{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T05:38:58Z","timestamp":1775885938320,"version":"3.50.1"},"reference-count":11,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Imaging"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Abnormalities in computed tomography myocardial perfusion has been associated with coronary artery disease and major adverse cardiovascular events (MACE). We sought to investigate if subendocardial attenuation using coronary computed tomography angiography predicts MACE 30 days postelective noncardiac surgery.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>\n              Using a 17-segment model, coronary computed tomography angiography images were analyzed for subendocardial and transmural attenuation and the corresponding blood pool. The segment with the lowest subendocardial attenuation and transmural attenuation were normalized to the segment with the highest subendocardial and transmural attenuation, respectively (SUB\n              <jats:sub>normalized<\/jats:sub>\n              , and TRANS\n              <jats:sub>normalized<\/jats:sub>\n              , respectively). We evaluated the independent and incremental value of myocardial attenuation to predict the composite of cardiovascular death or nonfatal myocardial infarction.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>\n              Of a total of 995 coronary CTA VISION (Coronary Computed Tomographic Angiography and Vascular Events in Noncardiac Surgery Patients Cohort Evaluation Study) patients, 735 had available images and complete data for these analyses. Among these patients, 60 had MACE. Based on Revised Cardiovascular Risk Index, 257, 302, 138, and 38 patients had scores of 0, 1, 2, and \u22653, respectively. On coronary computed tomography angiography, 75 patients had normal coronary arteries, 297 patients had nonobstructive coronary artery disease, 264 patients had obstructive disease, and 99 patients had extensive obstructive coronary artery disease. SUB\n              <jats:sub>normalized<\/jats:sub>\n              was an independent and incremental predictor of events in the model that included Revised Cardiovascular Risk Index and coronary artery disease severity. Compared with patients in the highest tertile of SUB\n              <jats:sub>normalized<\/jats:sub>\n              , patients in the second and first tertiles had an increased hazards ratio for events (2.23 [95% CI, 1.091\u20134.551] and 2.36 [95% CI, 1.16\u20134.81], respectively). TRANS\n              <jats:sub>normalized<\/jats:sub>\n              , as a continuous variable, was also found to be a predictor of MACE (\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.027).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>\n              Our study demonstrates that SUB\n              <jats:sub>normalized<\/jats:sub>\n              and TRANS\n              <jats:sub>normalized<\/jats:sub>\n              are independent and incremental predictors of MACE 30 days after elective noncardiac surgery.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Registration:<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              ; Unique identifier: NCT01635309.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circimaging.121.012654","type":"journal-article","created":{"date-parts":[[2022,1,18]],"date-time":"2022-01-18T19:14:02Z","timestamp":1642533242000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Normalized Subendocardial Myocardial Attenuation on Coronary Computed Tomography Angiography Predicts Postoperative Adverse Cardiovascular Events: Coronary CTA VISION Substudy"],"prefix":"10.1161","volume":"15","clinical-trial-number":[{"clinical-trial-number":"nct01635309","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9226-545X","authenticated-orcid":true,"given":"Jeroen","family":"Walpot","sequence":"first","affiliation":[{"name":"Division of Cardiology (J.W., S.M., P.J., M.S., O.C., L.G., A.S., I.R., K.G., K.J., A.M.C., B.J.W.C.), University of Ottawa Heart Institute, Ottawa, Ontario, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samia","family":"Massalha","sequence":"additional","affiliation":[{"name":"Division of Cardiology (J.W., S.M., P.J., M.S., O.C., L.G., A.S., I.R., K.G., K.J., A.M.C., B.J.W.C.), University of Ottawa Heart Institute, Ottawa, Ontario, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pranisha","family":"Jayasinghe","sequence":"additional","affiliation":[{"name":"Division of Cardiology (J.W., S.M., P.J., M.S., O.C., L.G., A.S., I.R., K.G., K.J., A.M.C., B.J.W.C.), University of Ottawa Heart Institute, Ottawa, Ontario, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Madiha","family":"Sadaf","sequence":"additional","affiliation":[{"name":"Division of Cardiology (J.W., S.M., P.J., M.S., O.C., L.G., A.S., I.R., K.G., K.J., A.M.C., B.J.W.C.), University of Ottawa Heart Institute, Ottawa, Ontario, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Owen","family":"Clarkin","sequence":"additional","affiliation":[{"name":"Division of Cardiology (J.W., S.M., P.J., M.S., O.C., L.G., A.S., I.R., K.G., K.J., A.M.C., B.J.W.C.), University of Ottawa Heart Institute, Ottawa, Ontario, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Godkin","sequence":"additional","affiliation":[{"name":"Division of Cardiology (J.W., S.M., P.J., M.S., O.C., L.G., A.S., I.R., K.G., K.J., A.M.C., B.J.W.C.), University of Ottawa Heart Institute, Ottawa, Ontario, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashwin","family":"Sharma","sequence":"additional","affiliation":[{"name":"Division of Cardiology (J.W., S.M., P.J., M.S., O.C., L.G., A.S., I.R., K.G., K.J., A.M.C., B.J.W.C.), University of Ottawa Heart Institute, Ottawa, Ontario, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Indeevari","family":"Ratnayake","sequence":"additional","affiliation":[{"name":"Division of Cardiology (J.W., S.M., P.J., M.S., O.C., L.G., A.S., I.R., K.G., K.J., A.M.C., B.J.W.C.), University of Ottawa Heart Institute, Ottawa, Ontario, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4871-0039","authenticated-orcid":true,"given":"Kara","family":"Godkin","sequence":"additional","affiliation":[{"name":"Division of Cardiology (J.W., S.M., P.J., M.S., O.C., L.G., A.S., I.R., K.G., K.J., A.M.C., B.J.W.C.), University of Ottawa Heart Institute, Ottawa, Ontario, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kateleen","family":"Jia","sequence":"additional","affiliation":[{"name":"Division of Cardiology (J.W., S.M., P.J., M.S., O.C., L.G., A.S., I.R., K.G., K.J., A.M.C., B.J.W.C.), University of Ottawa Heart Institute, Ottawa, Ontario, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7614-0072","authenticated-orcid":true,"given":"Alomgir","family":"Hossain","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Methods Centre (A.H.), University of Ottawa Heart Institute, Ottawa, Ontario, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2038-9178","authenticated-orcid":true,"given":"Andrew M.","family":"Crean","sequence":"additional","affiliation":[{"name":"Division of Cardiology (J.W., S.M., P.J., M.S., O.C., L.G., A.S., I.R., K.G., K.J., A.M.C., B.J.W.C.), University of Ottawa Heart Institute, Ottawa, Ontario, Canada."},{"name":"Department of Radiology, University of Ottawa, Ontario, Canada (A.M.C., B.J.W.C.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region (M.C.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Craig","family":"Butler","sequence":"additional","affiliation":[{"name":"Department of Medicine (Cardiology), Alberta Heart Institute and University of Alberta, Edmonton, Alberta, Canada (C.B.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vikas","family":"Tandon","sequence":"additional","affiliation":[{"name":"Population Health Research Institute and Department of Medicine, David Braley Cardiac, Vascular, and Stroke Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (V.T., P.J.D., T.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8369-3858","authenticated-orcid":true,"given":"Peter","family":"Nagele","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology (P.N.), Washington University School of Medicine, St. Louis, MO."},{"name":"Department of Anesthesia and Critical Care, University of Chicago, IL (P.N.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pamela K.","family":"Woodard","sequence":"additional","affiliation":[{"name":"Mallinckrodt Institute of Radiology (P.K.W.), Washington University School of Medicine, St. Louis, MO."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marko","family":"Mrkobrada","sequence":"additional","affiliation":[{"name":"Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada (M.M.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1349-1123","authenticated-orcid":true,"given":"Wojciech","family":"Szczeklik","sequence":"additional","affiliation":[{"name":"Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland (W.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0869-1972","authenticated-orcid":true,"given":"Yang Faridah Abdul","family":"Aziz","sequence":"additional","affiliation":[{"name":"Department of Biomedical Imaging, University Malaya Research Imaging Centre, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (Y.F.A.A.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruce","family":"Biccard","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa (B.B.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P.J.","family":"Devereaux","sequence":"additional","affiliation":[{"name":"Population Health Research Institute and Department of Medicine, David Braley Cardiac, Vascular, and Stroke Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (V.T., P.J.D., T.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tej","family":"Sheth","sequence":"additional","affiliation":[{"name":"Population Health Research Institute and Department of Medicine, David Braley Cardiac, Vascular, and Stroke Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (V.T., P.J.D., T.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8631-0234","authenticated-orcid":true,"given":"Benjamin J.W.","family":"Chow","sequence":"additional","affiliation":[{"name":"Division of Cardiology (J.W., S.M., P.J., M.S., O.C., L.G., A.S., I.R., K.G., K.J., A.M.C., B.J.W.C.), University of Ottawa Heart Institute, Ottawa, Ontario, Canada."},{"name":"Department of Radiology, University of Ottawa, Ontario, Canada (A.M.C., 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Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCIMAGING.121.012654","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T13:06:33Z","timestamp":1749042393000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCIMAGING.121.012654"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1]]},"references-count":11,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,1]]}},"alternative-id":["10.1161\/CIRCIMAGING.121.012654"],"URL":"https:\/\/doi.org\/10.1161\/circimaging.121.012654","relation":{},"ISSN":["1941-9651","1942-0080"],"issn-type":[{"value":"1941-9651","type":"print"},{"value":"1942-0080","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1]]},"assertion":[{"value":"2021-03-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-12-12","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-01-18","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}