1
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Andreini D, Collet C, Leipsic J, Nieman K, Bittencurt M, De Mey J, Buls N, Onuma Y, Mushtaq S, Conte E, Bartorelli AL, Stefanini G, Sonck J, Knaapen P, Ghoshhajra B, Serruys PW. Pre-procedural planning of coronary revascularization by cardiac computed tomography: An expert consensus document of the Society of Cardiovascular Computed Tomography. EUROINTERVENTION 2022; 18:e872-e887. [PMID: 35994043 PMCID: PMC9743242 DOI: 10.4244/eij-e-22-00036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/05/2022] [Indexed: 12/12/2022]
Abstract
Coronary CT angiography (CCTA) demonstrated high diagnostic accuracy for detecting coronary artery disease (CAD) and a key role in the management of patients with low-to-intermediate pretest likelihood of CAD. However, the clinical information provided by this noninvasive method is still regarded insufficient in patients with diffuse and complex CAD and for planning percutaneous coronary intervention (PCI) and surgical revascularization procedures. On the other hand, technology advancements have recently shown to improve CCTA diagnostic accuracy in patients with diffuse and calcific stenoses. Moreover, stress CT myocardial perfusion imaging (CT-MPI) and fractional flow reserve derived from CCTA (CT-FFR) have been introduced in clinical practice as new tools for evaluating the functional relevance of coronary stenoses, with the possibility to overcome the main CCTA drawback, i.e. anatomical assessment only. The potential value of CCTA to plan and guide interventional procedures lies in the wide range of information it can provide: a) detailed evaluation of plaque extension, volume and composition; b) prediction of procedural success of CTO PCI using scores derived from CCTA; c) identification of coronary lesions requiring additional techniques (e.g., atherectomy and lithotripsy) to improve stent implantation success by assessing calcium score and calcific plaque distribution; d) assessment of CCTA-derived Syntax Score and Syntax Score II, which allows to select the mode of revascularization (PCI or CABG) in patients with complex and multivessel CAD. The aim of this Consensus Document is to review and discuss the available data supporting the role of CCTA, CT-FFR and stress CT-MPI in the preprocedural and possibly intraprocedural planning and guidance of myocardial revascularization interventions.
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Affiliation(s)
- Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | | | - Jonathon Leipsic
- St Paul's Hospital & University of British Columbia, Vancouver, British Columbia Vancouver, Canada
| | - Koen Nieman
- Stanford University School of Medicine, Departments of Medicine and Radiology, USA
| | - Marcio Bittencurt
- Division of Internal Medicine, University Hospital, University of São Paulo, São Paulo, Brazil
- DASA, São Paulo, Brazil
- Division of Cardiology and the Heart and Vascular Institute, University of Pittsburgh Medical Center
| | - Johan De Mey
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussel, Belgium
| | - Nico Buls
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussel, Belgium
| | - Yoshinobu Onuma
- Clinical Science Institute, National University of Ireland, Galway, Ireland
| | | | - Edoardo Conte
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
- Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLVZ Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - Paul Knaapen
- Vrije Universiteit Medical Center, Amsterdam, Netherlands
| | - Brian Ghoshhajra
- Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Patrick W Serruys
- Clinical Science Institute, National University of Ireland, Galway, Ireland
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2
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Andreini D, Collet C, Leipsic J, Nieman K, Bittencurt M, De Mey J, Buls N, Onuma Y, Mushtaq S, Conte E, Bartorelli AL, Stefanini G, Sonck J, Knaapen P, Ghoshhajra B, Serruys P. Pre-procedural planning of coronary revascularization by cardiac computed tomography: An expert consensus document of the Society of Cardiovascular Computed Tomography. J Cardiovasc Comput Tomogr 2022; 16:558-572. [PMID: 36008263 DOI: 10.1016/j.jcct.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 06/07/2022] [Accepted: 08/05/2022] [Indexed: 10/15/2022]
Abstract
Coronary CT angiography (CCTA) demonstrated high diagnostic accuracy for detecting coronary artery disease (CAD) and a key role in the management of patients with low-to-intermediate pretest likelihood of CAD. However, the clinical information provided by this noninvasive method is still regarded insufficient in patients with diffuse and complex CAD and for planning percutaneous coronary intervention (PCI) and surgical revascularization procedures. On the other hand, technology advancements have recently shown to improve CCTA diagnostic accuracy in patients with diffuse and calcific stenoses. Moreover, stress CT myocardial perfusion imaging (CT-MPI) and fractional flow reserve derived from CCTA (CT-FFR) have been introduced in clinical practice as new tools for evaluating the functional relevance of coronary stenoses, with the possibility to overcome the main CCTA drawback, i.e. anatomical assessment only. The potential value of CCTA to plan and guide interventional procedures lies in the wide range of information it can provide: a) detailed evaluation of plaque extension, volume and composition; b) prediction of procedural success of CTO PCI using scores derived from CCTA; c) identification of coronary lesions requiring additional techniques (e.g., atherectomy and lithotripsy) to improve stent implantation success by assessing calcium score and calcific plaque distribution; d) assessment of CCTA-derived Syntax Score and Syntax Score II, which allows to select the mode of revascularization (PCI or CABG) in patients with complex and multivessel CAD. The aim of this Consensus Document is to review and discuss the available data supporting the role of CCTA, CT-FFR and stress CT-MPI in the preprocedural and possibly intraprocedural planning and guidance of myocardial revascularization interventions.
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Affiliation(s)
- Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy.
| | | | - Jonathon Leipsic
- St Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Vancouver, Canada
| | - Koen Nieman
- Stanford University School of Medicine, Departments of Medicine and Radiology, USA
| | - Marcio Bittencurt
- Division of Internal Medicine, University Hospital, University of São Paulo, São Paulo, Brazil; DASA, São Paulo, Brazil; Division of Cardiology and the Heart and Vascular Institute, University of Pittsburgh Medical Center, USA
| | - Johan De Mey
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussel, Belgium
| | - Nico Buls
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussel, Belgium
| | - Yoshinobu Onuma
- Clinical Science Institute, National University of Ireland, Galway, Ireland
| | | | - Edoardo Conte
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLVZ Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - Paul Knaapen
- Vrije Universiteit Medical Center, Amsterdam, Netherlands
| | - Brian Ghoshhajra
- Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Patrick Serruys
- Clinical Science Institute, National University of Ireland, Galway, Ireland
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3
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Coronary Computer Tomography Angiography in 2021-Acquisition Protocols, Tips and Tricks and Heading beyond the Possible. Diagnostics (Basel) 2021; 11:diagnostics11061072. [PMID: 34200866 PMCID: PMC8230532 DOI: 10.3390/diagnostics11061072] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/06/2021] [Accepted: 06/09/2021] [Indexed: 01/09/2023] Open
Abstract
Recent technological advances, together with an increasing body of evidence from randomized trials, have placed coronary computer tomography angiography (CCTA) in the center of the diagnostic workup of patients with coronary artery disease. The method was proven reliable in the diagnosis of relevant coronary artery stenosis. Furthermore, it can identify different stages of the atherosclerotic process, including early atherosclerotic changes of the coronary vessel wall, a quality not met by other non-invasive tests. In addition, newer computational software can measure the hemodynamic relevance (fractional flow reserve) of a certain stenosis. In addition, if required, information related to cardiac and valvular function can be provided with specific protocols. Importantly, recent trials have highlighted the prognostic relevance of CCTA in patients with coronary artery disease, which helped establishing CCTA as the first-line method for the diagnostic work-up of such patients in current guidelines. All this can be gathered in one relatively fast examination with minimal discomfort for the patient and, with newer machines, with very low radiation exposure. Herein, we provide an overview of the current technical aspects, indications, pitfalls, and new horizons with CCTA, providing examples from our own clinical practice.
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4
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Lehker A, Mukherjee D. Coronary Calcium Risk Score and Cardiovascular Risk. Curr Vasc Pharmacol 2021; 19:280-284. [PMID: 32242784 DOI: 10.2174/1570161118666200403143518] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/10/2020] [Accepted: 03/11/2020] [Indexed: 12/21/2022]
Abstract
The association between the presence of coronary artery calcium (CAC) and the risk of coronary artery disease (CAD) has been appreciated for decades. In this review, we critically appraise the role of CAC based on computerized tomography in contemporary risk stratification. Available evidence suggests that the measurement of CAC is a useful modality in many patients for more precise risk stratification and prognostic determination. Whether newer CAC score incorporating extra coronary calcification will add incremental value, especially for stroke and other non-coronary vascular outcomes, needs a prospective study.
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Affiliation(s)
- Angelica Lehker
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas 79905, United States
| | - Debabrata Mukherjee
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas 79905, United States
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5
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Madanchi M, Cioffi GM, Kobza R, Cuculi F, Bossard M. The Importance of Defining the Coronary Anatomy in Suspected Myopericarditis: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e929009. [PMID: 33780431 PMCID: PMC8019837 DOI: 10.12659/ajcr.929009] [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] [Indexed: 11/23/2022]
Abstract
Patient: Male, 36-year-old Final Diagnosis: NSTEMI Symptoms: Chest discomfort Medication:— Clinical Procedure: Coronary angiogram via trans radial route Specialty: Cardiology • General and Internal Medicine
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Affiliation(s)
- Mehdi Madanchi
- Department of Cardiology, Herzzentrum, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Giacomo Maria Cioffi
- Department of Cardiology, Herzzentrum, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Richard Kobza
- Department of Cardiology, Herzzentrum, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Florim Cuculi
- Department of Cardiology, Herzzentrum, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Matthias Bossard
- Department of Cardiology, Herzzentrum, Luzerner Kantonsspital, Lucerne, Switzerland
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6
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Andreini D, Mushtaq S, Conte E, Mei M, Nicoli F, Melotti E, Pompilio G, Pepi M, Bartorelli AL, Onuma Y, Serruys PW. The usefulness of cardiac CT integrated with FFRCT for planning myocardial revascularization in complex coronary artery disease: a lesson from SYNTAX studies. Cardiovasc Diagn Ther 2020; 10:2036-2047. [PMID: 33381442 PMCID: PMC7758756 DOI: 10.21037/cdt.2019.11.07] [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: 09/30/2019] [Accepted: 11/20/2019] [Indexed: 11/06/2022]
Abstract
After two decades of clinical use, during which coronary CT angiography (CCTA) was considered an appropriate method for the non-invasive assessment of patients with suspected stable coronary artery disease (CAD) and low-to-intermediate pretest likelihood of CAD, a growing body of literature is showing that CCTA may have also a clinical role in patients with high pretest likelihood of CAD, known CAD and complex and diffuse CAD. Particularly, the SYNTAX studies demonstrated the usefulness of CCTA in the field of non-invasive assessment of these patients and planning of interventional and surgical coronary procedures, thanks to its ability to combine, in a single method, precise stenosis quantification, accurate plaque characterization, functional assessment and selection of the revascularization modality for any individual patient and of the vessels that need to be revascularized. Of note, the SYNTAX III Revolution trial showed, in patients with three-vessel CAD, that treatment decision-making between PCI and CABG based on CCTA only has an almost perfect agreement with the treatment decision derived from invasive coronary angiography (ICA). Moreover, the SYNTAX Score II demonstrated a high degree of correlation between the two diagnostic strategies, suggesting the potential feasibility of a treatment decision-making based solely on non-invasive imaging and clinical information. New research prospects have opened up for the future to demonstrate the true feasibility and safety of this innovative approach in the clinical arena.
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Affiliation(s)
- Daniele Andreini
- Monzino Cardiology Center, IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | | | | | | | | | | | - Giulio Pompilio
- Monzino Cardiology Center, IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Mauro Pepi
- Monzino Cardiology Center, IRCCS, Milan, Italy
| | - Antonio L. Bartorelli
- Monzino Cardiology Center, IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, Milan, Italy
| | | | - Patrick W. Serruys
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Imperial College London, London, UK
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7
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Head-to-head comparison of prognostic accuracy in patients undergoing noncardiac surgery of dobutamine stress echocardiography versus computed tomography coronary angiography (PANDA trial): A prospective observational study. J Cardiovasc Comput Tomogr 2020; 14:471-477. [DOI: 10.1016/j.jcct.2020.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 01/20/2020] [Accepted: 02/03/2020] [Indexed: 12/26/2022]
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8
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Impact of Education-based HEART Score Pathway on Coronary Computed Tomography Angiography Utilization and Yield in the Emergency Department. Crit Pathw Cardiol 2020; 19:200-205. [PMID: 32701592 DOI: 10.1097/hpc.0000000000000234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE There is a growing consensus to reduce unnecessary testing among low-risk chest pain patients. The objective of this study was to evaluate the impact of implementing an education-based HEART score pathway in the emergency department on coronary computed tomography angiography (CCTA) utilization and yield. METHODS A retrospective before and after intervention study was conducted at a single site. Adult emergency department patients undergoing CCTA for suspected acute coronary syndrome were included. Primary outcomes were CCTA utilization and yield. Utilization was defined as the percentage of patients evaluated with CCTA and yield was calculated as the percentage of patients with a diagnosis of obstructive coronary artery disease, defined as ≥50% stenosis in any one coronary artery due to atherosclerosis. RESULTS 1540 patients undergoing CCTAs were included. CCTA utilization before and after were 2.2% [95% confidence interval (CI) 2.0-2.3] and 2.0% (95% CI 1.9-2.2), respectively; mean difference 0.1% (95% CI -0.1 to 0.3; P = 0.21). The mean age was 53 years (SD = 11) and females were 52%. Of 1477 patients included in CCTA yield analysis, patients diagnosed with obstructive coronary artery disease before and after were 15.0% (95% CI 12.6-17.7) and 16.2% (95% CI 13.6-19.1), respectively; mean difference 1.2% (95% CI -2.6 to 5.1; P = 0.53). CONCLUSIONS There was no significant change in the CCTA utilization or yield after the implementation of an education-based HEART pathway in a large academic center. Our findings suggest adopting a more comprehensive approach for deploying such evidence-based protocols to increase institutional compliance.
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9
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Nelson AJ, Ardissino M, Psaltis PJ. Current approach to the diagnosis of atherosclerotic coronary artery disease: more questions than answers. Ther Adv Chronic Dis 2019; 10:2040622319884819. [PMID: 31700595 PMCID: PMC6826912 DOI: 10.1177/2040622319884819] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/03/2019] [Indexed: 01/10/2023] Open
Abstract
Despite its commonality in routine clinical practice, the approach to a diagnosis of atherosclerotic coronary artery disease remains complex and, in part, contentious. The traditional dogma linking ischaemia to hard clinical outcomes has been questioned and reframed over the years; rather than being a predictor of hard clinical outcomes, the degree of ischaemia may simply be a marker of atherosclerotic disease burden. A renewed interest in the imaging of plaque burden has spawned the contemporary role of CT imaging for not only diagnosis and prognosis, but also for dictating downstream management. As the technology develops and evidence expands, decisions on investigative modalities remain centred around patient factors, local availability, test performance and cost. This review summarizes the available methods for diagnosis in the symptomatic patient and provides an overview of the current evidence behind functional and anatomical approaches.
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Affiliation(s)
- Adam J. Nelson
- Duke Clinical Research Institute, Durham, NC, USA
- Vascular Research Centre, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Maddalena Ardissino
- Duke Clinical Research Institute, Durham, NC, USA
- School of Medicine, Imperial College, London, UK
| | - Peter J. Psaltis
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA 5005, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
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10
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Myhre PL, Lyngbakken MN, Tveit SH, Røsjø H, Omland T. Cardiac imaging and circulating biomarkers for primary prevention in the era of precision medicine. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2019. [DOI: 10.1080/23808993.2019.1660162] [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]
Affiliation(s)
- Peder Langeland Myhre
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Magnus Nakrem Lyngbakken
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Sjur Hansen Tveit
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Helge Røsjø
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Torbjørn Omland
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
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11
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Poli FE, Gulsin GS, McCann GP, Burton JO, Graham-Brown MP. The assessment of coronary artery disease in patients with end-stage renal disease. Clin Kidney J 2019; 12:721-734. [PMID: 31583096 PMCID: PMC6768295 DOI: 10.1093/ckj/sfz088] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality among patients with end-stage renal disease (ESRD). Clustering of traditional atherosclerotic and non-traditional risk factors drive the excess rates of coronary and non-coronary CVD in patients with ESRD. Coronary artery disease (CAD) is a key disease process, present in ∼50% of the haemodialysis population ≥65 years of age. Patients with ESRD are more likely to be asymptomatic, posing a challenge to the correct identification of CAD, which is essential for appropriate risk stratification and management. Given the lack of randomized clinical trial evidence in this population, current practice is informed by observational data with a significant potential for bias. For this reason, the most appropriate approach to the investigation of CAD is the subject of considerable discussion, with practice patterns largely varying between different centres. Traditional imaging modalities are limited in their diagnostic accuracy and prognostic value for cardiac events and survival in patients with ESRD, demonstrated by the large number of adverse cardiac outcomes among patients with negative test results. This review focuses on the current understanding of CAD screening in the ESRD population, discussing the available evidence for the use of various imaging techniques to refine risk prediction, with an emphasis on their strengths and limitations.
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Affiliation(s)
- Federica E Poli
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - Gaurav S Gulsin
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - James O Burton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK.,John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK.,National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Matthew P Graham-Brown
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK.,John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK
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12
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Radiation exposure related to cardiovascular CT examination: comparison between conventional 64-MDCT and third-generation dual-source MDCT. Radiol Med 2019; 124:753-761. [DOI: 10.1007/s11547-019-01036-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 04/09/2019] [Indexed: 01/02/2023]
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13
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Koo HJ, Yang DH, Kang JW, Lee JY, Kim DH, Song JM, Kang DH, Song JK, Kim JB, Jung SH, Choo SJ, Chung CH, Lee JW, Lim TH. Demonstration of infective endocarditis by cardiac CT and transoesophageal echocardiography: comparison with intra-operative findings. Eur Heart J Cardiovasc Imaging 2019; 19:199-207. [PMID: 28329276 DOI: 10.1093/ehjci/jex010] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 01/16/2017] [Indexed: 12/25/2022] Open
Abstract
Aims We aimed to compare imaging findings of infective endocarditis between computed tomography (CT) and transoesophageal echocardiography (TEE) using surgical inspection as a reference standard. Methods and results Forty-nine patients (aged 54 ± 17 years, 69% men) who underwent pre-operative CT and TEE for infective endocarditis were included. Twelve of these patients had prosthetic valve endocarditis. Imaging findings of infective endocarditis were classified as vegetation, leaflet perforation, abscess/pseudoaneurysm, and paravalvular leakage. Diagnostic performances of CT and TEE were evaluated using surgical inspection as a reference standard. Interobserver agreements for CT findings were obtained using Cohen's κ test. The detection rates of infective endocarditis per patient with CT and TEE were 93.9% (46/49) and 95.9% (47/49), respectively. In per-imaging analysis, the sensitivities of CT and TEE were not significantly different for both native and prosthetic valve infective endocarditis (sensitivity: vegetation, 100% in TEE and 90.9% in CT; leaflet perforation, 87.5% in TEE and 50.0% in CT; abscess/pseudoaneurysm, 40.0% in TEE and 60.0% in CT; paravalvular leakage, 100% in TEE and 50.0% in CT). Interobserver agreements for CT findings were substantial or excellent (0.79-0.88). Conclusion Cardiac CT can accurately demonstrate infective endocarditis in pre-operative patients with a similar diagnostic accuracy to TEE. The interobserver agreements for the CT findings of infective endocarditis were excellent.
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Affiliation(s)
- Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joo Yeon Lee
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dae-Hee Kim
- Department of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jong-Min Song
- Department of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Duk-Hyun Kang
- Department of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae-Kwan Song
- Department of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joon Bum Kim
- Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, South Korea
| | - Sung-Ho Jung
- Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, South Korea
| | - Suk Jung Choo
- Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, South Korea
| | - Cheol Hyun Chung
- Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, South Korea
| | - Jae-Won Lee
- Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, South Korea
| | - Tae-Hwan Lim
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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14
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Coronary artery calcium score in predicting periprocedural myocardial infarction in patients undergoing an elective percutaneous coronary intervention. Coron Artery Dis 2018; 29:589-596. [DOI: 10.1097/mca.0000000000000651] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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15
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Computed tomography coronary angiography in patients without known coronary artery disease can demonstrate possible non-cardiovascular causes of non-acute retrosternal chest pain. Insights Imaging 2018; 9:687-694. [PMID: 30276668 PMCID: PMC6206382 DOI: 10.1007/s13244-018-0654-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 07/21/2018] [Accepted: 08/07/2018] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVES To assess the computed tomography coronary angiography (CTCA) accuracy for demonstrating possible non-cardiovascular causes of non-acute retrosternal chest pain in patients without known coronary artery disease (CAD) and to correlate CTCA results with the patient management and relief from pain. METHODS This prospective observational study was approved by the ethical committee. Consecutive patients suffering non-acute chest pain who underwent CTCA and with not known CAD were enrolled and classified as having coronary diseases (CD) or extracardiac diseases (ECD). Association between age, sex, body mass index (BMI), cardiovascular risk factors, and type of chest pain with CD or ECD was estimated. Correlation between BMI classes and each risk factor was also calculated. RESULTS A total of 106 patients (60 males; age 62 ± 14 years [mean ± standard deviation]; mean BMI 27) were enrolled. Hypertension was found in 71/106 (67%); smoking was significantly more frequent among males (p = 0.003) and hypercholesterolemia among females (p = 0.017); hypertension and hypercholesterolemia significantly correlated with age, and hypertension also with BMI. Pain was atypical in 70/106 (66%) patients. The kind of pain did not correlate with disease or gender. CTCA showed possible causes of chest pain in 69/106 (65%) patients; 32/69 (47%) having only CD, 23/69 (33%) only ECD, and 14/69 (20%) both CD and ECD. Prevalence was: hiatal hernia 35/106 (33%); significant CAD 24/106 (23%); myocardial bridging 22/106 (21%). At follow-up of 94/106 (89%) patients, 71/94 (76%) were pain-free, 14/17 (82%) significant CAD had been treated, and only one patient with non-significant CAD was treated after CTCA. CONCLUSION CTCA suggested possible causes of non-acute pain in 65% of patients. MAIN MESSAGES • CTCA can either rule in or rule out possible causes of chest pain alternative to CAD. • Clinically relevant findings were detected in 65% of patients with non-acute chest pain. • Non-cardiovascular diseases potentially explained symptoms in 35% of patients.
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Kolluri N, Klajda MD, Anavekar NS. 86-Year-Old Man With Sharp Chest Pain and Dyspnea. Mayo Clin Proc 2018; 93:1320-1324. [PMID: 30196818 DOI: 10.1016/j.mayocp.2018.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/23/2017] [Accepted: 01/12/2018] [Indexed: 11/22/2022]
Affiliation(s)
- Nikhil Kolluri
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Michael D Klajda
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Nandan S Anavekar
- Advisor to residents and Consultant in Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
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Zaghloul A, Iorgoveanu C, Balakumaran K, Balanescu DV, Donisan T. Limitations of Coronary Computed Tomography Angiography in Predicting Acute Coronary Syndrome in a Low to Intermediate-risk Patient with Chest Pain. Cureus 2018; 10:e2649. [PMID: 30034971 PMCID: PMC6051557 DOI: 10.7759/cureus.2649] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The optimal management of patients with chest pain relies on the prognostic information provided by noninvasive cardiovascular testing. Coronary computed tomography angiography (CCTA) is an increasingly utilized, highly accurate noninvasive test for diagnosing coronary artery disease. We illustrate an exceptional limitation of the prognostic information provided by CCTA. A 46-year-old female presented with chest pain suggestive of angina. Noninvasive testing for ischemia was negative, with CCTA showing mild stenosis of the proximal left anterior descending (LAD) artery. An electrocardiogram after two weeks demonstrated ST elevation in leads V1-V2 and aVR, with ST depression in the lateral leads. Cardiac catheterization revealed a significant proximal LAD lesion requiring percutaneous coronary intervention. An anatomic assessment of coronary arteries should be considered in cases of strong clinical suspicion for cardiac ischemia and initial nondiagnostic findings. Further studies are needed to improve the accuracy and the negative predictive value of CCTA in intermediate-risk individuals.
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Affiliation(s)
- Ahmed Zaghloul
- Internal Medicine, University of Connecticut Health Center, Farmington, USA
| | - Corina Iorgoveanu
- Internal Medicine, University of Connecticut Health Center, Farmington, USA
| | | | - Dinu V Balanescu
- Internal Medicine, Santa Maria Clinical Hospital, Santa Maria, USA
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18
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Alanazi M, AlDuraibi A, Shoukri MM, Fathala A. The Relationship Between Absence Coronary Artery Calcification and Myocardial Perfusion Single Photon Emission Computed Tomography. Cardiol Res 2018; 9:28-34. [PMID: 29479383 PMCID: PMC5819626 DOI: 10.14740/cr659w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 01/04/2018] [Indexed: 01/07/2023] Open
Abstract
Background Coronary artery calcification score (CACS) is well validated prognostic tool in coronary artery disease (CAD). The data on the prevalence of myocardial ischemia on myocardial perfusion single photon emission computed tomography (MPS) in symptomatic patients with zero CACS and low to intermediate risk probability is lacking and controversial. The aim of our study was to evaluate the capability of zero CACS to exclude myocardial ischemia on MPS. Methods A total of 157 patients ((mean age 53 ± 10 years), 88 (56%) female patients, 69 (44%) male patients) who were suspected to have CAD and having low to intermediate pretest likelihood for CAD underwent CACS on dedicated computed tomography (CT) scanners. CACS was reported as zero in all patients, subsequently all patients underwent MPS. Patients with abnormal MPS underwent additional imaging with coronary computed tomography angiography (CCTA). Results All patients had zero CACS, of which 122 (78%) had normal MPS, and 35 (22%) had abnormal MPS. Abnormal MPS included fixed defect in 22 (13%), equivocal in 10 (6%), and reversible defect in four (3%) patients. All patients with abnormal MPS had further imaging with CTCA. CTCA was normal in 30 (85%) patients, one patient had coronary artery stenosis more than 50%, one patient had coronary artery stenosis less than 50%, one patient had anomalous origin coronary artery, and two patients had myocardial bridging. Patients with abnormal MPS and normal coronary artery had dilated cardiomyopathy in 14 (40%), asymmetrical septal hypotrophy in one (3%), and mitral valve disease in three (9%). Conclusions Zero CACS in stable patients with low or intermediate risk indicated very low likelihood of obstructive CAD, less than 1%. Patients with zero CACS and normal MPS most likely will not benefit from further testing; however, patients with abnormal MPS will need further imaging with CCTA. CCTA is helpful in this group of patients for evaluation of coronary artery and cardiac morphology.
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Affiliation(s)
- Muhannad Alanazi
- Department of Radiology, Nuclear Medicine and Cardiovascular Imaging, Riyadh, Saudi Arabia
| | - Alaa AlDuraibi
- Department of Radiology, Nuclear Medicine and Cardiovascular Imaging, Riyadh, Saudi Arabia
| | - Mohamamed M Shoukri
- Research Center, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, Riyadh, Saudi Arabia
| | - Ahmed Fathala
- Department of Radiology, Nuclear Medicine and Cardiovascular Imaging, Riyadh, Saudi Arabia
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19
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Raggi P. Atherosclerosis imaging to refine cardiovascular risk assessment in diabetic patients: Computed tomography and positron emission tomography applications. Atherosclerosis 2018; 271:77-83. [PMID: 29477560 DOI: 10.1016/j.atherosclerosis.2018.02.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 02/09/2018] [Accepted: 02/14/2018] [Indexed: 01/24/2023]
Abstract
The lifetime cardiovascular risk of a diabetic patient is approximately 4-5 times higher than that of an age and sex matched individual without diabetes mellitus. Despite the well-publicized cardiovascular risk equivalence of diabetes mellitus, it has become apparent that not all diabetic patients are equally at high-risk and many patients may have a level of risk similar to that of the general population. Cardiovascular imaging has been employed to address the dilemma of a more accurate risk stratification of diabetic patients. Two randomized clinical trials aiming at uncovering the presence of unknown obstructive coronary artery disease (CAD) gave disappointing results. In fact, the number of patients with inducible myocardial ischemia and/or severe obstructive disease was lower than expected and the overall outcome was not improved after having brought the existence of CAD to light. Other techniques that may help identify a diabetic patient susceptible to suffer future events have therefore being explored. In this review we discuss two imaging tools that provide anatomical and functional information on pre-clinical coronary atherosclerosis: computed tomography for calcium scoring, and plaque characterization and myocardial ischemia detection and positron emission tomography using tracers to identify functionally unstable plaques. Despite the availability of several imaging techniques there remain numerous questions as to the utility of imaging to define risk in diabetes mellitus and an optimal approach has yet to be found.
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Affiliation(s)
- Paolo Raggi
- Mazankowski Alberta Heart Institute, Canada; University of Alberta, Edmonton, AB, Canada.
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20
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Tay SY, Chang PY, Lao WT, Lin YC, Chung YH, Chan WP. The proper use of coronary calcium score and coronary computed tomography angiography for screening asymptomatic patients with cardiovascular risk factors. Sci Rep 2017; 7:17653. [PMID: 29247160 PMCID: PMC5732297 DOI: 10.1038/s41598-017-17655-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 11/17/2017] [Indexed: 01/14/2023] Open
Abstract
Early detection and treatment of coronary artery disease (CAD) can reduce incidences of acute myocardial infarction. In this study, we determined the proper use of contributing risk factors and coronary artery calcium score (CACS) when screening asymptomatic patients with coronary arterial stenoses using coronary computed tomography angiography (CCTA). We reviewed 934 consecutive patients who received CACS and CCTA between December 2013 and November 2016. At least one cardiovascular disease risk factor was present in each of the 509 asymptomatic participants. Patients were grouped based on CACS into “zero,” “minimal” (0 < CACS ≤ 10), “mild” (10 < CACS ≤ 100), “moderate” (100 < CACS ≤ 400), and “excessive” (CACS > 400). Males over 45 years old with diabetes mellitus and hypertension had a higher risk of significant coronary stenosis. In multivariate analysis, age, sex, hypertension, and diabetes mellitus remained significant predictors of stenosis. A CACS of zero occurred in 227 patients (44.6%). There were no significant differences between the “zero” and “minimal” groups (p = 0.421), but the “mild,” “moderate,” and “excessive” groups showed correlations with significant coronary stenosis. Age, sex, diabetes mellitus, and hypertension were associated with higher risk of significant coronary stenosis. Asymptomatic patients with CACSs of zero do not require CCTA, and thereby avoid unnecessary radiation exposure.
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Affiliation(s)
- Shee Yen Tay
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, 116, Taiwan, Republic of China.,Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 110, Taiwan, Republic of China
| | - Po-Yen Chang
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, 116, Taiwan, Republic of China.,Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 110, Taiwan, Republic of China
| | - Wilson T Lao
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, 116, Taiwan, Republic of China.,Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 110, Taiwan, Republic of China
| | - Ying Chin Lin
- Department of Family Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, 235, Taiwan, Republic of China.,Department of Family Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 110, Taiwan, Republic of China
| | - Yi-Han Chung
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, 116, Taiwan, Republic of China
| | - Wing P Chan
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, 116, Taiwan, Republic of China. .,Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 110, Taiwan, Republic of China.
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21
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Raggi P, Pontone G, Andreini D. Role of new imaging modalities in pursuit of the vulnerable plaque and the vulnerable patient. Int J Cardiol 2017; 250:278-283. [PMID: 29102056 DOI: 10.1016/j.ijcard.2017.10.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 10/08/2017] [Accepted: 10/13/2017] [Indexed: 11/29/2022]
Abstract
Numerous biomarkers and imaging modalities were investigated during the past few decades to identify patients harboring plaques at high risk of rupturing and causing catastrophic events. The classical description of a vulnerable plaque included a large lipid core, covered by a thin fibrous cap and evidence of inflammation especially around the hinge points of the plaque. Unfortunately, the search has resulted to a large extent in a failure to accurately identify the site of a future event. In time the search focus switched to the vulnerable patient rather than the individual vulnerable plaques, but the debate continues as to the more appropriate approach to risk assessment. This review discusses the most recent developments in molecular, anatomical and functional imaging directed at identifying a patient at high-risk of coronary artery disease events.
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Affiliation(s)
- Paolo Raggi
- Mazankowski Alberta Heart Institute, Edmonton, AB, Canada; University of Alberta, Edmonton, AB, Canada.
| | - Gianluca Pontone
- Centro Cardiologico Monzino, IRCCS, University of Milan, Milan, Italy; Yonsei University Health System, Seoul, South Korea
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, University of Milan, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
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22
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Long-term prognostic performance of low-dose coronary computed tomography angiography with prospective electrocardiogram triggering. Eur Radiol 2017; 27:4650-4660. [PMID: 28500370 DOI: 10.1007/s00330-017-4849-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 03/24/2017] [Accepted: 04/10/2017] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To assess long-term prognosis after low-dose 64-slice coronary computed tomography angiography (CCTA) using prospective electrocardiogram-triggering. METHODS We included 434 consecutive patients with suspected or known coronary artery disease referred for low-dose CCTA. Patients were classified as normal, with non-obstructive or obstructive lesions, or previously revascularized. Coronary artery calcium score (CACS) was assessed in 223 patients. Follow-up was obtained regarding major adverse cardiac events (MACE): cardiac death, myocardial infarction and elective revascularization. We performed Kaplan-Meier analysis and Cox regressions. RESULTS Mean effective radiation dose was 1.7 ± 0.6 mSv. At baseline, 38% of patients had normal arteries, 21% non-obstructive lesions, 32% obstructive stenosis and 8% were revascularized. Twenty-nine patients (7%) were lost to follow-up. After a median follow-up of 6.1 ± 0.6 years, MACE occurred in 0% of patients with normal arteries, 6% with non-obstructive lesions, 30% with obstructive stenosis and 39% of those revascularized. MACE occurrence increased with increasing CACS (P < 0.001), but 4% of patients with CACS = 0 experienced MACE. Multivariate Cox regression identified obstructive stenosis, lesion burden in CCTA and CACS as independent MACE predictors (P ≤ 0.001). CONCLUSION Low-dose CCTA with prospective electrocardiogram-triggering has an excellent long-term prognostic performance with a warranty period >6 years for patients with normal coronary arteries. KEY POINTS • Coronary CT angiography (CCTA) has an excellent long-term prognostic performance. • CCTA can accurately stratify cardiac risk according to coronary lesion severity. • A normal CCTA predicts freedom from cardiac events for >6 years. • Patients with a coronary calcium score of 0 may experience cardiac events. • CCTA allows for reclassification of cardiac risk compared with ESC SCORE.
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Sareen N, Ananthasubramaniam K. Left main coronary artery disease: A review of the spectrum of noninvasive diagnostic modalities. J Nucl Cardiol 2016; 23:1411-1429. [PMID: 26487011 DOI: 10.1007/s12350-015-0152-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 04/15/2015] [Indexed: 11/29/2022]
Abstract
Medically managed significant left main (LM) stem disease has been considered a determinant of increased cardiac mortality approaching 50% at 3-year follow-up. Despite the clinical significance of LM disease, studies comparing the various diagnostic modalities, especially noninvasive, are sparse. Clinicians, particularly imagers, should be aware of the strengths and weaknesses of existing modalities to diagnose LM disease as integrating many clues (history, symptoms, electrocardiogram, and stress hemodynamics are essential to suspect this diagnosis and proceed to the next step). Here we review the existing data on the current role of electrocardiography, nuclear myocardial perfusion imaging (single photon emission computed tomography and positron emission tomography), stress echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging in diagnostic evaluation of LM disease. Wherever applicable we have extended our discussion to multivessel coronary artery disease encompassing scenarios where LMS can present as LM equivalent with or without extensive multivessel coronary artery disease.
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Affiliation(s)
- Nishtha Sareen
- Department of Cardiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI, USA
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24
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Nadel J, Holloway CJ. Screening and risk assessment for coronary artery disease in HIV infection: an unmet need. HIV Med 2016; 18:292-299. [PMID: 27553248 DOI: 10.1111/hiv.12422] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2016] [Indexed: 11/28/2022]
Abstract
HIV infection is now considered a chronic, treatable disease, although treatment is associated with increased rates of coronary artery disease (CAD). Increased risk of CAD in HIV-infected patients has been associated with the inflammatory sequelae of the infection as well as the greater prevalence of cardiac risk factors in HIV-positive populations and the side effects of life-prolonging antiretroviral therapies. Patients with HIV infection now have a 1.5 to 2-fold greater risk of developing CAD compared with noninfected individuals, raising the independent risk of CAD in HIV infection to levels similar to those in diabetes. Despite this increased risk, screening and other adjuvant assessment tools are lacking. In this paper we explore the current climate of CAD in the contemporary HIV-infected population and look at the tools used in the assessment and management of patients as well as the limitations of these approaches for this at-risk population group.
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Affiliation(s)
- J Nadel
- University of Notre Dame, Sydney, NSW, Australia.,St Vincent's Hospital, Sydney, NSW, Australia
| | - C J Holloway
- St Vincent's Hospital, Sydney, NSW, Australia.,Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
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25
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Mamudu HM, Paul TK, Wang L, Veeranki SP, Panchal HB, Alamian A, Sarnosky K, Budoff M. The effects of multiple coronary artery disease risk factors on subclinical atherosclerosis in a rural population in the United States. Prev Med 2016; 88:140-6. [PMID: 27090918 DOI: 10.1016/j.ypmed.2016.04.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 04/06/2016] [Accepted: 04/12/2016] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The risk factors for cardiovascular disease (CVD) are associated with coronary atherosclerosis and having multiple risk factors potentiates atherosclerosis. This study examined the prevalence of multiple biological and lifestyle/behavioral risk factors and their association with coronary artery calcium (CAC), a marker for subclinical coronary atherosclerosis. METHODS This is a cross-sectional study of 1607 community-dwelling asymptomatic individuals from central Appalachia who participated in CAC screening between January 2011 and December 2012. Data on demographics (sex and age) and 7 traditional risk factors for coronary artery disease (CAD) were collected and categorized into 5 groups (0-1, 2, 3, 4, and ≥5). Prevalence of these risk factors and CAC scores (0, 1-99, 100-399, ≥400) were assessed, and the impact of the number of risk factors on CAC scores were delineated using multiple logistic regression. RESULTS Over 98% of participants had ≥1 risk factor. While obesity, diabetes, hypertension, and family history of CAD significantly increased the odds of having CAC, CAC scores significantly increased with number of risk factors. After adjusting for demographic factors, having 3, 4, and ≥5 risk factors was significantly associated with increased odds of having higher CAC scores when compared to zero CAC score by more than one and half times [OR=1.65, CI (1.20-2.25)], two times [OR=2.32, CI (1.67-3.23)] and three times [OR=3.45, CI (2.42-4.92)], respectively. CONCLUSION The high prevalence of multiple risk factors in the study population suggests the need for aggressive multiple risk factors interventions for primary prevention of CAD, which could address CVD health disparities.
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Affiliation(s)
- Hadii M Mamudu
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, P.O. Box 70264, Johnson City, TN, United States.
| | - Timir K Paul
- Division of Cardiology, James. H. Quillen College of Medicine, East Tennessee State University, 329 N State of Franklin Rd, Johnson City, TN 37604, United States.
| | - Liang Wang
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, United States.
| | - Sreenivas P Veeranki
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, United States.
| | - Hemang B Panchal
- Department of Internal Medicine, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37604, United States.
| | - Arsham Alamian
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, United States.
| | - Kamrie Sarnosky
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, United States.
| | - Matthew Budoff
- Los Angeles Biomedical Research Institute, 1124 W Carson Street, Torrance, CA 90502, United States.
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Ben-Haim S, Kennedy J, Keidar Z. Novel Cadmium Zinc Telluride Devices for Myocardial Perfusion Imaging—Technological Aspects and Clinical Applications. Semin Nucl Med 2016; 46:273-85. [DOI: 10.1053/j.semnuclmed.2016.01.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Hanifehpour R, Motevalli M, Ghanaati H, Shahriari M, Aliyari Ghasabeh M. Diagnostic Accuracy of Coronary Calcium Score Less than 100 in Excluding Coronary Artery Disease. IRANIAN JOURNAL OF RADIOLOGY 2016; 13:e16705. [PMID: 27679688 PMCID: PMC5035795 DOI: 10.5812/iranjradiol.16705] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 09/14/2014] [Accepted: 09/17/2014] [Indexed: 01/07/2023]
Abstract
Background Coronary artery calcium score (CACS) is a quantitative assessment of calcifications and an established predictor of cardiovascular events. Objectives In this study, we evaluated the diagnostic accuracy, negative predictive value (NPV), positive predictive value (PPV), specificity and sensitivity of CACS less than 100 in predicting significant coronary artery stenosis in patients with risk of coronary artery disease (CAD) in a vessel-based analysis. Patients and Methods A cross sectional study was carried out on a study population of 2527 consecutive stable patients with symptoms suggestive of CAD who were referred for coronary computed tomographic angiography (CCTA). We performed 1343 studies with 256 slice machine in Shahid Rajaee hospital and the other studies were carried out with 64 slice machine in Imam Khomeini hospital and the calcium score was quantified according to the Agatston method. Results At the cutoff point of 100 for coronary calcium scoring, there was high specificity (87%), high sensitivity (79%), high efficiency (84%), high PPV (79%), and high NPV (87%) in the diagnosis of significant stenosis in the whole heart. The frequency of zero calcium scoring was 59% in normal or nonsignificant stenosis and 7.6% in significant stenosis in the whole heart. Calcium scoring increased with greater severity of the arterial stenosis (P values < 0.001). Conclusion We conclude that coronary calcium scoring provided useful information in the management of patients. In CACS less than 100, it has a NPV of 87% in excluding significant stenosis in patients with the risk of CAD but it does not have enough diagnostic accuracy for surely excluding coronary stenosis, so we should perform a combination of CACS and coronary CT angiography for patients.
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Affiliation(s)
- Reza Hanifehpour
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
- Corresponding author: Reza Hanifehpour, Advanced Diagnostic and Interventional Radiology Research Center, Medical Imaging Center, Tehran, Iran. Tel: +98-9143912450, Fax: +98-2166945117, E-mail:
| | - Marzieh Motevalli
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Ghanaati
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Mona Shahriari
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Mounes Aliyari Ghasabeh
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
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Liga R, Vontobel J, Rovai D, Marinelli M, Caselli C, Pietila M, Teresinska A, Aguadé-Bruix S, Pizzi MN, Todiere G, Gimelli A, Chiappino D, Marraccini P, Schroeder S, Drosch T, Poddighe R, Casolo G, Anagnostopoulos C, Pugliese F, Rouzet F, Le Guludec D, Cappelli F, Valente S, Gensini GF, Zawaideh C, Capitanio S, Sambuceti G, Marsico F, Filardi PP, Fernández-Golfín C, Rincón LM, Graner FP, de Graaf MA, Stehli J, Reyes E, Nkomo S, Mäki M, Lorenzoni V, Turchetti G, Carpeggiani C, Puzzuoli S, Mangione M, Marcheschi P, Giannessi D, Nekolla S, Lombardi M, Sicari R, Scholte AJHA, Zamorano JL, Underwood SR, Knuuti J, Kaufmann PA, Neglia D, Gaemperli O. Multicentre multi-device hybrid imaging study of coronary artery disease: results from the EValuation of INtegrated Cardiac Imaging for the Detection and Characterization of Ischaemic Heart Disease (EVINCI) hybrid imaging population. Eur Heart J Cardiovasc Imaging 2016; 17:951-60. [PMID: 26992419 DOI: 10.1093/ehjci/jew038] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 02/14/2016] [Indexed: 12/18/2022] Open
Abstract
AIMS Hybrid imaging provides a non-invasive assessment of coronary anatomy and myocardial perfusion. We sought to evaluate the added clinical value of hybrid imaging in a multi-centre multi-vendor setting. METHODS AND RESULTS Fourteen centres enrolled 252 patients with stable angina and intermediate (20-90%) pre-test likelihood of coronary artery disease (CAD) who underwent myocardial perfusion scintigraphy (MPS), CT coronary angiography (CTCA), and quantitative coronary angiography (QCA) with fractional flow reserve (FFR). Hybrid MPS/CTCA images were obtained by 3D image fusion. Blinded core-lab analyses were performed for CTCA, MPS, QCA and hybrid datasets. Hemodynamically significant CAD was ruled-in non-invasively in the presence of a matched finding (myocardial perfusion defect co-localized with stenosed coronary artery) and ruled-out with normal findings (both CTCA and MPS normal). Overall prevalence of significant CAD on QCA (>70% stenosis or 30-70% with FFR≤0.80) was 37%. Of 1004 pathological myocardial segments on MPS, 246 (25%) were reclassified from their standard coronary distribution to another territory by hybrid imaging. In this respect, in 45/252 (18%) patients, hybrid imaging reassigned an entire perfusion defect to another coronary territory, changing the final diagnosis in 42% of the cases. Hybrid imaging allowed non-invasive CAD rule-out in 41%, and rule-in in 24% of patients, with a negative and positive predictive value of 88% and 87%, respectively. CONCLUSION In patients at intermediate risk of CAD, hybrid imaging allows non-invasive co-localization of myocardial perfusion defects and subtending coronary arteries, impacting clinical decision-making in almost one every five subjects.
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Affiliation(s)
- Riccardo Liga
- Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | - Jan Vontobel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | | | | | | | - Mikko Pietila
- Heart Center and Turku PET Center, University of Turku, Turku University Hospital, Turku, Finland
| | - Anna Teresinska
- Department of Nuclear Medicine, Institute of Cardiology, Warsaw, Poland
| | - Santiago Aguadé-Bruix
- Department of Nuclear Medicine, University Hospital Val d'Hebron, Institut Catala de la Salut, Barcelona, Spain
| | - Maria Nazarena Pizzi
- Department of Nuclear Medicine, University Hospital Val d'Hebron, Institut Catala de la Salut, Barcelona, Spain
| | - Giancarlo Todiere
- Cardiothoracic Department, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Alessia Gimelli
- Imaging Department, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Dante Chiappino
- Imaging Department, Fondazione Toscana G. Monasterio, Pisa, Italy
| | | | | | - Tanja Drosch
- Department of Cardiology, Alb-Fils-Kliniken, Göppingen, Germany
| | - Rosa Poddighe
- Emergency Department, Cardiology, Ospedale della Versilia, Lido di Camaiore, Italy
| | - Giancarlo Casolo
- Emergency Department, Cardiology, Ospedale della Versilia, Lido di Camaiore, Italy
| | - Constantinos Anagnostopoulos
- Center for Experimental Surgery, Clinical and Translational Research, Biomedical Research Foundation, Academy of Athens, Athens, Greece Centre for Advanced Cardiovascular Imaging, National Institute for Health Research Cardiovascular Biomedical Research Unit at Barts, William Harvey Research Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UK
| | - Francesca Pugliese
- Centre for Advanced Cardiovascular Imaging, National Institute for Health Research Cardiovascular Biomedical Research Unit at Barts, William Harvey Research Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UK
| | - Francois Rouzet
- Department of Nuclear Medicine, Bichat University Hospital, Département Hospitalo-Universitaire FIRE, Assistance Publique-Hôpitaux de Paris, University Paris Diderot, Paris, France
| | - Dominique Le Guludec
- Department of Nuclear Medicine, Bichat University Hospital, Département Hospitalo-Universitaire FIRE, Assistance Publique-Hôpitaux de Paris, University Paris Diderot, Paris, France
| | - Francesco Cappelli
- Cardiothoracic and Vascular Department, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Serafina Valente
- Cardiothoracic and Vascular Department, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Gian Franco Gensini
- Cardiothoracic and Vascular Department, Azienda Ospedaliera Universitaria Careggi, Florence, Italy Don Carlo Gnocchi Foundation, IRCCS, Florence, Italy
| | - Camilla Zawaideh
- Department of Health Science and Internal Medicine, IRCCS Hospital San Martino, National Institute for Cancer Research and University of Genoa, Genoa, Italy
| | - Selene Capitanio
- Department of Health Science and Internal Medicine, IRCCS Hospital San Martino, National Institute for Cancer Research and University of Genoa, Genoa, Italy
| | - Gianmario Sambuceti
- Department of Health Science and Internal Medicine, IRCCS Hospital San Martino, National Institute for Cancer Research and University of Genoa, Genoa, Italy
| | - Fabio Marsico
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | | | | | - Luis M Rincón
- Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Spain
| | - Frank P Graner
- Department of Nuclear Medicine, Klinikum Rechts der Isar der Technischen Universität München, Muenchen, Germany
| | - Michiel A de Graaf
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Julia Stehli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | - Eliana Reyes
- Biomedical Research Unit, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK
| | - Sandy Nkomo
- Biomedical Research Unit, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK
| | - Maija Mäki
- Heart Center and Turku PET Center, University of Turku, Turku University Hospital, Turku, Finland
| | | | | | | | - Stefano Puzzuoli
- Technology Department, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Maurizio Mangione
- Technology Department, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Paolo Marcheschi
- Technology Department, Fondazione Toscana G. Monasterio, Pisa, Italy
| | | | - Stephan Nekolla
- Department of Nuclear Medicine, Klinikum Rechts der Isar der Technischen Universität München, Muenchen, Germany
| | - Massimo Lombardi
- Imaging Department, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Rosa Sicari
- Institute of Clinical Physiology, CNR, Pisa, Italy
| | - Arthur J H A Scholte
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - José L Zamorano
- Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Spain
| | - S Richard Underwood
- Biomedical Research Unit, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK
| | - Juhani Knuuti
- Heart Center and Turku PET Center, University of Turku, Turku University Hospital, Turku, Finland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | - Danilo Neglia
- Institute of Clinical Physiology, CNR, Pisa, Italy Cardiothoracic Department, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Oliver Gaemperli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
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Fordyce CB, Douglas PS. Optimal non-invasive imaging test selection for the diagnosis of ischaemic heart disease. Heart 2016; 102:555-64. [DOI: 10.1136/heartjnl-2015-307764] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Clerc OF, Possner M, Maire R, Liga R, Fuchs TA, Stehli J, Vontobel J, Mikulicic F, Gräni C, Benz DC, Lüscher TF, Herzog BA, Buechel RR, Kaufmann PA, Gaemperli O. Association of left bundle branch block with obstructive coronary artery disease on coronary CT angiography: a case-control study. Eur Heart J Cardiovasc Imaging 2015; 17:765-71. [PMID: 26320169 DOI: 10.1093/ehjci/jev202] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 07/27/2015] [Indexed: 11/14/2022] Open
Abstract
AIMS Left bundle branch block (LBBB) is considered an unfavourable prognostic marker in patients with underlying heart disease. Testing for coronary artery disease (CAD) is often prompted by incidental LBBB finding, but published studies disagree about a significant association between LBBB and CAD. We therefore assessed the association of LBBB with previously unknown CAD in patients undergoing coronary computed tomography angiography (CCTA). METHODS AND RESULTS We enrolled 818 patients (mean age 57.2 ± 11.1 years, 106 patients with presumably new LBBB and 712 controls) without known CAD who underwent 64-slice CCTA. Image quality was assessed for each coronary segment. Comparison of obstructive CAD prevalence (defined as ≥50% stenosis) was performed using triple case-matching for pre-test probability (based on age, gender, and symptom typicality) in 101 LBBB patients and 303 matched controls with diagnostic quality in all segments. We found no difference in obstructive CAD prevalence between LBBB patients and matched controls (15 vs. 16%, P = 0.88). Similarly, there were no significant differences in cardiovascular risk factors (CVRF), stenosis severity, CAD extent, non-obstructive CAD, and vessel-based analysis between patient groups. Image quality was very high in LBBB patients and comparable to controls. On multivariate analysis, age, gender, typical angina, and CVRF, but not LBBB (P = 0.94), emerged as significant and independent predictors of obstructive CAD. CONCLUSION CAD prevalence is similar in LBBB patients at low-to-moderate pre-test probability compared with controls with similar CVRF matched for age, gender, and symptom typicality. CCTA is a useful imaging modality in LBBB patients, providing comparable image quality to non-LBBB controls.
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Affiliation(s)
- Olivier F Clerc
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland Department of Cardiology, University Hospital Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland
| | - Mathias Possner
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland
| | - René Maire
- Cardiological and Aviation Medicine Practice, Männedorf CH-8708, Switzerland
| | - Riccardo Liga
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland
| | - Tobias A Fuchs
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland
| | - Julia Stehli
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland Department of Cardiology, University Hospital Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland
| | - Jan Vontobel
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland
| | - Fran Mikulicic
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland
| | - Christoph Gräni
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland
| | - Dominik C Benz
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland
| | - Thomas F Lüscher
- Department of Cardiology, University Hospital Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland
| | - Bernhard A Herzog
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland
| | - Ronny R Buechel
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland
| | - Philipp A Kaufmann
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland
| | - Oliver Gaemperli
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland Department of Cardiology, University Hospital Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland
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Meyersohn NM, Ghemigian K, Shapiro MD, Shah SV, Ghoshhajra BB, Ferencik M. Role of Computed Tomography in Assessment of the Thoracic Aorta. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2015; 17:395. [DOI: 10.1007/s11936-015-0395-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Kim C, Hong SJ, Shin DH, Kim JS, Kim BK, Ko YG, Choi D, Jang Y, Hong MK. Limitations of coronary computed tomographic angiography for delineating the lumen and vessel contours of coronary arteries in patients with stable angina. Eur Heart J Cardiovasc Imaging 2015; 16:1358-65. [PMID: 25925217 DOI: 10.1093/ehjci/jev100] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 03/31/2015] [Indexed: 01/22/2023] Open
Abstract
AIMS We sought to evaluate whether coronary computed tomographic angiography (CCTA) could accurately and reproducibly delineate the lumen and vessel contours of coronary arteries. METHODS AND RESULTS One hundred coronary stenotic lesions representing 91 patients with stable angina who received both CCTA and intravascular ultrasound (IVUS) were analysed. Three segments with minimal lumen cross-sectional area (CSA), proximal reference, and distal reference on IVUS images were selected for each lesion. Five observers measured lumen and vessel CSAs at three matching segments on CCTA images. These CSAs were compared with the IVUS-measured CSAs as a reference standard. All five observers underestimated lumen CSA at the three selected segments by CCTA. The minimal lumen CSA assessed by CCTA exhibited very weak correlations with those obtained by IVUS (r =0.23, 0.24, 0.15, 0.25, and 0.28, respectively). In contrast to the lumen CSA, the vessel CSA at the three segments was overestimated by all observers when assessed by CCTA. At the segment with minimal lumen CSA, the vessel CSA obtained by CCTA showed weak correlations with those assessed by IVUS (r = 0.43, 0.33, 0.44, 0.37, and 0.42, respectively). Moreover, intra-class correlation coefficients ranged from 0.44 to 0.73 among the five observers for lumen or vessel CSA measurements by CCTA at the segment with minimal lumen CSA. CONCLUSION CCTA has potential limitations in the accurate delineation of lumen and vessel contours in patients with angina, as there was a high level of discordance with the IVUS-measured lumen and vessel CSAs and high inter-observer variability.
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Affiliation(s)
- Choongki Kim
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Sung-Jin Hong
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Dong-Ho Shin
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jung-Sun Kim
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Byeong-Keuk Kim
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Guk Ko
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Donghoon Choi
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yangsoo Jang
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Myeong-Ki Hong
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
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Lee S, Kim YJ, Lee SP, Kim HK, Sohn DW. Coronary computed tomography angiography alone versus confirmatory functional testing for guiding treatment strategy for patients with intermediate coronary artery stenosis. Am J Cardiol 2015; 115:602-8. [PMID: 25727081 DOI: 10.1016/j.amjcard.2014.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 12/01/2014] [Accepted: 12/01/2014] [Indexed: 10/24/2022]
Abstract
Intermediate coronary artery stenosis (≥50% and <90%) on coronary computed tomography angiography (CTA) is usually considered as a significant lesion. However, anatomical diagnosis is not well correlated with the functional significance of myocardial ischemia. We investigated whether functional testing in addition to coronary CTA improves outcomes of patients with intermediate stenosis, compared with the 1-step CTA-alone-based strategy. From 2006 to 2011, we consecutively enrolled 335 patients with chest pain with intermediate stenosis detected by an initially performed coronary CTA. Of these, 159 patients followed the 1-step strategy, whereas 176 followed the 2-step strategy with confirmatory functional tests. One-year follow-up data were obtained for all patients. The primary end point was a composite of cardiovascular death, nonfatal myocardial infarction, and repeated or delayed revascularization (major adverse cardiac event) within a year. Baseline clinical parameters were comparable between patients of the 2 different strategies. The rate of invasive catheterization or percutaneous intervention was 75.5% in the 1-step group and 35.2% in the 2-step group (p <0.001). Consequently, more patients in the 2-step group were medically treated without unnecessary revascularization compared with patients in the 1-step group (71.0% vs 40.9%, p <0.001). Only 2.5% of the patients who received medical treatment in the 2-step group finally received delayed revascularization, whereas 14% in the 1-step group did. Overall, the primary end point occurred in 11.3% in the 1-step group and 4.0% in the 2-step group (p = 0.011). In conclusion, confirmatory functional testing reduces invasive catheterization and coronary intervention and improves clinical outcomes in patients with intermediate stenosis on coronary CTA.
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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: 36] [Impact Index Per Article: 4.0] [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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Cademartiri F, Di Cesare E, Francone M, Ballerini G, Ligabue G, Maffei E, Romagnoli A, Argiolas GM, Russo V, Buffa V, Marano R, Guzzetta M, Belgrano M, Carbone I, Macarini L, Borghi C, Di Renzi P, Barile V, Patriarca L. Italian Registry of Cardiac Computed Tomography. Radiol Med 2015; 120:919-29. [DOI: 10.1007/s11547-015-0518-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 01/28/2015] [Indexed: 12/20/2022]
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36
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Cheruvu S, Holloway CJ. Cardiovascular disease in human immunodeficiency virus. Intern Med J 2015; 44:315-24. [PMID: 24754684 DOI: 10.1111/imj.12381] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 12/17/2013] [Indexed: 01/05/2023]
Abstract
With widespread access to high-quality medical care as in Australia, human immunodeficiency virus (HIV) is now considered a chronic, treatable condition, with a good life expectancy. The use of combined highly active antiretroviral therapy has enabled effective suppression of the virus, but has also been associated with increased cardiac morbidity and mortality. Over representation of traditional cardiac risk factors, such as hyperlipidaemia and diabetes, as well as an increased incidence of ischaemic and non-ischaemic heart disease is now considered a major concern of treatment with antiretroviral therapy. Therefore, a contemporary management strategy for patients with HIV must include active prevention and treatment of cardiovascular risk. This review will outline the complex interplay between HIV infection, antiretroviral drug regimens and accelerated cardiovascular disease, with a particular focus on screening, prevention and treatment options in a contemporary Australian HIV population.
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Affiliation(s)
- S Cheruvu
- St Vincent's Hospital, Sydney, New South Wales, Australia
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37
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Tummala LS, Young RK, Singh T, Jani S, Srichai MB. Role of Non-invasive Imaging in the Work-Up of Cardiomyopathies. Curr Atheroscler Rep 2015; 17:486. [DOI: 10.1007/s11883-014-0486-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Shah N, Soon K, Wong C, Kelly AM. Screening for asymptomatic coronary heart disease in the young 'at risk' population: Who and how? IJC HEART & VASCULATURE 2014; 6:60-65. [PMID: 28785628 PMCID: PMC5497146 DOI: 10.1016/j.ijcha.2014.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 12/20/2014] [Indexed: 01/13/2023]
Abstract
Deaths due to coronary heart disease (CHD) remain high worldwide, despite recent achievements. An effective screening strategy may improve outcomes further if implemented in a high or ‘at risk’ cohort. Asymptomatic CHD in the young maybe underappreciated and applying an effective screening strategy to a young cohort may lead to improved outcomes due to significant socioeconomic impact from the consequences of CHD in this sub-group. A positive family history of CHD, which is known to be associated with an increased risk of future myocardial events, could aid in identifying the ‘at risk’ young cohort. Traditional cardiovascular risk scoring systems are in wide use but lack the sensitivity or specificity required to estimate risk in an individual. Rather their use is limited to predicting population attributable risk. Functional studies such as exercise stress tests are readily available and cost effective but do not have the required sensitivity required to suggest their use as part of a screening protocol. Coronary CT angiography has been demonstrated to have high sensitivity for the detection of CHD and therefore may be suitable for screening purposes but there are concerns regarding radiation exposure. Here we review the evidence for the use of potential screening strategies and the suitability of using such strategies to estimate risk of CHD in a young ‘at risk’ population.
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Motevalli M, Ghanaati H, Firouznia K, Kargar J, Aliyari Ghasabeh M, Shahriari M, Jalali AH, Shakiba M. Diagnostic efficacy of vessel specific coronary calcium score in detection of coronary artery stenosis. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e26010. [PMID: 25763246 PMCID: PMC4341255 DOI: 10.5812/ircmj.26010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 12/19/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND Coronary artery calcification which is determined quantitatively by coronary calcium scoring has been known as a sign of coronary stenosis and thus future cardiac events; hence it has been noticed on spotlight of researchers in recent years. Developing different method for early and optimal detection of coronary artery disease (CAD) is really essential as CAD are the first cause of death in population. OBJECTIVES To evaluate predictive value of vessel specific coronary artery calcium (CAC) score in predicting obstructive coronary artery disease. PATIENTS AND METHODS In this diagnostic test study we evaluated patients with coronary computed tomography angiography (CCTA) and CAC score which had been referred to two referral radiology center in Tehran, Iran and finally we selected 2525 patients in a single and sequential pattern to create a diagnostic study. The whole-heart CAC scores and vessel specific CAC scores were calculated individually for the 4 major epicardial coronary arteries in 2 distinct group; group A ( patients with previous history of CABG) and group B (patients without history of CABG). For evaluation of obstruction tree cut off points were described: 0 > ; at least 1 segment with any kind of stenosis, ≥ 50; at least 1 segment with stenosis ≥ 50, ≥ 70; at least 1 segment with stenosis ≥ 70. RESULTS Mean of coronary calcium scores in terms of each coronary artery vessel increase by increasing coronary stenosis grade in group B; LAD, RCA, LCX respectively have mean CAC score 6.06, 6.21 and 5.04 in normal patients and 221.6, 226.7 and 106.6 in patients with complete stenosis. As expected these findings don't work for group A. Also By increasing calcium score cutoff in all four vessels sensitivity decreased and specificity increased but steal LAD had higher sensitivity than other vessels and LM had higher specificity. Thus using calcium score method is useful for ruling out stenosis in LAD while calcium score of LM can predict existence of stenosis in LM. However none of the vessel specific CAC can reach to 100% sensitivity and specificity of CCTA method. CONCLUSIONS CCTA is highly superior than vessel specific CAC score thus to minimize patients radiation does maybe we can eliminate CAC scan as a routinely perform procedure at the beginning of the CCTA.
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Affiliation(s)
- Marzieh Motevalli
- Department of Radiology, Shahid Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Hossein Ghanaati
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, IR Iran
| | - Kavous Firouznia
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, IR Iran
| | - Jalal Kargar
- Department of Radiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mounes Aliyari Ghasabeh
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mona Shahriari
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, IR Iran
| | - Amir Hosein Jalali
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, IR Iran
| | - Madjid Shakiba
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, IR Iran
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Sun Z, Al Moudi M, Cao Y. CT angiography in the diagnosis of cardiovascular disease: a transformation in cardiovascular CT practice. Quant Imaging Med Surg 2014; 4:376-96. [PMID: 25392823 DOI: 10.3978/j.issn.2223-4292.2014.10.02] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 09/26/2014] [Indexed: 12/11/2022]
Abstract
Computed tomography (CT) angiography represents the most important technical development in CT imaging and it has challenged invasive angiography in the diagnostic evaluation of cardiovascular abnormalities. Over the last decades, technological evolution in CT imaging has enabled CT angiography to become a first-line imaging modality in the diagnosis of cardiovascular disease. This review provides an overview of the diagnostic applications of CT angiography (CTA) in cardiovascular disease, with a focus on selected clinical challenges in some common cardiovascular abnormalities, which include abdominal aortic aneurysm (AAA), aortic dissection, pulmonary embolism (PE) and coronary artery disease. An evidence-based review is conducted to demonstrate how CT angiography has changed our approach in the diagnosis and management of cardiovascular disease. Radiation dose reduction strategies are also discussed to show how CT angiography can be performed in a low-dose protocol in the current clinical practice.
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Affiliation(s)
- Zhonghua Sun
- 1 Discipline of Medical Imaging, Department of Imaging and Applied Physics, Curtin University, Perth, 6102, Western Australia, Australia ; 2 Department of Medical Imaging and Nuclear Medicine, King Saud Medical City, Riyadh, Saudi Arabia ; 3 Department of Medical Imaging, Shandong Medical College, Jinan 276000, China
| | - Mansour Al Moudi
- 1 Discipline of Medical Imaging, Department of Imaging and Applied Physics, Curtin University, Perth, 6102, Western Australia, Australia ; 2 Department of Medical Imaging and Nuclear Medicine, King Saud Medical City, Riyadh, Saudi Arabia ; 3 Department of Medical Imaging, Shandong Medical College, Jinan 276000, China
| | - Yan Cao
- 1 Discipline of Medical Imaging, Department of Imaging and Applied Physics, Curtin University, Perth, 6102, Western Australia, Australia ; 2 Department of Medical Imaging and Nuclear Medicine, King Saud Medical City, Riyadh, Saudi Arabia ; 3 Department of Medical Imaging, Shandong Medical College, Jinan 276000, China
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Diagnostic accuracy of multidetector computed tomography coronary angiography in 325 consecutive patients referred for transcatheter aortic valve replacement. Am Heart J 2014; 168:332-9. [PMID: 25173545 DOI: 10.1016/j.ahj.2014.04.022] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 04/06/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Multidetector computed tomography (MDCT) provides detailed assessment of valve annulus and iliofemoral vessels in transcatheter aortic valve replacement (TAVR) patients. However, data on diagnostic performance of MDCT coronary angiography (MDCT-CA) are scarce. The aim of the study is to assess diagnostic performance of MDCT for coronary artery evaluation before TAVR. METHODS A total of 325 consecutive patients (234 without previous myocardial revascularization, 49 with previous coronary stenting, and 42 with previous coronary artery bypass graft [CABG]) underwent invasive coronary angiography and MDCT before TAVR. MDCT-CA was performed using the same data set dedicated to standard MDCT aortic annulus evaluation. Multidetector computed tomography-CA evaluability and diagnostic accuracy in comparison with invasive coronary angiography as criterion standard were assessed. RESULTS The MDCT-CA evaluability of native coronaries was 95.6%. The leading cause of unevaluability was beam-hardening artifact due to coronary calcifications. In a segment-based analysis, MDCT-CA showed sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for detecting ≥50% stenosis of 91%, 99.2%, 83.4%, 99.6% and 98.8%, respectively. The MDCT-CA evaluability of coronary stents was 82.1%. In a segment-based analysis, MDCT-CA showed sensitivity, specificity, PPV, NPV, and accuracy for detecting ≥50% in-stent restenosis of 94.1%, 86.7%, 66.7%, 98.1%, and 88.3%, respectively. All CABGs were correctly assessed by MDCT-CA. In a patient-based analysis, MDCT-CA showed sensitivity, specificity, PPV, NPV, and accuracy of 89.7%, 90.8%, 80.6%, 95.4%, and 90.5%, respectively. CONCLUSIONS Multidetector computed tomography-CA allows to correctly rule out the presence of significant native coronary artery stenosis, significant in-stent restenosis, and CABG disease in patients referred for TAVR.
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Abstract
Noninvasive cardiac imaging is widely used to evaluate the presence of coronary artery disease. Recently, with improvements in imaging technology, noninvasive imaging has also been used for evaluation of the presence, severity, and prognosis of coronary artery disease. Coronary CT angiography and MRI of coronary arteries provide an anatomical assessment of coronary stenosis, whereas the hemodynamic significance of a coronary artery stenosis can be assessed by stress myocardial perfusion imaging, such as SPECT/PET and stress MRI. For appropriate use of multiple imaging modalities, the strengths and limitations of each modality are discussed in this review.
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Affiliation(s)
- Ran Heo
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY 10021
| | | | - Dan Kalra
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY 10021
| | - James K Min
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY 10021.
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Azarisman SM, Teo KS, Worthley MI, Worthley SG. Role of cardiovascular magnetic resonance in assessment of acute coronary syndrome. World J Cardiol 2014; 6:405-414. [PMID: 24976912 PMCID: PMC4072830 DOI: 10.4330/wjc.v6.i6.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 03/10/2014] [Accepted: 04/19/2014] [Indexed: 02/07/2023] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of death in the western world and is becoming more important in the developing world. Recently, advances in monitoring, revascularisation and pharmacotherapy have resulted in a reduction in mortality. However, although mortality rates have declined, the burden of disease remains large resulting in high direct and indirect healthcare costs related to CVDs. In Australia, acute coronary syndrome (ACS) accounts for more than 300000 years of life lost due to premature death and a total cost exceeding eight billion dollars annually. It is also the main contributor towards the discrepancy in life expectancy between indigenous and non-indigenous Australians. The high prevalence of CVD along with its associated cost urgently requires a reliable but non-invasive and cost-effective imaging modality. The imaging modality of choice should be able to accelerate the diagnosis of ACS, aid in the risk stratification of de novo coronary artery disease and avail incremental information of prognostic value such as viability which cardiovascular magnetic resonance (CMR) allows. Despite its manifold benefits, there are limitations to its wider use in routine clinical assessment and more studies are required into assessing its cost-effectiveness. It is hoped that with greater development in the technology and imaging protocols, CMR could be made less cumbersome, its imaging protocols less lengthy, the technology more inexpensive and easily applied in routine clinical practice.
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Mieres JH, Gulati M, Bairey Merz N, Berman DS, Gerber TC, Hayes SN, Kramer CM, Min JK, Newby LK, Nixon JVI, Srichai MB, Pellikka PA, Redberg RF, Wenger NK, Shaw LJ. Role of noninvasive testing in the clinical evaluation of women with suspected ischemic heart disease: a consensus statement from the American Heart Association. Circulation 2014; 130:350-79. [PMID: 25047587 DOI: 10.1161/cir.0000000000000061] [Citation(s) in RCA: 181] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Nørgaard KS, Isaksen C, Buhl JS, Nielsen AH, Nørgaard A, Urbonaviciene G, Frost L. CT coronary angiography in low- to intermediate-risk patients: less radiation, less invasive angiography, and less revascularisation. SCAND CARDIOVASC J 2014; 48:265-70. [PMID: 24866566 DOI: 10.3109/14017431.2014.928360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES We investigated whether any change in the use of invasive coronary angiography and coronary revascularisation after CT coronary angiography in patients with a low to intermediate pre-test probability of coronary artery disease could be explained from alterations in patient characteristics. DESIGN A cohort study based on data samples from the Western Denmark Heart Registry. Follow-up ended on 11 March 2014. RESULTS A total of 3541 persons were examined during the period of January 2010-December 2013. The median radiation dose was reduced from 4.2 to 2.2 mSv (p < 0.001) due to improved technology. The immediate referral rate for subsequent myocardial perfusion scans was increased from 2.8% to 10.0% (p < 0.001), while the immediate referral rate for invasive coronary angiography decreased from 25.3% to 10.8% (p < 0.001). The revascularisation rate diminished from 10.4% to 6.3%. The multivariable adjusted hazard ratio (95% confidence interval) for invasive coronary angiography during follow-up after CT coronary angiography was 0.59 (0.47-0.74) and that for coronary revascularisation was 0.66 (0.45-0.97) in 2013 compared to that in 2010. CONCLUSIONS The radiation dose diminished considerably. The reductions in the use of invasive coronary angiography and coronary revascularisation could not be explained by changes in patient characteristics but are driven by an increased use of perfusion scans in combination with increasing use of measurement of functional coronary flow reserve.
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Affiliation(s)
- Kirsten Schou Nørgaard
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital , Silkeborg , Denmark
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Lin CK, McDonough RJ, Prentice RL, Thomas DM, Steel KE, Rubal BJ, Shry EA, Villines TC, Hulten EA, Slim AM. Assessment of major adverse cardiovascular events and ischemic stroke with coronary computed tomography angiography based upon angiographic diagnosis in a high-volume single center. SAGE Open Med 2014; 2:2050312114533535. [PMID: 26770728 PMCID: PMC4607186 DOI: 10.1177/2050312114533535] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 04/05/2014] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Patient prognosis has been shown to directly correlate with the severity of coronary artery disease diagnosed by coronary computed tomography angiography (CCTA). Although the presence of coronary artery calcium has been associated with increased incidence of ischemic stroke, there are no data on the incidence of ischemic stroke based upon the severity of coronary artery disease by CCTA. Therefore, we sought to investigate the rate of major adverse cardiovascular events, including ischemic stroke, based upon the severity of coronary artery disease by CCTA over a 6-year period in a high-volume single military center. METHODS We performed a retrospective chart review of all CCTA studies to evaluate the incidence of all-cause mortality, non-fatal myocardial infarction, ischemic stroke, and late revascularization (>90 days following CCTA) from January 2005 until July 2012. We reviewed 1518 CCTA reports, dividing patients into groups with obstructive (≥50% stenosis), non-obstructive (<50% stenosis), and no coronary artery disease (no angiographic disease). Subsequent major adverse cardiovascular events data (incidence of all-cause mortality, ischemic stroke, non-fatal myocardial infarction, and late revascularization) were obtained. RESULTS Over a review period of 6 years with a resultant median follow-up period of 22 months (interquartile range = 13-34 months), the major adverse cardiovascular events rate was significantly higher with obstructive coronary artery disease compared to both non-obstructive coronary artery disease and no coronary artery disease (8.9% vs 0.7%, p < 0.001; 8.9% vs 1.6%, p < 0.001). The incidence of ischemic stroke alone was also significantly higher in those with obstructive coronary artery disease compared to those with no coronary artery disease (3.8% vs 0.4%, p < 0.001). CONCLUSION Being free of disease on CCTA was associated with excellent cardiovascular prognosis. Obstructive coronary artery disease was associated with a significantly increased incidence of ischemic stroke. There was also a direct correlation between the severity of coronary artery disease on CCTA and cardiovascular prognosis over the follow-up period of 24 months.
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Affiliation(s)
- Charles K Lin
- Cardiology Service, Brooke Army Medical Center, San Antonio, TX, USA
| | - Ryan J McDonough
- Cardiology Service, Brooke Army Medical Center, San Antonio, TX, USA
| | - Ryan L Prentice
- Cardiology Service, Brooke Army Medical Center, San Antonio, TX, USA
| | - Dustin M Thomas
- Cardiology Service, Brooke Army Medical Center, San Antonio, TX, USA
| | - Kevin E Steel
- Cardiology Service, Brooke Army Medical Center, San Antonio, TX, USA
| | - Bernard J Rubal
- Cardiology Service, Brooke Army Medical Center, San Antonio, TX, USA
| | - Eric A Shry
- Cardiology Service, Madigan Army Medical Center, Tacoma, WA, USA
| | - Todd C Villines
- Cardiology Service, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Edward A Hulten
- Cardiology Service, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Ahmad M Slim
- Cardiology Service, Brooke Army Medical Center, San Antonio, TX, USA
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Duvall WL, Savino JA, Levine EJ, Baber U, Lin JT, Einstein AJ, Hermann LK, Henzlova MJ. A comparison of coronary CTA and stress testing using high-efficiency SPECT MPI for the evaluation of chest pain in the emergency department. J Nucl Cardiol 2014; 21:305-18. [PMID: 24310280 DOI: 10.1007/s12350-013-9823-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 11/11/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Recent studies have compared CTA to stress testing and MPI using older Na-I SPECT cameras and traditional rest-stress protocols, but are limited by often using optimized CTA protocols but suboptimal MPI methodology. We compared CTA to stress testing with modern SPECT MPI using high-efficiency CZT cameras and stress-first protocols in an ED population. METHODS In a retrospective, non-randomized study, all patients who underwent CTA or stress testing (ETT or Tc-99m sestamibi SPECT MPI) as part of their ED assessment in 2010-2011 driven by ED attending preference and equipment availability were evaluated for their disposition from the ED (admission vs discharge, length of time to disposition), subsequent visits to the ED and diagnostic testing (within 3 months), and radiation exposure. CTA was performed using a 64-slice scanner (GE Lightspeed VCT) and MPI was performed using a CZT SPECT camera (GE Discovery 530c). Data were obtained from prospectively acquired electronic medical records and effective doses were calculated from published conversion factors. A propensity-matched analysis was also used to compare outcomes in the two groups. RESULTS A total of 1,458 patients underwent testing in the ED with 192 CTAs and 1,266 stress tests (327 ETTs and 939 MPIs). The CTA patients were a lower-risk cohort based on age, risk factors, and known heart disease. A statistically similar proportion of patients was discharged directly from the ED in the stress testing group (82% vs 73%, P = .27), but their time to disposition was longer (11.0 ± 5 vs 20.5 ± 7 hours, P < .0001). There was no significant difference in cardiac return visits to the ED (5.7% CTA vs 4.3% stress testing, P = .50), but more patients had follow-up studies in the CTA cohort compared to stress testing (14% vs 7%, P = .001). The mean effective dose of 12.6 ± 8.6 mSv for the CTA group was higher (P < .0001) than 5.0 ± 4.1 mSv for the stress testing group (ETT and MPI). A propensity score-matched cohort showed similar results to the entire cohort. CONCLUSIONS Stress testing with ETT, high-efficiency SPECT MPI, and stress-only protocols had a significantly lower patient radiation dose and less follow-up diagnostic testing than CTA with similar cardiac return visits. CTA had a shorter time to disposition, but there was a trend toward more revascularization than with stress testing.
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Affiliation(s)
- W Lane Duvall
- Mount Sinai Division of Cardiology (Mount Sinai Heart), Mount Sinai Medical Center, One Gustave L Levy Place, Box 1030, New York, NY, 10029, USA,
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Jeng CM, Wu MT, Wang PC, Chan T, Wan YL. A survey of the current status of coronary CT angiography using 64-slice multidetector CT in Taiwan. J Formos Med Assoc 2014; 113:124-32. [DOI: 10.1016/j.jfma.2012.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Revised: 04/24/2012] [Accepted: 05/08/2012] [Indexed: 01/29/2023] Open
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Sun Z. Coronary CT angiography: Beyond morphological stenosis analysis. World J Cardiol 2013; 5:444-452. [PMID: 24392188 PMCID: PMC3879698 DOI: 10.4330/wjc.v5.i12.444] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 10/04/2013] [Accepted: 11/19/2013] [Indexed: 02/06/2023] Open
Abstract
Rapid technological developments in computed tomography (CT) imaging technique have made coronary CT angiography an attractive imaging tool in the detection of coronary artery disease. Despite visualization of excellent anatomical details of the coronary lumen changes, coronary CT angiography does not provide hemodynamic changes caused by presence of plaques. Computational fluid dynamics (CFD) is a widely used method in the mechanical engineering field to solve complex problems through analysing fluid flow, heat transfer and associated phenomena by using computer simulations. In recent years, CFD is increasingly used in biomedical research due to high performance hardware and software. CFD techniques have been used to study cardiovascular hemodynamics through simulation tools to assist in predicting the behaviour of circulatory blood flow inside the human body. Blood flow plays a key role in the localization and progression of coronary artery disease. CFD simulation based on 3D luminal reconstructions can be used to analyse the local flow fields and flow profiling due to changes of vascular geometry, thus, identifying risk factors for development of coronary artery disease. The purpose of this article is to provide an overview of the coronary CT-derived CFD applications in coronary artery disease.
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Sun Z, Sabarudin A. Coronary CT angiography: State of the art. World J Cardiol 2013; 5:442-443. [PMID: 24392187 PMCID: PMC3879697 DOI: 10.4330/wjc.v5.i12.442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 07/24/2013] [Accepted: 08/29/2013] [Indexed: 02/06/2023] Open
Abstract
Coronary computed tomography (CT) angiography has been recognized as the most rapidly developed imaging technique in the diagnosis of coronary artery disease due to the emergence and technological advances in multislice CT scanners. Coronary CT angiography has been confirmed to demonstrate high diagnostic and predictive value in coronary artery disease when compared to invasive coronary angiography. However, it suffers from high radiation dose which raises concerns in the medical field. Various dose-reduction strategies have been proposed with effective outcomes having been achieved to reduce radiation exposure to patients. This article provides an introduction and overview of the series of articles that will focus on each particular topic related to coronary CT angiography.
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