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Natural History of Coronary Atherosclerosis in Real-World Stable Chest Pain Patients Underwent Computed Tomography Angiography in Comparison With Invasive Multimodality Imaging (REALITY)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT02440646
Recruitment Status : Terminated (The study is terminated due to cessation of the research collaboration with Russian institutions)
First Posted : May 12, 2015
Last Update Posted : August 30, 2022
Sponsor:
Collaborators:
Ural State Medical University
De Haar Research Task Force
Center of Endosurgery and Lithotripsy, Moscow, Russia
JHWH International Advanced Cardiovascular Imaging Consortium
Medis Medical Imaging Systems B.V.
Pie Medical Imaging B.V.
De Haar Research Foundation
Information provided by (Responsible Party):
Alexander Kharlamov, MD, FESC, FACC, FEACVI, De Haar Research Task Force

Brief Summary:

In a prospective international multicenter observational study, 1080 stable chest pain patients (REALITY Advanced registry of CCTA patients) with the suspected chronic coronary syndrome will be enrolled. All of them will undergo computed tomography angiography, CMR and/ or SPECT, and Echo. One of the cohorts will be examined with multimodality invasive imaging including quantitative coronary angiography, FFR, QFR with or without further percutaneous coronary intervention, OCT, and some of them - with IVUS, VH-IVUS. The plaque size and relevant stenosis, a composition of the atherosclerotic lesion, major adverse cardiovascular events (all-cause death, death from cardiac causes, myocardial infarction, or rehospitalization due to unstable or progressive angina, ischemia-driven revascularization) will be judged to be related to either originally treated (culprit) lesions or untreated (non-culprit) lesions. Moreover, the clinical potential of both non-invasive and invasive imaging, as well as anatomical vs functional modalities in two real-world patient flows, will be estimated with the special focus on the natural progression of atherosclerosis, clinical outcomes, and safety (contrast-induced nephropathy, radiocontrast-induced thyroid dysfunction, and radiation dose). The diagnostic accuracy will be analyzed.

The follow-up period will achieve 12 months prospectively with collected clinical events and imaging outcomes which will be determined at the baseline and 12-month follow-up.

The independent ethics expertise will be provided by the Ural State Medical University (Yekaterinburg, Russia) and Central Clinical Hospital of the Russian Academy of Sciences (Moscow, Russia). The monitoring of the clinical data with imaging as well as further CoreLab expertise (expert-level post-processing multimodal imaging software of Medis Imaging B.V., Leiden, The Netherlands) will be provided by De Haar Research Task Force, Amsterdam-Rotterdam, the Netherlands. FFR-CT is scheduled to be assessed by the ElucidVivo Research Edition software from Elucid Bio, Boston, MA, U.S.A.

The REALITY project is a part of the JHWH (Jahweh) International Advanced Cardiovascular Imaging Consortium. The main objective of the Consortium that is uniting international efforts of both Academia and Industry is a synergistic development of the advanced machine-learning imaging software in order to integrate benefits of both non-invasive and invasive imaging providing the daily clinical practice with the robust tool for the anatomical and functional examination of coronary atherosclerosis, PCI-related arterial remodeling, and relevant myocardial function.


Condition or disease Intervention/treatment
Coronary Atherosclerosis Coronary Artery Disease Contrast-induced Nephropathy Cerebrovascular Disease Alzheimer Disease Chronic Coronary Insufficiency Stable Chronic Angina Radiation: Coronary computed tomography angiography Radiation: Quantitative coronary angiography, intravascular imaging with percutaneous intervention

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Study Type : Observational [Patient Registry]
Actual Enrollment : 1080 participants
Observational Model: Cohort
Time Perspective: Prospective
Target Follow-Up Duration: 1 Year
Official Title: The Natural History of Coronary Atherosclerosis Within the Concept of the Glagovian Arterial Remodeling in REAL-world Stable Chest Pain Population Who Underwent nonInvasive compuTed tomographY Angiography in Comparison With Invasive Quantitative Coronary Angiography and Multimodality Imaging Handled by the Advanced Post-processing Software: Clinical potentIal and Safety
Actual Study Start Date : May 2015
Actual Primary Completion Date : December 2016
Actual Study Completion Date : August 2022


Group/Cohort Intervention/treatment
CCTA group
All stable chest pain comers admitted to the chest-pain outpatient or inpatient cardiac center with the chronic coronary syndrome who underwent functional tests (CMR and/ or SPECT, and Echo are mandatory) and coronary computed tomography angiography (CCTA) without further immediate quantitative coronary angiography (QCA), applicable intravascular imaging (FFR, QFR, OCT, IVUS, VH-IVUS) and/ or percutaneous intervention (PCI).
Radiation: Coronary computed tomography angiography
The coronary arteries will be visualized with the MSCT scan CT 5000 Ingenuity (Philips, The Netherlands) or systems from any other vendors.
Other Name: CCTA

CCTA + Invasive group
All stable chest pain comers admitted to the chest-pain outpatient or inpatient cardiac center with the chronic coronary syndrome who underwent functional tests (CMR, and/ or SPECT, and Echo are mandatory) and coronary computed tomography angiography (CCTA) with further quantitative coronary angiography (QCA), applicable intravascular imaging (FFR, QFR, OCT, IVUS, VH-IVUS) with or without implantation of a stent.
Radiation: Quantitative coronary angiography, intravascular imaging with percutaneous intervention
Coronaries will be shot with Artis zee (Siemens, Germany) or systems from any other vendors. In case if necessary the procedure will be delayed for intravascular imaging (FFR, QFR, OCT, IVUS, VH-IVUS) and/ or percutaneous intervention (with implantation of the medical device).
Other Names:
  • QCA
  • Coronary intravascular imaging




Primary Outcome Measures :
  1. Change of per cent of plaque burden from baseline to follow-up as assessed by either CCTA or QCA [ Time Frame: At 12 months after the baseline imaging procedure ]
    Plaque burden for both culprit and non-culprit lesions will be calculated as a lesion volume (vessel volume-lumen volume)/lumen volume x 100. The variable will be adjusted for computed tomography angiography (CCTA) and quantitative coronary angiography (QCA) including the available methods of both noninvasive (CMR, SPECT) and invasive (OCT, IVUS, VH-IVUS) imaging.

  2. Number of participants with major adverse cardiac events that are related to plaque burden [ Time Frame: At 12 months after the baseline imaging procedure ]
    The composite of cardiac death, cardiac arrest, myocardial infarction, acute coronary syndrome, revascularization by coronary artery bypass surgery (CABG) or percutaneous coronary intervention (PCI), or rehospitalization for angina for patients with both culprit- and non-culprit-lesion-related events. Event rates will be determined at: hospital, at 12 months. The results will be compared with the CCTA-related predictive model of the ElucidVivo Research Edition software from Elucid Bio, Boston, MA, U.S.A.

  3. Head-to-head comparison between non-invasive (CCTA, FFR-CT, CMR, SPECT, Echo) and invasive imaging (QCA, FFR, QFR, OCT, IVUS, VH-IVUS) [ Time Frame: At baseline and 12 months after the baseline imaging procedure ]
    A comparison will be performed to assess the diagnostic accuracy of both noninvasive and invasive imaging approaches for the detection of obstructive coronary artery disease, comprehensive characterization of atherosclerosis. The imaging data will be analyzed by the expert-level post-processing software.

  4. Non-invasive imaging for risk stratification [ Time Frame: At 12 months after the baseline imaging procedure ]
    To determine the prognostic value of CCTA, CMR, SPECT, and Echo handled with the expert-level post-processing software for predicting cardiac death and nonfatal myocardial infarction. The results will be compared with the CCTA-related predictive model of the ElucidVivo Research Edition software from Elucid Bio, Boston, MA, U.S.A.

  5. Invasive imaging for risk stratification [ Time Frame: At 12 months after the baseline imaging procedure ]
    To determine the prognostic value of QCA, FFR, QFR, OCT, IVUS, VH-IVUS, handled with the expert-level post-processing software for predicting cardiac death and nonfatal myocardial infarction. The results will be compared with the CCTA-related predictive model of the ElucidVivo Research Edition software from Elucid Bio, Boston, MA, U.S.A.

  6. Diagnostic accuracy of non-invasive and invasive imaging [ Time Frame: At baseline and 12 months after the baseline imaging procedure ]
    Determining the diagnostic accuracy of stand-alone cardiac imaging modalities including CCTA, CMR, SPECT, Echo, QCA, FFR, QFR, OCT, IVUS, VH-IVUS.

  7. Progression of atherosclerosis and plaque composition in comparison between non-invasive and invasive imaging methods [ Time Frame: At baseline and 12 months after the baseline imaging procedure ]
    The progression of atherosclerosis will be quantitatively characterized by the parameters of the lesions (e.g. plaque burden, cap thickness, arterial remodeling, presence of erosions or rupture, malaposition of stent, a vessel injury score and so on). The imaging data will be handled with the expert-level post-processing software.

  8. Comparison between anatomical and functional imaging modalities [ Time Frame: At baseline and 12 months after the baseline imaging procedure ]
    The anatomical (CCTA, CMR, SPECT, QCA, OCT, IVUS, VH-IVUS) and functional (MSCT, CMR, SPECT, Echo, FFR-CT, FFR, QFR) imaging modalities will be compared to assess the difference between the progression of coronary atherosclerosis, condition of blood flow, and myocardial function in the field of interest. The myocardium will be visualized with the CMR system Ingenia 3.0T (Philips, The Netherlands) or systems from any other vendors.


Secondary Outcome Measures :
  1. Change of serologic markers of inflammation from baseline to follow-up that are related to cardiovascular events and intervention [ Time Frame: At baseline and 12 months after the baseline imaging procedure ]
    Variables will be evaluated for predictive value relative to recurrent events in mmol/L.

  2. Number of participants with procedural success [ Time Frame: At 12 months after the baseline imaging procedure ]
    This is the cumulative variable comprising outcomes of each procedure. Ability to complete the imaging procedures without imaging device or procedure related complication.

  3. Change of complexity of coronary artery disease from baseline to follow-up as assessed by SYNTAX score I [ Time Frame: At baseline and 12 months after the baseline imaging procedure ]
    Calculated with the version 2.11 of the SYNTAX Score I calculator at: hospital, at 12 months. The variable will be adjusted for CCTA and QCA due to technical limitations. CT SYNTAX score I will be calculated within recommendations Papadopoulou SL, et al, 2013 (JACC Cardiovasc Imaging. 2013 Mar;6(3):413-5. doi: 10.1016/j.jcmg.2012.09.013; http://www.syntaxscore.com/calculator/syntaxscore/frameset.htm; https://syntaxscore2020.com/).

  4. Change of complexity of coronary artery disease from baseline to follow-up as assessed by SYNTAX score II [ Time Frame: At baseline and 12 months after the baseline imaging procedure ]
    Calculated with the version 2.11 of the SYNTAX Score II calculator at: hospital, at 12 months. The variable will be adjusted for CCTA and QCA due to technical limitations. CT SYNTAX score II will be calculated within recommendations Papadopoulou SL, et al, 2013 (JACC Cardiovasc Imaging. 2013 Mar;6(3):413-5. doi: 10.1016/j.jcmg.2012.09.013; http://www.syntaxscore.com/calculator/syntaxscore/framesetss2.htm; https://syntaxscore2020.com/).

  5. Change of fractional flow reserve (FFR) from baseline to follow-up that are related to the progress of atherosclerosis [ Time Frame: At baseline and 12 months after the baseline imaging procedure ]
    FFR less than 0.75-0.80 considered as hemodynamically significant and estimated for all the lesions. The variable will be adjusted for CCTA and QCA due to technical limitations. FFR will be compared with other variables (QFR of Medis Suite QFR, FFR-CT) including anatomical and functional imaging such as CCTA/ MSCT, CMR, SPECT, OCT, IVUS, VH-IVUS to evaluate any correlations.

  6. Number of participants with contrast-induced nephropathy (CIN) [ Time Frame: At baseline and 12 months after the baseline imaging procedure ]
    This is the cumulative variable comprising outcomes of each procedure. Mehran's criteria for CIN diagnosis (validated at 48-72 hours after exposure of each imaging procedure) as well as CIN risk score will be assessed.

  7. Number of participants with radiocontrast-induced thyroid dysfunction [ Time Frame: At baseline and 12 months after the baseline imaging procedure ]
    The serum thyroid-stimulating hormone (TSH) will be examined as the initial test for screening. In case of the clinical manifestation of the thyroid dysfunction, the concentrations of the serum TSH, thyroid peroxidase (TPO) antibody titers, free thyroxine (T4) and free triiodothyronine (T3) will be assessed.

  8. Safety of QCA and CCTA as assessed by the calculation of effective radiation dose [ Time Frame: At 12 months after the baseline imaging procedure ]
    The cumulative effective radiation dose (mSv), signal, noise, contrast (mean signal-signal in left ventricular myocardium), signal-to-noise ratio (SNR) and contrast-to-noise (CNR) ratio will be compared.

  9. Change of complexity of coronary artery disease from baseline to follow-up as assessed by Leaman Coronary Score [ Time Frame: At baseline and 12 months after the baseline imaging procedure ]
    Calculated within the recommendations of Leaman DM, et al, 1981 (Circulation 63, No. 2, 1981) at: hospital, at 12 months. The variable will be adjusted for CCTA and QCA due to technical limitations. CT-Leaman score will be calculated within the recommendations of Mushtaq S, et al, 2015 (Circ Cardiovasc Imaging. 2015 Feb;8(2):e002332. doi: 10.1161/CIRCIMAGING.114.002332).

  10. Number of participants with encephalopathy [ Time Frame: At 12 months after the baseline imaging procedure ]
    The clinical manifestation (medical history, mental status testing with the mini-mental state examination (MMSE) and mini-cog, a physical and neurological exam) of degenerative and/ or paroxysmal encephalopathy will be evaluated with multi-slice computed tomography (MSCT)-screening of the cerebrovascular disease and Alzheimer's disease in association with markers of Herpes Simplex Virus Type 1 (HSV-1) and fungi.

  11. Number of chest pain patients with non-obstructive coronary artery disease [ Time Frame: At 12 months after the baseline imaging procedure ]
    Patients with the negative acute markers of the myocardial damage (myoglobin, troponin I, CK, CK-MB, NT-proBNP) and without hemodynamically significant (<50% stenosis) coronary atherosclerosis verified by CCTA.

  12. Number of chest pain patients without coronary artery disease [ Time Frame: At 12 months after the baseline imaging procedure ]
    Patients with the negative acute markers of the myocardial damage (myoglobin, troponin I, CK, CK-MB, NT-proBNP) and without coronary atherosclerosis verified by CCTA.

  13. Change of global longitudinal strain [ Time Frame: At baseline and 12 months after the baseline imaging procedure ]
    Global longitudinal strain (GLS) will be assessed by the TTE (transthoracic echocardiogram) and then compared with the data from CMR, CCTA/ MSCT and SPECT. The findings will be examined with the validated software of Medis Suite Ultrasound/ AMID (https://medisimaging.com/ultrasound; http://www.amid.net/). The data of CMR including time signal intensity (TSI), delayed signal intensity (DSI), T1, T2 analysis will be assessed by the Medis Suite MR and compared with TTE data,

  14. Difference of direct effects between two groups with various imaging strategies on cost-effectiveness calculating cost of imaging testing [ Time Frame: At 12 months after the baseline imaging procedure ]
    Cost of imaging testing in both groups will be calculated and compared in U.S. dollars and then matched with cost of complications due to imaging testing, effects of radiation, effects of contrast material, other complications of noninvasive and invasive imaging, psychological effects of the imaging test. The difference between groups will be assessed.

  15. Difference of indirect effects between two groups with various imaging strategies on cost-effectiveness calculating cost of the treatment [ Time Frame: At 12 months after the baseline imaging procedure ]
    Cost of the treatment in both groups will be calculated and compared in U.S. dollars and then matched with cost of complications of treatment, cost of health outcome, medical pathway, and health outcome depending on a medical decision based on the image test result, psychological effects of the test result. The difference between groups will be assessed.

  16. Change of wall shear stress [ Time Frame: At baseline and 12 months after the baseline imaging procedure ]
    The wall shear stress (WSS) will be assessed using the imaging data of CCTA and QCA in both groups in dynamics from baseline to 12-month follow-up. The data of WSS will be compared with other anatomical and functional imaging modalities as well as clinical outcomes.


Biospecimen Retention:   Samples Without DNA
Blood samples to test the main hypothesis.


Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   40 Years to 79 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Probability Sample
Study Population
All stable chest pain comers with a chronic coronary syndrome without acute angina who underwent CCTA (CMR, and/ or SPECT, and Echo are mandatory) and/ or QCA, applicable intravascular imaging (OCT, IVUS, VH-IVUS) with or without further PCI.
Criteria

Inclusion Criteria:

  • all stable chest pain comers with chronic coronary syndrome or angina equivalent consistent with the manifestation of the stable coronary artery disease (by the 2019 Guidelines on Chronic Coronary Syndrome);
  • age between 40 and 79 years old;
  • patient must have one or two-vessel disease in a native coronary vessel requiring or not requiring PCI without indications for immediate bypass surgery with any SYNTAX score;
  • lesions may be either de novo or restenotic;
  • successful, uncomplicated PCI could be performed in the culprit vessels and all culprit lesions, but there should be no events or complications between the procedures of PCI in the past and six months before admission to the Chest Pain Center;
  • the non-culprit vessel should have no flow-limiting lesions (but any plaque burden) and be available for imaging. The non-culprit vessel must be considered safe for imaging evaluation;

Exclusion Criteria:

  • any acute comorbidities;
  • patient has had a documented ST-elevation acute myocardial infarction within the 24 hours or acute coronary syndrome (unstable angina, myocardial infarction) during four weeks before admission to the Chest Pain Center;
  • patient has had a recent PCI (last 6 months before admission to the Chest Pain Center) unless the patient is undergoing a staged procedure for dual vessel treatment;
  • unprotected left main lesion location;
  • imaging evidence of severe calcification (CCTA calcium scoring with a CAC>1000) or marked tortuosity of the vessel;
  • culprit lesion is located within or distal to an arterial or saphenous vein graft;
  • untreated, significant coronary lesion with a >50-75% diameter stenosis remaining in the culprit vessel after the planned intervention (branch stenosis is permitted) unless allowed by the Heart Team, or the Institutional Review Board (IRB), or the Data Safety and Monitoring Board (DSMB);
  • lesion or vessel contains visible thrombus within the imaging procedure;
  • patient has an additional lesion that requires intervention within 180 days after the initial hospitalization unless allowed by the Heart Team, or the IRB, or the DSMB;
  • any diameter stenosis more than 75% in the non-culprit vessel;
  • indications for immediate bypass surgery within one year of enrollment with the SYNTAX above 34 (including multi-vessel disease requiring intervention in all three major coronary arteries);
  • decompensated hypotension or heart failure requiring intubation, inotropes, intravenous diuretics, or intra-aortic balloon counterpulsation (including the presence of cardiogenic shock);
  • patient has a known left ventricular ejection fraction <40% or history of decompensated congestive heart failure;
  • uncontrolled tachycardia or refractory ventricular arrhythmia;
  • presence of cardiac implants;
  • acute conduction system disease requiring a pacemaker;
  • uncontrolled hypokalemia or digitalis intoxication;
  • uncontrolled arterial hypertension;
  • moderate or severe pulmonary hypertension with pulmonary artery systolic pressure >35 mmHg;
  • severe disorders of blood coagulation system/ coagulopathy;
  • fever; active infective endocarditis; active COVID-19 infection; any active or severe chronic viral infections; sepsis;
  • HIV infection: CDC acute retroviral syndrome/ acute HIV infection, CDC stage 3/ WHO stage 4 (AIDS; the CD4+ cell count is less than 200 or the percent of CD4+ cells is less than 15% of all lymphocytes); however, the subjects of the HIVE trial (NCT04810364) are allowed, but with chronic HIV infection (CDC stages 1, 2/ WHO stages 1, 2, 3) only;
  • tuberculosis;
  • creatinine clearance with GFR of <45 mL/min/1.73 m2 (severe CKD, G3b-G4-G5) by CKD-EPI (2009) or <45 mL/min by Cockroft-Gault (1976); a few reasons are there for these limitations, a) many medications are contraindicated and/ or dosages must be decreased in patients with severe CKD, b) already-in-use metformin with eGFR ≥45 mL/min/1.73 m2 is not an exclusion criterion, and metformin must be not stopped at the time of or before studies with IV contrast or withheld for 48 hours after the procedure, c) to reduce contrast material and radiation dose and therefore to prevent contrast-associated acute kidney injury, all the procedures with intravascular contrast (CCTA, CMR, SPECT, coronary angiography and any related invasive intravascular procedures) cannot be performed altogether subsequently during 24-48 hours, but it must undergo within two weeks with the recommended minimum break time between procedures of 48 hours and proper preventive hydration of the recruited patients.
  • need for dialysis;
  • liver cirrhosis;
  • severe endocrine disorders (diabetes is permitted) including pre-existing thyroid diseases unless allowed by the Heart Team, or the IRB, or the DSMB;
  • patient has a known hypersensitivity, allergy, or contraindication to any of the following: aspirin, heparin, clopidogrel, and ticlopidine, or to contrast (including iodine and gadolinium) that cannot be adequately pre-medicated;
  • severe asthma or chronic obstructive pulmonary disease with FEV-1 below 50%;
  • patient has other severe medical illness or recent history of substance abuse that may cause non-compliance; confound the data interpretation or is associated with an anticipated limited life expectancy of less than one year;
  • stage IV cancer;
  • patient on the transplant waiting list;
  • moderate and severe anemia with hemoglobin below 11.0 g/dL, any severe blood diseases;
  • acute or recent history of gastrointestinal bleeding;
  • pregnancy;
  • stroke or CVA within three months before admission to the Chest Pain Center;
  • mental diseases, claustrophobia, inability for patient cooperation;
  • prior participation in this study or patient is currently enrolled in another investigational use device, imaging, or drug study that has not been reached its primary endpoint.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02440646


Locations
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Estonia
De Haar Research Foundation
Tallinn, Estonia, 10151
Netherlands
De Haar Research Task Force
Amsterdam, North Holland, Netherlands, 1069CD
Russian Federation
Center of Endosurgery and Lithotripsy, Moscow, Russia
Moscow, Russian Federation, 111123
Central Clinical Hospital of the Russian Academy of Sciences
Moscow, Russian Federation, 117593
Sponsors and Collaborators
Central Clinical Hospital of the Russian Academy of Sciences
Ural State Medical University
De Haar Research Task Force
Center of Endosurgery and Lithotripsy, Moscow, Russia
JHWH International Advanced Cardiovascular Imaging Consortium
Medis Medical Imaging Systems B.V.
Pie Medical Imaging B.V.
De Haar Research Foundation
Investigators
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Study Chair: Alexander Kharlamov, M.D., FESC, FACC, FEACVI De Haar Research Task Force, Amsterdam-Rotterdam, The Netherlands
Study Director: Alexey Sozykin, M.D., D.Sc. Central Clinical Hospital of the Russian Academy of Sciences
Additional Information:
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Responsible Party: Alexander Kharlamov, MD, FESC, FACC, FEACVI, Principal investigator and coordinator of the REALITY project, De Haar Research Task Force
ClinicalTrials.gov Identifier: NCT02440646    
Other Study ID Numbers: REALITY Advanced
First Posted: May 12, 2015    Key Record Dates
Last Update Posted: August 30, 2022
Last Verified: August 2022
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided
Plan Description: The specific design of the study makes it infeasible to share the required information with the other researchers. Notwithstanding in case of the scientific inquiries regarding meta-analysis the situation might be considered.

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Alexander Kharlamov, MD, FESC, FACC, FEACVI, De Haar Research Task Force:
Computed tomography angiography
Quantitative coronary angiography
Coronary artery disease
Natural history of atherosclerosis
Radiocontrast-induced thyroid dysfunction
Contrast-induced nephropathy
Plaque burden
Glagovian artery remodeling
Radiation dose
SYNTAX score
Fractional flow reserve
Optical coherence tomography
Intravascular ultrasound
Intravascular imaging
Cardiac magnetic resonance
Echocardiography
Single photon emission computed tomography
Additional relevant MeSH terms:
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Alzheimer Disease
Cerebrovascular Disorders
Kidney Diseases
Coronary Artery Disease
Myocardial Ischemia
Coronary Disease
Atherosclerosis
Angina, Stable
Chest Pain
Dementia
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Tauopathies
Neurodegenerative Diseases
Neurocognitive Disorders
Mental Disorders
Heart Diseases
Cardiovascular Diseases
Arteriosclerosis
Arterial Occlusive Diseases
Vascular Diseases
Urologic Diseases
Pain
Neurologic Manifestations
Angina Pectoris