{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:48:50Z","timestamp":1760147330965,"version":"build-2065373602"},"reference-count":23,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,1,23]],"date-time":"2023-01-23T00:00:00Z","timestamp":1674432000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Aims: This study aimed to assess which variables on coronary computed tomography angiography (CTA) and vasodilator stress-echocardiography (SE) are best associated with long-term cardiac outcome in patients presenting for suspected chronic coronary syndrome (CCS) who performed both tests. Methods: We identified 397 patients with suspected CCS who, between 2007 and 2019, underwent both SE and CTA within 30 days. Coronary artery calcium score (CACS) and the number of coronary arteries with diameter stenosis &gt;50% were assessed on CTA. The presence of reversible regional wall motion abnormalities (RWMA) and reduced Doppler coronary flow velocity reserve in the left-anterior descending coronary artery (CFVR) were assessed on SE. The association of SE and CTA variables with cardiac outcome (cardiac death or myocardial infarction) was evaluated using Fine and Gray competing risk models. Results: During a median follow-up of 10 years, 38 (9.6%) patients experienced a nonfatal myocardial infarction and 19 (4.8%) died from a cardiac cause. RWMA (HR 7.189, p &lt; 0.001) and a lower CFVR (HR 0.034, p &lt; 0.001) on SE, along with CACS (HR 1.004, p &lt; 0.001) and the number of &gt;50% stenosed coronary vessels (HR 1.975, p &lt; 0.001) on CTA, were each associated with cardiac events. After adjusting for covariates, only CACS and CFVR remained associated (both p &lt; 0.001) with cardiac outcome. Conclusion: Our data suggest that only CFVR on vasodilatory SE and CACS on CTA are independently and strongly associated with long-term cardiac outcome, unlike RWMA or the number of stenosed coronary arteries, usually considered the hallmarks of coronary artery disease on each test.<\/jats:p>","DOI":"10.3390\/jcm12030903","type":"journal-article","created":{"date-parts":[[2023,1,24]],"date-time":"2023-01-24T01:59:03Z","timestamp":1674525543000},"page":"903","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Association of Coronary Computed Tomography Angiography and Stress Echocardiography with Long-Term Cardiac Outcome: A Comparison Study"],"prefix":"10.3390","volume":"12","author":[{"given":"Nicola","family":"Gaibazzi","sequence":"first","affiliation":[{"name":"Department of Cardiology, Parma University Hospital, 43126 Parma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fausto","family":"Rigo","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Villa Salus Hospital Foundation\/IRCCS San Camillo, 30126 Venice, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valentina","family":"Lorenzoni","sequence":"additional","affiliation":[{"name":"Istituto Sant\u2019Anna, 56127 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1032-5840","authenticated-orcid":false,"given":"Cristina","family":"Pasqualetto","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ospedale Civile di Dolo, ULSS 3 Serenissima, 30174 Venice, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto","family":"Fo\u00e0","sequence":"additional","affiliation":[{"name":"Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine\u2014DIMES, University of Bologna, 40126 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Enrico","family":"Cagliari","sequence":"additional","affiliation":[{"name":"Neuroradiology Department, Mestre Hospital, ULSS3 Serenissima, 30174 Mestre, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicola","family":"Cavasin","sequence":"additional","affiliation":[{"name":"Neuroradiology Department, Mestre Hospital, ULSS3 Serenissima, 30174 Mestre, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1305-4107","authenticated-orcid":false,"given":"Andrea","family":"Botti","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Parma University Hospital, 43126 Parma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0877-4954","authenticated-orcid":false,"given":"Chiara","family":"Martini","sequence":"additional","affiliation":[{"name":"Department Diagnostic, Parma University Hospital, 43126 Parma, Italy"},{"name":"Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1291-0306","authenticated-orcid":false,"given":"Domenico","family":"Tuttolomondo","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Parma University Hospital, 43126 Parma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.1056\/NEJMoa1415516","article-title":"Outcomes of anatomical versus functional testing for coronary artery disease","volume":"372","author":"Douglas","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"SCOT-HEART Investigators (2015). CT coronary angiography in patients with suspected angina due to coronary heart disease (SCOT-HEART): An open-label, parallel-group, multicentre trial. Lancet, 385, 2383\u20132391. Erratum in Lancet 2015, 385, 2354.","DOI":"10.1016\/S0140-6736(15)60291-4"},{"key":"ref_3","first-page":"1473","article-title":"Relative clinical value of coronary computed tomography and stress echocardiography-guided management of stable chest pain patients: A propensity-matched analysis","volume":"22","author":"Vamvakidou","year":"2020","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3869","DOI":"10.1093\/eurheartj\/ehab493","article-title":"Prognostic value of stress echocardiography assessed by the ABCDE protocol","volume":"42","author":"Ciampi","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1016\/j.echo.2020.01.007","article-title":"Coronary Flow Velocity Reserve Reduction Is Associated with Cardiovascular, Cancer, and Noncancer, Noncardiovascular Mortality","volume":"33","author":"Gaibazzi","year":"2020","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1582","DOI":"10.1093\/eurheartj\/ehab775","article-title":"Coronary flow reserve and cardiovascular outcomes: A systematic review and meta-analysis","volume":"43","author":"Kelshiker","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ijcard.2019.01.104","article-title":"Association of coronary artery Doppler-echocardiography diastolic-systolic velocity ratio at rest with obstructive coronary artery stenosis on the left main or left anterior descending coronary artery","volume":"281","author":"Gaibazzi","year":"2019","journal-title":"Int. J. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1186\/s12947-015-0035-2","article-title":"Prognostic value of calcium score and coronary flow velocity reserve in asymptomatic diabetic patients","volume":"13","author":"Dikic","year":"2015","journal-title":"Cardiovasc. Ultrasound"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/s12947-015-0013-8","article-title":"Dual imaging stress echocardiography versus computed tomography coronary angiography for risk stratification of patients with chest pain of unknown origin","volume":"13","author":"Ciampi","year":"2015","journal-title":"Cardiovasc. Ultrasound"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2278","DOI":"10.1016\/j.jacc.2019.08.1046","article-title":"Functional, Anatomical, and Prognostic Correlates of Coronary Flow Velocity Reserve during Stress Echocardiography","volume":"74","author":"Ciampi","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.echo.2019.07.001","article-title":"Guidelines for Performance, Interpretation, and Application of Stress Echocardiography in Ischemic Heart Disease: From the American Society of Echocardiography","volume":"33","author":"Pellikka","year":"2020","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1016\/j.jcct.2016.10.002","article-title":"SCCT guidelines for the performance and acquisition of coronary computed tomographic angiography: A report of the society of Cardiovascular Computed Tomography Guidelines Committee: Endorsed by the North American Society for Cardiovascular Imaging (NASCI)","volume":"10","author":"Abbara","year":"2016","journal-title":"J. Cardiovasc. Comput. Tomogr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1161\/hc0402.102975","article-title":"Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association","volume":"105","author":"Cerqueira","year":"2002","journal-title":"Circulation"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1016\/0735-1097(90)90282-T","article-title":"Quantification of coronary artery calcium using ultrafast computed tomography","volume":"15","author":"Agatston","year":"1990","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/j.atherosclerosis.2008.03.014","article-title":"Non-HDL cholesterol is strongly associated with coronary artery calcification in asymptomatic individuals","volume":"202","author":"Orakzai","year":"2009","journal-title":"Atherosclerosis"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2154","DOI":"10.1016\/j.amjcard.2017.09.001","article-title":"Comparison of the Coronary Artery Calcium Score and Number of Calcified Coronary Plaques for Predicting Patient Mortality Risk","volume":"120","author":"Arnson","year":"2017","journal-title":"Am. J. Cardiol."},{"key":"ref_17","first-page":"e618","article-title":"Executive Group on behalf of the Joint European Society of Cardiology (ESC)\/American College of Cardiology (ACC)\/American Heart Association (AHA)\/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction. Fourth Universal Definition of Myocardial Infarction (2018)","volume":"138","author":"Thygesen","year":"2018","journal-title":"Circulation"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1837","DOI":"10.1161\/01.CIR.97.18.1837","article-title":"Prediction of coronary heart disease using risk factor categories","volume":"97","author":"Wilson","year":"1998","journal-title":"Circulation"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.ijcard.2016.01.056","article-title":"The coronary calcium score is a more accurate predictor of significant coronary stenosis than conventional risk factors in symptomatic patients: Euro-CCAD study","volume":"207","author":"Nicoll","year":"2016","journal-title":"Int. J. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1395","DOI":"10.1056\/NEJMoa1915922","article-title":"Initial Invasive or Conservative Strategy for Stable Coronary Disease","volume":"382","author":"Maron","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2803","DOI":"10.1016\/j.jacc.2020.10.021","article-title":"Impact of Plaque Burden versus Stenosis on Ischemic Events in Patients with Coronary Atherosclerosis","volume":"76","author":"Mortensen","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/j.jacc.2018.10.066","article-title":"Coronary Artery Plaque Characteristics Associated with Adverse Outcomes in the SCOT-HEART Study","volume":"73","author":"Williams","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.ijcard.2021.05.040","article-title":"Human coronary inflammation by computed tomography: Relationship with coronary microvascular dysfunction","volume":"336","author":"Pasqualetto","year":"2021","journal-title":"Int. J. Cardiol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/3\/903\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:14:10Z","timestamp":1760120050000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/3\/903"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,23]]},"references-count":23,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["jcm12030903"],"URL":"https:\/\/doi.org\/10.3390\/jcm12030903","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2023,1,23]]}}}