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Devcich DA, Ellis CJ, Waltham N, Broadbent E, Petrie KJ. Seeing what's happening on the inside: Patients' views of the value of diagnostic cardiac computed tomography angiography. Br J Health Psychol 2013; 19:810-22. [DOI: 10.1111/bjhp.12080] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 09/19/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Daniel A. Devcich
- Department of Psychological Medicine; The University of Auckland; New Zealand
| | | | - Natasha Waltham
- School of Population Health; The University of Auckland; New Zealand
| | - Elizabeth Broadbent
- Department of Psychological Medicine; The University of Auckland; New Zealand
| | - Keith J. Petrie
- Department of Psychological Medicine; The University of Auckland; New Zealand
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Image quality of low-dose CCTA in obese patients: impact of high-definition computed tomography and adaptive statistical iterative reconstruction. Int J Cardiovasc Imaging 2013; 29:1565-74. [PMID: 23624958 DOI: 10.1007/s10554-013-0228-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 04/19/2013] [Indexed: 10/26/2022]
Abstract
The accuracy of coronary computed tomography angiography (CCTA) in obese persons is compromised by increased image noise. We investigated CCTA image quality acquired on a high-definition 64-slice CT scanner using modern adaptive statistical iterative reconstruction (ASIR). Seventy overweight and obese patients (24 males; mean age 57 years, mean body mass index 33 kg/m(2)) were studied with clinically-indicated contrast enhanced CCTA. Thirty-five patients underwent a standard definition protocol with filtered backprojection reconstruction (SD-FBP) while 35 patients matched for gender, age, body mass index and coronary artery calcifications underwent a novel high definition protocol with ASIR (HD-ASIR). Segment by segment image quality was assessed using a four-point scale (1 = excellent, 2 = good, 3 = moderate, 4 = non-diagnostic) and revealed better scores for HD-ASIR compared to SD-FBP (1.5 ± 0.43 vs. 1.8 ± 0.48; p < 0.05). The smallest detectable vessel diameter was also improved, 1.0 ± 0.5 mm for HD-ASIR as compared to 1.4 ± 0.4 mm for SD-FBP (p < 0.001). Average vessel attenuation was higher for HD-ASIR (388.3 ± 109.6 versus 350.6 ± 90.3 Hounsfield Units, HU; p < 0.05), while image noise, signal-to-noise ratio and contrast-to noise ratio did not differ significantly between reconstruction protocols (p = NS). The estimated effective radiation doses were similar, 2.3 ± 0.1 and 2.5 ± 0.1 mSv (HD-ASIR vs. SD-ASIR respectively). Compared to a standard definition backprojection protocol (SD-FBP), a newer high definition scan protocol in combination with ASIR (HD-ASIR) incrementally improved image quality and visualization of distal coronary artery segments in overweight and obese individuals, without increasing image noise and radiation dose.
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Ciszewski M, Zalewska J, Pregowski J, Mintz GS, Kepka C, Kalinczuk L, Kruk M, Jastrzebski J, Witkowski A. Comparison of stent length reported by the stent's manufacturer to that determined by quantitative coronary angiography at the time of implantation versus that determined by coronary computed tomographic angiography at a later time. Am J Cardiol 2013; 111:1111-6. [PMID: 23351463 DOI: 10.1016/j.amjcard.2012.12.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 12/12/2012] [Accepted: 12/12/2012] [Indexed: 10/27/2022]
Abstract
The aim of this study was to assess whether coronary computed tomographic angiography (CCTA) would allow accurate length measurements that may help select optimal stent length. In 19 patients who underwent stent implantation and CCTA, the lengths of 30 implanted stents were assessed independently using quantitative coronary angiography (QCA) at the time of implantation and CCTA during follow-up. Measurements on CCTA and QCA were compared with the actual lengths of the implanted stents. The mean actual stent length was 17.3 ± 6.3 mm; the mean length of the stents measured using CCTA was 17.25 ± 5.54 mm, and the mean length of the stents measured using QCA was 15.92 ± 5.86 mm. There was a stronger positive correlation between measurements on CCTA versus actual stent lengths (R = 0.99, p = 0.0001) than between measurements on QCA versus actual stent lengths (R = 0.82, p = 0.0001) (p <0.0001 for the difference between correlation coefficients). In conclusion, the length measurements obtained with CCTA correlate better with an anatomic gold standard (actual stent lengths) than those obtained using QCA.
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Rong J, Yu CQ, Yang P, Chen J. Association of retinopathy with coronary atherosclerosis determined by coronary 64-slice multidetector computed tomography angiography in type 2 diabetes. Diab Vasc Dis Res 2013; 10:161-8. [PMID: 22906861 DOI: 10.1177/1479164112454755] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Although there are substantial analyses for association of coronary artery disease (CAD) with diabetic retinopathy (DR), which was recognized as an indicator of risk for CAD in diabetes mellitus (DM), there is as yet little rigorous evaluation of the relationship between DR and subclinical coronary atherosclerosis (CAS) determined by coronary 64-slice multidetector computed tomography angiography (MDCTA) in persons with type 2 DM. In this article, we found that CAS associated with DR was independent of the traditional risk factors for CAD [odds ratio (OR): 5.1; 95% confidence interval (CI): 2.6-10.1; p < 0.001], and the severity and extent of CAS were significantly increased with the incidence and progression of DR (all p < 0.001). An independent association between hypertension, obesity, renal dysfunction and DR was also found (all p < 0.05). The relationship of CAS with DR was relatively continuous and graded under the diabetes status. Therefore, much of CAS and DR could be still multifactorial with common pathway.
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Affiliation(s)
- Jian Rong
- Geriatric Department, Military General Hospital of Chengdu PLA, Chengdu, Sichuan, People's Republic of China.
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Lubanski MS, Vanhecke TE, Chinnaiyan KM, Franklin BA, McCullough PA. Subclinical coronary atherosclerosis identified by coronary computed tomographic angiography in asymptomatic morbidly obese patients. Heart Int 2011; 5:e15. [PMID: 21977300 PMCID: PMC3184688 DOI: 10.4081/hi.2010.e15] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 10/04/2010] [Accepted: 11/02/2010] [Indexed: 11/23/2022] Open
Abstract
Obesity is a common public health problem and obese individuals in particular have a disproportionate incidence of acute coronary events. This study was undertaken to identify coronary artery lesions as well as associated clinical features, risk factors and demographics in patients with a body mass index (BMI) >40 kg/m2 without known coronary artery disease (CAD). Morbidly obese subjects were prospectively recruited to undergo coronary computed tomographic angiography (CCTA) using a dual-source computed tomography (CT) system. CAD was defined as the presence of any atherosclerotic lesion in any one coronary artery segment. The presence, location, and severity of atherosclerosis were related to patient characteristics. Forty-one patients (28 women, mean age, 50.4±10.0 years, mean BMI, 43.8±4.8 kg/m2) served as the study population. Of these, 25 patients (61%) had at least one coronary stenosis. All but 2 patients within the CAD cohort had coronary artery calcium (CAC) scores >0, and most plaques identified (75.4%) were non-calcified. There was a predilection of calcified and non-calcified atherosclerosis involving the left anterior descending (LAD) coronary artery compared with other coronary segments. Univariate predictors of CAD included older age, dyslipidemia, and diabetes. In this preliminary study of young morbidly obese patients, CCTA detected a high prevalence of calcified and non-calcified CAD, although the later predominated.
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Affiliation(s)
- Martin S Lubanski
- Department of Medicine, Department of Cardiology, Division of Nutrition and Preventive Medicine, William Beaumont Hospital, Royal Oak, MI, USA
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Radiation exposure to patients in a multicenter coronary angiography trial (CORE 64). AJR Am J Roentgenol 2011; 196:1126-32. [PMID: 21512080 DOI: 10.2214/ajr.09.3983] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of this study was to assess the exposure of patients to radiation for the cardiac CT acquisition protocol of the multicenter Coronary Artery Evaluation Using 64-Row Multidetector Computed Tomography Angiography (CORE 64) trial. MATERIALS AND METHODS An algorithm for patient dose assessment with Monte Carlo dosimetry was developed for the Aquilion 64-MDCT scanner. During the CORE 64 study, different acquisition protocols were used depending on patient size and sex; therefore, six patient models were constructed representing three men and three women in the categories of small, normal size, and obese. Organ dose and effective dose resulting from the cardiac CT protocol were assessed for these six patient models. RESULTS The average effective dose for coronary CT angiography (CTA) calculated according to Report 103 of the International Commission on Radiological Protection (ICRP) is 19 mSv (range, 16-26 mSv). The average effective dose for the whole cardiac CT protocol including CT scanograms, bolus tracking, and calcium scoring is slightly higher-22 mSv (range, 18-30 mSv). An average conversion factor for the calculation of effective dose from dose-length product of 0.030 mSv/mGy · cm was derived for coronary CTA. CONCLUSION The current methods of assessing patient dose are not well suited for cardiac CT acquisitions, and published effective dose values tend to underestimate effective dose. The effective dose of cardiac CT is approximately 25% higher when assessed according to the preferred ICRP Report 103 compared with ICRP Report 60. Underestimation of effective dose by 43% or 53% occurs in coronary CTA according to ICRP Report 103 when a conversion factor (E / DLP, where E is effective dose and DLP is dose-length product) for general chest CT of 0.017 or 0.014 mSv/mGy · cm, respectively, is used instead of 0.030 mSv/mGy · cm.
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Beneficial effect of anti-platelet therapies on atherosclerotic lesion formation assessed by phase-contrast X-ray CT imaging. Int J Cardiovasc Imaging 2011; 28:1181-91. [DOI: 10.1007/s10554-011-9910-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Accepted: 06/10/2011] [Indexed: 11/30/2022]
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Alexánderson Rosas E, Slomka PJ, García-Rojas L, Calleja R, Jácome R, Jiménez-Santos M, Romero E, Meave A, Berman DS. Functional Impact of Coronary Stenosis Observed on Coronary Computed Tomography Angiography: Comparison with 13N-Ammonia PET. Arch Med Res 2010; 41:642-8. [DOI: 10.1016/j.arcmed.2010.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Accepted: 10/27/2010] [Indexed: 10/18/2022]
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Cheng W, Zeng M, Arellano C, Mafori W, Goldin J, Krishnam M, Ruehm SG. Detection of myocardial perfusion abnormalities: standard dual-source coronary computed tomography angiography versus rest/stress technetium-99m single-photo emission CT. Br J Radiol 2010; 83:652-60. [PMID: 20413446 PMCID: PMC3473505 DOI: 10.1259/bjr/82257160] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Revised: 06/08/2009] [Accepted: 07/01/2009] [Indexed: 01/03/2023] Open
Abstract
We compared coronary dual-source computed tomography angiography (corDSCTA) with technetium-99m single-photon emission computed tomography (SPECT) for the detection of myocardial perfusion abnormalities. Fifty-five consecutive patients underwent both gated myocardial perfusion SPECT and corDSCTA, the latter during a single arterial-phase injection of contrast agent. The perfusion defects visualised by corDSCTA correlated with the findings of rest/stress SPECT. Abnormal findings on stress SPECT, which were due to either ischaemia or infarct, were found in 24 patients. In comparison to SPECT at rest, corDSCTA detected perfusion defects with a sensitivity and specificity of 100% and 78%, respectively. Compared to SPECT at stress, the sensitivity and specificity values of corDSCTA were 83.3% and 90.3%, respectively. On corDSCTA , the average attenuation values of perfusion defects that corresponded to chronic infarcts (-8.5+/-22.2 HU) were significantly lower (p = 0.002) than those of non-infarct-related perfusion defects (43.1+/-17.5 HU). Using rest/stress SPECT is the gold standard for the diagnosis of myocardial ischaemia, corDSCTA was able to diagnose ischaemic disease (defined as the presence of high-grade stenotic CAD (>or=50% luminal narrowing)) with a sensitivity and specificity of 59% and 89%, respectively, in patients with no known history of myocardial infarction (n = 4). Thus, corDSCTA may serve as a diagnostic tool for the detection of perfusion abnormalities (first) visualised by SPECT. There appears to be a limited correlation between coronary stenotic disease and SPECT findings.
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Affiliation(s)
- W Cheng
- Department of Radiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China.
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Boxt LM, Lipton MJ. Can computed tomography improve outcomes in acute coronary syndrome? Br J Hosp Med (Lond) 2009; 70:459-63. [PMID: 19684536 DOI: 10.12968/hmed.2009.70.8.43539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Each year, six million patients in the USA visit the emergency department for acute chest pain. Many patients are hospitalized because immediate discharge of those suspected of acute coronary syndrome could be disastrous. This review looks at whether patient outcomes could be improved by coronary computed tomography angiography.
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Affiliation(s)
- Lawrence M Boxt
- Section of Cardiac CT and MR Imaging, Division of Cardiology, Montefiore Medical Center, Bronx, NY 10467, USA
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Bernard S, Loffroy R, Sérusclat A, Boussel L, Bonnefoy E, Thévenon C, Rabilloud M, Revel D, Moulin P, Douek P. Increased levels of endothelial microparticles CD144 (VE-Cadherin) positives in type 2 diabetic patients with coronary noncalcified plaques evaluated by multidetector computed tomography (MDCT). Atherosclerosis 2009; 203:429-35. [DOI: 10.1016/j.atherosclerosis.2008.07.039] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Revised: 07/31/2008] [Accepted: 07/31/2008] [Indexed: 01/07/2023]
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[Update on cardiac imaging techniques: echocardiography, cardiac magnetic resonance, and multidetector computed tomography]. Rev Esp Cardiol 2009; 62 Suppl 1:129-50. [PMID: 19174056 DOI: 10.1016/s0300-8932(09)70047-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This article contains a review of the most important publications on cardiac imaging that have appeared during 2008. During the year, we assisted with the clinical implementation of three-dimensional real-time transesophageal echocardiography, with the use of echocardiography for selecting patients for and monitoring those who underwent percutaneous aortic valve replacement (the majority of centers performing the technique were still in the learning phase), and with the emergence in the clinic of techniques for studying myocardial deformation. Also reviewed are the most significant developments in the application of echocardiography to coronary heart disease and cardiac resynchronization therapy and in 2 other techniques whose use is constantly increasing: cardiac magnetic resonance and multidetector cardiac computed tomography. The review ends with a description of the current state of the art in contrast echocardiography, with particular emphasis on safety in the context of recommendations made by the US Food and Drug Administration at the end of 2007.
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Improved noninvasive coronary angiography in morbidly obese patients with dual-source computed tomography. J Cardiovasc Comput Tomogr 2009; 3:35-42. [DOI: 10.1016/j.jcct.2008.11.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Revised: 11/19/2008] [Accepted: 11/25/2008] [Indexed: 11/24/2022]
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McCullough PA, Chinnaiyan KM, Agrawal V, Danielewicz E, Abela GS. Amplification of atherosclerotic calcification and Mönckeberg's sclerosis: a spectrum of the same disease process. Adv Chronic Kidney Dis 2008; 15:396-412. [PMID: 18805386 DOI: 10.1053/j.ackd.2008.07.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Autopsy studies have shown the near universal presence of fatty streaks and fibroatheromas in the general population from which chronic kidney disease (CKD) patients arise. The vast majority of CKD patients have multiple conventional cardiovascular risk factors. Atherosclerosis, once present, can predominantly manifest as medial calcification, which has been previously termed Mönckeberg's sclerosis. This term has also been used in rare cases to describe vascular calcinosis not related to CKD. This clarification is critical to advance the field in terms of pathological diagnosis and treatment of CKD bone and mineral disorder. Factors that appear to promote the osteoblastic transformation of vascular smooth muscle cells and enhance deposition of calcium hydroxyapatite crystals include phosphorus activation of the Pit-1 receptor, bone morphogenic proteins 2 and 4, leptin, endogenous 1,25 dihydroxy vitamin D, vascular calcification activating factor, and measures of oxidative stress. These entities work to accelerate the atherosclerotic process in CKD patients and may be future targets for diagnosis and treatment. Although conventional atherosclerotic risk factors should be optimally managed, it should be noted that trials of hydroxymethylglutaryl-CoA reductase inhibitors have failed to attenuate the rate of progressive vascular calcification as measured by computed tomography scans.
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Min JK, Shaw LJ, Berman DS, Gilmore A, Kang N. Costs and clinical outcomes in individuals without known coronary artery disease undergoing coronary computed tomographic angiography from an analysis of Medicare category III transaction codes. Am J Cardiol 2008; 102:672-8. [PMID: 18773986 DOI: 10.1016/j.amjcard.2008.04.045] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Revised: 04/23/2008] [Accepted: 04/23/2008] [Indexed: 12/21/2022]
Abstract
Multidetector coronary computed tomographic angiography (CCTA) demonstrates high accuracy for the detection and exclusion of coronary artery disease (CAD) and predicts adverse prognosis. To date, opportunity costs relating the clinical and economic outcomes of CCTA compared with other methods of diagnosing CAD, such as myocardial perfusion single-photon emission computed tomography (SPECT), remain unknown. An observational, multicenter, patient-level analysis of patients without known CAD who underwent CCTA or SPECT was performed. Patients who underwent CCTA (n = 1,938) were matched to those who underwent SPECT (n = 7,752) on 8 demographic and clinical characteristics and 2 summary measures of cardiac medications and co-morbidities and were evaluated for 9-month expenditures and clinical outcomes. Adjusted total health care and CAD expenditures were 27% (p <0.001) and 33% (p <0.001) lower, respectively, for patients who underwent CCTA compared with those who underwent SPECT, by an average of $467 (95% confidence interval $99 to $984) for CAD expenditures per patient. Despite lower total health care expenditures for CCTA, no differences were observed for rates of adverse cardiovascular events, including CAD hospitalizations (4.2% vs 4.1%, p = NS), CAD outpatient visits (17.4% vs 13.3%, p = NS), myocardial infarction (0.4% vs 0.6%, p = NS), and new-onset angina (3.0% vs 3.5%, p = NS). Patients without known CAD who underwent CCTA, compared with matched patients who underwent SPECT, incurred lower overall health care and CAD expenditures while experiencing similarly low rates of CAD hospitalization, outpatient visits, myocardial infarction, and angina. In conclusion, these data suggest that CCTA may be a cost-efficient alternative to SPECT for the initial coronary evaluation of patients without known CAD.
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Amsterdam EA, Caputo GR. Noninvasive coronary angiography: a revolutionary technique seeking its role in patient care. PREVENTIVE CARDIOLOGY 2008; 11:133-134. [PMID: 18607147 DOI: 10.1111/j.1751-7141.2008.07759.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Abstract
Cardiovascular CT and MRI are rapidly emerging technologies that can potentially change the current paradigm of cardiovascular imaging. Cardiac CT is primarily focused on imaging of coronary arteries for the assessment of vessel wall plaque and lumen stenosis. Additional information about ventricular and valvular function can also be obtained from the same three-dimensional image dataset. Cardiovascular magnetic resonance is a versatile imaging modality now considered a reference standard in the evaluation of ventricular morphology and function, with the potential to achieve a similar status in perfusion and viability assessment. This review summarizes key concepts regarding CT and MRI technology, clinical applications, and their role in clinical decision making. Recently published appropriateness criteria for cardiac CT and MRI by the American College of Cardiology are also reviewed.
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Affiliation(s)
- Scott Beach
- Center for Advanced Cardiovascular Imaging, Gill Heart Institute, University of Kentucky, 800 Lexington, KY 40536, USA
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Gallagher MJ, Raff, GL. Use of multislice CT for the evaluation of emergency room patients with chest pain: The so-called “Triple rule-out”. Catheter Cardiovasc Interv 2007; 71:92-9. [DOI: 10.1002/ccd.21398] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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