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Chepurnenko SA, Nasytko AD, Shavkuta GV, Kostenko VL. Results of Computed Tomographic Coronary Angiography in Comparison with the Table of Pretest Probability of Chronic Coronary Syndrome. ACTA ACUST UNITED AC 2021; 61:30-35. [PMID: 33849416 DOI: 10.18087/cardio.2021.3.n1267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 12/28/2020] [Indexed: 11/18/2022]
Abstract
Aim To compare results of computed tomography coronary angiography (CTCA) with a table of pretest probability of chronic coronary syndrome (CCS) taking into account the following key variants: abnormality, microvascular damage, nonobstructive or obstructive atherosclerotic damage.Material and methods 50 patients (39 men, 20 women) aged 30 to 67 years were evaluated with a computed tomography scanner PHILIPS Brilliance iCT SP 128. A high pretest probability of ischemic heart disease was found in 44 % of cases and medium in 40%.Results According to CCS data, coronary artery (CA) pathology was not found in 28 % of patients. CA hypoplasia was observed in 4 % of patients. 22 % of patients had muscular bridges narrowing the CA lumen during systole by 40-50%. In 26 % of cases, CA had minimal and early stenoses. Moderate and pronounced stenoses were observed in 20% of cases. In one case, there was a total occlusion of the circumflex branch. Calcinates were found in 9.1 % of patients with muscular bridges, in 61.5 % of patients with minimal and early stenoses, and in 80% of patients with moderate and pronounced stenoses. In the group with "clean" CA and congenital defects, calcinates were absent. The mean value of pretest probability was the highest in the patient group with moderate and pronounced stenoses, 22.5±13.13. It was significantly higher than in the group with muscular bridges (р=0.045) and congenital pathology of CA (р=0.01). At the same time, this value did not significantly differ from the group with "clean" CA and the group with minimal and early stenoses. Based on the study results, 2 bypass surgeries and 5 CA stentings were performed.Conclusion Thus, the table of pretest probability of ischemic heart disease does not provide a differential diagnosis and evaluation of the nature of CA damage as compared to results of CTCA.
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Affiliation(s)
- S A Chepurnenko
- Rostov Regional Clinical Hospital, Rostov-na-Donu; Rostov State Medical University, Rostov-na-Donu
| | - A D Nasytko
- Rostov State Medical University, Rostov-na-Donu
| | | | - V L Kostenko
- Rostov Regional Clinical Hospital, Rostov-na-Donu
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Koubaissi SA, Kamar Z, El Ankouni M, Degheili JA, Haddad A. Coronary Computed Tomographic Angiography Imaging as a Prognostic Indicator for Coronary Artery Disease: Data from a Lebanese Tertiary Center. Heart Views 2021; 21:239-244. [PMID: 33986921 PMCID: PMC8104316 DOI: 10.4103/heartviews.heartviews_87_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 10/27/2020] [Indexed: 11/05/2022] Open
Abstract
Background: Coronary artery disease (CAD) is a major cause of death and disability worldwide. Coronary computed tomographic angiography (CCTA) is a noninvasive imaging technique with a high negative predictive value (NPV). Most studies were done in developed countries, where the prevalence of CAD does not reflect the actual disease burden in developing countries, such as Lebanon. Methods: We retrospectively evaluated the prognostic value of CCTA in predicting acute myocardial events (AMEs) in 200 Lebanese patients. We determined if specific medical and radiological characteristics are linked with AME and looked for any association between the patient's medical risk factors and the type/location of detected atheromatous plaques. Patients' records were reviewed, and the follow-up period of 5–8 years ensued. Chi-square/Fisher test and Student's t-test were used, in addition to multinomial logistic regression to adjust for the confounding variables. P <0.05 was considered statistically significant. Results: Our study showed that CCTA had a NPV that reaches 97.9% in asymptomatic patients, a positive predictive value (PPV) of 76.4% for symptomatic patients, a sensitivity of 88.9%, and a specificity of 52.5%. AMEs were significantly increased in patients with a mixed plaque type and/or a moderate-to-severe lumen reduction on CCTA. Conclusions: CCTA is a sensitive modality for plaque detection and is found to have a remarkably high NPV for asymptomatic patients. A CCTA, along with a low pretest clinical probability of CAD, can be sufficient to rule out an AME for up to 8 years.
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Affiliation(s)
- Salwa A Koubaissi
- Department of Internal Medicine, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Zeinab Kamar
- Department of Anaesthesiology, Lebanese University, Beirut, Lebanon
| | - Mahdi El Ankouni
- Department of Internal Medicine, Lebanese University, Beirut, Lebanon
| | - Jad A Degheili
- Department of Surgery, Division of Urology, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Antoine Haddad
- Department of Radiology, Saint Joseph University, Beirut, Lebanon
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Cherukuri L, Birudaraju D, Kinninger A, Chaganti BT, Pidikiti S, Pozon RG, Pozon ACG, Lakshmanan S, Dahal S, Hamal S, Flores F, Christopher D, Andreini D, Pontone G, Conte E, Nakanishi R, O’Rourke R, Hamilton-Craig C, Nasir K, Roy SK, Mao SS, Budoff MJ. Use of Advanced CT Technology to Evaluate Left Atrial Indices in Patients with a High Heart Rate or with Heart Rate Variability: The Converge Registry. J Nucl Med Technol 2020; 49:65-69. [DOI: 10.2967/jnmt.120.253781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/09/2020] [Indexed: 11/16/2022] Open
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Coronary Artery Disease Detection by Machine Learning with Coronary Bifurcation Features. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10217656] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Early accurate detection of coronary artery disease (CAD) is one of the most important medical research areas. Researchers are motivated to utilize machine learning techniques for quick and accurate detection of CAD. Methods: To obtain the high quality of features used for machine learning, we here extracted the coronary bifurcation features from the coronary computed tomography angiography (CCTA) images by using the morphometric method. The machine learning classifier algorithms, such as logistic regression (LR), decision tree (DT), linear discriminant analysis (LDA), k-nearest neighbors (k-NN), artificial neural network (ANN), and support vector machine (SVM) were applied for estimating the performance by using the measured features. Results: The results showed that in comparison with other machine learning methods, the polynomial-SVM with the use of the grid search optimization method had the best performance for the detection of CAD and had yielded the classification accuracy of 100.00%. Among six examined coronary bifurcation features, the exponent of vessel diameter (n) and the area expansion ratio (AER) were two key features in the detection of CAD. Conclusions: This study could aid the clinicians to detect CAD accurately, which may probably provide an alternative method for the non-invasive diagnosis in clinical.
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Hensley B, Huang C, Cruz Martinez CV, Shokoohi H, Liteplo A. Ultrasound Measurement of Carotid Intima-Media Thickness and Plaques in Predicting Coronary Artery Disease. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:1608-1613. [PMID: 32386846 DOI: 10.1016/j.ultrasmedbio.2020.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 01/17/2020] [Accepted: 03/10/2020] [Indexed: 06/11/2023]
Abstract
Ultrasound measurement of carotid intima-media thickness (CIMT) and plaque thickness (PT) may be an additional tool for risk stratification of patients with suspected acute coronary syndrome (ACS) in the emergency department (ED). The aim of this study was to evaluate the correlation of CIMT and PT with coronary artery disease (CAD) in risk stratification tests.This prospective observational study was conducted in an academic tertiary care ED. Carotid ultrasound measurements were obtained for emergency patients with suspected ACS. Carotid measurements included PT, mean CIMT and maximum CIMT. The correlations between carotid ultrasound and the results of coronary catheter angiography (CA), coronary computed tomography angiography (CCTA) and stress tests were identified. The convenience sample included 58 patients comprising 39 men and 19 women with a mean age of 60 ± 12 y. Twenty-two percent (13/58) of patients were positive for CAD, as indicated by results of the cardiac risk stratification tests. Presence of plaque correlated with CCTA findings, with a high specificity (92.8%) for a positive test. Max CIMT predicted abnormal CCTA (area under the curve [AUC] = 0.93, 95% confidence interval: 0.80-1). The correlations with stress test (0.78, 0.46-1) and CA (0.55, 0.28-0.82) were weaker. Presence of carotid plaque correlated significantly with findings of CAD on all risk stratification tests, but especially with CCTA. Carotid ultrasound could have a role in risk stratification in the ED, though more research is needed.
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Affiliation(s)
- Brooke Hensley
- Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, Florida, USA.
| | - Calvin Huang
- Department of Emergency Medicine, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts, USA
| | | | - Hamid Shokoohi
- Department of Emergency Medicine, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew Liteplo
- Department of Emergency Medicine, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts, USA
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Ha ET, Cohen M, Fields PJ, Van Daele J, Gaeta TJ. The Utility of Echocardiography for Non-ST-Segment Elevation Myocardial Infarction: A Retrospective Study. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2020. [DOI: 10.1177/8756479319886572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The objectives were to assess factors associated with a higher likelihood of predicting acute coronary atherothrombosis (ACA) in non-ST-segment elevation myocardial infarction (NSTEMI), evaluate the impact of adding echocardiographic data, and develop an algorithm that would reduce overutilization of emergent angiography. Methods: Data were retrospectively analyzed on a patient cohort presenting to an emergency department of an urban community hospital with NSTEMI from October 1, 2015, to July 31, 2018. The inclusion criterion was any adult patient with a first-time, primary diagnosis of NSTEMI without high-risk features. The main outcome variables were the presence of ACA on angiography. Results: Seventy-three patients with NSTEMI were included in this study. Logistic regression analysis identified the following independent variables useful for predicting ACA: age, wall motion abnormality on echo, and levels of low-density lipoprotein. The model’s overall fit was highly significant ( P = .0012). Conclusion: An integrative approach was demonstrated for the management of patients with NSTEMI presenting to the hospital. Although the positive predictive value of echo in predicting ACA was limited, when combined with demographic attributes and risk factors, it proved to be successful in determining the need for angiography in patients with NSTEMI.
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Affiliation(s)
- Edward T. Ha
- St. George’s University School of Medicine, Grenada, WI, USA
- Department of Internal Medicine, New York Presbyterian–Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Marc Cohen
- Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Paul J. Fields
- St. George’s University School of Medicine, Grenada, WI, USA
| | - Jessie Van Daele
- Department of Clinical Research, The Brooklyn Methodist Hospital, Brooklyn, Brooklyn, NY, USA
| | - Theodore J. Gaeta
- Department of Emergency Medicine, New York Presbyterian–Brooklyn Methodist Hospital, Brooklyn, NY, USA
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Fang W, Wang CH, Yu YF, Wang LH, Tang DH, Xu DB, Ding ZY, Gu WH. The feasibility of 1-stop examination of coronary CT angiography and abdominal enhanced CT. Medicine (Baltimore) 2018; 97:e11651. [PMID: 30095622 PMCID: PMC6133558 DOI: 10.1097/md.0000000000011651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aims to evaluate the feasibility of performing coronary computed tomography angiography (CCTA) and abdominal enhanced computed tomography (CT) with 1-time injection of the agent.CCTA images (right coronary artery, left anterior descending coronary artery, and left circumflex coronary artery) were collected from 20 patients who completed a 1-stop combined examination of CCTA and abdominal enhanced CT (group A), 20 patients who only underwent abdominal enhanced CT (group B1), and 20 patients who only underwent CCTA (group B2). These images were interpreted using the 5-point Likert scale system by 2 experienced radiologists, and abdominal images were observed for breathing artifact. CT value, signal-to-noise ratio (SNR), and CTDI were recorded and compare among the 3 groups.The difference in image quality of the coronary and total volume of the contrast agent between group A and group B1 was not statistical significant (P > .05). The CT value and SNR in group B1 (CCTA) (CT: 394.65 ± 59.23, SNR: 17.38 ± 4.13) increased, compare with Group A (CT: 360.35 ± 34.16, SNR: 13.76 ± 1.84, P = .03, .01), while CTDI was undifferentiated between group A (17.14 ± 6.20) and group B1 (18.38 ± 9.79) (P = .64). The difference in CT value and SNR at the arterial phase and CT value at the venous phase between group A (abdomen) and group B2 were statistically significant, the CTDI in group A (9.09 ± 1.05) increased, compared with group B2 (8.23 ± 1.33) (P = .03), and SNR at the venous phase in group B2 (12.50 ± 2.43) increased, compared with group A (10.89 ± 2.03) (P = .03).Revolution CT can capture full images and very rapidly switch to the scan mode, enabling a 1-stop axial CCTA and enhanced helical abdominal scan. The 1-stop combined scan resulted in a satisfactory image quality, which reduced the contrast agent dose and simplified the workflow.The 1-stop combined scan allows for the high success rate of the examination, reduces the number of examinations, and decreases the dose and risk of injection of the contrast agent. This would be helpful for patients to obtain diagnostic images in time.
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Joshi H, Shah R, Prajapati J, Bhangdiya V, Shah J, Kandre Y, Shah K. Diagnostic Accuracy of Computed Tomography Angiography as Compared to Conventional Angiography in Patients Undergoing Noncoronary Cardiac Surgery. Heart Views 2016; 17:88-91. [PMID: 27867455 PMCID: PMC5105229 DOI: 10.4103/1995-705x.192555] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To compare the diagnostic accuracy of multi-slice computed tomography (MSCT) angiography with conventional angiography in patients undergoing major noncoronary cardiac surgeries. MATERIALS AND METHODS We studied fifty major noncoronary cardiac surgery patients scheduled for invasive coronary angiography, 29 (58%) female and 21 (42%) male. Inclusion criteria of the study were age of the patients ≥40 years, having low or intermediate probability of coronary artery disease (CAD), left ventricular ejection fraction (LVEF) >35%, and patient giving informed consent for undergoing MSCT and conventional coronary angiography. The patients with LVEF <35%, high pretest probability of CAD, and hemodynamically unstable were excluded from the study. RESULTS The diagnostic accuracy of CT coronary angiography was evaluated regarding true positive, true negative values. The overall sensitivity and specificity of CT angiography technique was 100% (95% confidence interval [CI]: 39.76%-100%) and 91.30% (95% CI: 79.21%-97.58%). The positive (50%; 95% CI: 15.70%-84.30%) and negative predictive values (100%; 95% CI: 91.59%-100%) of CT angiography were also fairly high in these patients. CONCLUSION Our study suggests that this non-invasive technique may improve perioperative risk stratification in patients undegoing non-cardiac surgery.
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Affiliation(s)
- Hasit Joshi
- Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Ronak Shah
- Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Jayesh Prajapati
- Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Vipin Bhangdiya
- Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Jayal Shah
- Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Yogini Kandre
- Department of Research, U. N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Komal Shah
- Department of Research, U. N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
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Updates on Coronary CTA in the Emergency Department. CURRENT RADIOLOGY REPORTS 2015. [DOI: 10.1007/s40134-015-0096-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Melgies J, Hamilton MCK, Manghat NE. Computed tomographic coronary angiography - is it ready as a screening tool for coronary artery disease? Clin Med (Lond) 2013; 13:465-71. [PMID: 24115703 PMCID: PMC4953797 DOI: 10.7861/clinmedicine.13-5-465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Currently, there are no formal screening programmes for coronary artery disease (CAD). Computed tomographic coronary angiography (CTCA) has been suggested as a non-invasive and reliable method of atherosclerotic plaque assessment, with the potential for use in screening programmes. In this article, we briefly present the current understanding of atherosclerotic plaque formation, explain key technological aspects of CTCA and critique this method in the light of World Health Organisation (WHO) criteria for devising a screening programme. Current evolving and future insights are also considered. Overall, in our view, there is currently insufficient evidence to support the formal use of CTCA in a screening programme for CAD, although this viewpoint will undoubtedly evolve.
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Affiliation(s)
| | - Mark CK Hamilton
- Bristol Royal Infirmary, UK
- Bristol Heart Institute, UK
- NIHR Bristol Biomedical Research Unit, Bristol, UK
| | - Nathan E Manghat
- Bristol Heart Institute, UK
- NIHR Bristol Biomedical Research Unit, Bristol, UK
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Incremental Value of Computed Tomography in Triaging Emergency Department Patients with Acute Chest Pain. Can Assoc Radiol J 2012; 63:275-9. [DOI: 10.1016/j.carj.2011.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 06/14/2011] [Accepted: 06/23/2011] [Indexed: 11/18/2022] Open
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Hoang MVH, Linnau KF, Gill EA, Lehnert BE, Mannelli L. Computed tomography diagnosis of myocardial infarction in a patient with normal initial cardiac biomarkers. Emerg Radiol 2011; 19:75-8. [DOI: 10.1007/s10140-011-0987-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 09/15/2011] [Indexed: 10/17/2022]
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