title: Relationship of dyspnea vs. typical angina to coronary artery disease severity, burden, composition and location on coronary CT angiography.
abstract: OBJECTIVE
  Symptom presentations suspicious for coronary artery disease (CAD) vary widely. While dyspnea is associated with worse prognosis than typical angina (TypAng) for patients referred for non-invasive CAD imaging, the relation of dyspnea vs. TypAng to adverse measures of CAD prognosis-including severity, burden, composition, and myocardium at risk-has not been examined.
  
  
  METHODS
  We studied 1443 consecutive individuals without known CAD (mean 61 ± 13 years, 61.6% men) undergoing coronary computed tomographic angiography (CCTA) who presented with dyspnea (n = 170), TypAng (n = 249) or no dyspnea or TypAng (n = 1024). Multivariable logistic regression was performed to evaluate the association of dyspnea or TypAng to obstructive CAD (≥70% stenosis), plaque burden (total segments with plaque), composition (noncalcified, partially calcified) and location (proximal, mid, or distal location in a coronary artery).
  
  
  RESULTS
  By multivariable logistic regression, both dyspnea (OR1.9, 95% CI 1.1-3.3, p = 0.02) and TypAng (OR1.9, 95% CI 1.2-3.1, p = 0.01) were associated with obstructive CAD as compared to individuals without dyspnea or TypAng, while dyspnea (OR1.8, 95% CI 1.1-3.1, p = 0.02), but not TypAng (OR1.1, 95% CI 0.7-1.6, p = 0.76) was associated with plaque in the proximal portions of coronary arteries. Neither symptom type was associated with differences in plaque burden nor composition.
  
  
  CONCLUSIONS
  Both dyspnea and TypAng are associated with higher rates of obstructive CAD compared to those without dyspnea or TypAng, but only dyspnea is associated with coronary plaque in proximal vessel portions.
authors: Department of Imaging, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA.
authors: Rine
authors: R
authors: Nakanishi
authors: Jamal S
authors: JS
authors: Rana
authors: Alan
authors: A
authors: Rozanski
authors: Victor Y
authors: VY
authors: Cheng
authors: Heidi
authors: H
authors: Gransar
authors: Louise E J
authors: LE
authors: Thomson
authors: Romalisa
authors: R
authors: Miranda-Peats
authors: Sean W
authors: SW
authors: Hayes
authors: John D
authors: JD
authors: Friedman
authors: Daniel S
authors: DS
authors: Berman
authors: James K
authors: JK
authors: Min
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis* / Q000532:radiotherapy*; D001157:Arterial Occlusive Diseases / Q000473:pathology; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000503:physiopathology*; D003331:Coronary Vessels / Q000473:pathology; D004417:Dyspnea / Q000175:diagnosis* / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D011379:Prognosis; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed
keywords: CCTA; CP; Coronary computed tomographic angiography; Dyspnea; NCP; PCP; Plaque location; Plaque stenosis; SIS; TypAng; Typical angina; calcified plaque; coronary computed tomographic angiography; noncalcified plaque; partially calcified plaque; segment involvement score; typical angina pectoris