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Zhu L, Pan Z, Li Z, Chang Y, Zhu Y, Yan F, Tu S, Yang W. Can the Wall Shear Stress Values of Left Internal Mammary Artery Grafts during the Perioperative Period Reflect the One-Year Patency? Thorac Cardiovasc Surg 2020; 68:723-729. [PMID: 32937666 DOI: 10.1055/s-0040-1714385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE The left internal mammary artery (LIMA) is the preferred graft for coronary artery bypass grafting, but the reasoning for LIMA occlusion is unclear. We sought to examine whether the wall shear stress (WSS) values of LIMA grafts during the perioperative period reflected the 1-year patency by using combining computational fluid dynamics (CFD) and coronary computed tomography angiography (CCTA) images. METHODS CCTA was performed in 233 patients with LIMA graft perioperatively and 1 year later from October 2014 to May 2017. LIMA occlusion was detected in six patients at the 1-year follow-up CCTA. Two patients were excluded due to poor imaging quality. The remaining four patients were enrolled as occlusive (OCC) group, and eight patients with patent LIMA were recruited as patent (PAT) group. The WSS values of LIMA during perioperative period were calculated. LIMA graft was artificially divided into three even segments, proximal (pLIMA), middle (mLIMA) and distal (dLIMA) segments. The independent samples t-test and the Student-Newman-Keuls test were used. RESULTS The WSS values of dLIMA were significantly higher in the PAT group than in the OCC group (4.43 vs. 2.56, p < 0.05). The WSS values of dLIMA in the PAT group were significantly higher than pLIMA, which was absent in the OCC group. CONCLUSIONS A higher WSS value of the distal segment of LIMA and a higher WSS value of the distal segment compared with the proximal segment of LIMA in the PAT were observed; this tendency might be helpful in predicting the 1-year patency of LIMA.
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Affiliation(s)
- Lan Zhu
- Department of Radiology, Ruijin Hospital affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zilai Pan
- Department of Radiology, Ruijin Hospital affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zehang Li
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yunxiao Chang
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yunpeng Zhu
- Department of Cardiac Surgery, Ruijin Hospital affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Wenjie Yang
- Department of Radiology, Ruijin Hospital affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Clinical utility of early postoperative cardiac multidetector computed tomography after coronary artery bypass grafting. Sci Rep 2020; 10:9186. [PMID: 32514056 PMCID: PMC7280270 DOI: 10.1038/s41598-020-66176-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 05/13/2020] [Indexed: 11/22/2022] Open
Abstract
We evaluated the clinical utility of early postoperative cardiac computed tomography (CT) for evaluating left ventricular (LV) function and predicting prognosis in patients who had undergone coronary artery bypass grafting (CABG). Of the 205 patients who underwent CABG from March 2011 to December 2014, 136 underwent early postoperative cardiac CT (within 30 days after CABG) and were enrolled as the study population. The baseline and postoperative follow-up echocardiographic findings, major adverse cardiac events (MACE), and death were recorded for a follow-up period (mean, 5.9 ± 1.1 years). Functional cardiac CT parameters were compared to echocardiographic measurements. The associations between cardiac CT findings and functional recovery and prognosis were evaluated by logistic regression analyses. The LVEF measured via cardiac CT was significantly higher (56.2 ± 11.5% vs. 61.9 ± 12.9%; p = 0.0002) compared to those via early postoperative echocardiography, but the wall motion score index (WMSI) was not significantly different (1.23 ± 0.33 vs. 1.21 ± 0.28, p = 0.5041) between the two methods. During the follow-up period, 17 patients (12.5%) died and 40 (29.4%) developed MACE. Both the LVEF and WMSI measured with early postoperative echocardiography (p = 0.0202 and odds ratio [OR] = 5.0171, p = 0.0039, respectively), and cardiac CT (OR = 0.9625, p = 0.0091 and OR = 14.3605, p = 0.0001, respectively) predicted MACE OR = 0.9630, but only the WMSI, measured using cardiac CT, predicted all-cause death (OR = 10.6017, p = 0.0035). In CABG patients, LVEF and the WMSI measured with early postoperative cardiac CT were comparable with echocardiography and predicted the development of MACE and all-cause death.
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Ji Q, Xia L, Shi Y, Ma R, Shen J, Lai H, Ding W, Wang C. Sequential Grafting of in Situ Skeletonized Left Internal Mammary Artery to the Left Coronary System. Int Heart J 2018; 59:727-735. [PMID: 29794393 DOI: 10.1536/ihj.17-494] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Sequential grafting may be an effective way to maximize the benefits of the left internal mammary artery (LIMA) conduit. Despite increasing clinical application, the strategy of sequential LIMA grafting has not been proven its superiority. This single-center retrospective study aimed to evaluate the in-hospital and mid-term outcomes of sequential grafting of in situ skeletonized LIMA to the left coronary system.According to the use of sequential or separate LIMA grafting, 1505 eligible patients were assigned to a sequential group (n = 230) and a control group (n = 1275). According to sequential LIMA graft configurations, patients with sequential LIMA grafting were divided into a DOM subgroup (n = 113) and a DLAD subgroup (n = 117). The clinical outcomes and LIMA graft patency were investigated and compared.Sequential LIMA grafting compared with separate LIMA grafting was not an independent predictor either of in-hospital adverse events or follow-up survival free from repeat revascularization during the follow-up period of 32.4 ± 8.5 months. Sequential LIMA grafting had similar LIMA graft patency with separate LIMA grafting (99.5% of 1st sequential sites and 97.7% of 2nd sites versus 98.2% of LIMA-LAD grafts) at 32.3 ± 8.5 months after coronary artery bypass grafting (CABG) surgery. Additionally, the two subgroups received similar mid-term clinical outcomes and graft patency of LIMA segments.Sequential grafting of in situ skeletonized LIMA to the left coronary system resulted in excellent clinical outcomes and graft patency. The two sequential LIMA graft configurations received similar clinical outcomes and graft patency.
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Affiliation(s)
- Qiang Ji
- Department of Cardiovascular Surgery, Zhongshan Hospital Fudan University
| | - LiMin Xia
- Shanghai Institute of Cardiovascular Disease
| | - YunQing Shi
- Department of Cardiovascular Surgery, Zhongshan Hospital Fudan University
| | - RunHua Ma
- Department of Cardiovascular Surgery, Zhongshan Hospital Fudan University
| | - JinQiang Shen
- Department of Cardiovascular Surgery, Zhongshan Hospital Fudan University
| | - Hao Lai
- Shanghai Institute of Cardiovascular Disease
| | - WenJun Ding
- Department of Cardiovascular Surgery, Zhongshan Hospital Fudan University
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Characteristics of Coronary Artery to Pulmonary Artery Fistula on Coronary Computed Tomography Angiography. J Comput Assist Tomogr 2017; 40:398-401. [PMID: 26854415 DOI: 10.1097/rct.0000000000000370] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the characteristics of coronary artery-to-pulmonary artery fistula (CPAF) found by coronary computed tomography (CT) angiography. METHODS Among 10,121 cases of coronary CT angiography performed for 7 years, we found 32 cases of CPAF. We retrospectively evaluated the demographics, clinical symptoms, and anatomical characteristics such as the origin, number of origins, course, opening site of the fistula, and the presence of aneurysmal changes (defined as dilatation 1.5 times the diameter of the origin). We also categorized the fistula openings according to size compared with that of the proximal left anterior descending coronary artery. RESULTS The patients were 14 men and 18 women with a mean (range) age of 56.5 (34-86) years. Nineteen patients had no related symptoms, and the other 13 patients had symptoms such as angina, chest discomfort, palpitations, or shoulder pain. Among these patients, 2 patients were diagnosed with coronary artery disease. The origins of CPAF were single (n = 15, 46.9%) or multiple (n = 17, 53.1%). The CPAFs arose most commonly from the conus branch of the right coronary artery (n = 20, 62.5%) and proximal left anterior descending (n = 17, 53.1%). All CPAFs coursed anteriorly to the main pulmonary artery and drained into the anterolateral aspect. Twenty-five patients (78.1%) exhibited aneurysmal changes. The openings were small in 13 (40.6%), medium in 13 (40.6%), and large in 6 (18.8%) patients. CONCLUSIONS More than half of patients with CPAF had no related symptoms. Coronary artery-to-pulmonary artery fistula may have a single origin or multiple origins. All of the CPAFs coursed anteriorly to the main pulmonary artery and drained into the anterolateral aspect; the CPAFs identified here frequently exhibited aneurysmal changes.
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Barbero U, Iannaccone M, d'Ascenzo F, Barbero C, Mohamed A, Annone U, Benedetto S, Celentani D, Gagliardi M, Moretti C, Gaita F. 64 slice-coronary computed tomography sensitivity and specificity in the evaluation of coronary artery bypass graft stenosis: A meta-analysis. Int J Cardiol 2016; 216:52-7. [DOI: 10.1016/j.ijcard.2016.04.156] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 03/29/2016] [Accepted: 04/20/2016] [Indexed: 11/26/2022]
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Chan M, Ridley L, Dunn DJ, Tian DH, Liou K, Ozdirik J, Cheruvu C, Cao C. A systematic review and meta-analysis of multidetector computed tomography in the assessment of coronary artery bypass grafts. Int J Cardiol 2016; 221:898-905. [PMID: 27439070 DOI: 10.1016/j.ijcard.2016.06.264] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 06/04/2016] [Accepted: 06/27/2016] [Indexed: 02/08/2023]
Abstract
PURPOSE The present meta-analysis aimed to compare the diagnostic accuracy of more recent computed tomography coronary angiography (CTCA) with invasive coronary angiography (ICA) in the assessment of graft patency after coronary artery bypass graft surgery (CABG). MATERIAL AND METHODS A systematic review was performed using nine electronic databases from their dates of inception to July 2015. Predefined inclusion criteria included studies reporting on comparative outcomes using ≥64 slice multidetector computed tomography (MDCT) and ICA. The primary endpoints included graft occlusion and significant graft stenosis ≥50%. Secondary analyses included the comparison of arterial versus venous graft conduits, and the use of different MDCT techniques. RESULTS Thirty-one studies were identified according to selection criteria, involving 1975 patients with 5364 assessed grafts. Combined assessment of stenosis and occlusion for all grafts demonstrated a sensitivity of 96.1% [95% confidence interval (CI) 94.3-97.4%] and specificity of 96.3% (95% CI 95.1-97.3%). CTCA assessment of venous grafts demonstrated higher sensitivity compared to arterial grafts, when testing for both occlusion and stenosis (97.6% vs 89.2%, p=0.004). CONCLUSION Results of this study demonstrated that CTCA had a relatively high pooled sensitivity, specificity and negative predictive value compared to ICA. However, patient baseline characteristics varied between studies, and the results should be interpreted with caution. Nonetheless, our results indicate that CTCA should be recognized as an accurate and non-invasive investigation for graft patency in symptomatic patients after CABG.
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Affiliation(s)
- Michael Chan
- Department of Radiology, Concord Repatriation and General Hospital, Sydney, Australia
| | - Lloyd Ridley
- Department of Radiology, Concord Repatriation and General Hospital, Sydney, Australia
| | | | - David H Tian
- The Collaborative Research Group, Macquarie University, Sydney, Australia
| | - Kevin Liou
- The Collaborative Research Group, Macquarie University, Sydney, Australia
| | - Jessica Ozdirik
- The Collaborative Research Group, Macquarie University, Sydney, Australia
| | - Chaitu Cheruvu
- Department of Cardiology, Prince of Wales Hospital, Sydney, Australia
| | - Christopher Cao
- The Collaborative Research Group, Macquarie University, Sydney, Australia.
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Kim YJ, Yong HS, Kim SM, Kim JA, Yang DH, Hong YJ. Korean guidelines for the appropriate use of cardiac CT. Korean J Radiol 2015; 16:251-85. [PMID: 25741189 PMCID: PMC4347263 DOI: 10.3348/kjr.2015.16.2.251] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 01/03/2015] [Indexed: 01/07/2023] Open
Abstract
The development of cardiac CT has provided a non-invasive alternative to echocardiography, exercise electrocardiogram, and invasive angiography and cardiac CT continues to develop at an exponential speed even now. The appropriate use of cardiac CT may lead to improvements in the medical performances of physicians and can reduce medical costs which eventually contribute to better public health. However, until now, there has been no guideline regarding the appropriate use of cardiac CT in Korea. We intend to provide guidelines for the appropriate use of cardiac CT in heart diseases based on scientific data. The purpose of this guideline is to assist clinicians and other health professionals in the use of cardiac CT for diagnosis and treatment of heart diseases, especially in patients at high risk or suspected of heart disease.
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Affiliation(s)
- Young Jin Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Hwan Seok Yong
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 152-703, Korea
| | - Sung Mok Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
| | - Jeong A Kim
- Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang 411-706, Korea
| | - Dong Hyun Yang
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Yoo Jin Hong
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea
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Heye T, Kauczor HU, Szabo G, Hosch W. Computed tomography angiography of coronary artery bypass grafts: robustness in emergency and clinical routine settings. Acta Radiol 2014; 55:161-70. [PMID: 23908242 DOI: 10.1177/0284185113494977] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND There is a high probability for presence of irregular heart rates and artifacts in patients with previous coronary artery bypass graft (CABG) surgery. Previously reported diagnostic performance of ECG-gated 64-slice dual-source computer tomography angiography (CTA) in this patient group is based on pre-selection for normal heart rate and routine clinical setting. PURPOSE To investigate image quality and diagnostic performance of CTA in patients with previous CABG surgery in various clinical settings. MATERIAL AND METHODS Fifty-six non-selected, consecutive patients (110 grafts, 44 arterial, 66 venous) with previous CABG surgery were prospectively examined using a dual-source 64-slice CT (Siemens Definition, Forchheim, Germany) without utilization of CT-related pharmaceutical heart rate control. Patients were stratified according to the clinical setting: planned redo-cardiac surgery; emergency CTA within 30 days after CABG surgery; routine follow-up after CABG surgery. A reference standard was available for 30 patients (53.6%; 67/110 grafts). Image quality, artifacts, and graft patency were independently assessed by two observers. RESULTS All CTAs were diagnostic despite the presence of irregular heart rhythm (25% of cases) and artifacts (72.7% of grafts). CTA was accurate in all patient groups in assessing graft patency (97.9% sensitivity; 100% specificity; 98.5% accuracy) but artifacts decreased diagnostic performance for stenosis detection (60% sensitivity; 88.6% specificity; 84.1% accuracy). Arterial grafts exhibited more surgical clip artifacts compared to venous grafts, which predominantly showed motion artifacts. Overall diagnostic quality was rated excellent in 70.9%/56.4%, good in 23.4%/39.1%, and sufficient in 5.5%/4.5% by each observer, respectively. CTA detected acute findings in 10 cases (graft bleeding, graft occlusion, pericardial hematoma, sternal instability with retrosternal abscess formation, pericardial effusion, left ventricle thrombus) in the emergency group; seven cases required surgical revision. CONCLUSION Dual-source CTA is a robust and accurate method for assessment of graft patency and detection of relevant extra-cardiac pathologies in a non-selected patient population after CABG surgery in routine as well as emergency clinical settings. Artifacts caused by irregular heart rhythm or surgical clips do not impair graft patency evaluation but limit stenosis assessment.
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Affiliation(s)
- Tobias Heye
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Department of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Gabor Szabo
- Department of Cardiothoracic Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Waldemar Hosch
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
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Sano T. [6. Diagnosis of ischemic heart disease by multidetector computed tomography]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2013; 69:1444-1454. [PMID: 24366565 DOI: 10.6009/jjrt.2013_jsrt_69.12.1444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Bhatnagar G, Vardhanabhuti V, Nensey RR, Sidhu HS, Morgan-Hughes G, Roobottom CA. The role of multidetector computed tomography coronary angiography in imaging complications post-cardiac surgery. Clin Radiol 2013; 68:e254-65. [PMID: 23465325 DOI: 10.1016/j.crad.2012.11.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 11/20/2012] [Accepted: 11/26/2012] [Indexed: 10/27/2022]
Abstract
There have been numerous advances in the field of cardiac imaging. The advent of multidetector computed tomography coronary angiography (MDCT-CA) and in particular electrocardiographic (ECG)-gated acquisition has revolutionized the investigation of the complete spectrum of complications of common cardiothoracic surgical procedures. Generic complications, such as mediastinitis, pericardial effusion, sternal osteomyelitis, and mediastinal fibrosis, are discussed with illustrative examples of multiplanar and volume-rendered three-dimensional reconstructions. Graft-related complications of both coronary artery bypass grafts and aortic root grafts are reviewed. The role of MDCT-CA in the investigation of prosthetic valve endocarditis and root abscesses is outlined. We present a complete illustration of the detailed images that are obtained when investigating a full range of graft-related complications from both aortic and coronary surgery using ECG-gated MDCT-CA. MDCT-CA has the potential to become established as the optimal technique with which to image a multitude of complications post-cardiac surgery.
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Left ventricular ejection fraction impact on contrast opacification of coronary artery bypass grafts in 64-slice multidetector computed tomography angiography. J Comput Assist Tomogr 2011; 35:235-9. [PMID: 21412096 DOI: 10.1097/rct.0b013e3182067c05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of the study was to find whether changes in left ventricular ejection fraction (LVEF) have an impact on contrast opacification of coronary artery bypass grafts (CABGs) in coronary computed tomography angiography (CTA). METHODS One hundred two CABG patients were assessed using 64-slice CTA. Concurrently, their LVEF was measured using computed tomography. Density of grafts were measured, and their correlation with parameters including LVEF determined. RESULTS A total of 253 grafts including 89 left internal mammary artery (LIMA) grafts, 41 saphenous vein grafts (SVGs) to diagonal artery, 66 SVGs to obtuse marginal (OM) artery, and 57 SVGs to posterior descending artery (PDA) were patent and assessed. Mean measured LVEF was 49% (SD, 7%). Mean attenuation value of the LIMA grafts was 302.39 (SD, 91.16) Hounsfield units (HU), and those of SVGs to diagonal artery, SVGs to OM artery, and SVGs to PDA were 348.73 (SD, 100.38) HU, 326.95 (SD, 101.41) HU, and 339.50 (SD, 111.67) HU, respectively. A significant negative correlation was found between LVEF and mean attenuation values of LIMA graft (P < 0.001; r = -0.80), SVG to diagonal artery (P < 0.001; r = -0.66), SVG to OM artery (P < 0.001; r = -0.75), and SVG to PDA (P < 0.001; r = -0.76). CONCLUSIONS A negative correlation was found between density of grafts and LVEF of CABG patients, which is usually echocardiographically assessed before CTA.
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Low dose high-pitch spiral acquisition 128-slice dual-source computed tomography for the evaluation of coronary artery bypass graft patency. Invest Radiol 2010; 45:324-30. [PMID: 20404735 DOI: 10.1097/rli.0b013e3181dfa47e] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To prospectively assess electrocardiography (ECG)-synchronized dual-source computed tomography (CT) in high-pitch spiral acquisition mode for the evaluation of coronary artery bypass graft (CABG) patency regarding image quality and radiation dose. MATERIALS AND METHODS Fifty consecutive patients (47 men, age 69.6 +/- 9.6 years, body mass index 26.6 +/- 3.5 kg/m) underwent clinically indicated 128-slice dual-source CT angiography of the entire thorax for the evaluation of graft patency after CABG surgery using a prospectively ECG-synchronized high-pitch spiral acquisition mode (pitch 3.2; 100 kV tube voltage, 0.28 seconds gantry rotation time). Heart rates (HR) were noted. Image quality of the proximal anastomosis, graft body, distal anastomosis, and postanastomotic coronary artery were graded by 2 independent readers on a 3-point scale (1 = excellent, 2 = moderate, and 3 = poor/nondiagnostic). Quantitative image quality parameters (noise, contrast-to-noise ratio) were measured. Effective radiation doses were calculated. RESULTS Mean HR was 76 +/- 19 bpm (range, 45-135 bpm). Median scan time was 0.9 seconds (range, 0.76-1.17 seconds), mean scan length was 349 +/- 38 mm (range, 294-452 mm). A total of 125 CABG (54% arterial grafts) and 465 vessel sections were analyzed. Twelve grafts were proximally occluded. Diagnostic image quality was obtained in 462 (99.4%) sections. Of those, image quality was excellent in 397 (85.4%) and moderate in 65 (14.0%). All 3 (0.6%) nondiagnostic sections affected the distal anastomosis due to motion artifacts caused by high HR. Separating the study population by the median HR of 71 bpm, image quality of the distal anastomosis regarding motion artifacts was significantly lower at high HR (P < 0.05). Interobserver agreement in grading image quality of graft segments was good (kappa = 0.77). Image noise in the aorta was 36.9 +/- 8.1, contrast-to-noise ratio was 13.1 +/- 4.2. Effective radiation dose was 2.3 +/- 0.3 mSv. CONCLUSIONS The patency of coronary artery bypass grafts can be assessed with decreasing image quality at high HR in high-pitch prospectively ECG-synchronized thoracic 128-slice dual-source CT angiography at a low radiation dose.
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Laynez-Carnicero A, Estornell-Erill J, Trigo-Bautista A, Valle-Muñoz A, Nadal-Barangé M, Romaguera-Torres R, Planas del Viejo A, Corbí-Pascual M, Payá-Serrano R, Ridocci-Soriano F. Non-invasive assessment of coronary artery bypass grafts and native coronary arteries using 64-slice computed tomography: comparison with invasive coronary angiography. Rev Esp Cardiol 2010; 63:161-9. [PMID: 20191700 DOI: 10.1016/s1885-5857(10)70034-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES Although the diagnostic accuracy of CT in the non-invasive assessment of coronary arteries and grafts is known to be high, only a few studies have investigated the technique's reliability for the combined assessment of native coronary arteries, grafts, and vessels lying distal to anastomoses. The aim of this study was to evaluate the diagnostic accuracy of 64-slice CT for assessing coronary grafts and native coronary arteries. METHODS In the study, 64-slice CT was used to evaluate 36 patients who had undergone coronary artery bypass graft surgery and had a clinical indication for angiographic graft assessment. The diagnostic accuracy of CT for identifying significant lesions in grafts and native coronary arteries was determined and compared with that of invasive coronary angiography. RESULTS Of the 103 grafts studied (49 arterial and 54 venous), 96 (93.2%) could be visualized by angiography and 98 (95.1%) by CT. The sensitivity and specificity of CT for detecting significant lesions in grafts were 100% (30/30) and 97% (64/66), respectively, and the positive predictive value (PPV) and negative predictive value (NPV) were 94% and 100%, respectively. For non-revascularized coronary arteries (258 segments), the sensitivity, specificity, PPV and NPV were 94%, 95%, 80%, and 99%, respectively, and for distal vessels, 86%, 97%, 67%, and 99%, respectively. CONCLUSIONS The diagnostic accuracy of 64-slice CT for evaluating both coronary grafts and native coronary arteries was high.
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Affiliation(s)
- Ana Laynez-Carnicero
- Servicio de Cardiología, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
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Laynez-Carnicero A, Estornell-Erill J, Trigo-Bautista A, Valle-Muñoz A, Nadal-Barangé M, Romaguera-Torres R, del Viejo AP, Corbí-Pascual M, Payá-Serrano R, Ridocci-Soriano F. Valoración no invasiva de injertos aortocoronarios y coronarias nativas con tomografía computarizada de 64 detectores: comparación con la coronariografía invasiva. Rev Esp Cardiol 2010. [DOI: 10.1016/s0300-8932(10)70034-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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15
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Hamon M. [Diagnostic accuracy of 64 row multidetector computed tomography for coronary artery disease assessment]. JOURNAL DE RADIOLOGIE 2009; 90:779-785. [PMID: 19752783 DOI: 10.1016/s0221-0363(09)73209-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Due to technical advances, multidetector computed tomography (MDCT) allows evaluation of the coronary arteries and could in specific clinical indications provide a minimally invasive alternative to coronary angiography (CA). Recent technical advances combined with the availability of 64 row MDCT have significantly improved the evaluation of the native coronary arteries. However limitations remain for the evaluation of bypass grafts and stents. In this paper, we present a review the current literature on the diagnostic accuracy of 64 row MDCT in the assessment of coronary artery disease, and discuss the clinical implications and proposed indications of coronary CTA.
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Affiliation(s)
- M Hamon
- Service de Radiologie, Pôle d'Imagerie Médicale, Centre Hospitalier Universitaire de Caen, avenue Côte-de-Nacre, 14033 Caen.
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Weustink AC, Nieman K, Pugliese F, Mollet NR, Meijboom BW, van Mieghem C, ten Kate GJ, Cademartiri F, Krestin GP, de Feyter PJ. Diagnostic Accuracy of Computed Tomography Angiography in Patients After Bypass Grafting. JACC Cardiovasc Imaging 2009; 2:816-24. [DOI: 10.1016/j.jcmg.2009.02.010] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Revised: 02/09/2009] [Accepted: 02/09/2009] [Indexed: 12/15/2022]
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Is There an Indication for Computed Tomography and Magnetic Resonance Imaging in the Evaluation of Coronary Artery Bypass Grafts? J Comput Assist Tomogr 2009; 33:317-27. [DOI: 10.1097/rct.0b013e3181807a5e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dennie CJ, Leipsic J, Brydie A. Canadian Association of Radiologists: Consensus Guidelines and Standards for Cardiac CT. Can Assoc Radiol J 2009; 60:19-34. [DOI: 10.1016/j.carj.2009.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Carole J. Dennie
- Department of Diagnostic Imaging, The Ottawa Hospital, Civic Campus, Ottawa, Ontario, Canada
| | - Jonathan Leipsic
- Department of Radiology, Division of Cardiology, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Alan Brydie
- Department of Radiology, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
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CT angiography after coronary artery bypass graft surgery. CURRENT CARDIOVASCULAR IMAGING REPORTS 2008. [DOI: 10.1007/s12410-008-0019-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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20
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Informative value of clinical research on multislice computed tomography in the diagnosis of coronary artery disease: A systematic review. Int J Cardiol 2008; 130:386-404. [DOI: 10.1016/j.ijcard.2008.06.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 05/21/2008] [Accepted: 06/28/2008] [Indexed: 11/22/2022]
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21
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Hamon M, Lepage O, Malagutti P, Riddell JW, Morello R, Agostini D, Hamon M. Diagnostic Performance of 16- and 64-Section Spiral CT for Coronary Artery Bypass Graft Assessment: Meta-Analysis. Radiology 2008; 247:679-86. [PMID: 18403629 DOI: 10.1148/radiol.2473071132] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Michèle Hamon
- Departments of Radiology, University Hospital of Caen, Avenue Côte de Nacre 14033 Caen, Normandy, France.
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Jones CM, Chin KY, Yang GZ, Hamady M, Darzi A, Athanasiou T. Coronary Artery Bypass Graft Imaging with 64-Slice Multislice Computed Tomography: Literature Review. Semin Ultrasound CT MR 2008; 29:204-13. [DOI: 10.1053/j.sult.2008.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Marano R, Liguori C, Rinaldi P, Storto ML, Politi MA, Savino G, Bonomo L. Coronary artery bypass grafts and MDCT imaging: what to know and what to look for. Eur Radiol 2007; 17:3166-78. [PMID: 17874112 DOI: 10.1007/s00330-007-0722-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2007] [Revised: 07/01/2007] [Accepted: 07/02/2007] [Indexed: 11/30/2022]
Abstract
Multi-detector row CT (MDCT) scanners with high spatial and temporal resolutions are now available and are increasingly used for non-invasive assessment of vascular disease, including coronary arteries and coronary artery bypass grafts (CABG). Follow-up of patients who have previously undergone surgical revascularization for coronary artery disease is nowadays one of the main applications of MDCT. Thanks to the continuous technical evolution of the CT scanners, it is now possible to scan the heart and the full anatomic extent of grafts with sub-millimeter slice-thickness within a single breath-hold. In the evaluation of these patients, it is important for the radiologist to be familiar with the different types of grafts and surgical techniques to know the main characteristics of each graft type and what to look for in the assessment of a patient who has undergone coronary artery surgical revascularization. This review summarizes some surgical aspects, the biological characteristics of conduits, and the main technical MDCT features, and describes the CABG anatomy together with some typical CT findings.
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Affiliation(s)
- Riccardo Marano
- Department of Clinical Sciences and Bioimaging-Section of Radiology, G. d'Annunzio University, SS. Annunziata Hospital, Via Dei Vestini, 66013, Chieti, Italy.
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