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Ekmejian A, Howden N, Eipper A, Allahwala U, Ward M, Bhindi R. Association between vessel-specific coronary Aggregated plaque burden, Agatston score and hemodynamic significance of coronary disease (The CAPTivAte study). IJC HEART & VASCULATURE 2024; 51:101384. [PMID: 38496257 PMCID: PMC10940135 DOI: 10.1016/j.ijcha.2024.101384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 02/28/2024] [Accepted: 03/06/2024] [Indexed: 03/19/2024]
Abstract
Background CT coronary angiography (CTCA) is a guideline-endorsed assessment for patients with stable angina and suspected coronary disease. Although associated with excellent negative predictive value in ruling out obstructive coronary disease, there are limitations in the ability of CTCA to predict hemodynamically significant coronary disease. The CAPTivAte study aims to assess the utility of Aggregated Plaque Burden (APB) in predicting ischemia based on Fractional Flow Reserve (FFR). Methods In this retrospective study, patients who had a CTCA and invasive FFR of the LAD were included. The entire length of the LAD was analyzed using semi-automated software which characterized total plaque burden and plaque morphological subtype (including Low Attenuation Plaque (LAP), Non-calcific plaque (NCP) and Calcific Plaque (CP). Aggregated Plaque Burden (APB) was calculated. Univariate and multivariate analysis were performed to assess the association between these CT-derived parameters and invasive FFR. Results There were 145 patients included in this study. 84.8 % of patients were referred with stable angina. There was a significant linear association between APB and FFR in both univariate and multivariate analysis (Adjusted R-squared = 0.0469; p = 0.035). Mean Agatston scores are higher in FFR positive vessels compared to FFR negative vessels (371.6 (±443.8) vs 251.9 (±283.5, p = 0.0493). Conclusion CTCA-derived APB is a reliable predictor of ischemia assessed using invasive FFR and may aid clinicians in rationalizing invasive vs non-invasive management strategies. Vessel-specific Agatston scores are significantly higher in FFR-positive vessels than in FFR-negative vessels. Associations between HU-derived plaque subtype and invasive FFR were inconclusive in this study.
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Affiliation(s)
- Avedis Ekmejian
- Royal North Shore Hospital, Australia
- North Shore Private Hospital, Australia
- University of Sydney Northern Clinical School, Australia
| | - Nicklas Howden
- Royal North Shore Hospital, Australia
- North Shore Private Hospital, Australia
| | | | - Usaid Allahwala
- Royal North Shore Hospital, Australia
- North Shore Private Hospital, Australia
- University of Sydney Northern Clinical School, Australia
| | - Michael Ward
- Royal North Shore Hospital, Australia
- North Shore Private Hospital, Australia
- University of Sydney Northern Clinical School, Australia
| | - Ravinay Bhindi
- Royal North Shore Hospital, Australia
- North Shore Private Hospital, Australia
- University of Sydney Northern Clinical School, Australia
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Photon-Counting Computed Tomography (PCCT): Technical Background and Cardio-Vascular Applications. Diagnostics (Basel) 2023; 13:diagnostics13040645. [PMID: 36832139 PMCID: PMC9955798 DOI: 10.3390/diagnostics13040645] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/28/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
Photon-counting computed tomography (PCCT) is a new advanced imaging technique that is going to transform the standard clinical use of computed tomography (CT) imaging. Photon-counting detectors resolve the number of photons and the incident X-ray energy spectrum into multiple energy bins. Compared with conventional CT technology, PCCT offers the advantages of improved spatial and contrast resolution, reduction of image noise and artifacts, reduced radiation exposure, and multi-energy/multi-parametric imaging based on the atomic properties of tissues, with the consequent possibility to use different contrast agents and improve quantitative imaging. This narrative review first briefly describes the technical principles and the benefits of photon-counting CT and then provides a synthetic outline of the current literature on its use for vascular imaging.
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Counseller Q, Aboelkassem Y. Recent technologies in cardiac imaging. FRONTIERS IN MEDICAL TECHNOLOGY 2023; 4:984492. [PMID: 36704232 PMCID: PMC9872125 DOI: 10.3389/fmedt.2022.984492] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 11/30/2022] [Indexed: 01/11/2023] Open
Abstract
Cardiac imaging allows physicians to view the structure and function of the heart to detect various heart abnormalities, ranging from inefficiencies in contraction, regulation of volumetric input and output of blood, deficits in valve function and structure, accumulation of plaque in arteries, and more. Commonly used cardiovascular imaging techniques include x-ray, computed tomography (CT), magnetic resonance imaging (MRI), echocardiogram, and positron emission tomography (PET)/single-photon emission computed tomography (SPECT). More recently, even more tools are at our disposal for investigating the heart's physiology, performance, structure, and function due to technological advancements. This review study summarizes cardiac imaging techniques with a particular interest in MRI and CT, noting each tool's origin, benefits, downfalls, clinical application, and advancement of cardiac imaging in the near future.
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Affiliation(s)
- Quinn Counseller
- College of Health Sciences, University of Michigan, Flint, MI, United States
| | - Yasser Aboelkassem
- College of Innovation and Technology, University of Michigan, Flint, MI, United States,Michigan Institute for Data Science, University of Michigan, Ann Arbor, MI, United States,Correspondence: Yasser Aboelkassem
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Sieren MM, Maintz D, Gutberlet M, Krombach GA, Bamberg F, Hunold P, Lehmkuhl L, Fischbach K, Reinartz S, Antoch G, Barkhausen J, Sandstede J, Völker M, Naehle C. Current Status of Cardiovascular Imaging in Germany: Structured Data from the National Certification Program, ESCR Registry, and Survey among Radiologists. ROFO-FORTSCHR RONTG 2021; 194:181-191. [PMID: 34384112 DOI: 10.1055/a-1554-9236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE In the light of the increasing importance of cardiovascular cross-sectional imaging in current guidelines, the goal of this study is to provide a comprehensive overview of cardiovascular imaging (CVI) offered by radiological institutions across Germany. MATERIALS AND METHODS Data were extracted from the national certification program database of the German Roentgen Society (DRG) from 2015-2021. A nationwide online survey among radiology institutes (university hospitals, non-university hospitals, and private practices) was conducted for 2019, and data was extracted from the European Society of Cardiovascular Radiology (ESCR) registry. The data collection's key points included the number of centers and individuals certified for CVI, the number of cardiac CT and MRI examinations performed, the reporting habits, and the participation in the ESCR registry. RESULTS 71 centers and 1278 persons, both with a substantial increase since 2015, were registered and certified by the DRG to perform CVI. According to the survey, a total of 69,286 CT and 64,281 MRI examinations were performed annually. Data from the survey and the ESCR registry indicated that reporting was mostly done solely by radiologists or, to a lesser degree, in joint consensus meetings with non-radiologists. The overall participation rate in the ESCR registry was 48 % among the survey's participants. CONCLUSION This comprehensive analysis demonstrates that high-quality CVI by radiologists is available nationwide. The current challenges are to provide the best medical and technical quality of CVI by radiology for patient care and to ensure economic sustainability in the German health care system to accommodate the predicted substantial need for CVI in the future. KEY POINTS · High-quality advanced CVI service by radiologists is available nationwide.. · Highly qualified specialist knowledge is widely represented from university to private practices.. · Certification programs successfully contribute to the dissemination & deepening of CVI expertise.. · The ESCR registry is an established international tool for the documentation of CVI.. CITATION FORMAT · Sieren M, Maintz D, Gutberlet M et al. Current Status of Cardiovascular Imaging in Germany: Structured Data from the National Certification Program, ESCR Registry, and Survey among Radiologists. Fortschr Röntgenstr 2021; DOI: 10.1055/a-1554-9236.
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Affiliation(s)
- Malte Maria Sieren
- Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - David Maintz
- Department for Interventional and Diagnostic Radiology, University Hospital Cologne, Germany
| | - Matthias Gutberlet
- Department for Diagnostic and Interventional Radiology, Heart Center Leipzig - University Leipzig, Germany.,Steering Committee Chair MRCT-Registry of the ESCR, ESCR, Vienna, Austria
| | - Gabriele Anja Krombach
- Department of Diagnostic and Interventional Radiology, University-Hospital Gießen, Germany
| | - Fabian Bamberg
- Department for Diagnostic and Interventional Radiology, University Hospital Freiburg, Germany
| | - Peter Hunold
- n/a, FOKUS Radiologie & Nuklearmedizin, Göttingen, Germany
| | - Lukas Lehmkuhl
- Department for Diagnostic and Interventional Radiology, RHÖN Clinic, Campus Bad Neustadt, Germany
| | - Katharina Fischbach
- Diagnostische Radiologie, Otto-von-Guericke-Universität, Magdeburg, Germany.,Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Otto von Guericke University, Magdeburg, Germany
| | - Sebastian Reinartz
- Department for Diagnostic and Interventional Radiology, University Hospital Aachen, Germany
| | - Gerald Antoch
- Department for Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University Düsseldorf, University Hospital Düsseldorf, Germany
| | - Jörg Barkhausen
- Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - Jörn Sandstede
- Hamburg Wördemanns Weg, Radiologische Allianz, Hamburg, Germany.,Berufsverband der deutschen Radiologen e.V. (BDR), Munich, Germany
| | - Martin Völker
- Bereich Wissenschaft, Nachwuchsförderung, Zertifizierung, German Roentgen Society "Deutsche Röntgengesellschaft", Berlin, Germany
| | - Claas Naehle
- Department for Interventional and Diagnostic Radiology, University Hospital Cologne, Germany
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Nenna A, Nappi F, Spadaccio C, Greco SM, Pilato M, Stilo F, Montelione N, Catanese V, Lusini M, Spinelli F, Chello M. Advanced measurements of coronary calcium scores: how does it affect current clinical practice? Future Cardiol 2021; 18:35-41. [PMID: 33885330 DOI: 10.2217/fca-2020-0243] [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: 11/21/2022] Open
Abstract
Coronary artery calcium (CAC) scoring has emerged as a marker of the burden of atheromatous disease and has been included in scoring systems. The practice of myocardial revascularization, considering percutaneous procedures or surgical strategies, is dramatically changing over years and the prognostic significance of CAC scoring is gradually being conceived. In this interdisciplinary scenario, vessel specific calcium scoring, mapping of coronary calcification and its integration with functional assessment of coronary artery disease might change the future decisions in the catheterization lab and operative theaters. This article summarizes CAC evaluation techniques and its implications in clinical practice.
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Affiliation(s)
- Antonio Nenna
- Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Francesco Nappi
- Cardiac Surgery, Centre Cardiologique du Nord, Saint Denis, Paris, France
| | | | - Salvatore Matteo Greco
- Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy.,Cardiac Surgery, ISMETT-IRCCS, Palermo, Italy
| | | | - Francesco Stilo
- Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Nunzio Montelione
- Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Vincenzo Catanese
- Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Mario Lusini
- Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Francesco Spinelli
- Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Massimo Chello
- Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
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