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CCTA-Derived coronary plaque burden offers enhanced prognostic value over CAC scoring in suspected CAD patients
(Oxford University Press (OUP), 2025-03-25)
Jorge Dahdal
;
Ruurt A Jukema
;
Teemu Maaniitty
;
Nick S Nurmohamed
;
Pieter G Raijmakers
Aims To assess the prognostic utility of coronary artery calcium (CAC) scoring and coronary computed tomography angiography (CCTA)-derived quantitative plaque metrics for predicting adverse cardiovascular outcomes. Methods and results The study enrolled 2404 patients with suspected coronary artery disease (CAD) but without a prior history of CAD. All participants underwent CAC scoring and CCTA, with plaque metrics quantified using an artificial intelligence (AI)-based tool (Cleerly, Inc). Percent atheroma volume (PAV) and non-calcified plaque volume percentage (NCPV%), reflecting total plaque burden and the proportion of non-calcified plaque volume normalized to vessel volume, were evaluated. The primary endpoint was a composite of all-cause mortality and non-fatal myocardial infarction (MI). Cox proportional hazard models, adjusted for clinical risk factors and early revascularization, were employed for analysis. During a median follow-up of 7.0 years, 208 patients (8.7%) experienced the primary endpoint, including 73 cases of MI (3%). The model incorporating PAV demonstrated superior discriminatory power for the composite endpoint (AUC = 0.729) compared to CAC scoring (AUC = 0.706, P = 0.016). In MI prediction, PAV (AUC = 0.791) significantly outperformed CAC (AUC = 0.699, P < 0.001), with NCPV% showing the highest prognostic accuracy (AUC = 0.814, P < 0.001). Conclusion AI-driven assessment of coronary plaque burden enhances prognostic accuracy for future adverse cardiovascular events, highlighting the critical role of comprehensive plaque characterization in refining risk stratification strategies
3Scopus© Citations 19
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Homogeneity of the coronary microcirculation in angina with non-obstructive coronary artery disease
(Oxford University Press (OUP), 2025-03-24)
Masahiro Hoshino
;
Roel Hoek
;
Ruurt A Jukema
;
Jorge Dahdal
;
Pepijn van Diemen
The homogeneity of coronary microvascular dysfunction (CMD) across different myocardial territories in angina with nonobstructive coronary artery disease (ANOCA) patients is scarcely explored. This study investigates the variability in microvascular resistance reserve (MRR) across the 3 main perfusion territories of the coronary circulation to investigate the homogeneity or dishomogeneity of microcirculatory function
Scopus© Citations 1 2
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Myocardial perfusion imaging in advanced coronary artery disease
(Wiley, 2025-03-18)
Roel Hoek
;
Pepijn A. van Diemen
;
Yvemarie B. O. Somsen
;
Ruben W. de Winter
;
Ruurt A. Jukema
Myocardial perfusion imaging (MPI) is widely adapted as a noninvasive technique to assess the presence and extent of ischemia in patients with symptoms suggestive of obstructive coronary artery disease (CAD). However, as CAD advances, several factors can complicate the interpretation of MPI, subsequently impacting clinical decision‐making. This review focuses on the utility of MPI by means of cardiac magnetic resonance (CMR) imaging, single‐photon emission computed tomography (SPECT) and positron emission tomography (PET) in patients with advanced CAD—the latter characterized by documented CAD (i.e. prior myocardial infarction [MI] and/or percutaneous coronary intervention [PCI]), prior coronary artery bypass grafting (CABG) or the presence of a chronic total occlusion (CTO). It will discuss factors impacting the interpretation of MPI, the diagnostic performance for detecting obstructive CAD and coronary microvascular dysfunction (CMD), as well as the role of MPI in guiding revascularization.
Scopus© Citations 1 2
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Impact of myocardial scar burden on microvascular resistance reserve in patients with coronary artery disease
(Springer Science and Business Media LLC, 2025-02-20)
Masahiro Hoshino
;
Roel Hoek
;
Ruurt. A. Jukema
;
Jorge Dahdal
;
Pepijn van Diemen
Purpose The impact of myocardial scar on coronary microcirculation is not well understood. This study aims to evaluate the association between microvascular resistance reserve (MRR) and scar tissue. Methods In this post-hoc analysis of the PACIFIC 2 trial, symptomatic patients with prior myocardial infarction (MI) and/or percutaneous coronary intervention (PCI) underwent [15O]H2O positron emission tomography (PET), cardiac magnetic resonance (CMR) imaging, and fractional flow reserve (FFR). MRR was assessed utilizing PET-derived coronary flow reserve and FFR measurements. Scar quantification was assessed by CMR late gadolinium enhancement (LGE). Vessel LGE burden was defined as the scar tissue proportion in each myocardial territory. Total LGE burden was defined as the proportion of overall scar. Results The study included 154 patients with 397 vessels with a mean MRR of 3.56 ± 1.24. Patients with any scar tissues (LGE > 0%) exhibited a lower MRR in every myocardial territory than those without scar tissues. After adjusting for cardiovascular risk factors, either vessel LGE burden (β =-0.013, P = 0.006) or total LGE burden (β =-0.039, P = 0.002) independently predicted a reduced MRR. Compared to myocardial territories without scar tissues (LGE burdens = 0%), MRR was significantly lower in myocardial territories with vessel LGE burden = 0% + total LGE burden > 0%, and in myocardial territories with both LGE burdens > 0%. Conclusion Scar burden was negatively associated with MRR in patients with prior MI and/or PCI. Our findings indicate that both the proportion of myocardial scar in the vascular territory and the overall myocardial scar affect the microcirculation of individual vascular territories.
1Scopus© Citations 4
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CCTA-Guided Selective Invasive Coronary Catheterization: A Strategy to Reduce Contrast Volume and Improve Efficiency
(MDPI AG, 2025-04-01)
Jorge Dahdal
;
Ruurt Jukema
;
Aernout G. Somsen
;
Eline Kooijman
;
Ellaha Wahedi
Background: Symptomatic patients with unilateral obstructive coronary artery disease (CAD) identified by coronary computed tomography angiography (CCTA), involving either the right or left coronary artery, typically undergo per-protocol bilateral coronary visualization during invasive coronary angiography (ICA). However, a selective visualization approach may be sufficient. Objectives: The objectives of this study were to assess the accuracy of CCTA in excluding hemodynamically significant coronary stenosis in patients with unilateral CAD and to evaluate whether a CCTA-guided selective ICA strategy can reduce procedure time and contrast agent use. Methods: In this cross-sectional cohort study, 454 patients with clinically suspected stable CAD who underwent CCTA prior to ICA were included. The study population consisted of 190 patients with unilateral obstructive CAD, defined as ≥50% diameter stenosis on CCTA, and an absence of obstructive CAD on the contralateral side. ICA with invasive functional assessment was used as the reference standard. Results: CCTA demonstrated a high accuracy, 97.4% (95% CI: 94–99%), in excluding hemodynamically significant disease in the contralateral arteries without obstructive CAD. Compared to the conventional ICA approach, a CCTA-guided selective visualization strategy resulted in significant reductions in procedure time and contrast agent usage: procedure time and contrast agent usage were reduced by 27% (95% CI: 12.1–47.5%) and 46.8% (95% CI: 27.5–67.0%), respectively. Conclusions: In patients with unilateral obstructive CAD identified by CCTA, a CCTA-guided selective ICA visualization strategy is highly accurate in ruling out hemodynamically significant CAD on the contralateral side. Additionally, this unilateral ICA approach has the potential to reduce both contrast agent usage and procedure time compared to the conventional bilateral visualization strategy.
2Scopus© Citations 2
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Microvascular resistance reserve in relation to total and vessel-specific atherosclerotic burden
(Oxford University Press (OUP), 2024-11-12)
Masahiro Hoshino
;
Ruurt A Jukema
;
Roel Hoek
;
Jorge Dahdal
;
Pieter Raijmakers
The relationship between coronary artery atherosclerosis and microvascular resistance remains unclear. This study aims to clarify the relationship between total atherosclerotic and vessel-specific atherosclerotic burden and microvascular resistance reserve (MRR).</jats:p> Methods and results In this post hoc analysis of the PACIFIC 1 trial, symptomatic patients without prior coronary artery disease (CAD) underwent [15O]H2O positron emission tomography, coronary computed tomography angiography (CCTA), and invasive fractional flow reserve (FFR). MRR was assessed across all three coronary branches, utilizing PET-derived coronary flow reserve and invasive FFR measurements. CCTA was used to assess patient and vessel-specific plaque volumes. Percentage atheroma volume (PAV) was defined as total plaque volume divided by vessel volume. The study included 142 patients (55% male, 57.5 ± 8.6 years) with 426 vessels with a mean MRR of 3.77 ± 1.64. While a significantly higher PAV was observed in the left anterior descending artery territory, MRR was similar across the three coronary branches. Generalized estimating equations without correction for cardiovascular risk factors identified that patient-specific PAV tertiles but not vessel-specific PAV tertiles were related to vessel-specific MRR. After correction for cardiovascular risk factors, compared with the first tertile of patient-specific PAV, the second tertile showed a vessel-specific MRR decrease of β = −0.362, P = 0.018, and the third tertile showed a decrease of β = −0.347, P = 0.024.</jats:p> Conclusion In patients without prior CAD, patient-specific plaque burden was negatively associated to vessel-specific MRR; however, vessel-specific plaque burden was not related to vessel-specific MRR. Our findings suggest that the relation between atherosclerotic burden and an impaired microcirculatory function is of systemic origin.
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Diagnostic performance of CCTA and CTP imaging for clinically suspected in-stent restenosis: A meta-analysis
(2024)
Jorge Dahdal
;
Ruurt A. Jukema
;
Sharon Remmelzwaal
;
Pieter G. Raijmakers
;
Pim van der Harst
2Scopus© Citations 2

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