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Rose M, Rubal B, Hulten E, Slim JN, Steel K, Furgerson JL, Villines TC, Slim AM. Chamber dimensions and functional assessment with coronary computed tomographic angiography as compared to echocardiography using American Society of Echocardiography guidelines. SAGE Open Med 2014; 2:2050312114522789. [PMID: 26770706 PMCID: PMC4607219 DOI: 10.1177/2050312114522789] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 01/04/2014] [Indexed: 12/03/2022] Open
Abstract
Background: The correlation between normal cardiac chamber linear dimensions measured during retrospective coronary computed tomographic angiography as compared to transthoracic echocardiography using the American Society of Echocardiography guidelines is not well established. Methods: We performed a review from January 2005 to July 2011 to identify subjects with retrospective electrocardiogram-gated coronary computed tomographic angiography scans for chest pain and transthoracic echocardiography with normal cardiac structures performed within 90 days. Dimensions were manually calculated in both imaging modalities in accordance with the American Society of Echocardiography published guidelines. Left ventricular ejection fraction was calculated on echocardiography manually using the Simpson’s formula and by coronary computed tomographic angiography using the end-systolic and end-diastolic volumes. Results: We reviewed 532 studies, rejected 412 and had 120 cases for review with a median time between studies of 7 days (interquartile range (IQR25,75) = 0–22 days) with no correlation between the measurements made by coronary computed tomographic angiography and transthoracic echocardiography using Bland–Altman analysis. We generated coronary computed tomographic angiography cardiac dimension reference ranges for both genders for our population. Conclusion: Our findings represent a step towards generating cardiac chamber dimensions’ reference ranges for coronary computed tomographic angiography as compared to transthoracic echocardiography in patients with normal cardiac morphology and function using the American Society of Echocardiography guideline measurements that are commonly used by cardiologists.
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Affiliation(s)
- Michael Rose
- Cardiology Service MCHE-MDC, San Antonio Military Medical Center, Brooke Army Medical Center, San Antonio, TX, USA
| | - Bernard Rubal
- Cardiology Service MCHE-MDC, San Antonio Military Medical Center, Brooke Army Medical Center, San Antonio, TX, USA
| | - Edward Hulten
- Cardiology Service, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Jennifer N Slim
- Cardiology Service MCHE-MDC, San Antonio Military Medical Center, Brooke Army Medical Center, San Antonio, TX, USA
| | - Kevin Steel
- Cardiology Service MCHE-MDC, San Antonio Military Medical Center, Brooke Army Medical Center, San Antonio, TX, USA
| | - James L Furgerson
- Cardiology Service MCHE-MDC, San Antonio Military Medical Center, Brooke Army Medical Center, San Antonio, TX, USA
| | - Todd C Villines
- Cardiology Service, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Ahmad M Slim
- Cardiology Service MCHE-MDC, San Antonio Military Medical Center, Brooke Army Medical Center, San Antonio, TX, USA
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Chow CK, Sheth T. What is the role of invasive versus non-invasive coronary angiography in the investigation of patients suspected to have coronary heart disease? Intern Med J 2011; 41:5-13. [DOI: 10.1111/j.1445-5994.2009.02066.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bouzas-Mosquera A, Peteiro J, Broullón FJ, Alvarez-García N, Mosquera VX, Rodríguez-Vilela A, Casas S, Castro-Beiras A. Prognostic value of exercise echocardiography in patients with atrial fibrillation. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2010; 11:346-51. [PMID: 20164089 DOI: 10.1093/ejechocard/jep212] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
AIMS Non-invasive imaging techniques for the detection of coronary artery disease (CAD) may have technical problems in patients with atrial fibrillation (AF). Although the prognostic value of exercise echocardiography (ExEcho) has been well established in several subgroups of patients, it has not yet been specifically evaluated in these patients. METHODS AND RESULTS From a population of 8095 patients with known or suspected CAD referred for ExEcho, 419 had AF at the time of the tests. Ischaemia was defined as the development of new or worsening wall motion abnormalities with exercise. Endpoints were hard cardiac events (i.e. cardiac death or non-fatal myocardial infarction). Mean age was 68.4 +/- 8.5 years, and 256 patients (61.1%) were men. Ischaemia was detected in 92 patients (22%). Over a mean follow-up of 3.10 +/- 2.98 years, 59 hard cardiac events occurred. The 5-year hard cardiac event rate was 37.3% in patients with ischaemia, when compared with 14.5% in patients without ischaemia (P < 0.001). In multivariate analysis, ischaemia on ExEcho remained an independent predictor of hard cardiac events (hazard ratio 1.99, 95% confidence interval 1.06-3.74, P = 0.03), and also provided incremental value over clinical, resting echocardiographic and treadmill exercise data for the prediction of hard cardiac events (P = 0.04). CONCLUSION ExEcho provides significant prognostic information for predicting hard cardiac events in patients with AF.
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Affiliation(s)
- Alberto Bouzas-Mosquera
- Department of Cardiology, Hospital Universitario A Coruña, As Xubias, 84, 15006 A Coruña, Spain.
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Maurovich-Horvat P, Ferencik M, Bamberg F, Hoffmann U. Methods of plaque quantification and characterization by cardiac computed tomography. J Cardiovasc Comput Tomogr 2009; 3 Suppl 2:S91-8. [PMID: 20129522 DOI: 10.1016/j.jcct.2009.10.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Accepted: 10/23/2009] [Indexed: 10/20/2022]
Abstract
The pathologic evolution of coronary artery atherosclerosis occurs slowly over decades, which may provide an opportunity for diagnostic imaging to identify patients before clinical events evolve. Cardiac computed tomography (CT) is an emerging noninvasive imaging tool, which can visualize the entire coronary tree with submillimeter resolution. We reviewed the current status of cardiac CT to qualitatively and quantitatively determine coronary plaque dimensions and composition, and its potential to improve our understanding of the natural history of coronary artery disease as well as prevention of cardiovascular events.
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Affiliation(s)
- Pal Maurovich-Horvat
- Department of Radiology, Cardiac MR PET CT Program, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA 02114, USA.
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Haraldsdottir S, Gudnason T, Sigurdsson AF, Gudjonsdottir J, Lehman SJ, Eyjolfsson K, Scheving SS, Gibson CM, Hoffmann U, Jonsdottir B, Andersen K. Diagnostic accuracy of 64-slice multidetector CT for detection of in-stent restenosis in an unselected, consecutive patient population. Eur J Radiol 2009; 76:188-94. [PMID: 19570632 DOI: 10.1016/j.ejrad.2009.05.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Revised: 04/11/2009] [Accepted: 05/14/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate the diagnostic accuracy of 64-slice multidetector computed tomography (64-CT) for detection of in-stent restenosis (ISR) in an unselected, consecutive patient population. BACKGROUND Detection of in-stent restenosis by cardiac CT would be a major advance for the evaluation of patients suspected of having ISR. However, the diagnostic accuracy of current generation 64-CT in this context is not fully established. METHODS We conducted a prospective study on patients with stable angina or acute coronary syndrome with no prior history of coronary artery disease. Six months after percutaneous coronary intervention (PCI) with stent placement they underwent a 64-CT scan (Toshiba Multi-Slice Aquilion 64) and consequently a repeat coronary angiography for comparison. Cardiac CT data sets were analyzed for the presence of in-stent restenosis by two independent expert readers blinded to the coronary angiographic data. RESULTS Ninety-three patients with a total of 140 stents were evaluated. Males comprised 82% of the study group and the mean age was 63±10 years. The mean time from PCI to the repeat coronary angiography was 208±37 days and the mean time from 64-CT to repeat coronary angiography was 3.7±4.9 days. The restenosis rate according to coronary angiography was 26%. Stent diameter, strut thickness, heart rate and body mass index (BMI) significantly affected image quality. The sensitivity, specificity, positive and negative predictive values of 64-CT for detection of in-stent restenosis were 27%, 95%, 67% and 78%, respectively. CONCLUSIONS Current generation, 64-slice CT, remains limited in its ability to accurately detect in-stent restenosis.
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Coronary Artery WSS Profiling Using a Geometry Reconstruction Based on Biplane Angiography. Ann Biomed Eng 2009; 37:682-91. [DOI: 10.1007/s10439-009-9656-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Accepted: 02/10/2009] [Indexed: 11/25/2022]
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Kajander S, Ukkonen H, Sipilä H, Teräs M, Knuuti J. Low radiation dose imaging of myocardial perfusion and coronary angiography with a hybrid PET/CT scanner. Clin Physiol Funct Imaging 2008; 29:81-8. [PMID: 19016814 PMCID: PMC2701563 DOI: 10.1111/j.1475-097x.2008.00838.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objectives: To test the image quality and feasibility of a sequential low radiation dose protocol for hybrid cardiac PET/CT angiography (CTA). Background: Multidetector computed tomography (MDCT) is a non-invasive method for coronary angiography. The negative predictive value of MDCT is high but perfusion imaging has a role in detecting functional significance of coronary lesions. This has encouraged combining these techniques. However, radiation dose is of concern. We report our first experiences with a low dose sequential CTA mode applicable to hybrid imaging. Methods: In the first phase, 10 consecutive cardiac MDCT angiographies were performed with spiral acquisition and compared in terms of image quality and dose with the following 10 patients performed with a new sequential mode. In the second phase, feasibility and radiation dose of a combined 15O-water rest-stress PET perfusion/sequential CTA protocol were assessed in another group of 61 consecutive patients. Results: Mean effective radiation dose was 60% lower in the sequential group than in the spiral group (19·3 versus 7·6 mSv, P<0·001). In the second phase, the new sequential hybrid protocol proved possible in 87% of the patients given the preconditions determined by the manufacturer. Mean effective dose of the CT acquisition was 7·6 mSv and total dose from the PET/CTA hybrid study 9·5 mSv. Conclusion: Low dose PET/CT allows cardiac hybrid studies with <10 mSv. The protocol can be applied to almost nine out of 10 patients with CT image quality comparable to spiral acquisition.
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Ten Kate GJR, Weustink AC, de Feyter PJ. Coronary artery anomalies detected by MSCT-coronary angiography in the adult. Neth Heart J 2008; 16:369-75. [PMID: 19065275 PMCID: PMC2584765 DOI: 10.1007/bf03086181] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Before coronary evaluation by modern imaging techniques was feasible, premorbid diagnoses of coronary artery anomalies (CAAs) were usually made fortuitously by invasive coronary angiography (ICA). However, this technique is limited by its invasive and projectional nature. Coronary magnetic resonance angiography (CMRA) and multi-slice computed tomography (MSCT) broadened clinical information by enabling visualisation of the coronary arteries in their anatomical environment. METHODS This case series visualises and reviews anomalous coronary artery from the opposite sinus (ACAOS) and coronary artery fistulae. All CAAs were detected by means of 64-slice dual source computed tomography after 1000 cardiac scans at the Erasmus MC, Rotterdam, the Netherlands. RESULTS Eight ACAOS cases, one anomalous left coronary artery from the pulmonary artery (ALCAPA) and one congenital aneurysm of an aortic sinus were found. Seven out often detected CAAs were considered malignant whereas three CAAs of the ACAOS type (retroaortic path) were considered benign. Significant coronary artery disease was found in three out of eight ACAOS cases. In one of the ACAOS cases complete evaluation of the anomalous coronary artery was limited by motion artifacts. All five cases of right ACAOS were referred for MSCT because the right coronary artery could not be located by invasive angiography. CONCLUSION All CAAs were easy to diagnose because of 3D imaging and high temporal and spatial resolution. High resolution made it possible to not only depict coronary artery abnormalities, but also to quantify luminal and vessel properties such as stenosis grade, aspects of plaque, anomalous vessel length, luminal area ratio and the asymmetry ratio. Because of its comprehensiveness, MSCT can be an effective imaging modality in patients suspected of coronary artery abnormalities caused by coronary artery disease, CAAs, or a combination of both. (Neth Heart J 2008;16:369-75.).
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Affiliation(s)
- G J R Ten Kate
- Department of Radiology, Erasmus MC, Rotterdam, the Netherlands
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Wellnhofer E, Goubergrits L, Kertzscher U, Affeld K, Fleck E. Novel non-dimensional approach to comparison of wall shear stress distributions in coronary arteries of different groups of patients. Atherosclerosis 2008; 202:483-90. [PMID: 18617176 DOI: 10.1016/j.atherosclerosis.2008.05.044] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2008] [Revised: 05/06/2008] [Accepted: 05/19/2008] [Indexed: 12/26/2022]
Abstract
BACKGROUND Local wall shear stress (WSS) has an impact on local remodelling of the vessel wall. WSS in turn strongly depends on local geometry. Our aim was to characterize patterns of local wall shear stress associated with distinct types of remodelling in coronary arteries. Vessel size and flow rates are different between patients, however. To compare distribution patterns of WSS in analogy to fluid-dynamic modelling, non-dimensional WSS/area functions are calculated. METHODS Right coronary arteries from seven controls, five patients with coronary artery disease (CAD) and five patients with aneurysmatic CAD (AnCAD) were analyzed. Flow simulations were performed in three-dimensionally reconstructed coronary vessels from biplane angiographic projections. Local WSS was normalized as percentage of maximum value in a histogram (100 classes) and corresponding area was expressed as percentage of total area. RESULTS The normalized WSS distribution was characterized by a single peak with a large lower tie in controls, a loss of the single peak and a stochastic distribution in AnCAD and a narrowing of the lower tie in CAD. Correct classification of 16/17 coronary arteries was feasible by Fisher's discriminant functions based on median WSS, mean diameter, percentage of area with WSS <or=0.4 Pa and with WSS >or=15 Pa. CONCLUSION Normalized WSS distribution might be an efficient tool in comparing wall shear stress between different patient groups. Whether normalized WSS distribution curves are apt to grade severity of disease remains to be investigated.
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Affiliation(s)
- E Wellnhofer
- German Heart Institute of Berlin, Berlin, Germany.
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Cheng V, Gutstein A, Wolak A, Suzuki Y, Dey D, Gransar H, Thomson LE, Hayes SW, Friedman JD, Berman DS. Moving Beyond Binary Grading of Coronary Arterial Stenoses on Coronary Computed Tomographic Angiography. JACC Cardiovasc Imaging 2008; 1:460-71. [DOI: 10.1016/j.jcmg.2008.05.006] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Revised: 05/06/2008] [Accepted: 05/15/2008] [Indexed: 01/24/2023]
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Affiliation(s)
- Andrew M Taylor
- Cardiothoracic Unit, UCL Institute of Child Health and Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.
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von Birgelen C, Verhorst PM. Novel ultrasonic insight into coronary arteries. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2008; 9:713-4. [DOI: 10.1093/ejechocard/jen208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Kaple RK, Maehara A, Mintz GS. Characteristics of high-risk atherosclerotic plaque using intravascular ultrasound-derived virtual histology. ACTA ACUST UNITED AC 2008; 2:565-76. [DOI: 10.1517/17530059.2.5.565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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