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D’Errico F, Ricci F, Luciano A, Sbordone FP, Laudazi M, Mecchia D, Volpe M, Briganti F, Di Landro A, Muscoli S, Pugliese L, De Stasio V, Di Donna C, Romeo F, Garaci F, Floris R, Chiocchi M. The Impact of Nitroglycerin on the Evaluation of Coronary Stenosis in Coronary-CT: Preliminary Study in 131 Patients. J Clin Med 2023; 12:5296. [PMID: 37629336 PMCID: PMC10455480 DOI: 10.3390/jcm12165296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND The sublingual administration of short-acting nitroglycerin (NTG) before coronary computed tomography (CCT) improves the visualization of coronary arteries, causing vasodilatation. The aim of this study was to evaluate whether and how nitroglycerin can influence the concordance between radiologists and cardiologists in the evaluation of vessel stenosis measured in CCT by the former and during the following coronarography by the latter. METHODS We conducted a retrospective analysis of 131 patients who underwent CCT for cardiac symptoms in 2022, followed by coronarography performed six months later because of significant stenosis revealed by the CCT. First, the patients were divided into two groups: an NTG group who received sublingual nitroglycerin before CCT and a non-NTG group who did not because of contraindications. Second, 254 stenoses were measured by two radiologists after CCT and by two interventional cardiologists during the next coronarography; moreover, stenoses were classified on the basis of their location and plaque pattern (calcific, mixed and lipidic). Third, the strength of agreement was evaluated between the two radiologists, between the two cardiologists and finally between the radiologists and cardiologists in order to evaluate whether and how the interdisciplinary discrepancy in stenosis evaluation could change with or without the use of nitroglycerin before CCT and in relation to the different plaque pattern. RESULTS In the NTG group, the use of nitroglycerine reduced the agreement between radiologists and cardiologists in calcific stenosis but did not change the concordance in the case of mixed or lipidic plaques on the same vessels. CONCLUSIONS The use of sublingual nitroglycerin before CCT may lead to a radiological overestimation of calcific stenosis.
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Affiliation(s)
- Francesca D’Errico
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (F.D.); (A.L.); (F.P.S.); (M.L.); (D.M.); (M.V.); (F.B.); (L.P.); (V.D.S.); (C.D.D.); (F.G.); (R.F.); (M.C.)
| | - Francesca Ricci
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (F.D.); (A.L.); (F.P.S.); (M.L.); (D.M.); (M.V.); (F.B.); (L.P.); (V.D.S.); (C.D.D.); (F.G.); (R.F.); (M.C.)
| | - Alessandra Luciano
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (F.D.); (A.L.); (F.P.S.); (M.L.); (D.M.); (M.V.); (F.B.); (L.P.); (V.D.S.); (C.D.D.); (F.G.); (R.F.); (M.C.)
| | - Francesco Paolo Sbordone
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (F.D.); (A.L.); (F.P.S.); (M.L.); (D.M.); (M.V.); (F.B.); (L.P.); (V.D.S.); (C.D.D.); (F.G.); (R.F.); (M.C.)
| | - Mario Laudazi
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (F.D.); (A.L.); (F.P.S.); (M.L.); (D.M.); (M.V.); (F.B.); (L.P.); (V.D.S.); (C.D.D.); (F.G.); (R.F.); (M.C.)
| | - Daniele Mecchia
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (F.D.); (A.L.); (F.P.S.); (M.L.); (D.M.); (M.V.); (F.B.); (L.P.); (V.D.S.); (C.D.D.); (F.G.); (R.F.); (M.C.)
| | - Maria Volpe
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (F.D.); (A.L.); (F.P.S.); (M.L.); (D.M.); (M.V.); (F.B.); (L.P.); (V.D.S.); (C.D.D.); (F.G.); (R.F.); (M.C.)
| | - Flavia Briganti
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (F.D.); (A.L.); (F.P.S.); (M.L.); (D.M.); (M.V.); (F.B.); (L.P.); (V.D.S.); (C.D.D.); (F.G.); (R.F.); (M.C.)
| | - Alessio Di Landro
- Unit of Cardiology and Interventional Cardiology, Policlinico Tor Vergata, Viale Oxford 81, 00133 Rome, Italy; (A.D.L.); (S.M.)
| | - Saverio Muscoli
- Unit of Cardiology and Interventional Cardiology, Policlinico Tor Vergata, Viale Oxford 81, 00133 Rome, Italy; (A.D.L.); (S.M.)
| | - Luca Pugliese
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (F.D.); (A.L.); (F.P.S.); (M.L.); (D.M.); (M.V.); (F.B.); (L.P.); (V.D.S.); (C.D.D.); (F.G.); (R.F.); (M.C.)
| | - Vincenzo De Stasio
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (F.D.); (A.L.); (F.P.S.); (M.L.); (D.M.); (M.V.); (F.B.); (L.P.); (V.D.S.); (C.D.D.); (F.G.); (R.F.); (M.C.)
| | - Carlo Di Donna
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (F.D.); (A.L.); (F.P.S.); (M.L.); (D.M.); (M.V.); (F.B.); (L.P.); (V.D.S.); (C.D.D.); (F.G.); (R.F.); (M.C.)
| | - Francesco Romeo
- Faculty of Medicine, UniCamillus International Medical University, 00131 Rome, Italy;
| | - Francesco Garaci
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (F.D.); (A.L.); (F.P.S.); (M.L.); (D.M.); (M.V.); (F.B.); (L.P.); (V.D.S.); (C.D.D.); (F.G.); (R.F.); (M.C.)
| | - Roberto Floris
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (F.D.); (A.L.); (F.P.S.); (M.L.); (D.M.); (M.V.); (F.B.); (L.P.); (V.D.S.); (C.D.D.); (F.G.); (R.F.); (M.C.)
| | - Marcello Chiocchi
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (F.D.); (A.L.); (F.P.S.); (M.L.); (D.M.); (M.V.); (F.B.); (L.P.); (V.D.S.); (C.D.D.); (F.G.); (R.F.); (M.C.)
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Marano R, Rovere G, Savino G, Flammia FC, Carafa MRP, Steri L, Merlino B, Natale L. CCTA in the diagnosis of coronary artery disease. Radiol Med 2020; 125:1102-1113. [PMID: 32964325 DOI: 10.1007/s11547-020-01283-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/03/2020] [Indexed: 12/12/2022]
Abstract
The world of cardiac imaging is proposing to physicians an ever-increasing spectrum of options and tools with the disadvantages of patients presently submitted to multiple, sequential, time-consuming, and costly diagnostic procedures and tests, sometimes with contradicting results. In the last two decades, the CCTA has evolved into a valuable diagnostic test in today's patient care, changing the official existing guidelines and clinical practice with a pivotal role to exclude significant CAD, in the referral of patients to the Cath-Lab, in the follow-up after coronary revascularization, and finally in the cardiovascular risk stratification.
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Affiliation(s)
- Riccardo Marano
- Department of Radiological and Hematological Sciences, Section of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.go Agostino Gemelli 8, 00168, Rome, Italy.
| | - Giuseppe Rovere
- Department of Radiological and Hematological Sciences, Section of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Giancarlo Savino
- Department of Radiological and Hematological Sciences, Section of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Francesco Ciriaco Flammia
- Department of Radiological and Hematological Sciences, Section of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Maria Rachele Pia Carafa
- Department of Radiological and Hematological Sciences, Section of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Lorenzo Steri
- Department of Radiological and Hematological Sciences, Section of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Biagio Merlino
- Department of Radiological and Hematological Sciences, Section of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Luigi Natale
- Department of Radiological and Hematological Sciences, Section of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.go Agostino Gemelli 8, 00168, Rome, Italy
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Coronary Computed Tomography Angiography in the Clinical Workflow of Athletes With Anomalous Origin of Coronary Arteries From the Contralateral Valsalva Sinus. J Thorac Imaging 2020; 36:122-130. [PMID: 32384413 DOI: 10.1097/rti.0000000000000523] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE This study aimed to assess the role of coronary computed tomography-angiography (CCTA) in the workflow of competitive sports eligibility in a cohort of athletes with anomalous origin of the left-coronary artery (AOLCA)/anomalous origin of the right-coronary artery (AORCA) in an attempt to outline relevant computed tomography features likely to impact diagnostic assessment and clinic management. MATERIALS AND METHODS Patients with suspected AOLCA/AORCA at transthoracic echocardiography or with inconclusive transthoracic echocardiography underwent CCTA to rule out/confirm and characterize the anatomic findings: partially interarterial course or full-INT, high-take-off, acute-take-off-angle (ATO), slit-like origin, intramural course (IM), interarterial-course-length, and lumen-reduction/hypoplasia (HYPO). RESULTS CCTA identified 28 athletes: 6 AOLCA (3 males; 20.3±11.0 y) and 22 AORCA (18 males; 29.1±16.5 y). Symptoms were present only in 13 athletes (46.4%; 10 AORCA). Four patients (3 AORCA) had abnormal rest electrocardiogram, 11 (40.7%; 9 AORCA) had abnormal stress-electrocardiogram. The INT course was observed in 15 athletes (53.6%): 6/6 AOLCA and 9/22 AORCA (40.9%). Slit-like origin was present in 7/22 AORCA (31.8%) and never in AOLCA. Suspected IM resulted in 3 AOLCA (50%), always with HYPO/ATO, and in 6/22 AORCA (27.3%) with HYPO. No statistically significant differences were found between asymptomatic/symptomatic patients in the prevalence of partially INT/INT courses, high-take-off/ATO, and slit-like ostium. A slightly significant relationship between suspected proximal-IM (r=0.47, P<0.05) and proximal-HYPO of anomalous vessel (r=0.65, P<0.01) resulted in AORCA and was confirmed on AOLCA/AORCA pooled analysis (r=0.58, P<0.01 for HYPO). All AOLCA/AORCA athletes were disqualified from competitive sports and warned to avoid vigorous physical efforts. Surgery was recommended to all AOLCA athletes and to 13 AORCA (3 asymptomatic), but only 6 underwent surgery. No major cardiovascular event/ischemic symptoms/signs developed during a mean follow-up of 49.6±39.5 months. CONCLUSION CCTA provides essential information for safe/effective clinical management of athletes, with important prognostic/sport-activity implications.
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Coronary atherosclerosis in apparently healthy master athletes discovered during pre-PARTECIPATION screening. Role of coronary CT angiography (CCTA). Int J Cardiol 2018; 282:99-107. [PMID: 30482442 DOI: 10.1016/j.ijcard.2018.11.099] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/11/2018] [Accepted: 11/19/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Pre-participation screening (PPS) of athletes aged over 35 years (master athletes, MA) is a major concern in Sports Cardiology. In this population, sports-related sudden cardiac death is rare but usually due to coronary atherosclerosis (CA). Coronary CT Angiography (CCTA) has changed the approach to diagnosis/management of CA, but its role in this context still needs to be assessed. METHODS AND RESULTS We retrospectively examined 167 MA who underwent CCTA in our hospital since 2006, analyzing symptoms, stress-test ECG, cardiovascular risk profiles (SCORE) and CCTA findings. Among the whole enrolled population, 153 (91.6%) MA underwent CCTA for equivocal/positive stress-test ECG with/without symptoms, 13 (7.8%) just for clinical symptoms, 1 (0.6%) for the family history. The CCTA showed the presence of CA in 69 MA (41.3%), congenital coronary anomalies (anomalous origin or deep myocardial bridge) in 8 (4.8%), both in 7 (4.2%). A negative CCTA was observed in 83 MA (49.7%). The risk-SCORE (age, hypertension, hypercholesterolemia, smoking) was a good indicator for the presence of moderate/severe CA on CCTA. However, mild/moderate CA was present in 17.8% of MA clinically stratified at a low risk-SCORE. CONCLUSION While coronary angiography is more indicated in athletes with positive stress-test ECG and high clinical risk, the CCTA may be useful in the evaluation of MA with an abnormal stress test ECG and/or clinical symptoms engaged in competitive sports with a high cardiovascular involvement. Age, gender, presence of symptoms and clinical risk-SCORE assessment may help sports physicians and cardiologists to decide whether to request a CCTA or not.
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Zimarino M, Marano R, Radico F, Curione D, De Caterina R. Coronary computed tomography angiography, ECG stress test and nuclear imaging as sources of false-positive results in the detection of coronary artery disease. J Cardiovasc Med (Hagerstown) 2018. [PMID: 29538163 DOI: 10.2459/jcm.0000000000000591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Marco Zimarino
- Institute of Cardiology and Center of Excellence on Aging, 'G. d'Annunzio' University, Chieti
| | - Riccardo Marano
- Department of Radiological Sciences, Institute of Radiology, 'A. Gemelli' University Polyclinic Foundation, Catholic University, Rome, Italy
| | - Francesco Radico
- Institute of Cardiology and Center of Excellence on Aging, 'G. d'Annunzio' University, Chieti
| | - Davide Curione
- Department of Radiological Sciences, Institute of Radiology, 'A. Gemelli' University Polyclinic Foundation, Catholic University, Rome, Italy
| | - Raffaele De Caterina
- Institute of Cardiology and Center of Excellence on Aging, 'G. d'Annunzio' University, Chieti
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Marano R, Pitocco D, Di Stasio E, Savino G, Merlino B, Trani C, Pirro F, Rutigliano C, Santangelo C, Minoiu AC, Natale L, Bonomo L. MDCT assessment of CAD in type-2 diabetic subjects with diabetic neuropathy: the role of Charcot neuro-arthropathy. Eur Radiol 2015; 26:788-96. [PMID: 26139314 DOI: 10.1007/s00330-015-3864-3] [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: 11/20/2014] [Revised: 05/14/2015] [Accepted: 05/26/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To compare the CACS and CAD severity assessed by MDCT in neuropathic type-2 diabetic patients with and without Charcot-neuroarthropathy (CN). METHODS Thirty-four CN asymptomatic-patients and 36 asymptomatic-patients with diabetic-neuropathy (DN) without CN underwent MDCT to assess CACS and severity of CAD. Patients were classified as positive for significant CAD in presence of at least one stenosis >50 % on MDCT-coronary-angiography (MDCT-CA). Groups were matched for age, sex and traditional CAD risk-factors. The coronary-angiography (CA) was performed in all patients with at least a significant stenosis detected by MDCT-CA, both as reference and eventually as treatment. RESULTS CN patients showed higher rates of significant CAD in comparison with DN subjects [p < 0.001], while non-significant differences were observed in CACS (p = 0.980). No significant differences were also observed in CACS distribution in all subjects for stenosis ≥/<50 % (p = 0.814), as well as in both groups (p = 0.661 and 0.559, respectively). The MDCT-CA showed an overall diagnostic-accuracy for significant CAD of 87%. CONCLUSIONS These preliminary data suggest that CN-patients have a higher prevalence of severe CAD in comparison with DN-patients, while coronary plaques do not exhibit an increased amount of calcium. MDCT may be helpful to assess the CV risk in such asymptomatic type-2-diabetic patients with autonomic-neuropathy. KEY POINTS Type 2-diabetic-patients with CN result having more severe coronary artery plaque-burden. MDCT-CA may stratify the CV risk in type 2-diabetic-patients with CN. Adequate diagnostic is mandatory for optimal management of type 2-diabetic-patients with CN.
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Affiliation(s)
- Riccardo Marano
- Department of Radiological Sciences - Institute of Radiology, Catholic University of Rome, "A. Gemelli" University Hospital, L.go Agostino Gemelli 8, 00168, Rome, Italy.
| | - Dario Pitocco
- Department of Internal Medicine, Catholic University of Rome, "A. Gemelli" University Hospital, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Enrico Di Stasio
- Department of Clinical Biochemistry, Catholic University of Rome, "A. Gemelli" University Hospital, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Giancarlo Savino
- Department of Radiological Sciences - Institute of Radiology, Catholic University of Rome, "A. Gemelli" University Hospital, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Biagio Merlino
- Department of Radiological Sciences - Institute of Radiology, Catholic University of Rome, "A. Gemelli" University Hospital, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular Medicine - Institute of Cardiology, Catholic University of Rome, "A. Gemelli" University Hospital, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Federica Pirro
- Department of Radiological Sciences - Institute of Radiology, Catholic University of Rome, "A. Gemelli" University Hospital, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Claudia Rutigliano
- Department of Radiological Sciences - Institute of Radiology, Catholic University of Rome, "A. Gemelli" University Hospital, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Carolina Santangelo
- Department of Radiological Sciences - Institute of Radiology, Catholic University of Rome, "A. Gemelli" University Hospital, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Aurelian Costin Minoiu
- Department of Radiological Sciences - Institute of Radiology, Catholic University of Rome, "A. Gemelli" University Hospital, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Luigi Natale
- Department of Radiological Sciences - Institute of Radiology, Catholic University of Rome, "A. Gemelli" University Hospital, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Lorenzo Bonomo
- Department of Radiological Sciences - Institute of Radiology, Catholic University of Rome, "A. Gemelli" University Hospital, L.go Agostino Gemelli 8, 00168, Rome, Italy
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