Clinical significance of evaluating coronary atherosclerosis in adult patients with hypertrophic cardiomyopathy who have chest pain

Yoon Joo Shin, Jae Hwan Lee, Jin Young Yoo, Jeong A. Kim, Yongho Jeon, Yeon Yee Yoon, Eun Ju Chun

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objective: Chest pain is a common symptom in patients with hypertrophic cardiomyopathy (HCM), causing difficulty determining whether there is coexistent coronary artery disease (CAD). We investigated whether coronary computed tomography angiography (CCTA) can assess the prevalence and clinical significance of CAD in adult patients with HCM showing chest pain through longitudinal follow-up. Methods: In 238 adult patients with HCM, who underwent CCTA for chest pain, we analyzed the degree of stenosis and adverse plaque characteristics (APCs) as CCTA variables. Three prediction models for adverse cardiovascular events (ACEs: all-cause mortality, myocardial infarction, unstable angina, heart failure, implantable cardioverter-defibrillator implantation, and stroke) were assessed using the combination of clinical risk factors, echocardiographic parameters, and CCTA variables. Results: The prevalence of obstructive CAD (≥ 50% in luminal stenosis) and APC was 14.7% and 18.9%, respectively. During the follow-up period (median, 37 months; range, 2–108 months), there were 31 occurrences of ACEs (13.0%). Using multivariate Cox regression analysis, age, atrial fibrillation, low ejection fraction, obstructive CAD, and APCs were associated with ACEs (all p < 0.05). Among the prediction models for ACEs, the area under the curve (AUC) was higher (AUC = 0.92) when CCTA variables were added to the clinical (AUC = 0.84) and echocardiographic factors (AUC = 0.88) (p < 0.001). Conclusions: Using CCTA, about 20% of symptomatic HCM patients were associated with clinically significant atherosclerosis. Adding these CCTA variables to the clinical and echocardiographic variables may increase the predictions of ACEs; therefore, evaluating coronary atherosclerosis using CCTA may be helpful for symptomatic HCM patients. Key Points: • Chest pain in adult patients with hypertrophic cardiomyopathy (HCM) remains challenging to distinguish from coronary artery disease. • Coronary computed tomography angiography (CCTA) can assess the severity and characteristics of coronary atherosclerosis in symptomatic HCM patients. • Adding CCTA variables to clinical and echocardiographic factors may increase the predictions of adverse cardiac events in HCM patients, and thus evaluating coronary atherosclerosis using CCTA may be helpful for HCM patients with chest pain.

Original languageEnglish
Pages (from-to)4593-4602
Number of pages10
JournalEuropean Radiology
Volume29
Issue number9
DOIs
StatePublished - 1 Sep 2019

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Hypertrophic Cardiomyopathy
Chest Pain
Coronary Artery Disease
Area Under Curve
Pathologic Constriction
Computed Tomography Angiography
Cardiovascular Models
Implantable Defibrillators
Unstable Angina
Atrial Fibrillation
Atherosclerosis
Heart Failure
Stroke
Myocardial Infarction
Regression Analysis

Keywords

  • Cardiomyopathy, hypertrophic
  • Chest pain
  • Computed tomography angiography
  • Coronary artery disease

Cite this

Shin, Yoon Joo ; Lee, Jae Hwan ; Yoo, Jin Young ; Kim, Jeong A. ; Jeon, Yongho ; Yoon, Yeon Yee ; Chun, Eun Ju. / Clinical significance of evaluating coronary atherosclerosis in adult patients with hypertrophic cardiomyopathy who have chest pain. In: European Radiology. 2019 ; Vol. 29, No. 9. pp. 4593-4602.
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title = "Clinical significance of evaluating coronary atherosclerosis in adult patients with hypertrophic cardiomyopathy who have chest pain",
abstract = "Objective: Chest pain is a common symptom in patients with hypertrophic cardiomyopathy (HCM), causing difficulty determining whether there is coexistent coronary artery disease (CAD). We investigated whether coronary computed tomography angiography (CCTA) can assess the prevalence and clinical significance of CAD in adult patients with HCM showing chest pain through longitudinal follow-up. Methods: In 238 adult patients with HCM, who underwent CCTA for chest pain, we analyzed the degree of stenosis and adverse plaque characteristics (APCs) as CCTA variables. Three prediction models for adverse cardiovascular events (ACEs: all-cause mortality, myocardial infarction, unstable angina, heart failure, implantable cardioverter-defibrillator implantation, and stroke) were assessed using the combination of clinical risk factors, echocardiographic parameters, and CCTA variables. Results: The prevalence of obstructive CAD (≥ 50{\%} in luminal stenosis) and APC was 14.7{\%} and 18.9{\%}, respectively. During the follow-up period (median, 37 months; range, 2–108 months), there were 31 occurrences of ACEs (13.0{\%}). Using multivariate Cox regression analysis, age, atrial fibrillation, low ejection fraction, obstructive CAD, and APCs were associated with ACEs (all p < 0.05). Among the prediction models for ACEs, the area under the curve (AUC) was higher (AUC = 0.92) when CCTA variables were added to the clinical (AUC = 0.84) and echocardiographic factors (AUC = 0.88) (p < 0.001). Conclusions: Using CCTA, about 20{\%} of symptomatic HCM patients were associated with clinically significant atherosclerosis. Adding these CCTA variables to the clinical and echocardiographic variables may increase the predictions of ACEs; therefore, evaluating coronary atherosclerosis using CCTA may be helpful for symptomatic HCM patients. Key Points: • Chest pain in adult patients with hypertrophic cardiomyopathy (HCM) remains challenging to distinguish from coronary artery disease. • Coronary computed tomography angiography (CCTA) can assess the severity and characteristics of coronary atherosclerosis in symptomatic HCM patients. • Adding CCTA variables to clinical and echocardiographic factors may increase the predictions of adverse cardiac events in HCM patients, and thus evaluating coronary atherosclerosis using CCTA may be helpful for HCM patients with chest pain.",
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Clinical significance of evaluating coronary atherosclerosis in adult patients with hypertrophic cardiomyopathy who have chest pain. / Shin, Yoon Joo; Lee, Jae Hwan; Yoo, Jin Young; Kim, Jeong A.; Jeon, Yongho; Yoon, Yeon Yee; Chun, Eun Ju.

In: European Radiology, Vol. 29, No. 9, 01.09.2019, p. 4593-4602.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Clinical significance of evaluating coronary atherosclerosis in adult patients with hypertrophic cardiomyopathy who have chest pain

AU - Shin, Yoon Joo

AU - Lee, Jae Hwan

AU - Yoo, Jin Young

AU - Kim, Jeong A.

AU - Jeon, Yongho

AU - Yoon, Yeon Yee

AU - Chun, Eun Ju

PY - 2019/9/1

Y1 - 2019/9/1

N2 - Objective: Chest pain is a common symptom in patients with hypertrophic cardiomyopathy (HCM), causing difficulty determining whether there is coexistent coronary artery disease (CAD). We investigated whether coronary computed tomography angiography (CCTA) can assess the prevalence and clinical significance of CAD in adult patients with HCM showing chest pain through longitudinal follow-up. Methods: In 238 adult patients with HCM, who underwent CCTA for chest pain, we analyzed the degree of stenosis and adverse plaque characteristics (APCs) as CCTA variables. Three prediction models for adverse cardiovascular events (ACEs: all-cause mortality, myocardial infarction, unstable angina, heart failure, implantable cardioverter-defibrillator implantation, and stroke) were assessed using the combination of clinical risk factors, echocardiographic parameters, and CCTA variables. Results: The prevalence of obstructive CAD (≥ 50% in luminal stenosis) and APC was 14.7% and 18.9%, respectively. During the follow-up period (median, 37 months; range, 2–108 months), there were 31 occurrences of ACEs (13.0%). Using multivariate Cox regression analysis, age, atrial fibrillation, low ejection fraction, obstructive CAD, and APCs were associated with ACEs (all p < 0.05). Among the prediction models for ACEs, the area under the curve (AUC) was higher (AUC = 0.92) when CCTA variables were added to the clinical (AUC = 0.84) and echocardiographic factors (AUC = 0.88) (p < 0.001). Conclusions: Using CCTA, about 20% of symptomatic HCM patients were associated with clinically significant atherosclerosis. Adding these CCTA variables to the clinical and echocardiographic variables may increase the predictions of ACEs; therefore, evaluating coronary atherosclerosis using CCTA may be helpful for symptomatic HCM patients. Key Points: • Chest pain in adult patients with hypertrophic cardiomyopathy (HCM) remains challenging to distinguish from coronary artery disease. • Coronary computed tomography angiography (CCTA) can assess the severity and characteristics of coronary atherosclerosis in symptomatic HCM patients. • Adding CCTA variables to clinical and echocardiographic factors may increase the predictions of adverse cardiac events in HCM patients, and thus evaluating coronary atherosclerosis using CCTA may be helpful for HCM patients with chest pain.

AB - Objective: Chest pain is a common symptom in patients with hypertrophic cardiomyopathy (HCM), causing difficulty determining whether there is coexistent coronary artery disease (CAD). We investigated whether coronary computed tomography angiography (CCTA) can assess the prevalence and clinical significance of CAD in adult patients with HCM showing chest pain through longitudinal follow-up. Methods: In 238 adult patients with HCM, who underwent CCTA for chest pain, we analyzed the degree of stenosis and adverse plaque characteristics (APCs) as CCTA variables. Three prediction models for adverse cardiovascular events (ACEs: all-cause mortality, myocardial infarction, unstable angina, heart failure, implantable cardioverter-defibrillator implantation, and stroke) were assessed using the combination of clinical risk factors, echocardiographic parameters, and CCTA variables. Results: The prevalence of obstructive CAD (≥ 50% in luminal stenosis) and APC was 14.7% and 18.9%, respectively. During the follow-up period (median, 37 months; range, 2–108 months), there were 31 occurrences of ACEs (13.0%). Using multivariate Cox regression analysis, age, atrial fibrillation, low ejection fraction, obstructive CAD, and APCs were associated with ACEs (all p < 0.05). Among the prediction models for ACEs, the area under the curve (AUC) was higher (AUC = 0.92) when CCTA variables were added to the clinical (AUC = 0.84) and echocardiographic factors (AUC = 0.88) (p < 0.001). Conclusions: Using CCTA, about 20% of symptomatic HCM patients were associated with clinically significant atherosclerosis. Adding these CCTA variables to the clinical and echocardiographic variables may increase the predictions of ACEs; therefore, evaluating coronary atherosclerosis using CCTA may be helpful for symptomatic HCM patients. Key Points: • Chest pain in adult patients with hypertrophic cardiomyopathy (HCM) remains challenging to distinguish from coronary artery disease. • Coronary computed tomography angiography (CCTA) can assess the severity and characteristics of coronary atherosclerosis in symptomatic HCM patients. • Adding CCTA variables to clinical and echocardiographic factors may increase the predictions of adverse cardiac events in HCM patients, and thus evaluating coronary atherosclerosis using CCTA may be helpful for HCM patients with chest pain.

KW - Cardiomyopathy, hypertrophic

KW - Chest pain

KW - Computed tomography angiography

KW - Coronary artery disease

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DO - 10.1007/s00330-018-5951-8

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VL - 29

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JO - European radiology

JF - European radiology

SN - 0938-7994

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