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Widmer RJ, Rosol ZP, Banerjee S, Sandoval Y, Schussler JM. Cardiac Computed Tomography Angiography in the Evaluation of Coronary Artery Disease: An Interventional Perspective. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101301. [PMID: 39131218 PMCID: PMC11307630 DOI: 10.1016/j.jscai.2024.101301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 08/13/2024]
Abstract
Cardiac computed tomography angiography (CCTA) has become the gold standard for noninvasive anatomic assessment of the coronary arteries. With high positive predictive value and even higher negative predictive value, CCTA allows for rapid determination of the presence or absence of coronary plaque and triage of patients' need for further invasive evaluation and treatment. From an interventional cardiologist's perspective, CCTA (more so than stress testing) is helpful in determining the need for invasive therapy. In conjunction with functional assessments, the anatomic evaluation from CCTA mirrors the anatomical assessment of a coronary angiogram more than any other noninvasive assessment. This allows for catheter selection, percutaneous coronary intervention preplanning, as well as additional decision making before the patient has entered the catheterization laboratory. This manuscript explores some of the more recent developments in noninvasive coronary angiography and discusses the use and utility of CCTA from an interventional cardiologist's perspective.
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Affiliation(s)
| | - Zachary P. Rosol
- Baylor University Medical Center, Dallas, Texas
- Baylor Scott & White Heart and Vascular Hospital, Dallas, Texas
| | - Subhash Banerjee
- Baylor University Medical Center, Dallas, Texas
- Baylor Scott & White Heart and Vascular Hospital, Dallas, Texas
| | - Yader Sandoval
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Jeffrey M. Schussler
- Baylor University Medical Center, Dallas, Texas
- Baylor Scott & White Heart and Vascular Hospital, Dallas, Texas
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Krul IM, Opstal-van Winden AWJ, Zijlstra JM, Appelman Y, Schagen SB, Meijboom LJ, Serné E, Lambalk CB, Lips P, van Dulmen-den Broeder E, Hauptmann M, Daniëls LA, Aleman BMP, van Leeuwen FE. Rationale and design of a cohort study on primary ovarian insufficiency in female survivors of Hodgkin's lymphoma: influence on long-term adverse effects (SOPHIA). BMJ Open 2018; 8:e018120. [PMID: 30206072 PMCID: PMC6144325 DOI: 10.1136/bmjopen-2017-018120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Hodgkin's lymphoma (HL) has become the prototype of a curable disease. However, many young survivors suffer from late adverse effects of treatment. Both chemotherapy (CT) and radiotherapy (RT) may induce primary ovarian insufficiency (POI), which has been associated with reduced bone mineral density (BMD), neurocognitive dysfunction and possibly cardiovascular disease (CVD). While the general assumption is that POI increases CVD risk, other hypotheses postulate reverse causality, suggesting that cardiovascular risk factors determine menopausal age or that biological ageing underlies both POI and CVD risk. None of these hypotheses are supported by convincing evidence. Furthermore, most studies on POI-associated conditions have been conducted in women with early natural or surgery-induced menopause with short follow-up times. In this study, we will examine the long-term effects of CT-induced and/or RT-induced POI on BMD, cardiovascular status, neurocognitive function and quality of life in female HL survivors. METHODS AND ANALYSIS This study will be performed within an existing Dutch cohort of HL survivors. Eligible women were treated for HL at ages 15-39 years in three large hospitals since 1965 and survived for ≥8 years after their diagnosis. Women visiting a survivorship care outpatient clinic will be invited for a neurocognitive, cardiovascular and BMD assessment, and asked to complete several questionnaires and to provide a blood sample. Using multivariable regression analyses, we will compare the outcomes of HL survivors who developed POI with those who did not. Cardiovascular status will also be compared with women with natural POI. ETHICS AND DISSEMINATION This study has been approved by the Institutional Review Board of the Netherlands Cancer Institute and has been registered at 'Toetsingonline' from the Dutch Central Committee on Research involving Human Subjects (file no. NL44714.031.13). Results will be disseminated through peer-reviewed publications and will be incorporated in follow-up guidelines for HL survivors.
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Affiliation(s)
- Inge M Krul
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Josée M Zijlstra
- Department of Haemato-oncology, VU University Medical Center, Amsterdam, Netherlands
| | - Yolande Appelman
- Department of Cardiology, VU University Medical Center, Amsterdam, Netherlands
| | - Sanne B Schagen
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Lilian J Meijboom
- Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Erik Serné
- Department of Vascular Medicine, VU University Medical Center, Amsterdam, Netherlands
| | - Cornelis B Lambalk
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands
| | - Paul Lips
- Department of Internal Medicine, Endocrine Section, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Michael Hauptmann
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Laurien A Daniëls
- Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Berthe M P Aleman
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Flora E van Leeuwen
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Dugas CM, Schussler JM. Advanced technology in interventional cardiology: A roadmap for the future of precision coronary interventions. Trends Cardiovasc Med 2016; 26:466-73. [DOI: 10.1016/j.tcm.2016.02.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 02/14/2016] [Accepted: 02/17/2016] [Indexed: 01/17/2023]
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Bai Z, Yang X, Han X, Dong P, Liu A. Comparison between coronary plaque 64-slice spiral CT characteristics and risk factors of coronary artery disease patients in Chinese Han population and Mongolian. Pak J Med Sci 2013; 29:933-7. [PMID: 24353662 PMCID: PMC3817759 DOI: 10.12669/pjms.294.3618] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 06/01/2013] [Indexed: 11/15/2022] Open
Abstract
Objective: To compare the coronary atherosclerotic plaque 64-slice spiral CT characteristics and the risk factors of Han (in Inner Mongolia) and Mongolian coronary artery disease patients. Methods: The plaques of 126 Mongolian and 269 Han patients were analyzed by 64-slice spiral CT coronary angiography. Their gender, age, height, body mass, the history of hypertension, diabetes, smoking and family diseases, the levels of triglycerides (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) were compared. Results: The incidence of plaques (P <0.05), the proportion of plaques in the circumflex branch (P <0.05), the proportion of medium-severe lumen stenosis induced by plaques (P <0.05), and the proportion of obstructive plaque involved multi-branch (P <0.05) of the Mongolian patients were higher. The plaque compositions of the two groups did not differ significantly (P> 0.05). The body mass index of the Mongolian patients was higher (P <0.05). The hypertension, diabetes, smoking history, TG, TC, HDL-C and LDL-C of the two groups did not differ significantly (P> 0.05). Conclusion: The higher incidence of coronary atherosclerotic plaques and the more severe lesions of the Mongolian patients may be related to their higher body mass index.
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Affiliation(s)
- Zhigang Bai
- Zhigang Bai, Department of Radiology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010059, P. R. China
| | - Xiaoguang Yang
- Xiaoguang Yang, Department of Radiology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010059, P. R. China
| | - Xiaodong Han
- Xiaodong Han, Department of Radiology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010059, P. R. China
| | - Peide Dong
- Peide Dong, Department of Radiology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010059, P. R. China
| | - Aishi Liu
- Aishi Liu, Department of Radiology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010059, P. R. China
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Gopal A, Silvet H, Foster GP. Cardiovascular computed tomographic angiography evaluation following unsuccessful invasive angiography: the clinical utility of 3D volume rendering. Catheter Cardiovasc Interv 2010; 75:753-6. [PMID: 20146314 DOI: 10.1002/ccd.22396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In an appropriate clinical setting, cardiac CT angiography (CCT) can be used as a safe and effective noninvasive imaging modality for defining coronary arterial anatomy by providing detailed three-dimensional anatomic information that may be difficult to obtain with invasive coronary angiography (ICA). We present a patient where coronary angiography by ICA was unsuccessful and where the subsequent CCT proved to be very useful in providing us relevant information.
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Affiliation(s)
- Ambarish Gopal
- Medicine Department, Cardiology Section, VA Loma Linda Healthcare System, Loma Linda, California 92357, USA
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Roguin A, Abadi S, Engel A, Beyar R. Novel method for real-time hybrid cardiac CT and coronary angiography image registration: visualising beyond luminology, proof-of-concept. EUROINTERVENTION 2009; 4:648-53. [DOI: 10.4244/eijv4i5a108] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Gopal A, Nasir K, Ahmadi N, Gul K, Tiano J, Flores M, Young E, Witteman AM, Holland TC, Flores F, Mao SS, Budoff MJ. Cardiac computed tomographic angiography in an outpatient setting: An analysis of clinical outcomes over a 40-month period. J Cardiovasc Comput Tomogr 2009; 3:90-5. [DOI: 10.1016/j.jcct.2009.01.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Revised: 01/12/2009] [Accepted: 01/26/2009] [Indexed: 01/07/2023]
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Radiation reduction with prospective ECG-triggering acquisition using 64-multidetector computed tomographic angiography. Int J Cardiovasc Imaging 2008; 25:405-16. [DOI: 10.1007/s10554-008-9396-z] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Accepted: 11/18/2008] [Indexed: 10/21/2022]
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Ostrom MP, Gopal A, Ahmadi N, Nasir K, Yang E, Kakadiaris I, Flores F, Mao SS, Budoff MJ. Mortality incidence and the severity of coronary atherosclerosis assessed by computed tomography angiography. J Am Coll Cardiol 2008; 52:1335-43. [PMID: 18929245 DOI: 10.1016/j.jacc.2008.07.027] [Citation(s) in RCA: 246] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Revised: 07/11/2008] [Accepted: 07/14/2008] [Indexed: 01/07/2023]
Abstract
OBJECTIVES This study investigated whether cardiac computed tomography angiography (CTA) can predict all-cause mortality in symptomatic patients. BACKGROUND Noninvasive coronary angiography is being increasingly performed by CTA to assess for obstructive coronary artery disease (CAD), and minimal outcome data exist for coronary CTA. We have utilized a cohort of symptomatic patients who underwent electron beam tomography to allow for longer follow-up (up to 12 years) than currently available with newer 64-slice multidetector-row computed tomography studies. METHODS In all, 2,538 consecutive patients who underwent CTA by electron beam tomography (age 59 +/- 14 years, 70% males) without known CAD were studied. Computed tomographic angiography results were categorized as significant CAD (> or =50% luminal narrowing), mild CAD (<50% stenosis), and normal coronary arteries. Multivariable Cox proportional hazards models were developed to predict all-cause mortality. Risk-adjusted models incorporated traditional risk factors for coronary disease and coronary artery calcification (CAC). RESULTS During a mean follow-up of 78 +/- 12 months, the death rate was 3.4% (86 deaths). The CTA-diagnosed CAD was an independent predictor of mortality in a multivariable model adjusted for age, gender, cardiac risk factors, and CAC (p < 0.0001). The addition of CAC to CTA-diagnosed CAD increased the concordance index significantly (0.69 for risk factors, 0.83 for the CTA-diagnosed CAD, and 0.89 for the addition of CAC to CAD, p < 0.0001). Risk-adjusted hazard ratios for CTA-diagnosed CAD were 1.7-, 1.8-, 2.3-, and 2.6-fold for 3-vessel nonobstructive, 1-vessel obstructive, 2-vessel obstructive, and 3-vessel obstructive CAD, respectively (p < 0.0001), when compared with the group who did not have CAD. CONCLUSIONS The primary results of our study reveal that the burden of angiographic disease detected by CTA provides both independent and incremental value in predicting all-cause mortality in symptomatic patients independent of age, gender, conventional risk factors, and CAC.
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Affiliation(s)
- Matthew P Ostrom
- Division of Cardiology, Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California 90502, USA
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Safety and efficacy of patient preparation with intravenous esmolol before 64-slice computed tomography coronary angiography. Coron Artery Dis 2008; 19:33-6. [DOI: 10.1097/mca.0b013e3282f27c20] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kumar A, Bis KG, Shetty A, Vyas A, Anderson A, Balasubramaniam M, O'Neill W, Stein W. Aortic root catheter-directed coronary CT angiography in swine: coronary enhancement with minimum volume of iodinated contrast material. AJR Am J Roentgenol 2007; 188:W415-22. [PMID: 17449736 DOI: 10.2214/ajr.06.0945] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the minimum amount of contrast material for coronary imaging with aortic root catheter-directed enhancement and 64-MDCT angiography (MDCTA). MATERIALS AND METHODS A 64-MDCT scanner was used after animal institutional review board approval to study four swine (40-60 kg). Heart rate reduction to 65 beats per minute was achieved with atenolol by mouth and i.v. Cardizem. Common femoral artery access was obtained with a 5-French micropuncture kit and sonographic guidance. A diffusiontip (640 side holes), 5-French pigtail catheter was positioned in the aortic root on the CT table with a retrofitted C-arm fluoroscopy unit and connected to an arterial power injector. Aortic root MDCTA (retrospective ECG gating; collimation, 0.6 mm; tube rotation time, 0.33 second; scanning time, 10-12 seconds; tube voltage, 120 kVp; effective mAs, 850 mAs; pitch, 0.2; field of view, 109-123 mm; slice thickness and increment, 0.6 and 0.3 mm) was begun 1 second after the injection of 100 mL of various Visipaque (iodixanol) concentrations (10%, 20%, 30%, 40%) at 10 mL/s. Coronary mean and peak densities, 3D maximum intensity projections, and 4D projections were obtained. RESULTS The mean pooled coronary attenuation values (H +/- SD) for the right (RCA), left anterior descending (LAD), and left circumflex (LCx) coronary arteries at various concentrations (10%, 20%, 30%, 40%) were as follows: 10% (RCA [232.6 +/- 64.0], LAD [180.4 +/- 45.1], and LCx [176.6 +/- 56.2]); 20% (RCA [383.0 +/- 98.7], LAD [324.3 +/- 60.1], and LCx [331.8 +/- 105.5]); 30% (RCA [441.8 +/- 137.6], LAD [401.3 +/- 125.8], and LCx [418.5 +/- 173.0]); and 40% (RCA [717.3 +/- 377.7], LAD [573.3 +/- 233.3], and LCx [584.8 +/- 189.0]). Coronary imaging with aortic root MDCTA was feasible at all concentrations, and the attenuation values were statistically significantly greater than 250 H at 20%, 30%, and 40% (p < 0.05). The attenuation values with aortic root MDCTA using one fifth of the volume of contrast material are comparable to those currently achieved both clinically and experimentally with peripheral i.v. MDCTA. CONCLUSION Aortic root MDCTA can depict the coronary arteries with as little as 20 mL of contrast material. This may provide an alternative means of coronary evaluation in patients with renal insufficiency.
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Affiliation(s)
- Arun Kumar
- Department of Diagnostic Radiology, William Beaumont Hospital, 3601 W 13 Mile Rd., Royal Oak, MI 48073, USA
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