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Soeiro ADM, Biselli B, Leal TC, Bossa AS, César MC, Jallad S, Goldstein PG, Guimarães PO, Serrano CV, Nomura CH, Nakamura D, Rochitte CE, Soares PR, Oliveira MTD. Desempenho Diagnóstico da Angiotomografia Computadorizada e da Avaliação Seriada de Troponina Cardíaca Sensível em Pacientes com Dor Torácica e Risco Intermediário para Eventos Cardiovasculares. Arq Bras Cardiol 2021; 118:894-902. [PMID: 35137790 PMCID: PMC9368885 DOI: 10.36660/abc.20210006] [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: 01/05/2021] [Accepted: 06/16/2021] [Indexed: 11/21/2022] Open
Abstract
Fundamento A angiotomografia coronária (ATC) tem sido usada para avaliação de dor torácica principalmente em pacientes de baixo risco, e poucos dados existem com pacientes em risco intermediário. Objetivo Avaliar o desempenho de medidas seriadas de troponinas sensíveis e de ATC em pacientes de risco intermediário. Métodos Um total de 100 pacientes com dor torácica, TIMI score 3 ou 4 e troponina negativa foram prospectivamente incluídos. Todos os pacientes foram submetidos à ATC, e aqueles com obstruções ≥ 50% foram encaminhados à cineangiocoronariografia. Pacientes com lesões < 50% recebiam alta hospitalar, receberam alta e foram contatados 30 dias depois por telefonema para avaliação dos desfechos clínicos. Os desfechos foram hospitalização, morte, e infarto agudo do miocárdio em 30 dias. A comparação entre os métodos foi realizada pelo teste de concordância kappa. O desempenho das medidas de troponina e da ATC na detecção de lesões coronárias significativas e desfechos clínicos foi calculado. Os resultados foram considerados estatisticamente significativos quando p <0,05. Resultados Estenose coronária ≥ 50% na ATC foi encontrada em 38% dos pacientes e lesões coronárias significativas na angiografia coronária foram encontradas em 31 pacientes. Dois eventos clínicos foram observados. A análise de concordância Kappa mostrou baixa concordância entre as medidas de troponina e ATC na detecção de lesões coronárias significativas (kappa = 0,022, p = 0,78). O desempenho da ATC para detectar lesões coronárias significativas na angiografia coronária ou para prever eventos clínicos em 30 dias foi melhor que as medidas de troponina sensível (acurácia de 91% versus 60%). Conclusão ATC teve melhor desempenho que as medidas seriadas de troponina na detecção de doença coronariana significativa em pacientes com dor torácica e risco intermediário para eventos cardiovasculares.
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Qian W, Liu W, Zhu Y, Wang J, Chen Y, Meng H, Chen L, Xu Y, Zhu X. Influence of heart rate and coronary artery calcification on image quality and diagnostic performance of coronary CT angiography: comparison between 96-row detector dual source CT and 256-row multidetector CT. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2021; 29:529-539. [PMID: 33749627 DOI: 10.3233/xst-210837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND CT-derived fractional flow reserve (FFRCT) and diagnostic accuracy rely on good image quality during coronary CT angiography (CCTA). OBJECTIVE To investigate whether heart rate (HR) and coronary artery calcium (CAC) score decrease image quality and diagnostic performance of two advanced CT scanners including 96-row detector dual source CT (DSCT) and 256-row multidetector CT (MDCT). METHODS First, 79 patients who underwent CCTA (42 with DSCT and 37 with MDCT) and invasive coronary angiography (ICA) are enrolled. Next, coronary segments with excellent image quality are evaluated and the percentage is calculated. Then, diagnostic accuracy in detecting significant diameter stenosis is presented with ICA as the reference standard. RESULTS Compared with the DSCT, the percentage of coronary segments with excellent image quality is lower (P = 0.010) while diagnostic accuracy on per-segment level is improved (P = 0.037) using MDCT. CAC score≥400 is the only independent factor influencing the percentage of coronary segments with excellent image quality [odds ratio (OR): DSCT, 3.096 and MDCT, 1.982] and segmental diagnostic accuracy (OR: DSCT, 2.630 and MDCT, 2.336) for both scanners. HR≥70 bpm (OR: 5.506) is the independent factor influencing the percentage of coronary segments with excellent image quality with MDCT. CONCLULSION During CCTA, CAC score≥400 still decreases the proportion of coronary segments with excellent image quality and diagnostic accuracy with advanced CT scanners. HR≥70 bpm is another factor causing image quality decreasing with MDCT.
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Affiliation(s)
- Wen Qian
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wangyan Liu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yinsu Zhu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jun Wang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yang Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Haoyu Meng
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Leilei Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yi Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaomei Zhu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Computed Tomography in Heart Failure. CURRENT CARDIOVASCULAR IMAGING REPORTS 2019. [DOI: 10.1007/s12410-019-9512-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Tian P, Zheng X, Li M, Li W, Niu Q. Long-term prognostic value of coronary computed tomography angiography for asymptomatic patients with CAD in type 2 diabetes mellitus. Exp Ther Med 2019; 18:747-754. [PMID: 31258710 DOI: 10.3892/etm.2019.7593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 01/18/2019] [Indexed: 11/06/2022] Open
Abstract
The present study was performed to investigate the prognostic value of coronary computed tomography angiography (CTA) results for asymptomatic patients with coronary artery disease (CAD) in type 2 diabetes mellitus (T2DM). A total of 164 asymptomatic patients with T2DM were enrolled at Weifang Traditional Chinese Hospital (Weifang, China). Coronary plaques and stenosis severity were evaluated after CTA. Structures >1 mm2 adjacent to or within the coronary artery lumen that could be clearly separated from the vessel lumen, was scored as a coronary plaque. Stenosis of ≥50% was considered as being obstructive. CAD was defined as the presence of any coronary plaque or a coronary artery calcium (CAC) score of >0. A CAC score of 0 and no coronary plaques was considered to indicate the absence of CAD. A 5-year follow-up was performed to determine the impact of the CTA findings and various clinicopathological characteristics on the prognosis of all participants. The primary end-point was any cardiac event. Event-free survival curves were plotted using the Kaplan-Meier method and compared using the log-rank test. Based on the coronary CTA results, the patients were classified into 3 groups according to the extent of stenosis: Normal coronary arteries, obstructive CAD and non-obstructive CAD. Significant differences in 5-year event-free survival were identified among the groups with normal coronary arteries, non-obstructive CAD and obstructive CAD (P=0.026). Further analysis indicated that the event-free survival rate of patients with 1-vessel CAD was 94.11%, that of patients with 2-vessel CAD was 73.68% and that associated with 3-vessel CAD was 61.54%. Multivariate Cox regression analysis revealed that non-obstructive as well as obstructive CAD diagnosed by coronary CTA are prognostic indicators for asymptomatic T2DM patients [hazard ratio (HR)=11.132, 95% confidence interval (CI): 1.857-66.742, P=0.008; HR=7.792, 95% CI: 1.750-34.698, P=0.007, respectively]. In conclusion, the present study suggests that coronary CTA may predict the prognosis of asymptomatic patients with T2DM.
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Affiliation(s)
- Peigang Tian
- Imaging Center, Weifang Traditional Chinese Hospital, Weifang, Shandong 261000, P.R. China
| | - Xiangyang Zheng
- Imaging Center, Weifang Traditional Chinese Hospital, Weifang, Shandong 261000, P.R. China
| | - Mingzhi Li
- Imaging Center, Weifang Traditional Chinese Hospital, Weifang, Shandong 261000, P.R. China
| | - Weiwei Li
- Department of Radiology, Tai'an Central Hospital Branch, Tai'an, Shandong 271000, P.R. China
| | - Qingliang Niu
- Imaging Center, Weifang Traditional Chinese Hospital, Weifang, Shandong 261000, P.R. China
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Shuai T, Deng L, Pan Y, Li W, Liao K, Li J, Peng L, Li Z. Free-breathing coronary CT angiography using 16-cm wide-detector for challenging patients: comparison with invasive coronary angiography. Clin Radiol 2018; 73:986.e1-986.e6. [DOI: 10.1016/j.crad.2018.06.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 06/20/2018] [Indexed: 12/01/2022]
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Wen B, Xu L, Liang J, Fan Z, Sun Z. A Preliminary Study of Computed Tomography Coronary Angiography Within a Single Cardiac Cycle in Patients With Atrial Fibrillation Using 256-Row Detector Computed Tomography. J Comput Assist Tomogr 2018. [PMID: 29528910 DOI: 10.1097/rct.0000000000000683] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the image quality and radiation dose of computed tomography (CT) coronary angiography using a 256-row detector CT scanner in a single cardiac cycle in patients with atrial fibrillation (AF). METHODS Seventy consecutive patients (41 men and 29 women; age range was from 37 to 84 years, mean age was 61.7 ± 10.2 years; body mass index range was from 15.08 to 36.45 kg/m, mean body mass index was 25.9 ± 3.5 kg/m) with persistent or paroxysmal AF during acquisition, who were not receiving any medications for heart rate (HR) regulation, were imaged with a 256-row detector CT scanner (Revolution CT, GE healthcare). According to the HR or HR variability (HRV) the patients were divided into 4 groups: group A (HR, ≥75 bpm; n = 36), group B (HR, <75 bpm; n = 34), group C (HRV, ≥50 bpm; n = 26), and group D (HRV, <50 bpm; n = 44). The snapshot freeze algorithm reconstruction was used to reduce motion artifacts whenever necessary. Two experienced radiologists, who were blinded to the electrocardiograph and reconstruction information, independently graded the CT images in terms of visibility and artifacts with a 4-grade rating scale (1, excellent; 2, good; 3, poor; 4, insufficient) using the 18-segment model. Subjective image quality scores and effective dose (ED) were calculated and compared between these groups. RESULTS The HR during acquisition ranged from 47 to 222 bpm (88.24 ± 36.80 bpm). A total of 917 in 936 coronary artery segments were rated as diagnostically evaluable (98.2 ± 0.04%). There was no significant linear correlation between mean image quality and HR or HRV (P > 0.05). Snapshot freeze reconstruction technique was applied in 28 patients to reduce motion artifacts and thus showed image quality was improved from 93.2% to 98.4%. The ED was 3.05 ± 2.23 mSv (0.49-11.86 mSv) for all patients, and 3.76 ± 2.22 mSv (0.92-11.17 mSv), 2.30 ± 2.02 mSv (0.49-11.86 mSv), 3.89 ± 2.35 mSv (1.18-11.86 mSv), and 2.56 ± 2.03 mSv (0.49-11.17 mSv) for groups A, B, C, and D, respectively. There were significant differences in mean ED between groups A and B, as well as C and D (P <0.05). CONCLUSIONS This study shows that CT coronary angiography with use of a new 256-row detector CT in single cardiac cycle achieves diagnostic image quality but with lower radiation dose in patients with AF. Heart rate or HRV has no significant effect on image quality.
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Kim J, Kwag HJ, Yoo SM, Yoo JY, Chae IH, Choi DJ, Park MJ, Vembar M, Chun EJ. Discrepancies between coronary CT angiography and invasive coronary angiography with focus on culprit lesions which cause future cardiac events. Eur Radiol 2017; 28:1356-1364. [DOI: 10.1007/s00330-017-5095-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 09/06/2017] [Accepted: 09/25/2017] [Indexed: 11/30/2022]
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Urbonaviciene G, Isaksen C, Urbonavicius S, Buhl JS, Johansen JK, Nielsen AH, Nørgaard KS, Nørgaard A, Frost L. Coronary computed tomography angiography and calcium scoring in routine clinical practice for identification of patients who require revascularization. Arch Cardiovasc Dis 2016; 109:412-21. [PMID: 27215378 DOI: 10.1016/j.acvd.2016.01.013] [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: 05/25/2015] [Revised: 10/25/2015] [Accepted: 01/20/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND The predictive value of CCTA to predict coronary artery disease is high in particular in the absence of coronary calcification. However, the consideration of both CCTA and the calcium score, in addition to the risk factors to determine the indication for coronary revascularization, has not been yet studied. MATERIALS AND METHODS This study included 2302 patients (mean age: 60±9.8 years, 46% men), without known coronary artery disease (CAD), who underwent 320-row CCTA. Logistic regression, c-statistic and net reclassification improvement (NRI) were used to assess the role of coronary artery calcium score (CACS) in predicting revascularization after CCTA. RESULTS The revascularization rates were 0.75% in patients with a CACS of 0, and there were no adverse events during the follow-up period. The revascularization rates were 3.3% in patients with a CACS of 1-99, 15.4% in patients with a CACS of 100-399, 25.6% in patients with a CACS of 400-999, and 42.4% in patients with a CACS≥1000. The crude and adjusted odds ratios (95% confidence interval) for revascularization per CACS group category were 2.89 (2.53-2.3) and 2.71 (2.33-3.15), respectively; the area under the ROC curve (AUC) was 0.85 (0.83-0.88). The addition of CACS to conventional risk factors improved the accuracy of risk prediction model for revascularization (AUC 0.74 vs 0.63, P=0.001), but it did not reclassify a substantial proportion of patients with positive CACS to risk categories (NRI=-0.023, P=0.66). CONCLUSIONS The 320-row CCTA might rule out CAD in low- to intermediate-risk patients. However, its accuracy in identifying patients who require revascularization is limited. The CACS added to the conventional risk factors did not improve the identification of patients who require revascularization.
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Affiliation(s)
- Grazina Urbonaviciene
- University Clinic for Development of Innovative Patient Pathways, Silkeborg Hospital, Diagnostic Centre, Silkeborg, Denmark; Aarhus University, Institute for Clinical Medicine, Aarhus, Denmark.
| | - Christin Isaksen
- University Clinic for Development of Innovative Patient Pathways, Silkeborg Hospital, Diagnostic Centre, Silkeborg, Denmark
| | - Sigitas Urbonavicius
- Aarhus University, Institute for Clinical Medicine, Aarhus, Denmark; Viborg Hospital, Department of Vascular Surgery, Viborg, Denmark
| | - Jørgen Selmer Buhl
- University Clinic for Development of Innovative Patient Pathways, Silkeborg Hospital, Diagnostic Centre, Silkeborg, Denmark
| | - Jane Kirk Johansen
- University Clinic for Development of Innovative Patient Pathways, Silkeborg Hospital, Diagnostic Centre, Silkeborg, Denmark
| | - Agnete Hedemann Nielsen
- University Clinic for Development of Innovative Patient Pathways, Silkeborg Hospital, Diagnostic Centre, Silkeborg, Denmark
| | - Kirsten Schou Nørgaard
- University Clinic for Development of Innovative Patient Pathways, Silkeborg Hospital, Diagnostic Centre, Silkeborg, Denmark
| | - Aage Nørgaard
- University Clinic for Development of Innovative Patient Pathways, Silkeborg Hospital, Diagnostic Centre, Silkeborg, Denmark
| | - Lars Frost
- University Clinic for Development of Innovative Patient Pathways, Silkeborg Hospital, Diagnostic Centre, Silkeborg, Denmark; Aarhus University, Institute for Clinical Medicine, Aarhus, Denmark
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Kido T, Mochizuki T, Hirano M, Yamada Y, Tanaka R, Kanzaki S, Higashi M, Jinzaki M, Yoshioka K, Kuribayashi S. Radiation-Dose-Lowering Effects of Landiolol Hydrochloride in Coronary Angiography Using Computed Tomography (DELIGHT) – A Prospective Multicenter Study –. Circ J 2016; 80:1225-31. [DOI: 10.1253/circj.cj-15-0962] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Teruhito Kido
- Department of Radiology, Ehime University Graduate School of Medicine
| | | | | | - Yoshitake Yamada
- Department of Diagnostic Radiology, Keio University School of Medicine
| | - Ryoichi Tanaka
- Department of Cardiovascular Radiology, Memorial Heart Center, Iwate Medical University
| | - Suzu Kanzaki
- Department of Radiology, National Cerebral and Cardiovascular Center
| | - Masahiro Higashi
- Department of Radiology, National Cerebral and Cardiovascular Center
| | - Masahiro Jinzaki
- Department of Diagnostic Radiology, Keio University School of Medicine
| | - Kunihiro Yoshioka
- Department of Cardiovascular Radiology, Memorial Heart Center, Iwate Medical University
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Automated Computer-Assisted Diagnosis of Obstructive Coronary Artery Disease in Emergency Department Patients Undergoing 256-Slice Coronary Computed Tomography Angiography for Acute Chest Pain. Am J Cardiol 2015; 116:1017-21. [PMID: 26251004 DOI: 10.1016/j.amjcard.2015.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 07/03/2015] [Accepted: 07/03/2015] [Indexed: 11/22/2022]
Abstract
A 256-slice coronary computed tomography angiography (CCTA) is an accurate method for detection and exclusion of obstructive coronary artery disease (OBS-CAD). However, accurate image interpretation requires expertise and may not be available at all hours. The purpose of this study was to evaluate the usefulness of a fully automated computer-assisted diagnosis (COMP-DIAG) tool for exclusion of OBS-CAD in patients in the emergency department (ED) presenting with chest pain. Three hundred sixty-nine patients in ED without known coronary disease underwent 256-slice CCTA as part of the assessment of chest pain of uncertain origin. COMP-DIAG (CorAnalyzer II) automatically reported presence or exclusion of OBS-CAD (>50% stenosis, ≥1 vessel). Performance characteristics of COMP-DIAG for exclusion and detection of OBS-CAD were determined using expert reading as the reference standard. Seventeen (5%) studies were unassessable by COMP-DIAG software, and 352 patients (1,056 vessels) were therefore available for analysis. COMP-DIAG identified 33% of assessable studies as having OBS-CAD, but the prevalence of OBS-CAD on CCTA was only 18% (66 of 352 patients) by standard expert reading. However, COMP-DIAG correctly identified 61 of the 66 patients (93%) with OBS-CAD with 21 vessels (2%) with OBS-CAD misclassified as negative. In conclusion, compared to expert reading, automated computer-assisted diagnosis using the CorAnalyzer showed high sensitivity but only moderate specificity for detection of obstructive coronary disease in patients in ED who underwent 256-slice CCTA. The high negative predictive value of this computer-assisted algorithm may be useful in the ED setting.
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Abstract
Cardiac multidetector computed tomography (MDCT) has become a useful noninvasive modality for anatomical imaging of coronary artery disease (CAD). Currently, the main clinical advantage of coronary computed tomography angiography (CCTA) appears to be related to its high negative predictive value at low or intermediate pretest probability for CAD. With the development of technical aspects of MDCT, clinical practice and research are increasingly shifting toward defining the clinical implication of plaque morphology, myocardial perfusion, and patient outcomes. The presence of positive vessel remodeling, low-attenuation plaques, napkin-ring sign, or spotty calcification on CCTA could be useful information on high-risk vulnerable plaques. The napkin-ring sign, especially, showed higher accuracy for the detection of thin-cap fibroatheroma. Recently, it was reported that cardiac 3D single-photon emission tomography/CT fusion imaging, noninvasive fractional flow reserve computed from CT, and integrated CCTA and CT myocardial perfusion were associated with improved diagnostic accuracy for the detection of hemodynamically significant CAD. Furthermore, several randomized, large clinical trials have evaluated the clinical value of CCTA for chest pain triage in the emergency department or long-term reduction in death, myocardial infarction, or hospitalization for unstable angina. In this review we discuss the role of cardiac MDCT beyond coronary angiography, including a comparison with other currently available imaging modalities used to examine atherosclerotic plaque and myocardial perfusion.
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Affiliation(s)
- Akira Sato
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
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Zheng XZ, Yang B, Wu J. Comparison of the Efficacy of Conventional Echocardiographic Parameters in the Diagnosis of Significant Coronary Artery Stenosis. IRANIAN JOURNAL OF RADIOLOGY 2014; 12:e11405. [PMID: 25785175 PMCID: PMC4347731 DOI: 10.5812/iranjradiol.11405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 06/02/2013] [Accepted: 06/11/2013] [Indexed: 11/16/2022]
Abstract
Background: Objectives: Patients and Methods: Results: Conclusions:
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Affiliation(s)
- Xiao Zhi Zheng
- Department of Ultrasound, Affiliated Hospital of Nantong University (The First People’s Hospital of Yancheng), Yancheng, P.R China
| | - Bin Yang
- Department of Ultrasound, Jinling Hospital, Nanjing University School of Medicine, Nanjing City, P.R China
- Corresponding author: Bin Yang, Department of Ultrasound, Jinling Hospital, Nanjing University School of Medicine, Nanjing City, P.R China. Tel: +8625-80861314, Fax: +8625-80863136, E-mail:
| | - Jing Wu
- Department of Ultrasound, Affiliated Hospital of Nantong University (The First People’s Hospital of Yancheng), Yancheng, P.R China
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Korosoglou G, Giusca S, Gitsioudis G, Erbel C, Katus HA. Cardiac magnetic resonance and computed tomography angiography for clinical imaging of stable coronary artery disease. Diagnostic classification and risk stratification. Front Physiol 2014; 5:291. [PMID: 25147526 PMCID: PMC4123729 DOI: 10.3389/fphys.2014.00291] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 07/18/2014] [Indexed: 12/18/2022] Open
Abstract
Despite advances in the pharmacologic and interventional treatment of coronary artery disease (CAD), atherosclerosis remains the leading cause of death in Western societies. X-ray coronary angiography has been the modality of choice for diagnosing the presence and extent of CAD. However, this technique is invasive and provides limited information on the composition of atherosclerotic plaque. Coronary computed tomography angiography (CCTA) and cardiac magnetic resonance (CMR) have emerged as promising non-invasive techniques for the clinical imaging of CAD. Hereby, CCTA allows for visualization of coronary calcification, lumen narrowing and atherosclerotic plaque composition. In this regard, data from the CONFIRM Registry recently demonstrated that both atherosclerotic plaque burden and lumen narrowing exhibit incremental value for the prediction of future cardiac events. However, due to technical limitations with CCTA, resulting in false positive or negative results in the presence of severe calcification or motion artifacts, this technique cannot entirely replace invasive angiography at the present time. CMR on the other hand, provides accurate assessment of the myocardial function due to its high spatial and temporal resolution and intrinsic blood-to-tissue contrast. Hereby, regional wall motion and perfusion abnormalities, during dobutamine or vasodilator stress, precede the development of ST-segment depression and anginal symptoms enabling the detection of functionally significant CAD. While CT generally offers better spatial resolution, the versatility of CMR can provide information on myocardial function, perfusion, and viability, all without ionizing radiation for the patients. Technical developments with these 2 non-invasive imaging tools and their current implementation in the clinical imaging of CAD will be presented and discussed herein.
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Computer-assisted diagnosis of obstructive coronary atherosclerosis in patients undergoing 256-slice coronary computed tomography angiography: a comparison with invasive coronary angiography. Int J Cardiol 2014; 172:e130-1. [PMID: 24439780 DOI: 10.1016/j.ijcard.2013.12.112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 12/22/2013] [Indexed: 11/24/2022]
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Krul MMG, Bogaard K, Knol RJJ, van Rossum AC, Knaapen P, Cornel JH, van der Zant FM. Coronary artery disease in patients with atypical chest pain with and without diabetes mellitus assessed with coronary CT angiography. BMJ Open Diabetes Res Care 2014; 2:e000004. [PMID: 25452855 PMCID: PMC4212558 DOI: 10.1136/bmjdrc-2013-000004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 02/26/2014] [Accepted: 03/26/2014] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Coronary artery disease (CAD) in diabetes mellitus (DM) is often widespread when diagnosed. Non-invasive coronary calcium scoring and coronary CT angiography (CAC-score/CCTA) are accurate in the detection of CAD. This study compared CAD characteristics as identified by CCTA between patients with and without DM with atypical chest pain. METHODS CAD was defined as CAC-score >0 and/or presence of coronary plaque. Several CAD characteristics (number of affected segments, obstructive (>50% stenosis) CAD and CAD distribution) were compared on a per patient and segment basis. Subanalysis of duration of DM (<5 or >5 years) and gender was performed. RESULTS A total of 1148 patients (63.3% men, mean age 57.7±10.7), of whom 99 (8.6%) suffered from DM, were referred for CCTA. There was no difference in the prevalence of CAD between patients with and without DM (53.5% vs 50.9%, p=0.674). However patients with DM showed more affected coronary segments compared with patients without DM (2.5±3.4 vs 1.7±2.4, p=0.003). Multivariate analysis indicated that DM was an independent predictor of obstructive CAD (OR 2.16, 95% CI 1.23 to 3.78), as were age, women, and Diamond-Forrester score. In our study, obstructive CAD was more prevalent in women than in men (DM 40.0% vs 14.1%, p=0.003; non-DM 16.8% vs 8.4%, p<0.001). Patients suffering from DM >5 years showed more distal plaques (11.2% vs 7.7%, p=0.030). CONCLUSIONS Patients with atypical chest pain and DM showed more extensive CAD, as well as more obstructive CAD, particularly in women. Diabetes duration (>5 years) was not associated with more obstructive coronary disease or different plaque morphology, although more distal disease was present.
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Affiliation(s)
- Marije M G Krul
- Department of Cardiology , Medical Center Alkmaar , Alkmaar , The Netherlands
| | - Kjell Bogaard
- Department of Cardiology , Rijnland Hospital , Leiderdorp , The Netherlands
| | - Remco J J Knol
- Department of Nuclear Medicine , Medical Center Alkmaar , Alkmaar , The Netherlands
| | | | - Paul Knaapen
- Department of Cardiology , VU Medical Center , Amsterdam , The Netherlands
| | - Jan H Cornel
- Department of Cardiology , Medical Center Alkmaar , Alkmaar , The Netherlands
| | - Friso M van der Zant
- Department of Nuclear Medicine , Medical Center Alkmaar , Alkmaar , The Netherlands
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Sabarudin A, Sun Z. Coronary CT angiography: Diagnostic value and clinical challenges. World J Cardiol 2013; 5:473-483. [PMID: 24392192 PMCID: PMC3879693 DOI: 10.4330/wjc.v5.i12.473] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 09/06/2013] [Accepted: 10/12/2013] [Indexed: 02/06/2023] Open
Abstract
Coronary computed tomography (CT) angiography has been increasingly used in the diagnosis of coronary artery disease due to improved spatial and temporal resolution with high diagnostic value being reported when compared to invasive coronary angiography. Diagnostic performance of coronary CT angiography has been significantly improved with the technological developments in multislice CT scanners from the early generation of 4-slice CT to the latest 320- slice CT scanners. Despite the promising diagnostic value, coronary CT angiography is still limited in some areas, such as inferior temporal resolution, motion-related artifacts and high false positive results due to severe calcification. The aim of this review is to present an overview of the technical developments of multislice CT and diagnostic value of coronary CT angiography in coronary artery disease based on different generations of multislice CT scanners. Prognostic value of coronary CT angiography in coronary artery disease is also discussed, while limitations and challenges of coronary CT angiography are highlighted.
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Danad I, Raijmakers PG, Knaapen P. Diagnosing coronary artery disease with hybrid PET/CT: it takes two to tango. J Nucl Cardiol 2013; 20:874-90. [PMID: 23842709 DOI: 10.1007/s12350-013-9753-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The noninvasive diagnosis of coronary artery disease (CAD) is a challenging task. Although a large armamentarium of imaging modalities is available to evaluate the functional consequences of the extent and severity of CAD, cardiac perfusion positron emission tomography (PET) is considered the gold standard for this purpose. Alternatively, noninvasive anatomical imaging of coronary atherosclerosis with coronary computed tomography angiography (CCTA) has recently been successfully implemented in clinical practice. Although each of these diagnostic approaches has its own merits and caveats, functional and morphological imaging techniques provide fundamentally different insights into the disease process and should be considered to be complementary rather than overlapping. Hybrid imaging with PET/CT offers the possibility to evaluate both aspects nearly simultaneously, and studies have demonstrated that such a comprehensive assessment results in superior diagnostic accuracy, better prognostication, and helps in guiding clinical patient management. The aim of this review is to discuss the value of stand-alone CCTA and PET in CAD, and to summarize the available data on the surplus value of hybrid PET/CT including its strengths and limitations.
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Affiliation(s)
- Ibrahim Danad
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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