Dyspnea predicts mortality among patients undergoing coronary computed tomographic angiography
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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.
KeywordsDyspnea Prognosis Plaque stenosis Coronary computed tomographic angiography
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
- 5.Min JK, Dunning A, Lin FY, Achenbach S, Al-Mallah M, Budoff MJ, Cademartiri F, Callister TQ, Chang HJ, Cheng V, Chinnaiyan K, Chow BJ, Delago A, Hadamitzky M, Hausleiter J, Kaufmann P, Maffei E, Raff G, Shaw LJ, Villines T, Berman DS, Investigators C (2011) Age- and sex-related differences in all-cause mortality risk based on coronary computed tomography angiography findings results from the international multicenter CONFIRM (coronary CT angiography evaluation for clinical outcomes: an international multicenter registry) of 23,854 patients without known coronary artery disease. J Am Coll Cardiol 58:849–860CrossRefPubMedGoogle Scholar
- 8.Rozanski A, Gransar H, Shaw LJ, Kim J, Miranda-Peats L, Wong ND, Rana JS, Orakzai R, Hayes SW, Friedman JD, Thomson LE, Polk D, Min J, Budoff MJ, Berman DS (2011) Impact of coronary artery calcium scanning on coronary risk factors and downstream testing the EISNER (early identification of subclinical atherosclerosis by noninvasive imaging research) prospective randomized trial. J Am Coll Cardiol 57:1622–1632PubMedCentralCrossRefPubMedGoogle Scholar
- 9.Gutstein A, Wolak A, Lee C, Dey D, Ohba M, Suzuki Y, Cheng V, Gransar H, Suzuki S, Friedman J, Thomson LE, Hayes S, Pimentel R, Paz W, Slomka P, Berman DS (2008) Predicting success of prospective and retrospective gating with dual-source coronary computed tomography angiography: development of selection criteria and initial experience. J Cardiovasc Comput Tomogr 2:81–90CrossRefPubMedGoogle Scholar
- 11.Nakanishi R, Rana JS, Shalev A, Gransar H, Hayes SW, Labounty TM, Dey D, Miranda-Peats R, Thomson LE, Friedman JD, Abidov A, Min JK, Berman DS (2013) Mortality risk as a function of the ratio of pulmonary trunk to ascending aorta diameter in patients with suspected coronary artery disease. Am J Cardiol 111:1259–1263CrossRefPubMedGoogle Scholar
- 12.Nakazato R, Tamarappoo BK, Smith TW, Cheng VY, Dey D, Shmilovich H, Gutstein A, Gurudevan S, Hayes SW, Thomson LE, Friedman JD, Berman DS (2011) Assessment of left ventricular regional wall motion and ejection fraction with low-radiation dose helical dual-source CT: comparison to two-dimensional echocardiography. J Cardiovasc Comput Tomogr 5:149–157CrossRefPubMedGoogle Scholar
- 13.Imbens GW (2000) The role of the propensity score in estimating dose-response functions. Biom 87:706–710Google Scholar
- 15.Fischer M, Baessler A, Hense HW, Hengstenberg C, Muscholl M, Holmer S, Döring A, Broeckel U, Riegger G, Schunkert H (2003) Prevalence of left ventricular diastolic dysfunction in the community. Results from a Doppler echocardiographic-based survey of a population sample. Eur Heart J 24:320–328CrossRefPubMedGoogle Scholar
- 16.Burger IA, Husmann L, Herzog BA, Buechel RR, Pazhenkottil AP, Ghadri JR, Nkoulou RN, Jenni R, Russi EW, Kaufmann PA (2011) Main pulmonary artery diameter from attenuation correction CT scans in cardiac SPECT accurately predicts pulmonary hypertension. J Nucl Cardiol 18:634–641CrossRefPubMedGoogle Scholar