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1. Analytical quantification of aortic valve 18F-sodium fluoride PET uptake

Author

Massera, Daniele, Doris, Mhairi K, Cadet, Sebastien, Kwiecinski, Jacek, Pawade, Tania A, Peeters, Frederique ECM, Dey, Damini, Newby, David E, Dweck, Marc R, and Slomka, Piotr J

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Biomedical Imaging, Bioengineering, Cardiovascular, Clinical Research, Heart Disease, Detection, screening and diagnosis, 4.2 Evaluation of markers and technologies, Aged, Algorithms, Aortic Valve, Female, Fluorine Radioisotopes, Humans, Image Processing, Computer-Assisted, Male, Middle Aged, Motion, Observer Variation, Positron Emission Tomography Computed Tomography, Reproducibility of Results, Signal-To-Noise Ratio, Sodium Fluoride, Software, User-Computer Interface, Positron emission tomography, cardiac motion, computed tomography, valvular disease, Cardiorespiratory Medicine and Haematology, Cardiovascular System & Hematology, Cardiovascular medicine and haematology
Abstract

BackgroundChallenges to cardiac PET-CT include patient motion, prolonged image acquisition and a reduction of counts due to gating. We compared two analytical tools, FusionQuant and OsiriX, for quantification of gated cardiac 18F-sodium fluoride (18F-fluoride) PET-CT imaging.MethodsTwenty-seven patients with aortic stenosis were included, 15 of whom underwent repeated imaging 4 weeks apart. Agreement between analytical tools and scan-rescan reproducibility was determined using the Bland-Altman method and Lin's concordance correlation coefficients (CCC).ResultsImage analysis was faster with FusionQuant [median time (IQR) 7:10 (6:40-8:20) minutes] compared with OsiriX [8:30 (8:00-10:10) minutes, p = .002]. Agreement of uptake measurements between programs was excellent, CCC = 0.972 (95% CI 0.949-0.995) for mean tissue-to-background ratio (TBRmean) and 0.981 (95% CI 0.965-0.997) for maximum tissue-to-background ratio (TBRmax). Mean noise decreased from 11.7% in the diastolic gate to 6.7% in motion-corrected images (p = .002); SNR increased from 25.41 to 41.13 (p = .0001). Aortic valve scan-rescan reproducibility for TBRmax was improved with FusionQuant using motion correction compared to OsiriX (error ± 36% vs ± 13%, p

Published
2020

3. Lipoprotein(a) and Oxidized Phospholipids Promote Valve Calcification in Patients With Aortic Stenosis

Author

Zheng, Kang H, Tsimikas, Sotirios, Pawade, Tania, Kroon, Jeffrey, Jenkins, William SA, Doris, Mhairi K, White, Audrey C, Timmers, Nyanza KLM, Hjortnaes, Jesper, Rogers, Maximillian A, Aikawa, Elena, Arsenault, Benoit J, Witztum, Joseph L, Newby, David E, Koschinsky, Marlys L, Fayad, Zahi A, Stroes, Erik SG, Boekholdt, S Matthijs, and Dweck, Marc R

Subjects
Biomedical and Clinical Sciences, Cardiovascular Medicine and Haematology, Clinical Sciences, Biomedical Imaging, Cardiovascular, Heart Disease, Age Factors, Aged, Aged, 80 and over, Aortic Valve, Aortic Valve Stenosis, Apolipoprotein B-100, Biomarkers, Calcinosis, Cohort Studies, Disease Progression, Echocardiography, Doppler, Female, Humans, Hyperlipidemias, Lipoprotein(a), Male, Middle Aged, Phospholipids, Positron-Emission Tomography, Prognosis, Proportional Hazards Models, Prospective Studies, Risk Assessment, Sex Factors, Survival Analysis, Tomography, X-Ray Computed, aortic valve stenosis, calcific aortic valve disease, lipoprotein(a), oxidized phospholipids, valvular interstitial cells, Cardiorespiratory Medicine and Haematology, Public Health and Health Services, Cardiovascular System & Hematology, Cardiovascular medicine and haematology
Abstract

BackgroundLipoprotein(a) [Lp(a)], a major carrier of oxidized phospholipids (OxPL), is associated with an increased incidence of aortic stenosis (AS). However, it remains unclear whether elevated Lp(a) and OxPL drive disease progression and are therefore targets for therapeutic intervention.ObjectivesThis study investigated whether Lp(a) and OxPL on apolipoprotein B-100 (OxPL-apoB) levels are associated with disease activity, disease progression, and clinical events in AS patients, along with the mechanisms underlying any associations.MethodsThis study combined 2 prospective cohorts and measured Lp(a) and OxPL-apoB levels in patients with AS (Vmax >2.0 m/s), who underwent baseline 18F-sodium fluoride (18F-NaF) positron emission tomography (PET), repeat computed tomography calcium scoring, and repeat echocardiography. In vitro studies investigated the effects of Lp(a) and OxPL on valvular interstitial cells.ResultsOverall, 145 patients were studied (68% men; age 70.3 ± 9.9 years). On baseline positron emission tomography, patients in the top Lp(a) tertile had increased valve calcification activity compared with those in lower tertiles (n = 79; 18F-NaF tissue-to-background ratio of the most diseased segment: 2.16 vs. 1.97; p = 0.043). During follow-up, patients in the top Lp(a) tertile had increased progression of valvular computed tomography calcium score (n = 51; 309 AU/year [interquartile range: 142 to 483 AU/year] vs. 93 AU/year [interquartile range: 56 to 296 AU/year; p = 0.015), faster hemodynamic progression on echocardiography (n = 129; 0.23 ± 0.20 m/s/year vs. 0.14 ± 0.20 m/s/year] p = 0.019), and increased risk for aortic valve replacement and death (n = 145; hazard ratio: 1.87; 95% CI: 1.13 to 3.08; p = 0.014), compared with lower tertiles. Similar results were noted with OxPL-apoB. In vitro, Lp(a) induced osteogenic differentiation of valvular interstitial cells, mediated by OxPL and inhibited with the E06 monoclonal antibody against OxPL.ConclusionsIn patients with AS, Lp(a) and OxPL drive valve calcification and disease progression. These findings suggest lowering Lp(a) or inactivating OxPL may slow AS progression and provide a rationale for clinical trials to test this hypothesis.

Published
2019

4. Thoracic Aortic 18F-Sodium Fluoride Activity and Ischemic Stroke in Patients With Established Cardiovascular Disease

Author

Fletcher, Alexander J., Tew, Yong Y., Tzolos, Evangelos, Joshi, Shruti S., Kaczynski, Jakub, Nash, Jennifer, Debono, Samuel, Lembo, Maria, Kwiecinski, Jacek, Bing, Rong, Syed, Maaz B.J., Doris, Mhairi K., van Beek, Edwin J.R., Moss, Alistair J., Jenkins, William S., Walker, Niki L., Joshi, Nikhil V., Pawade, Tania A., Adamson, Philip D., Whiteley, William N., Wardlaw, Joanna M., Slomka, Piotr J., Williams, Michelle C., Newby, David E., and Dweck, Marc R.

Published
2022
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5. Pericoronary Adipose Tissue Attenuation, Low-Attenuation Plaque Burden, and 5-Year Risk of Myocardial Infarction

Author

Tzolos, Evangelos, Williams, Michelle C., McElhinney, Priscilla, Lin, Andrew, Grodecki, Kajetan, Flores Tomasino, Guadalupe, Cadet, Sebastien, Kwiecinski, Jacek, Doris, Mhairi, Adamson, Philip D., Moss, Alastair J., Alam, Shirjel, Hunter, Amanda, Shah, Anoop S.V., Mills, Nicholas L., Pawade, Tania, Wang, Chengjia, Weir-McCall, Jonathan R., Roditi, Giles, van Beek, Edwin J.R., Shaw, Leslee J., Nicol, Edward D., Berman, Daniel S., Slomka, Piotr J., Dweck, Marc R., Newby, David E., and Dey, Damini

Published
2022
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6. Computed Tomography Aortic Valve Calcium Scoring in Patients With Bicuspid Aortic Valve Stenosis

Author

Shen, Mylène, Oh, Jin Kyung, Guzzetti, Ezequiel, Singh, Gurpreet K., Pawade, Tania, Tastet, Lionel, Clavel, Marie-Annick, Delgado, Victoria, Bax, Jeroen J., Dweck, Marc R., Abbas, Amr E., Mando, Ramy, Falconi, Mariano Luis, Perez de Arenaza, Diego, Poh, Kian Keong, Kong, William, Tay, Edgar, Pressman, Gregg, Brito, Daniel, Song, Jae Kwan, and Pibarot, Philippe

Published
2022
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7. Imaging calcification in aortic stenosis

Author

Pawade, Tania Ashwinikumar, Newby, David, and Dweck, Marc

Subjects
616.1, aortic stenosis, calcification, cardiac imaging, valve calcification, positron emission tomography, Computed Tomography scanning, CT scanning
Abstract

BACKGROUND Aortic stenosis is a common and potentially fatal condition in which fibro-calcific changes within the valve leaflets lead to the obstruction of blood flow. Severe symptomatic stenosis is an indication for aortic valve replacement and timely referral is essential to prevent adverse clinical events. Calcification is believed to represent the central process driving disease progression. 18F-Fluoride positron emission tomography computed tomography (PET-CT) and CT aortic valve calcium scoring (CT-AVC) quantify calcification activity and burden respectively. The overarching aim of this thesis was to evaluate the applications of these techniques to the study and management of aortic stenosis. METHODS AND RESULTS REPRODUCIBILITY The scan-rescan reproducibility of 18F-fluoride PET-CT and CT-AVC were investigated in 15 patients with mild, moderate and severe aortic stenosis who underwent repeated 18F-fluoride PET-CT scans 3.9±3.3 weeks apart. Modified techniques enhanced image quality and facilitated clear localization of calcification activity. Percentage error was reduced from ±63% to ±10% (tissue-to-background ratio most-diseased segment (MDS) mean of 1.55, bias -0.05, limits of agreement - 0·20 to +0·11). Excellent scan-rescan reproducibility was also observed for CT-AVC scoring (mean of differences 2% [limits of agreement, 16 to -12%]). AORTIC VALVE CALCIUM SCORE: SINGLE CENTRE STUDY Sex-specific CT-AVC thresholds (2065 in men and 1271 in women) have been proposed as a flow-independent technique for diagnosing severe aortic stenosis. In a prospective cohort study, the impact of CT-AVC scores upon echocardiographic measures of severity, disease progression and aortic valve replacement (AVR)/death were examined. Volunteers (20 controls, 20 with aortic sclerosis, 25 with mild, 33 with moderate and 23 with severe aortic stenosis) underwent CT-AVC and echocardiography at baseline and again at either 1 or 2-year time-points. Women required less calcification than men for the same degree of stenosis (p < 0.001). Baseline CT-AVC measurements appeared to provide the best prediction of subsequent disease progression. After adjustment for age, sex, peak aortic jet velocity (Vmax) ≥ 4m/s and aortic valve area (AVA) < 1 cm2, the published CT-AVC thresholds were the only independent predictor of AVR/death (hazard ratio = 6.39, 95% confidence intervals, 2.90-14.05, p < 0.001). AORTIC VALVE CALCIUM SCORE: MULTICENTRE STUDY CT-AVC thresholds were next examined in an international multicenter registry incorporating a wide range of patient populations, scanner vendors and analysis platforms. Eight centres contributed data from 918 patients (age 77±10, 60% male, Vmax 3.88±0.90 m/s) who had undergone ECG-gated CT within 3 months of echocardiography. Of these 708 (77%) had concordant echocardiographic assessments, in whom our own optimum sex-specific CT-AVC thresholds (women 1377, men 2062 AU) were nearly identical to those previously published. These thresholds provided excellent discrimination for severe stenosis (c-statistic: women 0.92, men 0.88) and independently predicted AVR and death after adjustment for age, sex, Vmax ≥4 m/s and AVA < 1 cm2 (hazards ratio, 3.02 [95% confidence intervals, 1.83-4.99], p < 0.001). In patients with discordant echocardiographic assessments (n=210), CT-AVC thresholds predicted an adverse prognosis. BICUSPID AORTIC VALVES Within the multicentre study, higher continuity-derived estimates of aortic valve area were observed in patients with bicuspid valves (n=68, 1.07±0.35 cm) compared to those with tri-leaflet valves (0.89±0.36 cm p < 0.001,). This was despite no differences in measurements of Vmax (p=0.152), or CT-AVC scores (p=0.313). The accuracy of AVA measurments in bicuspid valves was therefore tested against alternative markers of disease severity. AVA measurements in bicuspid valves demonstrated extremely weak associations with CT-AVC scores (r2=0.08, p=0.02) and failed to correlate with downstream markers of disease severity in the valve and myocardium and against clinical outcomes. AVA measurements in bicuspid patients also failed to independently predict AVR/death after adjustment for Vmax ≥4 m/s, age and gender. In this population CT-AVC thresholds (women 1377, men 2062 AU) again provided excellent discrimination for severe stenosis. CONCLUSIONS Optimised 18F-fluoride PET-CT scans quantify and localise calcification activity, consolidating its potential as a biomarker or end-point in clinical trials of novel therapies. CT calcium scoring of aortic valves is a reproducible technique, which provides diagnostic clarity in addition to powerful prediction of disease progression and adverse clinical events.

Published
2018

11. Detection and Prediction of Bioprosthetic Aortic Valve Degeneration

Author

Cartlidge, Timothy R.G., Doris, Mhairi K., Sellers, Stephanie L., Pawade, Tania A., White, Audrey C., Pessotto, Renzo, Kwiecinski, Jacek, Fletcher, Alison, Alcaide, Carlos, Lucatelli, Christophe, Densem, Cameron, Rudd, James H.F., van Beek, Edwin J.R., Tavares, Adriana, Virmani, Renu, Berman, Daniel, Leipsic, Jonathon A., Newby, David E., and Dweck, Marc R.

Published
2019
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13. Low-Attenuation Noncalcified Plaque on Coronary Computed Tomography Angiography Predicts Myocardial Infarction: Results From the Multicenter SCOT-HEART Trial (Scottish Computed Tomography of the HEART)

Author

Williams, Michelle C., Kwiecinski, Jacek, Doris, Mhairi, McElhinney, Priscilla, D’Souza, Michelle S., Cadet, Sebastien, Adamson, Philip D., Moss, Alastair J., Alam, Shirjel, Hunter, Amanda, Shah, Anoop S.V., Mills, Nicholas L., Pawade, Tania, Wang, Chengjia, Weir McCall, Jonathan, Bonnici-Mallia, Michael, Murrills, Christopher, Roditi, Giles, van Beek, Edwin J.R., Shaw, Leslee J., Nicol, Edward D., Berman, Daniel S., Slomka, Piotr J., Newby, David E., Dweck, Marc R., and Dey, Damini

Published
2020
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15. 149 QUANTIFICATION OF FIBROCALCIFIC VOLUME IN AORTIC VALVE STENOSIS BY A NOVEL CONTRAST COMPUTED TOMOGRAPHY METHOD BASED ON A GAUSSIAN MIXTURE MODEL

Author

Lembo, Maria, primary, Joshi, Shruti J, additional, Carnevale, Lorenzo, additional, Bing, Rong, additional, Tzolos, Evangelos, additional, Barton, Anna K, additional, Geers, Jolien, additional, Pawade, Tania A, additional, Newby, David E, additional, Dey, Damini, additional, and Dweck, Marc R, additional

Published
2022
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16. Computed Tomography Aortic Valve Calcium Scoring in Patients With Aortic Stenosis

Author

Pawade, Tania, Clavel, Marie-Annick, Tribouilloy, Christophe, Dreyfus, Julien, Mathieu, Tiffany, Tastet, Lionel, Renard, Cedric, Gun, Mesut, Jenkins, William Steven Arthur, Macron, Laurent, Sechrist, Jacob W., Lacomis, Joan M., Nguyen, Virginia, Galian Gay, Laura, Cuéllar Calabria, Hug, Ntalas, Ioannis, Cartlidge, Timothy Robert Graham, Prendergast, Bernard, Rajani, Ronak, Evangelista, Arturo, Cavalcante, João L., Newby, David E., Pibarot, Philippe, Messika Zeitoun, David, and Dweck, Marc R.

Published
2018
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17. High-Sensitivity Cardiac Troponin I and the Diagnosis of Coronary Artery Disease in Patients With Suspected Angina Pectoris

Author

Adamson, Philip D., Hunter, Amanda, Madsen, Debbie M., Shah, Anoop S.V., McAllister, David A., Pawade, Tania A., Williams, Michelle C., Berry, Colin, Boon, Nicholas A., Flather, Marcus, Forbes, John, McLean, Scott, Roditi, Giles, Timmis, Adam D., van Beek, Edwin J.R., Dweck, Marc R., Mickley, Hans, Mills, Nicholas L., and Newby, David E.

Published
2018
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18. Diagnostic and prognostic benefits of computed tomography coronary angiography using the 2016 National Institute for Health and Care Excellence guidance within a randomised trial

Author

Adamson, Philip D, Hunter, Amanda, Williams, Michelle C, Shah, Anoop S V, McAllister, David A, Pawade, Tania A, Dweck, Marc R, Mills, Nicholas L, Berry, Colin, Boon, Nicholas A, Clark, Elizabeth, Flather, Marcus, Forbes, John, McLean, Scott, Roditi, Giles, van Beek, Edwin J R, Timmis, Adam D, and Newby, David E

Published
2018
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20. Hepatosteatosis and atherosclerotic plaque on coronary computed tomography angiography

Author

Carter , Jessica, Heseltine, Thomas D, Meah, Mohammed N, Tzolos, Evangelos, Kwiecinski, Jacek, Doris, Mhairi, McElhinney , Priscilla, Moss, Alastair J, Adamson, Philip D, Hunter, Amanda L, Alam, Shirjel, Shah, Anoop S V, Pawade, Tania, Wang, Chengjia, Weir-McCall , Jonathan R, Roditi, Giles, van Beek, Edwin J R, Nicol, Edward D, Shaw, Leslee J, Berman, Daniel S., Slomka, Piotr J, Mills, Nicholas L, Dweck, Marc R, Newby, David E, Murray , Scott W, Dey, Damini, and Williams, Michelle C

Abstract

PurposeTo assess the association between non-alcoholic fatty liver disease (NAFLD) and quantitative atherosclerotic plaque on CT. Materials and MethodsIn this post-hoc analysis of the prospective Scottish Computed Tomography of the HEART trial (November 2010 to September 2014), hepatosteatosis and coronary artery calcium score were measured on non-contrast CT. Presence of stenoses, visually assessed high-risk plaque, and quantitative plaque burden were assessed on coronary CT angiography. Multivariable models were constructed to assess the impact of hepatosteatosis and cardiovascular risk factors on coronary artery disease.ResultsImages from 1726 participants (mean age, 58 years  9 [standard deviation]; 974 men) were included. Participants with hepatosteatosis (n=155/1726, 9%) had a higher BMI, more hypertension and diabetes mellitus, and higher cardiovascular risk scores (P < .001 for all) compared with those without hepatosteatosis. They had increased coronary artery calcium scores (median, 43 [interquartile range, 0 to 273] Agatston units [AU] versus 19 [0 to 225] AU, P = .046), more non-obstructive disease (48% versus 37%, P = .02) and higher low-attenuation plaque burden (5.11% [0 to 7.16] versus 4.07% [0 to 6.84], P = .04). However, these associations were not independent of cardiovascular risk factors. Over median 4.7 years, there was no evidence of a difference in myocardial infarction between those with and without hepatosteatosis (1.9% versus 2.4%, P = .92). Conclusion Hepatosteatosis on CT was associated with an increased prevalence of coronary artery disease on CT, but this was not independent of the presence of cardiovascular risk factors.

Published
2022

23. Hepatosteatosis and Atherosclerotic Plaque at Coronary CT Angiography

Author

Carter, Jessica, primary, Heseltine, Thomas D., additional, Meah, Mohammed N., additional, Tzolos, Evangelos, additional, Kwiecinski, Jacek, additional, Doris, Mhairi, additional, McElhinney, Priscilla, additional, Moss, Alastair J., additional, Adamson, Philip D., additional, Hunter, Amanda, additional, Alam, Shirjel, additional, Shah, Anoop S. V., additional, Pawade, Tania, additional, Wang, Chengjia, additional, Weir-McCall, Jonathan R., additional, Roditi, Giles, additional, van Beek, Edwin J. R., additional, Nicol, Edward D., additional, Shaw, Leslee J., additional, Berman, Daniel S., additional, Slomka, Piotr J., additional, Mills, Nicholas L., additional, Dweck, Marc R., additional, Newby, David E., additional, Murray, Scott W., additional, Dey, Damini, additional, and Williams, Michelle C., additional

Published
2022
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26. Association of coronary artery calcium score with qualitatively and quantitatively assessed adverse plaque on coronary CT angiography in the SCOT-HEART trial

Author

Osborne-Grinter, Maia, primary, Kwiecinski, Jacek, additional, Doris, Mhairi, additional, McElhinney, Priscilla, additional, Cadet, Sebastien, additional, Adamson, Philip D, additional, Moss, Alastair J, additional, Alam, Shirjel, additional, Hunter, Amanda, additional, Shah, Anoop S V, additional, Mills, Nicholas L, additional, Pawade, Tania, additional, Wang, Chengjia, additional, Weir-McCall, Jonathan R, additional, Roditi, Giles, additional, van Beek, Edwin J R, additional, Shaw, Leslee J, additional, Nicol, Edward D, additional, Berman, Daniel, additional, Slomka, Piotr J, additional, Newby, David E, additional, Dweck, Marc R, additional, Dey, Damini, additional, and Williams, Michelle C, additional

Published
2021
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27. Sex-Specific Computed Tomography Coronary Plaque Characterization and Risk of Myocardial Infarction

Author

Williams, Michelle C., primary, Kwiecinski, Jacek, additional, Doris, Mhairi, additional, McElhinney, Priscilla, additional, D’Souza, Michelle S., additional, Cadet, Sebastien, additional, Adamson, Philip D., additional, Moss, Alastair J., additional, Alam, Shirjel, additional, Hunter, Amanda, additional, Shah, Anoop S.V., additional, Mills, Nicholas L., additional, Pawade, Tania, additional, Wang, Chengjia, additional, Weir-McCall, Jonathan R., additional, Bonnici-Mallia, Michael, additional, Murrills, Christopher, additional, Roditi, Giles, additional, van Beek, Edwin J.R., additional, Shaw, Leslee J., additional, Nicol, Edward D., additional, Berman, Daniel S., additional, Slomka, Piotr J., additional, Newby, David E., additional, Dweck, Marc R., additional, and Dey, Damini, additional

Published
2021
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28. A Machine-Learning Framework to Identify Distinct Phenotypes of Aortic Stenosis Severity

Author

Sengupta, Partho P., primary, Shrestha, Sirish, additional, Kagiyama, Nobuyuki, additional, Hamirani, Yasmin, additional, Kulkarni, Hemant, additional, Yanamala, Naveena, additional, Bing, Rong, additional, Chin, Calvin W.L., additional, Pawade, Tania A., additional, Messika-Zeitoun, David, additional, Tastet, Lionel, additional, Shen, Mylène, additional, Newby, David E., additional, Clavel, Marie-Annick, additional, Pibarot, Phillippe, additional, Dweck, Marc R., additional, Larose, Éric, additional, Guzzetti, Ezequiel, additional, Bernier, Mathieu, additional, Beaudoin, Jonathan, additional, Arsenault, Marie, additional, Côté, Nancy, additional, Everett, Russell, additional, Jenkins, William S.A., additional, Tribouilloy, Christophe, additional, Dreyfus, Julien, additional, Mathieu, Tiffany, additional, Renard, Cedric, additional, Gun, Mesut, additional, Macron, Laurent, additional, Sechrist, Jacob W., additional, Lacomis, Joan M., additional, Nguyen, Virginia, additional, Gay, Laura Galian, additional, Calabria, Hug Cuéllar, additional, Ntalas, Ioannis, additional, Prendergast, Bernard, additional, Rajani, Ronak, additional, Evangelista, Arturo, additional, and Cavalcante, João L., additional

Published
2021
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29. Association of coronary artery calcium score with qualitatively and quantitatively assessed adverse plaque on coronary CT angiography in the SCOT-HEART trial.

Author

Osborne-Grinter, Maia, Kwiecinski, Jacek, Doris, Mhairi, McElhinney, Priscilla, Cadet, Sebastien, Adamson, Philip D, Moss, Alastair J, Alam, Shirjel, Hunter, Amanda, Shah, Anoop S V, Mills, Nicholas L, Pawade, Tania, Wang, Chengjia, Weir-McCall, Jonathan R, Roditi, Giles, Beek, Edwin J R van, Shaw, Leslee J, Nicol, Edward D, Berman, Daniel, and Slomka, Piotr J

Subjects
CARDIOVASCULAR diseases risk factors, STATISTICS, CORONARY angiography, DESCRIPTIVE statistics, CHEST pain, CORONARY artery calcification, DATA analysis, PHENOTYPES
Abstract

Aims Coronary artery calcification is a marker of cardiovascular risk, but its association with qualitatively and quantitatively assessed plaque subtypes is unknown. Methods and results In this post-hoc analysis, computed tomography (CT) images and 5-year clinical outcomes were assessed in SCOT-HEART trial participants. Agatston coronary artery calcium score (CACS) was measured on non-contrast CT and was stratified as zero (0 Agatston units, AU), minimal (1–9 AU), low (10–99 AU), moderate (100–399 AU), high (400–999 AU), and very high (≥1000 AU). Adverse plaques were investigated by qualitative (visual categorization of positive remodelling, low-attenuation plaque, spotty calcification, and napkin ring sign) and quantitative (calcified, non-calcified, low-attenuation, and total plaque burden; Autoplaque) assessments. Of 1769 patients, 36% had a zero, 9% minimal, 20% low, 17% moderate, 10% high, and 8% very high CACS. Amongst patients with a zero CACS, 14% had non-obstructive disease, 2% had obstructive disease, 2% had visually assessed adverse plaques, and 13% had low-attenuation plaque burden >4%. Non-calcified and low-attenuation plaque burden increased between patients with zero, minimal, and low CACS (P  < 0.001), but there was no statistically significant difference between those with medium, high, and very high CACS. Myocardial infarction occurred in 41 patients, 10% of whom had zero CACS. CACS >1000 AU and low-attenuation plaque burden were the only predictors of myocardial infarction, independent of obstructive disease, and 10-year cardiovascular risk score. Conclusion In patients with stable chest pain, zero CACS is associated with a good but not perfect prognosis, and CACS cannot rule out obstructive coronary artery disease, non-obstructive plaque, or adverse plaque phenotypes, including low-attenuation plaque. [ABSTRACT FROM AUTHOR]

Published
2022
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30. Validation of aortic valve calcium quantification thresholds measured by computed tomography in Asian patients with calcific aortic stenosis

Author

Guzzetti, Ezequiel, primary, Oh, Jin Kyung, additional, Shen, Mylène, additional, Dweck, Marc R, additional, Poh, Kian Keong, additional, Abbas, Amr E, additional, Mando, Ramy, additional, Pressman, Gregg S, additional, Brito, Daniel, additional, Tastet, Lionel, additional, Pawade, Tania, additional, Falconi, Mariano Luis, additional, de Arenaza, Diego Perez, additional, Kong, William, additional, Tay, Edgar, additional, Pibarot, Philippe, additional, Song, Jae-Kwan, additional, and Clavel, Marie-Annick, additional

Published
2021
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31. Effect of Denosumab or Alendronic Acid on the Progression of Aortic Stenosis: A Double-Blind Randomized Controlled Trial

Author

Pawade, Tania A., primary, Doris, Mhairi K., additional, Bing, Rong, additional, White, Audrey C., additional, Forsyth, Laura, additional, Evans, Emily, additional, Graham, Catriona, additional, Williams, Michelle C., additional, van Beek, Edwin J.R., additional, Fletcher, Alison, additional, Adamson, Philip D., additional, Andrews, Jack P.M., additional, Cartlidge, Timothy R.G., additional, Jenkins, William S.A., additional, Syed, Maaz, additional, Fujisawa, Takeshi, additional, Lucatelli, Christophe, additional, Fraser, William, additional, Ralston, Stuart H., additional, Boon, Nicholas, additional, Prendergast, Bernard, additional, Newby, David E., additional, and Dweck, Marc R., additional

Published
2021
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32. 157 18F-sodium fluoride positron emission tomography, aortic disease activity and ischaemic stroke risk

Author

Fletcher, Alexander, primary, Tzolos, Evangelos, additional, Joshi, Shruti, additional, Kwiecinski, Jacek, additional, Bing, Rong, additional, Syed, Maaz, additional, Doris, Mhairi, additional, van Beek, Edwin, additional, Moss, Alistiar, additional, Walker, Niki, additional, Joshi, Nikhil, additional, Pawade, Tania, additional, Adamson, Philip, additional, Whiteley, William, additional, Wardlaw, Joanna, additional, Slomka, Piotr, additional, Williams, Michelle, additional, Newby, David, additional, and Dweck, Marc, additional

Published
2021
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33. 155 Pericoronary adipose tissue attenuation, low attenuation plaque burden and 5-year risk of myocardial infarction

Author

Tzolos, Evangelos, primary, Williams, Michelle, additional, McElhinney, Priscilla, additional, Lin, Andrew, additional, Grodecki, Kajetan, additional, Guadalupe, Flores T, additional, Cadet, Sebastien, additional, Kwiecinski, Jacek, additional, Doris, Mhairi, additional, Adamson, Philip D, additional, Moss, Alastair J, additional, Alam, Shirjel, additional, Hunter, Amanda, additional, Shah, Anoop SV, additional, Mills, Nicholas L, additional, Pawade, Tania, additional, Wang, Chengjia, additional, Weir-McCall, Jonathan R, additional, Roditi, Giles, additional, van Beek, Edwin, additional, Shaw, Leslee, additional, Nicol, Edward D, additional, Berman, Daniel S, additional, Slomka, Piotr, additional, Dweck, Marc, additional, Newby, David, additional, and Dey, Damini, additional

Published
2021
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35. Validation of aortic valve calcium quantification thresholds measured by computed tomography in Asian patients with calcific aortic stenosis.

Author

Guzzetti, Ezequiel, Oh, Jin Kyung, Shen, Mylène, Dweck, Marc R, Poh, Kian Keong, Abbas, Amr E, Mando, Ramy, Pressman, Gregg S, Brito, Daniel, Tastet, Lionel, Pawade, Tania, Falconi, Mariano Luis, Arenaza, Diego Perez de, Kong, William, Tay, Edgar, Pibarot, Philippe, Song, Jae-Kwan, and Clavel, Marie-Annick

Subjects
REFERENCE values, AORTIC stenosis, CALCINOSIS, DESCRIPTIVE statistics, COMPUTED tomography, HEMODYNAMICS, ETHNIC groups, AORTIC valve
Abstract

Aims Sex-specific thresholds of aortic valve calcification (AVC) have been proposed and validated in Caucasians. Thus, we aimed to validate their accuracy in Asians. Methods and results Patients with calcific aortic stenosis (AS) from seven international centres were included. Exclusion criteria were ≥moderate aortic/mitral regurgitation and bicuspid valve. Optimal AVC and AVC-density sex-specific thresholds for severe AS were obtained in concordant grading and normal flow patients (CG/NF). We included 1263 patients [728 (57%) Asians, 573 (45%) women, 837 (66%) with CG/NF]. Mean gradient was 48 (26–64) mmHg and peak aortic velocity 4.5 (3.4–5.1) m/s. Optimal AVC thresholds were: 2145 Agatston Units (AU) in men and 1301 AU in women for Asians; and 1885 AU in men and 1129 AU in women for Caucasians. Overall, accuracy (% correctly classified) was high and comparable either using optimal or guidelines' thresholds (2000 AU in men, 1200 AU in women). However, accuracy was lower in Asian women vs. Caucasian women (76–78% vs. 94–95%; P  < 0.001). Accuracy of AVC-density (476 AU/cm2 in men and 292 AU/cm2 in women) was comparable to absolute AVC in Caucasians (91% vs. 91%, respectively, P  = 0.74), but higher than absolute AVC in Asians (87% vs. 81%, P  < 0.001). There was no interaction between AVC/AVC-density and ethnicity (all P  > 0.41) with regards to AS haemodynamic severity. Conclusion AVC thresholds defining severe AS are comparable in Asian and Caucasian populations, and similar to those proposed in the guidelines. However, accuracy of AVC to identify severe AS in Asians (especially women) is sub-optimal. Therefore, the use of AVC-density is preferable in Asians. [ABSTRACT FROM AUTHOR]

Published
2022
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36. Contrast-enhanced computed tomography assessment of aortic stenosis

Author

Cartlidge, Timothy RG, primary, Bing, Rong, additional, Kwiecinski, Jacek, additional, Guzzetti, Ezequiel, additional, Pawade, Tania A, additional, Doris, Mhairi K, additional, Adamson, Philip D, additional, Massera, Daniele, additional, Lembo, Maria, additional, Peeters, Frederique E C M, additional, Couture, Christian, additional, Berman, Daniel S, additional, Dey, Damini, additional, Slomka, Piotr, additional, Pibarot, Philippe, additional, Newby, David E, additional, Clavel, Marie-Annick, additional, and Dweck, Marc R, additional

Published
2021
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38. Prevalence and clinical implications of valvular calcification on coronary computed tomography angiography

Author

Williams, Michelle C, primary, Massera, Daniele, additional, Moss, Alastair J, additional, Bing, Rong, additional, Bularga, Anda, additional, Adamson, Philip D, additional, Hunter, Amanda, additional, Alam, Shirjel, additional, Shah, Anoop S V, additional, Pawade, Tania, additional, Roditi, Giles, additional, van Beek, Edwin J R, additional, Nicol, Edward D, additional, Newby, David E, additional, and Dweck, Marc R, additional

Published
2020
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39. Computed tomography aortic valve calcium scoring for the assessment of aortic stenosis progression

Author

Doris, Mhairi Katrina, primary, Jenkins, William, additional, Robson, Philip, additional, Pawade, Tania, additional, Andrews, Jack Patrick, additional, Bing, Rong, additional, Cartlidge, Timothy, additional, Shah, Anoop, additional, Pickering, Alice, additional, Williams, Michelle Claire, additional, Fayad, Zahi A, additional, White, Audrey, additional, van Beek, Edwin JR, additional, Newby, David E, additional, and Dweck, Marc R, additional

Published
2020
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40. 18F-fluoride PET/MR in cardiac amyloid: A comparison study with aortic stenosis and age- and sex-matched controls

Author

Andrews, Jack P. M., primary, Trivieri, Maria Giovanni, additional, Everett, Russell, additional, Spath, Nicholas, additional, MacNaught, Gillian, additional, Moss, Alastair J., additional, Doris, Mhairi K., additional, Pawade, Tania, additional, van Beek, Edwin J. R., additional, Lucatelli, Christophe, additional, Newby, David E., additional, Robson, Philip, additional, Fayad, Zahi A., additional, and Dweck, Marc R., additional

Published
2020
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42. Ticagrelor to Reduce Myocardial Injury in Patients With High-Risk Coronary Artery Plaque

Author

Moss, Alastair J., primary, Dweck, Marc R., additional, Doris, Mhairi K., additional, Andrews, Jack P.M., additional, Bing, Rong, additional, Forsythe, Rachael O., additional, Cartlidge, Timothy R., additional, Pawade, Tania A., additional, Daghem, Marwa, additional, Raftis, Jennifer B., additional, Williams, Michelle C., additional, van Beek, Edwin J.R., additional, Forsyth, Laura, additional, Lewis, Steff C., additional, Lee, Robert J., additional, Shah, Anoop S.V., additional, Mills, Nicholas L., additional, Newby, David E., additional, and Adamson, Philip D., additional

Published
2020
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43. LOW-DENSITY NON-CALCIFIED PLAQUE ON CORONARY CT ANGIOGRAPHY IS THE STRONGEST INDEPENDENT PREDICTOR OF FUTURE MYOCARDIAL INFARCTION

Author

Williams, Michelle, primary, Kwiecinski, Jacek, additional, Doris, Mhairi, additional, McElhinney, Priscilla, additional, D'Souza, Michelle S., additional, Cadet, Sebastien J., additional, Adamson, Philip D., additional, Moss, Alastair, additional, Alam, Shirjel, additional, Hunter, Amanda, additional, Shah, Anoop, additional, Mills, Nicholas L., additional, Pawade, Tania, additional, Wang, Chengjia, additional, Weir-McCall, Jonathan, additional, Roditi, Giles, additional, Van Beek, Edwin, additional, Shaw, Leslee J., additional, Nicol, Edward David, additional, Berman, Daniel S., additional, Slomka, Piotr, additional, Newby, David E., additional, Dweck, Marc, additional, and Dey, Damini, additional

Published
2020
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44. 18F-FLUORIDE PET/MR IN CARDIAC AMYLOID: A COMPARISON STUDY WITH AORTIC STENOSIS, MYOCARDIAL INFARCTION AND HEALTHY VOLUNTEERS

Author

Andrews, Jack, primary, Trivieri, Maria Giovanna, additional, Everett, Russell, additional, Spath, Nicholas, additional, MacNaught, Gillian, additional, Moss, Alastair, additional, Doris, Mhairi, additional, Pawade, Tania, additional, Van Beek, Edwin, additional, Lucatelli, Christophe, additional, Newby, David E., additional, Fayad, Zahi A., additional, Robson, Philip, additional, and Dweck, Marc, additional

Published
2020
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45. ETHNIC DIFFERENCES IN COMPUTED TOMOGRAPHY AORTIC VALVE CALCIUM QUANTIFICATION IN PATIENTS WITH AORTIC STENOSIS

Author

Guzzetti, Ezequiel, primary, Oh, Jin Kyung, additional, Shen, Mylène, additional, Dweck, Marc, additional, Poh, Kian Keong, additional, Abbas, Amr E., additional, Mando, Ramy, additional, Pressman, Gregg S., additional, Brito, Daniel, additional, Tastet, Lionel Lloyd, additional, Pawade, Tania, additional, Falconi, Mariano, additional, de Arenaza, Diego Perez, additional, Kong, William, additional, Tay, Edgar, additional, Pibarot, Philippe, additional, Song, Jae-Kwan, additional, and Clavel, Marie-Annick, additional

Published
2020
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46. Sex associations and computed tomography coronary angiography-guided management in patients with stable chest pain

Author

Mangion, Kenneth, primary, Adamson, Philip D, additional, Williams, Michelle C, additional, Hunter, Amanda, additional, Pawade, Tania, additional, Shah, Anoop S V, additional, Lewis, Stephanie, additional, Boon, Nicholas A, additional, Flather, Marcus, additional, Forbes, John, additional, McLean, Scott, additional, Roditi, Giles, additional, van Beek, Edwin J R, additional, Timmis, Adam D, additional, Newby, David E, additional, McAllister, David A, additional, and Berry, Colin, additional

Published
2019
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47. Cardiovascular 18F-fluoride positron emission tomography-magnetic resonance imaging: A comparison study.

Author

Andrews, Jack P. M., MacNaught, Gillian, Moss, Alastair J., Doris, Mhairi K., Pawade, Tania, Adamson, Philip D., van Beek, Edwin J. R., Lucatelli, Christophe, Lassen, Martin L., Robson, Philip M., Fayad, Zahi A., Kwiecinski, Jacek, Slomka, Piotr J., Berman, Daniel S., Newby, David E., and Dweck, Marc R.

Abstract

Background: 18F-Fluoride uptake denotes calcification activity in aortic stenosis and atherosclerosis. While PET/MR has several advantages over PET/CT, attenuation correction of PET/MR data is challenging, limiting cardiovascular application. We compared PET/MR and PET/CT assessments of 18F-fluoride uptake in the aortic valve and coronary arteries.Methods and Results: 18 patients with aortic stenosis or recent myocardial infarction underwent 18F-fluoride PET/CT followed immediately by PET/MR. Valve and coronary 18F-fluoride uptake were evaluated independently. Both standard (Dixon) and novel radial GRE) MR attenuation correction (AC) maps were validated against PET/CT with results expressed as tissue-to-background ratios (TBRs). Visually, aortic valve 18F-fluoride uptake was similar on PET/CT and PET/MR. TBRMAX values were comparable with radial GRE AC (PET/CT 1.55±0.33 vs. PET/MR 1.58 ± 0.34, P = 0.66; 95% limits of agreement - 27% to + 25%) but performed less well with Dixon AC (1.38 ± 0.44, P = 0.06; bias (-)14%; 95% limits of agreement - 25% to + 53%). In native coronaries, 18F-fluoride uptake was similar on PET/MR to PET/CT regardless of AC approach. PET/MR identified 28/29 plaques identified on PET/CT; however, stents caused artifact on PET/MR making assessment of 18F-fluoride uptake challenging.Conclusion: Cardiovascular PET/MR demonstrates good visual and quantitative agreement with PET/CT. However, PET/MR is hampered by stent-related artifacts currently limiting clinical application. [ABSTRACT FROM AUTHOR]

Published
2021
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48. Detection and Prediction of Bioprosthetic Aortic Valve Degeneration

Author

Cartlidge, Timothy RG, Doris, Mhairi K, Sellers, Stephanie L, Pawade, Tania A, White, Audrey C, Pessotto, Renzo, Kwiecinski, Jacek, Fletcher, Alison, Alcaide, Carlos, Lucatelli, Christophe, Densem, Cameron, Rudd, James HF, Van Beek, Edwin, Tavares, Adriana, Virmani, Renu, Berman, Daniel, Leipsic, Jonathon A, Newby, David E, and Dweck, Marc R

Subjects
Bioprosthesis, Male, positron emission tomography, Computed Tomography Angiography, Aortic Valve Insufficiency, Calcinosis, Aortic Valve Stenosis, Prognosis, bioprosthetic valve degeneration, Prosthesis Failure, calcification, histology, Postoperative Complications, Echocardiography, Fluorodeoxyglucose F18, Predictive Value of Tests, Aortic Valve, Heart Valve Prosthesis, Positron Emission Tomography Computed Tomography, Humans, aortic valve replacement, Female, Radiopharmaceuticals, Aged
Abstract

BACKGROUND: Bioprosthetic aortic valve degeneration is increasingly common, often unheralded, and can have catastrophic consequences. OBJECTIVES: The authors sought to assess whether 18F-fluoride positron emission tomography (PET)-computed tomography (CT) can detect bioprosthetic aortic valve degeneration and predict valve dysfunction. METHODS: Explanted degenerate bioprosthetic valves were examined ex vivo. Patients with bioprosthetic aortic valves were recruited into 2 cohorts with and without prosthetic valve dysfunction and underwent in vivo contrast-enhanced CT angiography, 18F-fluoride PET, and serial echocardiography during 2 years of follow-up. RESULTS: All ex vivo, degenerate bioprosthetic valves displayed 18F-fluoride PET uptake that colocalized with tissue degeneration on histology. In 71 patients without known bioprosthesis dysfunction, 14 had abnormal leaflet pathology on CT, and 24 demonstrated 18F-fluoride PET uptake (target-to-background ratio 1.55 [interquartile range (IQR): 1.44 to 1.88]). Patients with increased 18F-fluoride uptake exhibited more rapid deterioration in valve function compared with those without (annualized change in peak transvalvular velocity 0.30 [IQR: 0.13 to 0.61] vs. 0.01 [IQR: -0.05 to 0.16] ms-1/year; p < 0.001). Indeed 18F-fluoride uptake correlated with deterioration in all the conventional echocardiographic measures of valve function assessed (e.g., change in peak velocity, r = 0.72; p < 0.001). Each of the 10 patients who developed new overt bioprosthesis dysfunction during follow-up had evidence of 18F-fluoride uptake at baseline (target-to-background ratio 1.89 [IQR: 1.46 to 2.59]). On multivariable analysis, 18F-fluoride uptake was the only independent predictor of future bioprosthetic dysfunction. CONCLUSIONS: 18F-fluoride PET-CT identifies subclinical bioprosthetic valve degeneration, providing powerful prediction of subsequent valvular dysfunction and highlighting patients at risk of valve failure. This technique holds major promise in the diagnosis of valvular degeneration and the surveillance of patients with bioprosthetic valves. (18F-Fluoride Assessment of Aortic Bioprosthesis Durability and Outcome [18F-FAABULOUS]; NCT02304276).

Published
2019

50. Coronary artery plaque characteristics associated with adverse outcomes in the SCOT-HEART study

Author

Williams, Michelle C., Moss, Alastair J., Dweck, Marc, Adamson, Philip D., Alam, Shirjel, Hunter, Amanda, Shah, Anoop S.V., Pawade, Tania, Weir-McCall, Jonathan R., Roditi, Giles, van Beek, Edwin J.R., Newby, David E., and Nicol, Edward D.

Subjects
Male, Cardiac & Cardiovascular Systems, Computed Tomography Angiography, Myocardial Infarction, Coronary Artery Disease, atherosclerotic plaque, DISEASE, CALCIUM, 1117 Public Health and Health Services, Humans, 1102 Cardiorespiratory Medicine and Haematology, Aged, RISK, Science & Technology, LESIONS, Coronary Stenosis, Calcinosis, computed tomography, Middle Aged, Plaque, Atherosclerotic, ATHEROSCLEROSIS, Cardiovascular System & Hematology, Cardiovascular System & Cardiology, Female, coronary angiography, COMPUTED TOMOGRAPHIC ANGIOGRAPHY, Life Sciences & Biomedicine, PROMISE, Follow-Up Studies
Abstract

Background: Unlike most noninvasive imaging modalities, coronary computed tomography angiography can characterize subtypes of atherosclerotic plaque.Objectives: The purpose of this study was to investigate the prognostic implications of adverse coronary plaque characteristics in patients with suspected coronary artery disease.Methods: In this SCOT-HEART (Scottish COmputed Tomography of the HEART Trial) post hoc analysis, the presence of adverse plaque (positive remodeling or low attenuation plaque), obstructive disease, and coronary artery calcification within 15 coronary segments was assessed on coronary computed tomography angiography of 1,769 patients who were followed-up for 5 years.Results: Among study participants (mean age 58 ± 10 years; 56% male), 608 (34%) patients had 1 or more adverse plaque features. Coronary heart disease death or nonfatal myocardial infarction was 3 times more frequent in patients with adverse plaque (n = 25 of 608 [4.1%] vs. n = 16 of 1,161 [1.4%]; p < 0.001; hazard ratio [HR]: 3.01; 95% confidence interval (CI): 1.61 to 5.63; p = 0.001) and was twice as frequent in those with obstructive disease (n = 22 of 452 [4.9%] vs. n = 16 of 671 [2.4%]; p = 0.024; HR: 1.99; 95% CI: 1.05 to 3.79; p = 0.036). Patients with both obstructive disease and adverse plaque had the highest event rate, with a 10-fold increase in coronary heart disease death or nonfatal myocardial infarction compared with patients with normal coronary arteries (HR: 11.50; 95% CI: 3.39 to 39.04; p < 0.001). However, these associations were not independent of coronary artery calcium score, a surrogate measure of coronary plaque burden.Conclusions: Adverse coronary plaque characteristics and overall calcified plaque burden confer an increased risk of coronary heart disease death or nonfatal myocardial infarction. (Scottish COmputed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590)

Published
2018

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