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Manolis AA, Manolis TA, Manolis AS. Managing chronic coronary syndrome: how do we achieve optimal patient outcomes? Expert Rev Cardiovasc Ther 2024; 22:243-263. [PMID: 38757743 DOI: 10.1080/14779072.2024.2357344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 05/15/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION Chronic coronary syndrome (CCS) remains the leading cause of death worldwide with high admission/re-admission rates. Medical databases were searched on CCS & its management. AREAS COVERED This review discusses phenotypes per stress-echocardiography, noninvasive/invasive testing (coronary computed-tomography angiography-CCTA; coronary artery calcium - CAC score; echocardiography assessing wall-motion, LV function, valvular disease; biomarkers), multidisciplinary management (risk factors/anti-inflammatory/anti-ischemic/antithrombotic therapies and revascularization), newer treatments (colchicine/ivabradine/ranolazine/melatonin), cardiac rehabilitation/exercise improving physical activity and quality-of-life, use of the implantable-defibrillator, and treatment with extracorporeal shockwave-revascularization for refractory symptoms. EXPERT OPINION CCS is age-dependent, leading cause of death worldwide with high hospitalization rates. Stress-echocardiography defines phenotypes and guides prophylaxis and management. CAC is a surrogate for atherosclerosis burden, best for patients of intermediate/borderline risk. Higher CAC-scores indicate more severe coronary abnormalities. CCTA is preferred for noninvasive detection of CAC and atherosclerosis burden, determining stenosis' functional significance, and guiding management. Combining CAC score with CCTA improves diagnostic yield and assists prognosis. Echocardiography assesses LV wall-motion and function and valvular disease. Biomarkers guide diagnosis/prognosis. CCS management is multidisciplinary: risk-factor management, anti-inflammatory/anti-ischemic/antithrombotic therapies, and revascularization. Newer therapies comprise colchicine, ivabradine, ranolazine, melatonin, glucagon-like peptide-1-receptor antagonists. Cardiac rehabilitation/exercise improves physical activity and quality-of-life. An ICD protects from sudden death. Extracorporeal shockwave-revascularization treats refractory symptoms.
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Affiliation(s)
| | - Theodora A Manolis
- Department of Psychiatry, Aiginiteio University Hospital, Athens, Greece
| | - Antonis S Manolis
- First Department of Cardiology, Ippokrateio University Hospital, Athens, Greece
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Luciano A, Cerimele C, Mecchia D, Mozzani M, Steffani S, D’Errico F, Di Donna C, De Stasio V, Garaci F, Chiocchi M. The role of cardiac computed tomography in diagnostic and prognostic assessment of pregnancy related spontaneous coronary artery dissection: a case report. Oxf Med Case Reports 2024; 2024:omae030. [PMID: 38680778 PMCID: PMC11049560 DOI: 10.1093/omcr/omae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 02/16/2024] [Accepted: 03/08/2024] [Indexed: 05/01/2024] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is the most common cause of myocardial infarction during pregnancy or the postpartum period and has a major impact on cardiovascular morbidity and death in pregnant women. A 38-year-old woman with sudden cardiac arrest ten days postpartum urgently underwent coronarography, which showed an intraparietal hematoma of the left anterior descending (LAD) artery. Two days later, coronary computed tomography angiography (CCTA) was performed, which showed the evidence of SCAD in the mid-distal tract of LAD and the presence of transmural ischemic infarction in the apex and mid antero-septal wall in delayed acquisition. The patient was treated with a beta-blocker. Four months later CCTA showed complete resolution of SCAD and evolution of the infarcted areas. Given the high accuracy and noninvasiveness of CCTA, our case highlights the potential role of this imaging modality in the diagnosis and follow-up of pregnancy associated SCAD.
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Affiliation(s)
- Alessandra Luciano
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Cecilia Cerimele
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Daniele Mecchia
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Marcello Mozzani
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Simone Steffani
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Francesca D’Errico
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Carlo Di Donna
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Vincenzo De Stasio
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Francesco Garaci
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Marcello Chiocchi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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Tonet E, Amantea V, Lapolla D, Assabbi P, Boccadoro A, Berloni ML, Micillo M, Marchini F, Chiarello S, Cossu A, Campo G. Cardiac Computed Tomography in Monitoring Revascularization. J Clin Med 2023; 12:7104. [PMID: 38002715 PMCID: PMC10672590 DOI: 10.3390/jcm12227104] [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: 09/23/2023] [Revised: 11/01/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
The use of coronary computed tomography angiography (CCTA) in the setting of stable coronary artery disease is highly recommended for low-risk patients. High-risk patients, such as symptomatic subjects with prior revascularization, are suggested to be investigated with noninvasive functional tests or invasive coronary angiography. CCTA is not considered for these patients because of some well-known CCTA artifacts, such as blooming and motion artifacts. However, new technology has allowed us to obtain images with high spatial resolution, overcoming these well-known limitations of CCTA. Furthermore, the introduction of CT-derived fractional flow reserve and stress CT perfusion has made CCTA a comprehensive examination, including anatomical and functional assessments of coronary plaques. Additionally, CCTA allows for plaque characterization, which has become a cornerstone for the optimization of medical therapy, which is not possible with functional tests. Recent evidence has suggested that CCTA could be used with the aim of monitoring revascularization, both after coronary bypass grafts and percutaneous coronary intervention. With this background information, CCTA can also be considered the exam of choice in subjects with a history of revascularization. The availability of a noninvasive anatomic test for patients with previous coronary revascularization and its possible association with functional assessments in a single exam could play a key role in the follow-up management of these subjects, especially considering the rate of false-positive and negative results of noninvasive functional tests. The present review summarizes the main evidence about CCTA and coronary artery bypass grafts, complex percutaneous coronary intervention, and bioresorbable stent implantation.
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Affiliation(s)
- Elisabetta Tonet
- Cardiology Unit, Azienda Ospedaliero Universitaria of Ferrara, 44124 Ferrara, Italy
| | - Veronica Amantea
- Cardiology Unit, Azienda Ospedaliero Universitaria of Ferrara, 44124 Ferrara, Italy
| | - Davide Lapolla
- Cardiology Unit, Azienda Ospedaliero Universitaria of Ferrara, 44124 Ferrara, Italy
| | - Paolo Assabbi
- Cardiology Unit, Azienda Ospedaliero Universitaria of Ferrara, 44124 Ferrara, Italy
| | - Alberto Boccadoro
- Cardiology Unit, Azienda Ospedaliero Universitaria of Ferrara, 44124 Ferrara, Italy
| | | | - Marco Micillo
- Cardiology Unit, Azienda Ospedaliero Universitaria of Ferrara, 44124 Ferrara, Italy
| | - Federico Marchini
- Cardiology Unit, Azienda Ospedaliero Universitaria of Ferrara, 44124 Ferrara, Italy
| | - Serena Chiarello
- Radiology Unit, Department of Translational Medicine, University of Ferrara, 44124 Ferrara, Italy
| | - Alberto Cossu
- Radiology Unit, Department of Translational Medicine, University of Ferrara, 44124 Ferrara, Italy
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliero Universitaria of Ferrara, 44124 Ferrara, Italy
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Zhang Y, Liu P, Tang LJ, Lin PM, Li R, Luo HR, Luo P. Basing on the machine learning model to analyse the coronary calcification score and the coronary flow reserve score to evaluate the degree of coronary artery stenosis. Comput Biol Med 2023; 163:107130. [PMID: 37329614 DOI: 10.1016/j.compbiomed.2023.107130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/23/2023] [Accepted: 06/01/2023] [Indexed: 06/19/2023]
Abstract
AIM To obtain the coronary artery calcium score (CACS) for each branch in coronary artery computed tomography angiography (CCTA) examination combined with the flow fraction reserve (FFR) of each branch in the coronary artery detected by CT and apply a machine learning model (ML) to analyse and predict the severity of coronary artery stenosis. METHODS All patients who underwent coronary computed tomography angiography (CCTA) from January 2019 to April 2022 in the HOSPITAL (T.C.M) AFFILIATED TO SOUTHWEST MEDICAL UNIVERSITY) were retrospectively screened, and their sex, age, characteristics of lipid-containing lesions, coronary calcium score (CACS) and CT-FFR values were collected. Five machine learning models, random forest (RF), k-nearest neighbour algorithm (KNN), kernel logistic regression, support vector machine (SVM) and radial basis function neural network (RBFNN), were used as predictive models to evaluate the severity of coronary stenosis. RESULTS Among the five machine learning models, the SVM model achieved the best prediction performance, and the prediction accuracy of mild stenosis was up to 90%. Second, age and male sex were important influencing factors of increasing CACS and decreasing CT-FFR. Moreover, the critical CACS value of myocardial ischemia >200.70 was calculated. CONCLUSION Through computer machine learning model analysis, we prove the importance of CACS and FFR in predicting coronary stenosis, especially the prominent vector machine model, which promotes the application of artificial intelligence computer learning methods in the field of medical analysis.
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Affiliation(s)
- Ying Zhang
- State Key Laboratories for Quality Research in Chinese Medicines, Faculty of Pharmacy, Macau University of Science and Technology, Macau; Department of Anaesthesiology, HOSPITAL (T.C.M) AFFILIATED TO SOUTHWEST MEDICAL UNIVERSITY), Lu Zhou, (646000), Sichuan, China.
| | - Ping Liu
- Department of Anaesthesiology, HOSPITAL (T.C.M) AFFILIATED TO SOUTHWEST MEDICAL UNIVERSITY), Lu Zhou, (646000), Sichuan, China.
| | - Li-Jia Tang
- Department of Anaesthesiology, HOSPITAL (T.C.M) AFFILIATED TO SOUTHWEST MEDICAL UNIVERSITY), Lu Zhou, (646000), Sichuan, China.
| | - Pei-Min Lin
- Department of Anaesthesiology, HOSPITAL (T.C.M) AFFILIATED TO SOUTHWEST MEDICAL UNIVERSITY), Lu Zhou, (646000), Sichuan, China.
| | - Run Li
- Department of Anaesthesiology, HOSPITAL (T.C.M) AFFILIATED TO SOUTHWEST MEDICAL UNIVERSITY), Lu Zhou, (646000), Sichuan, China.
| | - Huai-Rong Luo
- State Key Laboratories for Quality Research in Chinese Medicines, Faculty of Pharmacy, Macau University of Science and Technology, Macau.
| | - Pei Luo
- State Key Laboratories for Quality Research in Chinese Medicines, Faculty of Pharmacy, Macau University of Science and Technology, Macau.
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Tonet E, Boccadoro A, Micillo M, Cocco M, Cossu A, Pompei G, Giganti M, Campo G. Coronary Computed Tomography Angiography: Beyond Obstructive Coronary Artery Disease. Life (Basel) 2023; 13:1086. [PMID: 37240730 PMCID: PMC10223586 DOI: 10.3390/life13051086] [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: 03/09/2023] [Revised: 04/10/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Abstract
Nowadays, coronary computed tomography angiography (CCTA) has a role of paramount importance in the diagnostic algorithm of ischemic heart disease (IHD), both in stable coronary artery disease (CAD) and acute chest pain. Alongside the quantification of obstructive coronary artery disease, the recent technologic developments in CCTA provide additional relevant information that can be considered as "novel markers" for risk stratification in different settings, including ischemic heart disease, atrial fibrillation, and myocardial inflammation. These markers include: (i) epicardial adipose tissue (EAT), associated with plaque development and the occurrence of arrhythmias; (ii) late iodine enhancement (LIE), which allows the identification of myocardial fibrosis; and (iii) plaque characterization, which provides data about plaque vulnerability. In the precision medicine era, these emerging markers should be integrated into CCTA evaluation to allow for the bespoke interventional and pharmacological management of each patient.
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Affiliation(s)
- Elisabetta Tonet
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy
| | - Alberto Boccadoro
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy
| | - Marco Micillo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy
| | - Marta Cocco
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy
| | - Alberto Cossu
- Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, 44121 Ferrara, Italy
| | - Graziella Pompei
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy
| | - Melchiore Giganti
- Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, 44121 Ferrara, Italy
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, Italy
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Rabbat MG, Lakshmanan S, Benjamin MM, Doros G, Kinninger A, Budoff MJ, Bhatt DL. Benefit of icosapent ethyl on coronary physiology assessed by computed tomography angiography fractional flow reserve: EVAPORATE-FFRCT. Eur Heart J Cardiovasc Imaging 2023:7135508. [PMID: 37082990 PMCID: PMC10284047 DOI: 10.1093/ehjci/jead063] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/08/2022] [Accepted: 03/10/2023] [Indexed: 04/22/2023] Open
Abstract
AIMS Icosapent ethyl (IPE) significantly reduced ischaemic events in statin-treated patients with atherosclerosis or diabetes and elevated triglycerides in REDUCE-IT, including large reductions in myocardial infarction and elective, urgent, and emergent coronary revascularization. However, the mechanisms driving this clinical benefit are not fully known. The EVAPORATE trial demonstrated that IPE significantly reduced plaque burden. No study to date has assessed the impact of IPE on coronary physiology. Fractional flow reserve (FFR) derived from coronary computed tomography angiography (CTA) data sets (FFRCT) applies computational fluid dynamics to calculate FFR values in epicardial coronary arteries. Our objective was to assess the impact of IPE on coronary physiology assessed by FFRCT using imaging data from EVAPORATE. METHODS AND RESULTS A total of 47 patients and of 507 coronary lesions at baseline, 9 months, and 18 months with coronary CTA and FFRCT were studied in a blinded core lab. The pre-specified primary endpoint was the FFRCT value in the distal coronary segment from baseline to follow-up in the most diseased vessel per patient using IPE compared with placebo. The pre-specified secondary endpoint was the change in translesional FFRCT (ΔFFRCT) across the most severe (minimum 30% diameter stenosis) coronary lesion per vessel. Baseline FFRCT was similar for IPE compared with placebo (0.83 ± 0.08 vs. 0.84 ± 0.08, P = 0.55). There was significant improvement in the primary endpoint, as IPE improved mean distal segment FFRCT at 9- and 18-month follow-up compared with placebo (0.01 ± 0.05 vs. -0.05 ± 0.09, P = 0.02, and -0.01 ± 0.09 vs. -0.09 ± 0.12, P = 0.03, respectively). ΔFFRCT in 140 coronary lesions was improved, although not statistically significant, with IPE compared with placebo (-0.06 ± 0.08 vs. -0.09 ± 0.1, P = 0.054). CONCLUSION Icosapent ethyl demonstrated significant benefits in coronary physiology compared with placebo. This early and sustained improvement in FFRCT at 9- and 18-month follow-up provides mechanistic insight into the clinical benefit observed in the REDUCE-IT trial. Furthermore, this is the first assessment of FFRCT to determine drug effect.
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Affiliation(s)
- Mark G Rabbat
- Department of Medicine, Division of Cardiology, Loyola University Medical Center, 2160 S. 1st Avenue, Maywood, IL 60153, USA
- Department of Medicine, Division of Cardiology, Edward Hines Jr. VA Hospital, 5000 South 5th Avenue, Hines, IL, USA
| | - Suvasini Lakshmanan
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA 90502, USA
| | - Mina M Benjamin
- Department of Medicine, Division of Cardiology, Loyola University Medical Center, 2160 S. 1st Avenue, Maywood, IL 60153, USA
| | - Gheorghe Doros
- Department of Biostatistics, Baim Institute for clinical research, Boston University, 930 Commonwealth Ave #3, Boston, MA 02215, USA
| | - April Kinninger
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA 90502, USA
| | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA 90502, USA
| | - Deepak L Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, Box 1030, New York, NY 10029, USA
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Liu B, Li Q, Ding H, Wang S, Pang L, Li L. Myocardial injury is a risk factor for 6-week mortality in liver cirrhosis associated esophagogastric variceal bleeding. Sci Rep 2023; 13:6237. [PMID: 37069298 PMCID: PMC10107553 DOI: 10.1038/s41598-023-33325-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/11/2023] [Indexed: 04/19/2023] Open
Abstract
This study sought to investigate risk factors for 6-week mortality of patients with decompensated liver cirrhosis associated esophagogastric variceal bleeding (EGVB) and clinical characteristics of myocardial injury in cirrhotic patients with EGVB. This retrospective cohort study included 249 patients with decompensated liver cirrhosis associated EGVB in the Department of Emergency. Patients were divided into two groups including liver cirrhosis associated EGVB without myocardial injury and liver cirrhosis associated EGVB with myocardial injury. Myocardial injury, recurrent bleeding, total bilirubin (TBIL) level and dyslipidemia are independent risk factors for 6-week mortality in liver cirrhosis associated EGVB. Among all patients with liver cirrhosis associated EGVB, 90 (36.2%) had myocardial injury and 159 individuals (63.8%) not. The 6-week mortality in the group with myocardial injury was 21%, which was significantly higher than that of 7% in the group without myocardial injury. More patients in the myocardial injury group smoked, had moderate to severe esophageal varices, liver failure, and Child-Pugh C liver function compared to the non-myocardial injury group. Myocardial injury, recurrent bleeding, TBIL level and dyslipidemia are independent risk factors for death within 6 weeks in liver cirrhosis associated EGVB. The 6-week mortality is considerably higher in patients with myocardial injury in liver cirrhosis associated EGVB than those without myocardial injury.
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Affiliation(s)
- Bihan Liu
- Department of Gastroenterology and Hepatology, Beijing You'an Hospital, Capital Medical University, Beijing, 100069, China
| | - Qi Li
- Department of Gastroenterology and Hepatology, Beijing You'an Hospital, Capital Medical University, Beijing, 100069, China
| | - Huiguo Ding
- Department of Gastroenterology and Hepatology, Beijing You'an Hospital, Capital Medical University, Beijing, 100069, China
| | - Shanshan Wang
- Department of Molecular Biology, Beijing Institute of Hepatology, Beijing You'an Hospital, Capital Medical University, Beijing, 100069, China
| | - Lifang Pang
- Department of Electrocardiography, Beijing You'an Hospital, Capital Medical University, Beijing, 100069, China
| | - Lei Li
- Department of Gastroenterology and Hepatology, Beijing You'an Hospital, Capital Medical University, Beijing, 100069, China.
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Yang P, Zhao R, Deng W, An S, Li Y, Sheng M, Chen X, Qian Y, Yu Y, Mu D, Wang Y, Li X. Feasibility and accuracy of coronary artery calcium score on virtual non-contrast images derived from a dual-layer spectral detector CT: A retrospective multicenter study. Front Cardiovasc Med 2023; 10:1114058. [PMID: 36937907 PMCID: PMC10018184 DOI: 10.3389/fcvm.2023.1114058] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/10/2023] [Indexed: 03/06/2023] Open
Abstract
Rationale and objective This retrospective study was to evaluate the feasibility and accuracy of coronary artery calcium score (CACS) from virtual non-contrast (VNC) images in comparison with that from true non-contrast (TNC) images. Materials and methods A total of 540 patients with suspected of coronary artery disease (CAD) who underwent a dual-layer spectral detector CT (SDCT) in three hospitals were eligible for this study and 233 patients were retrospectively enrolled for further analysis. The CACS was calculated from both TNC and VNC images and compared. Linear regression analysis of the CACS was performed between TNC and VNC images. Results The correlation of overall CACS from VNC and TNC images was very strong (r = 0.923, p < 0.001). The CACS from VNC images were lower than that from TNC images (221 versus. 69, p < 0.001). When the regression equation of the overall coronary artery was applied, the mean calibrated CACS-VNC was 221 which had a significant difference from the CACS-TNC (p = 0.017). When the regression equation of each coronary branch artery was applied, the mean calibrated CACS-VNC was 221, which had a significant difference from the CACS-TNC (p = 0.003). But the mean difference between the CACS-TNC and the calibrated CACS-VNC in either way was less than 1. The agreement on risk stratification with CACS-TNC and CCACS-VNC was almost perfect. Conclusion This multicenter study with dual-layer spectral detector CT showed that it was feasible to calculate CACS from the VNC images derived from the spectral coronary artery CT angiography scan, and the results were in good accordance with the TNC images after correction. Therefore, the TNC scan could be omitted, reducing the radiation dose to patients and saving examination time while using dual-layer spectral detector CT.
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Affiliation(s)
- Panpan Yang
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, Hefei, Anhui, China
| | - Ren Zhao
- Department of Cardiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Wei Deng
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, Hefei, Anhui, China
| | - Shutian An
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, Hefei, Anhui, China
| | - Yuguo Li
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, Hefei, Anhui, China
| | - Mao Sheng
- Department of Radiology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Xingbiao Chen
- Clinical Science, Philips Healthcare, Shanghai, China
| | - Yingfeng Qian
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, Hefei, Anhui, China
| | - Yongqiang Yu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, Hefei, Anhui, China
| | - Dan Mu
- Department of Radiology, Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- *Correspondence: Dan Mu, ; Yining Wang, ; Xiaohu Li,
| | - Yining Wang
- Department of Radiology, Peking Union Medical College Hospital, Beijing, China
- *Correspondence: Dan Mu, ; Yining Wang, ; Xiaohu Li,
| | - Xiaohu Li
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, Hefei, Anhui, China
- *Correspondence: Dan Mu, ; Yining Wang, ; Xiaohu Li,
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Huang Y, Ren Y, Yang H, Ding Y, Liu Y, Yang Y, Mao A, Yang T, Wang Y, Xiao F, He Q, Zhang Y. Using a machine learning-based risk prediction model to analyze the coronary artery calcification score and predict coronary heart disease and risk assessment. Comput Biol Med 2022; 151:106297. [PMID: 36435054 DOI: 10.1016/j.compbiomed.2022.106297] [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: 08/07/2022] [Revised: 10/12/2022] [Accepted: 11/06/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To calculate the coronary artery calcification score (CACS) obtained from coronary artery computed tomography angiography (CCTA) examination and combine it with the influencing factors of coronary artery calcification (CAC), which is then analyzed by machine learning (ML) to predict the probability of coronary heart disease(CHD). METHODS All patients who were admitted to the Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University from January 2019 to March 2022, suspected of CHD, and underwent CCTA inspection were retrospectively selected. The degree of CAC was quantified based on the Agatston score. To compare the correlation between the CACS and clinical-related factors, we collected 31 variables, including hypertension, diabetes, smoking, hyperlipidemia, among others. ML models containing the random forest (RF), radial basis function neural network (RBFNN),support vector machine (SVM),K-Nearest Neighbor algorithm (KNN) and kernel ridge regression (KRR) were used to assess the risk of CHD based on CACS and clinical-related factors. RESULTS Among the five ML models, RF achieves the best performance about accuracy (ACC) (78.96%), sensitivity (SN) (93.86%), specificity(Spe) (51.13%), and Matthew's correlation coefficient (MCC) (0.5192).It also has the best area under the receiver operator characteristic curve (ROC) (0.8375), which is far superior to the other four ML models. CONCLUSION Computer ML model analysis confirmed the importance of CACS in predicting the occurrence of CHD, especially the outstanding RF model, making it another advancement of the ML model in the field of medical analysis.
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Affiliation(s)
- Yue Huang
- Department of Anesthesiology, Hospital (T.C.M) Affiliated to Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - YingBo Ren
- Department of Anesthesiology, Hospital (T.C.M) Affiliated to Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Hai Yang
- Department of Anesthesiology, Hospital (T.C.M) Affiliated to Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - YiJie Ding
- Yangtze Delta Region Institute (Quzhou), University of Electronic Science and Technology of China, 324000, Quzhou, Zhejiang, China
| | - Yan Liu
- Department of Anesthesiology, Hospital (T.C.M) Affiliated to Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - YunChun Yang
- Department of Anesthesiology, Hospital (T.C.M) Affiliated to Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - AnQiong Mao
- Department of Anesthesiology, Hospital (T.C.M) Affiliated to Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Tan Yang
- Department of Cardiac and Vascular Surgery, Hospital (T.C.M) Affiliated to Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - YingZi Wang
- Southwest Medical University, Luzhou, 646099, Sichuan, China
| | - Feng Xiao
- Southwest Medical University, Luzhou, 646099, Sichuan, China
| | - QiZhou He
- Department of Radiology,Hospital (T.C.M) Affiliated to Southwest Medical University, Luzhou, 646000, Sichuan, China.
| | - Ying Zhang
- Department of Anesthesiology, Hospital (T.C.M) Affiliated to Southwest Medical University, Luzhou, 646000, Sichuan, China.
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10
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Schuessler M, Saner F, Al-Rashid F, Schlosser T. Diagnostic accuracy of coronary computed tomography angiography-derived fractional flow reserve (CT-FFR) in patients before liver transplantation using CT-FFR machine learning algorithm. Eur Radiol 2022; 32:8761-8768. [PMID: 35729425 DOI: 10.1007/s00330-022-08921-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 05/19/2022] [Accepted: 05/30/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Liver transplantation (LT) is associated with high stress on the cardiovascular system. Ruling out coronary artery disease (CAD) is an important part of evaluation for LT. The aim of our study was to assess whether CT-derived fractional flow reserve (CT-FFR) allows for differentiation of hemodynamically significant and non-significant coronary stenosis in patients evaluated for LT. METHODS In total, 201 patients undergoing LT evaluation were included in the study. The patients received coronary computed tomography angiography (CCTA) to rule out CAD and invasive coronary angiography (ICA) to further evaluate coronary lesions found in CCTA if a significant (≥ 50 % on CCTA) stenosis was suspected. CT-FFR was computed from CCTA datasets using a machine learning-based algorithm and compared to ICA as a standard of reference. Coronary lesions with CT-FFR ≤ 0.80 were defined as hemodynamically significant. RESULTS In 127 of 201 patients (63%), an obstructive CAD was ruled out by CCTA. In the remaining 74 patients (37%), at least one significant stenosis was suspected in CCTA. Compared to ICA, sensitivity, specificity, PPV, and NPV of the CT-FFR measurements were 71% (49-92%), 90% (82-98%), 67% (45-88%), and 91% (84-99%), respectively. The diagnostic accuracy was 85% (85-86%). In 69% of cases (52 of 75 lesions), additional analysis by CT-FFR correctly excluded the hemodynamic significance of the stenosis. CONCLUSIONS Machine learning-based CT-FFR seems to be a very promising noninvasive approach for exclusion of hemodynamic significant coronary stenoses in patients undergoing evaluation for LT and could help to reduce the rate of invasive coronary angiography in this high-risk population. KEY POINTS • Machine learning-based computed tomography-derived fractional flow reserve (CT-FFR) seems to be a very promising noninvasive approach for exclusion of hemodynamic significance of coronary stenoses in patients undergoing evaluation for liver transplantation and could help to reduce the rate of invasive coronary angiography in this high-risk population.
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Affiliation(s)
- Maximilian Schuessler
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.
| | - Fuat Saner
- Department of General-, Visceral- and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Fadi Al-Rashid
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Thomas Schlosser
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
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11
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Spione F, Arevalos V, Gabani R, Sabaté M, Brugaletta S. Coronary Microvascular Angina: A State-of-the-Art Review. Front Cardiovasc Med 2022; 9:800918. [PMID: 35433857 PMCID: PMC9005807 DOI: 10.3389/fcvm.2022.800918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 03/08/2022] [Indexed: 12/28/2022] Open
Abstract
Up to 60–70% of patients, undergoing invasive coronary angiography due to angina and demonstrable myocardial ischemia with provocative tests, do not have any obstructive coronary disease. Coronary microvascular angina due to a dysfunction of the coronary microcirculation is the underlying cause in almost 50% of these patients, associated with a bad prognosis and poor quality of life. In recent years, progress has been made in the diagnosis and management of this condition. The aim of this review is to provide an insight into current knowledge of this condition, from current diagnostic methods to the latest treatments.
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Affiliation(s)
- Francesco Spione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Victor Arevalos
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Rami Gabani
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Manel Sabaté
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Salvatore Brugaletta
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- *Correspondence: Salvatore Brugaletta,
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12
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Baggiano A, Italiano G, Guglielmo M, Fusini L, Guaricci AI, Maragna R, Giacari CM, Mushtaq S, Conte E, Annoni AD, Formenti A, Mancini ME, Andreini D, Rabbat M, Pepi M, Pontone G. Changing Paradigms in the Diagnosis of Ischemic Heart Disease by Multimodality Imaging. J Clin Med 2022; 11:jcm11030477. [PMID: 35159929 PMCID: PMC8836710 DOI: 10.3390/jcm11030477] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/24/2021] [Accepted: 01/13/2022] [Indexed: 02/01/2023] Open
Abstract
Coronary artery disease (CAD) represents the most common cardiovascular disease, with high morbidity and mortality. Historically patients with chest pain of suspected coronary origin have been assessed with functional tests, capable to detect haemodynamic consequences of coronary obstructions through depiction of electrocardiographic changes, myocardial perfusion defects or regional wall motion abnormalities under stress condition. Stress echocardiography (SE), single-photon emission computed tomography (SPECT), positron emission tomography (PET) and cardiovascular magnetic resonance (CMR) represent the functional techniques currently available, and technical developments contributed to increased diagnostic performance of these techniques. More recently, cardiac computed tomography angiography (cCTA) has been developed as a non-invasive anatomical test for a direct visualisation of coronary vessels and detailed description of atherosclerotic burden. Cardiovascular imaging techniques have dramatically enhanced our knowledge regarding physiological aspects and myocardial implications of CAD. Recently, after the publication of important trials, international guidelines recognised these changes, updating indications and level of recommendations. This review aims to summarise current standards with main novelties and specific limitations, and a diagnostic algorithm for up-to-date clinical management is also proposed.
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Affiliation(s)
- Andrea Baggiano
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
- Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Gianpiero Italiano
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Marco Guglielmo
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Laura Fusini
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Andrea Igoren Guaricci
- Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico of Bari, 70124 Bari, Italy;
| | - Riccardo Maragna
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Carlo Maria Giacari
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Saima Mushtaq
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Edoardo Conte
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | - Andrea Daniele Annoni
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Alberto Formenti
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Maria Elisabetta Mancini
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Daniele Andreini
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
- Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Mark Rabbat
- Division of Cardiology, Department of Medicine and Radiology, Loyola University of Chicago, Chicago, IL 60660, USA;
- Division of Cardiology, Department of Medicine, Edward Hines Jr. VA Hospital, Hines, IL 60141, USA
| | - Mauro Pepi
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
| | - Gianluca Pontone
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (G.I.); (M.G.); (L.F.); (R.M.); (C.M.G.); (S.M.); (E.C.); (A.D.A.); (A.F.); (M.E.M.); (D.A.); (M.P.)
- Correspondence: ; Tel.: +39-02-5800-2574; Fax: +39-02-5800-2231
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Pradella S, Zantonelli G, Grazzini G, Cozzi D, Danti G, Acquafresca M, Miele V. The Radiologist as a Gatekeeper in Chest Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6677. [PMID: 34205792 PMCID: PMC8296491 DOI: 10.3390/ijerph18126677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 12/20/2022]
Abstract
Chest pain is a symptom that can be found in life-threatening conditions such as acute coronary syndrome (ACS). Those patients requiring invasive coronary angiography treatment or surgery should be identified. Often the clinical setting and laboratory tests are not sufficient to rule out a coronary or aortic syndrome. Cardiac radiological imaging has evolved in recent years both in magnetic resonance (MR) and in computed tomography (CT). CT, in particular, due to its temporal and spatial resolution, the quickness of the examination, and the availability of scanners, is suitable for the evaluation of these patients. In particular, the latest-generation CT scanners allow the exclusion of diagnoses such as coronary artery disease and aortic pathology, thereby reducing the patient's stay in hospital and safely selecting patients by distinguishing those who do not need further treatment from those who will need more- or less-invasive therapies. CT additionally reduces costs by improving long-term patient outcome. The limitations related to patient characteristics and those related to radiation exposure are weakening with the improvement of CT technology.
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Affiliation(s)
- Silvia Pradella
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy; (G.Z.); (G.G.); (D.C.); (G.D.); (M.A.); (V.M.)
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
| | - Giulia Zantonelli
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy; (G.Z.); (G.G.); (D.C.); (G.D.); (M.A.); (V.M.)
| | - Giulia Grazzini
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy; (G.Z.); (G.G.); (D.C.); (G.D.); (M.A.); (V.M.)
| | - Diletta Cozzi
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy; (G.Z.); (G.G.); (D.C.); (G.D.); (M.A.); (V.M.)
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
| | - Ginevra Danti
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy; (G.Z.); (G.G.); (D.C.); (G.D.); (M.A.); (V.M.)
| | - Manlio Acquafresca
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy; (G.Z.); (G.G.); (D.C.); (G.D.); (M.A.); (V.M.)
| | - Vittorio Miele
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy; (G.Z.); (G.G.); (D.C.); (G.D.); (M.A.); (V.M.)
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Coronary Computer Tomography Angiography in 2021-Acquisition Protocols, Tips and Tricks and Heading beyond the Possible. Diagnostics (Basel) 2021; 11:diagnostics11061072. [PMID: 34200866 PMCID: PMC8230532 DOI: 10.3390/diagnostics11061072] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/06/2021] [Accepted: 06/09/2021] [Indexed: 01/09/2023] Open
Abstract
Recent technological advances, together with an increasing body of evidence from randomized trials, have placed coronary computer tomography angiography (CCTA) in the center of the diagnostic workup of patients with coronary artery disease. The method was proven reliable in the diagnosis of relevant coronary artery stenosis. Furthermore, it can identify different stages of the atherosclerotic process, including early atherosclerotic changes of the coronary vessel wall, a quality not met by other non-invasive tests. In addition, newer computational software can measure the hemodynamic relevance (fractional flow reserve) of a certain stenosis. In addition, if required, information related to cardiac and valvular function can be provided with specific protocols. Importantly, recent trials have highlighted the prognostic relevance of CCTA in patients with coronary artery disease, which helped establishing CCTA as the first-line method for the diagnostic work-up of such patients in current guidelines. All this can be gathered in one relatively fast examination with minimal discomfort for the patient and, with newer machines, with very low radiation exposure. Herein, we provide an overview of the current technical aspects, indications, pitfalls, and new horizons with CCTA, providing examples from our own clinical practice.
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15
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Bays HE, Khera A, Blaha MJ, Budoff MJ, Toth PP. Ten things to know about ten imaging studies: A preventive cardiology perspective ("ASPC top ten imaging"). Am J Prev Cardiol 2021; 6:100176. [PMID: 34327499 PMCID: PMC8315431 DOI: 10.1016/j.ajpc.2021.100176] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 02/07/2023] Open
Abstract
Knowing the patient's current cardiovascular disease (CVD) status, as well as the patient's current and future CVD risk, helps the clinician make more informed patient-centered management recommendations towards the goal of preventing future CVD events. Imaging tests that can assist the clinician with the diagnosis and prognosis of CVD include imaging studies of the heart and vascular system, as well as imaging studies of other body organs applicable to CVD risk. The American Society for Preventive Cardiology (ASPC) has published "Ten Things to Know About Ten Cardiovascular Disease Risk Factors." Similarly, this "ASPC Top Ten Imaging" summarizes ten things to know about ten imaging studies related to assessing CVD and CVD risk, listed in tabular form. The ten imaging studies herein include: (1) coronary artery calcium imaging (CAC), (2) coronary computed tomography angiography (CCTA), (3) cardiac ultrasound (echocardiography), (4) nuclear myocardial perfusion imaging (MPI), (5) cardiac magnetic resonance (CMR), (6) cardiac catheterization [with or without intravascular ultrasound (IVUS) or coronary optical coherence tomography (OCT)], (7) dual x-ray absorptiometry (DXA) body composition, (8) hepatic imaging [ultrasound of liver, vibration-controlled transient elastography (VCTE), CT, MRI proton density fat fraction (PDFF), magnetic resonance spectroscopy (MRS)], (9) peripheral artery / endothelial function imaging (e.g., carotid ultrasound, peripheral doppler imaging, ultrasound flow-mediated dilation, other tests of endothelial function and peripheral vascular imaging) and (10) images of other body organs applicable to preventive cardiology (brain, kidney, ovary). Many cardiologists perform cardiovascular-related imaging. Many non-cardiologists perform applicable non-cardiovascular imaging. Cardiologists and non-cardiologists alike may benefit from a working knowledge of imaging studies applicable to the diagnosis and prognosis of CVD and CVD risk - both important in preventive cardiology.
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Affiliation(s)
- Harold E. Bays
- Louisville Metabolic and Atherosclerosis Research Center, 3288 Illinois Avenue, Louisville KY 40213 USA
| | - Amit Khera
- UT Southwestern Medical Center, Dallas, TX USA
| | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore MD USA
| | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor-UCLA, Torrance CA USA
| | - Peter P. Toth
- CGH Medical Cener, Sterling, IL 61081 USA
- Cicarrone center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD USA
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Coronary Microvascular Dysfunction: PET, CMR and CT Assessment. J Clin Med 2021; 10:jcm10091848. [PMID: 33922841 PMCID: PMC8123021 DOI: 10.3390/jcm10091848] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/16/2021] [Accepted: 04/21/2021] [Indexed: 01/05/2023] Open
Abstract
Microvascular dysfunction is responsible for chest pain in various kinds of patients, including those with obstructive coronary artery disease and persistent symptoms despite revascularization, or those with myocardial disease without coronary stenosis. Its diagnosis can be performed with an advanced imaging technique such as positron emission tomography, which represents the gold standard for diagnosing microvascular abnormalities. In recent years, cardiovascular magnetic resonance and cardiac computed tomography have demonstrated to be emerging modalities for microcirculation assessment. The identification of microvascular disease represents a fundamental step in the characterization of patients with chest pain and no epicardial coronary disease: its identification is important to manage medical strategies and improve prognosis. The present overview summarizes the main techniques and current evidence of these advanced imaging strategies in assessing microvascular dysfunction and, if present, their relationship with invasive evaluation.
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