BACKGROUND
Coronary computed tomography angiography (CCTA) reported with Coronary Artery Disease Reporting and Data System (CAD-RADS) 2.0 is increasingly used in chronic coronary syndromes, but real-world adherence to the recommended downstream pathways is poorly characterized.
AIMS
To describe the population referred for CCTA in a Polish tertiary center, the distribution of CAD-RADS 2.0 categories by sex and age, and adherence to guideline-recommended downstream pathways.
METHODS
We retrospectively analyzed 10 005 consecutive patients who underwent CCTA between July 1, 2022 and December 31, 2024. Downstream procedures were identified in the National Health Fund registry. A pre-specified multivariable logistic regression model (CAD-RADS category, age, sex) described referral for invasive coronary angiography (ICA); discrimination was quantified as the area under the receiver-operating-characteristic curve (AUC).
RESULTS
Women constituted 57.8% of the cohort and were older than men (mean 66.4 vs. 64.1 years; P < 0.001). The distribution of categories differed by sex (P < 0.001). Among patients with CAD-RADS 0-2, 18.5% underwent at least one additional test. Among patients with CAD-RADS 3, 41.8% proceeded directly to ICA without prior functional testing and 17.7% followed a functional-testing-first pathway. Among patients with CAD-RADS 4-5, 26.0% did not undergo ICA and 17.8% had no further testing. CAD-RADS category dominated referral for ICA (full model AUC 0.886; 95% confidence interval, 0.877-0.894; CAD-RADS alone 0.883; age and sex alone 0.677).
CONCLUSIONS
Divergence between observed and guideline-recommended pathways was evident across all CAD-RADS categories, indicating a need for structured implementation of CAD-RADS-guided care pathways.
Jadwiga Fijałkowska, K. Sienkiewicz, Dorota Gałąska et al.· Kardiologia polska· 0 citations
STUDY TYPE
Retrospective monocentric study.
PURPOSE
To estimate the probability of severe aortic stenosis(SAS) by calculating the aortic valve calcium score (AVCS) using virtual noncontrast (VNC) reconstructions derived from non-ECG-gated dual-energy computed tomography (DECT) scans.
MATERIALS AND METHODS
This study retrospectively included 59 patients who underwent DECT scans for noncardiac indications and presented with visible aortic valve calcifications. AVCS was calculated on VNC images using semiautomatic software. All patients had an echocardiogram performed within 12 months before or after the DECT scan. We then analyzed the correlation between AVCS values and the degree of aortic stenosis.
RESULTS
Both male and female patients with SAS had a significantly higher mean AVCS (919.2 AU, SD=1262.4) compared with those with nonsevere aortic stenosis (NSAS) (127.9 AU, SD=278.6). AVCS demonstrated good diagnostic performance in distinguishing between severe and nonsevere AS in both female and male (AUC=0.91 and 0.95, respectively). Estimated thresholds values showed high sensitivity in both genders, with good specificity in men, and moderate in women. When analyzed irrespective of gender, AVCS demonstrated good ability to distinguish severe AS from mild and no stenosis (AUC=0.926), and moderate ability to distinguish moderate AS from mild and no stenosis (AUC=0.781). However, it lacked statistical significance in discriminating severe and moderate AS (AUC=0.714, P=0.1325).
CONCLUSIONS
Aortic Valve Calcium Score obtained on VNC images from DECT examinations is a promising method for noninvasively differentiation between severe and nonsevere aortic stenosis, which could be potentially useful in patients who have undergone examinations for noncardiac indications.
Jakub Byczkowski, Gregorio Chierchia, G. Muscogiuri et al.· Journal of thoracic imaging· 0 citations
