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Abstract
An automatic coronary artery tree labeling algorithm is described to identify the anatomical segments of the extracted centerlines from coronary computed tomography angiography (CCTA) images. This method will facilitate the automatic lesion reporting and risk stratification of cardiovascular disease. Three-dimensional (3D) models for both right dominant (RD) and left dominant (LD) coronary circulations were built. All labels in the model were matched with their possible candidates in the extracted tree to find the optimal labeling result. In total, 83 CCTA datasets with 1149 segments were included in the testing of the algorithm. The results of the automatic labeling were compared with those by two experts. In all cases, the proximal parts of main branches including LM were labeled correctly. The automatic labeling algorithm was able to identify and assign labels to 89.2% RD and 83.6% LD coronary tree segments in comparison with the agreements of the two experts (97.6% RD, 87.6% LD). The average precision of start and end points of segments was 92.0% for RD and 90.7% for LD in comparison with the manual identification by two experts while average differences in experts is 1.0% in RD and 2.2% in LD cases. All cases got similar clinical risk scores as the two experts. The presented fully automatic labeling algorithm can identify and assign labels to the extracted coronary centerlines for both RD and LD circulations.
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Murphy DJ, Keraliya A, Himes N, Aghayev A, Blankstein R, Steigner ML. Quantification of radiation dose reduction by reducing z-axis coverage in 320-detector coronary CT angiography. Br J Radiol 2017; 90:20170252. [PMID: 28613933 DOI: 10.1259/bjr.20170252] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To quantify the radiation dose reduction achievable by minimizing z-axis coverage in 320-detector coronary CT angiography (CCTA). METHODS We retrospectively reviewed 130 CCTAs performed on 320-detector CT that offers up to 16 cm z-axis coverage (adjustable in 2-cm increments), allowing complete coverage of the heart in a single gantry rotation. For each CT, we obtained the radiation dose [CT dose index and dose-length product (DLP)], measured the z-axis field of view and measured the craniocaudal cardiac size (distance from the left main coronary artery to the cardiac apex). We calculated the radiation dose savings achievable by reducing the z-axis coverage to the minimum necessary to cover the heart using 320 × 0.5-mm (maximum 16 cm) and 256 × 0.5-mm (maximum 12.8 cm) detector collimations. RESULTS Results are expressed as mean ± standard deviation. The mean craniocaudal cardiac size was 10.5 ± 1.0 cm, with 85% (n = 112) of CCTAs performed with 16 cm of z-axis coverage. The mean DLP was 417.6 ± 182.4 mGy cm, with the mean DLP saving achievable using the minimum z-axis coverage required to completely image the heart being 96.2 ± 47.4 mGy cm, an average dose reduction of 26.9 ± 7.0%. z-axis coverage of ≤12 cm was adequate for 92% and 12.8 cm for 98% of subjects. CONCLUSION Using the minimal z-axis coverage to adequately image the heart is a simple step that can reduce the DLP in 320-detector CCTA by approximately 27%. z-axis coverage of ≤12 cm is adequate for 92%, 12.8 cm for 98% and 14 cm for 100% of patients undergoing CCTA. Advances in knowledge: Reducing z-axis coverage in 320-detector CCTA can reduce DLP by approximately 27%.
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Affiliation(s)
- David J Murphy
- Cardiovascular Imaging Program, Departments of Radiology and Medicine (Cardiovascular Division), Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Abhishek Keraliya
- Cardiovascular Imaging Program, Departments of Radiology and Medicine (Cardiovascular Division), Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Nathan Himes
- Cardiovascular Imaging Program, Departments of Radiology and Medicine (Cardiovascular Division), Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Ayaz Aghayev
- Cardiovascular Imaging Program, Departments of Radiology and Medicine (Cardiovascular Division), Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Ron Blankstein
- Cardiovascular Imaging Program, Departments of Radiology and Medicine (Cardiovascular Division), Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Michael L Steigner
- Cardiovascular Imaging Program, Departments of Radiology and Medicine (Cardiovascular Division), Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Contijoch F, Stayman JW, McVeigh ER. The impact of small motion on the visualization of coronary vessels and lesions in cardiac CT: A simulation study. Med Phys 2017; 44:3512-3524. [PMID: 28432820 DOI: 10.1002/mp.12295] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 02/27/2017] [Accepted: 04/16/2017] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Coronary x-ray computed tomography angiography (CCTA) is used to non-invasively assess coronary artery geometry and has, combined with computational modeling, demonstrated the potential to identify physiologically significant lesions. These measurements require robust and accurate coronary imaging and delineation of vessels despite the presence of small motion. This simulation study characterizes the impact of small, uncorrected vessel drifts during data acquisition on the assessment of vessel intensity, diameter, and shape. METHODS We developed a digital phantom and simulated projection data for a clinical scanner geometry for a range of vessel drifts that can occur during relative vessel stasis (0 to 2 mm per 360° gantry rotation) for vessels between 0.2 and 3.0 mm in diameter (covering 0% through 93% stenosis of a 3 mm vessel). In addition to the impact of vessel drift, we evaluated the performance of half-scan acquisitions (relative to full-scans) over a range of gantry positions. The performance of FDK reconstructions was compared to an iterative technique and potential improvement in sampling from focal spot deflection and quarter detector offset was compared. RESULTS At rest, vessel intensity and diameter were accurately obtained in vessels greater than 1.5 mm with all vessels appearing circular in shape (major-to-minor axis ratio ~1). Vessels between 1.5 and 0.2 mm in diameter demonstrated a rapid decrease in signal intensity with full width half maximum (FWHM) vessel diameters remaining above 0.75 mm as true vessel diameter decreased. Uncorrected vessel motion resulted in decreased vessel intensity, increased vessel diameter, and distortion of vessel shape. The extent of these changes depended on both the position of the gantry as well as the reconstruction approach (half- vs. full-scan). FDK reconstruction results depended on choice of filter with Ram-Lak results yielding comparable performance to an unconstrained iterative reconstruction. Focal spot deflection and quarter detector offset did not result in large changes in performance, likely due to the high sampling density near the isocenter. CONCLUSIONS Despite improvement in gantry speed and acquisition of coronary images during cardiac phases that have relatively stationary vessels, small coronary drifts (0-2 mm per 360° rotation) have been reported and if uncorrected, can present challenges to visual grading and computational modeling of stenoses because vessels will appear dimmer, larger, and more ellipsoidal in shape. The impact of a particular motion depends on the gantry position, the use of half vs. full-scan acquisitions, and the reconstruction technique.
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Affiliation(s)
- Francisco Contijoch
- Department of Medicine, Division of Cardiology, UC San Diego School of Medicine, La Jolla, CA, 92123, USA
| | - J Webster Stayman
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Elliot R McVeigh
- Department of Medicine, Division of Cardiology, UC San Diego School of Medicine, La Jolla, CA, 92123, USA.,Department of Bioengineering, UC San Diego School of Engineering, La Jolla, CA, 92037-0412, USA.,Department of Radiology, UC San Diego School of Medicine, La Jolla, CA, 92123, USA
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54
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Nakahara T, Dweck MR, Narula N, Pisapia D, Narula J, Strauss HW. Coronary Artery Calcification. JACC Cardiovasc Imaging 2017; 10:582-593. [DOI: 10.1016/j.jcmg.2017.03.005] [Citation(s) in RCA: 158] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/23/2017] [Accepted: 03/24/2017] [Indexed: 01/02/2023]
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Moradi M, Nouri S, Nourozi A, Golbidi D. Prognostic Value of Coronary Artery Calcium Score for Determination of Presence and Severity of Coronary Artery Disease. Pol J Radiol 2017; 82:165-169. [PMID: 28392854 PMCID: PMC5378275 DOI: 10.12659/pjr.900643] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 08/10/2016] [Indexed: 11/13/2022] Open
Abstract
Background There are controversies regarding the usefulness of coronary artery calcium score (CACS) for predicting coronary artery stenosis. The aim of this study was to determine the prognostic value of CACS for determining the presence and severity of coronary artery disease (CAD) in patients with sign and symptoms of the disease. Material/Methods In this cross-sectional study, 748 consecutive patients with suspected CAD, referred for coronary computed tomography angiography (CCTA), were enrolled. The mean CACS was compared between patients with different severities of coronary artery stenosis. The association between CACS and different CAD risk factors was determined as well. Different cutoff points of CACS for discriminating between different levels of coronary artery stenosis was determined using receiver operating characteristic (ROC) curves. Results The mean CACS was significantly different between different levels of coronary artery stenosis (P<0.001) and there was a significant positive association between the severity of CAD and CACS (P<0.001,r=0.781). ROC curve analysis indicated that the optimal cutoff point for discriminating between CAD (presence of stenosis) and the non-stenosis condition was 5.35 with 88.6% sensitivity and 86.2% specificity. Area under the curve for different levels of coronary artery stenosis did not have sufficient sensitivity and specificity for discriminating between different levels of CAD severity (<70%). Conclusions The study demonstrated that there is a significant association between CACS and the presence as well as the severity of CAD. CACS could have an appropriate prognostic value for the determination of coronary artery stenosis but not for discriminating between different severities of stenoses.
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Affiliation(s)
- Maryam Moradi
- Department of Radiology, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shadi Nouri
- Department of Radiology, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Nourozi
- Department of Radiology, Sina Hospital, Isfahan, Iran
| | - Danial Golbidi
- Department of Radiology, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
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Karthikeyan G, Guzic Salobir B, Jug B, Devasenapathy N, Alexanderson E, Vitola J, Kraft O, Ozkan E, Sharma S, Purohit G, Dolenc Novak M, Meave A, Trevethan S, Cerci R, Zier S, Gotthardtová L, Jonszta T, Altin T, Soydal C, Patel C, Gulati G, Paez D, Dondi M, Kashyap R. Functional compared to anatomical imaging in the initial evaluation of patients with suspected coronary artery disease: An international, multi-center, randomized controlled trial (IAEA-SPECT/CTA study). J Nucl Cardiol 2017; 24:507-517. [PMID: 27796852 PMCID: PMC5413523 DOI: 10.1007/s12350-016-0664-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 08/14/2016] [Accepted: 08/14/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To test the hypothesis that, in the initial evaluation of patients with suspected coronary artery disease (CAD), stress myocardial perfusion imaging (MPI) would result in less downstream testing than coronary computed tomographic angiography (CCTA). METHODS In this international, randomized trial, mildly symptomatic patients with an intermediate likelihood of having CAD, and asymptomatic patients at intermediate risk of cardiac events, underwent either initial stress-rest MPI or CCTA. The primary outcome was downstream noninvasive or invasive testing at 6 months. Secondary outcomes included cumulative effective radiation dose (ERD) and costs at 12 months. RESULTS We recruited 303 patients (151 MPI and 152 CTA) from 6 centers in 6 countries. The initial MPI was abnormal in 29% (41/143) and CCTA in 56% (79/141) of patients. Fewer patients undergoing initial stress-rest MPI had further downstream testing at 6 months (adjusted OR 0.51, 95% CI 0.28-0.91, P = 0.023). There was a small increase in the median cumulative ERD with MPI (9.6 vs. 8.8 mSv, P = 0.04), but no difference in costs between the two strategies at 12 months. CONCLUSION In the management of patients with suspected CAD, a strategy of initial stress MPI is substantially less likely to require further downstream testing than initial testing with CCTA. TRIAL REGISTRATION clinicaltrials.gov identification number NCT01368770.
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Affiliation(s)
- Ganesan Karthikeyan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Barbara Guzic Salobir
- Department of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Borut Jug
- Department of Vascular Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Erick Alexanderson
- Department of Nuclear Medicine, Ignacio Chávez National Institute of Cardiology, Mexico City, Mexico
| | - Joao Vitola
- Quanta Diagnóstico & Terapia, Curitiba, Brazil
| | - Otakar Kraft
- Department of Nuclear Medicine, Faculty Hospital Ostrava, Ostrava, Czech Republic
| | - Elgin Ozkan
- Department of Nuclear Medicine, Ankara University Medical Faculty, Ankara, Turkey
| | - Saket Sharma
- Indian Institute of Public Health-Delhi, Gurgaon, India
| | - Gaurav Purohit
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Maja Dolenc Novak
- Department of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Aloha Meave
- Department of Radiology, Ignacio Chávez National Institute of Cardiology, Mexico City, Mexico
| | - Sergio Trevethan
- Department of Nuclear Medicine, Ignacio Chávez National Institute of Cardiology, Mexico City, Mexico
| | | | - Sandra Zier
- Quanta Diagnóstico & Terapia, Curitiba, Brazil
| | - Lucia Gotthardtová
- Department of Cardiology, Faculty Hospital Ostrava, Ostrava, Czech Republic
| | - Tomáš Jonszta
- Department of Radiology, Faculty Hospital Ostrava, Ostrava, Czech Republic
| | - Timucin Altin
- Department of Cardiology, Ankara University Medical Faculty, Ankara, Turkey
| | - Cigdem Soydal
- Department of Nuclear Medicine, Ankara University Medical Faculty, Ankara, Turkey
| | - Chetan Patel
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Gurpreet Gulati
- Department of Cardiac Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Diana Paez
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Maurizio Dondi
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Ravi Kashyap
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
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Dowsley TF, Chepelev L, McArdle B, Alam M, Dwivedi G, Chow BJ. Improved diagnostic accuracy when combining computed tomography angiography and corrected coronary opacification in patients with coronary stents. Acta Cardiol 2017; 72:53-60. [PMID: 28597738 DOI: 10.1080/00015385.2017.1281525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background The accuracy of coronary computed tomography angiography (CCTA) is sub-optimal in patients with coronary stents. Methods that can increase its diagnostic accuracy are desirable. Objective A proof-of-concept study was undertaken to determine if corrected coronary opacification (CCO) differences can improve the accuracy of CCTA in stented coronary arteries. Methods PCI patients who underwent both CCTA and invasive coronary angiography (ICA) within 3 months were analyzed. Coronary luminal attenuation values (normalized to the aorta) were measured proximally and distally to coronary stents. CCO differences were evaluated for ability to predict (i) stenosis on invasive angiography, (ii) abnormal resting coronary flow as measured by the corrected thrombolysis in myocardial infarction (TIMI) frame count (cTFC), and (iii) the combination of abnormal resting flow and significant stenosis on invasive angiography. Results Twenty-nine stented coronary arteries (n = 25, mean age =61.4 years, men =80.0%) were assessed. In stented coronary vessels, CCO identified stenosis (≥ 70%) with an area under the curve of 0.767 (P = 0.021). CCO predicted abnormal resting coronary flow with high accuracy (AUC =0.867, P = 0.002). Combined CCTA/CCO identified both abnormal cTFC and stenosis ≥70% on ICA (functionally significant stenosis) with diagnostic accuracy of 92.3%. In contrast, CCTA visual assessment alone had lower diagnostic accuracy of 66.7% for identifying functionally significant stenosis. Conclusion CCO differences are predictive of abnormal resting flow and consequently, in-stent restenosis. Incorporation of this technique may improve the specificity of CCTA in PCI patients.
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Affiliation(s)
- Taylor F. Dowsley
- University of Ottawa Heart Institute, Department of Medicine (Cardiology), Canada
| | - Leonid Chepelev
- University of Ottawa Heart Institute, Department of Medicine (Cardiology), Canada
| | - Brian McArdle
- University of Ottawa Heart Institute, Department of Medicine (Cardiology), Canada
| | - Mohammed Alam
- University of Ottawa Heart Institute, Department of Medicine (Cardiology), Canada
| | - Girish Dwivedi
- University of Ottawa Heart Institute, Department of Medicine (Cardiology), Canada
| | - Benjamin J.W. Chow
- University of Ottawa Heart Institute, Department of Medicine (Cardiology), Canada
- University of Ottawa, Canada Department of Radiology, Canada
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Budoff MJ, Li D, Kazerooni EA, Thomas GS, Mieres JH, Shaw LJ. Diagnostic Accuracy of Noninvasive 64-row Computed Tomographic Coronary Angiography (CCTA) Compared with Myocardial Perfusion Imaging (MPI): The PICTURE Study, A Prospective Multicenter Trial. Acad Radiol 2017; 24:22-29. [PMID: 27771227 DOI: 10.1016/j.acra.2016.09.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 09/05/2016] [Accepted: 09/14/2016] [Indexed: 11/15/2022]
Abstract
RATIONALE AND OBJECTIVES Although multiple studies have shown excellent accuracy statistics for noninvasive angiography by coronary computed tomographic angiography (CCTA), most studies comparing nuclear imaging to CCTA were performed on patients already referred for cardiac catheterization, introducing referral and selection bias. This prospective trial evaluated the diagnostic accuracy of 64-row CCTA to detect obstructive coronary stenosis compared to myocardial perfusion imaging (MPI), using quantitative coronary angiography (QCA) as a reference standard. MATERIALS AND METHODS Twelve sites prospectively enrolled 230 patients (49% male, 57.8 years) with chest pain. All patients underwent MPI and CCTA (Lightspeed VCT/Visipaque 320, GE Healthcare, Milwaukee, WI, USA) prior to invasive coronary angiography (ICA). All patients were evaluated, and those found to have either an abnormal MPI or CCTA were clinically referred for ICA. CCTAs were graded on a 15-segment American Heart Association model by three blinded readers for presence of obstructive stenosis (>50% or >70%); MPI was graded by two blinded readers using a 17-segment model for estimation of the % myocardium ischemic or with stress defects. ICAs were independently graded for % stenosis by QCA. The efficacies of MPI and CCTA were assessed including all vessel segments for per-patient and per-vessel analyses. RESULTS The prevalence of stenosis ≥50% by ICA was 52.1% (25 of 48). The sensitivity of CCTA was significantly higher than nuclear imaging (92.0% vs 54.5%, P < 0.001), with similar specificity (87.0% vs 78.3%) when obstructive disease was defined as ≥50%. CCTA provided superior sensitivity (92.6% vs 59.3%, P < 0.001) and similar specificity (88.9% vs 81.5%) using QCA stenosis ≥70%. For ≥50% stenosis, the computed tomographic angiography odds ratio for ICA disease was 51.75 (95% CI = 8.50-314.94, P < 0.001). For summed stress score ≥5%, the odds ratio for ICA CAD was 12.73 (95% CI = 2.43-66.55, P < 0.001). Using receiver operating characteristic curve analysis, CCTA was better at classifying obstructive coronary artery disease when compared to MPI (area = 0.85 vs 0.71, P < 0.0001). CONCLUSIONS This study represents one of the first prospective multicenter, controlled clinical trials comparing 64-row CCTA to MPI in the same patients, demonstrating superior diagnostic accuracy of CCTA over myocardial perfusion single photon emission computed tomography (MPS) to reliably detect >50% and >70% stenosis in stable chest pain patients.
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Affiliation(s)
- Matthew J Budoff
- Los Angeles Biomedical Research Institute, 1124 W Carson Street, Torrance 90502, California.
| | - Dong Li
- Los Angeles Biomedical Research Institute, 1124 W Carson Street, Torrance 90502, California
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Markham R, Murdoch D, Walters DL, Hamilton-Craig C. Coronary computed tomography angiography and its increasing application in day to day cardiology practice. Intern Med J 2016; 46:29-34. [PMID: 26813899 DOI: 10.1111/imj.12960] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/22/2015] [Accepted: 10/22/2015] [Indexed: 12/22/2022]
Abstract
Coronary artery disease (CAD) is the leading single cause of death in Australia affecting around 1.4 million people. Coronary computed tomography angiography has an established role in the assessment of patients with low to intermediate pretest probability for CAD who have chest pain and is typically used with the aim to rule out significant coronary artery stenosis. Use was initially limited because of concerns over radiation exposure, a Medicare rebate restricted to specialist referrals and an absence of data supporting its use as an alternative to functional testing in patients with chest pain. Recent advances in scanner technology and image sequencing, along with data from randomised control trials, have addressed these issues and indicate that coronary computed tomography angiography will play a greater role in the assessment of CAD in the coming years.
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Affiliation(s)
- R Markham
- Heart and Lung Institute, The Prince Charles Hospital, Brisbane, Australia.,University of Queensland, Brisbane, Australia
| | - D Murdoch
- Heart and Lung Institute, The Prince Charles Hospital, Brisbane, Australia.,University of Queensland, Brisbane, Australia
| | - D L Walters
- Heart and Lung Institute, The Prince Charles Hospital, Brisbane, Australia.,University of Queensland, Brisbane, Australia
| | - C Hamilton-Craig
- Heart and Lung Institute, The Prince Charles Hospital, Brisbane, Australia.,University of Queensland, Brisbane, Australia.,University of Washington, Seattle, Washington, USA
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Lee WH, Nguyen PK, Fleischmann D, Wu JC. DNA damage-associated biomarkers in studying individual sensitivity to low-dose radiation from cardiovascular imaging. Eur Heart J 2016; 37:3075-3080. [PMID: 27272147 PMCID: PMC6279211 DOI: 10.1093/eurheartj/ehw206] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 04/10/2016] [Accepted: 05/04/2016] [Indexed: 12/29/2022] Open
Affiliation(s)
- Won Hee Lee
- Department of Medicine, Division of Cardiology
- Department of Radiology
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Patricia K Nguyen
- Department of Medicine, Division of Cardiology
- Department of Radiology
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Dominik Fleischmann
- Department of Radiology
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Joseph C Wu
- Department of Medicine, Division of Cardiology
- Department of Radiology
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
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61
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Muhlestein JB, Moreno FL. Coronary Computed Tomography Angiography for Screening in Patients with Diabetes: Can Enhanced Detection of Subclinical Coronary Atherosclerosis Improve Outcome? Curr Atheroscler Rep 2016; 18:64. [DOI: 10.1007/s11883-016-0620-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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62
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Sozzi FB, Maiello M, Pelliccia F, Parato VM, Canetta C, Savino K, Lombardi F, Palmiero P. Italian Chapter of the International Society of Cardiovascular Ultrasound expert consensus document on coronary computed tomography angiography: overview and new insights. Echocardiography 2016; 33:1413-8. [DOI: 10.1111/echo.13273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | | | | | | | | | - Ketty Savino
- Hospital Santa Maria della Misericordia; Perugia Italy
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Morris JR, Bellolio MF, Sangaralingham LR, Schilz SR, Shah ND, Goyal DG, Bell MR, Kopecky SL, Gilani WI, Hess EP. Comparative Trends and Downstream Outcomes of Coronary Computed Tomography Angiography and Cardiac Stress Testing in Emergency Department Patients With Chest Pain: An Administrative Claims Analysis. Acad Emerg Med 2016; 23:1022-30. [PMID: 27155236 DOI: 10.1111/acem.13005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/26/2016] [Accepted: 04/27/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Coronary computerized tomography angiography (CCTA) is a rapidly emerging technology for the evaluation of chest pain in the emergency department (ED). We assessed trends in CCTA use and compared downstream healthcare utilization between CCTA and cardiac stress testing modalities. METHODS Using administrative claims data (Optum Labs Data Warehouse) from over 100 million geographically diverse privately insured and Medicare Advantage enrollees across the United States, we identified 2,047,799 ED patients from January 2006 to December 2013 who presented with chest pain and had a CCTA or cardiac stress test within 72 hours. Cohorts were established based on CCTA or functional stress testing (myocardial perfusion scintigraphy [MPS], stress echocardiogram [SE], or treadmill exercise electrocardiogram [TMET]) performed within 72 hours of the ED visit. We tracked subsequent invasive cardiac procedures (invasive coronary angiography [ICA], percutaneous coronary intervention [PCI], and coronary artery bypass grafting [CABG]), repeat noninvasive testing, return ED visits, hospitalization, and the rate of acute myocardial infarction (AMI) within 30 days. We used propensity-score matching to adjust for coronary artery disease (CAD) risk factors, Charlson-Deyo comorbidity index, and baseline differences between patients selected for CCTA or cardiac stress testing. Logistic regression was used to measure adjusted associations between testing modality and outcomes. RESULTS During the study period, CCTA use increased from 0.8% to 4.5% of all cardiac testing within 72 hours, a change of 434% (p-value for trend < 0.001), while rates of other cardiac stress testing modalities decreased (-22% for TMET [p < 0.001]; -11% for SE [p = 0.11]; -6% for MPS [p = 0.04]. After matching, there was no difference in the 30-day rate of AMI between testing modalities. Compared to MPS, CCTA was associated with higher rates of PCI (odds ratio [OR] = 1.25, 95% confidence interval [CI] = 1.04 to 1.51), and CABG (OR = 1.47; 95% CI = 1.03 to 2.13). Compared to SE and treadmill stress testing, CCTA was associated with more invasive procedures, hospitalizations, return ED visits, and repeat noninvasive testing. CONCLUSIONS CCTA use increased fourfold during the study period and was associated with higher rates of PCI, CABG, repeat noninvasive testing, hospitalization, and return ED visits. The authors have no relevant financial information or potential conflicts to disclose.
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Affiliation(s)
- Jacob R Morris
- Mayo Medical School, Mayo Clinic College of Medicine, Rochester, MN
| | - M Fernanda Bellolio
- Division of Emergency Medicine Research, Department of Emergency Medicine, Mayo Clinic, Rochester, MN
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN
| | - Lindsey R Sangaralingham
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN
- Division of Healthcare Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Stephanie R Schilz
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Nilay D Shah
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN
- Division of Healthcare Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
- Optum Labs, Cambridge, MA
| | - Deepi G Goyal
- Division of Emergency Medicine Research, Department of Emergency Medicine, Mayo Clinic, Rochester, MN
| | | | | | - Waqas I Gilani
- Division of Emergency Medicine Research, Department of Emergency Medicine, Mayo Clinic, Rochester, MN
| | - Erik P Hess
- Division of Emergency Medicine Research, Department of Emergency Medicine, Mayo Clinic, Rochester, MN.
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN.
- Division of Healthcare Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN.
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Stillman AE, Gatsonis C, Lima JAC, Black WC, Cormack J, Gareen I, Hoffmann U, Liu T, Mavromatis K, Schnall MD, Udelson JE, Woodard PK. Rationale and design of the Randomized Evaluation of patients with Stable angina Comparing Utilization of noninvasive Examinations (RESCUE) trial. Am Heart J 2016; 179:19-28. [PMID: 27595676 PMCID: PMC5443342 DOI: 10.1016/j.ahj.2016.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 06/12/2016] [Indexed: 11/23/2022]
Abstract
RESCUE is a phase III, randomized, controlled, multicenter, comparative efficacy study, designed to compare two diagnostic imaging/treatment paradigms that use coronary computed tomography angiography (CCTA) or single photon emission computed tomography myocardial perfusion imaging (SPECT MPI) for assisting in the diagnosis of ischemic heart disease in patients with stable angina symptoms, and guiding subsequent treatment. The study is based on the hypothesis that CCTA as a diagnostic tool is associated with no increase in cardiac risk, decreased cost, and reduced radiation exposure compared with SPECT MPI. The RESCUE trial was funded by the Agency for Healthcare Research and Quality (AHRQ) and the American College of Radiology Imaging Network (ACRIN) Fund for Imaging Innovation, began in 2011, and completed in 2014.
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Affiliation(s)
- Arthur E Stillman
- Department of Radiology and Imaging Sciences, Emory University, 1365 Clifton Rd NE Atlanta, GA 30322; Division of Cardiology, Emory University, Atlanta GA.
| | - Constantine Gatsonis
- Center for Statistical Sciences, Brown University, Providence RI; Department of Biostatistics, Brown University School of Public Health, Providence RI
| | - João A C Lima
- Departments of Medicine and Radiology, Johns Hopkins University, Baltimore MD
| | - William C Black
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon NH
| | - Jean Cormack
- Center for Statistical Sciences, Brown University, Providence RI
| | - Ilana Gareen
- Center for Statistical Sciences, Brown University, Providence RI; Department of Epidemiology, Brown University School of Public Health
| | - Udo Hoffmann
- Department of Radiology, Massachusetts General Hospital, Boston MA
| | - Tao Liu
- Center for Statistical Sciences, Brown University, Providence RI; Department of Biostatistics, Brown University School of Public Health, Providence RI
| | | | | | - James E Udelson
- Division of Cardiology, Tufts-New England Medical Center, Boston MA
| | - Pamela K Woodard
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University, St. Louis MO
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Lewis MA, Pascoal A, Keevil SF, Lewis CA. Selecting a CT scanner for cardiac imaging: the heart of the matter. Br J Radiol 2016; 89:20160376. [PMID: 27302494 PMCID: PMC5124932 DOI: 10.1259/bjr.20160376] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 06/01/2016] [Accepted: 06/13/2016] [Indexed: 11/05/2022] Open
Abstract
Coronary angiography to assess the presence and degree of arterial stenosis is an examination now routinely performed on CT scanners. Although developments in CT technology over recent years have made great strides in improving the diagnostic accuracy of this technique, patients with certain characteristics can still be "difficult to image". The various groups will benefit from different technological enhancements depending on the type of challenge they present. Good temporal and spatial resolution, wide longitudinal (z-axis) detector coverage and high X-ray output are the key requirements of a successful CT coronary angiography (CTCA) scan. The requirement for optimal patient dose is a given. The different scanner models recommended for CTCA all excel in different aspects. The specification data presented here for these scanners and the explanation of the impact of the different features should help in making a more informed decision when selecting a scanner for CTCA.
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Affiliation(s)
- Maria A Lewis
- Department of Medical Physics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ana Pascoal
- King's Technology Evaluation Centre (KiTEC), King's College London, London, UK
- Department of Medical Engineering and Physics, King's College Hospital NHS Foundation Trust, London, UK
| | - Stephen F Keevil
- Department of Medical Physics, Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's Technology Evaluation Centre (KiTEC), King's College London, London, UK
- Division of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
| | - Cornelius A Lewis
- King's Technology Evaluation Centre (KiTEC), King's College London, London, UK
- Department of Medical Engineering and Physics, King's College Hospital NHS Foundation Trust, London, UK
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Harden S, Bull R, Bury R, Castellano E, Clayton B, Hamilton M, Morgan-Hughes G, O'Regan D, Padley S, Roditi G, Roobottom C, Stirrup J, Nicol E. The safe practice of CT coronary angiography in adult patients in UK imaging departments. Clin Radiol 2016; 71:722-8. [DOI: 10.1016/j.crad.2016.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 04/02/2016] [Accepted: 04/05/2016] [Indexed: 10/21/2022]
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Nagahara Y, Motoyama S, Sarai M, Ito H, Kawai H, Takakuwa Y, Miyagi M, Shibata D, Takahashi H, Naruse H, Ishii J, Ozaki Y. Eicosapentaenoic acid to arachidonic acid (EPA/AA) ratio as an associated factor of high risk plaque on coronary computed tomography in patients without coronary artery disease. Atherosclerosis 2016; 250:30-7. [DOI: 10.1016/j.atherosclerosis.2016.04.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 04/18/2016] [Accepted: 04/26/2016] [Indexed: 12/13/2022]
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Budoff MJ, Nakazato R, Mancini GJ, Gransar H, Leipsic J, Berman DS, Min JK. CT Angiography for the Prediction of Hemodynamic Significance in Intermediate and Severe Lesions. JACC Cardiovasc Imaging 2016; 9:559-64. [DOI: 10.1016/j.jcmg.2015.08.021] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 07/30/2015] [Accepted: 08/05/2015] [Indexed: 01/01/2023]
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Reconstruction of coronary arteries from X-ray angiography: A review. Med Image Anal 2016; 32:46-68. [PMID: 27054277 DOI: 10.1016/j.media.2016.02.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 01/29/2016] [Accepted: 02/22/2016] [Indexed: 01/18/2023]
Abstract
Despite continuous progress in X-ray angiography systems, X-ray coronary angiography is fundamentally limited by its 2D representation of moving coronary arterial trees, which can negatively impact assessment of coronary artery disease and guidance of percutaneous coronary intervention. To provide clinicians with 3D/3D+time information of coronary arteries, methods computing reconstructions of coronary arteries from X-ray angiography are required. Because of several aspects (e.g. cardiac and respiratory motion, type of X-ray system), reconstruction from X-ray coronary angiography has led to vast amount of research and it still remains as a challenging and dynamic research area. In this paper, we review the state-of-the-art approaches on reconstruction of high-contrast coronary arteries from X-ray angiography. We mainly focus on the theoretical features in model-based (modelling) and tomographic reconstruction of coronary arteries, and discuss the evaluation strategies. We also discuss the potential role of reconstructions in clinical decision making and interventional guidance, and highlight areas for future research.
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Measurement of epicardial fat thickness by transthoracic echocardiography for predicting high-risk coronary artery plaques. Heart Vessels 2016; 31:1758-1766. [PMID: 26833041 DOI: 10.1007/s00380-016-0802-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 01/22/2016] [Indexed: 10/22/2022]
Abstract
Epicardial adipose tissue (EAT) volume is reported to be associated with coronary plaques. We evaluated whether non-invasive measurement of EAT thickness by echocardiography can predict high-risk coronary plaque characteristics determined independently by coronary computed tomography (CT) angiography. We enrolled 406 patients (mean age 63 years, 57 % male) referred for 64-slice CT. EAT was measured on the right ventricle free wall from a parasternal long-axis view at the end of systole. High-risk coronary plaques were defined as low-density plaques (<30 Hounsfield units) with positive remodeling (remodeling index >1.05). Patients were divided into thin or thick EAT groups using a cutoff value derived from receiver operator characteristic curve analysis for discriminating high-risk plaques. The receiver operator characteristic cutoff value was 5.8 mm with a sensitivity of 83 % and specificity of 64 % (area under the curve 0.77, 95 % confidence interval 0.70-0.83, p < 0.01). Compared with the thin EAT group, the thick EAT group had a high prevalence of low-density plaques (4 vs. 24 %, p < 0.01), positive remodeling (39 vs. 60 %, p < 0.01), and high-risk plaques (3 vs. 17 %, p < 0.01). Multiple logistic analysis revealed that thick EAT was a significant predictor of high-risk plaques (odds ratio 7.98, 95 % confidence interval 2.77-22.98, p < 0.01) after adjustment for covariates, including conventional risk factors, visceral adipose tissue area, and medications. The measurement of EAT thickness by echocardiography may provide a non-invasive option for predicting high-risk coronary plaques.
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Vadvala HV, Sayegh K, Moy M, Staziaki PV, Ghoshhajra BB. Salvage of diagnostic quality of image acquired by low-radiation-dose prospectively ECG-triggered coronary CTA during ventricular trigeminy: A case report of a novel image processing method. HeartRhythm Case Rep 2016; 2:20-23. [PMID: 28491624 PMCID: PMC5412625 DOI: 10.1016/j.hrcr.2015.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
| | | | | | | | - Brian B. Ghoshhajra
- Address reprint requests and correspondence: Brian B. Ghoshhajra, Assistant Professor of Radiology, Harvard Medical School, Service Chief, Cardiovascular Imaging, Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114
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Delgado Sánchez-Gracián C, Oca Pernas R, Trinidad López C, Santos Armentia E, Vaamonde Liste A, Vázquez Caamaño M, Tardáguila de la Fuente G. Quantitative myocardial perfusion with stress dual-energy CT: iodine concentration differences between normal and ischemic or necrotic myocardium. Initial experience. Eur Radiol 2015; 26:3199-207. [PMID: 26699372 DOI: 10.1007/s00330-015-4128-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 11/16/2015] [Accepted: 11/17/2015] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To determine whether the quantification of iodine with stress dual-energy computed tomography (DECT-S) allows for the discrimination between a normal and an ischemic or necrotic myocardium using magnetic resonance (MR) as a reference. METHODS This retrospective study was approved by the institutional review board, with waiver of informed consent. Thirty-six cardiac MR and DECT-S images from patients with suspected coronary artery disease were evaluated. Perfusion defects were visually determined, and myocardial iodine concentration was calculated by two observers using DECT colour-coded iodine maps. Iodine concentration differences were calculated using parametric tests. Receiver operating characteristic (ROC) curve analysis was conducted to estimate the optimal iodine concentration threshold for discriminating pathologic myocardium. RESULTS In total, 576 cardiac segments were evaluated. There were differences in mean iodine concentration (p < 0.001) between normal (2.56 ± 0.66 mg/mL), ischemic (1.98 ± 0.36 mg/dL) and infarcted segments (1.35 ± 0.57 mg/mL). A myocardium iodine concentration of 2.1 mg/mL represented the optimal threshold to discriminate between normal and pathologic myocardium (sensitivity 75 %, specificity 73.6 %, area under the curve 0.806). Excellent agreement was found in measured myocardium iodine concentration (intraclass correlation coefficient 0.814). CONCLUSION Cardiac DECT-S with iodine quantification may be useful to differentiate healthy and ischemic or necrotic myocardium. KEY POINTS • DECT-S allows for determination of myocardial iodine concentration as a quantitative perfusion parameter. • A high interobserver correlation exists in measuring myocardial iodine concentration with DECT-S. • Myocardial iodine concentration may be useful in the assessment of patients with CAD.
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Affiliation(s)
| | - Roque Oca Pernas
- Radiology Department, Povisa Hospital, Salamanca, 36211, Vigo, Pontevedra, Spain.
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Agouridis AP, Elisaf MS, Nair DR, Mikhailidis DP. Ear lobe crease: a marker of coronary artery disease? Arch Med Sci 2015; 11:1145-55. [PMID: 26788075 PMCID: PMC4697048 DOI: 10.5114/aoms.2015.56340] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 11/25/2014] [Indexed: 11/17/2022] Open
Abstract
The ear lobe crease (ELC) has been defined as a deep wrinkle that extends backwards from the tragus to the auricle. It has been proposed that ELC is a predictor of coronary artery disease (CAD). In this review, we consider the possible association between ELC and CAD. Our aim is to systematically address all the relevant evidence in this field. There are many studies that support an association between ELC and CAD. However, other studies did not find such an association. A recent meta-analysis supports the hypothesis that ELC could be a marker of CAD. However, several limitations raise doubts as to whether we should accept this link.
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Affiliation(s)
- Aris P. Agouridis
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free London Foundation Trust, Pond Street, London, UK
| | - Moses S. Elisaf
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Devaki R. Nair
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free London Foundation Trust, Pond Street, London, UK
| | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK
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ACR Appropriateness Criteria Acute Nonspecific Chest Pain—Low Probability of Coronary Artery Disease. J Am Coll Radiol 2015; 12:1266-71. [DOI: 10.1016/j.jacr.2015.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 09/03/2015] [Indexed: 11/24/2022]
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Improvement of Image Quality and Diagnostic Performance by an Innovative Motion-Correction Algorithm for Prospectively ECG Triggered Coronary CT Angiography. PLoS One 2015; 10:e0142796. [PMID: 26571417 PMCID: PMC4646467 DOI: 10.1371/journal.pone.0142796] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 10/27/2015] [Indexed: 11/19/2022] Open
Abstract
Objective To investigate the effect of a novel motion-correction algorithm (Snap-short Freeze, SSF) on image quality and diagnostic accuracy in patients undergoing prospectively ECG-triggered CCTA without administering rate-lowering medications. Materials and Methods Forty-six consecutive patients suspected of CAD prospectively underwent CCTA using prospective ECG-triggering without rate control and invasive coronary angiography (ICA). Image quality, interpretability, and diagnostic performance of SSF were compared with conventional multisegment reconstruction without SSF, using ICA as the reference standard. Results All subjects (35 men, 57.6 ± 8.9 years) successfully underwent ICA and CCTA. Mean heart rate was 68.8±8.4 (range: 50–88 beats/min) beats/min without rate controlling medications during CT scanning. Overall median image quality score (graded 1–4) was significantly increased from 3.0 to 4.0 by the new algorithm in comparison to conventional reconstruction. Overall interpretability was significantly improved, with a significant reduction in the number of non-diagnostic segments (690 of 694, 99.4% vs 659 of 694, 94.9%; P<0.001). However, only the right coronary artery (RCA) showed a statistically significant difference (45 of 46, 97.8% vs 35 of 46, 76.1%; P = 0.004) on a per-vessel basis in this regard. Diagnostic accuracy for detecting ≥50% stenosis was improved using the motion-correction algorithm on per-vessel [96.2% (177/184) vs 87.0% (160/184); P = 0.002] and per-segment [96.1% (667/694) vs 86.6% (601/694); P <0.001] levels, but there was not a statistically significant improvement on a per-patient level [97.8 (45/46) vs 89.1 (41/46); P = 0.203]. By artery analysis, diagnostic accuracy was improved only for the RCA [97.8% (45/46) vs 78.3% (36/46); P = 0.007]. Conclusion The intracycle motion correction algorithm significantly improved image quality and diagnostic interpretability in patients undergoing CCTA with prospective ECG triggering and no rate control.
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Galas A, Hryniewiecki T, Michałowska I, Kępka C, Abramczuk E, Orłowska-Baranowska E, Rużyłło W. Aortic valve calcification in 499 consecutive patients referred for computed tomography. Arch Med Sci 2015; 11:952-7. [PMID: 26528335 PMCID: PMC4624733 DOI: 10.5114/aoms.2015.47874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 12/05/2013] [Accepted: 12/10/2013] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Aortic valve calcification (AVC) is the most common cause of aortic stenosis. The aim of the study was to assess the prevalence of aortic valve, coronary artery and aortic calcifications and to evaluate the correlation between calcification of the aortic valve, coronary arteries and aorta. MATERIAL AND METHODS The study included 499 patients aged 60 years and over who underwent coronary computed tomography because of chest pain. Beside coronary artery calcium score (CAC), we evaluated AVC and ascending aorta calcifications (AAC). RESULTS Aortic valve calcification was found in 144 subjects (28.9% of the whole study population). Prevalence of CAC and AAC was higher than AVC and amounted to 73.8% and 54.0%. Prevalence of AVC, CAC and AAC was significantly lower in the group of patients ≤ 70 years than in the group of patients > 70 years of age (p = 0.0002, p < 0.0001, p < 0.0001). Aortic valve calcification was more often observed in men than women (34.7% vs. 25.4%, p = 0.02). Degree of aortic valve calcification was also significantly higher among men than women (median score 4 vs. 0, p = 0.01). Similar observations were true for CAC and AAC, where both prevalence and degree of calcification was higher among men than women. In the whole study population no correlation was noted between AVC and CAC or AAC (p = 0.34, p = 0.85). There was a significant correlation between AAC and CAC (p < 0.0001). CONCLUSIONS Despite some similarities in pathological mechanism and risk factors, a degenerative defect of the aortic valve could be independent of atheromatous lesions in the coronary arteries and aorta.
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Affiliation(s)
- Anna Galas
- Department of Valvular Heart Disease, Institute of Cardiology, Warsaw, Poland
| | - Tomasz Hryniewiecki
- Department of Valvular Heart Disease, Institute of Cardiology, Warsaw, Poland
| | | | - Cezary Kępka
- Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw, Poland
| | - Elżbieta Abramczuk
- Department of Valvular Heart Disease, Institute of Cardiology, Warsaw, Poland
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Plaque Characterization by Coronary Computed Tomography Angiography and the Likelihood of Acute Coronary Events in Mid-Term Follow-Up. J Am Coll Cardiol 2015. [PMID: 26205589 DOI: 10.1016/j.jacc.2015.05.069] [Citation(s) in RCA: 592] [Impact Index Per Article: 65.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Coronary computed tomography angiography (CTA)-verified positive remodeling and low attenuation plaques are considered morphological characteristics of high-risk plaque (HRP) and predict short-term risk of acute coronary syndrome (ACS). OBJECTIVES This study evaluated whether plaque characteristics by CTA predict mid-term likelihood of ACS. METHODS The presence of HRP and significant stenosis (SS) of ≥70% were evaluated in 3,158 patients undergoing CTA. Serial CTA was performed in 449 patients, and plaque progression (PP) was evaluated. Outcomes (fatal and nonfatal ACS) were recorded during follow-up (mean 3.9 ± 2.4 years). RESULTS ACS occurred in 88 (2.8%) patients: 48 (16.3%) of 294 HRP(+) and 40 (1.4%) of 2,864 HRP(-) patients. ACS was also significantly more frequent in SS(+) (36 of 659; 5.5%) than SS(-) patients (52 of 2,499; 2.1%). HRP(+)/SS(+) (19%) and HRP(+)/SS(-) (15%) had higher rates of ACS compared with no-plaque patients (0.6%). Although ACS incidence was relatively low in HRP(-) patients, the cumulative number of patients with ACS developing from HRP(-) lesions (n = 43) was similar to ACS patients with HRP(+) lesions (n = 45). In patients with serial CTA, PP also was an independent predictor of ACS, with HRP (27%; p < 0.0001) and without HRP (10%) compared with HRP(-)/PP(-) patients (0.3%). CONCLUSIONS CTA-verified HRP was an independent predictor of ACS. However, the cumulative number of ACS patients with HRP(-) was similar to patients with HRP(+). Additionally, plaque progression detected by serial CTA was an independent predictor of ACS.
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Computed tomography segmental calcium score (SCS) to predict stenosis severity of calcified coronary lesions. Int J Cardiovasc Imaging 2015; 31:1663-75. [DOI: 10.1007/s10554-015-0750-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 07/29/2015] [Indexed: 11/26/2022]
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Mols RE, Jensen JM, Sand NP, Fuglesang C, Bagdat D, Vedsted P, Bøtker HE, Nielsen LH, Nørgaard BL. Visualization of Coronary Artery Calcification: Influence on Risk Modification. Am J Med 2015; 128:1023.e23-31. [PMID: 25910787 DOI: 10.1016/j.amjmed.2015.03.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 03/27/2015] [Accepted: 03/27/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Direct health provider to patient presentation of coronary computed tomography angiography findings may increase adherence to preventive therapy and risk modification. The purpose of this study was to assess the influence of visualization of coronary artery calcification and lifestyle recommendations on cholesterol concentrations and other risk variables in symptomatic patients with nonobstructive coronary artery disease and hyperlipidemia. METHODS We performed a prospective 2-center randomized controlled trial. Patients were randomized 1:1 to intervention or standard follow-up in general practice. The primary end point was change in plasma total cholesterol concentration at 6 months follow-up. RESULTS We included 189 patients (mean [± standard deviation] age 61 [12] years, 57% were male). Median (range) Agatston score was 166 (70-2054). The reduction in plasma total cholesterol concentrations tended to be higher in the intervention group than in the control group, 51.04 mg/dL versus 45.63 mg/dL (P = .181). In a subgroup including patients continuing statin therapy during follow-up (n = 147), the reduction in plasma total cholesterol concentrations was more pronounced in the intervention group than in the control group, 66.13 mg/dL versus 55.68 mg/dL (P = .027). In the intervention group, there was a higher degree of statin adherence and a higher proportion of patients who stopped smoking and commenced healthier dietary behavior than in the control group. CONCLUSIONS Visualization of coronary artery calcification and brief recommendations about risk modification after coronary computed tomography angiography in symptomatic patients with nonobstructive coronary artery disease and hyperlipidemia may have a favorable influence on plasma total cholesterol concentration, adherence to statin therapy, and risk behavior. Further investigations are needed.
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Affiliation(s)
- Rikke E Mols
- Department of Cardiology, Lillebaelt Hospital-Vejle, Vejle, Denmark
| | - Jesper M Jensen
- Department of Cardiology, Aarhus University Hospital-Skejby, Aarhus, Denmark
| | - Niels Peter Sand
- Department of Cardiology, Hospital of South West Denmark-Esbjerg and The Regional Unit of Health Research, University of Southern Denmark, Esbjerg, Denmark
| | - Charlotte Fuglesang
- Department of Cardiology, Aarhus University Hospital-Skejby, Aarhus, Denmark
| | - Døne Bagdat
- Department of Cardiology, Hospital of South West Denmark-Esbjerg and The Regional Unit of Health Research, University of Southern Denmark, Esbjerg, Denmark
| | - Peter Vedsted
- Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital-Skejby, Aarhus, Denmark
| | - Lene H Nielsen
- Department of Cardiology, Lillebaelt Hospital-Vejle, Vejle, Denmark
| | - Bjarne L Nørgaard
- Department of Cardiology, Aarhus University Hospital-Skejby, Aarhus, Denmark.
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Garcia MJ, Blankstein R, Budoff MJ, Dent JM, Drachman DE, Lesser JR, Grover-McKay M, Schussler JM, Voros S, Wann LS. COCATS 4 Task Force 7: Training in Cardiovascular Computed Tomographic Imaging : Endorsed by the American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Atherosclerosis Imaging and Prevention, and the Society of Cardiovascular Computed Tomography. J Nucl Cardiol 2015; 22:826-39. [PMID: 26134884 DOI: 10.1007/s12350-015-0163-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Mario J Garcia
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA,
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Deseive S, Chen MY, Korosoglou G, Leipsic J, Martuscelli E, Carrascosa P, Mirsadraee S, White C, Hadamitzky M, Martinoff S, Menges AL, Bischoff B, Massberg S, Hausleiter J. Prospective Randomized Trial on Radiation Dose Estimates of CT Angiography Applying Iterative Image Reconstruction. JACC Cardiovasc Imaging 2015; 8:888-96. [DOI: 10.1016/j.jcmg.2015.02.024] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 01/03/2015] [Accepted: 02/05/2015] [Indexed: 12/15/2022]
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Nguyen PK, Lee WH, Li YF, Hong WX, Hu S, Chan C, Liang G, Nguyen I, Ong SG, Churko J, Wang J, Altman RB, Fleischmann D, Wu JC. Assessment of the Radiation Effects of Cardiac CT Angiography Using Protein and Genetic Biomarkers. JACC Cardiovasc Imaging 2015. [PMID: 26210695 DOI: 10.1016/j.jcmg.2015.04.016] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate whether radiation exposure from cardiac computed tomographic angiography (CTA) is associated with deoxyribonucleic acid (DNA) damage and whether damage leads to programmed cell death and activation of genes involved in apoptosis and DNA repair. BACKGROUND Exposure to radiation from medical imaging has become a public health concern, but whether it causes significant cell damage remains unclear. METHODS We conducted a prospective cohort study in 67 patients undergoing cardiac CTA between January 2012 and December 2013 in 2 U.S. medical centers. Median blood radiation exposure was estimated using phantom dosimetry. Biomarkers of DNA damage and apoptosis were measured by flow cytometry, whole genome sequencing, and single cell polymerase chain reaction. RESULTS The median dose length product was 1,535.3 mGy·cm (969.7 to 2,674.0 mGy·cm). The median radiation dose to the blood was 29.8 mSv (18.8 to 48.8 mSv). Median DNA damage increased 3.39% (1.29% to 8.04%, p < 0.0001) and median apoptosis increased 3.1-fold (interquartile range [IQR]: 1.4- to 5.1-fold, p < 0.0001) post-radiation. Whole genome sequencing revealed changes in the expression of 39 transcription factors involved in the regulation of apoptosis, cell cycle, and DNA repair. Genes involved in mediating apoptosis and DNA repair were significantly changed post-radiation, including DDB2 (1.9-fold [IQR: 1.5- to 3.0-fold], p < 0.001), XRCC4 (3.0-fold [IQR: 1.1- to 5.4-fold], p = 0.005), and BAX (1.6-fold [IQR: 0.9- to 2.6-fold], p < 0.001). Exposure to radiation was associated with DNA damage (odds ratio [OR]: 1.8 [1.2 to 2.6], p = 0.003). DNA damage was associated with apoptosis (OR: 1.9 [1.2 to 5.1], p < 0.0001) and gene activation (OR: 2.8 [1.2 to 6.2], p = 0.002). CONCLUSIONS Patients exposed to >7.5 mSv of radiation from cardiac CTA had evidence of DNA damage, which was associated with programmed cell death and activation of genes involved in apoptosis and DNA repair.
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Affiliation(s)
- Patricia K Nguyen
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California; Veterans Administration Palo Alto, Palo Alto, California; Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, California.
| | - Won Hee Lee
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California; Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, California
| | - Yong Fuga Li
- Department of Genetics, Stanford University School of Medicine, Stanford, California
| | - Wan Xing Hong
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California; Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, California
| | - Shijun Hu
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California; Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, California
| | - Charles Chan
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Grace Liang
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Ivy Nguyen
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Sang-Ging Ong
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California; Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, California
| | - Jared Churko
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California; Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, California
| | - Jia Wang
- Environmental Health and Safety, Stanford University School of Medicine, Stanford, California
| | - Russ B Altman
- Department of Genetics, Stanford University School of Medicine, Stanford, California
| | - Dominik Fleischmann
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California; Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Joseph C Wu
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California; Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, California; Department of Radiology, Stanford University School of Medicine, Stanford, California.
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Hell MM, Achenbach S, Shah PK, Berman DS, Dey D. Noncalcified Plaque in Cardiac CT: Quantification and Clinical Implications. CURRENT CARDIOVASCULAR IMAGING REPORTS 2015. [DOI: 10.1007/s12410-015-9343-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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86
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Gao Y, Lu B, Hou ZH, Yu FF, Yin WH, Wang ZQ, Wu YJ, Mu CW, Meinel FG, McQuiston AD, Schoepf UJ. Coronary In-Stent Restenosis: Assessment with Corrected Coronary Opacification Difference across Coronary Stents Measured with CT Angiography. Radiology 2015; 275:403-12. [DOI: 10.1148/radiol.14140820] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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87
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Kikuchi K, Une D, Suzuki K, Endo Y, Matsuyama T, Osaka SI, Kurata A. Off-Pump Minimally Invasive Coronary Artery Bypass Grafting with a Heart Positioner Direct Retraction for a Better Exposure. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2015. [DOI: 10.1177/155698451501000307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Keita Kikuchi
- Division of Cardiovascular Surgery, Yamato Seiwa Hospital, Kanagawa, Japan
| | - Dai Une
- Division of Cardiovascular Surgery, Yamato Seiwa Hospital, Kanagawa, Japan
| | - Koutaro Suzuki
- Division of Cardiovascular Surgery, Yamato Seiwa Hospital, Kanagawa, Japan
| | - Yoshiki Endo
- Division of Cardiovascular Surgery, Yamato Seiwa Hospital, Kanagawa, Japan
| | | | - Shin-ichi Osaka
- Division of Cardiovascular Surgery, Yamato Seiwa Hospital, Kanagawa, Japan
| | - Atsushi Kurata
- Division of Cardiovascular Surgery, Yamato Seiwa Hospital, Kanagawa, Japan
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Kikuchi K, Une D, Suzuki K, Endo Y, Matsuyama T, Osaka SI, Kurata A. Off-Pump Minimally Invasive Coronary Artery Bypass Grafting with a Heart Positioner Direct Retraction for a Better Exposure. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2015; 10:183-7. [DOI: 10.1097/imi.0000000000000167] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective Lateral and inferior territories are difficult to expose during off-pump minimally invasive coronary artery bypass grafting (MICS CABG). The use of cardiopulmonary bypass is required at times. We initiated a direct retraction method by using a cardiac positioner for a better exposure, in order to complete off-pump, multivessel MICS CABG safely. Methods We recently initiated multivessel MICS CABG, performed via a 6- to 9-cm left thoracotomy. For distal anastomoses, the lateral pericardial edge was pulled to the chest wall to optimize exposure of the lateral and inferior area. Next, a single- or multisuction cardiac positioner was put on the sides of the target vessel through the small thoracotomy and pulled directly toward the incision. Finally, a distal anastomosis was made with an epicardial stabilizer via the thoracotomy, as in standard off-pump CABG. Results There was no mortality or conversion to sternotomy. A total of 10 cases were targeted for off-pump multivessel MICS CABG with this approach. Nine were completed, while 1 still required pump assist. The average number of distal anastomoses was 2.8 ± 0.8. Two were successful off-pump quadruple bypass grafting with sequential anastomoses. All patients were discharged and remain well to this day. Conclusions Most multivessel MICS CABG was feasible without pump assist even at the initiation period. This approach is easy and helpful in providing good exposure of target vessels without requirement of additional incisions.
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Affiliation(s)
- Keita Kikuchi
- Division of Cardiovascular Surgery, Yamato Seiwa Hospital, Kanagawa, Japan
| | - Dai Une
- Division of Cardiovascular Surgery, Yamato Seiwa Hospital, Kanagawa, Japan
| | - Koutaro Suzuki
- Division of Cardiovascular Surgery, Yamato Seiwa Hospital, Kanagawa, Japan
| | - Yoshiki Endo
- Division of Cardiovascular Surgery, Yamato Seiwa Hospital, Kanagawa, Japan
| | | | - Shin-ichi Osaka
- Division of Cardiovascular Surgery, Yamato Seiwa Hospital, Kanagawa, Japan
| | - Atsushi Kurata
- Division of Cardiovascular Surgery, Yamato Seiwa Hospital, Kanagawa, Japan
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Douglas PS, Hoffmann U, Patel MR, Mark DB, Al-Khalidi HR, Cavanaugh B, Cole J, Dolor RJ, Fordyce CB, Huang M, Khan MA, Kosinski AS, Krucoff MW, Malhotra V, Picard MH, Udelson JE, Velazquez EJ, Yow E, Cooper LS, Lee KL. Outcomes of anatomical versus functional testing for coronary artery disease. N Engl J Med 2015; 372:1291-300. [PMID: 25773919 PMCID: PMC4473773 DOI: 10.1056/nejmoa1415516] [Citation(s) in RCA: 1055] [Impact Index Per Article: 117.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Many patients have symptoms suggestive of coronary artery disease (CAD) and are often evaluated with the use of diagnostic testing, although there are limited data from randomized trials to guide care. METHODS We randomly assigned 10,003 symptomatic patients to a strategy of initial anatomical testing with the use of coronary computed tomographic angiography (CTA) or to functional testing (exercise electrocardiography, nuclear stress testing, or stress echocardiography). The composite primary end point was death, myocardial infarction, hospitalization for unstable angina, or major procedural complication. Secondary end points included invasive cardiac catheterization that did not show obstructive CAD and radiation exposure. RESULTS The mean age of the patients was 60.8±8.3 years, 52.7% were women, and 87.7% had chest pain or dyspnea on exertion. The mean pretest likelihood of obstructive CAD was 53.3±21.4%. Over a median follow-up period of 25 months, a primary end-point event occurred in 164 of 4996 patients in the CTA group (3.3%) and in 151 of 5007 (3.0%) in the functional-testing group (adjusted hazard ratio, 1.04; 95% confidence interval, 0.83 to 1.29; P=0.75). CTA was associated with fewer catheterizations showing no obstructive CAD than was functional testing (3.4% vs. 4.3%, P=0.02), although more patients in the CTA group underwent catheterization within 90 days after randomization (12.2% vs. 8.1%). The median cumulative radiation exposure per patient was lower in the CTA group than in the functional-testing group (10.0 mSv vs. 11.3 mSv), but 32.6% of the patients in the functional-testing group had no exposure, so the overall exposure was higher in the CTA group (mean, 12.0 mSv vs. 10.1 mSv; P<0.001). CONCLUSIONS In symptomatic patients with suspected CAD who required noninvasive testing, a strategy of initial CTA, as compared with functional testing, did not improve clinical outcomes over a median follow-up of 2 years. (Funded by the National Heart, Lung, and Blood Institute; PROMISE ClinicalTrials.gov number, NCT01174550.).
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Affiliation(s)
- Pamela S Douglas
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (P.S.D., M.R.P., D.B.M., H.R.A.-K., R.J.D., C.B.F., M.H., A.S.K., M.W.K., E.J.V., E.Y., K.L.L.); Massachusetts General Hospital, Harvard Medical School (U.H., M.H.P.), and Tufts Medical Center, Tufts University School of Medicine (J.E.U.) - both in Boston; New Mexico Heart Institute, Albuquerque (B.C.); Cardiology Associates, Mobile, AL (J.C.); North Dallas Research Associates, Dallas (M.A.K.); Cardiac Study Group, Puyallup, WA (V.M.); and the National Heart, Lung, and Blood Institute, Bethesda, MD (L.S.C.)
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90
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Wang LF, Tao LW, Huang MX, Liao WB, Zhu YZ, Zhou WB, Li H, Li D, Lu HT, Zhang BZ, Chen Z. Clinical Evaluation of Coronary In-Stent Restenosis Using Dual-Source Computed Tomography. Echocardiography 2015; 32:1681-7. [PMID: 25816917 DOI: 10.1111/echo.12932] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Lian-Fa Wang
- Department of Cardiology; People's Liberation Army No. 105 Hospital; Hefei Anhui China
| | - Li-Wei Tao
- Department of Cardiothoracic Surgery; The Second People's Hospital of Fuyang City; Fuyang Anhui China
| | - Meng-Xun Huang
- Department of Cardiology; People's Liberation Army No. 105 Hospital; Hefei Anhui China
| | - Wen-Bin Liao
- Department of Cardiology; People's Liberation Army No. 105 Hospital; Hefei Anhui China
| | - You-Zhi Zhu
- Department of Radiology; People's Liberation Army No. 105 Hospital; Hefei Anhui China
| | - Wen-Bing Zhou
- Department of Cardiology; People's Liberation Army No. 105 Hospital; Hefei Anhui China
| | - Hua Li
- Department of Cardiology; People's Liberation Army No. 105 Hospital; Hefei Anhui China
| | - Dan Li
- Department of Cardiology; People's Liberation Army No. 105 Hospital; Hefei Anhui China
| | - Hong-Tao Lu
- Department of Cardiology; People's Liberation Army No. 105 Hospital; Hefei Anhui China
| | - Bang-Zhu Zhang
- Department of Cardiology; People's Liberation Army No. 105 Hospital; Hefei Anhui China
| | - Zhen Chen
- Department of Cardiology; People's Liberation Army No. 105 Hospital; Hefei Anhui China
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Garcia MJ, Blankstein R, Budoff MJ, Dent JM, Drachman DE, Lesser JR, Grover-McKay M, Schussler JM, Voros S, Wann LS. COCATS 4 Task Force 7: Training in Cardiovascular Computed Tomographic Imaging. J Am Coll Cardiol 2015; 65:1810-21. [PMID: 25777650 DOI: 10.1016/j.jacc.2015.03.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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92
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Optimizing Contrast Media Injection Protocols in State-of-the Art Computed Tomographic Angiography. Invest Radiol 2015; 50:161-7. [DOI: 10.1097/rli.0000000000000119] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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93
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Deux JF, Mihalache CI, Legou F, Damy T, Mayer J, Rappeneau S, Planté-Bordeneuve V, Luciani A, Kobeiter H, Rahmouni A. Noninvasive detection of cardiac amyloidosis using delayed enhanced MDCT: a pilot study. Eur Radiol 2015; 25:2291-7. [DOI: 10.1007/s00330-015-3642-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 01/17/2015] [Accepted: 01/30/2015] [Indexed: 10/24/2022]
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Cardim N, Galderisi M, Edvardsen T, Plein S, Popescu BA, D'Andrea A, Bruder O, Cosyns B, Davin L, Donal E, Freitas A, Habib G, Kitsiou A, Petersen SE, Schroeder S, Lancellotti P, Camici P, Dulgheru R, Hagendorff A, Lombardi M, Muraru D, Sicari R. Role of multimodality cardiac imaging in the management of patients with hypertrophic cardiomyopathy: an expert consensus of the European Association of Cardiovascular Imaging Endorsed by the Saudi Heart Association. Eur Heart J Cardiovasc Imaging 2015; 16:280. [PMID: 25650407 DOI: 10.1093/ehjci/jeu291] [Citation(s) in RCA: 190] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Taking into account the complexity and limitations of clinical assessment in hypertrophic cardiomyopathy (HCM), imaging techniques play an essential role in the evaluation of patients with this disease. Thus, in HCM patients, imaging provides solutions for most clinical needs, from diagnosis to prognosis and risk stratification, from anatomical and functional assessment to ischaemia detection, from metabolic evaluation to monitoring of treatment modalities, from staging and clinical profiles to follow-up, and from family screening and preclinical diagnosis to differential diagnosis. Accordingly, a multimodality imaging (MMI) approach (including echocardiography, cardiac magnetic resonance, cardiac computed tomography, and cardiac nuclear imaging) is encouraged in the assessment of these patients. The choice of which technique to use should be based on a broad perspective and expert knowledge of what each technique has to offer, including its specific advantages and disadvantages. Experts in different imaging techniques should collaborate and the different methods should be seen as complementary, not as competitors. Each test must be selected in an integrated and rational way in order to provide clear answers to specific clinical questions and problems, trying to avoid redundant and duplicated information, taking into account its availability, benefits, risks, and cost.
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MESH Headings
- Cardiac Imaging Techniques/methods
- Cardiac Imaging Techniques/standards
- Cardiomyopathy, Hypertrophic/diagnosis
- Cardiomyopathy, Hypertrophic/therapy
- Consensus
- Echocardiography, Doppler/methods
- Echocardiography, Doppler/standards
- Europe
- Female
- Humans
- Image Interpretation, Computer-Assisted
- Magnetic Resonance Imaging, Cine/methods
- Magnetic Resonance Imaging, Cine/standards
- Male
- Multimodal Imaging/methods
- Multimodal Imaging/standards
- Positron-Emission Tomography/methods
- Positron-Emission Tomography/standards
- Practice Guidelines as Topic/standards
- Role
- Saudi Arabia
- Societies, Medical/standards
- Tomography, X-Ray Computed/methods
- Tomography, X-Ray Computed/standards
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Divakaran S, Cheezum MK, Hulten EA, Bittencourt MS, Silverman MG, Nasir K, Blankstein R. Use of cardiac CT and calcium scoring for detecting coronary plaque: implications on prognosis and patient management. Br J Radiol 2014; 88:20140594. [PMID: 25494818 DOI: 10.1259/bjr.20140594] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Clinicians often use risk factor-based calculators to estimate an individual's risk of developing cardiovascular disease. Non-invasive cardiovascular imaging, particularly coronary artery calcium (CAC) scoring and coronary CT angiography (CTA), allows for direct visualization of coronary atherosclerosis. Among patients without prior coronary artery disease, studies examining CAC and coronary CTA have consistently shown that the presence, extent and severity of coronary atherosclerosis provide additional prognostic information for patients beyond risk factor-based scores alone. This review will highlight the basics of CAC scoring and coronary CTA and discuss their role in impacting patient prognosis and management.
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Affiliation(s)
- S Divakaran
- 1 Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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96
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Funabashi N, Uehara M, Takaoka H, Ozawa K, Kushida S, Kanda J, Fujimoto Y, Kobayashi Y. A two center 320 slice CT study for evaluating coronary arteries in subjects with chronic atrial fibrillation: A comparison of prospective and retrospective ECG-gating acquisition. Int J Cardiol 2014; 177:374-9. [DOI: 10.1016/j.ijcard.2014.07.126] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 07/26/2014] [Indexed: 10/24/2022]
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97
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Budoff MJ, Liu S, Chow D, Flores F, Hsieh B, Gebow D, DeFrance T, Ahmadi N. Coronary CT angiography versus standard of care strategies to evaluate patients with potential coronary artery disease; effect on long term clinical outcomes. Atherosclerosis 2014; 237:494-8. [DOI: 10.1016/j.atherosclerosis.2014.09.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 09/13/2014] [Accepted: 09/22/2014] [Indexed: 01/07/2023]
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98
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Fihn SD, Blankenship JC, Alexander KP, Bittl JA, Byrne JG, Fletcher BJ, Fonarow GC, Lange RA, Levine GN, Maddox TM, Naidu SS, Ohman EM, Smith PK, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH, DeMets D, Guyton RA, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Thorac Cardiovasc Surg 2014; 149:e5-23. [PMID: 25827388 DOI: 10.1016/j.jtcvs.2014.11.002] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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99
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Mody PS, Wang Y, Geirsson A, Kim N, Desai MM, Gupta A, Dodson JA, Krumholz HM. Trends in aortic dissection hospitalizations, interventions, and outcomes among medicare beneficiaries in the United States, 2000-2011. Circ Cardiovasc Qual Outcomes 2014; 7:920-8. [PMID: 25336626 PMCID: PMC4380171 DOI: 10.1161/circoutcomes.114.001140] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 08/27/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND The epidemiology of aortic dissection (AD) has not been well described among older persons in the United States. It is not known whether advancements in AD care over the last decade have been accompanied by changes in outcomes. METHODS AND RESULTS The Inpatient Medicare data from 2000 to 2011 were used to determine trends in hospitalization rates for AD. Mortality rates were ascertained through corresponding vital status files. A total of 32 057 initial AD hospitalizations were identified. The overall hospitalization rate for AD remained unchanged at 10 per 100 000 person-years. For 30-day and 1-year mortality associated with AD, the observed rate decreased from 31.8% to 25.4% (difference, 6.4%; 95% confidence interval [CI], 6.2-6.5; adjusted, 6.4%; 95% CI, 5.7-6.9) and from 42.6% to 37.4% (difference, 5.2%; 95% CI, 5.1-5.2; adjusted, 6.2%; 95% CI, 5.3-6.7), respectively. For patients undergoing surgical repair for type A dissections, the observed 30-day mortality decreased from 30.7% to 21.4% (difference, 9.3%; 95% CI, 8.3-10.2; adjusted, 7.3%; 95% CI, 5.8-7.8) and the observed 1-year mortality decreased from 39.9% to 31.6% (difference, 8.3%; 95% CI, 7.5-9.1%; adjusted, 8.2%; 95% CI, 6.7-9.1). The 30-day mortality decreased from 24.9% to 21% (difference, 3.9%; 95% CI, 3.5-4.2; adjusted, 2.9%; 95% CI, 0.7-4.4) and 1-year decreased from 36.4% to 32.5% (difference, 3.9%; 95% CI, 3.3-4.3; adjusted, 3.9%; 95% CI, 2.5-6.3) for surgical repair of type B dissection. CONCLUSIONS Although AD hospitalization rates remained stable, improvement in mortality was noted, particularly in patients undergoing surgical repair.
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Affiliation(s)
- Purav S Mody
- From the Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX (P.S.M.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (Y.W., N.K., M.M.D., H.M.K.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (Y.W.); Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT (A. Geirsson); Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (N.K.); Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (M.M.D.); Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (A. Gupta) Section of Cardiology, Department of Internal Medicine, New York University School of Medicine, New York, NY (J.A.D.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
| | - Yun Wang
- From the Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX (P.S.M.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (Y.W., N.K., M.M.D., H.M.K.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (Y.W.); Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT (A. Geirsson); Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (N.K.); Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (M.M.D.); Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (A. Gupta) Section of Cardiology, Department of Internal Medicine, New York University School of Medicine, New York, NY (J.A.D.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
| | - Arnar Geirsson
- From the Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX (P.S.M.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (Y.W., N.K., M.M.D., H.M.K.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (Y.W.); Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT (A. Geirsson); Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (N.K.); Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (M.M.D.); Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (A. Gupta) Section of Cardiology, Department of Internal Medicine, New York University School of Medicine, New York, NY (J.A.D.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
| | - Nancy Kim
- From the Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX (P.S.M.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (Y.W., N.K., M.M.D., H.M.K.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (Y.W.); Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT (A. Geirsson); Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (N.K.); Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (M.M.D.); Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (A. Gupta) Section of Cardiology, Department of Internal Medicine, New York University School of Medicine, New York, NY (J.A.D.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
| | - Mayur M Desai
- From the Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX (P.S.M.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (Y.W., N.K., M.M.D., H.M.K.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (Y.W.); Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT (A. Geirsson); Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (N.K.); Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (M.M.D.); Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (A. Gupta) Section of Cardiology, Department of Internal Medicine, New York University School of Medicine, New York, NY (J.A.D.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
| | - Aakriti Gupta
- From the Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX (P.S.M.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (Y.W., N.K., M.M.D., H.M.K.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (Y.W.); Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT (A. Geirsson); Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (N.K.); Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (M.M.D.); Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (A. Gupta) Section of Cardiology, Department of Internal Medicine, New York University School of Medicine, New York, NY (J.A.D.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
| | - John A Dodson
- From the Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX (P.S.M.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (Y.W., N.K., M.M.D., H.M.K.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (Y.W.); Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT (A. Geirsson); Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (N.K.); Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (M.M.D.); Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (A. Gupta) Section of Cardiology, Department of Internal Medicine, New York University School of Medicine, New York, NY (J.A.D.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
| | - Harlan M Krumholz
- From the Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX (P.S.M.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (Y.W., N.K., M.M.D., H.M.K.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (Y.W.); Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT (A. Geirsson); Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (N.K.); Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (M.M.D.); Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (A. Gupta) Section of Cardiology, Department of Internal Medicine, New York University School of Medicine, New York, NY (J.A.D.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.).
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Shariat M, Thavendiranathan P, Nguyen E, Wintersperger B, Paul N, Rakowski H, Crean AM. Utility of coronary CT angiography in outpatients with hypertrophic cardiomyopathy presenting with angina symptoms. J Cardiovasc Comput Tomogr 2014; 8:429-37. [DOI: 10.1016/j.jcct.2014.09.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 08/15/2014] [Accepted: 09/16/2014] [Indexed: 12/25/2022]
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