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Open Access 01-04-2023 | Hypercholesterolemia | Cardiac Radiology

Effectiveness of clinical scores in predicting coronary artery disease in familial hypercholesterolemia: a coronary computed tomography angiography study

Authors: Federica Catapano, Nicola Galea, Giacomo Pambianchi, Laura D’Erasmo, Cristian Borrazzo, Giulia Cundari, Livia Marchitelli, Marianna Maranghi, Ilenia Minicocci, Alessia Di Costanzo, Iacopo Carbone, Marco Francone, Marcello Arca, Carlo Catalano

Published in: La radiologia medica | Issue 4/2023

Abstract

Purpose

One of the major challenges in the management of familial hypercholesterolemia (FH) is the stratification of cardiovascular risk in asymptomatic subjects. Our purpose is to investigate the performance of clinical scoring systems, Montreal-FH-score (MFHS), SAFEHEART risk (SAFEHEART-RE) and FH risk score (FHRS) equations and Dutch Lipid Clinic Network (DLCN) diagnostic score, in predicting extent and severity of CAD at coronary computed tomography angiography (CCTA) in asymptomatic FH.

Material and methods

One-hundred and thirty-nine asymptomatic FH subjects were prospectively enrolled to perform CCTA. MFHS, FHRS, SAFEHEART-RE and DLCN were assessed for each patient. Atherosclerotic burden scores at CCTA (Agatston score [AS], segment stenosis score [SSS]) and CAD-RADS score were calculated and compared to clinical indices.

Results

Non-obstructive CAD was found in 109 patients, while 30 patients had a CAD-RADS ≥ 3. Classifying the two groups according to AS, values varied significantly for MFHS (p < 0.001), FHRS (p < 0.001) and SAFEHEART-RE (p = 0.047), while according to SSS only MFHS and FHRS showed significant differences (p < 0.001). MFHS, FHRS and SAFEHEART-RE, but not DLCN, showed significant differences between the two CAD-RADS groups (p < .001).

MFHS proved to have the best discriminatory power (AUC = 0.819; 0.703–0.937, p < 0.001) at ROC analysis, followed by FHRS (AUC = 0.795; 0.715–0.875, p < .0001) and SAFEHEART-RE (AUC = .725; .61–.843, p < .001).

Conclusions

Greater values of MFHS, FHRS and SAFEHEART-RE are associated to higher risk of obstructive CAD and might help to select asymptomatic patients that should be referred to CCTA for secondary prevention.

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Hobbs HH, Brown MS, Goldstein JL (1992) Molecular genetics of the LDL receptor gene in familial hypercholesterolemia. Hum Mutat 1(6):445–466. https://doi.org/10.1002/humu.1380010602CrossRefPubMed

De Ferranti SD, Rodday AM, Mendelson MM et al (2016) Prevalence of familial hypercholesterolemia in the 1999 to 2012 United States national health and nutrition examination surveys (NHANES). Circulation 133(11):1067–1072. https://doi.org/10.1161/CIRCULATIONAHA.115.018791CrossRefPubMed

Santos RD, Gidding SS, Hegele RA et al (2016) Defining severe familial hypercholesterolaemia and the implications for clinical management: a consensus statement from the international atherosclerosis society severe familial hypercholesterolemia panel. Lancet Diabetes Endocrinol. https://doi.org/10.1016/S2213-8587(16)30041-9CrossRefPubMed

Besseling J, Hovingh GK, Huijgen R et al (2016) Statins in familial hypercholesterolemia: consequences for coronary artery disease and all-cause mortality. J Am Coll Cardiol 68(3):252–260. https://doi.org/10.1016/j.jacc.2016.04.054CrossRefPubMed

Neil HAW, Seagroatt V, Betteridge DJ et al (2004) Established and emerging coronary risk factors in patients with heterozygous familial hypercholesterolaemia. Heart 90(12):1431–1437. https://doi.org/10.1136/hrt.2003.022764CrossRefPubMedPubMedCentral

Piepoli MF, Hoes AW, Agewall S et al (2017) European guidelines on cardiovascular disease prevention in clinical practice. The sixth joint task force of the european society of cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of 10 societies and by invited experts. Developed with the special contribution of the European association for cardiovascular prevention & rehabilitation. G Ital Cardiol (Rome) 18(7):80–86. https://doi.org/10.1714/2729.27821CrossRef

Paquette M, Dufour R, Baass A (2017) The Montreal-FH-SCORE: a new score to predict cardiovascular events in familial hypercholesterolemia. J Clin Lipidol. https://doi.org/10.1016/j.jacl.2016.10.004CrossRefPubMed

Pérez De Isla L, Alonso R, Mata N et al (2017) Predicting cardiovascular events in familial hypercholesterolemia: The SAFEHEART registry (Spanish Familial Hypercholesterolemia Cohort Study). Circulation. https://doi.org/10.1161/CIRCULATIONAHA.116.024541CrossRefPubMed

Paquette M, Bernard S, Cariou B et al (2021) Familial hypercholesterolemia-risk-score: a new score predicting cardiovascular events and cardiovascular mortality in familial hypercholesterolemia. Arterioscler Thromb Vasc Biol 41:2632–2640. https://doi.org/10.1161/ATVBAHA.121.316106CrossRefPubMed

10.

Miname MH, Bittencourt MS, Nasir K et al (2019) Subclinical coronary atherosclerosis and cardiovascular risk stratification in heterozygous familial hypercholesterolemia patients undergoing statin treatment. Curr Opin Lipidol. https://doi.org/10.1097/MOL.0000000000000573CrossRefPubMed

11.

Nordestgaard BG, Chapman MJ, Humphries SE et al (2013) European atherosclerosis society consensus panel. Familial hypercholesterolaemia is underdiagnosed and undertreated in the general population: guidance for clinicians to prevent coronary heart disease: consensus statement of the European Atherosclerosis Society. Eur Heart J 34(45):3478–90. https://doi.org/10.1093/eurheartj/eht273. (Erratum in: Eur Heart J. 2020 Dec 14;41(47):4517)CrossRefPubMedPubMedCentral

12.

Abdelrahman KM, Chen MY et al (2020) Coronary computed tomography angiography from clinical uses to emerging technologies: JACC state-of-the-art review. J Am Coll Cardiol 76(10):1226–1243. https://doi.org/10.1016/j.jacc.2020.06.076CrossRefPubMedPubMedCentral

13.

Miname MH, Ribeiro MS 2nd, Filho JP et al (2010) Evaluation of subclinical atherosclerosis by computed tomography coronary angiography and its association with risk factors in familial hypercholesterolemia. Atherosclerosis 213(2):486–491. https://doi.org/10.1016/j.atherosclerosis.2010.10.001CrossRefPubMed

14.

Neefjes LA, Ten Kate GJR, Rossi A et al (2011) Accelerated subclinical coronary atherosclerosis in patients with familial hypercholesterolemia. Atherosclerosis 219(2):721–727. https://doi.org/10.1016/j.atherosclerosis.2011.09.052CrossRefPubMed

15.

Pérez de Isla L, Alonso R, Muñiz-Grijalvo O et al (2018) Coronary computed tomographic angiography findings and their therapeutic implications in asymptomatic patients with familial hypercholesterolemia. Lessons from the SAFEHEART study. J Clin Lipidol 12(4):948–957. https://doi.org/10.1016/j.jacl.2018.04.003CrossRefPubMed

16.

Miname MH, Sommer Bittencourt M, Moraes SR et al (2019) Coronary artery calcium and cardiovascular events in patients with familial hypercholesterolemia receiving standard lipid-lowering therapy. JACC Cardiovasc Imaging 12(9):1797–1804. https://doi.org/10.1016/j.jcmg.2018.09.019CrossRefPubMed

17.

Averna M, Cefalù AB, Casula M et al (2017) Familial hypercholesterolemia: the Italian atherosclerosis society network (LIPIGEN). Atheroscler Suppl. https://doi.org/10.1016/j.atherosclerosissup.2017.07.001CrossRefPubMed

18.

Van Aalst-Cohen ES, Jansen ACM, Tanck MWT et al (2006) Diagnosing familial hypercholesterolaemia: the relevance of genetic testing. Eur Heart J 27(18):2240–2246. https://doi.org/10.1093/eurheartj/ehl113CrossRefPubMed

19.

D ‘erasmo L, Minicocci I, Di Costanzo A et al (2021) Clinical implications of monogenic versus polygenic hypercholesterolemia: long-term response to treatment, coronary atherosclerosis burden, and cardiovascular events. J Am Heart Assoc 10(9):85. https://doi.org/10.1161/JAHA.120.018932CrossRef

20.

Futema M, Shah A, Cooper JA et al (2015) Refinement of variant selection for the LDL cholesterol genetic risk score in the diagnosis of the polygenic form of clinical familial hypercholesterolemia and replication in samples from 6 countries. Clin Chem 61(1):231–238. https://doi.org/10.1373/clinchem.2014.231365CrossRefPubMed

21.

Raff GL, Chair Abidov A et al (2003) SCCT guidelines for the interpretation and reporting of coronary computed tomographic angiography. J Cardiovasc Comput Tomogr 3(2):89. https://doi.org/10.1016/j.jcct.2009.01.001CrossRef

22.

Cury RC, Abbara S, Achenbach S et al (2016) CAD-RADSTM coronary artery disease – reporting and data system. An expert consensus document of the society of cardiovascular computed tomography (SCCT), the American college of radiology (ACR) and the North American society for cardiovascular imaging (NASCI). Endorsed by the American college of cardiology. J Cardiovasc Comput Tomogr. 10(4):268–281. https://doi.org/10.1016/j.jcct.2016.04.005CrossRef

23.

Gallo A, Pérez de Isla L, Charrière S et al (2021) The added value of coronary calcium score in predicting cardiovascular events in familial hypercholesterolemia. JACC Cardiovasc Imaging 14(12):2414–2424. https://doi.org/10.1016/j.jcmg.2021.06.011CrossRefPubMed

24.

Béland-Bonenfant S, Paquette M, Fantino M et al (2021) Montreal-FH-SCORE predicts coronary artery calcium score in patients with familial hypercholesterolemia. CJC Open. https://doi.org/10.1016/j.cjco.2020.09.007CrossRefPubMed

25.

Miname MH, Bittencourt MS, Moraes SR et al (2019) Coronary artery calcium and cardiovascular events in patients with familial hypercholesterolemia receiving standard lipid-lowering therapy. JACC Cardiovasc Imaging. https://doi.org/10.1016/j.jcmg.2018.09.019CrossRefPubMed

26.

Kolossváry M, Szilveszter B, Merkely B, Maurovich-Horvat P (2017) Plaque imaging with CT-A comprehensive review on coronary CT angiography based risk assessment. Cardiovasc Diagn Ther. https://doi.org/10.21037/cdt.2016.11.06CrossRefPubMedPubMedCentral

27.

Cheruvu C, Precious B, Naoum C et al (2016) Long term prognostic utility of coronary CT angiography in patients with no modifiable coronary artery disease risk factors: results from the 5 year follow-up of the CONFIRM international multicenter registry. J Cardiovasc Comput Tomogr. https://doi.org/10.1016/j.jcct.2015.12.005CrossRefPubMed

28.

Hadamitzky M, Täubert S, Deseive S et al (2013) Prognostic value of coronary computed tomography angiography during 5 years of follow-up in patients with suspected coronary artery disease. Eur Heart J. https://doi.org/10.1093/eurheartj/eht293CrossRefPubMed

29.

Cho I, Chang HJ, Hartaigh BO et al (2015) Incremental prognostic utility of coronary CT angiography for asymptomatic patients based upon extent and severity of coronary artery calcium: results from the COronary CT angiography evaluation for clinical outcomes international multicenter (CONFIRM) study. Eur Heart J. 36(8):96–99. https://doi.org/10.1093/eurheartj/ehu358CrossRef

30.

Visseren FLJ, MacH F, Smulders YM et al (2021) ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. https://doi.org/10.1093/eurheartj/ehab484CrossRefPubMed

31.

Nordestgaard BG, Chapman MJ, Ray K et al (2010) Lipoprotein(a) as a cardiovascular risk factor: current status. Eur Heart J. https://doi.org/10.1093/eurheartj/ehq386CrossRefPubMedPubMedCentral

32.

Zaid G, Yehudai D, Rosenschein U et al (2010) Coronary artery disease in an asymptomatic population undergoing a multidetector computed tomography (MDCT) coronary angiography. Open Cardiovasc Med J 4:7–13. https://doi.org/10.2174/1874192401004010007CrossRefPubMedPubMedCentral

33.

Muhlestein JB, Lappé DL, Lima JAC et al (2014) Effect of screening for coronary artery disease using ct angiography on mortality and cardiac events in high-risk patients with diabetes: the FACTOR-64 randomized clinical trial. JAMA 312(21):2234–2243. https://doi.org/10.1001/jama.2014.15825CrossRefPubMed

Title: Effectiveness of clinical scores in predicting coronary artery disease in familial hypercholesterolemia: a coronary computed tomography angiography study
Authors: Federica Catapano
Nicola Galea
Giacomo Pambianchi
Laura D’Erasmo
Cristian Borrazzo
Giulia Cundari
Livia Marchitelli
Marianna Maranghi
Ilenia Minicocci
Alessia Di Costanzo
Iacopo Carbone
Marco Francone
Marcello Arca
Carlo Catalano
Publication date: 01-04-2023
Publisher: Springer Milan
Keywords: Hypercholesterolemia
CT Angiography
Published in: La radiologia medica / Issue 4/2023
Print ISSN: 0033-8362
Electronic ISSN: 1826-6983
DOI: https://doi.org/10.1007/s11547-023-01610-z

2024 ESC Congress

Springer Medicine

Effectiveness of clinical scores in predicting coronary artery disease in familial hypercholesterolemia: a coronary computed tomography angiography study

Abstract

Purpose

Material and methods

Results

Conclusions

2024 ESC Congress

Springer Medicine

Abstract

Purpose

Material and methods

Results

Conclusions

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