We thank Dr. Dong for the thoughtful comments and interest in our recently published article describing the rationale and design of the CT-STEMI study.1,2 We appreciate the opportunity to clarify several aspects of the study design and objectives.
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Evaluating the Early-HFpEF study: The controversies and future directions in peripheral arterial calcification and central arterial stiffness in T2DM
We have read with great interest the recent publication by Meer R et al., entitled “The association between peripheral medial and intimal arterial calcification patterns with central arterial stiffness in individuals with type 2 diabetes mellitus: The cross-sectional Early-HFpEF study”.1 In this study, authors investigated the association between patterns of peripheral arterial calcification and central arterial stiffness in subjects with type 2 diabetes mellitus (T2DM). Nevertheless, the follow…
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Diagnostic performance of coronary CT angiography to diagnose acute spontaneous coronary artery dissection
The diagnosis of spontaneous coronary artery dissection (SCAD) is made with invasive coronary angiography (ICA). The literature on the diagnostic performance of coronary CT angiography (coronary CTA) is sparse. The purpose of this study was to evaluate the performance of coronary CTA for the diagnosis of acute SCAD.
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Fractional flow reserve from coronary CT angiography compared with quantitative flow ratio in complex CAD
This study demonstrated that QFR tends to have higher values in proximal bifurcations compared with FFRCTand μFR, which can underestimate lesion severity. Clinicians should, therefore, be aware of the methodological nuances and potential variability when selecting and interpreting these tools. Classification of lesions as focal or diffuse based on virtual pullback indices showed poor concordance across the three methods, highlighting methodological differences in phenotype characterization. Thes…
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Balancing innovation and evidence: Coronary computed tomography angiography in preoperative valve surgery
We read with great interest the recent article by Bhatia et al., “Coronary CT angiography versus invasive angiography for preoperative coronary assessment prior to valve surgery,” which provides a systematic review and meta-analysis addressing the diagnostic and perioperative outcomes of a CCTA-first strategy.1 The authors conclude that CCTA may effectively reduce the need for ICA without compromising patient safety. While these findings are encouraging, we believe that several aspects of the an…
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Limitations of coronary computed tomography angiography for spontaneous coronary artery dissection
We read with great interest the article by Ahmed et al. evaluating coronary computed tomography angiography (CCTA) utilization in spontaneous coronary artery dissection (SCAD) hospitalizations across the United States from 2017 to 2022.1 The study provides a valuable large-scale overview of national trends; however, several critical aspects deserve further scrutiny to contextualize the role of CCTA in SCAD management.
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Reassessing pretest probability: Coronary artery calcium alone predicts obstructive CAD
Since the 1970s, patient selection for cardiac stress testing—using electrocardiographic, nuclear, and echocardiographic modalities—has relied on estimating the pretest likelihood of obstructive coronary artery disease (oCAD). In recent years, several algorithms have integrated coronary artery calcium (CAC) scores into predictive models for assessing oCAD risk. However, even the simplest of these models combine CAC with other variables such as age, sex, and clinical symptoms.1
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Analysis of the coronary artery calcium score for identifying coronary artery plaque in patients clinically referred for preventive screening with non-typical symptoms stratified by age and sex
This article evaluates how age and sex affect the diagnostic value of the coronary artery calcium (CAC) score in detecting coronary plaque on coronary CT angiography in a patients who were clinically referred for CAD prevention screening with non-typical symptoms. It analyzed 1372 patients undergoing CAC scoring and coronary CT angiography. Findings show that CAC score’s sensitivity increases with age and is generally higher in males and those on lipid-lowering therapy. A CAC score of 0 is less …
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Integrating radiomics into coronary computed tomography angiography: Enhancing prognostic value after percutaneous coronary intervention
We read with great interest the article by Komaki et al., “Coronary computed tomography angiography radiomics for predicting major adverse cardiovascular events after percutaneous coronary interventions,” recently published in the Journal of Cardiovascular Computed Tomography.1 The authors provide an innovative perspective on integrating radiomics into conventional coronary artery calcium (CAC) scoring to enhance risk prediction in patients with chronic coronary syndrome undergoing PCI. We comme…
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Coronary CT angiography versus invasive angiography for preoperative coronary assessment prior to valve surgery
In patients undergoing valve surgery, invasive coronary angiography (ICA) is recommended to exclude significant coronary artery disease (CAD) in those at significant risk.1 However, in this population, routine ICA often has a low diagnostic yield for detecting obstructive CAD and carries a small but non-negligible risk of major cardiac and vascular complications. Coronary computed tomography angiography (CCTA), with its high sensitivity for detecting stenosis >50 % has emerged as a noninvasi…