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Zuin M, Rigatelli G, Vassilev D, Ronco F, Rigatelli A, Roncon L. Computational fluid dynamic-derived wall shear stress of non-significant left main bifurcation disease may predict acute vessel thrombosis at 3-year follow-up. Heart Vessels 2020; 35:297-306. [PMID: 31482218 DOI: 10.1007/s00380-019-01494-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 08/23/2019] [Indexed: 02/07/2023]
Abstract
Wall shear stress (WSS) plays a pivotal role on plaque progression in coronary artery disease. We assess the prognostic role of baseline mean WSS in developing a bifurcation-located myocardial infarction (B-MI) over the following 3 years in angiographically non-significant LM bifurcation disease. For this purpose, we retrospectively reviewed the procedural and medical records of consecutive patients evaluated in our center from 1st January 2014 to 1st January 2019 who had a non-significant LM bifurcation disease as evaluated at coronary computed tomography angiography (CCTA) and confirmed by coronary angiography. Each bifurcation model was reconstructed on the patient-specific geometries derived from the CCTA. The population was divided into two groups: patients with (n = 12) and without B-MI (n = 20) over the following 3 years. Both the mean WSSprox of each branch and the WSSentire_lesion of each vessel, adjusted for the respective mean lesions lengths and 3-dimensional percentage of stenosis (DS%), resulted in independent predictors of 3-year B-MI. Multivariate Cox-regression analysis confirmed that a baseline mean WSSentire_model ≥ 5.05 Pa (HR 1.98, 95% CI 1.83-2.10, p = 0.001) was a predictor of 3-year B-MI independently from the entire mean lesions lengths (HR 1.56. 95% CI 1.43.1.68, p = 0.002) and DS% (HR 1.26, 95% CI 1.18-1.37, p = 0.03). In conclusion, in patients with angiographically non-significant LM bifurcation disease, both the mean WSSprox of each branch and WSSentire_lesion of each stenotic vessel predicted the occurrence of B-MI over the following 3 years. Moreover, the WSSentire_bifurcation ≥ 5.05 Pa seems to be a predictor of 3-year B-MI independently from the DS% and lesions lengths.
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Affiliation(s)
- Marco Zuin
- Section of Internal and Cardiopulmonary Medicine, Faculty of Medicine, University of Ferrara, Ferrara, Italy
- Division of Cardiology, Santa Maria Della Misericordia Hospital, Rovigo, Italy
| | - Gianluca Rigatelli
- Department of Cardiovascular Diagnosis and Endoluminal Interventions, Santa Maria Della Misericordia Hospital, Viale Tre Martiri, 45100, Rovigo, Italy.
| | - Dobrin Vassilev
- "Alexandrovska" University Hospital, Medical University, Sofia, Bulgaria
| | - Federico Ronco
- Interventional Cardiology, Cardiology Department, Mestre General Hospital, Mestre, Italy
| | - Alberto Rigatelli
- Department of Emergency, Borgo Trento University Hospital, Verona, Italy
| | - Loris Roncon
- Division of Cardiology, Santa Maria Della Misericordia Hospital, Rovigo, Italy
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Intravascular hemodynamics and coronary artery disease: New insights and clinical implications. Hellenic J Cardiol 2016; 57:389-400. [PMID: 27894949 DOI: 10.1016/j.hjc.2016.11.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 07/26/2016] [Indexed: 11/23/2022] Open
Abstract
Intracoronary hemodynamics play a pivotal role in the initiation and progression of the atherosclerotic process. Low pro-inflammatory endothelial shear stress impacts vascular physiology and leads to the occurrence of coronary artery disease and its implications.
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Giannopoulos AA, Chatzizisis YS, Maurovich-Horvat P, Antoniadis AP, Hoffmann U, Steigner ML, Rybicki FJ, Mitsouras D. Quantifying the effect of side branches in endothelial shear stress estimates. Atherosclerosis 2016; 251:213-218. [PMID: 27372207 DOI: 10.1016/j.atherosclerosis.2016.06.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 06/08/2016] [Accepted: 06/22/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS Low and high endothelial shear stress (ESS) is associated with coronary atherosclerosis progression and high-risk plaque features. Coronary ESS is currently assessed via computational fluid dynamic (CFD) simulation of coronary blood flow in the lumen geometry determined from invasive imaging such as intravascular ultrasound and optical coherence tomography. This process typically omits side branches of the target vessel in the CFD model as invasive imaging of those vessels is not usually clinically-indicated. The purpose of this study was to determine the extent to which this simplification affects the determination of those regions of the coronary endothelium subjected to pathologic ESS. METHODS We determined the diagnostic accuracy of ESS profiling without side branches to detect pathologic ESS in the major coronary arteries of 5 hearts imaged ex vivo with computed tomography angiography (CTA). ESS of the three major coronary arteries was calculated both without (test model), and with (reference model) inclusion of all side branches >1.5 mm in diameter, using previously-validated CFD approaches. Diagnostic test characteristics (accuracy, sensitivity, specificity and negative and positive predictive value [NPV/PPV]) with respect to the reference model were assessed for both the entire length as well as only the proximal portion of each major coronary artery, where the majority of high-risk plaques occur. RESULTS Using the model without side branches overall accuracy, sensitivity, specificity, NPV and PPV were 83.4%, 54.0%, 96%, 95.9% and 55.1%, respectively to detect low ESS, and 87.0%, 67.7%, 90.7%, 93.7% and 57.5%, respectively to detect high ESS. When considering only the proximal arteries, test characteristics differed for low and high ESS, with low sensitivity (67.7%) and high specificity (90.7%) to detect low ESS, and low sensitivity (44.7%) and high specificity (95.5%) to detect high ESS. CONCLUSIONS The exclusion of side branches in ESS vascular profiling studies greatly reduces the ability to detect regions of the major coronary arteries subjected to pathologic ESS. Single-conduit models can in general only be used to rule out pathologic ESS.
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Affiliation(s)
- Andreas A Giannopoulos
- Applied Imaging Science Laboratory, Radiology Department, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Pal Maurovich-Horvat
- MTA-SE Lendület Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Antonios P Antoniadis
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA; Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Udo Hoffmann
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Michael L Steigner
- Applied Imaging Science Laboratory, Radiology Department, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Frank J Rybicki
- Applied Imaging Science Laboratory, Radiology Department, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, The Ottawa Hospital, The University of Ottawa, Ontario, ON, Canada
| | - Dimitrios Mitsouras
- Applied Imaging Science Laboratory, Radiology Department, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Di Marco L, Rosset M, Zhang-Yin J, Ohana M. [Multimodal imaging of ischemic heart diseases: A 2015 update]. Rev Med Interne 2016; 37:350-62. [PMID: 26775644 DOI: 10.1016/j.revmed.2015.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 10/08/2015] [Accepted: 12/08/2015] [Indexed: 11/26/2022]
Abstract
Current realities and future possibilities of imaging in the ischemic heart diseases are very broad and constantly evolving, with the improvement of existing technologies and the introduction of new features such as dual-energy CT, strain ultrasound, multimodality fusion or perfusion MRI. Regular collaboration between prescribing clinicians, cardiologists, radiologists and nuclear radiologists is therefore essential to tailor the examination to the specific clinical question. The indications for each modality will therefore depend on its diagnostic performance, cost, acquisition and post-processing times and eventual radiation exposure. This review will detail principles and applications of current cardiac imaging examinations: echocardiography, nuclear medicine, MRI, CT and coronary angiography, emphasizing their current strengths and weaknesses in the ischemic heart diseases management.
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Affiliation(s)
- L Di Marco
- Imagerie, Bocage Central, 14, rue Paul-Gaffarel, 21000 Dijon, France.
| | - M Rosset
- Cardiologie, hôpital Louis-Pradel, 28, avenue du Doyen-Jean-Lépine, 69500 Bron, France
| | - J Zhang-Yin
- Médecine nucléaire, hôpital d'instruction des armées du Val-de-Grâce, 74, boulevard de Port-Royal, 75005 Paris, France
| | - M Ohana
- Imagerie, Nouvel Hôpital Civil, 1, place de l'Hôpital, 67000 Strasbourg, France
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Antoniadis AP, Mortier P, Kassab G, Dubini G, Foin N, Murasato Y, Giannopoulos AA, Tu S, Iwasaki K, Hikichi Y, Migliavacca F, Chiastra C, Wentzel JJ, Gijsen F, Reiber JH, Barlis P, Serruys PW, Bhatt DL, Stankovic G, Edelman ER, Giannoglou GD, Louvard Y, Chatzizisis YS. Biomechanical Modeling to Improve Coronary Artery Bifurcation Stenting. JACC Cardiovasc Interv 2015; 8:1281-1296. [DOI: 10.1016/j.jcin.2015.06.015] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 06/05/2015] [Accepted: 06/18/2015] [Indexed: 02/04/2023]
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Antoniadis AP, Giannopoulos AA, Wentzel JJ, Joner M, Giannoglou GD, Virmani R, Chatzizisis YS. Impact of local flow haemodynamics on atherosclerosis in coronary artery bifurcations. EUROINTERVENTION 2015; 11 Suppl V:V18-22. [DOI: 10.4244/eijv11sva4] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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High Risk Plaque Features on Coronary CT Angiography. CURRENT CARDIOVASCULAR IMAGING REPORTS 2014. [DOI: 10.1007/s12410-014-9279-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Chatzizisis YS, Blankstein R, Libby P. Inflammation goes with the flow: Implications for non-invasive identification of high-risk plaque. Atherosclerosis 2014; 234:476-8. [DOI: 10.1016/j.atherosclerosis.2014.02.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 02/19/2014] [Indexed: 11/29/2022]
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Maurovich-Horvat P, Ferencik M, Voros S, Merkely B, Hoffmann U. Comprehensive plaque assessment by coronary CT angiography. Nat Rev Cardiol 2014; 11:390-402. [PMID: 24755916 DOI: 10.1038/nrcardio.2014.60] [Citation(s) in RCA: 250] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Most acute coronary syndromes are caused by sudden luminal thrombosis due to atherosclerotic plaque rupture or erosion. Preventing such an event seems to be the only effective strategy to reduce mortality and morbidity of coronary heart disease. Coronary lesions prone to rupture have a distinct morphology compared with stable plaques, and provide a unique opportunity for noninvasive imaging to identify vulnerable plaques before they lead to clinical events. The submillimeter spatial resolution and excellent image quality of modern computed tomography (CT) scanners allow coronary atherosclerotic lesions to be detected, characterized, and quantified. Large plaque volume, low CT attenuation, napkin-ring sign, positive remodelling, and spotty calcification are all associated with a high risk of acute cardiovascular events in patients. Computation fluid dynamics allow the calculation of lesion-specific endothelial shear stress and fractional flow reserve, which add functional information to plaque assessment using CT. The combination of morphologic and functional characteristics of coronary plaques might enable noninvasive detection of vulnerable plaques in the future.
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Affiliation(s)
- Pál Maurovich-Horvat
- MTA-SE Lendület Cardiovascular Imaging Research Group, Heart and Vascular Centre, Semmelweis University, 68 Varosmajor ut, 1025 Budapest, Hungary
| | - Maros Ferencik
- Cardiac MR PET CT Program, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA 02114. USA
| | - Szilard Voros
- Stony Brook University, 101 Nicolls Road, Stony Brook, NY 11794 USA
| | - Béla Merkely
- MTA-SE Lendület Cardiovascular Imaging Research Group, Heart and Vascular Centre, Semmelweis University, 68 Varosmajor ut, 1025 Budapest, Hungary
| | - Udo Hoffmann
- Cardiac MR PET CT Program, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA 02114. USA
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Kakouros N, Rybicki FJ, Mitsouras D, Miller JM. Coronary pressure-derived fractional flow reserve in the assessment of coronary artery stenoses. Eur Radiol 2012. [PMID: 23179519 DOI: 10.1007/s00330-012-2670-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Catheter-based angiography is the reference-standard to establish coronary anatomy. While routinely employed clinically, lumen assessment correlates poorly with physiological measures of ischaemia. Moreover, functional studies to identify and localise ischaemia before elective angiography are often not available. This article reviews fractional flow reserve (FFR) and its role in guiding patient management for patients with a potentially haemodynamic significant coronary lesion. METHODS This review discusses the theory, evidence, indications, and limitations of FFR. Also included are emerging non-invasive imaging FFR surrogates currently under evaluation for accuracy with respect to standard FFR. RESULTS Coronary pressure-derived fractional flow reserve (FFR) rapidly assesses the haemodynamic significance of individual coronary artery lesions and can readily be performed in the catheterisation laboratory. The use of FFR has been shown to effectively guide coronary revascularization procedures leading to improved patient outcomes. CONCLUSIONS FFR is an invaluable modality in guiding coronary disease treatment decisions. It is safe, cost-effective and leads to improved patient outcomes. Non-invasive imaging modalities to assess the physiologic significance of CAD are currently being developed and evaluated.
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Affiliation(s)
- Nikolaos Kakouros
- Division of Cardiology, Johns Hopkins Hospital and Johns Hopkins University, 600 N. Wolfe Street, Blalock 536, Baltimore, MD 21287, USA
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Wentzel JJ, Chatzizisis YS, Gijsen FJH, Giannoglou GD, Feldman CL, Stone PH. Endothelial shear stress in the evolution of coronary atherosclerotic plaque and vascular remodelling: current understanding and remaining questions. Cardiovasc Res 2012; 96:234-43. [PMID: 22752349 DOI: 10.1093/cvr/cvs217] [Citation(s) in RCA: 228] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
The heterogeneity of plaque formation, the vascular remodelling response to plaque formation, and the consequent phenotype of plaque instability attest to the extraordinarily complex pathobiology of plaque development and progression, culminating in different clinical coronary syndromes. Atherosclerotic plaques predominantly form in regions of low endothelial shear stress (ESS), whereas regions of moderate/physiological and high ESS are generally protected. Low ESS-induced compensatory expansive remodelling plays an important role in preserving lumen dimensions during plaque progression, but when the expansive remodelling becomes excessive promotes continued influx of lipids into the vessel wall, vulnerable plaque formation and potential precipitation of an acute coronary syndrome. Advanced plaques which start to encroach into the lumen experience high ESS at their most stenotic region, which appears to promote plaque destabilization. This review describes the role of ESS from early atherogenesis to early plaque formation, plaque progression to advanced high-risk stenotic or non-stenotic plaque, and plaque destabilization. The critical implication of the vascular remodelling response to plaque growth is also discussed. Current developments in technology to characterize local ESS and vascular remodelling in vivo may provide a rationale for innovative diagnostic and therapeutic strategies for coronary patients that aim to prevent clinical coronary syndromes.
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Affiliation(s)
- Jolanda J Wentzel
- Biomedical Engineering, Department Cardiology, ErasmusMC, Rotterdam, The Netherlands.
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Boytsov SA, Kukharchuk VV, Karpov YA, Sergienko IV, Drapkina OM, Semenova AE, Urazalina SZ. Subclinical atherosclerosis as a risk factor of cardiovascular events. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2012. [DOI: 10.15829/1728-8800-2012-3-82-86] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Subclinical atherosclerosis is an initial, latent stage of chronic progressing arterial inflammation. Destabilisation of asymptomatic, hemodynamically non-significant atherosclerotic plaques (AP) could lead to myocardial infarction, stroke, or sudden death. Since the assessment of AP stability is problematic in real-world clinical settings, the risk stratification should, at least, account for the presence of subclinical atherosclerosis. In 600 ambulatory patients from the Moscow City Western Administrative Okrug who had low and moderate SCORE-assessed cardiovascular risk levels, the prevalence of AP, based on the duplex carotid ultrasound results, was 59% (n=358). Presently, no standard guidelines exist on cardiovascular risk stratification which would include the assessment of subclinical atherosclerosis, despite the importance of the latter as a prognostic factor. Large clinical studies on prognosis in patients with subclinical atherosclerosis will clarify the role of this parameter as an independent cardiovascular risk factor and facilitate the development of respective clinical recommendations.
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Affiliation(s)
- S. A. Boytsov
- Russian Cardiology Scientific and Clinical Complex, Moscow
| | | | - Yu. A. Karpov
- Russian Cardiology Scientific and Clinical Complex, Moscow
| | | | - O. M. Drapkina
- Russian Cardiology Scientific and Clinical Complex, Moscow
| | - A. E. Semenova
- Russian Cardiology Scientific and Clinical Complex, Moscow
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13
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Cardiovascular imaging 2011 in the International Journal of Cardiovascular Imaging. Int J Cardiovasc Imaging 2012; 28:439-51. [PMID: 22476909 PMCID: PMC3326368 DOI: 10.1007/s10554-012-0040-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Salavati A, Rybicki FJ. Evidence for prospective ECG-triggering coronary CT angiography in routine practice. Int J Cardiovasc Imaging 2012; 28:2121-4. [PMID: 22318542 DOI: 10.1007/s10554-012-0024-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 01/24/2012] [Indexed: 01/09/2023]
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15
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Salavati A, Radmanesh F, Heidari K, Dwamena BA, Kelly AM, Cronin P. Dual-source computed tomography angiography for diagnosis and assessment of coronary artery disease: systematic review and meta-analysis. J Cardiovasc Comput Tomogr 2011; 6:78-90. [PMID: 22226727 DOI: 10.1016/j.jcct.2011.10.018] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 08/22/2011] [Accepted: 10/20/2011] [Indexed: 01/01/2023]
Abstract
BACKGROUND Development of an accurate test for noninvasive assessment of coronary arteries has been highly desirable. OBJECTIVES We performed a systematic review of diagnostic accuracy of the dual-source computed tomography (DSCT) in the diagnosis of coronary artery disease (CAD). METHODS Eight medical databases were searched for articles published from January 2005 through March 2011. Studies compared DSCT coronary angiography (DSCT-CA) and invasive coronary angiography, as the reference standard, in consecutive patients with suspected or known CAD, and relevant data were extracted by 2 independent reviewers. Summary diagnostic accuracies were calculated, and the effect of covariates on the diagnostic performance was evaluated by meta-regression. RESULTS Twenty-five studies were included. In per-patient analysis (n = 2303), pooled sensitivity was 99% [95% confidence interval (CI), 97%-99%] with specificity of 89% (95% CI, 84%-92%). The summary positive (+LR) and negative (-LR) likelihood ratios were 8.6 (95% CI, 6.4-11.6) and 0.02 (95% CI, 0.01-0.03), respectively. In per-segment analysis (n = 32,615), pooled sensitivity was 94% (95% CI, 92%-96%) with specificity of 97% (95% CI, 96%--98%). Summary +LR and -LR were 30.2 (95% CI, 22.1-43.5) and 0.06 (95% CI, 0.04-0.08), respectively. CONCLUSIONS DSCT-CA seems to be robust to elevate heart rates while maintaining a high level of diagnostic performance.
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Affiliation(s)
- Ali Salavati
- Department of Nuclear Medicine, Center for PET/CT, Zentralklinik Bad Berka, Bad Berka 99437, Germany.
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Report from the 4th annual Society of Cardiac Computed Tomography Japan Forum. Int J Cardiovasc Imaging 2011; 27:773-5. [DOI: 10.1007/s10554-010-9720-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Accepted: 09/23/2010] [Indexed: 10/19/2022]
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Abstract
Multidetector computed tomography (MDCT) has rapidly evolved from 4-detector row systems in 1998 to 256-slice and 320-detector row CT systems. With smaller detector element size and faster gantry rotation speed, spatial and temporal resolution of the 64-detector MDCT scanners have made coronary artery imaging a reliable clinical test. Wide-area coverage MDCT, such as the 256-slice and 320-detector row MDCT scanners, has enabled volumetric imaging of the entire heart free of stair-step artifacts at a single time point within one cardiac cycle. It is hoped that these improvements will be realized with greater diagnostic accuracy of CT coronary angiography. Such scanners hold promise in performing a rapid high quality "triple rule-out" test without high contrast load, improved myocardial perfusion imaging, and even four-dimensional CT subtraction angiography. These emerging technical advances and novel applications will continue to change the way we study coronary artery disease beyond detecting luminal stenosis.
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Affiliation(s)
- Edward M Hsiao
- Applied Imaging Science Laboratory, Brigham and Women's Hospital Radiology & Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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Kumamaru KK, Hoppel BE, Mather RT, Rybicki FJ. CT angiography: current technology and clinical use. Radiol Clin North Am 2010; 48:213-35, vii. [PMID: 20609871 DOI: 10.1016/j.rcl.2010.02.006] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Since 1958, catheter angiography has assumed the role of gold standard for vascular imaging, despite the invasive nature of the procedure. Less invasive techniques for vascular imaging, such as computed tomographic angiography (CTA), have been developed and have matured in conjunction with developments in catheter arteriography. In a few cases, such as imaging, the aorta and the pulmonary arteries, CTA has supplanted catheter angiography as the gold standard. The expanding role of CTA emphasizes the need for deep, broad-based understanding of physical principles. This review describes CT hardware and associated software for angiography. The fundamentals of CTA physics are complemented with several clinical examples.
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