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Coronary CTA Amidst the COVID-19 Pandemic: A Quicker Examination Protocol with Preserved Image Quality Using a Dedicated Cardiac Scanner. Diagnostics (Basel) 2023; 13:diagnostics13030406. [PMID: 36766511 PMCID: PMC9914678 DOI: 10.3390/diagnostics13030406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 01/24/2023] Open
Abstract
There has been an ongoing debate on the means to minimize the time patients spend at health care providers during the COVID-19 pandemic. We propose a strategy relying solely on intravenous (i.v.) beta-blocker administration for heart-rate (HR) control prior to coronary CT angiography (CCTA). We aimed to assess a potential difference in CCTA image quality (IQ) after implementation of a modified strategy compared to our standard protocol of oral premedication during the first wave of COVID-19. We analyzed CCTA examinations conducted one year before (n = 1511) and after (n = 1064) implementation of this new regime. Examinations were performed both on our 256-slice multidetector CT (MDCT) and dedicated cardiac CT (DCCT) scanners. We used a four-point Likert scale (excellent/good/moderate/non-diagnostic) for IQ assessment of the coronaries. We detected a significant increase in mean HR during examinations on both CT scanners (MDCT: 62.4 ± 10.0 vs. 65.3 ± 9.7, p < 0.001; DCCT: 61.7 ± 15.2 vs. 65.0 ± 10.7, p < 0.001). The rate of moderate/non-diagnostic IQ significantly increased on the MDCT (192/1005, 19.1% vs. 144/466, 30.9%, p < 0.001), while this ratio did not change significantly on the DCCT (62/506, 12.3% vs. 84/598, 14.0%, p = 0.38). The improved temporal resolution of DCCT allows the stand-alone use of i.v. premedication with preserved IQ; hence, the duration of visits can be shortened.
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Andre F, Fortner P, Emami M, Seitz S, Brado M, Gückel F, Sokiranski R, Sommer A, Frey N, Görich J, Buss SJ. Factors influencing the safety of outpatient coronary CT angiography: a clinical registry study. BMJ Open 2022; 12:e058304. [PMID: 35940836 PMCID: PMC9364403 DOI: 10.1136/bmjopen-2021-058304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Since the safety of coronary CT angiography (CTA) is of great importance, especially with regard to widening indications and increasing morbidity, the aim of this study was to assess influencing factors. METHODS Patients undergoing coronary CTA in a third-generation dual-source CT in a radiological centre were included in a clinical registry. Up to 20 mg metoprolol was administered intravenously to attain a heart rate ≤65/min. Glyceryl trinitrate (GTN) was administered in doses of 0.8 mg and 0.4 mg. Blood pressure was measured before the administration and after the CTA. RESULTS Out of 5500 consecutive patients (3194 men, 62.3 (54.9-70.0) years), adverse events occurred in 68 patients (1.2%) with mild anaphylactoid reactions (0.4%), vasovagal symptoms (0.3%) and extravasation (0.3%) being most frequent. Anti-allergic drugs were given in 17 patients, atropine in 3 patients and volume in 1 patient. Drug administration resulted in a significant mean arterial pressure decline (96.0 (88.3-106.0) vs 108.7 (99.7-117.3) mmHg; p<0.001). Patients who suffered systolic blood pressure drops >20 mmHg or >40 mmHg were older (66.5 (58.6-73.3) vs 60.5 (53.6-68.3) years; 70.2 (63.3-76.5) vs 62.1 (54.7-69.6) years), more often male (65.1% vs 54.4%; 68.9% vs 57.3%) and had higher Agatston score equivalents (83.0 (2.0-432.0) vs 15.0 (0.0-172.0); 163.0 (16.3-830.8) vs 25.0 (0.0-220.0); all p<0.001). GTN dose reduction lowered the fraction of patients suffering from blood pressure drops >20 mmHg or >40 mmHg from 34.5% to 27.4% and from 6.1% to 3.5% (both p<0.001), respectively. The proportion of coronary segments with impaired image quality did not differ significantly. CONCLUSIONS Coronary CTA with intravenous beta-blocker administration is a safe procedure in an outpatient setting as adverse events are rare and mostly mild. Reduced GTN doses can further improve safety by lowering the rate of significant blood pressure drops, which occurred especially in elderly men with increased plaque burden. TRIAL REGISTRATION NUMBER NCT03815123.
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Affiliation(s)
- Florian Andre
- Department of Cardiology, Angiology and Pneumology, Heidelberg University, Heidelberg, Germany
- MVZ-DRZ Sinsheim Eberbach Erbach Walldorf Heidelberg, Heidelberg, Germany
| | - Philipp Fortner
- MVZ-DRZ Sinsheim Eberbach Erbach Walldorf Heidelberg, Heidelberg, Germany
| | - Mostafa Emami
- MVZ-DRZ Sinsheim Eberbach Erbach Walldorf Heidelberg, Heidelberg, Germany
| | - Sebastian Seitz
- MVZ-DRZ Sinsheim Eberbach Erbach Walldorf Heidelberg, Heidelberg, Germany
| | - Matthias Brado
- MVZ-DRZ Sinsheim Eberbach Erbach Walldorf Heidelberg, Heidelberg, Germany
| | - Friedemann Gückel
- MVZ-DRZ Sinsheim Eberbach Erbach Walldorf Heidelberg, Heidelberg, Germany
| | - Roman Sokiranski
- MVZ-DRZ Sinsheim Eberbach Erbach Walldorf Heidelberg, Heidelberg, Germany
| | - André Sommer
- MVZ-DRZ Sinsheim Eberbach Erbach Walldorf Heidelberg, Heidelberg, Germany
| | - Norbert Frey
- Department of Cardiology, Angiology and Pneumology, Heidelberg University, Heidelberg, Germany
| | - Johannes Görich
- MVZ-DRZ Sinsheim Eberbach Erbach Walldorf Heidelberg, Heidelberg, Germany
| | - Sebastian J Buss
- MVZ-DRZ Sinsheim Eberbach Erbach Walldorf Heidelberg, Heidelberg, Germany
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Vecsey-Nagy M, Jermendy ÁL, Kolossváry M, Vattay B, Boussoussou M, Suhai FI, Panajotu A, Csőre J, Borzsák S, Fontanini DM, Csobay-Novák C, Merkely B, Maurovich-Horvat P, Szilveszter B. Heart Rate-Dependent Degree of Motion Artifacts in Coronary CT Angiography Acquired by a Novel Purpose-Built Cardiac CT Scanner. J Clin Med 2022; 11:jcm11154336. [PMID: 35893427 PMCID: PMC9369248 DOI: 10.3390/jcm11154336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/19/2022] [Accepted: 07/25/2022] [Indexed: 11/23/2022] Open
Abstract
Although reaching target heart rate (HR) before coronary CT angiography (CCTA) is still of importance, adequate HR control remains a challenge for many patients. Purpose-built cardiac scanners may provide optimal image quality at higher HRs by further improving temporal resolution. We aimed to compare the amount of motion artifacts on CCTA acquired using a dedicated cardiac CT (DCCT) compared to a conventional multidetector CT (MDCT) scanner. We compared 80 DCCT images to 80 MDCT scans matched by sex, age, HR, and coronary dominance. Image quality was graded on a per-patient, per-vessel and per-segment basis. Motion artifacts were assessed using Likert scores (1: non-diagnostic, 2: severe artifacts, 3: mild artifacts, 4: no artifacts). Patients were stratified into four groups according to HR (<60/min, 60−65/min, 66−70/min and >70/min). Overall, 2328 coronary segments were evaluated. DCCT demonstrated superior overall image quality compared to MDCT (3.7 ± 0.4 vs. 3.3 ± 0.7, p < 0.001). DCCT images yielded higher Likert scores in all HR ranges, which was statistically significant in the 60−65/min, 66−70/min and >70/min ranges (3.9 ± 0.2 vs. 3.7 ± 0.2, p = 0.008; 3.5 ± 0.5 vs. 3.1 ± 0.6, p = 0.048 and 3.5 ± 0.4 vs. 2.7 ± 0.7, p < 0.001, respectively). Using a dedicated cardiac scanner results in fewer motion artifacts, which may allow optimal image quality even in cases of high HRs.
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Affiliation(s)
- Milán Vecsey-Nagy
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (Á.L.J.); (M.K.); (B.V.); (M.B.); (F.I.S.); (A.P.); (S.B.); (P.M.-H.); (B.S.)
- Correspondence:
| | - Ádám Levente Jermendy
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (Á.L.J.); (M.K.); (B.V.); (M.B.); (F.I.S.); (A.P.); (S.B.); (P.M.-H.); (B.S.)
| | - Márton Kolossváry
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (Á.L.J.); (M.K.); (B.V.); (M.B.); (F.I.S.); (A.P.); (S.B.); (P.M.-H.); (B.S.)
| | - Borbála Vattay
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (Á.L.J.); (M.K.); (B.V.); (M.B.); (F.I.S.); (A.P.); (S.B.); (P.M.-H.); (B.S.)
| | - Melinda Boussoussou
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (Á.L.J.); (M.K.); (B.V.); (M.B.); (F.I.S.); (A.P.); (S.B.); (P.M.-H.); (B.S.)
| | - Ferenc Imre Suhai
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (Á.L.J.); (M.K.); (B.V.); (M.B.); (F.I.S.); (A.P.); (S.B.); (P.M.-H.); (B.S.)
| | - Alexisz Panajotu
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (Á.L.J.); (M.K.); (B.V.); (M.B.); (F.I.S.); (A.P.); (S.B.); (P.M.-H.); (B.S.)
| | - Judit Csőre
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (J.C.); (D.M.F.); (C.C.-N.); (B.M.)
| | - Sarolta Borzsák
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (Á.L.J.); (M.K.); (B.V.); (M.B.); (F.I.S.); (A.P.); (S.B.); (P.M.-H.); (B.S.)
| | | | - Csaba Csobay-Novák
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (J.C.); (D.M.F.); (C.C.-N.); (B.M.)
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (J.C.); (D.M.F.); (C.C.-N.); (B.M.)
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (Á.L.J.); (M.K.); (B.V.); (M.B.); (F.I.S.); (A.P.); (S.B.); (P.M.-H.); (B.S.)
- Medical Imaging Centre, Semmelweis University, 1082 Budapest, Hungary
| | - Bálint Szilveszter
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (Á.L.J.); (M.K.); (B.V.); (M.B.); (F.I.S.); (A.P.); (S.B.); (P.M.-H.); (B.S.)
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Cademartiri F, Casolo G, Clemente A, Seitun S, Mantini C, Bossone E, Saba L, Sverzellati N, Nistri S, Punzo B, Cavaliere C, La Grutta L, Gentile G, Maffei E. Coronary CT angiography: a guide to examination, interpretation, and clinical indications. Expert Rev Cardiovasc Ther 2021; 19:413-425. [PMID: 33884942 DOI: 10.1080/14779072.2021.1915132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The introduction of Cardiac Computed Tomography (CCT) has changed the paradigm in the field of diagnostic cardiovascular medicine. CCT is the primary tool in the assessment of suspected Coronary Artery Disease (CAD) and should be followed by functional assessment when needed to stratify disease and to plan potential interventional or surgical therapy. AREAS COVERED We provided the current state of the knowledge on the main aspects of technique of examination, image interpretation and clinical indications. We have focused our attention on the basic routine applications and activities. EXPERT OPINION The primary role of CCT in suspected CAD will progressively become the standard approach. In general, any situation in which anatomy of the heart and thoracic vessels/structures is mandatory must be approached using CT first, whenever possible. The quantity and quality of information that can be provided by CCT is big and the operators should learn how to deal with this information. On the other hand, CCT is only apparently a straightforward and simple examination. It is actually the most complex diagnostic procedure that can be performed on CT and requires highly skilled operators and state-of-art-technology.
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Affiliation(s)
| | - Giancarlo Casolo
- Department of Cardiology, Ospedale Della Versilia, Viareggio, Italy
| | - Alberto Clemente
- Department of Radiology, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - Sara Seitun
- Department of Radiology, Ospedale San Martino, Genova, Italy
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Eduardo Bossone
- Department of Cardiology, Ospedale Cardarelli, Naples, Italy
| | - Luca Saba
- Department of Radiology, University of Cagliari, Cagliari, Italy
| | | | | | - Bruna Punzo
- Department of Radiology, SDN IRCCS, Naples, Italy
| | | | | | | | - Erica Maffei
- Department of Radiology, Area Vasta 1, ASUR Marche, Urbino, Italy
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Maffei E, Punzo B, Cavaliere C, Bossone E, Saba L, Cademartiri F. Coronary atherosclerosis as the main endpoint of non-invasive imaging in cardiology: a narrative review. Cardiovasc Diagn Ther 2021; 10:1897-1905. [PMID: 33381433 DOI: 10.21037/cdt-20-525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The change of paradigm determined by the introduction of cardiac computed tomography (CCT) in the field of cardiovascular medicine has allowed new evidence to emerge. These evidences point towards a major role, probably the most important one in terms of prognostic impact, in the detection, characterization and quantification of atherosclerosis as the main driver and endpoint for the management of coronary artery disease (CAD). Extensive literature has been published in the last decade with large numbers and patients' populations, investigating several aspects and correlations between atherosclerotic plaque features and risk factors; also, the relationship between plaque features, both with qualitative and quantitative approaches, and cardiovascular events has been investigated. More recent studies have also pointed out the relationship between the knowledge and classification of sub-clinical atherosclerosis and the induced modification of medical therapy (both aggressiveness and compliance) that is most likely able to increase the effect of anti-atherosclerotic drugs, hence significantly improving prognosis. Non-invasive assessment of CAD by means of CCT is becoming the primary tool for management and also the most important parameter for the comprehension of natural history of CAD and how the therapies we adopt are affecting plaque burden as a whole. In this review we will address the modern concepts of CAD driven understanding and management of cardiovascular disease.
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Affiliation(s)
- Erica Maffei
- Department of Radiology, Area Vasta 1, ASUR Marche, Urbino (PU), Italy
| | - Bruna Punzo
- Department of Radiology, SDN IRCCS, Naples, Italy
| | | | - Eduardo Bossone
- Department of Cardiology, Ospedale Cardarelli, Naples, Italy
| | - Luca Saba
- Department of Radiology, University of Cagliari, Italy
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Androshchuk V, Sabharwal N, St Noble V, Kelion A. Speeding up beta-blockade prior to coronary CT angiography: can we predict the dose of intravenous metoprolol required to achieve target heart rate in a given patient? Clin Radiol 2020; 76:236.e21-236.e25. [PMID: 33298312 DOI: 10.1016/j.crad.2020.09.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/30/2020] [Indexed: 10/22/2022]
Abstract
AIM To evaluate the use and safety of intravenous (IV) metoprolol in a cohort of patients undergoing coronary computed tomographic angiography (CCTA) at a university hospital, and in particular, to establish if the minimum dose required to achieve the target heart rate (HR) in a given patient can be predicted from the baseline HR. MATERIALS AND METHODS Patients undergoing CCTA at a tertiary centre between January 2015 and May 2018, with baseline HR ≥60 bpm requiring IV metoprolol, were identified retrospectively from the database. Patients with a contraindication to beta-blockade or an indication for CCTA other than coronary disease were excluded. HR at baseline and at the time of scanning were recorded, together with the total dose of IV metoprolol administered. RESULTS Of 625 patients identified, 330 (52.8%) achieved HR ≤60 with IV metoprolol. Patients who achieved target HR had lower baseline HR. They received a lower radiation exposure due to tight prospective gating and a lower tube voltage. The lower quartile dose of metoprolol administered was 5 mg for patients with baseline HR <65 beats per minute (bpm), but 10 mg for HR 65-74 bpm, and ≥20 mg for higher HRs. There were no cases of symptomatic bradycardia/hypotension. CONCLUSION Patients with a resting HR of ≥60 bpm can reasonably be given an initial minimum dose of 5-20 mg metoprolol IV before CCTA, with additional doses as required.
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Affiliation(s)
- V Androshchuk
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford OX3 9DU, UK.
| | - N Sabharwal
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - V St Noble
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - A Kelion
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford OX3 9DU, UK
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Rovere G, Meduri A, Savino G, Flammia FC, Lo Piccolo F, Carafa MRP, Larici AR, Natale L, Merlino B, Marano R. Practical instructions for using drugs in CT and MR cardiac imaging. Radiol Med 2020; 126:356-364. [PMID: 32833196 DOI: 10.1007/s11547-020-01261-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 08/10/2020] [Indexed: 11/26/2022]
Abstract
The progressive increase in numbers of noninvasive cardiac imaging examinations broadens the spectrum of knowledge radiologists are expected to acquire in the management of drugs during CT coronary angiography (CTCA) and cardiac MR (CMR) to improve image quality for optimal visualization and assessment of the coronary arteries and adequate MR functional analysis. Aim of this review is to provide an overview on different class of drugs (nitrate, beta-blockers, ivabradine, anxiolytic, adenosine, dobutamine, atropine, dipyridamole and regadenoson) that can be used in CTCA and CMR, illustrating their main indications, contraindications, efficacy, mechanism of action, metabolism, safety, side effects or complications, and providing advices in their use.
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Affiliation(s)
- Giuseppe Rovere
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Agostino Meduri
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Giancarlo Savino
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Francesco Ciriaco Flammia
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Francesca Lo Piccolo
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Maria Rachele Pia Carafa
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Anna Rita Larici
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Luigi Natale
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Biagio Merlino
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Riccardo Marano
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy.
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Abstract
It was aimed to investigate possible late cardiac effects of Sulfur mustard (SM) exposure in Iranian veterans. Thirty-eight veterans with late complications of SM exposure were investigated. Clinical history, physical examinations, 12 leads electrocardiography and transthoracic echocardiography were performed. Computed tomography coronary angiography (CTCA) was performed as clinically indicated for angiographic assessment and patients were stratified according to the CTCA findings. Incomplete right bundle branch block and right axis deviation were detected in 3 (7.9%) and 4 (10.5%) cases, respectively. Mean value of left ventricular ejection fraction was 55.7 ± 2.9%. Different degrees of right ventricular dilation was observed in seven (18.4%) patients. All the patients showed mild to moderate degrees of tricuspid regurgitation. Increased pulmonary artery pressure (PAP) was detected in 16 (42.1%) patients. Out of 18 patients who underwent CTCA, non-obstructive and obstructive coronary artery disease (CAD) were observed in three (16.66%) and eight (44.44%) patients, respectively. CAD was stratified to single vessel (5.5%), two vessels (27.8%) and three vessels disease (11.1%). Mean coronary artery calcium score was 50.91 ± 115.58. SM has cardiovascular toxicity, as a delayed complication of this chemical warfare poisoning.
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Yamazaki D, Shimura Y, Enjoji Y, Nishinaga M, Kanmatuse K, Endo M. Pilot study of bisoprolol 8mg transdermal patch at bedtime before coronary computed tomography angiography. J Cardiol 2019; 75:394-399. [PMID: 31627998 DOI: 10.1016/j.jjcc.2019.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/30/2019] [Accepted: 09/18/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Coronary computed tomography angiography (CCTA) is recommended for first-line evaluation of stable coronary artery disease, and there is a standard protocol to control heart rate (HR) in guidelines. However, time is required to decrease HR to the recommended ≤60 beats per minute (bpm). We investigated whether the bisoprolol 8mg transdermal patch at bedtime on the day before CCTA can achieve a target HR and simplify the CCTA process. METHODS We randomly assigned 63 patients with an HR of ≥70 bpm and systolic blood pressure ≥120mmHg to a standard protocol group (n=33) or a group (n=30) that applied a bisoprolol 8mg transdermal patch (Bis) at bedtime on the day before CCTA evaluation. The primary endpoint was a change in HR between enrollment in the study and the time of CCTA evaluation. The secondary endpoints were elapsed time from arrival at the CCTA suite to starting CCTA image acquisition, and the rates of oral metoprolol and intravenous landiolol administration (UMIN00035246). RESULTS Baseline characteristics did not significantly differ between two groups. HR was significantly lower upon arrival at the CCTA suite in Bis, than standard protocol group (67.5±7.8 bpm vs. 75.0±10.6 bpm; p=0.00002), and the amount of elapsed time from arrival to the start of CCTA evaluation was also significantly decreased in Bis group (76.9±34.9min vs. 94.8±29.2min; p=0.0356). Rates of oral metoprolol and intravenous landiolol administration did not significantly differ between two groups (63.3% vs. 83.3%, p=0.143 and 36.7% vs. 60.0%, p=0.12, respectively). CONCLUSIONS The bisoprolol 8mg transdermal patch lowered HR and decreased the amount of time needed for CCTA, thus streamlining the evaluation process.
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Affiliation(s)
- Daisuke Yamazaki
- Department of Cardiovascular Medicine, Tokyo Heart Center, Tokyo, Japan.
| | - Yumi Shimura
- Department of Cardiovascular Medicine, Tokyo Heart Center, Tokyo, Japan
| | - Yoshihisa Enjoji
- Department of Cardiovascular Medicine, Tokyo Heart Center, Tokyo, Japan
| | - Masanori Nishinaga
- Department of Cardiovascular Medicine, Saitama Memorial Hospital, Saitama City, Saitama, Japan
| | - Katuo Kanmatuse
- Department of Cardiovascular Medicine, Tokyo Heart Center, Tokyo, Japan
| | - Masahiro Endo
- Department of Cardiovascular Medicine, Tokyo Heart Center, Tokyo, Japan
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Forte E, Monti S, Parente CA, Beyer L, De Rosa R, Infante T, Cavaliere C, Cademartiri F, Salvatore M, Stroszczynski C, Tedeschi C. Image Quality and Dose Reduction by Dual Source Computed Tomography Coronary Angiography: Protocol Comparison. Dose Response 2018; 16:1559325818805838. [PMID: 30349426 PMCID: PMC6194939 DOI: 10.1177/1559325818805838] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 09/06/2018] [Accepted: 09/18/2018] [Indexed: 01/18/2023] Open
Abstract
Purpose: To compare image quality and radiation dose among different protocols in patients who underwent a 128-slice dual source computed tomography coronary angiography (DSCT-CTCA). Methods: Ninety patients were retrospectively grouped according to heart rate (HR): 26 patients (group A) with stable HR ≤60 bpm were acquired using high pitch spiral mode (FLASH); 48 patients (group B) with irregular HR ≤60 bpm or stable HR between 60 and 70 bpm using step and shoot mode; and 16 patients (group C) with irregular HR >60 bpm or stable HR ≥70 bpm by retrospective electrocardiogram pulsing acquisition. Signal to noise ratio (SNR) and contrast to noise ratio (CNR) were measured for the main vascular structures. Moreover, the dose-length product and the effective dose were assessed. Results: Both SNR and CNR were higher in group A compared to group C (18.27 ± 0.32 vs 11.22 ± 0.50 and 16.75 ± 0.32 vs 10.17 ± 0.50; P = .001). The effective dose was lower in groups A and B (2.09 ± 1.27 mSv and 4.60 ± 2.78 mSv, respectively) compared to group C (9.61 ± 5.95 mSv) P < .0001. Conclusion: The correct selection of a low-dose, HR-matched CTCA scan protocol with a DSCT scanner provides substantial reduction of radiation exposure and better SNR and CNR.
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Affiliation(s)
| | | | | | - Lukas Beyer
- Department of Radiology, Universitätsklinikum Regensburg, Regensburg, Germany
| | | | | | | | | | | | | | - Carlo Tedeschi
- Department of Radiology, Universitätsklinikum Regensburg, Regensburg, Germany.,P.S.I. Napoli Est, ASL Napoli 1 Centro, Naples, Italy
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Ohana M, Sellers SL, Mooney J, Kueh SH, Grover R, Arepalli CD, Selvakumar K, Kim U, Blanke P, Leipsic JA. Prevalence and impact of scan-related anxiety during coronary CT angiography: A prospective cohort study of 366 patients. J Cardiovasc Comput Tomogr 2018; 12:364-371. [DOI: 10.1016/j.jcct.2018.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/21/2018] [Accepted: 04/30/2018] [Indexed: 10/17/2022]
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12
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Kim J, Kang JW, Kim K, Choi SI, Chun EJ, Kim YG, Kim WY, Seo DW, Shin J, Lee H, Jin KN, Ahn S, Hwang SS, Kim KP, Jeong RB, Ha SO, Choi B, Yoon CH, Suh JW, Kim HL, Kim JK, Jang S, Seo JS. SEALONE (Safety and Efficacy of Coronary Computed Tomography Angiography with Low Dose in Patients Visiting Emergency Room) trial: study protocol for a randomized controlled trial. Clin Exp Emerg Med 2018; 4:208-213. [PMID: 29306269 PMCID: PMC5758626 DOI: 10.15441/ceem.17.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 09/20/2017] [Accepted: 09/20/2017] [Indexed: 11/29/2022] Open
Abstract
Objective Chest pain is one of the most common complaints in the emergency department (ED). Cardiac computed tomography angiography (CCTA) is a frequently used tool for the early triage of patients with low- to intermediate-risk acute chest pain. We present a study protocol for a multicenter prospective randomized controlled clinical trial testing the hypothesis that a low-dose CCTA protocol using prospective electrocardiogram (ECG)-triggering and limited-scan range can provide sufficient diagnostic safety for early triage of patients with acute chest pain. Methods The trial will include 681 younger adult (aged 20 to 55) patients visiting EDs of three academic hospitals for acute chest pain or equivalent symptoms who require further evaluation to rule out acute coronary syndrome. Participants will be randomly allocated to either low-dose or conventional CCTA protocol at a 2:1 ratio. The low-dose group will undergo CCTA with prospective ECG-triggering and restricted scan range from sub-carina to heart base. The conventional protocol group will undergo CCTA with retrospective ECG-gating covering the entire chest. Patient disposition is determined based on computed tomography findings and clinical progression and all patients are followed for a month. The primary objective is to prove that the chance of experiencing any hard event within 30 days after a negative low-dose CCTA is less than 1%. The secondary objectives are comparisons of the amount of radiation exposure, ED length of stay and overall cost. Results and Conclusion Our low-dose protocol is readily applicable to current multi-detector computed tomography devices. If this study proves its safety and efficacy, dose-reduction without purchasing of expensive newer devices would be possible.
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Affiliation(s)
- Joonghee Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joon-Won Kang
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyuseok Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang Il Choi
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun Ju Chun
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yeo Goon Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Won Young Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Woo Seo
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jonghwan Shin
- Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Huijai Lee
- Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Kwang-Nam Jin
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Soyeon Ahn
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seung Sik Hwang
- Department of Preventive Medicine, Seoul National University School of Public Health, Seoul, Korea
| | - Kwang Pyo Kim
- Department of Nuclear Engineering, Kyung Hee University, Suwon, Korea
| | - Ru-Bi Jeong
- Department of Emergency Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Sang Ook Ha
- Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Byungho Choi
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang-Hwan Yoon
- Department of Cardiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung-Won Suh
- Department of Cardiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hack-Lyoung Kim
- Department of Cardiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Ju Kyoung Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sujin Jang
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji Seon Seo
- Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
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Rigsby CK, McKenney SE, Hill KD, Chelliah A, Einstein AJ, Han BK, Robinson JD, Sammet CL, Slesnick TC, Frush DP. Radiation dose management for pediatric cardiac computed tomography: a report from the Image Gently 'Have-A-Heart' campaign. Pediatr Radiol 2018; 48:5-20. [PMID: 29292481 PMCID: PMC6230472 DOI: 10.1007/s00247-017-3991-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/21/2017] [Accepted: 09/12/2017] [Indexed: 12/28/2022]
Abstract
Children with congenital or acquired heart disease can be exposed to relatively high lifetime cumulative doses of ionizing radiation from necessary medical imaging procedures including radiography, fluoroscopic procedures including diagnostic and interventional cardiac catheterizations, electrophysiology examinations, cardiac computed tomography (CT) studies, and nuclear cardiology examinations. Despite the clinical necessity of these imaging studies, the related ionizing radiation exposure could pose an increased lifetime attributable cancer risk. The Image Gently "Have-A-Heart" campaign is promoting the appropriate use of medical imaging studies in children with congenital or acquired heart disease while minimizing radiation exposure. The focus of this manuscript is to provide a comprehensive review of radiation dose management and CT performance in children with congenital or acquired heart disease.
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Affiliation(s)
- Cynthia K Rigsby
- Department of Medical Imaging #9, Ann & Robert H. Lurie Children's Hospital of Chicago, Departments of Radiology and Pediatrics, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave., Chicago, IL, 60611, USA.
| | - Sarah E McKenney
- Division of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC, USA
| | - Kevin D Hill
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Anjali Chelliah
- Division of Pediatric Cardiology, Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - Andrew J Einstein
- Division of Cardiology, Departments of Medicine and Radiology, Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - B Kelly Han
- Department of Pediatrics, Children's Heart Clinic at The Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | - Joshua D Robinson
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Departments of Pediatrics and Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Christina L Sammet
- Department of Medical Imaging #9, Ann & Robert H. Lurie Children's Hospital of Chicago, Departments of Radiology and Pediatrics, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave., Chicago, IL, 60611, USA
| | - Timothy C Slesnick
- Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Donald P Frush
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
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14
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Nerlekar N, Ko BS, Nasis A, Cameron JD, Leung M, Brown AJ, Wong DTL, Ngu PJ, Troupis JM, Seneviratne SK. Impact of heart rate on diagnostic accuracy of second generation 320-detector computed tomography coronary angiography. Cardiovasc Diagn Ther 2017; 7:296-304. [PMID: 28567355 DOI: 10.21037/cdt.2017.03.05] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To assess the impact of elevated heart rate (HR) on the diagnostic accuracy and image quality of second-generation 320-detector computed tomography coronary angiography (320-CTCA). METHODS Consecutive patients with suspected coronary disease referred for invasive coronary angiography (ICA) were prospectively recruited and underwent 320-CTCA. Pre-scan beta-blockers were administered if native HR>80 bpm and post-scan cohorts stratified by traditional (HR ≤60 bpm) and elevated HR (61-80 bpm). A wider phase window was used for the elevated HR group (30-80%). 320-CTCA and ICA were analyzed by independent readers blinded to other data. Significant disease was defined as ≥50% visual stenosis on ICA. Uninterpretable segments by 320-CTCA were considered to be significant on an intention-to-diagnose principle. Image quality was assessed by 5-point Likert score. RESULTS Of 107 patients studied (1,662 segments), there was no significant difference in sensitivity, specificity, positive and negative predictive value between patients with HR ≤60 bpm (n=55) vs. HR 61-80 bpm (n=52): 97%, 88%, 95%, 94% vs. 100%, 88%, 95%, 100%; Receiver operator characteristic-area under the curve 0.93 vs. 0.94, P=0.82). Overall per-patient diagnostic accuracy was 96% in both groups with no significant difference in interpretable segments (Likert ≥2) or median radiation dose (2.4 mSv vs. 2.7 mSv, P=0.35). Only 4/1,662 (0.2%) segments were uninterpretable by motion artefact in the whole cohort. CONCLUSIONS In patients with HR >60 and up to 80bpm, second generation 320-CTCA provides comparably adequate diagnostic accuracy to HR ≤60 without significantly impacting upon overall segmental evaluability.
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Affiliation(s)
- Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia
| | - Brian S Ko
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia
| | - Arthur Nasis
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia
| | - James D Cameron
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia
| | - Michael Leung
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia
| | - Adam J Brown
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia
| | - Dennis T L Wong
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia
| | - Philip J Ngu
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia
| | - John M Troupis
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia.,Department of Diagnostic Imaging, MMC, Southern Health, Melbourne, Australia
| | - Sujith K Seneviratne
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia
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15
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Heart-Rate Reduction With Adjusted-Dose Ivabradine in Patients Undergoing Coronary Computed Tomographic Angiography. J Comput Assist Tomogr 2017; 41:360-363. [DOI: 10.1097/rct.0000000000000556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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16
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Aguiar Rosa S, Ramos R, Marques H, Santos R, Leal C, Casado H, Saraiva M, Figueiredo L, Cruz Ferreira R. Bailout intravenous esmolol for heart rate control in cardiac computed tomography angiography. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.repce.2016.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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17
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Aguiar Rosa S, Ramos R, Marques H, Santos R, Leal C, Casado H, Saraiva M, Figueiredo L, Cruz Ferreira R. Bailout intravenous esmolol for heart rate control in cardiac computed tomography angiography. Rev Port Cardiol 2016; 35:673-678. [PMID: 27865676 DOI: 10.1016/j.repc.2016.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 06/16/2016] [Accepted: 07/08/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of a heart rate (HR) reduction protocol using intravenous esmolol as bailout for failed oral metoprolol regimens in patients undergoing coronary computed tomography angiography (CCTA) with 64-slice multidetector computed tomography (64-MDCT). METHODS Patients who underwent cardiac 64-MDCT in a single institution between 2011 and 2014 were analyzed. Those with HR above 60 beats per minute (bpm) on presentation received oral metoprolol (50-200 mg) at least one hour before CCTA. Intravenous esmolol 1-2 mg/kg was administered as a bolus whenever HR remained over 65 bpm just before imaging. The primary efficacy endpoint was HR <65 bpm during CCTA. The primary safety endpoint was symptomatic hypotension or bradycardia up to hospital discharge. RESULTS During the study period CCTA was performed in 947 cases. In 86% of these, oral metoprolol was the only medication required to successfully reduce HR <60 bpm. Esmolol was used in the remaining 130 patients (14%). For esmolol-treated patients mean baseline and acquisition HR were 74±14 bpm and 63±9 bpm, respectively (p<0.001). The target HR of <65 bpm was achieved in 82 of the 130 esmolol-treated patients (63%). Considering the whole population, esmolol use led to a significant increase in the primary efficacy endpoint from 86% to 95% (p<0.001). Esmolol also resulted in a statistically, but not clinically, significant reduction in systolic blood pressure (144±22 to 115±17 mmHg; p<0.001). The combined primary safety endpoint was only observed in two (1.5%) patients. CONCLUSION Despite optimal use of oral beta-blockers, 14% of patients needed intravenous esmolol for HR control. The pre-medication combination of oral metoprolol and on-demand administration of intravenous esmolol was safe and effective and enabled 95% of patients to be imaged with HR below 65 bpm.
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Affiliation(s)
| | - Ruben Ramos
- Cardiology Department, Santa Marta Hospital, Lisbon, Portugal
| | - Hugo Marques
- Radiology Department, Santa Marta Hospital, Lisbon, Portugal
| | - Rosana Santos
- Radiology Department, Santa Marta Hospital, Lisbon, Portugal
| | - Cecília Leal
- Radiology Department, Santa Marta Hospital, Lisbon, Portugal
| | - Helena Casado
- Radiology Department, Santa Marta Hospital, Lisbon, Portugal
| | - Márcia Saraiva
- Radiology Department, Santa Marta Hospital, Lisbon, Portugal
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Sheta HM, Egstrup K, Husic M, Heinsen LJ, Nieman K, Lambrechtsen J. Impact of a motion correction algorithm on image quality in patients undergoing CT angiography: A randomized controlled trial. Clin Imaging 2016; 42:1-6. [PMID: 27838576 DOI: 10.1016/j.clinimag.2016.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/20/2016] [Accepted: 11/04/2016] [Indexed: 10/20/2022]
Abstract
AIMS To investigate the motion correction algorithm Snapshot-Freeze (SSF) compared to standard reconstruction (STD) in patients randomized to receive beta-blockers (BB) or no beta-blockers (non-BB) before coronary CT, and to investigate if SSF can replace BB. METHODS One hundred and forty patients scheduled for coronary CT were randomized. All images were reconstructed by the SSF and STD algorithms. Image quality was evaluated according to Likert score (1: excellent, 2: good, 3: adequate, 4: non-diagnostic) and presence of artifacts was noted. RESULTS Images from 64 patients in the BB group (mean HR 56±4bpm) and 51 patients in the non-BB group (mean HR 67±7bpm) were analyzed. Twenty five patients were excluded because of tachycardia, bradycardia or reconstruction errors in SSF. SSF increased the number of excellent images in both groups compared to the STD algorithm (BB: 59% vs.44%; non-BB: 25% vs. 8%), but the number of non-diagnostic images was not significantly reduced. SSF reduced motion artifacts (BB: 11% vs. 31%; non-BB: 49% vs. 75%), but despite this reduction, motion artifacts in non-BB were still more frequent compared to the BB group analyzed by STD (49% vs. 31%). CONCLUSION SSF improves image quality and reduces motion artifacts, but does not compensate for the absence of BB.
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Affiliation(s)
- Hussam M Sheta
- Department of Medical Research, OUH Svendborg Hospital, Institute of Regional Health Research, Valdemarsgade 53, 5700 Svendborg, Denmark.
| | - Kenneth Egstrup
- Department of Medical Research, OUH Svendborg Hospital, Institute of Regional Health Research, Valdemarsgade 53, 5700 Svendborg, Denmark
| | - Mirza Husic
- Department of Medical Research, OUH Svendborg Hospital, Institute of Regional Health Research, Valdemarsgade 53, 5700 Svendborg, Denmark
| | - Laurits J Heinsen
- Department of Medical Research, OUH Svendborg Hospital, Institute of Regional Health Research, Valdemarsgade 53, 5700 Svendborg, Denmark
| | - Koen Nieman
- Erasmus University Medical Centre Rotterdam, 's-Gravendijkwal 230, 3015 CE Rotterdam, Netherlands
| | - Jess Lambrechtsen
- Institute of Regional Health Research, OUH Svendborg Sygehus, Valdemarsgade 53, 5700 Svendborg, Denmark
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Abbara S, Blanke P, Maroules CD, Cheezum M, Choi AD, Han BK, Marwan M, Naoum C, Norgaard BL, Rubinshtein R, Schoenhagen P, Villines T, Leipsic J. SCCT guidelines for the performance and acquisition of coronary computed tomographic angiography: A report of the society of Cardiovascular Computed Tomography Guidelines Committee: Endorsed by the North American Society for Cardiovascular Imaging (NASCI). J Cardiovasc Comput Tomogr 2016; 10:435-449. [PMID: 27780758 DOI: 10.1016/j.jcct.2016.10.002] [Citation(s) in RCA: 611] [Impact Index Per Article: 76.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 10/09/2016] [Indexed: 01/20/2023]
Abstract
In response to recent technological advancements in acquisition techniques as well as a growing body of evidence regarding the optimal performance of coronary computed tomography angiography (coronary CTA), the Society of Cardiovascular Computed Tomography Guidelines Committee has produced this update to its previously established 2009 "Guidelines for the Performance of Coronary CTA" (1). The purpose of this document is to provide standards meant to ensure reliable practice methods and quality outcomes based on the best available data in order to improve the diagnostic care of patients. Society of Cardiovascular Computed Tomography Guidelines for the Interpretation is published separately (2). The Society of Cardiovascular Computed Tomography Guidelines Committee ensures compliance with all existing standards for the declaration of conflict of interest by all authors and reviewers for the purpose ofclarity and transparency.
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Affiliation(s)
- Suhny Abbara
- University of Texas Southwestern Medical Center, Dallas, TX, United States.
| | - Philipp Blanke
- Department of Radiology and Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Michael Cheezum
- Cardiology Service Ft. Belvoir Community Hospital, Ft. Belvoir, VA, United States
| | - Andrew D Choi
- Division of Cardiology and Department of Radiology, The George Washington University School of Medicine, Washington DC, United States
| | - B Kelly Han
- Minneapolis Heart Institute and Children's Heart Clinic, Minneapolis, MN, United States
| | - Mohamed Marwan
- Cardiology Department, University Hospital, Erlangen, Germany
| | - Chris Naoum
- Concord Hospital, The University of Sydney, Sydney, Australia
| | - Bjarne L Norgaard
- Department of Cardiology B, Aarhus University Hospital-Skejby, Aarhus N, Denmark
| | - Ronen Rubinshtein
- Lady Davis Carmel Medical Center & Rappaport School of Medicine- Technion- IIT, Haifa, Israel
| | - Paul Schoenhagen
- Cardiovascular Imaging, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, United States
| | - Todd Villines
- Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Jonathon Leipsic
- Department of Radiology and Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
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Qiu S, Shi S, Ping H, Zhou S, Wang H, Yang B. Efficacy of Ivabradine versus β-Blockers for Heart Rate Reduction during Computed Tomography Coronary Angiography: A Meta-Analysis of Randomized Controlled Trials. Cardiology 2016; 135:133-140. [DOI: 10.1159/000447236] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 05/27/2016] [Indexed: 01/09/2023]
Abstract
Objective: To quantify the efficacy of pretreatment with ivabradine compared to β-blockers before computed tomography coronary angiography (CTCA) via a meta-analysis of clinical randomized controlled trial data. Methods: We conducted a search for randomized controlled trials of pretreatment with ivabradine compared to β-blockers before CTCA in Medline, PubMed, Embase, SCI/SSCI/A&HCI, SAS Publishers, Web of Science, and the Cochrane Central Register. The Jadad quality score of the included studies, and the mean difference (MD) in heart rate reduction, were indicators of efficacy. RevMan 5.2 and Stata 12.0 software were used for the meta-analysis. Results: Eight studies involving a total of 1,324 patients were included in the final analysis. The results showed that ivabradine was significantly more effective at improving the heart rate of patients achieving the target heart rate (<65 bpm) during CTCA (OR 5.02; 95% CI 3.16-7.98, p < 0.00001, I2 = 20%). A comparison of efficacy between ivabradine and β-blockers showed a statistically significant effect of ivabradine on heart rate reduction during CTCA (MD -4.39; 95% CI −4.80 to −3.99, p < 0.00001, I2 = 0%). Ivabradine also led to a significant reduction in heart rate prior to CTCA (MD −5.33; 95% CI −10.26 to −0.39, p = 0.03, I2 = 92%). In terms of the total reduction in heart rate during CTCA, significant differences were noted between the ivabradine group and the β-blocker group (MD 2.64; 95% CI 1.25-4.02, p = 0.0002, I2 = 0%). The mean percentage reduction in heart rate in the ivabradine group was significantly higher than that in the β-blocker group (MD 7.18; 95% CI 5.64-8.72, p < 0.00001, I2 = 43%). Ivabradine had no significant effect on either systolic blood pressure (BP) (MD 11.41; 95% CI 6.43-16.40, p < 0.00001, I2 = 85%) or diastolic BP (MD 1.79; 95% CI -0.00 to 3.58, p = 0.05, I2 = 56%). Conclusion: Compared to β-blockers for heart rate reduction, ivabradine is a potentially attractive alternative for patients undergoing CTCA.
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Ng MY, Karimzad Y, Menezes RJ, Wintersperger BJ, Li Q, Forero J, Paul NS, Nguyen ET. Randomized controlled trial of relaxation music to reduce heart rate in patients undergoing cardiac CT. Eur Radiol 2016; 26:3635-42. [DOI: 10.1007/s00330-016-4215-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 10/22/2015] [Accepted: 01/13/2016] [Indexed: 10/22/2022]
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Oda S, Katahira K, Utsunomiya D, Takaoka H, Honda K, Noda K, Oshima S, Yuki H, Namimoto T, Yamashita Y. Improved image quality at 256-slice coronary CT angiography in patients with a high heart rate and coronary artery disease: comparison with 64-slice CT imaging. Acta Radiol 2015; 56:1308-14. [PMID: 25348474 DOI: 10.1177/0284185114555152] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 09/19/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND The 256-slice computed tomography (CT) scanners with wider detector coverage and faster gantry rotation speed are now available. The performance of scanners that feature a rotation speed of 270 ms at coronary CT angiography (CCTA) has not been evaluated in patients with a higher heart rate. PURPOSE To evaluate the image quality of 256-slice CT with faster gantry rotation speed in patients undergoing CCTA. MATERIAL AND METHODS We enrolled 886 patients; 357(40.3%) underwent study on a 64-slice CT at a rotation speed of 420 ms, the other 529 (59.7%) were examined using a 256-slice CT scanner at 270 ms. Two observers judged the image quality of 2658 imaged coronary arteries on a 4-point scale. RESULTS The mean image quality score was significantly higher for the 256 - than the 64-slice CT scans (3.94 ± 0.28 vs. 3.73 ± 0.61; P < 0.01). There was no significant difference in the image quality scores between 64 - and 256-slice scans in patients whose heart rate (HR) was <60 bpm. However, in patients whose HR exceeded 60 bpm these scores were significantly higher for 256-slice CT images (P < 0.01). CONCLUSION CCTA performed on the 256-slice CT scanner yielded significantly better image quality in patients with an HR exceeding 60 bpm.
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Affiliation(s)
- Seitaro Oda
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Kazuhiro Katahira
- Department of Diagnostic Radiology, Kumamoto Chuo Hospital, Kumamoto, Japan
| | - Daisuke Utsunomiya
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroko Takaoka
- Department of Diagnostic Radiology, Kumamoto Chuo Hospital, Kumamoto, Japan
| | - Keiichi Honda
- Department of Diagnostic Radiology, Kumamoto Chuo Hospital, Kumamoto, Japan
| | - Katsuo Noda
- Department of Cardiology, Kumamoto Chuo Hospital, Kumamoto, Japan
| | - Shuichi Oshima
- Department of Cardiology, Kumamoto Chuo Hospital, Kumamoto, Japan
| | - Hideaki Yuki
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Tomohiro Namimoto
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yasuyuki Yamashita
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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Cademartiri F, Garot J, Tendera M, Zamorano JL. Intravenous ivabradine for control of heart rate during coronary CT angiography: A randomized, double-blind, placebo-controlled trial. J Cardiovasc Comput Tomogr 2015; 9:286-94. [DOI: 10.1016/j.jcct.2015.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 04/22/2015] [Accepted: 04/22/2015] [Indexed: 10/23/2022]
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Maurovich-Horvat P, Károlyi M, Horváth T, Szilveszter B, Bartykowszki A, Jermendy ÁL, Panajotu A, Celeng C, Suhai FI, Major GP, Csobay-Novák C, Hüttl K, Merkely B. Esmolol is noninferior to metoprolol in achieving a target heart rate of 65 beats/min in patients referred to coronary CT angiography: A randomized controlled clinical trial. J Cardiovasc Comput Tomogr 2015; 9:139-45. [DOI: 10.1016/j.jcct.2015.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 01/24/2015] [Accepted: 02/07/2015] [Indexed: 10/24/2022]
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25
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Coronary vasospasm in CT angiography procedure. J Cardiovasc Comput Tomogr 2015; 9:e1. [DOI: 10.1016/j.jcct.2014.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 11/09/2014] [Indexed: 11/18/2022]
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26
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Entezari P, Collins J, Chalian H, Tore HG, Carr J, Yaghmai V. Impact of beta-blockade premedication on image quality of ECG-gated thoracic aorta CT angiography. Acta Radiol 2014; 55:1180-5. [PMID: 24345768 DOI: 10.1177/0284185113516950] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Thoracic aortic aneurysm is one of the most common aorta pathologies worldwide, which is commonly evaluated by computed tomography angiography (CTA). One of the routine methods to improve the image quality of CTA is heart rate reduction prior to study by beta-blockade administration. PURPOSE To assess the effect of beta-blockade on image quality of the ascending aorta in electrocardiography (ECG)-gated dual-source CTA (DSCTA) images. MATERIAL AND METHODS In this retrospective study, ECG-gated thoracic aorta CTA images of 40 patients without beta-blocker administration were compared with ECG-gated images of 40 patients with beta-blockade. Images of the aorta were analyzed objectively and subjectively at three levels: sinus of Valsalva (sinus), sinotubular junction (STJ), and mid ascending aorta (MAA). Quantitative sharpness index (SI) and signal-to-noise ratio (SNR) were calculated and two radiologists evaluated the image quality using a 3-point scale. RESULTS Mean heart rate in beta-blocker and non-beta-blocker groups was 61.7 beats per minute (bpm) (range, 58.1-63.9 bpm) and 72.9 bpm (range, 69.3-84.1 bpm), respectively (P < 0.05). Aorta wall SI, SNR, and subjective grading were comparable between the two groups at all three levels (P > 0.05). CONCLUSION Beta-blocker premedication may not be necessary for imaging of ascending aorta with ECG-gated DSCTA.
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Affiliation(s)
- Pegah Entezari
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University-Feinberg School of Medicine, Chicago, IL, USA
| | - Jeremy Collins
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University-Feinberg School of Medicine, Chicago, IL, USA
| | - Hamid Chalian
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University-Feinberg School of Medicine, Chicago, IL, USA
| | - Huseyin Gurkan Tore
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University-Feinberg School of Medicine, Chicago, IL, USA
| | - James Carr
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University-Feinberg School of Medicine, Chicago, IL, USA
| | - Vahid Yaghmai
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University-Feinberg School of Medicine, Chicago, IL, USA
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Safety of an IV β-Adrenergic Blockade Protocol for Heart Rate Optimization Before Coronary CT Angiography. AJR Am J Roentgenol 2014; 203:759-62. [PMID: 25247941 DOI: 10.2214/ajr.13.11492] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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28
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Pedersen C, Thomsen CF, Hosbond SE, Thomassen A, Mickley H, Diederichsen ACP. Coronary computed tomography angiography - tolerability of β-blockers and contrast media, and temporal changes in radiation dose. SCAND CARDIOVASC J 2014; 48:271-7. [PMID: 25100617 DOI: 10.3109/14017431.2014.951958] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine the risk in administering β-blockers, contrast-induced nephropathy (CIN) and the trend in X-ray use, during coronary computed tomography angiography (CCTA). METHODS A total of 416 patients were referred for elective CCTA. To achieve a resting heart rate below 60 beats per minute, oral and/or intravenous β-blockers were administered. Using questionnaires, information on the adverse effects of β-blockers was collected from the patients. The levels of s-creatinine and estimated GFR (eGFR) were measured before and after contrast enhanced CCTA. Radiation exposure was compared with the exposure 3 years earlier. RESULTS There was no significant difference in the symptoms (dizziness, lipothymia and palpitations) between patients with and patients without β-blocker pretreatment. Compared to baseline values, the decrease in s-creatinine was not significant (75.2 vs. 74.6 μmol/L, p = 0.09), while the increase in eGFR was not significant (78 vs. 79 mL/min, p = 0.17). Also, subgroups of patients with hypertension, hypercholesterolemia, diabetes or pre-existing slight impairment in renal function did not develop CIN. The mean radiation exposure decreased from 17.5 to 6.7 mSv, p < 0.0001. CONCLUSIONS In terms of the side effects of β-blockers and contrast media, there were no short term complications to CCTA. Furthermore, the radiation dose has been dramatically diminished over the last three years.
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Affiliation(s)
- Charlotte Pedersen
- Department of Cardiology, Odense University Hospital , Odense C , Denmark
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Sadamatsu K, Koide S, Nakano K, Yoshida K. Heart rate control with single administration of a long-acting β-blocker at bedtime before coronary computed tomography angiography. J Cardiol 2014; 65:293-7. [PMID: 25113950 DOI: 10.1016/j.jjcc.2014.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 06/24/2014] [Accepted: 07/11/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Beta-blockers are used to control the heart rate prior to coronary computed tomography (CT) angiography. However, in-hospital administration is time-consuming, and it is hard to decrease the heart rate to <60 beats per minute (bpm) when the initial heart rate is increased. In this study, we examined whether the single administration of long-acting β-blocker at bedtime before angiography is effective for achieving the target heart rate. METHODS AND RESULTS A total of 314 consecutive patients with a resting heart rate >60bpm who underwent coronary CT angiography were retrospectively collected. Either bisoprolol or atenolol was orally administered the night before to 166 patients (beta group), and no additional medication was administered to the other 148 patients (control group). When the heart rate was >60bpm on arrival, a β-blocker or verapamil was orally administered at the discretion of the physician. Although the baseline heart rate was not significantly different between the groups, the β-blocker treatment the night before significantly reduced the heart rate compared to control group upon arrival at the hospital and at the time of angiography. The rate of achievement of a heart rate ≤60bpm on arrival at the hospital was significantly higher in the beta group, and even after the additional treatment. CONCLUSIONS Bedtime administration of a long-acting β-blocker the night before coronary CT angiography is an effective option to achieve the target heart rate at the time of examination.
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Affiliation(s)
- Kenji Sadamatsu
- Department of Cardiology, Saga-ken Medical Centre Koseikan, Saga, Japan.
| | - Sachiko Koide
- Department of Nursing, Saga-ken Medical Centre Koseikan, Saga, Japan
| | - Kayoko Nakano
- Department of Nursing, Saga-ken Medical Centre Koseikan, Saga, Japan
| | - Keiki Yoshida
- Department of Cardiology, Saga-ken Medical Centre Koseikan, Saga, Japan
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High-dose intravenous metoprolol usage for reducing heart rate at CT coronary angiography: Efficacy and safety. Clin Radiol 2014; 69:739-44. [DOI: 10.1016/j.crad.2014.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 03/02/2014] [Accepted: 03/03/2014] [Indexed: 01/21/2023]
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31
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Belgrano M, Bregant P, Djoguela MF, Toscano W, Marchese E, Cova MA. 256-slice CT coronary angiography: in vivo dosimetry and technique optimization. LA RADIOLOGIA MEDICA 2013; 119:249-56. [PMID: 24337756 DOI: 10.1007/s11547-013-0334-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 01/23/2013] [Indexed: 12/01/2022]
Abstract
PURPOSE This study was undertaken to compare the different acquisition protocols available in a last-generation multislice computed tomography scanner used for cardiovascular studies, with particular attention to dosimetric aspects. MATERIALS AND METHODS Our study compared prospective and retrospective electrocardiographic-gating techniques for cardiac imaging. For each patient, we performed in vivo dose measurements, using Gafchromic film. We compared the effective dose values estimated from the experimental measurements and the dose data reported on the CT console. Image quality was also assessed. RESULTS Prospective acquisition allows for major dose savings compared to retrospective acquisition (mean effective dose, 4.5 mSv with prospective acquisition versus 27.5 mSv with retrospective acquisition). The agreement between the experimental and software-based dose estimates was excellent and showed below 10% of variation of the measured dose. CONCLUSION In patients with regular rhythm and a heart rate lower than 75 bpm, the prospective acquisition technique ensures adequate diagnostic results and allows for significant patient dose savings.
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Affiliation(s)
- Manuel Belgrano
- UCO di Radiologia, Dipartimento di Scienze Mediche, Chirurgiche e della Salute, Azienda Ospedaliero-Universitaria di Trieste, Ospedale di Cattinara, strada di Fiume 447, Trieste, Italy,
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32
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Acceptance of noninvasive computed tomography coronary angiography: for a patient-friendly medicine. LA RADIOLOGIA MEDICA 2013; 119:128-34. [DOI: 10.1007/s11547-013-0319-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Accepted: 07/12/2012] [Indexed: 11/26/2022]
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Lambrechtsen J, Egstrup K. Pre-treatment with a sinus node blockade, ivabradine, before coronary CT angiography: A retrospective audit. Clin Radiol 2013; 68:1054-8. [DOI: 10.1016/j.crad.2013.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 04/29/2013] [Accepted: 05/15/2013] [Indexed: 10/26/2022]
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Heart rate control with oral ivabradine in computed tomography coronary angiography: A randomized comparison of 7.5mg vs 5mg regimen. Int J Cardiol 2013; 168:362-8. [DOI: 10.1016/j.ijcard.2012.09.041] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 09/06/2012] [Accepted: 09/15/2012] [Indexed: 11/17/2022]
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LAD coronary artery myocardial bridging and apical ballooning syndrome. JACC Cardiovasc Imaging 2013; 6:32-41. [PMID: 23328559 DOI: 10.1016/j.jcmg.2012.08.013] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 07/30/2012] [Accepted: 08/23/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVES This study sought to evaluate the prevalence and potential role of myocardial bridging in the pathogenesis of apical ballooning syndrome (ABS). BACKGROUND ABS is characterized by reversible left ventricular dysfunction, frequently precipitated by a stressful event, but the pathogenesis remains still unclear. METHODS Forty-two consecutive patients (40 female, mean age 66 ± 7 years) with ABS underwent echocardiography, cardiac magnetic resonance, coronary angiography (CA) with intravascular ultrasound, and computed tomography angiography (CTA). Myocardial bridging was diagnosed by CA when a dynamic compression phenomenon was observed in the coronary artery and by CTA when a segment of coronary artery was completely (full encasement) or incompletely (partial encasement) surrounded by the myocardium. The prevalence of myocardial bridging detected by CTA and CA in ABS patients was compared with 401 controls without ABS who underwent both CTA and CA. RESULTS Myocardial bridging by CTA was observed in 32 ABS patients (76%): 23 with partial encasement and 9 with full encasement. All myocardial bridging was located in the mid segment of the left anterior descending coronary artery (LAD) with a mean length of 17 ± 9 mm. CA revealed myocardial bridging in 17 subjects (40%) (9 with partial encasement and 8 with full encasement by CTA). All subjects in which dynamic compression was observed by CA showed myocardial bridging by CTA, while none of the subjects with negative findings for myocardial bridging by CTA revealed dynamic compression by CA. Compared with controls, ABS patients showed a significant higher prevalence of myocardial bridging in the LAD either by CA (40% vs. 8%; p < 0.001) or by CTA (76% vs. 31%; p < 0.001). CONCLUSIONS Our study showed that myocardial bridging of the LAD is a frequent finding in ABS patients as revealed both by CA and, mostly, by CTA, suggesting a role of myocardial bridging as potential substrate in the pathogenesis of ABS.
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Fraccaro C, Napodano M, Tarantini G. Conduction disorders in the setting of transcatheter aortic valve implantation: a clinical perspective. Catheter Cardiovasc Interv 2013; 81:1217-23. [DOI: 10.1002/ccd.24713] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 10/12/2012] [Indexed: 11/09/2022]
Affiliation(s)
- Chiara Fraccaro
- Division of Cardiology; Department of Cardiac; Thoracic and Vascular Sciences; University of Padova; Padova; Italy
| | - Massimo Napodano
- Division of Cardiology; Department of Cardiac; Thoracic and Vascular Sciences; University of Padova; Padova; Italy
| | - Giuseppe Tarantini
- Division of Cardiology; Department of Cardiac; Thoracic and Vascular Sciences; University of Padova; Padova; Italy
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Cotarlan V, Brofferio A, Gerhard GS, Chu X, Shirani J. Impact of β(1)- and β(2)-adrenergic receptor gene single nucleotide polymorphisms on heart rate response to metoprolol prior to coronary computed tomographic angiography. Am J Cardiol 2013; 111:661-6. [PMID: 23261005 DOI: 10.1016/j.amjcard.2012.11.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 11/14/2012] [Accepted: 11/14/2012] [Indexed: 11/18/2022]
Abstract
A slow, steady heart rate (HR) is necessary for optimal image quality during coronary computed tomographic angiography. Beta blockers are often used, but the goal HR is not achieved in some patients. The aim of this study was to examine the influence of single-nucleotide polymorphisms (SNPs) of the β(1) (codons 49 and 389) and β(2) (codons 16, 27, and 164) adrenergic receptor (AR) genes on HR response to metoprolol in 200 adults (mean age 56 ± 11 years) referred for coronary computed tomographic angiography (using a 64-slice scanner). Oral and intravenous (IV) metoprolol was given to achieve a goal HR of <60 beats/min. Overall, 37 patients (18.5%) did not reach the goal HR despite the administration of oral (181 ± 116 mg) and IV (4.2 ± 9.4 mg) metoprolol. Patients with the β(1)-AR Ser49Gly or Gly49Gly genotype (n = 49) more often failed to reach an optimal HR compared to those with the Ser49Ser genotype (n = 151) (29% vs 15%, p = 0.04), despite receiving higher doses of oral (210 ± 115 vs 172 ± 115 mg, p = 0.048) and IV (7 ± 13 vs 3 ± 8 mg, p = 0.02) metoprolol. Similarly, patients with the β(1)-AR Gly389Gly genotype (n = 11) more often failed to reach an optimal HR compared to those with the Arg389Arg and Arg389Gly genotypes (n = 189) (45% vs 17%, p = 0.02), despite receiving higher doses of IV (13 ± 15 vs 4 ± 9 mg, p = 0.002) but not oral (162 ± 105 vs 182 ± 117 mg, p = 0.50) metoprolol. Multivariate analysis identified β(1)-AR SNPs at codons 49 and 389 and β(2)-AR SNP at codon 27 as independent predictors of suboptimal HR response. In conclusion, these data indicate that the selected SNPs of β(1)-AR and β(2)-AR genes influence HR response to metoprolol in patients who undergo coronary computed tomographic angiography.
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MESH Headings
- Adrenergic beta-Antagonists/administration & dosage
- Adult
- Aged
- Aged, 80 and over
- Coronary Angiography/methods
- Coronary Artery Disease/diagnostic imaging
- Coronary Artery Disease/drug therapy
- Coronary Artery Disease/genetics
- DNA/genetics
- Female
- Genotype
- Heart Rate/genetics
- Humans
- Male
- Metoprolol/administration & dosage
- Middle Aged
- Polymorphism, Single Nucleotide
- Prospective Studies
- Receptors, Adrenergic, beta-1/genetics
- Receptors, Adrenergic, beta-1/metabolism
- Receptors, Adrenergic, beta-2/genetics
- Receptors, Adrenergic, beta-2/metabolism
- Tomography, X-Ray Computed
- Young Adult
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Affiliation(s)
- Vlad Cotarlan
- Department of Cardiology, Geisinger Medical Center, Danville, PA, USA
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Rationale, design and methods of CTCA-PRORECAD (Computed Tomography Coronary Angiography Prognostic Registry for Coronary Artery Disease): a multicentre and multivendor registry. Radiol Med 2013; 118:591-607. [PMID: 23358817 DOI: 10.1007/s11547-012-0912-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 11/15/2011] [Indexed: 10/27/2022]
Abstract
PURPOSE This study was done to assess the prognostic value of computed tomography coronary angiography (CTCA) in a large multicentre population of patients with suspected coronary artery disease (CAD) and, in particular, its incremental value compared with traditional methods for risk stratification. MATERIALS AND METHODS This is a retrospective observational study that began in January 2003 conducted on patients with suspected CAD assessed with CTCA on the basis of symptoms (chest pain, dyspnoea) and/or abnormal or equivocal stress test and/or a high cardiovascular risk profile. The participating centres will provide data obtained with CTCA performed with 16-slice or higher equipment. Exclusion criteria are renal insufficiency, allergy to iodinated contrast material, pregnancy and previous myocardial infarction or revascularisation (percutaneous coronary intervention and/or coronary artery bypass graft). All patients are stratified by means of clinical assessment and/or data retrieved from a clinical database. Risk factors considered are hypertension, dyslipidaemia, diabetes mellitus, smoking, family history and obesity. Symptoms are classified as absent, typical chest pain, atypical chest pain and dyspnoea. Primary endpoints are death, major adverse cardiovascular events (cardiac death, unstable angina requiring hospitalisation, acute myocardial infarction) and shifting of cardiovascular risk category on the basis of coronary plaque burden. The secondary endpoint is coronary revascularisation. Telephone interviews and/or clinical databases are used for the follow-up. The study will be conducted on a population >1,000 patients. CONCLUSIONS The information collected from the Prognostic Registry for Coronary Artery Disease (PRORECAD) will provide insight into the prognostic value of CTCA in addition to demographic and clinical features. The results will allow for better use and interpretation of CTCA for prognostic purposes.
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Cademartiri F, Maffei E, Arcadi T, Catalano O, Midiri M. CT coronary angiography at an ultra-low radiation dose (<0.1 mSv): feasible and viable in times of constraint on healthcare costs. Eur Radiol 2013; 23:607-13. [PMID: 23344906 DOI: 10.1007/s00330-012-2767-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 12/13/2012] [Accepted: 12/19/2012] [Indexed: 11/29/2022]
Abstract
Computed tomography coronary angiography (CTCA) has reached very high standards both in terms of diagnostic performance and radiation dose reduction. This commentary follows a report on CTCA using less than 0.1 mSv in selected patients. This is an extraordinary accomplishment, both for technology and for medicine. The difficult task is now to implement this tool in clinical practice so it can play the best possible role. CTCA can improve diagnostic pathways, can save money for healthcare systems and could even improve pharmacological therapy. All of this may happen, but it will require the combined effort of all the experienced operators in this field, including the referring clinicians. In times of financial constraint, CTCA may also help to restrict ineffective medical expenses.
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Affiliation(s)
- Filippo Cademartiri
- Department of Radiology, Erasmus Medical Center University, 's Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
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Adile KK, Kapoor A, Jain SK, Gupta A, Kumar S, Tewari S, Garg N, Goel PK. Safety and efficacy of oral ivabradine as a heart rate-reducing agent in patients undergoing CT coronary angiography. Br J Radiol 2012; 85:e424-8. [PMID: 22815422 DOI: 10.1259/bjr/22102914] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the role of oral ivabradine as a heart rate reducing agent in patients undergoing CT coronary angiography (CTCA). Despite the routine use of β-blockers prior to CTCA studies, it is not uncommon to have patients with heart rates persistently above the target range of 65 bpm. Ivabradine is a selective inhibitor of the I(f) current, which primarily contributes to sinus node pacemaker activity, and has no significant direct cardiovascular effects such as reduction of blood pressure, cardiac contractility or impairment of cardiac conduction. METHODS We investigated 100 consecutive patients who had been referred for CTCA for the evaluation of suspected coronary artery disease (CAD). Patients were randomised to receive either of the following two pre-medication protocols: oral metorprolol or oral ivabradine. RESULTS Ivabradine was significantly more effective than metorprolol in lowering the heart rate; the mean percentage reduction in heart rate with ivabradine vs metorpolol was 23.89+6.95% vs 15.20+4.50%, respectively (p=0.0001). Metoprolol significantly lowered both systolic and diastolic blood pressure while ivabradine did not. The requirement of additional doses to achieve a target heart rate of <65 beats per min was also significantly more frequent with metoprolol. CONCLUSION Ivabradine is a potentially attractive alternative to currently used drugs for reduction of heart rate in patients undergoing CTCA.
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Affiliation(s)
- K K Adile
- Department of Cardiology, Sanjay Grandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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Failed heart rate control with oral metoprolol prior to coronary CT angiography: effect of additional intravenous metoprolol on heart rate, image quality and radiation dose. Int J Cardiovasc Imaging 2012; 29:199-206. [DOI: 10.1007/s10554-012-0049-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2011] [Accepted: 03/31/2012] [Indexed: 12/13/2022]
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Clinical indications for cardiac computed tomography. From the Working Group of the Cardiac Radiology Section of the Italian Society of Medical Radiology (SIRM). Radiol Med 2012; 117:901-38. [PMID: 22466874 DOI: 10.1007/s11547-012-0814-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 09/14/2011] [Indexed: 12/13/2022]
Abstract
Cardiac computed tomography (CCT) has grown as a useful means in different clinical contexts. Technological development has progressively extended the indications for CCT while reducing the required radiation dose. Even today there is little documentation from the main international scientific societies describing the proper use and clinical indications of CCT; in particular, there are no complete guidelines. This document reflects the position of the Working Group of the Cardiac Radiology Section of the Italian Society of Radiology concerning the indications for CCT.
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Maffei E, Seitun S, Palumbo A, Martini C, Emiliano E, Cuttone A, Aldrovandi A, Malagò R, La Grutta L, Midiri M, Tedeschi C, De Rosa R, Catalano O, Weustink A, Mollet N, Cademartiri F. Prognostic value of Morise clinical score, calcium score and computed tomography coronary angiography in patients with suspected or known coronary artery disease. Radiol Med 2011; 116:1188-202. [DOI: 10.1007/s11547-011-0721-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Accepted: 09/24/2009] [Indexed: 11/28/2022]
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Maffei E, Martini C, Tedeschi C, Spagnolo P, Zuccarelli A, Arcadi T, Guaricci A, Seitun S, Weustink A, Mollet N, Cademartiri F. Diagnostic accuracy of 64-slice computed tomography coronary angiography in a large population of patients without revascularisation: registry data on the comparison between male and female population. Radiol Med 2011; 117:6-18. [PMID: 21643636 DOI: 10.1007/s11547-011-0693-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Accepted: 11/09/2010] [Indexed: 11/30/2022]
Abstract
PURPOSE This study was undertaken to evaluate the diagnostic accuracy of computed tomography coronary angiography (CTCA) for detecting significant coronary artery stenosis (≥50% lumen reduction) compared with conventional coronary angiography (CAG) in a male and female population. MATERIAL AND METHODS A total of 1,372 patients (882 men, 490 women; mean age 59.3 ± 11.9 years) in sinus rhythm imaged with CTCA (64-slice technology) and CAG were enrolled. Diagnostic accuracy and likelihood ratios (LR+ and LR-) of CTCA were assessed against CAG for the male and female populations. RESULTS The prevalence of obstructive disease was 53% (men 58%; women 43%). CAG demonstrated the absence of significant coronary artery disease (CAD) in 47% (men 42%; women 56%), single-vessel disease in 25% (men 36%; women 22%) and multivessel disease in 29% (men 32%; women 23%) of patients. In the per-patient analysis, sensitivity, specificity and positive (PPV) and negative (NPV) predictive values of CTCA were 99% (men 98%; women 100%), 92% (men 92%; women 92%), 94% (men 95%; women 90%) and 99% (men 98%; women 100%), respectively. The per-patient likelihood ratios (LR) in the total population (LR+=12.4 and LR-=0.011), the male (LR+=12.9 and LR-=0.016) and female (LR =11.9 and LR-=0) populations were very good. We observed no significant differences in diagnostic accuracy between male and female populations. CONCLUSIONS CTCA is a reliable diagnostic modality with high sensitivity and NPV in the female population.
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Affiliation(s)
- E Maffei
- Dipartimento di Radiologia e del Cardio-Polmonare, Azienda Ospedaliero-Universitaria di Parma, c/o Piastra Tecnica - Piano 0, Via Gramsci 14, 43100, Parma, Italy
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Diagnostic accuracy of 64-slice computed tomography coronary angiography in a large population of patients without revascularisation: registry data in NSTEMI acute coronary syndrome and influence of gender and risk factors. Radiol Med 2011; 116:1014-26. [DOI: 10.1007/s11547-011-0696-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Accepted: 11/19/2010] [Indexed: 10/18/2022]
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Maffei E, Martini C, Seitun S, Arcadi T, Tedeschi C, Guaricci A, Malagò R, Tarantini G, Aldrovandi A, Cademartiri F. Computed tomography coronary angiography in the selection of outlier patients: a feasibility report. Radiol Med 2011; 117:214-29. [PMID: 21643634 DOI: 10.1007/s11547-011-0695-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Accepted: 10/27/2010] [Indexed: 11/26/2022]
Abstract
PURPOSE This study evaluated criteria, presence and distribution of outlier patients by means of computed tomography coronary angiography (CTCA) in a large institutional database. MATERIAL AND METHODS From a population of 2,881 consecutive patients (1,842 men, mean age 62 ± 13 years) in sinus rhythm who underwent CTCA, we extracted data on patients with suspected coronary artery disease (CAD). We selected patient outliers in the fifth and sixth decades of life with the following criteria: ≥ 3 risk factors and absence of CAD, zero to one risk factors and ≥ 5 diseased coronary segments. Diabetes was excluded from risk factors because of the different impact on CAD. RESULTS The patient population consisted of 2,432 individuals with suspected CAD (1,495 men, age 62 ± 13 years). The prevalence of obstructive CAD (≥ 50% lumen reduction at CTCA) was 36% (863/2,432). Patients with normal coronary arteries accounted for 34% of the total (837/2,432; 431 men, age 55 ± 14 years). Of these, 210 were in the fifth and 231 in the 6th decade (men 196, women 245); those with ≥ 3 risk factors accounted for 4.2% of the total (102/2,432; men 42, women 60). Patients with ≥ 5 diseased coronary segments accounted for 28% of the total (686/2,432; 510 men, age 68 ± 10 years). Of these, 115 were in the fifth and 270 in the sixth decade (men 309, women 76); those with zero to one risk factors accounted for 3.0% (73/2,432; men 66, women 7). CONCLUSIONS CTCA is a reliable noninvasive diagnostic modality that can be used to identify outlier patients. This will enable dedicated trials aimed at characterising biomarkers and genomics of protective and nonprotective factors against CAD and its complications.
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Affiliation(s)
- E Maffei
- Dipartimento di Radiologia e del Cuore, c/o Piastra Tecnica - Piano 0, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43100, Parma, Italy
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Torres FS, Jeddiyan S, Jiménez-Juan L, Nguyen ET. β-Blockers to Control Heart Rate during Coronary CT Angiography. Radiology 2011; 259:615-6; author reply 616-7. [DOI: 10.1148/radiol.11102288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Diagnostic accuracy of 64-slice computed tomography coronary angiography in a large population of patients without revascularisation: registry data on the impact of calcium score. Radiol Med 2011; 116:1000-13. [DOI: 10.1007/s11547-011-0662-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Accepted: 09/17/2010] [Indexed: 01/08/2023]
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Maffei E, Seitun S, Martini C, Aldrovandi A, Cervellin G, Tedeschi C, Guaricci A, Messalli G, Catalano O, Cademartiri F. Prognostic value of computed tomography coronary angiography in patients with chest pain of suspected cardiac origin. Radiol Med 2011; 116:690-705. [DOI: 10.1007/s11547-011-0647-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Accepted: 08/06/2010] [Indexed: 12/31/2022]
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Tardáguila de la Fuente G, Delgado Sánchez-Gracián C, Aguilar Arjona JA, Prada González R, Fernández Pérez G, Tardáguila Montero F. [Oral versus intravenous beta-blockers for computed tomography coronary angiography? A randomized controlled trial]. RADIOLOGIA 2011; 53:254-60. [PMID: 21334033 DOI: 10.1016/j.rx.2010.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2010] [Revised: 06/27/2010] [Accepted: 07/16/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To determine whether the time employed in the radiological management of outpatients undergoing computed tomography (CT) coronary angiography varies in function of whether oral or intravenous beta-blockers are administered. MATERIAL AND METHODS This was a prospective, analytical, randomized controlled trial. A total of 40 patients with heart rates greater than 65 beats per minute were randomly assigned to one of two groups. Patients in group 1 were administered oral beta-blockers and patients in group 2 were administered intravenous beta-blockers. We measured the overall time from entry to the radiology department to exit from the CT examination room. We also measured heart rate, blood pressure, and the number of conclusive studies. RESULTS The median (interquartile range) overall time was 120 (100-150) minutes in the 19 patients who received oral beta-blockers compared to 35 (27.5-67.5) minutes in the 21 patients who received intravenous beta-blockers (p<0.001). The median time that patients were in the CT examination room was 10 (6-15) minutes in Group 1 and 10 (9-20) minutes in Group 2 (p = 0.57). The decrease in mean arterial pressure was 10 mmHg after the administration of intravenous beta-blockers compared to 3.3 mmHg after the administration of oral beta-blockers (p = 0.01). No significant differences were found in the diagnostic quality of the examinations. CONCLUSIONS The time employed in the radiological management of patients undergoing CT coronary angiography is significantly lower when beta-blockers are administered intravenously. There was no difference in the time patients were in the CT examination room or in the diagnostic quality of the examinations.
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