The Role of Coronary CT Angiography in the Evaluation of Dual Left Anterior Descending Artery Prevalence and Subtypes: A Retrospective Multicenter Study

Apical Acute Myocardial Infarction Due to Occluded Posterior Descending Branch of Right Coronary Artery Concomitant With Short Left Anterior Descending Artery: Multi-imaging Modality Assessment

Regional wall motion abnormality in the left ventricular (LV) apex detected on transthoracic echocardiography is commonly interpreted as the presence of a distal left anterior descending (LAD) artery lesion in clinical practice. Herein, we reported a rare case of apical acute myocardial infarction (AMI) caused by an occluded posterior descending branch of the right coronary artery (RCA), in which the correspondence between coronary arterial anatomy and supplied LV apex was evaluated by multi-imaging modalities. Despite the presence of regional wall motion abnormality in the LV apex, left coronary angiography showed no significant coronary artery diseases. It was of note that LAD terminated before the LV apex. Right coronary angiography showed total occlusion of the posterior descending branch. Cardiac computed tomography (CT) clearly demonstrated that the spontaneously recanalized posterior descending branch extended toward the LV apex. Cardiac magnetic resonance imaging (MRI) clearly revealed regional wall motion abnormality corresponding to myocardial edema in the LV apex. Cardiac CT and MRI were powerful tools in clarifying the correspondence between coronary arterial anatomy and supplied LV apex. Clinicians should be aware that localized apical AMI can occur under the condition of occluded posterior descending branch of RCA concomitant with short LAD.

The Role of the 18F-FDG PET/CT in the Management of Patients Suspected of Cardiac Implantable Electronic Devices' Infection

Background: Infection of Cardiac Implantable Electronic Devices (CIEDI) is a real public health problem. The main aim of this study was to determine the diagnostic performance of 18F-FDG PET/CT in the diagnosis of CIEDI. Methods: A total of 48 patients, who performed 18F-FDG PET/CT for the clinical suspicion of CIEDI were retrospectively analyzed; all patients were provided with a model with procedural recommendations before the exam. Sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy (DA) of 18F-FDG PET/CT were calculated; the reproducibility of qualitative analysis was assessed with Cohen's κ test. The semi-quantitative parameters (SUVmax, SQR and TBR) were evaluated in CIEDI+ and CIEDI- patients using the Student' t-test; ROC curves were elaborated to detect cut-off values. The trend of image quality with regards to procedural recommendation adherence was evaluated. Results: Se, Sp, PPV, NPV and DA were respectively 96.2%, 81.8%, 86.2%, 94.7% and 89.6%. The reproducibility of qualitative analysis was excellent (K = 0.89). Semiquantitative parameters resulted statistically different in CIEDI+ and CIEDI- patients. Cut-off values were SUVmax = 2.625, SQR = 3.766 and TBR = 1.29. Trend curves showed increasing image quality due to adherence to procedural recommendations. Conclusions:18F-FDG-PET/CT is a valid tool in the management of patients suspected of CIEDI and adherence to procedural recommendations improves its image quality.