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Hamilton MCK, Charters PFP, Lyen S, Harries IB, Armstrong L, Richards GHC, Strange JW, Johnson T, Manghat NE. Computed tomography-derived fractional flow reserve (FFR CT) has no additional clinical impact over the anatomical Coronary Artery Disease - Reporting and Data System (CAD-RADS) in real-world elective healthcare of coronary artery disease. Clin Radiol 2022; 77:883-890. [PMID: 35985847 DOI: 10.1016/j.crad.2022.05.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 05/22/2022] [Accepted: 05/30/2022] [Indexed: 02/08/2023]
Abstract
AIM To evaluate the impact of computed tomography-derived fractional flow reserve (FFRCT) compared to the anatomical Coronary Artery Disease - Reporting and Data System (CAD-RADS) in the elective assessment of coronary artery disease in real-world cardiology practise. MATERIALS AND METHODS A retrospective review was undertaken of 1,239 coronary CT examinations from August 2018 to December 2019 with a minimum follow-up period of 1 year. Coronary disease was classified according to the CAD-RADS system. A non-occlusive ≥30% maximum diameter stenosis was considered eligible for FFRCT. Lesion-specific FFRCT and FFR were considered positive if ≤ 0.80. The patients were followed up using the hospital radiology information system and the electronic patient record. A positive outcome was defined by a subsequent invasive angiogram (ICA) showing disease requiring revascularisation or FFR ≤0.80 or a positive stress test or medical therapy for angina in CAD-RADS 4. RESULTS Of the 1,145 analysable studies (mean follow up 618 ± 153 days) the incidence of a positive result was 7% with a 5.4% elective revascularisation rate. Two hundred and forty-five patients (CAD-RADS 2-4) had FFRCT. FFRCT reduced the accuracy of the CAD-RADS grade from 91% to 78.4% (p<0.001). In CAD-RADS 2, the accuracy is reduced from 99% to 90.7% (p=0.005), and in CAD-RADS 3 from 93.9% to 67.7% (p<0.001). In CAD-RADS 4, FFRCT increases accuracy from 69.4% to 75.5% (p=0.025), but 89.8% of FFRCT are positive and specificity is low (26.7%). CONCLUSION In the present "real-world" practise, FFRCT does not improve standard radiological assessment of coronary disease graded by the CAD-RADS alone.
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Affiliation(s)
- M C K Hamilton
- Department of Clinical Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
| | - P F P Charters
- Department of Clinical Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - S Lyen
- Department of Clinical Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - I B Harries
- Department of Clinical Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK; Department of Cardiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - L Armstrong
- Department of Clinical Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - G H C Richards
- Department of Cardiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - J W Strange
- Department of Cardiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - T Johnson
- Department of Cardiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - N E Manghat
- Department of Clinical Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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Harries IB, Biglino G, Berlot B, Williams M, De Francesco V, Mitrousi K, Lawton C, Plana J, Bucciarelli-Ducci C. 531Myocardial fibrosis is associated with adverse left ventricular remodelling and heart failure hospitalisations in anthracycline-treated cancer survivors at 5 years follow-up. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez115.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- I B Harries
- Bristol Heart Institute, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - G Biglino
- University of Bristol, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - B Berlot
- Bristol Heart Institute, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - M Williams
- Bristol Heart Institute, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - V De Francesco
- Bristol Heart Institute, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - K Mitrousi
- Bristol Heart Institute, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - C Lawton
- Bristol Heart Institute, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - J Plana
- Baylor College of Medicine, Houston, United States of America
| | - C Bucciarelli-Ducci
- Bristol Heart Institute, Bristol, United Kingdom of Great Britain & Northern Ireland
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Harries IB, Williams M, Weir-Mccall J, Vedwan K, Shambrook J, Roditi G, Nicol E, Moss A. 189CT TAVR assessment in the United Kingdom: insights from a national BSCI/BSCCT survey. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- I B Harries
- Bristol Heart Institute, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - M Williams
- University of Edinburgh, Edinburgh Imaging Facility, Edinburgh, United Kingdom of Great Britain & Northern Ireland
| | - J Weir-Mccall
- University of Cambridge, School of Clinical Medicine, Biomedical Research Centre, Cambridge, United Kingdom of Great Britain & Northern Ireland
| | - K Vedwan
- University of Southampton, Department of Cardiothoracic Radiology, Southampton, United Kingdom of Great Britain & Northern Ireland
| | - J Shambrook
- University of Southampton, Department of Cardiothoracic Radiology, Southampton, United Kingdom of Great Britain & Northern Ireland
| | - G Roditi
- University of Glasgow, Institute of Clinical Sciences, Glasgow, United Kingdom of Great Britain & Northern Ireland
| | - E Nicol
- Royal Brompton Hospital, Departments of Cardiology and Radiology, London, United Kingdom of Great Britain & Northern Ireland
| | - A Moss
- University of Edinburgh, Edinburgh Imaging Facility, Edinburgh, United Kingdom of Great Britain & Northern Ireland
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Harries IB, Curran M, Mitrousi K, Williams M, Berlot B, De Francesco V, Lawton C, Bucciarelli-Ducci C. 530Anthracycline-treated cancer survivors with normal LVEF have significant perturbations of longitudinal strain and myocardial tissue composition. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez115.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- I B Harries
- Bristol Heart Institute, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - M Curran
- University of Bristol, Medical School, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - K Mitrousi
- Bristol Heart Institute, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - M Williams
- Bristol Heart Institute, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - B Berlot
- Bristol Heart Institute, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - V De Francesco
- Bristol Heart Institute, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - C Lawton
- Bristol Heart Institute, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - C Bucciarelli-Ducci
- Bristol Heart Institute, Bristol, United Kingdom of Great Britain & Northern Ireland
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Harries IB, Williams M, Berlot B, Mitrousi K, De Francesco V, Milano E, Benedetto U, Lyen S, Bucciarelli-Ducci C. 505Shot through the heart. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez105.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- I B Harries
- Bristol Heart Institute, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - M Williams
- Bristol Heart Institute, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - B Berlot
- Bristol Heart Institute, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - K Mitrousi
- Bristol Heart Institute, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - V De Francesco
- Bristol Heart Institute, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - E Milano
- Bristol Heart Institute, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - U Benedetto
- Bristol Heart Institute, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - S Lyen
- Bristol Heart Institute, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - C Bucciarelli-Ducci
- Bristol Heart Institute, Bristol, United Kingdom of Great Britain & Northern Ireland
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Harries IB, Levoir H, Bucciarelli-Ducci C, Ramcharitar S. Takotsubo cardiomyopathy in myasthaenia gravis crisis confirmed by cardiac MRI. BMJ Case Rep 2015; 2015:bcr-2015-209631. [PMID: 26416798 DOI: 10.1136/bcr-2015-209631] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Myasthaenia gravis crisis and Takotsubo cardiomyopathy are rare conditions that can be precipitated by emotional or physical stress. Myasthaenia gravis has a variety of cardiac manifestations but Takotsubo cardiomyopathy, particularly in male patients, has rarely been reported. We describe a unique case of a 70-year-old man who developed Takotsubo cardiomyopathy during his first presentation with a myasthaenia gravis crisis. He had not received plasmapharesis or immunoglobulin therapy. Striking ECG traces and cardiac MRI helped to confirm the diagnosis. Cardiac manifestations of myasthaenia gravis and myasthaenia gravis itself have overlapping symptoms; the importance of cardiac monitoring and clinical vigilance in such cases is discussed. The utility of cardiac MRI in assessing cardiac manifestations of myasthaenia gravis is also highlighted.
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Affiliation(s)
| | - H Levoir
- Wiltshire Cardiac Centre, Swindon, UK
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Harries IB, Davies BJ, Schultz L, McCrea WA, Foley PW. 57 * Remote monitoring of permanent pacemakers is associated with reduced mortality. Europace 2014. [DOI: 10.1093/europace/euu241.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Harries IB, Jones MJT. Sling woe: an unusual cause of respiratory compromise. Anaesthesia 2009; 64:222. [PMID: 19143710 DOI: 10.1111/j.1365-2044.2008.05841.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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