1
|
Rodriguez-Granillo GA, Cirio J, Vila JF, Langzam E, Ivanc T, Fontana L, Descalzo A, Rubilar B, Lylyk P. Noncontrast Myocardial Characterization in Acute Myocardial Infarction Using Electron Density Imaging. J Thorac Imaging 2024; 39:173-177. [PMID: 37884390 DOI: 10.1097/rti.0000000000000749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
PURPOSE Spectral computed tomography (CT) enables improved tissue characterization, although virtually all research has focused on contrast-enhanced examinations. We hypothesized that changes in myocardial tissue related to acute myocardial infarction (AMI) might potentially be identified without the need for contrast administration using electron density (ED) imaging. PATIENTS AND METHODS This retrospective observational study involved a small series (n = 15) of patients admitted to our institution with a first AMI without signs of hemodynamic instability and identification of a culprit vessel with invasive coronary angiography during the same admission, who also underwent a noncontrast, low-dose chest CT using a dual-layer spectral CT scanner. Images were assessed in search of dark areas with low density on ED imaging, and the mean percentage ED relative to water (%EDW) was calculated. RESULTS Using a qualitative approach, ED assessment enabled the identification of 11/15 (73%) affected coronary territories, with a sensitivity of 73% (95% CI: 45; 92%) and a specificity of 87% (95% CI: 69; 96%). AMI segments showed significantly lower ED values than the remote myocardium (103.8 ± 0.8 vs 104.3 ± 0.6 %EDW, P < 0.0001), and a threshold below 103.9 %EDW had a sensitivity of 66% and specificity of 79% for the identification of AMI. In a control group of patients without a history of cardiovascular disease, none had areas with focal reduction of ED following the shape of the myocardial wall. CONCLUSIONS In our preliminary series, ED imaging showed the potential to enable the identification of myocardial tissue changes related to AMI without iodinated contrast requirement.
Collapse
Affiliation(s)
| | | | | | - Eran Langzam
- Philips Healthcare, CT Clinical Science, Buenos Aires, Argentina
| | - Thomas Ivanc
- Philips Healthcare, CT Clinical Science, Buenos Aires, Argentina
| | | | | | | | - Pedro Lylyk
- Department of Interventional Neuroradiology, Instituto Medico ENERI, Clinica La Sagrada Familia
| |
Collapse
|
2
|
Butaish Z, Alajmi M, Elahi A, Bafaraj SM. Evaluation of Cardiac Scan in Diagnosing Coronary-artery Disease. Curr Med Imaging 2021; 16:1022-1028. [PMID: 32473003 DOI: 10.2174/1573405616666200530211415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 05/07/2020] [Accepted: 05/11/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND With the evaluation of focal epicardial coronary stenosis and non-obstructive atherosclerosis, the cardiac scans play a significant role in diagnosing coronary artery disease (CAD). Moreover, the advancements in the imaging techniques leading to improved risk assessment and timely therapies help in early diagnosis of CAD with greater accuracy. AIMS To evaluate the role of cardiac scan in diagnosing CAD. METHODS Recruited 100 individuals without any history of CAD that refers to the assessment of suspected angina, conducted the prospective study. Electrocardiogram (ECG) findings assisted in the evaluation of left bundle branch blockage, abnormalities of ST-segment, and pathological Q waves. RESULTS The results depicted negative N.M findings among 38 respondents; whereas, ischemia and myocardial infarctions were diagnosed in 26% and 19% of the respondents, respectively. The majority of the males (59) were positive in contrast to 37 females with positive results. Similarly, 24 respondents were presented with mild dilated left atria (LA), 37 respondents suffered from impaired relaxation pattern of left ventricular (LV) diastolic filling; while, 40 of the respondents had normal global LV systolic function. CONCLUSION The study results have concluded that non-invasive, low-risk, and cost-effective technique like ECG is an important beneficial advancement in the diagnosis of CAD.
Collapse
Affiliation(s)
- Zubaida Butaish
- Diagnostic Radiology Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Masheal Alajmi
- Diagnostic Radiology Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Arouba Elahi
- Diagnostic Radiology Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Saeed M Bafaraj
- Diagnostic Radiology Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| |
Collapse
|
3
|
Rodriguez-Granillo GA, Cirio JJ, Ciardi C, Caballero ML, Diluca P, Castrillon R, Ceron M, Scrivano E, Lylyk P. Cardiovascular thrombotic complications in acute ischemic stroke assessed by chest spectral computed tomography during COVID-19. Minerva Cardiol Angiol 2021; 69:606-618. [PMID: 33703860 DOI: 10.23736/s2724-5683.21.05547-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
During the pandemic context, diagnostic algorithms had to be adapted considering the decimated medical personnel, local technical resources, and the likelihood of contamination. Given the higher probability of thrombotic complications related to COVID-19 and the availability of a dual-layer spectral computed tomography (CT) scanner, we have recently adopted the use of low-dose, non-gated, chest CT scans performed five minutes after contrast administration among patients admitted with acute ischemic stroke (AIS) undergoing cerebrovascular CT angiography. Dual-layer spectral CT comprises a single X-ray source and two-layer detector with different photon-absorption capabilities. In addition to conventional images, the two distinct energy datasets obtained enable multiparametric spectral analysis without need to change the original scanning protocol. The two spectral features that emerge as most useful for patients with AIS are virtual monoenergetic imaging and iodine-based results. Aside from the evaluation of lung parenchyma, this novel strategy enables ruling out cardioembolic sources and simultaneously providing evidence of pulmonary and myocardial injury in a single session and immediately after CT cerebrovascular angiography. Furthermore, it involves a non-invasive, seemingly accurate, unsophisticated, safer (very low radiation dose and no contrast administration), and cheaper tool for ruling out cardioembolic sources compared to transesophageal echocardiogram and cardiac CT. Accordingly, we sought to standardize the technical aspects and overview the usefulness of delayed-phase, low-dose chest spectral CT in patients admitted with AIS.
Collapse
Affiliation(s)
- Gaston A Rodriguez-Granillo
- Department of Cardiovascular Imaging, ENERI Medical Institute, La Sagrada Familia Clinic, Buenos Aires, Argentina - .,National Council of Scientific and Technical Investigations - Consejo Nacional de Investigaciones Cientificas y Tecnicas (CONICET), Buenos Aires, Argentina -
| | - Juan J Cirio
- Stroke Unit, ENERI Medical Institute, La Sagrada Familia Clinic, Buenos Aires, Argentina
| | - Celina Ciardi
- Stroke Unit, ENERI Medical Institute, La Sagrada Familia Clinic, Buenos Aires, Argentina
| | - Maria L Caballero
- Stroke Unit, ENERI Medical Institute, La Sagrada Familia Clinic, Buenos Aires, Argentina
| | - Pablo Diluca
- Department of Radiology, ENERI Medical Institute, La Sagrada Familia Clinic, Buenos Aires, Argentina
| | - Ricardo Castrillon
- Department of Radiology, ENERI Medical Institute, La Sagrada Familia Clinic, Buenos Aires, Argentina
| | - Marcos Ceron
- Department of Cardiovascular Imaging, ENERI Medical Institute, La Sagrada Familia Clinic, Buenos Aires, Argentina
| | - Esteban Scrivano
- Department of Interventional Radiology, ENERI Medical Institute, La Sagrada Familia Clinic, Buenos Aires, Argentina
| | - Pedro Lylyk
- Department of Interventional Radiology, ENERI Medical Institute, La Sagrada Familia Clinic, Buenos Aires, Argentina
| |
Collapse
|
4
|
Piemjaiswang R, Ding Y, Feng Y, Piumsomboon P, Chalermsinsuwan B. Effect of transport parameters on atherosclerotic lesion growth: A parameter sensitivity analysis. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 199:105904. [PMID: 33360530 DOI: 10.1016/j.cmpb.2020.105904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/06/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Atherosclerosis is a degenerative disease of the arterial wall. It results in the formation of progressively growing plaque lesions that can harden and narrow their host arteries. Current computational models of the inflammatory process that govern atherosclerosis growth are reliant on a number of parameters that can freely vary and whose precise values are not well known. METHODS To identify the significance of variation in such parameters, a parametric sensitivity study had been conducted on the blood density, blood viscosity, plasma viscosity and bulk flow low density lipoprotein (LDL) concentration. Using computational modeling, the significance of variation in these parameters was assessed on the transport of LDL. The simulation was performed via the 2k factorial experimental design, which was conducted to identify the significance of the select parameters on the intima LDL concentration and endothelial LDL coverage area. RESULTS Results identified the blood viscosity and bulk flow LDL concentration are the dominant parameters for the atherosclerotic lesion growth. The coverage of LDL on the arterial wall surface was strongly dependent on the blood viscosity. The significance of these findings was discussed. CONCLUSION This statistical study identifies two dominating blood factors, LDL concentration and blood viscosity, and how they influence atherosclerosis which will serves as a guideline for further investigation on the atherosclerosis topic.
Collapse
Affiliation(s)
- Ratchanon Piemjaiswang
- Environmental Research Institute, Chulalongkorn University, 254 Phyathai Road, Wangmai, Pathumwan, Bangkok 10330, Thailand; Department of Chemical Technology, Faculty of Science, Chulalongkorn University, 254 Phyathai Road, Wangmai, Pathumwan, Bangkok 10330, Thailand
| | - Yan Ding
- Mathematical Sciences, School of Science, RMIT University, Victoria 3001, Australia
| | - Yuqing Feng
- CSIRO Minerals Resources, Clayton, Victoria 3169, Australia
| | - Pornpote Piumsomboon
- Department of Chemical Technology, Faculty of Science, Chulalongkorn University, 254 Phyathai Road, Wangmai, Pathumwan, Bangkok 10330, Thailand; Advanced Computational Fluid Dynamics Research Unit, Chulalongkorn University, 254 Phyathai Road, Wangmai, Pathumwan, Bangkok 10330, Thailand
| | - Benjapon Chalermsinsuwan
- Department of Chemical Technology, Faculty of Science, Chulalongkorn University, 254 Phyathai Road, Wangmai, Pathumwan, Bangkok 10330, Thailand; Advanced Computational Fluid Dynamics Research Unit, Chulalongkorn University, 254 Phyathai Road, Wangmai, Pathumwan, Bangkok 10330, Thailand.
| |
Collapse
|
5
|
Benetos G, Benz DC, Rampidis GP, Giannopoulos AA, von Felten E, Bakula A, Sustar A, Fuchs TA, Pazhenkottil AP, Gebhard C, Kaufmann PA, Gräni C, Buechel RR. Coronary artery lumen volume index as a marker of flow-limiting atherosclerosis-validation against 13N-ammonia positron emission tomography. Eur Radiol 2021; 31:5116-5126. [PMID: 33454800 PMCID: PMC8213544 DOI: 10.1007/s00330-020-07586-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/02/2020] [Accepted: 12/01/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Coronary artery volume indexed to left myocardial mass (CAVi), derived from coronary computed tomography angiography (CCTA), has been proposed as an indicator of diffuse atherosclerosis. We investigated the association of CAVi with quantitative flow parameters and its ability to predict ischemia as derived from 13N-ammonia positron emission tomography myocardial perfusion imaging (PET-MPI). METHODS Sixty patients who underwent hybrid CCTA/PET-MPI due to suspected CAD were retrospectively included. CAVi was defined as total coronary artery lumen volume over myocardial mass, both derived from CCTA. From PET-MPI, quantitative stress and rest myocardial blood flow (MBF) and myocardial flow reserve (MFR) were obtained and correlated with CAVi, and semi-quantitative perfusion images were analyzed for the presence of ischemia. Harrell's c-statistic and net reclassification improvement (NRI) analysis were performed to evaluate the incremental value of CAVi over the CCTA model (i.e., stenosis > 50% and > 70%). RESULTS CAVi correlated moderately with stress MBF and MFR (R = 0.50, p < 0.001, and R = 0.39, p = 0.002). Mean stress MBF and MFR were lower in patients with low (i.e., ≤ 20.2 mm3/g, n = 24) versus high (i.e., > 20.2 mm3/g, n = 36) CAVi (p < 0.001 for both comparisons). CAVi was independently associated with abnormal stress MBF (OR 0.90, 95% CI 0.82-0.998, p = 0.045). CAVi increased the predictive ability of the CCTA model for abnormal stress MBF and ischemia (c-statistic 0.763 versus 0.596, pdiff < 0.05 and 0.770 versus 0.645, pdiff < 0.05, NRI 0.84, p = 0.001 and 0.96, p < 0.001, respectively). CONCLUSIONS CAVi exhibits incremental value to predict both abnormal stress MBF and ischemia over CCTA alone. KEY POINTS • Coronary artery volume indexed to left myocardial mass (CAVi), derived from coronary computed tomography angiography (CCTA), is correlated with myocardial blood flow indices derived from 13N-ammonia positron emission tomography myocardial perfusion imaging. • CAVi is independently associated with abnormal stress myocardial blood flow. • CAVi provides incremental diagnostic value over CCTA for both abnormal stress MBF and ischemia.
Collapse
Affiliation(s)
- Georgios Benetos
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Dominik C Benz
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Georgios P Rampidis
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Andreas A Giannopoulos
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Elia von Felten
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Adam Bakula
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Aleksandra Sustar
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Tobias A Fuchs
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Catherine Gebhard
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Christoph Gräni
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, University Hospital and University Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
| |
Collapse
|
6
|
Anastasius M, Maggiore P, Huang A, Blanke P, Patel MR, Nørgaard BL, Fairbairn TA, Nieman K, Akasaka T, Berman DS, Raff GL, Hurwitz Koweek LM, Pontone G, Kawasaki T, Rønnow Sand NP, Jensen JM, Amano T, Poon M, Øvrehus KA, Sonck J, Rabbat MG, Mullen S, De Bruyne B, Rogers C, Matsuo H, Bax JJ, Leipsic J. The clinical utility of FFR CT stratified by age. J Cardiovasc Comput Tomogr 2020; 15:121-128. [PMID: 33032976 DOI: 10.1016/j.jcct.2020.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/09/2020] [Accepted: 08/10/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND CT coronary angiography (CTA) with Fractional Flow Reserve as determined by CT (FFRCT) is a safe alternative to invasive coronary angiography. A negative FFRCT has been shown to have low cardiac event rates compared to those with a positive FFRCT. However, the clinical utility of FFRCT according to age is not known. METHODS Patients' in the ADVANCE (Assessing Diagnostic Value of Non-invasive FFRCT in Coronary Care) registry, were stratified into those ≥65 or <65 years of age. The impact of FFRCT on clinical decision-making, as assessed by patient age, was determined by evaluating patient management using CTA results alone, followed by site investigators submitting a report on the treatment plan based upon the newly provided FFRCT data. Outcomes at 1-year post CTA were assessed, including major adverse cardiovascular events (myocardial infarction, all-cause mortality or unplanned hospitalization for ACS leading to revascularisation) and total revascularisation. Positive FFRCT was deemed to be ≤ 0.8. RESULTS FFRCT was calculated in 1849 (40.6%) subjects aged <65 and 2704 (59.4%) ≥ 65 years of age. Subjects ≥65 years were more likely to have anatomic obstructive disease on CTA (≥50% stenosis), compared to those aged <65 (69.7% and 73.2% respectively, p = 0.008). There was a similar graded increase in recommended and actual revascularisation with either CABG or PCI, with declining FFRCT strata for subjects above and below the age of 65. MACE and revascularisation rates were not significantly different for those ≥ or <65, regardless of FFRCT positivity or stenosis severity <50% or ≥50%. With a negative FFRCT result, and anatomical stenosis ≥50%, those ≥ and <65 years of age, had similar rates of MACE (0.2% for both, p = 0.1) and revascularisation (8.7% and 10.4% respectively p = 0.4). Logistic regression analysis, with age as a continuous variable, and adjustment for Diamond Forrester Risk, baseline FFRCT and treatment (CABG, PCI, medical therapy), indicated a statistically significant, but small increase in the odds of a MACE event with increasing age (OR 1.04, 95% CI 1.006-1.08, p = 0.02). Amongst patients with a FFRCT > 0.80, there was no effect of age on the odds of revascularisation. CONCLUSION The findings of this study point to a low risk of MACE events or need for revascularisation in those aged ≥ or <65 with a FFRCT>0.80, despite the higher incidence of anatomic obstructive CAD in those ≥65 years. The findings show the clinical usefulness and outcomes of FFRCT are largely constant regardless of age.
Collapse
Affiliation(s)
- Malcom Anastasius
- Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Paul Maggiore
- Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Alex Huang
- Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Phillip Blanke
- Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Manesh R Patel
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | | | - Timothy A Fairbairn
- Department of Cardiology, University of Liverpool, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Koen Nieman
- Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, CA, USA
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Daniel S Berman
- Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Gilbert L Raff
- Division of Cardiology, Beaumont Academic Heart and Vascular Group, Royal Oak, MI, USA
| | - Lynne M Hurwitz Koweek
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | | | | | - Niels Peter Rønnow Sand
- Department of Cardiology, University Hospital of Southern DK, Esbjerg, and Department of Regional Health Research, University of Southern DK, Denmark
| | - Jesper M Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Aichi, Japan
| | - Michael Poon
- Department of Noninvasive Cardiac Imaging, Northwell Health, New York, NY, USA
| | - Kristian A Øvrehus
- Department of Cardiology, University Hospital of Southern DK, Esbjerg, and Department of Regional Health Research, University of Southern DK, Denmark
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Mark G Rabbat
- Division of Cardiology, Loyola University Chicago, Chicago, IL, USA
| | | | | | | | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jonathon Leipsic
- Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada.
| |
Collapse
|
7
|
Rodriguez-Granillo GA, Nieman K, Carrascosa P, Campisi R, Ambrose JA. Anatomic or functional testing in stable patients with suspected CAD: contemporary role of cardiac CT in the ISCHEMIA trial era. Int J Cardiovasc Imaging 2020; 36:1351-1362. [PMID: 32180079 DOI: 10.1007/s10554-020-01815-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 03/07/2020] [Indexed: 11/30/2022]
Abstract
One of the foundations of the management of patients with suspected coronary artery disease (CAD) is to avoid unnecessary invasive coronary angiography (ICA) referrals. However, the diagnostic yield of ICA following abnormal conventional stress testing is low. The ability of ischemia testing to predict subsequent myocardial infarction and death is currently being challenged, and more than half of cardiac events among stable patients with suspected CAD occur in those with normal functional tests. The optimal management of patients with stable CAD remains controversial and ischemia-driven interventions, though improving anginal symptoms, have failed to reduce the risk of hard cardiovascular events. In this context, there is an ongoing debate whether the initial diagnostic test among patients with stable suspected CAD should be a functional test or coronary computed tomography angiography. Aside from considering the specific characteristics of individual patients and local availability and conditions, the choice of the initial test relates to whether the objective concerns its role as gatekeeper for ICA, prognosis, or treatment decision-making. Therefore, the aim of this review is to provide a contemporary overview of these issues and discuss the emerging role of CCTA as the upfront imaging tool for most patients with suspected CAD.
Collapse
Affiliation(s)
- Gaston A Rodriguez-Granillo
- Department of Cardiovascular Imaging, Instituto Medico Eneri, Clinica La Sagrada Familia, Av. Libertador 6647 (C1428ARJ), Buenos Aires, Argentina. .,Consejo Nacional de Investigaciones Cientificas y Tecnicas (CONICET), Buenos Aires, Argentina.
| | - Koen Nieman
- Stanford University School of Medicine, Cardiovascular Institute, Stanford, CA, USA
| | - Patricia Carrascosa
- Department of Cardiovascular Imaging, Diagnostico Maipu, Buenos Aires, Argentina
| | - Roxana Campisi
- Department of Nuclear Medicine, Diagnostico Maipu, Buenos Aires, Argentina
| | - John A Ambrose
- Division of Cardiology, Department of Internal Medicine, University of California San Francisco-Fresno, Fresno, USA
| |
Collapse
|
8
|
Iyngkaran P, Chan W, Liew D, Zamani J, Horowitz JD, Jelinek M, Hare DL, Shaw JA. Risk stratification for coronary artery disease in multi-ethnic populations: Are there broader considerations for cost efficiency? World J Methodol 2019; 9:1-19. [PMID: 30705870 PMCID: PMC6354077 DOI: 10.5662/wjm.v9.i1.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 11/22/2018] [Accepted: 12/24/2018] [Indexed: 02/06/2023] Open
Abstract
Coronary artery disease (CAD) screening and diagnosis are core cardiac specialty services. From symptoms, autopsy correlations supported reductions in coronary blood flow and dynamic epicardial and microcirculatory coronaries artery disease as etiologies. While angina remains a clinical diagnosis, most cases require correlation with a diagnostic modality. At the onset of the evidence building process much research, now factored into guidelines were conducted among population and demographics that were homogenous and often prior to newer technologies being available. Today we see a more diverse multi-ethnic population whose characteristics and risks may not consistently match the populations from which guideline evidence is derived. While it would seem very unlikely that for the majority, scientific arguments against guidelines would differ, however from a translational perspective, there will be populations who differ and importantly there are cost-efficacy questions, e.g., the most suitable first-line tests or what parameters equate to an adequate test. This article reviews non-invasive diagnosis of CAD within the context of multi-ethnic patient populations.
Collapse
Affiliation(s)
- Pupalan Iyngkaran
- Department of Cardiology, Flinders University, NT Medical School, Darwin 0810, Australia
| | - William Chan
- Department of Cardiology Alfred and Western Health, University of Melbourne, Victoria 3004, Australia
| | - Danny Liew
- Clinical Outcomes Research, School of Public Health and Preventive Medicine, Monash University, Melbourne VIC 3004, Australia
| | - Jalal Zamani
- Department of Interventional Cardiology, Feris Shiraz University, Shiraz University of Medical Sciences, Shiraz 71348-14336, Iran
| | - John D Horowitz
- Department of Cardiology and Clinical Pharmacology, the Queen Elizabeth Hospital, University of Adelaide, Adelaide 5011, Australia
| | - Michael Jelinek
- Department of Cardiology, Vincent’s Hospital, Melbourne, Victoria 3065, Australia
| | - David L Hare
- Cardiovascular Research, University of Melbourne, Melbourne, Victoria 3084, Australia
| | - James A Shaw
- Department of Cardiology, The Alfred Hospital, Baker IDI Heart and Diabetes Institute, Melbourne, Vic 3004, Australia
| |
Collapse
|
9
|
Additional diagnostic value of new CT imaging techniques for the functional assessment of coronary artery disease: a meta-analysis. Eur Radiol 2019; 29:3044-3061. [DOI: 10.1007/s00330-018-5919-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 10/30/2018] [Accepted: 11/27/2018] [Indexed: 12/14/2022]
|
10
|
The Value of Imaging—The Case for Coronary Computed Tomography Angiography. J Thorac Imaging 2019; 34:2-3. [DOI: 10.1097/rti.0000000000000381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
11
|
Spitzer E, Pavo N, Abdelghani M, Beitzke D, Ren B, García-Ruiz V, Goliasch G, Gottsauner-Wolf M, Kaneider A, Garcia-Garcia H, Soliman O, Wolf F, Loewe C. Assessment of left ventricular ejection fraction with late-systolic and mid-diastolic cardiac phases using multi-slice computed tomography. Radiography (Lond) 2018; 24:e85-e90. [DOI: 10.1016/j.radi.2018.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/08/2018] [Accepted: 04/19/2018] [Indexed: 11/25/2022]
|
12
|
Kerut EK, Turner M. Fractional flow reserve-CT assessment of coronary stenosis. Echocardiography 2018; 35:730-732. [PMID: 29569282 DOI: 10.1111/echo.13867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Coronary computed tomography angiography (CCTA) has been an established noninvasive method for detection of coronary artery disease (CAD). Although CCTA has had a high sensitivity and negative predictive value for CAD detection, specificity for obstructive CAD has been relatively low, partly due to coronary calcium, imaging artifacts, and other factors leading to an overestimation of stenosis severity. A relatively new noninvasive method of calculation of fractional flow reserve (FFR) using CCTA (FFRCT ) data has been developed. This noninvasive method yields similar results to invasive FFR measurement, improving specificity for noninvasively detecting lesion-specific ischemia thus helping guide revascularization.
Collapse
Affiliation(s)
- Edmund K Kerut
- Division of Cardiovascular Diseases, Department of Medicine, University of Mississippi School of Medicine, Jackson, MS, USA.,Heart Clinic of Louisiana, Marrero, LA, USA
| | - Michael Turner
- Cardiovascular Specialists of Southwest Louisiana, Lake Charles, LA, USA
| |
Collapse
|
13
|
Improved Discrimination of Myocardial Perfusion Defects at Low Energy Levels Using Virtual Monochromatic Imaging. J Comput Assist Tomogr 2017; 41:661-667. [PMID: 28296684 DOI: 10.1097/rct.0000000000000584] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The aim of this study was to explore the diagnostic performance of dual-energy computed tomography perfusion (DE-CTP) at different energy levels. METHODS Patients with known or suspected coronary artery disease underwent stress and rest DE-CTP and single-photon emission computed tomography. Images were evaluated using monochromatic data, and perfusion defects were initially identified in a qualitative manner and subsequently confirmed using attenuation levels. RESULTS Thirty-six patients were included. Sensitivity, specificity, positive predictive value, and negative predictive value of DE-CTP for the identification of perfusion defects were 84.1%, 94.2%, 77.3%, and 96.2%, respectively. Perfusion defects showed significantly lower attenuation than normal segments, with the largest differences among low energy levels (sensitivity of 96% and specificity of 98% using a cutoff value ≤ 153 Hounsfield units at 40 keV), progressively declining at the higher levels (P < 0.001). CONCLUSIONS Dual-energy CTP at the lowest energy levels allowed improved discrimination of perfusion defects compared with higher energy levels.
Collapse
|
14
|
van Rosendael AR, Dimitriu-Leen AC, de Graaf MA, van Zwet EW, Jukema JW, Bax JJ, Kroft LJ, Scholte AJ. Impact of computed tomography myocardial perfusion following computed tomography coronary angiography on downstream referral for invasive coronary angiography, revascularization and, outcome at 12 months. Eur Heart J Cardiovasc Imaging 2017; 18:969-977. [DOI: 10.1093/ehjci/jex055] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 03/06/2017] [Indexed: 02/02/2023] Open
|
15
|
de Araújo Gonçalves P, Hideo-Kajita A, Garcia-Garcia HM. Impact of plaque characteristics on the degree of functional stenosis. Cardiovasc Diagn Ther 2017; 7:219-226. [PMID: 28540216 DOI: 10.21037/cdt.2017.04.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Coronary CT angiography (CCTA) is mainly regarded as a gatekeeper for invasive coronary angiography, in face of its widely recognized value to noninvasively rule out significant coronary stenosis. Nevertheless, it is also increasingly recognized that this noninvasive modality can depict several atherosclerotic plaque features and quantify total coronary plaque burden. This opens a new field for cardiac CT, since these atherosclerotic features beyond stenosis severity have been correlated with the degree of functional significance, and are the focus of the present manuscript. Although recently acknowledged and documented in CCTA studies, the relation between plaque burden and functional significance has been previously described using several intracoronary imaging modalities, which are also reviewed in the manuscript, to help put in perspective the relation between anatomy and function in coronary artery disease.
Collapse
Affiliation(s)
- Pedro de Araújo Gonçalves
- Department of Cardiology and Radiology, Hospital da Luz, Lisbon, Portugal.,Department of Cardiology, Hospital de Santa Cruz - Centro Hospitalar de Lisboa Ocidental, Carnaxide, Lisbon, Portugal.,Chronic Diseases Research Center - Nova Medical School, Lisbon, Portugal
| | - Alexandre Hideo-Kajita
- Division of Interventional Cardiology, MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC, USA
| | - Hector Manuel Garcia-Garcia
- Division of Interventional Cardiology, MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC, USA
| |
Collapse
|
16
|
Campisi R, Marengo FD. Coronary microvascular dysfunction in women with nonobstructive ischemic heart disease as assessed by positron emission tomography. Cardiovasc Diagn Ther 2017; 7:196-205. [PMID: 28540214 DOI: 10.21037/cdt.2017.04.08] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Traditional approaches for risk assessment of ischemic heart disease (IHD) are based on the physiological consequences of an epicardial coronary stenosis. Of note, normal coronary arteries or nonobstructive coronary artery disease (CAD) is a common finding in women with signs and symptoms of ischemia. Therefore, assessment of risk based on a coronary stenosis approach may fail in women. Positron emission tomography (PET) quantifies absolute myocardial blood flow (MBF) which may help to elucidate other mechanisms involved such as endothelial dysfunction and alterations in the smooth muscle cell relaxation responsible for IHD in women. The objective of the present review is to describe the current state of the art of PET imaging in assessing IHD in women with nonobstructive CAD.
Collapse
Affiliation(s)
- Roxana Campisi
- Department of Nuclear Medicine and Cardiovascular Imaging, Diagnóstico Maipú, Buenos Aires, Argentina.,Department of Nuclear Medicine, Instituto Argentino de Diagnóstico y Tratamiento S.A., Buenos Aires, Argentina
| | - Fernando D Marengo
- Laboratorio de Fisiología y Biología Molecular, Instituto de Fisiología, Biología Molecular y Neurociencias (CONICET), Departamento de Fisiología y Biología Molecular y Celular, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina
| |
Collapse
|
17
|
Xiong G, Sun P, Zhou H, Ha S, Hartaigh BO, Truong QA, Min JK. Comprehensive Modeling and Visualization of Cardiac Anatomy and Physiology from CT Imaging and Computer Simulations. IEEE TRANSACTIONS ON VISUALIZATION AND COMPUTER GRAPHICS 2017; 23:1014-1028. [PMID: 26863663 PMCID: PMC4975682 DOI: 10.1109/tvcg.2016.2520946] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
In clinical cardiology, both anatomy and physiology are needed to diagnose cardiac pathologies. CT imaging and computer simulations provide valuable and complementary data for this purpose. However, it remains challenging to gain useful information from the large amount of high-dimensional diverse data. The current tools are not adequately integrated to visualize anatomic and physiologic data from a complete yet focused perspective. We introduce a new computer-aided diagnosis framework, which allows for comprehensive modeling and visualization of cardiac anatomy and physiology from CT imaging data and computer simulations, with a primary focus on ischemic heart disease. The following visual information is presented: (1) Anatomy from CT imaging: geometric modeling and visualization of cardiac anatomy, including four heart chambers, left and right ventricular outflow tracts, and coronary arteries; (2) Function from CT imaging: motion modeling, strain calculation, and visualization of four heart chambers; (3) Physiology from CT imaging: quantification and visualization of myocardial perfusion and contextual integration with coronary artery anatomy; (4) Physiology from computer simulation: computation and visualization of hemodynamics (e.g., coronary blood velocity, pressure, shear stress, and fluid forces on the vessel wall). Substantially, feedback from cardiologists have confirmed the practical utility of integrating these features for the purpose of computer-aided diagnosis of ischemic heart disease.
Collapse
|
18
|
Alkema M, Spitzer E, Soliman OII, Loewe C. Multimodality Imaging for Left Ventricular Hypertrophy Severity Grading: A Methodological Review. J Cardiovasc Ultrasound 2016; 24:257-267. [PMID: 28090249 PMCID: PMC5234336 DOI: 10.4250/jcu.2016.24.4.257] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 10/28/2016] [Accepted: 11/30/2016] [Indexed: 01/04/2023] Open
Abstract
Left ventricular hypertrophy (LVH), defined by an increase in left ventricular mass (LVM), is a common cardiac finding generally caused by an increase in pressure or volume load. Assessing severity of LVH is of great clinical value in terms of prognosis and treatment choices, as LVH severity grades correlate with the risk for presenting cardiovascular events. The three main cardiac parameters for the assessment of LVH are wall thickness, LVM, and LV geometry. Echocardiography, with large availability and low cost, is the technique of choice for their assessment. Consequently, reference values for LVH severity in clinical guidelines are based on this technique. However, cardiac magnetic resonance (CMR) and computed tomography (CT) are increasingly used in clinical practice, providing excellent image quality. Nevertheless, there is no extensive data to support reference values based on these techniques, while comparative studies between the three techniques show different results in wall thickness and LVM measurements. In this paper, we provide an overview of the different methodologies used to assess LVH severity with echocardiography, CMR and CT. We argue that establishing reference values per imaging modality, and possibly indexed to body surface area and classified per gender, ethnicity and age-group, might be essential for the correct classification of LVH severity.
Collapse
Affiliation(s)
- Maaike Alkema
- Department of Biomedical Sciences, Leiden University Medical Center, Leiden, the Netherlands.; Cardialysis, Clinical Trial Management & Core Laboratories, Rotterdam, the Netherlands
| | - Ernest Spitzer
- Cardialysis, Clinical Trial Management & Core Laboratories, Rotterdam, the Netherlands.; Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Osama I I Soliman
- Cardialysis, Clinical Trial Management & Core Laboratories, Rotterdam, the Netherlands.; Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Christian Loewe
- Section of Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
19
|
Mental Stress–Induced Myocardial Ischemia Related to Generalized Anxiety Disorder in a Patient With Acute Coronary Syndrome and Normal Coronary Arteries. Clin Nucl Med 2016; 41:e487-e490. [DOI: 10.1097/rlu.0000000000001348] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
20
|
Hecht HS, Narula J, Fearon WF. Fractional Flow Reserve and Coronary Computed Tomographic Angiography. Circ Res 2016; 119:300-16. [DOI: 10.1161/circresaha.116.307914] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 05/25/2016] [Indexed: 12/14/2022]
Abstract
Invasive fractional flow reserve (FFR) is now the gold standard for intervention. Noninvasive functional imaging analyses derived from coronary computed tomographic angiography (CTA) offer alternatives for evaluating lesion-specific ischemia. CT-FFR, CT myocardial perfusion imaging, and transluminal attenuation gradient/corrected contrast opacification have been studied using invasive FFR as the gold standard. CT-FFR has demonstrated significant improvement in specificity and positive predictive value compared with CTA alone for predicting FFR of ≤0.80, as well as decreasing the frequency of nonobstructive invasive coronary angiography. High-risk plaque characteristics have also been strongly implicated in abnormal FFR. Myocardial computed tomographic perfusion is an alternative method with promising results; it involves more radiation and contrast. Transluminal attenuation gradient/corrected contrast opacification is more controversial and may be more related to vessel diameter than stenosis. Important considerations remain: (1) improvement of CTA quality to decrease unevaluable studies, (2) is the diagnostic accuracy of CT-FFR sufficient? (3) can CT-FFR guide intervention without invasive FFR confirmation? (4) what are the long-term outcomes of CT-FFR–guided treatment and how do they compare with other functional imaging-guided paradigms? (5) what degree of stenosis on CTA warrants CT-FFR? (6) how should high-risk plaque be incorporated into treatment decisions? (7) how will CT-FFR influence other functional imaging test utilization, and what will be the effect on the practice of cardiology? (8) will a workstation-based CT-FFR be mandatory? Rapid progress to date suggests that CTA-based lesion-specific ischemia will be the gatekeeper to the cardiac catheterization laboratory and will transform the world of intervention.
Collapse
Affiliation(s)
- Harvey S. Hecht
- From the Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York (H.S.H., J.N.); Department of Cardiology, Stanford University School of Medicine, CA (W.F.F.)
| | - Jagat Narula
- From the Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York (H.S.H., J.N.); Department of Cardiology, Stanford University School of Medicine, CA (W.F.F.)
| | - William F. Fearon
- From the Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York (H.S.H., J.N.); Department of Cardiology, Stanford University School of Medicine, CA (W.F.F.)
| |
Collapse
|