risk factors, the area under the curve (AUC) to predict MACE for proximal PAV was 0.73 (95% CI 0.69–0.76), which was similar compared with mid PAV (AUC 0.72, 95% CI 0.68–0.76) and distal PAV (AUC 0.72, 95% CI 0.68–0.76). Similar results were obtained using diameter stenosis instead of PAV. The presence of proximal low-attenuation plaque had borderline additional prognostic value. Conclusion Proximal PAV was the strongest predictor of MACE when adjusted for cardiovascular risk factors and plaque at other locations. However, when the presence of plaque was only adjusted for cardiovascular risk factors, proximal, mid, and distal plaque localization showed a similar predictive ability for MACE. [ABSTRACT FROM AUTHOR]

Published
2025
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4. Determining Hemodynamically Significant Coronary Artery Disease: Patient-Specific Cutoffs in Quantitative Myocardial Blood Flow Using [15O]H2O PET Imaging

Author

Hoek, Roel, primary, van Diemen, Pepijn A., additional, Raijmakers, Pieter G., additional, Driessen, Roel S., additional, Somsen, Yvemarie B.O., additional, de Winter, Ruben W., additional, Jukema, Ruurt A., additional, Twisk, Jos W.R., additional, Robbers, Lourens F.H.J., additional, van der Harst, Pim, additional, Saraste, Antti, additional, Lubberink, Mark, additional, Sörensen, Jens, additional, Knaapen, Paul, additional, Knuuti, Juhani, additional, and Danad, Ibrahim, additional

Published
2024
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6. Microvascular resistance reserve before and after PCI: A serial FFR and [15O] H2O PET study

Author

Circulatory Health, Team Medisch, Hoshino, Masahiro, Jukema, Ruurt A., Pijls, Nico, Hoek, Roel, Raijmakers, Pieter, Driessen, Roel, van Diemen, Pepijn, Twisk, Jos, van der Hoef, Tim, Danad, Ibrahim, Kakuta, Tsunekazu, Knaapen, Paul, Circulatory Health, Team Medisch, Hoshino, Masahiro, Jukema, Ruurt A., Pijls, Nico, Hoek, Roel, Raijmakers, Pieter, Driessen, Roel, van Diemen, Pepijn, Twisk, Jos, van der Hoef, Tim, Danad, Ibrahim, Kakuta, Tsunekazu, and Knaapen, Paul

Published
2024

7. AI-Guided Quantitative Plaque Staging Predicts Long-Term Cardiovascular Outcomes in Patients at Risk for Atherosclerotic CVD

Author

Cardiologie, Team Medisch, Nurmohamed, Nick S., Bom, Michiel J., Jukema, Ruurt A., de Groot, Robin J., Driessen, Roel S., van Diemen, Pepijn A., de Winter, Ruben W., Gaillard, Emilie L., Sprengers, Ralf W., Stroes, Erik S.G., Min, James K., Earls, James P., Cardoso, Rhanderson, Blankstein, Ron, Danad, Ibrahim, Choi, Andrew D., Knaapen, Paul, Cardiologie, Team Medisch, Nurmohamed, Nick S., Bom, Michiel J., Jukema, Ruurt A., de Groot, Robin J., Driessen, Roel S., van Diemen, Pepijn A., de Winter, Ruben W., Gaillard, Emilie L., Sprengers, Ralf W., Stroes, Erik S.G., Min, James K., Earls, James P., Cardoso, Rhanderson, Blankstein, Ron, Danad, Ibrahim, Choi, Andrew D., and Knaapen, Paul

Published
2024

8. Determining Hemodynamically Significant Coronary Artery Disease : Patient-Specific Cutoffs in Quantitative Myocardial Blood Flow Using [15O]H2O PET Imaging

Author

Hoek, Roel, van Diemen, Pepijn A., Raijmakers, Pieter G., Driessen, Roel S., Somsen, Yvemarie B. O., de Winter, Ruben W., Jukema, Ruurt A., Twisk, Jos W. R., Robbers, Lourens F. H. J., van der Harst, Pim, Saraste, Antti, Lubberink, Mark, Sörensen, Jens, Knaapen, Paul, Knuuti, Juhani, Danad, Ibrahim, Hoek, Roel, van Diemen, Pepijn A., Raijmakers, Pieter G., Driessen, Roel S., Somsen, Yvemarie B. O., de Winter, Ruben W., Jukema, Ruurt A., Twisk, Jos W. R., Robbers, Lourens F. H. J., van der Harst, Pim, Saraste, Antti, Lubberink, Mark, Sörensen, Jens, Knaapen, Paul, Knuuti, Juhani, and Danad, Ibrahim

Abstract

Currently, cutoffs of quantitative [15O]H2O PET to detect fractional flow reserve (FFR)-defined coronary artery disease (CAD) were derived from a single cohort that included patients without prior CAD. However, prior CAD, sex, and age can influence myocardial blood flow (MBF). Therefore, the present study determined the influence of prior CAD, sex, and age on optimal cutoffs of hyperemic MBF (hMBF) and coronary flow reserve (CFR) and evaluated whether cutoff optimization enhanced diagnostic performance of quantitative [15O]H2O PET against an FFR reference standard. Methods: Patients with chronic coronary symptoms underwent [15O]H2O PET and invasive coronary angiography with FFR. Optimal cutoffs for patients with and without prior CAD and subpopulations based on sex and age were determined. Results: This multicenter study included 560 patients. Optimal cutoffs were similar for patients with (n = 186) and without prior CAD (hMBF, 2.3 vs. 2.3 mL center dot min-1 center dot g-1; CFR, 2.7 vs. 2.6). Females (n = 190) had higher hMBF cutoffs than males (2.8 vs. 2.3 mL center dot min-1 center dot g-1), whereas CFRs were comparable (2.6 vs. 2.7). However, female sex-specific hMBF cutoff implementation decreased diagnostic accuracy as compared with the cutoff of 2.3 mL center dot min-1 center dot g-1 (72% vs. 82%, P , 0.001). Patients aged more than 70 y (n = 79) had lower hMBF (1.7 mL center dot min-1 center dot g-1) and CFR (2.3) cutoffs than did patients aged 50 y or less, 51-60 y, and 61-70 y (hMBF, 2.3-2.4 mL center dot min-1 center dot g-1; CFR, 2.7). Age-specific cutoffs in patients aged more than 70 y yielded comparable accuracy to the previously established cutoffs (hMBF, 72% vs. 76%, P = 0.664; CFR, 80% vs. 75%, P = 0.289). Conclusion: Patients with and without prior CAD had similar [15O]H2O PET cutoffs for detecting FFR-defined significant CAD. Stratifying patients according to sex and age led to different optimal cutoffs; however, these values did not translate in

Published
2024
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9. Hemodynamic Insights into Combined Fractional Flow Reserve and Instantaneous Wave-Free Ratio Assessment Through Quantitative [15O]H2O PET Myocardial Perfusion Imaging

Author

de Winter, Ruben W., primary, van Diemen, Pepijn A., additional, Schumacher, Stefan P., additional, Jukema, Ruurt A., additional, Somsen, Yvemarie B.O., additional, Hoek, Roel, additional, van Rossum, Albert C., additional, Twisk, Jos W.R., additional, de Waard, Guus A., additional, Nap, Alexander, additional, Raijmakers, Pieter G., additional, Driessen, Roel S., additional, Knaapen, Paul, additional, and Danad, Ibrahim, additional

Published
2024
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10. Determining Hemodynamically Significant Coronary Artery Disease: Patient-Specific Cutoffs in Quantitative Myocardial Blood Flow Using [15O]H2O PET Imaging.

Author

Hoek, Roel, van Diemen, Pepijn A., Raijmakers, Pieter G., Driessen, Roel S., Somsen, Yvemarie B. O., de Winter, Ruben W., Jukema, Ruurt A., Twisk, Jos W. R., Robbers, Lourens F. H. J., van der Harst, Pim, Saraste, Antti, Lubberink, Mark, Sörensen, Jens, Knaapen, Paul, Knuuti, Juhani, and Danad, Ibrahim

Published
2024
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11. TCT-526 Same-Day Discharge After Large-Bore Vascular Access in Percutaneous Coronary Intervention of Chronic Total Coronary Occlusions

Author

Somsen, Yvemarie, primary, Wilgenhof, Adriaan, additional, de Winter, Ruben, additional, Schumacher, Stefan, additional, van Diemen, Pepijn, additional, Jukema, Ruurt, additional, Hoek, Roel, additional, Stuijfzand, Wynand, additional, Twisk, Jos, additional, Danad, Ibrahim, additional, Verouden, Niels, additional, Nap, Alexander, additional, Henriques, Jose, additional, and Knaapen, Paul, additional

Published
2023
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12. Prognostic Value of Modified Coronary Flow Capacity Derived From [ 15 O]H 2 O Positron Emission Tomography Perfusion Imaging

Author

de Winter, Ruben W., primary, Jukema, Ruurt A., additional, van Diemen, Pepijn A., additional, Schumacher, Stefan P., additional, Somsen, Yvemarie B.O., additional, van de Hoef, Tim P., additional, van Rossum, Albert C., additional, Twisk, Jos W.R., additional, Maaniitty, Teemu, additional, Knuuti, Juhani, additional, Saraste, Antti, additional, Nap, Alexander, additional, Raijmakers, Pieter G., additional, Danad, Ibrahim, additional, and Knaapen, Paul, additional

Published
2023
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13. The diagnostic performance of quantitative flow ratio and perfusion imaging in patients with prior coronary artery disease

Author

van Diemen, Pepijn A, primary, de Winter, Ruben W, additional, Schumacher, Stefan P, additional, Everaars, Henk, additional, Bom, Michiel J, additional, Jukema, Ruurt A, additional, Somsen, Yvemarie B, additional, Raijmakers, Pieter G, additional, Kooistra, Rolf A, additional, Timmer, Janny, additional, Maaniitty, Teemu, additional, Robbers, Lourens F, additional, von Bartheld, Martin B, additional, Demirkiran, Ahmet, additional, van Rossum, Albert C, additional, Reiber, Johan H, additional, Knuuti, Juhani, additional, Underwood, S Richard, additional, Nagel, Eike, additional, Knaapen, Paul, additional, Driessen, Roel S, additional, and Danad, Ibrahim, additional

Published
2023
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15. AI-Guided Quantitative Plaque Staging Predicts Long-Term Cardiovascular Outcomes in Patients at Risk for Atherosclerotic CVD

Author

Nurmohamed, Nick S., primary, Bom, Michiel J., additional, Jukema, Ruurt A., additional, de Groot, Robin J., additional, Driessen, Roel S., additional, van Diemen, Pepijn A., additional, de Winter, Ruben W., additional, Gaillard, Emilie L., additional, Sprengers, Ralf W., additional, Stroes, Erik S.G., additional, Min, James K., additional, Earls, James P., additional, Cardoso, Rhanderson, additional, Blankstein, Ron, additional, Danad, Ibrahim, additional, Choi, Andrew D., additional, and Knaapen, Paul, additional

Published
2023
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16. Impact of percutaneous coronary intervention of chronic total occlusions on absolute perfusion in remote myocardium

Author

de Winter, Ruben W., Schumacher, Stefan P., van Diemen, Pepijn A., Jukema, Ruurt A., Somsen, Yvemarie B. O., Stuijfzand, Wynand J., Driessen, Roel S., Bom, Michiel J., Everaars, Henk, van Rossum, Albert C., van de Ven, Peter M., Opolski, Maksymilian P., Verouden, Niels J., Danad, Ibrahim, Raijmakers, Pieter G., Nap, Alex, Knaapen, Paul, Cardiology, ACS - Heart failure & arrhythmias, ACS - Atherosclerosis & ischemic syndromes, Radiology and nuclear medicine, AII - Infectious diseases, and AMS - Tissue Function & Regeneration

Subjects
Perfusion, Percutaneous Coronary Intervention, Treatment Outcome, Coronary Occlusion, Coronary Circulation, Myocardium, Chronic Disease, Myocardial Perfusion Imaging, Humans, Hyperemia, Coronary Angiography, Cardiology and Cardiovascular Medicine
Abstract

Background: Revascularisation of a chronic total coronary occlusion (CTO) impacts on the coronary physiology of the remote myocardial territory. Aims: This study aimed to evaluate the intrinsic effect of CTO percutaneous coronary intervention (PCI) on changes in absolute perfusion in remote myocardium. Methods: A total of 164 patients who underwent serial [ 15O]H 2O positron emission tomography (PET) perfusion imaging at baseline and three months after successful single-vessel CTO PCI were included to evaluate changes in hyperaemic myocardial blood flow (hMBF) and coronary flow reserve (CFR) in the remote myocardium supplied by both non-target coronary arteries. Results: Perfusion indices in CTO and remote myocardium showed a positive correlation before (resting MBF: r=0.84, hMBF: r =0.75, and CFR: r =0.77, p–1·g –1 and from 2.48±0.76 to 2.74±0.85, respectively, p

Published
2022
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18. The diagnostic performance of quantitative flow ratio and perfusion imaging in patients with prior coronary artery disease.

Author

Diemen, Pepijn A van, Winter, Ruben W de, Schumacher, Stefan P, Everaars, Henk, Bom, Michiel J, Jukema, Ruurt A, Somsen, Yvemarie B, Raijmakers, Pieter G, Kooistra, Rolf A, Timmer, Janny, Maaniitty, Teemu, Robbers, Lourens F, Bartheld, Martin B von, Demirkiran, Ahmet, Rossum, Albert C van, Reiber, Johan H, Knuuti, Juhani, Underwood, S Richard, Nagel, Eike, and Knaapen, Paul

Subjects
STATISTICS, RESEARCH, PERCUTANEOUS coronary intervention, CONFIDENCE intervals, OPERATIVE surgery, MAGNETIC resonance imaging, MYOCARDIAL infarction, RETROSPECTIVE studies, COMPARATIVE studies, CORONARY artery disease, POSITRON emission tomography, DESCRIPTIVE statistics, INTRACLASS correlation, PERFUSION imaging, DATA analysis software, DATA analysis, PERFUSION, CARDIAC-gated SPECT
Abstract

Aims In chronic coronary syndrome (CCS) patients with documented coronary artery disease (CAD), ischaemia detection by myocardial perfusion imaging (MPI) and an invasive approach are viable diagnostic strategies. We compared the diagnostic performance of quantitative flow ratio (QFR) with single-photon emission computed tomography (SPECT), positron emission tomography (PET), and cardiac magnetic resonance imaging (CMR) in patients with prior CAD [previous percutaneous coronary intervention (PCI) and/or myocardial infarction (MI)]. Methods and results This PACIFIC-2 sub-study evaluated 189 CCS patients with prior CAD for inclusion. Patients underwent SPECT, PET, and CMR followed by invasive coronary angiography with fractional flow reserve (FFR) measurements of all major coronary arteries (N = 567), except for vessels with a sub-total or chronic total occlusion. Quantitative flow ratio computation was attempted in 488 (86%) vessels with measured FFR available (FFR ≤0.80 defined haemodynamically significant CAD). Quantitative flow ratio analysis was successful in 334 (68%) vessels among 166 patients and demonstrated a higher accuracy (84%) and sensitivity (72%) compared with SPECT (66%, P < 0.001 and 46%, P = 0.001), PET (65%, P < 0.001 and 58%, P = 0.032), and CMR (72%, P < 0.001 and 33%, P < 0.001). The specificity of QFR (87%) was similar to that of CMR (83%, P = 0.123) but higher than that of SPECT (71%, P < 0.001) and PET (67%, P < 0.001). Lastly, QFR exhibited a higher area under the receiver operating characteristic curve (0.89) than SPECT (0.57, P < 0.001), PET (0.66, P < 0.001), and CMR (0.60, P < 0.001). Conclusion QFR correlated better with FFR in patients with prior CAD than MPI, as reflected in the higher diagnostic performance measures for detecting FFR-defined, vessel-specific, significant CAD. [ABSTRACT FROM AUTHOR]

Published
2024
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19. IMPACT OF SEX-DIFFERENCES ON CHANGES IN MYOCARDIAL PERFUSION FOLLOWING PERCUTANEOUS CORONARY INTERVENTION OF CHRONIC TOTAL CORONARY OCCLUSIONS

Author

Somsen, Yvemarie, primary, De Winter, Ruben Willem, additional, Van Veelen, Anna, additional, Schumacher, Stefan, additional, Van Diemen, Pepijn, additional, Jukema, Ruurt, additional, Hoek, Roel, additional, Stuijfzand, Wijnand, additional, Danad, Ibrahim, additional, Verouden, Niels, additional, Nap, Alexander, additional, Appelman, Yolande, additional, Henriques, Jose, additional, and Knaapen, Paul, additional

Published
2023
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20. HIGH DIAGNOSTIC ACCURACY OF AI-ISCHEMIA IN COMPARISON TO PET, FFR-CT, SPECT, AND INVASIVE FFR: A PACIFIC SUB-STUDY

Author

Nurmohamed, Nick S., primary, Danad, Ibrahim, additional, Jukema, Ruurt, additional, Driessen, Roel, additional, Bom, Michiel, additional, Winter, Ruben Willem De, additional, Sprengers, Ralf, additional, Katz, Richard J., additional, Cantlay, Catherine, additional, Knuuti, Juhani M., additional, Min, James K., additional, Earls, James P., additional, Choi, Andrew D., additional, and Knaapen, Paul, additional

Published
2023
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21. CORONARY FLOW CAPACITY PREDICTS ADVERSE OUTCOME BEYOND STANDARD PERFUSION METRICS IN STABLE CHEST PAIN PATIENTS

Author

Winter, Ruben Willem De, primary, Jukema, Ruurt, additional, Van Diemen, Pepijn, additional, Schumacher, Stefan, additional, Somsen, Yvemarie, additional, van de Hoef, Tim P., additional, van Rossum, Albert, additional, Twisk, Jos, additional, Maaniitty, Teemu, additional, Knuuti, Juhani M., additional, Saraste, Antti, additional, Nap, Alexander, additional, Raijmakers, Pieter, additional, Danad, Ibrahim, additional, and Knaapen, Paul, additional

Published
2023
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22. DIAGNOSTIC PERFORMANCE OF QUANTITATIVE CARDIAC MAGNETIC RESONANCE IMAGING IN PATIENTS WITH PRIOR CORONARY ARTERY DISEASE

Author

Hoek, Roel, primary, Borodzicz-Jazdzyk, Sonia, additional, Van Diemen, Pepijn, additional, Somsen, Yvemarie, additional, Willem De Winter, Ruben, additional, Jukema, Ruurt, additional, Raijmakers, Pieter, additional, Knuuti, Juhani M., additional, Maaniitty, Teemu, additional, Underwood, Stephen Richard, additional, Nagel, Eike C., additional, Robbers, Lourens, additional, Demirkiran, Ahmet, additional, von Bartheld, Bob, additional, Driessen, Roel, additional, Danad, Ibrahim, additional, Gotte, Marc, additional, and Knaapen, Paul, additional

Published
2023
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23. QUANTITATIVE PLAQUE STAGING SYSTEM PREDICTS LONG-TERM CARDIOVASCULAR OUTCOMES IN PATIENTS AT RISK FOR ATHEROSCLEROTIC CARDIOVASCULAR DISEASE

Author

Nurmohamed, Nick S., primary, Bom, Michiel, additional, Jukema, Ruurt, additional, De Groot, Robin, additional, Driessen, Roel, additional, Van Diemen, Pepijn, additional, Sprengers, Ralf, additional, Min, James K., additional, Earls, James P., additional, Danad, Ibrahim, additional, Choi, Andrew D., additional, and Knaapen, Paul, additional

Published
2023
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24. AI-QCT DEMONSTRATES SUPERIOR ACCURACY FOR THE DIAGNOSIS OF OBSTRUCTIVE CAD BY QCA STANDARD COMPARED TO CORE LAB CCTA INTERPRETATION

Author

Nurmohamed, Nick S., primary, Jukema, Ruurt, additional, Driessen, Roel, additional, Bom, Michiel, additional, Winter, Ruben Willem De, additional, Sprengers, Ralf, additional, Nap, Alexander, additional, Sidahmed, Alfateh, additional, Min, James K., additional, Earls, James P., additional, Choi, Andrew D., additional, Knaapen, Paul, additional, and Danad, Ibrahim, additional

Published
2023
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26. TCT-231 Correlation and Diagnostic Agreement of Quantitative Flow Ratio With Fractional Flow Reserve in Saphenous Vein Grafts

Author

de Winter, Ruben, primary, Somsen, Yvemarie, additional, van Diemen, Pepijn, additional, Jukema, Ruurt, additional, Hoek, Roel, additional, Jonker, Mathé, additional, van Rossum, Albert, additional, Kooistra, Rolf, additional, Janssen, Jasper, additional, Porouchani, Sina, additional, Wilgenhof, Adriaan, additional, Danad, Ibrahim, additional, Verouden, Niels, additional, Reiber, Johan, additional, Nap, Alexander, additional, and Knaapen, Paul, additional

Published
2022
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27. TCT-116 Impact of Sex Differences on Changes in Myocardial Perfusion Following Percutaneous Coronary Intervention of Chronic Total Coronary Occlusions: A Serial [15O]H2O Positron Emission Tomographic Perfusion Imaging Study

Author

Somsen, Yvemarie, primary, de Winter, Ruben, additional, van Veelen, Anna, additional, Schumacher, Stefan, additional, van Diemen, Pepijn, additional, Jukema, Ruurt, additional, Hoek, Roel, additional, Stuijfzand, Wynand, additional, Danad, Ibrahim, additional, Verouden, Niels, additional, Nap, Alexander, additional, Henriques, Jose, additional, and Knaapen, Paul, additional

Published
2022
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28. TCT-264 Prognostic Value of Coronary Flow Capacity Derived From [15O]H2O Positron Emission Tomography Perfusion Imaging

Author

de Winter, Ruben, primary, Jukema, Ruurt, additional, van Diemen, Pepijn, additional, Schumacher, Stefan, additional, Somsen, Yvemarie, additional, Van de Hoef, Tim, additional, van Rossum, Albert, additional, Twisk, Jos, additional, Maaniitty, Teemu, additional, Knuuti, Juhani, additional, Saraste, Antti, additional, Nap, Alexander, additional, Raijmakers, Pieter, additional, Danad, Ibrahim, additional, and Knaapen, Paul, additional

Published
2022
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29. The relation of RAAS activity and endothelin-1 levels to coronary atherosclerotic burden and microvascular dysfunction in chest pain patients

Author

Jukema, Ruurt A., de Winter, Ruben W., van Diemen, Pepijn A., Driessen, Roel S., Danser, A. H.Jan, Garrelds, Ingrid M., Raijmakers, Pieter G., van de Ven, Peter M., Knaapen, Paul, Danad, Ibrahim, de Waard, Guus A., Jukema, Ruurt A., de Winter, Ruben W., van Diemen, Pepijn A., Driessen, Roel S., Danser, A. H.Jan, Garrelds, Ingrid M., Raijmakers, Pieter G., van de Ven, Peter M., Knaapen, Paul, Danad, Ibrahim, and de Waard, Guus A.

Abstract

Background and aims: In this study, we investigated whether increased renin angiotensin aldosterone system (RAAS) activation and endothelin-1 levels are related to coronary artery calcium (CAC) score, total plaque volume (TPV), high risk plaque, hyperemic myocardial blood flow (MBF) and coronary microvascular dysfunction (CMD). Methods: In a prospective, observational, cross-sectional cohort, renin as a marker for RAAS activation and endothelin-1 were measured in peripheral venous blood of 205 patients (64% men; age 58 ± 8.7 years) with suspected coronary artery disease (CAD) who underwent coronary computed tomography angiography (CCTA), [15O]H2O positron emission tomography (PET) perfusion imaging and invasive fractional flow reserve (FFR) measurements. Patients were categorized into three groups based on FFR (≤0.80) and hyperemic MBF <2.3 ml/min/g: [1] obstructive CAD (n = 92), [2] CMD (n = 26) or [3] no or non-obstructive CAD (n = 85). Results: After correction for baseline characteristics, including RAAS inhibiting therapy, renin associated positively with CAC score and TPV, but not with hyperemic MBF (p < 0.01; p = 0.02 and p = 0.23). Patients with high risk plaque displayed higher levels of renin (mean logarithmic renin 1.25 ± 0.43 vs. 1.12 ± 0.35 pg/ml; p = 0.04), but not endothelin-1. Compared to no or non-obstructive CAD patients, renin was significantly elevated in obstructive CAD patients but not in CMD patients (mean logarithmic renin 1.06 ± 0.34 vs. 1.23 ± 0.36; p < 0.01 and 1.06 ± 0.34 vs. 1.16 ± 0.41 pg/ml; p = 0.65). Endothelin-1 did not differ between the three patient groups. Conclusions: Our report provides evidence that RAAS activity measured by renin concentration is elevated in patients with coronary atherosclerosis and high risk plaque but not in patients with CMD, whereas endothelin-1 is not related to either.

Published
2022

30. IMPACT OF PERCUTANEOUS CORONARY INTERVENTION OF CHRONIC TOTAL OCCLUSIONS ON ABSOLUTE PERFUSION IN REMOTE MYOCARDIUM

Author

De Winter, Ruben Willem, primary, Schumacher, Stefan, additional, Van Diemen, Pepijn, additional, Jukema, Ruurt, additional, Somsen, Yvemarie, additional, Stuijfzand, Wynand, additional, Driessen, Roel, additional, Bom, Michiel, additional, Everaars, Henk, additional, van Rossum, Albert, additional, van de Ven, Peter, additional, Opolski, Maksymilian, additional, Verouden, Niels, additional, Danad, Ibrahim, additional, Raijmakers, Pieter, additional, Nap, Alexander, additional, and Knaapen, Paul, additional

Published
2022
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31. THE DIAGNOSTIC PERFORMANCE OF QFR AND MYOCARDIAL PERFUSION IMAGING IN PATIENTS WITH PRIOR CORONARY ARTERY DISEASE.

Author

Van Diemen, Pepijn, primary, De Winter, Ruben Willem, additional, Schumacher, Stefan, additional, Everaars, Henk, additional, Bom, Michiel, additional, Jukema, Ruurt, additional, Somsen, Yvemarie, additional, Raijmakers, Pieter, additional, Kooistra, Rolf A., additional, Timmer, Janny, additional, Maaniitty, Teemu, additional, Robbers, Lourens FHJ, additional, Bartheld, Bob von, additional, Demirkiran, Ahmet, additional, van Rossum, Albert, additional, Reiber, Johan H.C., additional, Knuuti, Juhani M., additional, Underwood, Stephen Richard, additional, Nagel, Eike C., additional, Knaapen, Paul, additional, Driessen, Roel, additional, and Danad, Ibrahim, additional

Published
2022
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32. THE RELATION OF RENIN-ANGIOTENSIN-ALDOSTERONE-SYSTEM ACTIVITY AND ENDOTHELIN-1 LEVELS TO CORONARY ATHEROSCLEROTIC BURDEN AND MICROVASCULAR DYSFUNCTION IN SYMPTOMATIC CHEST PAIN PATIENTS

Author

Jukema, Ruurt, primary, De Winter, Ruben Willem, additional, Van Diemen, Pepijn, additional, Driessen, Roel, additional, Danser, Jan, additional, Garrelds, Ingrid, additional, Raijmakers, Pieter, additional, van de Ven, Peter, additional, Knaapen, Paul, additional, Danad, Ibrahim, additional, and de Waard, Guus, additional

Published
2022
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33. MYOCARDIAL DAMAGE IN CHRONIC TOTAL CORONARY OCCLUSION TERRITORY COLLATERALIZED BY AN INFARCT-RELATED ARTERY: DEFINING DOUBLE JEOPARDY

Author

Somsen, Yvemarie, primary, Giunta, Rocco, additional, De Winter, Ruben Willem, additional, Schumacher, Stefan, additional, Van Diemen, Pepijn, additional, Jukema, Ruurt, additional, Stuijfzand, Wynand, additional, Danad, Ibrahim, additional, Verouden, Niels, additional, Nap, Alexander, additional, Galassi, Alfredo R., additional, Henriques, José P., additional, and Knaapen, Paul, additional

Published
2022
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34. CONCORDANT LOW AND DISCORDANT FRACTIONAL FLOW RESERVE AND INSTANTANEOUS WAVE-FREE RATIO MEASUREMENTS ARE ASSOCIATED WITH REDUCED MYOCARDIAL PERFUSION:A COMPARISON BETWEEN PRESSURE RATIO MEASUREMENTS AND 15O-WATER PET PERFUSION IMAGING

Author

De Winter, Ruben Willem, primary, Van Diemen, Pepijn, additional, Schumacher, Stefan, additional, Jukema, Ruurt, additional, Somsen, Yvemarie, additional, Bom, Michiel, additional, Everaars, Henk, additional, van Rossum, Albert, additional, Verouden, Niels, additional, Raijmakers, Pieter, additional, Nap, Alexander, additional, Driessen, Roel, additional, Danad, Ibrahim, additional, and Knaapen, Paul, additional

Published
2022
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35. PREDICTING SUCCESS OF THE RETROGRADE APPROACH IN PERCUTANEOUS CORONARY INTERVENTION OF CHRONIC TOTAL CORONARY OCCLUSIONS WITH COLLATERAL GRADING SYSTEMS

Author

Somsen, Yvemarie, primary, Giunta, Rocco, additional, De Winter, Ruben Willem, additional, Schumacher, Stefan, additional, Van Diemen, Pepijn, additional, Jukema, Ruurt, additional, Stuijfzand, Wynand, additional, Danad, Ibrahim, additional, Verouden, Niels, additional, Nap, Alexander, additional, Galassi, Alfredo R., additional, Henriques, Jose, additional, and Knaapen, Paul, additional

Published
2022
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36. Warranty period of coronary computed tomography angiography and [15O]H2O positron emission tomography in symptomatic patients.

Author

Jukema, Ruurt, Maaniitty, Teemu, Diemen, Pepijn van, Berkhof, Hans, Raijmakers, Pieter G, Sprengers, Ralf, Planken, R Nils, Knaapen, Paul, Saraste, Antti, Danad, Ibrahim, and Knuuti, Juhani

Subjects
BLOOD vessels, PREDICTIVE tests, CORONARY angiography, POSITRON emission tomography, DESCRIPTIVE statistics, COMPUTED tomography
Abstract

Aims Data on the warranty period of coronary computed tomography angiography (CTA) and combined coronary CTA/positron emission tomography (PET) are scarce. The present study aimed to determine the event-free (warranty) period after coronary CTA and the potential additional value of PET. Method and results Patients with suspected but not previously diagnosed coronary artery disease (CAD) who underwent coronary CTA and/or [15O]H2O PET were categorized based upon coronary CTA as no CAD, non-obstructive CAD, or obstructive CAD. A hyperaemic myocardial blood flow (MBF) ≤ 2.3 mL/min/g was considered abnormal. The warranty period was defined as the time for which the cumulative event rate of death and non-fatal myocardial infarction (MI) was below 5%. Of 2575 included patients (mean age 61.4 ± 9.9 years, 41% male), 1319 (51.2%) underwent coronary CTA only and 1237 (48.0%) underwent combined coronary CTA/PET. During a median follow-up of 7.0 years 163 deaths and 68 MIs occurred. The warranty period for patients with no CAD on coronary CTA was ≥10 years, whereas patients with non-obstructive CAD had a 5-year warranty period. Patients with obstructive CAD and normal hyperaemic MBF had a 2-year longer warranty period compared to patients with obstructive CAD and abnormal MBF (3 years vs. 1 year). Conclusion As standalone imaging, the warranty period for normal coronary CTA is ≥10 years, whereas patients with non-obstructive CAD have a warranty period of 5 years. Normal PET yielded a 2-year longer warranty period in patients with obstructive CAD. [ABSTRACT FROM AUTHOR]

Published
2023
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37. The impact of coronary revascularization on vessel-specific coronary flow capacity and long-term outcomes: a serial [15O]H2O positron emission tomography perfusion imaging study

Author

de Winter, Ruben W, primary, Jukema, Ruurt A, additional, van Diemen, Pepijn A, additional, Schumacher, Stefan P, additional, Driessen, Roel S, additional, Stuijfzand, Wynand J, additional, Everaars, Henk, additional, Bom, Michiel J, additional, van Rossum, Albert C, additional, van de Ven, Peter M, additional, Verouden, Niels J, additional, Nap, Alexander, additional, Raijmakers, Pieter G, additional, Danad, Ibrahim, additional, and Knaapen, Paul, additional

Published
2021
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38. Abstract 11071: Increased Circulating Raas Activity is Related to Functionally Significant Coronary Artery Disease as Defined by Ffr and [ 15 O]h2o Pet Perfusion as Well as Vulnerable Plaque Characteristics on CT Angiography

Author

Jukema, Ruurt, primary, de Winter, Ruben, additional, van Diemen, Pepijn, additional, Driessen, Roel, additional, Danser, Jan H, additional, Garrelds, Ingrid, additional, Raijmakers, Pieter, additional, van de Ven, Peter, additional, Knaapen, Paul, additional, Danad, Ibrahim, additional, and De Waard, Guus, additional

Published
2021
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39. Abstract 11014: Circulating Endothelin-1 Levels Are Not Elevated in Atherosclerotic Coronary Artery Disease and Coronary Microvascular Dysfunction Defined Using [ 15 O]h2o Pet Perfusion, Invasive Ffr and Coronary Ct Angiography

Author

Jukema, Ruurt, primary, de Winter, Ruben, additional, van Diemen, Pepijn, additional, Driessen, Roel, additional, Danser, Jan H, additional, Garrelds, Ingrid, additional, Raijmakers, Pieter, additional, van de Ven, Peter, additional, Knaapen, Paul, additional, Danad, Ibrahim, additional, and De Waard, Guus, additional

Published
2021
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40. Abstract 10176: Absolute Perfusion Increase in Remote Myocardium Following Chronic Total Coronary Occlusion Percutaneous Coronary Intervention

Author

de Winter, Ruben W, primary, Schumacher, Stefan P, additional, van Diemen, Pepijn A, additional, Jukema, Ruurt A, additional, Somsen, Yvemarie B, additional, Stuijfzand, Wijnand J, additional, Driessen, Roel S, additional, Bom, Michiel J, additional, Everaars, Henk, additional, Van Rossum, Albert C. C, additional, van de Ven, Peter M, additional, Verouden, Niels J, additional, Danad, Ibrahim, additional, Raijmakers, Pieter G, additional, Alexander, Nap, additional, and Knaapen, Paul, additional

Published
2021
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41. Residual Quantitative Flow Ratio to Estimate Post‐Percutaneous Coronary Intervention Fractional Flow Reserve

Author

van Diemen, Pepijn A., primary, de Winter, Ruben W., additional, Schumacher, Stefan P., additional, Bom, Michiel J., additional, Driessen, Roel S., additional, Everaars, Henk, additional, Jukema, Ruurt A., additional, Somsen, Yvemarie B., additional, Popelkova, Lenka, additional, van de Ven, Peter M., additional, van Rossum, Albert C., additional, van de Hoef, Tim P., additional, de Haan, Stefan, additional, Marques, Koen M., additional, Lemkes, Jorrit S., additional, Appelman, Yolande, additional, Nap, Alexander, additional, Verouden, Niels J., additional, Opolski, Maksymilian P., additional, Danad, Ibrahim, additional, and Knaapen, Paul, additional

Published
2021
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42. PRE-PCI RESIDUAL QUANTITATIVE FLOW RATIO FOR ESTIMATING POST-PCI FFR

Author

Van Diemen, Pepijn, primary, Schumacher, Stefan, additional, Bom, Michiel, additional, Driessen, Roel, additional, Everaars, Henk, additional, de Winter, Ruben, additional, Jukema, Ruurt, additional, Van Rossum, Albert, additional, Opolski, Maksymilian, additional, Danad, Ibrahim, additional, and Knaapen, Paul, additional

Published
2021
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43. THE IMPACT OF CORONARY REVASCULARIZATION ON REGIONAL VESSEL-SPECIFIC CORONARY FLOW CAPACITY: A SERIAL [15O]H2O POSITRON EMISSION TOMOGRAPHY PERFUSION IMAGING STUDY

Author

De Winter, Ruben Willem, primary, Jukema, Ruurt, additional, Van Diemen, Pepijn, additional, Schumacher, Stefan, additional, Driessen, Roel, additional, Stuijfzand, Wijnand, additional, Bom, Michiel, additional, Everaars, Henk, additional, van Rossum, Albert, additional, van de Ven, Peter, additional, Verouden, Niels, additional, Nap, Alexander, additional, Danad, Ibrahim, additional, Raijmakers, Pieter, additional, and Knaapen, Paul, additional

Published
2021
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44. A 7-YEAR WARRANTY PERIOD FOR CHEST PAIN PATIENTS WITH A NORMAL QUANTITATIVE [15O] H2O PET MYOCARDIAL PERFUSION SCAN

Author

Jukema, Ruurt, primary, Van Diemen, Pepijn, additional, Driessen, Roel, additional, Stuijfzand, Wijnand, additional, Bom, Michiel, additional, Schumacher, Stefan, additional, Everaars, Henk, additional, Raijmakers, Pieter, additional, de Winter, Ruben, additional, van de Ven, Peter, additional, van Rossum, Albert, additional, Knaapen, Paul, additional, and Danad, Ibrahim, additional

Published
2021
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45. impact of coronary revascularization on vessel-specific coronary flow capacity and long-term outcomes: a serial [15O]H2O positron emission tomography perfusion imaging study.

Author

Winter, Ruben W de, Jukema, Ruurt A, Diemen, Pepijn A van, Schumacher, Stefan P, Driessen, Roel S, Stuijfzand, Wynand J, Everaars, Henk, Bom, Michiel J, Rossum, Albert C van, Ven, Peter M van de, Verouden, Niels J, Nap, Alexander, Raijmakers, Pieter G, Danad, Ibrahim, and Knaapen, Paul

Subjects
CORONARY arterial radiography, CORONARY artery surgery, ISCHEMIA, PATIENT aftercare, HEALTH outcome assessment, MYOCARDIAL infarction, CORONARY circulation, RISK assessment, MYOCARDIAL revascularization, RADIOPHARMACEUTICALS, POSITRON emission tomography, DESCRIPTIVE statistics, PERFUSION imaging, DEATH, PERFUSION
Abstract

Aims Coronary flow capacity (CFC) integrates quantitative hyperaemic myocardial blood flow (hMBF) and coronary flow reserve (CFR) to comprehensively assess physiological severity of coronary artery disease (CAD). This study evaluated the effects of revascularization on CFC as assessed by serial [15O]H2O positron emission tomography (PET) perfusion imaging. Methods and results A total of 314 patients with stable CAD underwent [15O]H2O PET imaging at baseline and after myocardial revascularization to assess changes in hMBF, CFR, and CFC in 415 revascularized vessels. Using thresholds for ischaemia and normal perfusion, vessels were stratified in five CFC categories: myocardial steal, severely reduced CFC, moderately reduced CFC, minimally reduced CFC, and normal flow. Additionally, the association between CFC increase and the composite endpoint of death and non-fatal myocardial infarction (MI) was studied. Vessel-specific CFC improved after revascularization (P < 0.01). Furthermore, baseline CFC was an independent predictor of CFC increase (P < 0.01). The largest changes in ΔhMBF (0.90 ± 0.74, 0.93 ± 0.65, 0.79 ± 0.74, 0.48 ± 0.61, and 0.29 ± 0.66 mL/min/g) and ΔCFR (1.01 ± 0.88, 0.99 ± 0.69, 0.87 ± 0.88, 0.66 ± 0.91, and −0.01 ± 1.06) were observed in vessels with lower baseline CFC (P < 0.01 for both). During a median follow-up of 3.5 (95% CI 3.1–3.9) years, an increase in CFC was independently associated with lower rates of death and non-fatal MI (HR 0.43, 95% CI 0.19–0.98, P = 0.04). Conclusion Successful revascularization results in an increase in CFC. Furthermore, baseline CFC was an independent predictor of change in hMBF, CFR, and subsequently CFC. In addition, an increase in CFC was associated with a favourable outcome in terms of death and non-fatal MI. [ABSTRACT FROM AUTHOR]

Published
2022
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46. Abstract 11014: Circulating Endothelin-1 Levels Are Not Elevated in Atherosclerotic Coronary Artery Disease and Coronary Microvascular Dysfunction Defined Using [15O]h2o Pet Perfusion, Invasive Ffr and Coronary Ct Angiography

Author

Jukema, Ruurt, de Winter, Ruben, van Diemen, Pepijn, Driessen, Roel, Danser, Jan H, Garrelds, Ingrid, Raijmakers, Pieter, van de Ven, Peter, Knaapen, Paul, Danad, Ibrahim, and De Waard, Guus

Abstract

Introduction:Endothelin-1 (ET-1), the most potent cardiovascular vasoconstrictor in humans, is increasingly being linked to coronary microvascular dysfunction (CMD) and atherosclerosis, thus providing a therapeutically modifiable target. In this study we investigated whether increased ET-1 levels are related to atherosclerosis, high risk plaque (HRP), myocardial perfusion and CMD in chest pain patients.Methods:Serum ET-1 was measured by ELISA in 205 patients (64% men; age 58 ± 9 years) with suspected coronary artery disease. All patients underwent 256-slice coronary CT angiography for (quantitative) plaque analysis and coronary artery calcium (CAC) scoring, [15O]H2O PET perfusion imaging and invasive FFR measurements in all coronary arteries. A total of 585 vessels were stratified upon four categories based on [15O]H2O PET perfusion (hyperemic MBF 2.3 ml/min/g) and invasive pressure measurements (FFR 0.80). Vessels with a FFR >0.80 but with an ischemic hyperemic MBF below 2.3 ml/min/g were defined as CMD.Results:In univariable analysis, ET-1 was not related to the CAC score, total plaque volume (TPV) or perfusion (p=0.33; p=0.55; p=0.75, respectively). Also, patients with HRP did not show higher levels of ET-1 (mean logarithmic ET-1 0.29 vs 0.30; p=0.83). ET-1 levels were equally distributed across the four vessel categories and were not elevated in CMD patients (p=0.31).Conclusions:Our findings indicate that circulating ET-1 levels are not elevated in stable patients with either atherosclerotic coronary artery disease or coronary microvascular dysfunction, suggesting that ET-1 may not be a useful therapeutic target in these disease states.Figure 1. A typical case example of a CMD patient with non-flow limiting coronary arteries (A) and an ischemic perfusion (B). ET-1 depicted for the four vessels categories. (C) The upper and lower whiskers represent the 10th and 90th percentile.

Published
2021
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47. Abstract 11071: Increased Circulating Raas Activity is Related to Functionally Significant Coronary Artery Disease as Defined by Ffr and [15O]h2o Pet Perfusion as Well as Vulnerable Plaque Characteristics on CT Angiography

Author

Jukema, Ruurt, de Winter, Ruben, van Diemen, Pepijn, Driessen, Roel, Danser, Jan H, Garrelds, Ingrid, Raijmakers, Pieter, van de Ven, Peter, Knaapen, Paul, Danad, Ibrahim, and De Waard, Guus

Abstract

Introduction:Renin-angiotensin-aldosterone-system (RAAS) activity has been linked to coronary artery disease (CAD) and coronary microvascular dysfunction (CMD), opening potential frontiers for treatment. In this study we investigated if increased RAAS activation is related to CAD, high risk plaque (HRP), myocardial perfusion, and CMD in chest pain patients.Methods:Renin as a measure for RAAS activation, was quantified by immunoradiometric assay in 205 patients (64% men; age 58 ± 9 years) with suspected CAD. Patients underwent 256-slice coronary CT angiography for (quantitative) plaque analysis and coronary artery calcium (CAC) scoring, [15O]H2O PET perfusion imaging and invasive FFR measurements in all coronary arteries. A total of 585 vessels were stratified upon four categories based on [15O]H2O PET perfusion and invasive pressure measurements. Vessels with a FFR >0.80 but with an ischemic hyperemic MBF below 2.3 ml/min/g were defined as CMD.Results:In univariable analysis, renin associated positively with the CAC score, total plaque volume (TPV) and impaired perfusion (p<0.01 for all). Patients with HRP displayed higher levels of renin (p=0.04). As expected, renin (p<0.01) was elevated in males. After correction for baseline characteristics including sex, renin associated positively with CAC score and TPV (p<0.01 and p=0.03), but not with HRP and perfusion (p=0.14 and p=0.40). Figure 1 shows that vessels with a significant flow limiting stenosis (FFR+, PET+; p=0.04) occur in patient with elevated renin levels, while vessels defined as CMD (FFR-, PET+) do not, except for patient without RAAS inhibition.Conclusion:RAAS activation is associated with CAD defined by FFR and [15O]H2O PET and HRP. Future studies should clarify whether RAAS activation and CAD are causally related and represent modifiable targets.Figure 1. Intergroup p values are depicted for significant p values only. The upper and lower whiskers represent the 10thand 90thpercentile.

Published
2021
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48. TCT-69 The Effect of Chronic Total Coronary Occlusion Percutaneous Coronary Intervention on Absolute Perfusion in Remote Myocardium.

Author

Schumacher, Stefan, van Diemen, Pepijn, Jukema, Ruurt, Somsen, Yvemarie, Stuijfzand, Wynand, Driessen, Roel, Bom, Michiel, Everaars, Henk, van Rossum, Albert, Opolski, Maksymilian, Verouden, Niels, Danad, Ibrahim, Nap, Alexander, Knaapen, Paul, and de Winter, Ruben

Subjects
*CHRONIC total occlusion, *PERCUTANEOUS coronary intervention, *CORONARY occlusion, *MYOCARDIUM, *PERFUSION
Published
2021
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49. TCT-70 Success of the Retrograde Approach in Percutaneous Coronary Intervention of Chronic Total Coronary Occlusions Guided by Collateral Grading Systems.

Author

Somsen, Yvemarie, Giunta, Rocco, de Winter, Ruben, Schumacher, Stefan, van Diemen, Pepijn, Jukema, Ruurt, Stuijfzand, Wynand, Danad, Ibrahim, Verouden, Niels, Nap, Alexander, Galassi, Alfredo, Henriques, Jose, and Knaapen, Paul

Subjects
*CHRONIC total occlusion, *PERCUTANEOUS coronary intervention
Published
2021
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50. Location-specific prognostic significance of plaque burden, stenosis, and plaque morphology in coronary artery disease.

Author

Jukema RA, Maaniitty T, Nurmohamed NS, Raijmakers PG, Planken RN, Twisk J, van der Harst P, Cramer MJ, Min JK, Earls JP, Knaapen P, Saraste A, Knuuti J, and Danad I

Subjects
Humans, Male, Female, Middle Aged, Prognosis, Aged, Risk Assessment, Retrospective Studies, Cohort Studies, Severity of Illness Index, Risk Factors, Plaque, Atherosclerotic diagnostic imaging, Coronary Artery Disease diagnostic imaging, Computed Tomography Angiography methods, Coronary Stenosis diagnostic imaging, Coronary Angiography methods
Abstract

Aims: To investigate the location-specific prognostic significance of plaque burden, diameter stenosis, and plaque morphology., Methods and Results: Patients without a documented cardiac history that underwent coronary computed tomography angiography (CCTA) for suspected coronary artery disease were included. Percentage atheroma volume (PAV), maximum diameter stenosis, and plaque morphology were assessed and classified into proximal, mid, or distal segments of the coronary tree. Major adverse cardiac events (MACE) were defined as death or non-fatal myocardial infarction. Among 2819 patients 267 events (9.5%) occurred during a median follow-up of 6.9 years. When adjusted for traditional risk factors and the presence of PAV in other locations, only proximal PAV was independently associated with MACE. However, PAV of the proximal segments was strongly correlated to PAV localized at the mid (R = 0.76) and distal segments (R = 0.74, P < 0.01 for both). When only adjusted for cardiovascular risk factors, the area under the curve (AUC) to predict MACE for proximal PAV was 0.73 (95% CI 0.69-0.76), which was similar compared with mid PAV (AUC 0.72, 95% CI 0.68-0.76) and distal PAV (AUC 0.72, 95% CI 0.68-0.76). Similar results were obtained using diameter stenosis instead of PAV. The presence of proximal low-attenuation plaque had borderline additional prognostic value., Conclusion: Proximal PAV was the strongest predictor of MACE when adjusted for cardiovascular risk factors and plaque at other locations. However, when the presence of plaque was only adjusted for cardiovascular risk factors, proximal, mid, and distal plaque localization showed a similar predictive ability for MACE., Competing Interests: Conflict of interest: Drs. J.K.M. and J.P.E. are employees of and hold equity in Cleerly Inc. Dr Knaapen has received research grants from Cleerly Inc., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Published
2024
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