Cardiac computed tomography for rule-out of ischaemic heart disease in patients with new-onset heart failure

Christina Boesgaard Graversen; Laust Dupont Rasmussen; Jens Sundbøll; Morten Würtz; Kristian Hay Kragholm; Morten Bøttcher; Simon Winther

doi:10.1093/ehjci/jeaf090

Cardiac computed tomography for rule-out of ischaemic heart disease in patients with new-onset heart failure

Christina Boesgaard Graversen, Laust Dupont Rasmussen, Jens Sundbøll, Morten Würtz, Kristian Hay Kragholm, Morten Bøttcher, Simon Winther

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

Abstract

Aims In patients with new-onset heart failure (HF), invasive coronary angiography (ICA) is recommended to rule out coronary artery disease (CAD). The objective is to investigate the utility of a coronary artery calcium score (CACS) and coronary computed tomography angiography (CCTA) for rule-out of obstructive CAD in patients with new-onset HF. Methods Patients with new-onset HF referred for cardiac computed tomography (CT) were included (2008–22). Patients were and results grouped according to CACS and CCTA findings. Stenosis on CCTA was defined as ≥1 vessel with ≥50% luminal diameter stenosis. Obstructive CAD was defined as ≥1 vessel with ≥50% luminal diameter stenosis at ICA performed within 120 days from cardiac CT. Revascularization procedures within 120 days from cardiac CT were identified. Overall, 3336 patients were eligible. Obstructive CAD was ruled out in 2332/2780 patients (83.8%) with complete cardiac CT. A total of 1032 (30.9%) patients had CACS = 0, and 377 (11.3%) patients had CACS ≥ 1000. A total of 18.0% of patients had stenosis on CCTA, ranging from 2.8% to 71.7% in patients with CACS = 0 and CACS ≥ 1000, respectively. Obstructive CAD at second-line ICA was diagnosed in 11.5% of patients, ranging from 1.2% to 47.2% in patients with CACS = 0 and CACS ≥ 1000, respectively. Revascularization was performed in 6.9% of patients, ranging from 0.6% to 26.5% in patients with CACS = 0 and CACS ≥ 1000, respectively. Conclusion In stable patients with new-onset HF, cardiac CT may be considered as the primary imaging modality to rule out ischaemic heart disease, and implementation of a CT-based strategy for ischaemia rule-out may substantially reduce the need for invasive examination.

Original language	English
Journal	European Heart Journal Cardiovascular Imaging
Volume	26
Issue	5
Pages (from-to)	794-801
Number of pages	8
ISSN	1525-2167
DOIs	https://doi.org/10.1093/ehjci/jeaf090
Publication status	Published - 1 May 2025

Keywords

coronary computed tomography angiography invasive coronary angiography
coronary stenosis
heart failure ischaemic heart disease coronary artery calcium scoring

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@article{2516091f9db74ac7a5cca8019a1f6597,

title = "Cardiac computed tomography for rule-out of ischaemic heart disease in patients with new-onset heart failure",

abstract = "Aims In patients with new-onset heart failure (HF), invasive coronary angiography (ICA) is recommended to rule out coronary artery disease (CAD). The objective is to investigate the utility of a coronary artery calcium score (CACS) and coronary computed tomography angiography (CCTA) for rule-out of obstructive CAD in patients with new-onset HF. Methods Patients with new-onset HF referred for cardiac computed tomography (CT) were included (2008–22). Patients were and results grouped according to CACS and CCTA findings. Stenosis on CCTA was defined as ≥1 vessel with ≥50% luminal diameter stenosis. Obstructive CAD was defined as ≥1 vessel with ≥50% luminal diameter stenosis at ICA performed within 120 days from cardiac CT. Revascularization procedures within 120 days from cardiac CT were identified. Overall, 3336 patients were eligible. Obstructive CAD was ruled out in 2332/2780 patients (83.8%) with complete cardiac CT. A total of 1032 (30.9%) patients had CACS = 0, and 377 (11.3%) patients had CACS ≥ 1000. A total of 18.0% of patients had stenosis on CCTA, ranging from 2.8% to 71.7% in patients with CACS = 0 and CACS ≥ 1000, respectively. Obstructive CAD at second-line ICA was diagnosed in 11.5% of patients, ranging from 1.2% to 47.2% in patients with CACS = 0 and CACS ≥ 1000, respectively. Revascularization was performed in 6.9% of patients, ranging from 0.6% to 26.5% in patients with CACS = 0 and CACS ≥ 1000, respectively. Conclusion In stable patients with new-onset HF, cardiac CT may be considered as the primary imaging modality to rule out ischaemic heart disease, and implementation of a CT-based strategy for ischaemia rule-out may substantially reduce the need for invasive examination.",

keywords = "coronary computed tomography angiography invasive coronary angiography, coronary stenosis, heart failure ischaemic heart disease coronary artery calcium scoring",

author = "Graversen, {Christina Boesgaard} and Rasmussen, {Laust Dupont} and Jens Sundb{\o}ll and Morten W{\"u}rtz and Kragholm, {Kristian Hay} and Morten B{\o}ttcher and Simon Winther",

note = "{\textcopyright} The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact [email protected].",

year = "2025",

month = may,

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doi = "10.1093/ehjci/jeaf090",

language = "English",

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Cardiac computed tomography for rule-out of ischaemic heart disease in patients with new-onset heart failure. / Graversen, Christina Boesgaard; Rasmussen, Laust Dupont ; Sundbøll, Jens et al.
In: European Heart Journal Cardiovascular Imaging, Vol. 26, No. 5, 01.05.2025, p. 794-801.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Cardiac computed tomography for rule-out of ischaemic heart disease in patients with new-onset heart failure

AU - Graversen, Christina Boesgaard

AU - Rasmussen, Laust Dupont

AU - Sundbøll, Jens

AU - Würtz, Morten

AU - Kragholm, Kristian Hay

AU - Bøttcher, Morten

AU - Winther, Simon

N1 - © The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact [email protected].

PY - 2025/5/1

Y1 - 2025/5/1

N2 - Aims In patients with new-onset heart failure (HF), invasive coronary angiography (ICA) is recommended to rule out coronary artery disease (CAD). The objective is to investigate the utility of a coronary artery calcium score (CACS) and coronary computed tomography angiography (CCTA) for rule-out of obstructive CAD in patients with new-onset HF. Methods Patients with new-onset HF referred for cardiac computed tomography (CT) were included (2008–22). Patients were and results grouped according to CACS and CCTA findings. Stenosis on CCTA was defined as ≥1 vessel with ≥50% luminal diameter stenosis. Obstructive CAD was defined as ≥1 vessel with ≥50% luminal diameter stenosis at ICA performed within 120 days from cardiac CT. Revascularization procedures within 120 days from cardiac CT were identified. Overall, 3336 patients were eligible. Obstructive CAD was ruled out in 2332/2780 patients (83.8%) with complete cardiac CT. A total of 1032 (30.9%) patients had CACS = 0, and 377 (11.3%) patients had CACS ≥ 1000. A total of 18.0% of patients had stenosis on CCTA, ranging from 2.8% to 71.7% in patients with CACS = 0 and CACS ≥ 1000, respectively. Obstructive CAD at second-line ICA was diagnosed in 11.5% of patients, ranging from 1.2% to 47.2% in patients with CACS = 0 and CACS ≥ 1000, respectively. Revascularization was performed in 6.9% of patients, ranging from 0.6% to 26.5% in patients with CACS = 0 and CACS ≥ 1000, respectively. Conclusion In stable patients with new-onset HF, cardiac CT may be considered as the primary imaging modality to rule out ischaemic heart disease, and implementation of a CT-based strategy for ischaemia rule-out may substantially reduce the need for invasive examination.

AB - Aims In patients with new-onset heart failure (HF), invasive coronary angiography (ICA) is recommended to rule out coronary artery disease (CAD). The objective is to investigate the utility of a coronary artery calcium score (CACS) and coronary computed tomography angiography (CCTA) for rule-out of obstructive CAD in patients with new-onset HF. Methods Patients with new-onset HF referred for cardiac computed tomography (CT) were included (2008–22). Patients were and results grouped according to CACS and CCTA findings. Stenosis on CCTA was defined as ≥1 vessel with ≥50% luminal diameter stenosis. Obstructive CAD was defined as ≥1 vessel with ≥50% luminal diameter stenosis at ICA performed within 120 days from cardiac CT. Revascularization procedures within 120 days from cardiac CT were identified. Overall, 3336 patients were eligible. Obstructive CAD was ruled out in 2332/2780 patients (83.8%) with complete cardiac CT. A total of 1032 (30.9%) patients had CACS = 0, and 377 (11.3%) patients had CACS ≥ 1000. A total of 18.0% of patients had stenosis on CCTA, ranging from 2.8% to 71.7% in patients with CACS = 0 and CACS ≥ 1000, respectively. Obstructive CAD at second-line ICA was diagnosed in 11.5% of patients, ranging from 1.2% to 47.2% in patients with CACS = 0 and CACS ≥ 1000, respectively. Revascularization was performed in 6.9% of patients, ranging from 0.6% to 26.5% in patients with CACS = 0 and CACS ≥ 1000, respectively. Conclusion In stable patients with new-onset HF, cardiac CT may be considered as the primary imaging modality to rule out ischaemic heart disease, and implementation of a CT-based strategy for ischaemia rule-out may substantially reduce the need for invasive examination.

KW - coronary computed tomography angiography invasive coronary angiography

KW - coronary stenosis

KW - heart failure ischaemic heart disease coronary artery calcium scoring

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U2 - 10.1093/ehjci/jeaf090

DO - 10.1093/ehjci/jeaf090

M3 - Journal article

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SN - 1525-2167

VL - 26

SP - 794

EP - 801

JO - European Heart Journal Cardiovascular Imaging

JF - European Heart Journal Cardiovascular Imaging

IS - 5

ER -

Cardiac computed tomography for rule-out of ischaemic heart disease in patients with new-onset heart failure

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