Associations between dyspnoea, coronary atherosclerosis, and cardiovascular outcomes: results from the long-term follow-up CONFIRM registry

Alexander R. van Rosendael; A. Maxim Bax; Inge J. van den Hoogen; Jeff M. Smit; Subhi J. Al’Aref; Stephan Achenbach; Mouaz H. Al-Mallah; Daniele Andreini; Daniel S. Berman; Matthew J. Budoff; Filippo Cademartiri; Tracy Q. Callister; Hyuk Jae Chang; Kavitha Chinnaiyan; Benjamin J.W. Chow; Ricardo C. Cury; Augustin DeLago; Gudrun Feuchtner; Martin Hadamitzky; Joerg Hausleiter; Philipp A. Kaufmann; Yong Jin Kim; Jonathon A. Leipsic; Erica Maffei; Hugo Marques; Pedro de Araújo Gonçalves; Gianluca Pontone; Gilbert L. Raff; Ronen Rubinshtein; Todd C. Villines; Heidi Gransar; Yao Lu; Jessica M. Peña; Fay Y. Lin; Leslee J. Shaw; Jagat Narula; James K. Min; Jeroen J. Bax

doi:10.1093/ehjci/jeaa323

Associations between dyspnoea, coronary atherosclerosis, and cardiovascular outcomes: results from the long-term follow-up CONFIRM registry

Alexander R. van Rosendael, A. Maxim Bax, Inge J. van den Hoogen, Jeff M. Smit, Subhi J. Al’Aref, Stephan Achenbach, Mouaz H. Al-Mallah, Daniele Andreini, Daniel S. Berman, Matthew J. Budoff, Filippo Cademartiri, Tracy Q. Callister, Hyuk Jae Chang, Kavitha Chinnaiyan, Benjamin J.W. Chow, Ricardo C. Cury, Augustin DeLago, Gudrun Feuchtner, Martin Hadamitzky, Joerg HausleiterPhilipp A. Kaufmann, Yong Jin Kim, Jonathon A. Leipsic, Erica Maffei, Hugo Marques, Pedro de Araújo Gonçalves, Gianluca Pontone, Gilbert L. Raff, Ronen Rubinshtein, Todd C. Villines, Heidi Gransar, Yao Lu, Jessica M. Peña, Fay Y. Lin, Leslee J. Shaw, Jagat Narula, James K. Min, Jeroen J. Bax

Research output: Contribution to journal › Article › peer-review

4 Scopus citations

Abstract

AIMS: The relationship between dyspnoea, coronary artery disease (CAD), and major cardiovascular events (MACE) is poorly understood. This study evaluated (i) the association of dyspnoea with the severity of anatomical CAD by coronary computed tomography angiography (CCTA) and (ii) to which extent CAD explains MACE in patients with dyspnoea.

METHODS AND RESULTS: From the international COronary CT Angiography EvaluatioN for Clinical Outcomes: An InteRnational Multicenter (CONFIRM) registry, 4425 patients (750 with dyspnoea) with suspected but without known CAD were included and prospectively followed for ≥5 years. First, the association of dyspnoea with CAD severity was assessed using logistic regression analysis. Second, the prognostic value of dyspnoea for MACE (myocardial infarction and death), and specifically, the interaction between dyspnoea and CAD severity was investigated using Cox proportional-hazard analysis. Mean patient age was 60.3 ± 11.9 years, 63% of patients were male and 592 MACE events occurred during a median follow-up duration of 5.4 (IQR 5.1-6.0) years. On uni- and multivariable analysis (adjusting for age, sex, body mass index, chest pain typicality, and risk factors), dyspnoea was associated with two- and three-vessel/left main (LM) obstructive CAD. The presence of dyspnoea increased the risk for MACE [hazard ratio (HR) 1.57, 95% confidence interval (CI): 1.29-1.90], which was modified after adjusting for clinical predictors and CAD severity (HR 1.26, 95% CI: 1.02-1.55). Conversely, when stratified by CAD severity, dyspnoea did not provide incremental prognostic value in one-, two-, or three-vessel/LM obstructive CAD, but dyspnoea did provide incremental prognostic value in non-obstructive CAD.

CONCLUSION: In patients with suspected CAD, dyspnoea was independently associated with severe obstructive CAD on CCTA. The severity of obstructive CAD explained the elevated MACE rates in patients presenting with dyspnoea, but in patients with non-obstructive CAD, dyspnoea portended additional risk.

Original language	English (US)
Pages (from-to)	266-274
Number of pages	9
Journal	European Heart Journal Cardiovascular Imaging
Volume	23
Issue number	2
DOIs	https://doi.org/10.1093/ehjci/jeaa323
State	Published - Feb 1 2022

Keywords

coronary artery disease
coronary computed tomography angiography
dyspnoea
prognosis
Predictive Value of Tests
Prognosis
Prospective Studies
Follow-Up Studies
Humans
Middle Aged
Risk Factors
Male
Coronary Artery Disease/complications
Dyspnea
Registries
Aged
Coronary Angiography/methods

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine
Radiology Nuclear Medicine and imaging

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10.1093/ehjci/jeaa323

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van Rosendael, A. R., Bax, A. M., van den Hoogen, I. J., Smit, J. M., Al’Aref, S. J., Achenbach, S., Al-Mallah, M. H., Andreini, D., Berman, D. S., Budoff, M. J., Cademartiri, F., Callister, T. Q., Chang, H. J., Chinnaiyan, K., Chow, B. J. W., Cury, R. C., DeLago, A., Feuchtner, G., Hadamitzky, M., ... Bax, J. J. (2022). Associations between dyspnoea, coronary atherosclerosis, and cardiovascular outcomes: results from the long-term follow-up CONFIRM registry. European Heart Journal Cardiovascular Imaging, 23(2), 266-274. https://doi.org/10.1093/ehjci/jeaa323

Associations between dyspnoea, coronary atherosclerosis, and cardiovascular outcomes: results from the long-term follow-up CONFIRM registry. / van Rosendael, Alexander R.; Bax, A. Maxim; van den Hoogen, Inge J. et al.
In: European Heart Journal Cardiovascular Imaging, Vol. 23, No. 2, 01.02.2022, p. 266-274.

Research output: Contribution to journal › Article › peer-review

van Rosendael, AR, Bax, AM, van den Hoogen, IJ, Smit, JM, Al’Aref, SJ, Achenbach, S, Al-Mallah, MH, Andreini, D, Berman, DS, Budoff, MJ, Cademartiri, F, Callister, TQ, Chang, HJ, Chinnaiyan, K, Chow, BJW, Cury, RC, DeLago, A, Feuchtner, G, Hadamitzky, M, Hausleiter, J, Kaufmann, PA, Kim, YJ, Leipsic, JA, Maffei, E, Marques, H, de Araújo Gonçalves, P, Pontone, G, Raff, GL, Rubinshtein, R, Villines, TC, Gransar, H, Lu, Y, Peña, JM, Lin, FY, Shaw, LJ, Narula, J, Min, JK & Bax, JJ 2022, 'Associations between dyspnoea, coronary atherosclerosis, and cardiovascular outcomes: results from the long-term follow-up CONFIRM registry', European Heart Journal Cardiovascular Imaging, vol. 23, no. 2, pp. 266-274. https://doi.org/10.1093/ehjci/jeaa323

@article{acd4c8096665414fa35583fd21d6681b,

title = "Associations between dyspnoea, coronary atherosclerosis, and cardiovascular outcomes: results from the long-term follow-up CONFIRM registry",

abstract = "AIMS: The relationship between dyspnoea, coronary artery disease (CAD), and major cardiovascular events (MACE) is poorly understood. This study evaluated (i) the association of dyspnoea with the severity of anatomical CAD by coronary computed tomography angiography (CCTA) and (ii) to which extent CAD explains MACE in patients with dyspnoea.METHODS AND RESULTS: From the international COronary CT Angiography EvaluatioN for Clinical Outcomes: An InteRnational Multicenter (CONFIRM) registry, 4425 patients (750 with dyspnoea) with suspected but without known CAD were included and prospectively followed for ≥5 years. First, the association of dyspnoea with CAD severity was assessed using logistic regression analysis. Second, the prognostic value of dyspnoea for MACE (myocardial infarction and death), and specifically, the interaction between dyspnoea and CAD severity was investigated using Cox proportional-hazard analysis. Mean patient age was 60.3 ± 11.9 years, 63% of patients were male and 592 MACE events occurred during a median follow-up duration of 5.4 (IQR 5.1-6.0) years. On uni- and multivariable analysis (adjusting for age, sex, body mass index, chest pain typicality, and risk factors), dyspnoea was associated with two- and three-vessel/left main (LM) obstructive CAD. The presence of dyspnoea increased the risk for MACE [hazard ratio (HR) 1.57, 95% confidence interval (CI): 1.29-1.90], which was modified after adjusting for clinical predictors and CAD severity (HR 1.26, 95% CI: 1.02-1.55). Conversely, when stratified by CAD severity, dyspnoea did not provide incremental prognostic value in one-, two-, or three-vessel/LM obstructive CAD, but dyspnoea did provide incremental prognostic value in non-obstructive CAD.CONCLUSION: In patients with suspected CAD, dyspnoea was independently associated with severe obstructive CAD on CCTA. The severity of obstructive CAD explained the elevated MACE rates in patients presenting with dyspnoea, but in patients with non-obstructive CAD, dyspnoea portended additional risk.",

keywords = "coronary artery disease, coronary computed tomography angiography, dyspnoea, prognosis, Predictive Value of Tests, Prognosis, Prospective Studies, Follow-Up Studies, Humans, Middle Aged, Risk Factors, Male, Coronary Artery Disease/complications, Dyspnea, Registries, Aged, Coronary Angiography/methods",

author = "{van Rosendael}, {Alexander R.} and Bax, {A. Maxim} and {van den Hoogen}, {Inge J.} and Smit, {Jeff M.} and Al{\textquoteright}Aref, {Subhi J.} and Stephan Achenbach and Al-Mallah, {Mouaz H.} and Daniele Andreini and Berman, {Daniel S.} and Budoff, {Matthew J.} and Filippo Cademartiri and Callister, {Tracy Q.} and Chang, {Hyuk Jae} and Kavitha Chinnaiyan and Chow, {Benjamin J.W.} and Cury, {Ricardo C.} and Augustin DeLago and Gudrun Feuchtner and Martin Hadamitzky and Joerg Hausleiter and Kaufmann, {Philipp A.} and Kim, {Yong Jin} and Leipsic, {Jonathon A.} and Erica Maffei and Hugo Marques and {de Ara{\'u}jo Gon{\c c}alves}, Pedro and Gianluca Pontone and Raff, {Gilbert L.} and Ronen Rubinshtein and Villines, {Todd C.} and Heidi Gransar and Yao Lu and Pe{\~n}a, {Jessica M.} and Lin, {Fay Y.} and Shaw, {Leslee J.} and Jagat Narula and Min, {James K.} and Bax, {Jeroen J.}",

note = "Funding Information: The research reported in this publication was funded, in part, by the National Institute of Health (Bethesda, MD, USA) under award number R01 HL115150. This research was also supported, in part, by the Dalio Institute of Cardiovascular Imaging (New York, NY, USA) and the Michael Wolk Foundation (New York, NY, USA) . Publisher Copyright: {\textcopyright} The Author(s) 2020.",

year = "2022",

month = feb,

day = "1",

doi = "10.1093/ehjci/jeaa323",

language = "English (US)",

volume = "23",

pages = "266--274",

journal = "European Heart Journal Cardiovascular Imaging",

issn = "2047-2404",

publisher = "Oxford University Press",

number = "2",

}

TY - JOUR

T1 - Associations between dyspnoea, coronary atherosclerosis, and cardiovascular outcomes

T2 - results from the long-term follow-up CONFIRM registry

AU - van Rosendael, Alexander R.

AU - Bax, A. Maxim

AU - van den Hoogen, Inge J.

AU - Smit, Jeff M.

AU - Al’Aref, Subhi J.

AU - Achenbach, Stephan

AU - Al-Mallah, Mouaz H.

AU - Andreini, Daniele

AU - Berman, Daniel S.

AU - Budoff, Matthew J.

AU - Cademartiri, Filippo

AU - Callister, Tracy Q.

AU - Chang, Hyuk Jae

AU - Chinnaiyan, Kavitha

AU - Chow, Benjamin J.W.

AU - Cury, Ricardo C.

AU - DeLago, Augustin

AU - Feuchtner, Gudrun

AU - Hadamitzky, Martin

AU - Hausleiter, Joerg

AU - Kaufmann, Philipp A.

AU - Kim, Yong Jin

AU - Leipsic, Jonathon A.

AU - Maffei, Erica

AU - Marques, Hugo

AU - de Araújo Gonçalves, Pedro

AU - Pontone, Gianluca

AU - Raff, Gilbert L.

AU - Rubinshtein, Ronen

AU - Villines, Todd C.

AU - Gransar, Heidi

AU - Lu, Yao

AU - Peña, Jessica M.

AU - Lin, Fay Y.

AU - Shaw, Leslee J.

AU - Narula, Jagat

AU - Min, James K.

AU - Bax, Jeroen J.

N1 - Funding Information: The research reported in this publication was funded, in part, by the National Institute of Health (Bethesda, MD, USA) under award number R01 HL115150. This research was also supported, in part, by the Dalio Institute of Cardiovascular Imaging (New York, NY, USA) and the Michael Wolk Foundation (New York, NY, USA) . Publisher Copyright: © The Author(s) 2020.

PY - 2022/2/1

Y1 - 2022/2/1

N2 - AIMS: The relationship between dyspnoea, coronary artery disease (CAD), and major cardiovascular events (MACE) is poorly understood. This study evaluated (i) the association of dyspnoea with the severity of anatomical CAD by coronary computed tomography angiography (CCTA) and (ii) to which extent CAD explains MACE in patients with dyspnoea.METHODS AND RESULTS: From the international COronary CT Angiography EvaluatioN for Clinical Outcomes: An InteRnational Multicenter (CONFIRM) registry, 4425 patients (750 with dyspnoea) with suspected but without known CAD were included and prospectively followed for ≥5 years. First, the association of dyspnoea with CAD severity was assessed using logistic regression analysis. Second, the prognostic value of dyspnoea for MACE (myocardial infarction and death), and specifically, the interaction between dyspnoea and CAD severity was investigated using Cox proportional-hazard analysis. Mean patient age was 60.3 ± 11.9 years, 63% of patients were male and 592 MACE events occurred during a median follow-up duration of 5.4 (IQR 5.1-6.0) years. On uni- and multivariable analysis (adjusting for age, sex, body mass index, chest pain typicality, and risk factors), dyspnoea was associated with two- and three-vessel/left main (LM) obstructive CAD. The presence of dyspnoea increased the risk for MACE [hazard ratio (HR) 1.57, 95% confidence interval (CI): 1.29-1.90], which was modified after adjusting for clinical predictors and CAD severity (HR 1.26, 95% CI: 1.02-1.55). Conversely, when stratified by CAD severity, dyspnoea did not provide incremental prognostic value in one-, two-, or three-vessel/LM obstructive CAD, but dyspnoea did provide incremental prognostic value in non-obstructive CAD.CONCLUSION: In patients with suspected CAD, dyspnoea was independently associated with severe obstructive CAD on CCTA. The severity of obstructive CAD explained the elevated MACE rates in patients presenting with dyspnoea, but in patients with non-obstructive CAD, dyspnoea portended additional risk.

AB - AIMS: The relationship between dyspnoea, coronary artery disease (CAD), and major cardiovascular events (MACE) is poorly understood. This study evaluated (i) the association of dyspnoea with the severity of anatomical CAD by coronary computed tomography angiography (CCTA) and (ii) to which extent CAD explains MACE in patients with dyspnoea.METHODS AND RESULTS: From the international COronary CT Angiography EvaluatioN for Clinical Outcomes: An InteRnational Multicenter (CONFIRM) registry, 4425 patients (750 with dyspnoea) with suspected but without known CAD were included and prospectively followed for ≥5 years. First, the association of dyspnoea with CAD severity was assessed using logistic regression analysis. Second, the prognostic value of dyspnoea for MACE (myocardial infarction and death), and specifically, the interaction between dyspnoea and CAD severity was investigated using Cox proportional-hazard analysis. Mean patient age was 60.3 ± 11.9 years, 63% of patients were male and 592 MACE events occurred during a median follow-up duration of 5.4 (IQR 5.1-6.0) years. On uni- and multivariable analysis (adjusting for age, sex, body mass index, chest pain typicality, and risk factors), dyspnoea was associated with two- and three-vessel/left main (LM) obstructive CAD. The presence of dyspnoea increased the risk for MACE [hazard ratio (HR) 1.57, 95% confidence interval (CI): 1.29-1.90], which was modified after adjusting for clinical predictors and CAD severity (HR 1.26, 95% CI: 1.02-1.55). Conversely, when stratified by CAD severity, dyspnoea did not provide incremental prognostic value in one-, two-, or three-vessel/LM obstructive CAD, but dyspnoea did provide incremental prognostic value in non-obstructive CAD.CONCLUSION: In patients with suspected CAD, dyspnoea was independently associated with severe obstructive CAD on CCTA. The severity of obstructive CAD explained the elevated MACE rates in patients presenting with dyspnoea, but in patients with non-obstructive CAD, dyspnoea portended additional risk.

KW - coronary artery disease

KW - coronary computed tomography angiography

KW - dyspnoea

KW - prognosis

KW - Predictive Value of Tests

KW - Prognosis

KW - Prospective Studies

KW - Follow-Up Studies

KW - Humans

KW - Middle Aged

KW - Risk Factors

KW - Male

KW - Coronary Artery Disease/complications

KW - Dyspnea

KW - Registries

KW - Aged

KW - Coronary Angiography/methods

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U2 - 10.1093/ehjci/jeaa323

DO - 10.1093/ehjci/jeaa323

M3 - Article

C2 - 33538308

AN - SCOPUS:85123876130

SN - 2047-2404

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JO - European Heart Journal Cardiovascular Imaging

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Associations between dyspnoea, coronary atherosclerosis, and cardiovascular outcomes: results from the long-term follow-up CONFIRM registry

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