Impact of Coronary CT angiography in combination with CAD-RADS on the management of coronary artery disease patients

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Siemens Healthineers

Introduction

Coronary CT angiography (CCTA) plays an increasing role in the detection and risk stratification of patients with coronary artery disease (CAD). The Coronary Artery Disease – Reporting and Data System (CAD-RADS) allows for standardized classification of CCTA results and, thus, may improve patient management.

Purpose

Aim of this study was to assess the impact of CCTA in combination with CAD-RADS on patient management and to identify the impact of cardiovascular risk factors (CVRF) on CAD severity.

Methods

CCTA was performed on a third-generation dual-source CT scanner in patients, who were referred to a radiology centre by their attending physicians. In a total of 4801 patients, CVRF were derived from medical reports and anamnesis.

Results

The study population consisted of 4770 patients (62.0 (54.0-69.0) years, 2841 males) with CAD (CAD-RADS 1-5), while 31 patients showed no CAD and were excluded from further analyses. Age, male gender and the number of CVRF were associated with more severe CAD stages (all p < 0.001). 3040 patients (63.7 %) showed minimal or mild CAD requiring optimization of CVRF i.e. medical therapy but no further assessment at his time. A group of 266 patients (5.6 %) had a severe CAD defined as CAD-RADS 4B/5. In the multivariate regression analysis, age, male gender, history of smoking, diabetes mellitus and hyperlipidaemia were significant predictors for severe CAD, whereas arterial hypertension and family history of CAD did not reach significance. Of note, a subgroup of 28 patients (10.5 %) with a severe CAD (68.5 (65.5-70.0) years, 26 males, both p = n.s.) had no CVRF.

Conclusions

CCTA in combination with the CAD-RADS allowed for effective risk stratification of CAD patients. The majority of the patients showed non-obstructive CAD and, thus, could be treated conservatively without the need for further CAD assessment. CVRF out of arterial hypertension and family history had an impact on CAD severity reflected in higher CAD-RADs gradings. Of note, a relevant fraction of patients with CAD did not have any CVRF and, thus, may not be covered by risk stratification models.

CAD-RADS n Age (years) Males (%) 1 1453 56.0 (50.0-62.0) 623 (42.9 %) 2 1587 62.0 (55.0-69.0) 918 (57.8 %) 3 1067 66.0 (59.0-71.0) 749 (70.2 %) 4A 397 66.0 (59.0-72.0) 317 (79.8 %) 4B 162 67.0 (61.0-74.0) 139 (85.8 %) 5 104 66.0 (58.5.0-77.0) 95 (91.3 %)

P5259Evaluation of functional impairment and cardiac remodelling in isolated left branch bundle block using magnetic resonance imaging

Introduction

Left bundle-branch block (LBBB) is associated with underlying cardiovascular abnormalities, such as dilated cardiomyopathy and coronary heart disease. However, an isolated LBBB can be found in individuals without detectable cardiovascular disease. Echocardiographic studies demonstrated a reduced left ventricular (LV) ejection fraction (EF) and an increased LV cavity volume and mass in patients with isolated LBBB. Recent studies have shown larger cavity volumes (end-diastolic volume – EDV; end-systolic volume – ESV) and lower LVEF using CMR. However, there is still limited data on cardiac function, volumes and mass and the correlation between the parameters and the QRS duration (QRS) in patients with isolated LBBB.

Purpose

In this retrospective study LV function, volume, mass, T1-values and myocardial strain were measured and correlation between QRS duration in patients with isolated LBBB was identified using CMR.

Methods

Potential cases were identified from our local database, who underwent CMR during 2015–2018. We excluded patients with echocardiographic abnormalities besides abnormal septal motion or greater than a mild valve disease, known cardiovascular disease (coronary artery disease, cardiomyopathy or arrhythmia), history of potential cardiotoxic chemotherapy. We could identify 26 adults, who underwent CMR in a 1.5- or 3-Tesla scanner. LBBB was confirmed by ECG prior to CMR by a cardiologist. T1-values (MOLLI) were available in 19 patients. Myocardial strain (tissue tracking) could be performed in 23 patients. Associations were tested using Pearson's correlation analysis.

Results

26 patients (age 61.5±9.6 years, 19 women, BMI 25.4 (18.2–38.1)) with isolated LBBB were included (QRS duration: 138±12ms). CMR results in the cohort revealed a reduced LVEF (53.4±3,8%) and slightly enlarged LV cavity when corrected to body-surface area (BSA) (LV-EDV/BSA: 83.7±13.8ml/m2; LV-ESV/BSA: 39.3±8.6ml/m2), when compared to normal values from the study center. There is a negative correlation between LVEF and QRS duration (r=−0.550, p<0.05) and a positive correlation between QRS duration and LV-EDV/BSA (r=0.627, p<0.05) as well as between QRS and LV-ESV/BSA (r=0.661, p<0.05). In addition, there is a positive correlation between QRS duration and myocardial mass (r=0.645, p<0.05), septal myocardial thickness (r=0.405, p<0.05) and lateral wall thickness (r=0.495, p<0.05). In addition, there is a positive correlation between LV longitudinal strain and QRS (r=0.449, p<0.05). T1-values were in normal range. There is no correlation between QRS and T1-values.

Conclusion

Using CMR a negative correlation between LV function and QRS duration and the positive correlation between LV volumes and QRS duration in patients with isolated LBBB could be identified. The absence of significant myocardial fibrosis with normal T1-values indicates an electromechanical dissociation rather than an underlying myocardial abnormality as an explanation for the reduced LVEF.

Incidental finding of a giant intracardiac angioma infiltrating both ventricles in a 35-year-old woman: a case report

Background

Primary cardiac tumors are rare and often asymptomatic or present with unspecific symptoms. Benign cardiac tumors of vascular origin are especially rare, with only few existing data in the literature.

Case presentation

A 35-year-old Caucasian female patient presented to our department with an asymptomatic giant intracardiac angioma infiltrating both ventricles. Evaluation of this tumor involved electrocardiography, echocardiography, cardiac magnetic resonance imaging, coronary angiography, an open myocardial biopsy, and histological examination of the resected specimen. Because our patient was asymptomatic, she was managed conservatively with regular follow-up. We discuss the treatment options available in comparison with similar cases.

Conclusion

Diagnosis and therapy of benign cardiac tumors, especially of asymptomatic lesions, can be a challenge. There is no evidence available to help in the management of such patients. An extensive evaluation is needed with different imaging modalities, and case-specific decisions should be made that involve experts in cardiology, cardio-oncology, and heart surgery.

Electronic supplementary material

The online version of this article (doi:10.1186/s13256-016-0860-4) contains supplementary material, which is available to authorized users.

Flow-cytometric characterization of cardiac allograft-infiltrating cells following MHC class I antigen pretreatment in the mouse

Changes in the graft-infiltrating cell population (GIC) induced by Class I MHC pretreatment were characterized using flow cytometric analysis. C3H mice received 10(7) EL4 cells intravenously 14 days prior to transplant with C57BL/10 (H-2b) hearts. Transplanted hearts were removed from six recipients in both groups at 4, 6, 9, 12, 15, and 21 days after transplantation. GICs were harvested and incubated with FITC-conjugated Lyt-1 and Lyt-2 and phycoerythrin-conjugated L3T4 monoclonal antibodies. The proportion of GICs which were Lyt-1, L3T4, or Lyt-2 positive was similar in both control and pretreated groups at all times posttransplant, and all three cell populations exhibited similar changes over the course of the study in both groups. At Post-transplant Day (PTD) 9, there were significantly more double-staining cells (L3T4+, Lyt2+) in the pretreated group than in the control group (8.58 +/- 2.49% vs 4.36 +/- 1.32%, P < 0.05). By PTD 15, the double-staining cells had increased in pretreated mice to 17.46 +/- 4.36% of the total GICs (P < 0.05). The percentage of GICs in EL4-pretreated mice which were Lyt-1- was significantly higher at all time points than the percentage of L3T4- or Lyt-2- cells, whereas in the control, these cell populations were equivalent, implying that in pretreated mice, cells are present which are L3T4+ or Lyt2+ but Lyt-1-.(ABSTRACT TRUNCATED AT 250 WORDS)

Human basophil degranulation triggered by very dilute antiserum against IgE

When human polymorphonuclear basophils, a type of white blood cell with antibodies of the immunoglobulin E (IgE) type on its surface, are exposed to anti-IgE antibodies, they release histamine from their intracellular granules and change their staining properties. The latter can be demonstrated at dilutions of anti-IgE that range from 1 x 10(2) to 1 x 10(120); over that range, there are successive peaks of degranulation from 40 to 60% of the basophils, despite the calculated absence of any anti-IgE molecules at the highest dilutions. Since dilutions need to be accompanied by vigorous shaking for the effects to be observed, transmission of the biological information could be related to the molecular organization of water.

Application of weak electric field to the hindpaw enhances sciatic motor nerve regeneration in the adult rat

Direct current (DC) electrical stimulation of the hindpaw is shown to enhance sciatic motor nerve regeneration in the adult rat. Cathodal stimulation, using weak currents (10 microA/cm2; field strength approximately 100 mV/cm) increased the reinnervation of the hindpaw muscles as measured by evoked electromyograms. This enhanced regeneration only occurred after cut-and-suture lesions, but not after crushing injury of the sciatic nerve. This enhancement of motor nerve regeneration by weak DC fields had been previously described in amphibians but we are the first to describe this phenomenon in mammals.

Orthotopic bone transplantation in mice. III. Methods of reducing the immune response and their effect on healing

Various methods of reducing the immune response to allogeneic bone grafts, either by pretreating the graft or by immunosuppressing the recipient, were compared. Tibial grafts from B10.D2 mice, either untreated or pretreated in various ways, were transplanted into B10 recipients. The antibody response was followed and the extent of bone healing at 4 months was assessed. Pretreatment of the graft by X-irradiation, freezing, or by incubation in alloantisera (either anti-H-2 or anti-Ia) reduced or abolished the immunogenicity of the graft. Immunosuppression of the recipient with methotrexate or antilymphocyte serum (ALS) also greatly depressed the antibody response. But when healing was assessed, none of these treatments except ALS improved the delayed healing of the bone allografts. The reason for this failure was probably that X-irradiation, freezing, alloantiserum pretreatment, and methotrexate all interfered with bone healing directly, whereas ALS did not. We conclude that many methods will reduce the immune response to allogeneic bone, but that only ALS will improve the healing of the allogeneic bone. Furthermore, as a corollary to the observation that pretreatment with anti-Ia serum markedly reduced the immunogenicity of bone allografts, we conclude that much of the immunogenicity of bone allografts is attributable to a population of Ia-positive cells.