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Dyspnea predicts mortality among patients undergoing coronary computed tomographic angiography

  • Rine Nakanishi
  • Heidi Gransar
  • Alan Rozanski
  • Jamal S. Rana
  • Victor Y. Cheng
  • Louise E. J. Thomson
  • Romalisa Miranda-Peats
  • Damini Dey
  • Sean W. Hayes
  • John D. Friedman
  • James K. Min
  • Daniel S. Berman
Original Paper

Abstract

The prognostic implications of dyspnea and typical angina in patients referred for coronary CT angiography have not been examined. We examined features associated with incident mortality risk among individuals undergoing coronary computed tomographic angiography (CCTA) presenting with dyspnea, typical angina, and neither of these symptoms. 1147 consecutive individuals without known CAD (mean 61 years, 61.6 % men) undergoing CCTA comprised the study population 132 with dyspnea, 218 with typical angina, and 797 without dyspnea or typical angina (reference group). Mortality risk in relation to dyspnea or typical angina was evaluated with multivariable Cox proportional hazards models compared to reference. In addition, the prognosis associated with dyspnea or typical angina was assessed among age-matched subgroups. Patients with dyspnea had a greater prevalence of ≥70 % stenosis (p < 0.001) and coronary segments with plaque (p = 0.02) compared to the other two groups. During a follow-up of 3.1 years, 52 individuals died. By multivariable Cox models, compared to patients in reference group, dyspnea patients experienced higher mortality (HR 2.0, 95 % CI 1.0–4.0, p = 0.049) while typical angina patients did not (HR 1.1, 95 % CI 0.6–2.3, p = 0.76). In the matched group, the patients with dyspnea (HR 2.2, 95 % CI 1.1–4.3, p = 0.03) still had significantly reduced survival compared to the other two groups, while those with typical angina did not (HR 1.2, 95 % CI 0.6–2.6, p = 0.62). Dyspnea is associated with increased mortality rate compared to patients with typical angina and those with neither of these symptoms among patients undergoing CCTA.

Keywords

Dyspnea Prognosis Plaque stenosis Coronary computed tomographic angiography 

Notes

Acknowledgments

Dr. Nakanishi was supported in part by research fellowship awards from the Society of Nuclear Medicine and Toho University School of Medicine, Tokyo, Japan. This work was partly supported by grants to Dr. Berman from the Eisner, Glazer, and Lincy Foundations. The authors would like to thank Dr. Ishac Cohen, PhD, for correcting and managing much of the data of this study.

Compliance with ethical standards

Conflict of interest

None.

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Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  • Rine Nakanishi
    • 1
  • Heidi Gransar
    • 1
  • Alan Rozanski
    • 2
  • Jamal S. Rana
    • 1
  • Victor Y. Cheng
    • 1
    • 3
  • Louise E. J. Thomson
    • 1
    • 3
  • Romalisa Miranda-Peats
    • 1
  • Damini Dey
    • 1
  • Sean W. Hayes
    • 1
    • 3
  • John D. Friedman
    • 1
    • 3
  • James K. Min
    • 4
  • Daniel S. Berman
    • 1
    • 3
  1. 1.Department of Imaging and Medicine, Cedars-Sinai Heart InstituteCedars-Sinai Medical CenterLos AngelesUSA
  2. 2.Division of CardiologySt. Luke’s Roosevelt HospitalNew YorkUSA
  3. 3.Department of Medicine, David Geffen School of MedicineUniversity of CaliforniaLos AngelesUSA
  4. 4.Department of Public HealthWeill Cornell Medical College and the New York Presbyterian HospitalNew YorkUSA

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