title: Dyspnea predicts mortality among patients undergoing coronary  computed tomographic angiography.
abstract: The prognostic implications of dyspnea and typical angina in patients referred for coronary CT angiography have not been examined. We examined features associated with incident mortality risk among individuals undergoing coronary computed tomographic angiography (CCTA) presenting with dyspnea, typical angina, and neither of these symptoms. 1147 consecutive individuals without known CAD (mean 61 years, 61.6 %men) undergoing CCTA comprised the study population 132 with dyspnea, 218 with typical angina, and 797 without dyspnea or typical angina (reference group). Mortality risk in relation to dyspnea or typical angina was evaluated with multivariable Cox proportional hazards models compared to reference. In addition, the prognosis associated with dyspnea or typical angina was assessed among age matched subgroups. Patients with dyspnea had a greater prevalence of C70 % stenosis (p\0.001) and coronary segments with plaque (p = 0.02) compared to the other two groups. During a follow-up of 3.1 years, 52 individuals died. By multivariable Cox models, compared to patients in reference group, dyspnea patients experienced higher mortality (HR 2.0, 95 % CI 1.0–4.0, p = 0.049) while typical angina patients did not (HR 1.1, 95 % CI 0.6–2.3, p = 0.76). In the matched group, the patients with dyspnea (HR 2.2, 95 % CI 1.1–4.3, p = 0.03) still had significantly reduced survival compared to the other two groups, while those with typical angina did not (HR 1.2, 95 % CI 0.6–2.6,p = 0.62). Dyspnea is associated with increased mortality ate compared to patients with typical angina and those with neither of these symptoms among patients undergoing CCTA.
authors.affiliation: Department of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA.
authors.forename: Rine
authors.initials: R
authors.lastname: Nakanishi
authors.affiliation: Department of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA.
authors.forename: Heidi
authors.initials: H
authors.lastname: Gransar
authors.affiliation: Division of Cardiology, St. Luke's Roosevelt Hospital, New York, NY, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Rozanski
authors.affiliation: Department of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA.
authors.forename: Jamal S
authors.initials: JS
authors.lastname: Rana
authors.affiliation: Department of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA.|Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
authors.forename: Victor Y
authors.initials: VY
authors.lastname: Cheng
authors.affiliation: Department of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA.|Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
authors.forename: Louise E J
authors.initials: LEJ
authors.lastname: Thomson
authors.affiliation: Department of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA.
authors.forename: Romalisa
authors.initials: R
authors.lastname: Miranda-Peats
authors.affiliation: Department of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA.
authors.forename: Damini
authors.initials: D
authors.lastname: Dey
authors.affiliation: Department of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA.|Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
authors.forename: Sean W
authors.initials: SW
authors.lastname: Hayes
authors.affiliation: Department of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA.|Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Friedman
authors.affiliation: Department of Public Health, Weill Cornell Medical College and the New York Presbyterian Hospital, New York, NY, USA.
authors.forename: James K
authors.initials: JK
authors.lastname: Min
authors.affiliation: Department of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA. Daniel.Berman@cshs.org.|Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA. Daniel.Berman@cshs.org.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Berman
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000401:mortality; D015984:Causality; D015897:Comorbidity; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality*; D004417:Dyspnea / Q000401:mortality*; D005260:Female; D006801:Humans; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D014057:Tomography, X-Ray Computed