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Pastorini G, Anastasio F, Botto A, Tardivo V, Feola M. Predicting cardiovascular events in out-of-hospital patients presenting with atypical chest pain and complete left bundle branch block: role of CTA and echocardiographic Global Longitudinal Strain. J Geriatr Cardiol 2024; 21:760-767. [PMID: 39183950 PMCID: PMC11341527 DOI: 10.26599/1671-5411.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2024] Open
Abstract
Background Out-of-hospital patients presenting with atypical chest pain and complete left bundle branch block (LBBB) have to be stratified for the presence of coronary artery disease and the risk of developing heart failure (HF). We investigated the prognostic role of coronary CT-angiography (CTA) and echocardiographic global longitudinal strain (GLS) in those patients in a mid-term follow-up. Methods Out-of-hospital patients with LBBB underwent echocardiography and a 64-slice CT angiography were evaluated retrospectively. Development of HF or a cardiovascular death were the events scheduled. Results Seventy-eight patients (32 female; mean age: 66.0 ± 10.4 years were enrolled. During a follow-up of 33 months (IQR: 17-77), one patient (1.5%) experienced a cardiovascular death, 14 patients (17.9%) required urgent outpatient visits due to acute decompensated HF (12 hospitalizations). Echocardiography showed a slightly reduced left ventricular ejection fraction (LVEF) (50.0% ± 9.8%) and GLS within the normal range (-16.2% ± 4.1%). CTA analysis showed coronary stenosis > 50% in 28 patients (35.9%). A high Agatston score (> 100) was observed in 29.5%. Notably, 25 patients (32.1%) were diagnosed with left main coronary artery disease and 15 patients (16.7%) underwent revascularization during the follow up. Significant associations were observed between events and LVEF (P = 0.001), diastolic dysfunction grade ≥ 2 (P = 0.02), GLS (P < 0.001), multiple coronary stenosis (P = 0.04) and Agatston score (P = 0.05). Multivariate analysis confirmed the relationships with LVEF (R2 = 0.89, P < 0.001), diastolic dysfunction (R2 = 3.30, P = 0.04), GLS (R2 = 1.43, P < 0.001), and Agatston score (R2 = 1.01, P = 0.05). Conclusions In patients with complete LBBB, CTA and GLS identified those at a high risk of development HF.
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Affiliation(s)
- Guido Pastorini
- Cardiology Division, Regina Montis Regalis Hospital, ASLCN1, Mondovi’, Italy
| | - Fabio Anastasio
- Cardiology Division, Regina Montis Regalis Hospital, ASLCN1, Mondovi’, Italy
| | - Anna Botto
- Intensive Care, Regina Montis Regalis Hospital, ASLCN1 Mondovi’, Italy
| | | | - Mauro Feola
- Cardiology Division, Regina Montis Regalis Hospital, ASLCN1, Mondovi’, Italy
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Blom DJ, Gaudet D, Hegele RA, Patel DS, Cegla J, Kolovou G, Marin LM. A Case Series Assessing the Effects of Lomitapide on Carotid Intima-Media Thickness in Adult Patients with Homozygous Familial Hypercholesterolaemia in a Real-World Setting. Adv Ther 2022; 39:1857-1870. [PMID: 35194765 PMCID: PMC8989825 DOI: 10.1007/s12325-021-02031-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/10/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Homozygous familial hypercholesterolaemia (HoFH) is characterised by extremely elevated levels of low-density lipoprotein cholesterol (LDL-C) and results from multiple mutations in genes affecting the LDL receptor pathway. Patients are at risk of premature atherosclerotic cardiovascular disease (ASCVD) and premature death. Lomitapide is a microsomal triglyceride transfer protein inhibitor developed to treat HoFH, but cardiovascular outcome data are lacking. METHODS We evaluated detailed data from five HoFH patients and one patient with heterozygous FH (HeFH) and a very severe phenotype. We also analysed confirmatory data from a further 8 HoFH cases. In total, we analysed data from patients in seven global centres in six countries who were all treated with lomitapide with long-term follow-up. Carotid intima-media thickness (CIMT) imaging was recorded on an ad hoc basis to monitor ASCVD in HoFH. RESULTS Lomitapide resulted in marked decreases in LDL-C of 56.8-93.9% [77.7-93.9% in the 6 initial cases (mean nadir 64.8 ± 30.1 mg/dL); 56.8-86.0% in the 8 confirmatory cases (mean nadir 131.4 ± 38.2 mg/dL)]. CIMT regressed in 50% of cases (mean follow-up 5.0 ± 3.1 years in initial six cases, and 4.4 ± 1.4 years in confirmatory cases). In the remaining patients, CIMT showed little further change. In patients where assessments of plaque area were available, regression or stabilisation in CIMT was accompanied by clinically significant regression of plaque area. CONCLUSIONS Lomitapide reduces LDL-C levels in patients with HoFH and severe LDL-C phenotypes, and results in stabilisation and/or regression of CIMT, which is an established marker of ASCVD risk. Additional data are needed to determine if this confers a survival benefit in these very high-risk patients.
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Bays HE, Khera A, Blaha MJ, Budoff MJ, Toth PP. Ten things to know about ten imaging studies: A preventive cardiology perspective ("ASPC top ten imaging"). Am J Prev Cardiol 2021; 6:100176. [PMID: 34327499 PMCID: PMC8315431 DOI: 10.1016/j.ajpc.2021.100176] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 02/07/2023] Open
Abstract
Knowing the patient's current cardiovascular disease (CVD) status, as well as the patient's current and future CVD risk, helps the clinician make more informed patient-centered management recommendations towards the goal of preventing future CVD events. Imaging tests that can assist the clinician with the diagnosis and prognosis of CVD include imaging studies of the heart and vascular system, as well as imaging studies of other body organs applicable to CVD risk. The American Society for Preventive Cardiology (ASPC) has published "Ten Things to Know About Ten Cardiovascular Disease Risk Factors." Similarly, this "ASPC Top Ten Imaging" summarizes ten things to know about ten imaging studies related to assessing CVD and CVD risk, listed in tabular form. The ten imaging studies herein include: (1) coronary artery calcium imaging (CAC), (2) coronary computed tomography angiography (CCTA), (3) cardiac ultrasound (echocardiography), (4) nuclear myocardial perfusion imaging (MPI), (5) cardiac magnetic resonance (CMR), (6) cardiac catheterization [with or without intravascular ultrasound (IVUS) or coronary optical coherence tomography (OCT)], (7) dual x-ray absorptiometry (DXA) body composition, (8) hepatic imaging [ultrasound of liver, vibration-controlled transient elastography (VCTE), CT, MRI proton density fat fraction (PDFF), magnetic resonance spectroscopy (MRS)], (9) peripheral artery / endothelial function imaging (e.g., carotid ultrasound, peripheral doppler imaging, ultrasound flow-mediated dilation, other tests of endothelial function and peripheral vascular imaging) and (10) images of other body organs applicable to preventive cardiology (brain, kidney, ovary). Many cardiologists perform cardiovascular-related imaging. Many non-cardiologists perform applicable non-cardiovascular imaging. Cardiologists and non-cardiologists alike may benefit from a working knowledge of imaging studies applicable to the diagnosis and prognosis of CVD and CVD risk - both important in preventive cardiology.
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Affiliation(s)
- Harold E. Bays
- Louisville Metabolic and Atherosclerosis Research Center, 3288 Illinois Avenue, Louisville KY 40213 USA
| | - Amit Khera
- UT Southwestern Medical Center, Dallas, TX USA
| | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore MD USA
| | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor-UCLA, Torrance CA USA
| | - Peter P. Toth
- CGH Medical Cener, Sterling, IL 61081 USA
- Cicarrone center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD USA
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Elgebaly SA, Christenson RH, Kandil H, Ibrahim M, Rizk H, El-Khazragy N, Rashed L, Yacoub B, Eldeeb H, Ali MM, Kreutzer DL. Nourin-Dependent miR-137 and miR-106b: Novel Biomarkers for Early Diagnosis of Myocardial Ischemia in Coronary Artery Disease Patients. Diagnostics (Basel) 2021; 11:diagnostics11040703. [PMID: 33919942 PMCID: PMC8070915 DOI: 10.3390/diagnostics11040703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 02/08/2023] Open
Abstract
Background: Although cardiovascular imaging techniques are widely used to diagnose myocardial ischemia in patients with suspected stable coronary artery disease (CAD), they have limitations related to lack of specificity, sensitivity and “late” diagnosis. Additionally, the absence of a simple laboratory test that can detect myocardial ischemia in CAD patients, has led to many patients being first diagnosed at the time of the development of myocardial infarction. Nourin is an early blood-based biomarker rapidly released within five minutes by “reversible” ischemic myocardium before progressing to necrosis. Recently, we demonstrated that the Nourin-dependent miR-137 (marker of cell damage) and miR-106b-5p (marker of inflammation) can diagnose myocardial ischemia in patients with unstable angina (UA) and also stratify severity of ischemia, with higher expression in acute ST-segment elevation myocardial infarction (STEMI) patients compared to UA patients. Minimal baseline-gene expression levels of Nourin miRNAs were detected in healthy subjects. Objectives: To determine: (1) whether Nourin miRNAs are elevated in chest pain patients with myocardial ischemia suspected of CAD, who also underwent dobutamine stress echocardiography (DSE) or ECG/Treadmill stress test, and (2) whether the elevated levels of serum Nourin miRNAs correlate with results of ECHO/ECG stress test in diagnosing CAD patients. Methods: Serum gene expression levels of miR-137, miR-106b-5p and their corresponding molecular pathway network were measured blindly in 70 enrolled subjects using quantitative real time PCR (qPCR). Blood samples were collected from: (1) patients with chest pain suspected of myocardial ischemia (n = 38) both immediately “pre-stress test” and “post-stress test” 30 min. after test termination; (2) patients with acute STEMI (n = 16) functioned as our positive control; and (3) healthy volunteers (n = 16) who, also, exercised on ECG/Treadmill stress test for Nourin baseline-gene expression levels. Results: (1) strong correlation was observed between Nourin miRNAs serum expression levels and results obtained from ECHO/ECG stress test in diagnosing myocardial ischemia in CAD patients; (2) positive “post-stress test” patients with CAD diagnosis showed upregulation of miR-137 by 572-fold and miR-106b-5p by 122-fold, when compared to negative “post-stress test” patients (p < 0.001); (3) similarly, positive “pre-stress test” CAD patients showed upregulation of miR-137 by 1198-fold and miR-106b-5p by 114-fold, when compared to negative “pre-stress test” patients (p < 0.001); and (4) healthy subjects had minimal baseline-gene expressions of Nourin miRNAs. Conclusions: Nourin-dependent miR-137 and miR-106b-5p are promising novel blood-based biomarkers for early diagnosis of myocardial ischemia in chest pain patients suspected of CAD in outpatient clinics. Early identification of CAD patients, while patients are in the stable state before progressing to infarction, is key to providing crucial diagnostic steps and therapy to limit adverse cardiac events, improve patients’ health outcome and save lives.
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Affiliation(s)
- Salwa A. Elgebaly
- Research & Development, Nour Heart, Inc., Vienna, VA 22180, USA
- Department of Surgery, UConn Health, School of Medicine, Farmington, CT 06032, USA;
- Correspondence: ; Tel.: +1-860-680-8860
| | - Robert H. Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Hossam Kandil
- Department of Cardiology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo 11562, Egypt; (H.K.); (M.I.); (H.R.); (B.Y.); (H.E.); (M.M.A.)
| | - Mohsen Ibrahim
- Department of Cardiology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo 11562, Egypt; (H.K.); (M.I.); (H.R.); (B.Y.); (H.E.); (M.M.A.)
| | - Hussien Rizk
- Department of Cardiology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo 11562, Egypt; (H.K.); (M.I.); (H.R.); (B.Y.); (H.E.); (M.M.A.)
| | - Nashwa El-Khazragy
- Department of Clinical Pathology-Hematology, Ain Shams Medical Research Institute (MASRI), Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt;
| | - Laila Rashed
- Department of Biochemistry and Molecular Biology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo 11562, Egypt;
| | - Beshoy Yacoub
- Department of Cardiology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo 11562, Egypt; (H.K.); (M.I.); (H.R.); (B.Y.); (H.E.); (M.M.A.)
| | - Heba Eldeeb
- Department of Cardiology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo 11562, Egypt; (H.K.); (M.I.); (H.R.); (B.Y.); (H.E.); (M.M.A.)
| | - Mahmoud M. Ali
- Department of Cardiology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo 11562, Egypt; (H.K.); (M.I.); (H.R.); (B.Y.); (H.E.); (M.M.A.)
| | - Donald L. Kreutzer
- Department of Surgery, UConn Health, School of Medicine, Farmington, CT 06032, USA;
- Cell & Molecular Tissue Engineering, LLC, Farmington, CT 06032, USA
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Gul M, Sheikh M, Chaudhry A, Gerges L, Al Halabi H, Feldman E, Chaudhry A. Role of cardiac nuclear stress perfusion exam after computed tomographic coronary angiogram for evaluation of obstructive coronary artery disease in patients with chest pain. J Thorac Dis 2020; 12:5067-5077. [PMID: 33145083 PMCID: PMC7578483 DOI: 10.21037/jtd-2019-pitd-12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Clinical workup for chest pain varies among institutions. Acute coronary syndrome (ACS) is the primary diagnosis to rule out in the differential diagnosis, due to its associated mortality and morbidity. Although studies have demonstrated efficacy of coronary computed tomographic angiography (CCTA) in diagnosis obstructive coronary artery disease (CAD), there is limited evidence in the clinical value of performing cardiac nuclear stress perfusion imaging [myocardial perfusion imaging (MPI)] exam in patients with chest pain after undergoing CCTA. We aim to evaluate clinical value of follow-up nuclear cardiac MPI in patients with chest pain who have undergone recent CCTA. Methods A total of 1,000 patients were evaluated in this IRB approved retrospective study who presented with symptoms of ACS. Patients who had elevated troponin or abnormal electrocardiogram (ECG) findings at initial presentation or prior to cardiac nuclear MPI were excluded from the study. All patients who underwent 64- or 320-detector row ECG-gated CCTA as well as a follow-up nuclear MPI. Patients who had diagnostics studies limited by artifact [e.g., suboptimal intravenous (IV) contrast bolus in CCTA, motion artifact on CCTA or MPI, etc.] were excluded. Results One hundred patients met the inclusion criteria. Patient demographics include average age 64.3 [32–89] years, 59 male, 41 females. Ninety-five/100 patients had at least one vessel with 50–70% coronary artery diameter stenosis measured on CCTA. There were no focal perfusion abnormalities identified on cardiac nuclear MPI in patients with less than 70% stenosis diagnosed on CCTA. Five percent of patients were identified with coronary arterial narrowing greater than 70% on CCTA and all 5 of these patients have evidence of abnormal cardiac nuclear stress test (perfusion abnormalities, chest pain, abnormal ECG). Conclusions In low-to-intermediate risk patients with chest pain and evidence of non-critical coronary artery stenosis (i.e., less than 70% stenosis) diagnosed on CCTA, a follow-up cardiac nuclear perfusion imaging is of limited value.
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Affiliation(s)
- Maryam Gul
- Precision Rheumatology, Anaheim, CA, USA
| | - Mubashir Sheikh
- Department of Diagnostic and Interventional Radiology, City of Hope National Medical Center, Duarte, CA, USA
| | - Abbas Chaudhry
- Department of Diagnostic and Interventional Radiology, City of Hope National Medical Center, Duarte, CA, USA
| | - Luke Gerges
- Department of Diagnostic and Interventional Radiology, City of Hope National Medical Center, Duarte, CA, USA
| | - Hadi Al Halabi
- Department of Diagnostic and Interventional Radiology, City of Hope National Medical Center, Duarte, CA, USA
| | - Eric Feldman
- Department of Diagnostic and Interventional Radiology, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Ammar Chaudhry
- Department of Diagnostic and Interventional Radiology, Stony Brook University Medical Center, Stony Brook, NY, USA
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Ker WDS, Neves DGD, Magalhães TA, Santos AASMDD, Mesquita CT, Nacif MS. Myocardial Perfusion by Coronary Computed Tomography in the Evaluation of Myocardial Ischemia: Simultaneous Stress Protocol with SPECT. Arq Bras Cardiol 2019; 113:1092-1101. [PMID: 31596324 PMCID: PMC7021272 DOI: 10.5935/abc.20190201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 02/13/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Functional assessment to rule out myocardial ischemia using coronary computed tomography angiography (CCTA) is extremely important and data on the Brazilian population are still limited. OBJECTIVE To assess the diagnostic performance of myocardial perfusion by CCTA in the detection of severe obstructive coronary artery disease (CAD) compared with single-photon emission computerized tomography (SPECT). To analyze the importance of anatomical knowledge to understand the presence of myocardial perfusion defects on SPECT imaging that is not identified on computed tomography (CT) scan. METHOD A total of 35 patients were evaluated by a simultaneous pharmacologic stress protocol. Fisher's exact test was used to compare proportions. The patients were grouped according to the presence or absence of significant CAD. The area under the ROC curve was used to identify the diagnostic performance of CCTA and SPECT in perfusion assessment. P < 0.05 values were considered statistically significant. RESULTS For detection of obstructive CAD, CT myocardial perfusion analysis yielded an area under the ROC curve of 0.84 [a 95% confidence interval (CI95%): 0.67-0.94, p < 0.001]. SPECT myocardial perfusion imaging, on the other hand, showed an AUC of 0.58 (95% CI 0.40 - 0.74, p < 0.001). In this study, false-positive results with SPECT are described. CONCLUSION Myocardial perfusion analysis by CTA displays satisfactory results compared to SPECT in the detection of obstructive CAD. CCTA can rule out false-positive results of SPECT.
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Affiliation(s)
- Wilter Dos Santos Ker
- Hospital Universitário Antonio Pedro, Niterói, RJ - Brazil.,Universidade Federal Fluminense, Niterói, RJ - Brazil
| | | | - Tiago Augusto Magalhães
- Complexo Hospital de Clínicas da Universidade Federal do Paraná (CHC-UFPR), Curitiba, PR - Brazil
| | | | | | - Marcelo Souto Nacif
- Hospital Universitário Antonio Pedro, Niterói, RJ - Brazil.,Universidade Federal Fluminense, Niterói, RJ - Brazil.,Complexo Hospital de Clínicas da Universidade Federal do Paraná (CHC-UFPR), Curitiba, PR - Brazil
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Comparative Effectiveness of CT-Derived Atherosclerotic Plaque Metrics for Predicting Myocardial Ischemia. JACC Cardiovasc Imaging 2019; 12:1367-1376. [DOI: 10.1016/j.jcmg.2018.05.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 05/16/2018] [Accepted: 05/24/2018] [Indexed: 12/21/2022]
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Keles ME, Samadi A, Isikhan SY, Sener YZ, Sezgin A, Keles E, Lay I, Canpolat U. The Effect of Effort Test on the Levels of Ischemia Modified Albumin, 7-ketocholesterol and Cholestan-3β , 5α , 6β -triol and their Role in the Diagnosis of Coronary Artery Disease. J Med Biochem 2019; 38:249-255. [PMID: 31156334 PMCID: PMC6534955 DOI: 10.2478/jomb-2018-0028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 06/08/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Oxysterols have been shown to play a role in plaque formation while ischemia modified albumin (IMA) is widely accepted as an acute marker for ischemia. The effort test is one of the methods used to identify the presence of coronary artery disease. Thus, there may be a relationship between effort test result and the levels of IMA, 7-ketocholesterol (7-KC) and cholestane-3β,5α,6β-triol (C-triol). METHODS Thirty patients who underwent effort test and 30 healthy subjects were included in the study. IMA levels were determined with the albumin-cobalt binding test, 7-KC and C-triol levels were determined with LC-MS/MS. Among the patients, two subgroups were identified according to the results of the effort test, group 1 consisted of patients with a positive effort test (n = 12), and group 2 consisted of patients who had a negative effort test (n = 18). RESULTS 7-KC levels of patients were significantly higher compared to healthy subjects (39.87 ± 2.13 ng/mL, 20.26 ± 1.35 ng/mL; p=0.001). In patients, post-test 7-KC levels were significantly lower than pre-test levels (post-test vs. pre-test: 37.73 ± 2.44 ng/mL vs. 41.07 ± 2.18 ng/mL; p<0.001). There was a significant difference in post-test 7-KC levels among all study groups (negative, positive and healthy: 37.73 ± 2.44 ng/mL, 39.87 ± 2.13 ng/mL, 20.26 ± 1.35 ng/mL, respectively). There was no significant difference in IMA levels. CONCLUSIONS Patients with positive effort test had significantly higher levels of 7-KC. Additionally, after the effort test, the 7-KC value was reduced. 7-KC is a biomarker of oxidative damage and its value or changes before and after the effort test may be used as a biomarker in the diagnosis and follow-up of coronary artery disease.
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Affiliation(s)
- Muhammed Emin Keles
- Hacettepe University, Faculty of Medicine, Department of Medical Biochemistry, Ankara, Turkey
| | - Afshin Samadi
- Hacettepe University, Faculty of Medicine, Department of Medical Biochemistry, Ankara, Turkey
| | - Selen Yilmaz Isikhan
- Hacettepe University, Faculty of Medicine, Department of Biostatistics, Ankara, Turkey
| | - Yusuf Ziya Sener
- Hacettepe University, Faculty of Medicine, Department of Cardiology, Ankara, Turkey
| | - Ali Sezgin
- Hacettepe University, Faculty of Medicine, Department of Cardiology, Ankara, Turkey
| | - Emine Keles
- Hacettepe University, Faculty of Medicine, Department of Chest Diseases, Ankara, Turkey
| | - Incilay Lay
- Hacettepe University, Faculty of Medicine, Department of Medical Biochemistry, Ankara, Turkey
| | - Uğur Canpolat
- Hacettepe University, Faculty of Medicine, Department of Cardiology, Ankara, Turkey
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Sumin AN, Korok EV, Korotkevitch AA, Kachurina EN, Kokov AN, Barbarash OL. Difficulties of Diagnostics of Obstructive Coronary Artery Lesions in Patients with Stable Ischemic Heart Disease and Possibilities of Single-Photon Emission Computed Tomography. ACTA ACUST UNITED AC 2019; 59:28-35. [PMID: 30710986 DOI: 10.18087/cardio.2019.1.10226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 01/27/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE to assess diagnostic capabilities of single-photon emission computed tomography (SPECT) in the detection of obstructive coronary artery (CA) lesions, depending on the meeting appropriate use criteria. MATERIALS AND METHODS We used in this retrospective analysis data from 107 patients with previously diagnosed ischemic heart disease (IHD) or in need to exclude it, who were hospitalized in inpatient departments of the Research Institute for Complex Issues of Cardiovascular Diseases in the period from 2012 to 2015. All patients underwent coronary angiography (CAG) and SPECT (the time interval between the studies did not exceed 3 months) for detection of hemodynamically significant CA stenoses. Patients were distributed into two groups according SPECT imaging appropriateness score: group 1-88 patients with score 7-9 (in whom SPECT imaging was appropriate), group 2-19 patients with score 1-6 (in whom SPECT imaging was uncertain, possibly appropriate, or inappropriate. RESULTS Clinical signs and symptoms of angina pectoris were predominantly found in group 1 patients (p=0.499). Asymptomatic patients were more likely to be found in group 2 (p<0.001). Group 1 patients commonly had high pretest probability (PTP) (over 90 %, p<0.001), whereas group 2 patients commonly had low PTP (5-10 %, p<0.001). Mean PTP was 77 and 58 % in groups 1 and 2, respectively (p=0.003). According to positive SPECT imaging, significant CA lesions were more often found in group 1 compared to group 2 (31.8 and 10.5 %, respectively, p=0.060). Two- and three-vessel disease prevailed in group 1 (25 % and 14.7 %) according the analysis of prevalence and location of hemodynamically significant CA lesions, although the data did not reach statistical significance (p=0.057 and p=0.073). Stenoses >70 % were more commonly detected in group 1, compared to group 2: in anterior descending artery 52.3 vs. 5.3 % (p<0.001), circumflex artery 35.2 vs. 10.5 %; (p=0.034), right coronary artery 34.1 vs. 10.5 % (p=0.041). The sensitivity in both groups was rather low (40 % vs. 25 %), whereas specificity was 83 % in group 1 and 93 % in group 2. CONCLUSION According to clinical examination, patients with IHD and indications for SPECT imaging more often had obstructive CA lesions (63.6 %), than patients with questionable or no indications (21.1 %). However, rate of positive findings during stress tests with SPECT imaging was low in both groups and did not differ significantly (p=0.06). Despite high specificity of SPECT imaging, its sensitivity was low in both groups.
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Affiliation(s)
- A N Sumin
- Research Institute for Complex Issues of Cardiovascular Disease.
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10
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Cuddy S, Falk R, Dorbala S. Molecular Imaging of Cardiac Amyloidosis. CURRENT CARDIOVASCULAR IMAGING REPORTS 2018. [DOI: 10.1007/s12410-018-9457-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Tang Z. Application of double low dose combined low flow injection in coronary dual-source coronary computed tomography angiography. Echocardiography 2018; 35:1442-1447. [PMID: 29864195 DOI: 10.1111/echo.14036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE This study was aimed to explore the feasibility of lower tube voltage, low volumes of contrast medium, and low flow injection in prospective electrocardiogram (ECG)-triggered high-pitch dual-source coronary computed tomography angiography (CCTA) for coronary artery imaging. MATERIAL AND METHODS A total of 140 patients with body mass index (BMI) ranging from 18.5 to 24.3 kg/m2 and heart rate (HR) lower than 65 times/min underwent CCTA were divided randomly into two groups. The enhanced CT value and noise as well as signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. Coronary artery was evaluated by double-blind method using a four-point grading scale. RESULTS No significant differences were found in the average enhanced CT value, noise, SNR, and CNR of all segments between the two groups (P > .05). Meanwhile, effective radiation dosages in group A were markedly lower than those in group B (P < .01). CONCLUSION The prospective ECG-triggered high-pitch dual-source CCTA with low voltage, contrast medium, and flow rate injection using sinogram affirmed iterative reconstruction is feasible which can observably reduce radiation and obtain satisfactory images.
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Affiliation(s)
- Zhenhua Tang
- Department of Medical Imaging, Xin Tai People's Hospital, Taian, China
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Sagarad SV, Sukhani N, Machanur B, Patil S. Study to Evaluate Current Trends in Appropriate Usage of Tread Mill Exercise Testing. J Clin Diagn Res 2016; 10:OC40-OC42. [PMID: 27790492 PMCID: PMC5071992 DOI: 10.7860/jcdr/2016/21281.8581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 07/21/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Non-invasive tests are used to diagnose and prognosticate Coronary Artery Disease (CAD) patients and also in pre-operative evaluation and rehabilitation. Millions of these tests are performed worldwide in these situations. However, previous studies have shown inappropriate use of these tests. AIM The study was to evaluate the appropriate use of treadmill exercise test. MATERIALS AND METHODS The present retrospective study was done in Rajiv Gandhi Super Speciality Hospital, Raichur and Institute of Medical sciences and RKB Super Speciality Clinic, Raichur, Karnataka, India. Tread Mill Tests (TMT) which were done between November 2013 and February 2016 were included in the study. A total of 600 tests were evaluated for appropriateness. Demographic, clinical and risk factors, indications were studied. RESULTS Overall 298 (49.66%) tests were found to be inappro-priate. Younger age, female sex, pre-operative evaluation, evaluation in master health check up and insurance were predictors of inappropriate use (p<0.05) in this study. CONCLUSION The treadmill exercise testing appears to be particularly vulnerable to overuse in clinical setting due to its wide availability, affordability and awareness. The inappropriate use of the method, however, may result in additional unnecessary cost to health care system.
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Affiliation(s)
- Suresh V Sagarad
- Assistant Professor, Department of Cardiology, Rajiv Gandhi Super Speciality Hospital, Raichur Institute of Medical Sciences, Raichur, Karnataka, India
| | - Neha Sukhani
- Assistant Professor, Department of Medicine, Raichur Institute of Medical Sciences, Raichur, Karnataka, India
| | - Basavaraj Machanur
- Assistant Professor, Department of Medicine, Raichur Institute of Medical Sciences, Raichur, Karnataka, India
| | - Shashidhar Patil
- Assistant Professor, Department of Medicine, Raichur Institute of Medical Sciences, Raichur, Karnataka, India
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13
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Achenbach S, Paul JF, Laurent F, Becker HC, Rengo M, Caudron J, Leschka S, Vignaux O, Knobloch G, Benea G, Schlosser T, Andreu J, Cabeza B, Jacquier A, Souto M, Revel D, Qanadli SD, Cademartiri F. Comparative assessment of image quality for coronary CT angiography with iobitridol and two contrast agents with higher iodine concentrations: iopromide and iomeprol. A multicentre randomized double-blind trial. Eur Radiol 2016; 27:821-830. [PMID: 27271922 PMCID: PMC5209424 DOI: 10.1007/s00330-016-4437-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 05/19/2016] [Accepted: 05/23/2016] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To demonstrate non-inferiority of iobitridol 350 for coronary CT angiography (CTA) compared to higher iodine content contrast media regarding rate of patients evaluable for the presence of coronary artery stenoses. METHODS In this multicentre trial, 452 patients were randomized to receive iobitridol 350, iopromide 370 or iomeprol 400 and underwent coronary CTA using CT systems with 64-detector rows or more. Two core lab readers assessed 18 coronary segments per patient regarding image quality (score 0 = non diagnostic to 4 = excellent quality), vascular attenuation, signal and contrast to noise ratio (SNR, CNR). Patients were considered evaluable if no segment had a score of 0. RESULTS Per-patient, the rate of fully evaluable CT scans was 92.1, 95.4 and 94.6 % for iobitridol, iopromide and iomeprol, respectively. Non-inferiority of iobitridol over the best comparator was demonstrated with a 95 % CI of the difference of [-8.8 to 2.1], with a pre-specified non-inferiority margin of -10 %. Although average attenuation increased with higher iodine concentrations, average SNR and CNR did not differ between groups. CONCLUSIONS With current CT technology, iobitridol 350 mg iodine/ml is not inferior to contrast media with higher iodine concentrations in terms of image quality for coronary stenosis assessment. KEY POINTS • Iodine concentration is an important parameter for image quality in coronary CTA. • Contrast enhancement must be balanced against the amount of iodine injected. • Iobitridol 350 is non-inferior compared to CM with higher iodine concentrations. • Higher attenuation with higher iodine concentrations, but no SNR or CNR differences.
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Affiliation(s)
- Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany.
| | - Jean-François Paul
- Department of Radiology, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France
| | - François Laurent
- University of Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, F-33000, Bordeaux, France.,CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, F-33600, Pessac, France
| | | | - Marco Rengo
- Department of Radiological Sciences, Oncology and Pathology, Sapienza - University of Rome, ICOT Hospital, Latina, Italy
| | - Jerome Caudron
- Department of Radiology, University Hospital of Rouen, Rouen, France
| | - Sebastian Leschka
- Department of Radiology, Saint Gallen Hospital, Saint Gallen, Switzerland
| | | | | | | | | | | | | | - Alexis Jacquier
- Department of Radiology, La Timone Adult Hospital, Marseille, France
| | - Miguel Souto
- Complejo Hospitalario Universitario, Santiago de Compostela, Spain
| | - Didier Revel
- Department of Radiology, Louis Pradel Hospital, Lyon, France
| | | | - Filippo Cademartiri
- Department of Radiology, Giovanni XXIII Hospital, Monastier di Treviso, Italy
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14
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Kishi S, Magalhães TA, Cerci RJ, Matheson MB, Vavere A, Tanami Y, Kitslaar PH, George RT, Brinker J, Miller JM, Clouse ME, Lemos PA, Niinuma H, Reiber JHC, Rochitte CE, Rybicki FJ, Di Carli MF, Cox C, Lima JAC, Arbab-Zadeh A. Total coronary atherosclerotic plaque burden assessment by CT angiography for detecting obstructive coronary artery disease associated with myocardial perfusion abnormalities. J Cardiovasc Comput Tomogr 2016; 10:121-7. [PMID: 26817414 DOI: 10.1016/j.jcct.2016.01.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 12/08/2015] [Accepted: 01/11/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND Total atherosclerotic plaque burden assessment by CT angiography (CTA) is a promising tool for diagnosis and prognosis of coronary artery disease (CAD) but its validation is restricted to small clinical studies. We tested the feasibility of semi-automatically derived coronary atheroma burden assessment for identifying patients with hemodynamically significant CAD in a large cohort of patients with heterogenous characteristics. METHODS This study focused on the CTA component of the CORE320 study population. A semi-automated contour detection algorithm quantified total coronary atheroma volume defined as the difference between vessel and lumen volume. Percent atheroma volume (PAV = [total atheroma volume/total vessel volume] × 100) was the primary metric for assessment (n = 374). The area under the receiver operating characteristic curve (AUC) determined the diagnostic accuracy for identifying patients with hemodynamically significant CAD defined as ≥50% stenosis by quantitative coronary angiography and associated myocardial perfusion abnormality by SPECT. RESULTS Of 374 patients, 139 (37%) had hemodynamically significant CAD. The AUC for PAV was 0.78 (95% confidence interval [CI] 0.73-0.83) compared with 0.84 [0.79-0.88] by standard expert CTA interpretation (p = 0.02). Accuracy for both CTA (0.91 [0.87, 0.96]) and PAV (0.86 [0.81-0.91]) increased after excluding patients with history of CAD (p < 0.01 for both). Bland-Altman analysis revealed good agreement between two observers (bias of 280.2 mm(3) [161.8, 398.7]). CONCLUSIONS A semi-automatically derived index of total coronary atheroma volume yields good accuracy for identifying patients with hemodynamically significant CAD, though marginally inferior to CTA expert reading. These results convey promise for rapid, reliable evaluation of clinically relevant CAD.
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Affiliation(s)
- Satoru Kishi
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tiago A Magalhães
- Department of Medicine, Division of Cardiology, Catholic University of Paraná (PUC-PR), Brazil
| | - Rodrigo J Cerci
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew B Matheson
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrea Vavere
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yutaka Tanami
- Department of Radiology, Keio University, Tokyo, Japan
| | - Pieter H Kitslaar
- Division of Image Processing, Department of Radiology, Leiden University Medical Center / Medis Medical Imaging Systems, Leiden, The Netherlands
| | - Richard T George
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeffrey Brinker
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Julie M Miller
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Melvin E Clouse
- Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA
| | - Pedro A Lemos
- Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil
| | - Hiroyuki Niinuma
- Division of Cardiology, St. Luke's International Hospital, Tokyo, Japan
| | - Johan H C Reiber
- Division of Image Processing, Department of Radiology, Leiden University Medical Center / Medis Medical Imaging Systems, Leiden, The Netherlands
| | - Carlos E Rochitte
- Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil
| | - Frank J Rybicki
- The Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa Faculty of Medicine, Ottawa, Canada
| | - Marcelo F Di Carli
- Department of Radiology, Brigham and Women's Hospital, Harvard University, Boston, MA, USA
| | - Christopher Cox
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joao A C Lima
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Armin Arbab-Zadeh
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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