1
|
Thakur U, Nogic J, Comella A, Nerlekar N, Chan J, Abrahams T, Michail M, Nelson A, Dey D, Ko B, Seneviratne S, Brown AJ. Computed tomography coronary angiography assessment of left main coronary artery stenosis severity. J Cardiovasc Comput Tomogr 2024:S1934-5925(24)00393-9. [PMID: 39025758 DOI: 10.1016/j.jcct.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/16/2024] [Accepted: 07/08/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Angiographic assessment of left main coronary artery (LMCA) stenosis severity can be unreliable. In cases of ambiguity, intravascular ultrasound (IVUS) can be utilised with a minimal lumen area (MLA) of ≥6 mm2 an accepted threshold for safe deferral of revascularization. We sought to assess whether quantitative computer tomography coronary angiography (CTCA) measures could assist clinicians making LMCA revascularization decisions when compared with IVUS as gold standard. METHODS Consecutive patients undergoing IVUS assessment of angiographically intermediate LMCA stenosis were included. All patients had undergone 320-slice CTCA <90 days prior to IVUS imaging. Offline quantitative assessment of IVUS- and CT-derived measures were undertaken with the cohort divided into those with significant (s-LMCA) versus non-significant (ns-LMCA) disease using the accepted IVUS threshold. RESULTS Fifty-eight patients were included, with no difference in mean age (61.5 ± 12.2 vs. 59.7 ± 11.9 years, p = 0.57), diabetic status (24.2% vs 16.0%, p = 0.44) or other baseline demographics between groups. Patients with ns-LMCA had larger CT luminal area (8.64 ± 3.91 vs. 5.41 ± 1.54 mm2, p < 0.001), larger minimal lumen diameter (MLD) (3.25 ± 0.74 vs. 2.56 ± 0.38 mm, p < 0.001) and lower area stenosis (45.74 ± 18.10 vs. 60.93 ± 14.68%, p = 0.001). There was a significant positive correlation between CTCA and IVUS MLA (r = 0.68, p < 0.001) and MLD (r = 0.67, p < 0.001). ROC analysis demonstrated CTCA MLA cut-off <8.29 mm2 provides the greatest negative predictive value and sensitivity in predicting the presence of significant LMCA disease. CONCLUSION CTCA derived MLA and MLD have a strong correlation with IVUS. A CTCA derived MLA cut-off <8.29 mm2 showed greatest clinical utility for predicting the need for further assessment, based on IVUS gold standard.
Collapse
Affiliation(s)
- Udit Thakur
- Monash Cardiovascular Research Centre, MonashHeart, Monash Health, Monash University, Melbourne, Australia
| | - Jason Nogic
- Monash Cardiovascular Research Centre, MonashHeart, Monash Health, Monash University, Melbourne, Australia
| | - Andrea Comella
- Monash Cardiovascular Research Centre, MonashHeart, Monash Health, Monash University, Melbourne, Australia
| | - Nitesh Nerlekar
- Monash Cardiovascular Research Centre, MonashHeart, Monash Health, Monash University, Melbourne, Australia
| | - Jasmine Chan
- Monash Cardiovascular Research Centre, MonashHeart, Monash Health, Monash University, Melbourne, Australia
| | - Timothy Abrahams
- Monash Cardiovascular Research Centre, MonashHeart, Monash Health, Monash University, Melbourne, Australia
| | - Michael Michail
- Monash Cardiovascular Research Centre, MonashHeart, Monash Health, Monash University, Melbourne, Australia
| | - Adam Nelson
- Monash Cardiovascular Research Centre, MonashHeart, Monash Health, Monash University, Melbourne, Australia
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Brian Ko
- Monash Cardiovascular Research Centre, MonashHeart, Monash Health, Monash University, Melbourne, Australia
| | - Sujith Seneviratne
- Monash Cardiovascular Research Centre, MonashHeart, Monash Health, Monash University, Melbourne, Australia
| | - Adam J Brown
- Monash Cardiovascular Research Centre, MonashHeart, Monash Health, Monash University, Melbourne, Australia.
| |
Collapse
|
2
|
Nitrates administered by spray versus tablet: comparison of coronary vasodilation on CT angiography. Eur Radiol 2020; 31:515-524. [PMID: 32785771 DOI: 10.1007/s00330-020-07104-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 05/04/2020] [Accepted: 07/22/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To compare the coronary vasodilation effects of spray with those induced by tablet administration in coronary CT angiography (CCTA). METHODS A total of 2024 patients who underwent CCTA were identified for this retrospective study, including 828 patients with spray (spray group) and 1169 with tablets (tablet group). Of these, 93 patients underwent CCTA at least twice using both spray and tablets. The number of measurable segments and diameters of all 18 segments was measured. The number of measurable segments was compared between groups. RESULTS No statistically significant differences were evident between these two groups in terms of clinical characteristics. All coronary segments except the ramus intermedius (RI) and left posterior descending artery (L-PDA) were significantly larger in the spray group than in the tablet group (all p < 0.001). In peripheral and branch vessels, as well as in central and main coronary arteries, the diameters were significantly larger in the spray group than in the tablet group (all p < 0.001). Although not always statistically significant, all coronary segments tended to be more measurable on CCTA with spray than with tablet. In the subgroup that underwent CCTA twice using both spray and tablets, all coronary segments except the RI, obtuse marginal artery 2 (OM2), and L-PDA were significantly larger in the spray group than in the tablet group (all p < 0.05). CONCLUSION Lingual isosorbide dinitrate (ISDN) spray was more efficacious than sublingual nitroglycerin (NTG) tablets in coronary vasodilation for CCTA. Therefore, lingual ISDN spray should be preferred over sublingual NTG tablets for CCTA. KEY POINTS • Lingual ISDN spray was more efficacious than sublingual NTG tablet for coronary vasodilation in coronary CT angiography, even in elderly patients. • The diameters of all coronary segments except RI and L-PDA were significantly larger, and there were significantly more coronary segments greater than 1.5 mm, except RI and L-PDA, in the spray group than in the tablet group in the whole study group. • Even in peripheral and branch vessels, the diameters of coronary arteries were significantly larger in the spray group than in the tablet group, and they were also larger in elderly patients.
Collapse
|
3
|
Qi L, Shi K, Li C, Ju Z, Mao D, Zhang L, Qu X, Hua Y, Li M. Coronary Computed Tomography (CT) Angiography Characteristics of High-Risk Plaque: Correlation with Stress Myocardial Perfusion Imaging in Patients with Moderate Coronary Stenosis. MEDICAL SCIENCE MONITOR : INTERNATIONAL MEDICAL JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2020; 26:e920950. [PMID: 32495750 PMCID: PMC7294846 DOI: 10.12659/msm.920950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background The aim of this study was to investigate the ability of coronary computed tomographic angiography (CCTA) characteristics of high-risk plaque (HRP) in moderate stenosis to improve differentiation of myocardial ischemia detected by stress CT perfusion (CTP) imaging. Material/Methods Sixty-two patients with coronary plaques and moderate stenosis confirmed by invasive coronary angiography (ICA) had stress CTP and 26 of these patients were found to have myocardial ischemia. The other 36 patients without myocardial ischemia were defined as controls. Characteristics of major plaques on CCTA images of the ischemia and non-ischemia groups were analyzed and compared. Results Differences between the 2 groups were observed in plaque volume, burden and rough inner surface necrotic core volume, plaque-lipid interface and plaque length. In a multivariable analysis, plaque burden and necrotic core volume were significantly associated with myocardial ischemia: plaque burden odds ratio (OR) was 1.28 (95% confidence interval [CI], 1.12–1.48); necrotic core volume OR was 1.78 (95% CI, 1.03–1.34). Compared with other quantitative measurements, optimized thresholds for plaque burden (area under the curve was 0.852) and necrotic core volume (area under the curve was 0.730) showed significantly higher diagnostic performance for ischemia with threshold values of 60.8% and 11.25 mm3, respectively. Conclusions CCTA characteristics of major plaques may improve the discrimination of ACS patients with myocardial ischemia on stress CTP.
Collapse
Affiliation(s)
- Lin Qi
- Department of Radiology, Huadong Hospital Affiliated to Fudan University, Shanghai, China (mainland)
| | - Kailei Shi
- Department of Cardiology, Huadong Hospital Affiliated to Fudan University, Shanghai, China (mainland)
| | - Cheng Li
- Department of Radiology, Huadong Hospital Affiliated to Fudan University, Shanghai, China (mainland)
| | - Zhiguo Ju
- Department of Radiology, College of Medical Imaging, Shanghai University of Medicine and Health Science, Shanghai, China (mainland)
| | - Dingbiao Mao
- Department of Radiology, Huadong Hospital Affiliated to Fudan University, Shanghai, China (mainland)
| | - Lukai Zhang
- Department of Radiology, Huadong Hospital Affiliated to Fudan University, Shanghai, China (mainland)
| | - Xinkai Qu
- Department of Cardiology, Huadong Hospital Affiliated to Fudan University, Shanghai, China (mainland)
| | - Yanqing Hua
- Department of Radiology, Huadong Hospital Affiliated to Fudan University, Shanghai, China (mainland)
| | - Ming Li
- Department of Radiology, Huadong Hospital Affiliated to Fudan University, Shanghai, China (mainland)
| |
Collapse
|