Associations between dyspnoea, coronary atherosclerosis, and cardiovascular outcomes: results from the long-term follow-up CONFIRM registry

Alexander R. van Rosendael, A. Maxim Bax, Inge J. van den Hoogen, Jeff M. Smit, Subhi J. Al’Aref, Stephan Achenbach, Mouaz H. Al-Mallah, Daniele Andreini, Daniel S. Berman, Matthew J. Budoff, Filippo Cademartiri, Tracy Q. Callister, Hyuk Jae Chang, Kavitha Chinnaiyan, Benjamin J.W. Chow, Ricardo C. Cury, Augustin DeLago, Gudrun Feuchtner, Martin Hadamitzky, Joerg HausleiterPhilipp A. Kaufmann, Yong Jin Kim, Jonathon A. Leipsic, Erica Maffei, Hugo Marques, Pedro de Araújo Gonçalves, Gianluca Pontone, Gilbert L. Raff, Ronen Rubinshtein, Todd C. Villines, Heidi Gransar, Yao Lu, Jessica M. Peña, Fay Y. Lin, Leslee J. Shaw, Jagat Narula, James K. Min, Jeroen J. Bax

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)


Aims The relationship between dyspnoea, coronary artery disease (CAD), and major cardiovascular events (MACE) is poorly understood. This study evaluated (i) the association of dyspnoea with the severity of anatomical CAD by coronary computed tomography angiography (CCTA) and (ii) to which extent CAD explains MACE in patients with dyspnoea. Methods From the international COronary CT Angiography EvaluatioN for Clinical Outcomes: An InteRnational Multicenter and results (CONFIRM) registry, 4425 patients (750 with dyspnoea) with suspected but without known CAD were included and prospectively followed for >_5 years. First, the association of dyspnoea with CAD severity was assessed using logistic regression analysis. Second, the prognostic value of dyspnoea for MACE (myocardial infarction and death), and specifically, the interaction between dyspnoea and CAD severity was investigated using Cox proportional-hazard analysis. Mean patient age was 60.3 ± 11.9 years, 63% of patients were male and 592 MACE events occurred during a median followup duration of 5.4 (IQR 5.1–6.0) years. On uni- and multivariable analysis (adjusting for age, sex, body mass index, chest pain typicality, and risk factors), dyspnoea was associated with two- and three-vessel/left main (LM) obstructive CAD. The presence of dyspnoea increased the risk for MACE [hazard ratio (HR) 1.57, 95% confidence interval (CI): 1.29–1.90], which was modified after adjusting for clinical predictors and CAD severity (HR 1.26, 95% CI: 1.02–1.55). Conversely, when stratified by CAD severity, dyspnoea did not provide incremental prognostic value in one-, two-, or three-vessel/LM obstructive CAD, but dyspnoea did provide incremental prognostic value in non-obstructive CAD. Conclusion In patients with suspected CAD, dyspnoea was independently associated with severe obstructive CAD on CCTA. The severity of obstructive CAD explained the elevated MACE rates in patients presenting with dyspnoea, but in patients with non-obstructive CAD, dyspnoea portended additional risk.

Original languageEnglish
Pages (from-to)266-274
Number of pages9
JournalEuropean heart journal cardiovascular Imaging
Issue number2
Publication statusPublished - 2022 Feb 1

Bibliographical note

Publisher Copyright:
© The Author(s) 2020.

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


Dive into the research topics of 'Associations between dyspnoea, coronary atherosclerosis, and cardiovascular outcomes: results from the long-term follow-up CONFIRM registry'. Together they form a unique fingerprint.

Cite this