64-slice Computed Tomography Angiography Research Articles

Association of cardiac events with coronary artery disease detected by 64-slice or greater coronary CT angiography: A systematic review and meta-analysis

BackgroundThe value of ≥64-slice coronary CT angiography (CCTA) to determine odds of cardiac death or non-fatal myocardial infarction (MI) needs further clarification. MethodsWe performed a systematic review and meta-analysis using publications reporting events/severity of coronary artery disease (CAD) in patients with suspected CAD undergoing CCTA. Patients were divided into: no CAD, non-obstructive CAD (maximal stenosis <50%), and obstructive CAD (≥50% stenosis). Odds ratios with 95% confidence intervals were calculated using a fixed or random effects model. Heterogeneity was assessed using the I2 index. ResultsWe included thirty-two studies comprising 41,960 patients with 363 all-cause deaths (15.0%), 114 cardiac deaths (4.7%), 342 MI (14.2%), 69 unstable angina (2.8%), and 1527 late revascularizations (63.2%) over 1.96 (SD 0.77) years of follow-up. Cardiac death or MI occurred in 0.04% without, 1.29% with non-obstructive, and 6.53% with obstructive CAD. OR for cardiac death or MI was: 14.92 (95% CI, 6.78 to 32.85) for obstructive CAD, 6.41 (95% CI, 2.44 to 16.84) for non-obstructive CAD versus no CAD, and 3.19 (95% CI, 2.29 to 4.45) for non-obstructive versus obstructive CAD and 6.56 (95% CI, 3.07 to 14.02) for no versus any CAD. Similar trends were noted for all-cause mortality and composite major adverse cardiovascular events. ConclusionsIncreasing CAD severity detected by CCTA is associated with cardiac death or MI, all-cause mortality, and composite major adverse cardiovascular events. Absence of CAD is associated with very low odds of major adverse events, but non-obstructive disease significantly increases odds of cardiac adverse events in this follow-up period.

Hybrid CT angiography and quantitative 15O-water PET for assessment of coronary artery disease: comparison with quantitative coronary angiography

CT angiography (CTA) can rule out significant stenoses with a very high reliability, whereas its ability to confirm significant stenoses is suboptimal. In contrast, measurements of myocardial blood flow (MBF) provide information on the haemodynamic consequences of stenoses. Therefore, a combination of the two might improve diagnostic accuracy. We conducted a head-to-head comparison of CTA, measurement of MBF by (15)O-water PET, and hybrid PET/CTA for the detection of significant coronary artery stenoses. The study group comprised 44 outpatients scheduled for invasive coronary angiography (ICA) with an intermediate pretest likelihood of coronary artery disease. The patients underwent 64-slice CTA and baseline and hyperaemic PET before ICA with quantitative coronary angiography analysis. On a per-patient basis, the negative predictive values (NPV; 95% confidence intervals in parentheses) were 88 % (64 - 97%) for CTA, 90% (71 - 97%) for PET and 92% (74 - 98%) for PET/CTA, and the positive predictive values (PPV) were 71% (53 - 85%) for CTA, 87% (68 - 95%) for PET and 100% (84 - 100%) for PET/CTA. Similarly, on a per-vessel basis the NPVs (which were generally high) were 97% (94 - 100%) for CTA, 95 % (90 - 99%) for PET and 97% (95 - 100%) for PET/CTA, and the PPVs (which were lower, but higher with PET/CTA) were 53% (39 - 66%) for CTA, 53 % (40 - 66%) for PET and 85 % (73 - 97%) for PET/CTA. In six patients, CTA analysis was hampered by the presence of severe calcifications. However, with the addition of the PET data, all six patients were correctly categorized. Cardiac quantitative hybrid PET/CTA imaging has better diagnostic accuracy than CTA alone and PET alone. CTA has a suboptimal PPV, suggesting that hybrid PET/CTA imaging should be used to assess the significance of coronary stenoses diagnosed by CTA.

Composite versus conventional coronary artery bypass grafting strategy for the anterolateral territory: study protocol for a randomized controlled trial

BackgroundIn severe coronary artery disease, coronary artery bypass grafting (CABG) surgery is indicated to re-establish an adequate blood supply to the ischemic myocardium. Effectiveness of CABG surgery for symptom relief and mortality decrease should therefore depend on bypass graft patency. As bypass using a left internal mammary artery (LIMA)-to-left anterior descending coronary artery (LAD) anastomosis allows the best results in terms of graft patency, we designed a new surgical technique using a saphenous vein graft as a venous bridge to distribute the LIMA flow to the cardiac anterolateral territory. This novel strategy could extend the patency benefits associated to the LIMA. Other potential benefits of this technique include easier surgical technique, possibility to use saphenous vein grafts as vein patch angioplasty, shorter saphenous vein grafts requirement and reduced or eliminated manipulations of the ascendant aorta (and associated stroke risk).Methods/DesignBetween July 2012 and 2016, 200 patients undergoing a primary isolated CABG surgery using cardiopulmonary bypass with a LAD bypass graft and at least another target on the anterolateral territory will be randomized (1:1) according to 1) the new composite strategy and 2) the conventional strategy with a LIMA-to-LAD anastomosis and revascularization of the other anterolateral target(s) with a separated aorto-coronary saphenous vein graft. The primary objective of the trial is to assess whether the composite strategy allows non-inferior anterolateral graft patency index (proportion of non-occluded CABGs out of the total number of CABGs) compared to the conventional technique. The primary outcome is the anterolateral graft patency index, evaluated at one year by 256-slice computed tomography angiography. Ten years of clinical follow-up is planned to assess clinical outcomes including death, myocardial infarction and need for revascularization.DiscussionThis non-inferiority trial has the potential to advance the adult cardiac surgery field, given the potential benefits associated with the composite grafting strategy.Trial registrationClinicalTrials.gov: NCT01585285.

Differential impact of visceral abdominal adipose tissue on vulnerable plaque detected by coroanry multi-detector row CT in patients with or without diabetes

Background: Excess visceral abdominal adipose tissue (VAT) is strongly associated with atherosclerosis and cardiovascular disease, since VAT secrets many inflammatory cytokines. The significance of VAT in patients with or without DM has not fully investigated. The aim of this study was to investigate the association between VAT and the presence and characteristics of coronary artery plaques in the patients with or without DM using 64 slice computed tomography angiography. Methods and results: We retrospectively evaluated 456 consecutive patients (57% male, age 64±14 years) who were suspected CAD with MDCT. 71 (16%) patients had vulnerable plaque (VP) with low density area 60cm2 and ≤106cm2, T3 n=111 VAT >106cm2 and DM group: T1, n=40, ≤87cm2, T2, n=41, >87cm2 and ≤130cm2, T3, n=41, >130cm2) (Table). In non-DM patients, higher age, male, current smoking history, lower HDL cholesterol and VAT areas were significantly correlated with of VP. Multivariate analysis in no-DM patients revealed higher VAT area was independently associated with VP (odds ratio [OR]: 3.84; 95% confidence interval [CI]: 1.04-14.14,p=0.04). However, in DM patients, no association between VAT area and VP was found. View this table: Table 1. Multivariate analysis for VP Conclusion: VAT was significantly associated with VP independent of traditional measures of CAD in only non-DM patients. Risk assessment of cardiovascular disease could be improved by combining VAT measurements and traditional risk factors in non DM patients.

Lipoprotein(a) is an important factor to determine coronary artery plaque morphology in patients with acute myocardial infarction

Lipoprotein(a) [Lp(a)] can influence the development and disruption of atherosclerotic plaques through its effect on lipid accumulation. The purpose of this study was to evaluate the relationship between serum Lp(a) levels and plaque morphology of an infarct-related lesion and non-infarct-related lesion of the coronary artery in acute myocardial infarction (AMI). Coronary plaque morphology was evaluated in 68 patients (age 62.1±12.1 years, mean±SD; men n=58, women n=10) with AMI by intravascular ultrasound with radiofrequency data analysis before coronary intervention and by 64-slice computed tomography angiography within 2 weeks. Patients were divided into a group with an Lp(a) level of 25 mg/dl or more (n=20) and a group with an Lp(a) level of less than 25 mg/dl (n=48). Intravascular ultrasound with radiofrequency data analysis identified four types of plaque components at the infarct-related lesion: fibrous, fibrofatty, dense calcium, and necrotic core. The necrotic core component was significantly larger in the group with an Lp(a) level of 25 mg/dl or more than in the group with an Lp(a) level of less than 25 mg/dl (27.6±8.0 vs. 15.7±10.0%, P=0.0001). Coronary plaques were classified as calcified plaques, noncalcified plaques, mixed plaques, and low-attenuation plaques on 64-slice computed tomography angiography. Computed tomography indicated that the group with an Lp(a) level of 25 mg/dl or more had a greater number of total plaques, noncalcified plaques, and low-attenuation plaques in whole coronary arteries than did the group with an Lp(a) level of less than 25 mg/dl (5.3±1.8 vs. 3.7±2.2, P=0.0061; 4.0±2.0 vs. 1.2±1.3, P=0.0001; 2.2±2.1 vs. 0.5±0.7, P=0.0001, respectively). Elevated serum Lp(a) levels are associated with the number of plaques and plaque morphology. Patients with a high Lp(a) level during AMI require more intensive treatment for plaque stabilization.

Clinical usefulness of the 16-slice computed tomography coronary angiography for evaluation of early phase intracoronary stent patency

Coronary artery stenting is currently treatment of choice for management of coronary artery disease. Stent restenosis is the most important problem during follow up. Conventional coronary angiography is the gold standart for assessment of intracoronary stent patency. It is an invasive method and even though rare, has some significant risks. For this reason, noninvasive imaging methods are necessary to evaluate stent potency. Noninvasive methods such as the exercise test, myocardial perfusion scintigraphy and stress echocardiography could not reach enough diagnostic accuracy. Multislice computed tomography (MSCT) has been under investigation for stent restenosis detection. Aim of this study is to investigate usefulness of the 16-slice CT for evaluation of stent potency in patients with suspicion of stent restenosis. Thirty six patients were included in the study and 16-slice CT and conventional coronary angiographies were performed in all patients. The results of 16-slice CT and conventional coronary angiography were compared. Sufficient or good quality imaging with 16-slice CT angiography was obtained in 69% of all patients. Sixteen-slice CT angiography detected 42/49 (86%) stents and gave the correct localization for all of the detected stents. Stent lumen could be assessed in 30 (61%) stents and according to the results of luminal assessment, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of 16-slice MSCT were calculated as 33%, 95%, 75%, 77% and 77%, respectively. According to these results, the diagnostic performance of 16-slice CT angiography for detection of stent restenosis was relatively low. However, the assessment of relatively small number of stents because of insufficient heart rate control did not allow reliable and precise evaluation. Our results showed that diagnostic capacity of 16 slice CT angiography for detection of coronary stent restenosis is limited.

Prevalence, extent and composition of coronary plaque in patients with rheumatoid arthritis without symptoms or prior diagnosis of coronary artery disease

ObjectivesAccelerated cardiovascular morbidity and mortality occur in patients with rheumatoid arthritis (RA). We evaluated the presence, burden and compositional differences of coronary plaque in patients with RA without symptoms or...

Correction: Prospectively versus Retrospectively ECG-Gated 256-Slice CT Angiography to Assess Coronary Artery Bypass Grafts — Comparison of Image Quality and Radiation Dose

Correction: Prospectively versus Retrospectively ECG-Gated 256-Slice CT Angiography to Assess Coronary Artery Bypass Grafts — Comparison of Image Quality and Radiation Dose

Association of pericardial adipose tissue volume with presence and severity of coronary atherosclerosis

This study was to investigate whether high pericardial adipose tissue (PAT) volume is related to the presence and severity of coronary artery disease (CAD). Consecutive patients (310 patients) who underwent both dual-source 64-slice CT and percutaneous coronary angiography were recruited into this study. Waist circumference (WC), body mass index (BMI), blood biochemical variables, coronary artery calcium (CAC) score and Gensini score were measured. Pericardial adipose tissue (PAT) volume was determined by dual-source CT. PAT volume was positively correlated with BMI, WC, gender (male), hypertension, diabetes, age, total cholesterol and low-density lipoprotein-cholesterol. PAT volume in CAD patients was significantly higher than that in patients without CAD (238.36 ± 81.21 cm3 vs. 200.13±72.34 cm3). PAT volumes in patients with multi-vessel lesions were significantly higher than those with one-vessel lesions (P < 0.001). A significant correlation between PAT volume and CAC score (r=0.305, P < 0.001) was found. PAT volume was an independent factor affecting Gensini score. PAT volume was significantly correlated with traditional cardiovascular risk factors, the severity of coronary atherosclerosis and the number of stenotic coronary vessels. Thus, PAT volume may be a reliable marker to evaluate the presence and severity of CAD.

Diagnostic accuracy of coronary 320 slice CT angiography using retrospective electrocardiogram gated acquisition compared with virtual prospective electrocardiogram gated acquisition with and without padding

To reduce radiation-exposure, prospective-ECG-gating without padding is preferable. To evaluate diagnostic-accuracy of coronary 320-slice-CT angiography using various-acquisition-methods, we compared retrospective-ECG-gated with dose-modulation and "virtual" prospective-ECG-gating with and without padding. We retrospectively selected seventy-seven consecutive symptomatic subjects (52-males, 62 ± 12 years) with normal-sinus-rhythm who underwent both retrospective-ECG-gated 320-slice-CT and conventional-coronary-angiograms (CCAG) within 3-months. CT images were reconstructed at 5% from 0 to 95% of RR-interval. Three-methods were used to assess >50% coronary-stenosis; 1) using only 75% of data named virtual prospective-ECG-gating without padding, 2) using 70-100% of data if heart-rate (HR) was <66 beats/minute (bpm), or using 35-100% of data if HR was >65 bpm, named as virtual prospective-ECG-gating with padding, and 3) using all-phase-data named retrospective-ECG-gating. In 42-subjects with HR <66 bpm, there were zero unevaluable-segments in virtual prospective-ECG-gating with and without padding and retrospective-ECG-gating. But in 35-subjects with HR >65 bpm, the percentage of unevaluable-segments were significantly-higher in virtual prospective-ECG-gating without padding (13.6 ± 27.9%) than in virtual prospective-ECG-gating with padding (0.7 ± 3.1%), and retrospective-ECG-gating (0.7 ± 3.1%) (both P = 0.012). Using only evaluable-lesions, in 35-subjects with HR >65 bpm, sensitivity, specificity, positive-predictive-value and negative-predictive-value of CT for detecting >50% luminal-stenosis compared with CCAG were 82%, 94%, 60%, and 98%, respectively, for virtual prospective-ECG-gating without padding, 97%, 96%, 73%, and 100%, respectively, for virtual prospective-ECG-gating with padding, and 97%, 96%, 73%, and 100%, respectively, for retrospective-ECG-gating (all P = not-significant). Virtual prospective-ECG gating at 75% of RR-interval without padding had significantly-more unevaluable-segments than virtual prospective-ECG-gating with padding and retrospective-ECG-gating only in subjects with HR >65 bpm.

Association of serum total bilirubin levels with the severity, extent and subtypes of coronary atherosclerotic plaques detected by coronary CT angiography

In this study, we aimed to evaluate whether serum total bilirubin was associated with the severity and morphology of coronary atherosclerotic plaques detected by computed tomography angiography (CTA). The study population consisted of 1,115 patients (55.2 % men) who underwent dual-source 64-slice CTA for the assessment of coronary artery disease (CAD). Coronary arteries were evaluated on 16 segment basis and critical coronary plaque was described as luminal narrowing >50 %, whereas plaque morphology was assessed on per segment basis. Serum bilirubin levels were determined using commercially available assay kits. The critical atherosclerotic lesions were detected in 431/1,115 (38.6 %) subjects by CTA. Serum total bilirubin levels were found to be lower in patients with any coronary plaque (0.62 ± 0.21 vs. 0.70 ± 0.25 mg/dL, p = 0.002). Also bilirubin level was lower in patients with critical stenosis compared to non-critical stenosis (0.57 ± 0.18 vs. 0.70 ± 0.24 mg/dL, p < 0.001). Subjects having primarily noncalcified plaque (NCP) and mixed plaque (MP) have lower bilirubin levels compared to calcified plaque (CP) and normal subjects (0.62 ± 0.20 for NCP and 0.60 ± 0.19 for MP, 0.65 ± 0.26 for CP and 0.71 ± 0.25 for normal subjects, p < 0.001). This independent association was remained for NCP after multinominal regression analysis (OR: 0.76; 95 % CI 0.58-0.88; p < 0.001). Our study demonstrated that serum bilirubin level was significantly associated with the presence, severity and the noncalcified morphology of atherosclerotic plaques detected by CTA. Further prospective clinical studies are needed to clarify the exact physiopathologic and prognostic role of bilirubin in CAD.

Comparison of 64-slice CT angiography with 3D digital subtraction angiography in the diagnosis of intracranial aneurysms: a Meta-analysis

Background The difference of diagnostic accuracy of 64-slice computed tomography angiography (CTA) with 3D digital subtraction angiography (3D-DSA) in the detection of intracranial aneurysms is not clear yet. This study compares the diagnostic value of 64-slice CTA with 3D-DSA in the diagnosis of intracranial aneurysms via a Meta-analysis. Methods In this study, 64-slice, 64-row, CT, angiography, intracranial aneurysms, cerebral aneurysms, subarachnoid hemorrhage, etc. were used as key words, and searched in the electronic databases including Embase, MEDLINE, Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), and Wanfang Data, assisted by manual searching, in order to retrieve articles both in English and Chinese that reported on comparisons of 64-slice CTA and 3D-DSA in the evaluation of suspected intracranial aneurysms. Meta-disc Version 1.4 was used for the Meta-analysis, and Quality Assessment of Diagnostic Accuracy Studies (QUADAS) was applied to assess the quality of these research studies. Results Four clinical trials were selected. According to the Meta-analysis, the pooled sensitivity, specificity, diagnostic odds ratios (DOR) and summary receiver operating characteristics (SROC) area under curve (AUC) was 97% (95% CI: 0.950-0.980), 91% (95% CI: 0.860-0.950), 269.640 (95% CI: 137.250-529.720) and 0.993 respectively. Conclusion On the basis of Meta-analysis, 64-slice CTA has a high level of sensitivity and specificity for diagnoses of intracranial aneurysms and it can be used as an important examination tool in the diagnoses of intracranial aneurysms. Because the sample size of selected studies is small, it is necessary to perform well-designed and larger sample studies to further assess the diagnostic value of intracranial aneurysms by 64-slice CTA.

Single Resting hsTnT Level Predicts Abnormal Myocardial Stress Test in Acute Chest Pain Patients With Normal Initial Standard Troponin

The goal of this study was to determine the ability of a single, resting high-sensitivity troponin T (hsTnT) measurement to predict abnormal myocardial perfusion imaging (MPI) in patients presenting with acute chest pain to the emergency department (ED). HsTnT assays precisely detect very low levels of troponin T, which may be a surrogate for the presence and extent of myocardial ischemia. We included all patients from the ROMICAT I (Rule Out Myocardial Infarction Using Computer Assisted Tomography) trial, an observational cohort study, who underwent both single-photon emission computed tomography (SPECT)-MPI stress testing and 64-slice computed tomography angiography (CTA) and in whom hsTnT measurements were available. We assessed the discriminatory value of hsTnT for abnormal SPECT-MPI and the association of reversible myocardial ischemia by SPECT-MPI and the extent of coronary atherosclerosis by CTA to hsTnT levels. Of the 138 patients (mean age 54 ± 11 years, 46% male), 19 (13.7%) had abnormal SPECT-MPI. Median hsTnT levels were significantly different between patients with normal and abnormal SPECT-MPI (9.41 pg/ml [interquartile range (IQR): 5.73 to 19.20 pg/ml] vs. 4.89 pg/ml [IQR: 2.34 to 7.68 pg/ml], p = 0.001). Sensitivity of 80% and 90% to detect abnormal SPECT-MPI was reached at hsTnT levels as low as 5.73 and 4.26 pg/ml, respectively. Corresponding specificity was 62% and 46%, and negative predictive value was 96% and 96%, respectively. HsTnT levels had good discriminatory ability for prediction of abnormal SPECT-MPI (area under the curve: 0.739, 95% confidence interval: 0.609 to 0.868). Both reversible myocardial ischemia and the extent of coronary atherosclerosis (combined model r(2) = 0.19 with partial of r(2) = 0.12 and r(2) = 0.05, respectively) independently and incrementally predicted the measured hsTnT levels. In patients with acute chest pain, myocardial perfusion abnormalities and coronary artery disease are predicted by resting hsTnT levels. Prospective evaluations are warranted to confirm whether resting hsTnT could serve as a powerful triage tool in chest pain patients in the ED before diagnostic testing and improve the effectiveness of patient management.

Assessment of myocardial bridge and mural coronary artery using ECG-gated 256-slice CT angiography: a retrospective study.

Recent clinical reports have indicated that myocardial bridge and mural coronary artery complex (MB-MCA) might cause major adverse cardiac events. 256-slice CT angiography (256-slice CTA) is a newly developed CT system with faster scanning and lower radiation dose compared with other CT systems. The objective of this study is to evaluate the morphological features of MB-MCA and determine its changes from diastole to systole phase using 256-slice CTA. The imaging data of 2462 patients were collected retrospectively. Two independent radiologists reviewed the collected images and the diagnosis of MB-MCA was confirmed when consistency was obtained. The length, diameter, and thickness of MB-MCA in diastole and systole phases were recorded, and changes of MB-MCA were calculated. Our results showed that among the 2462 patients examined, 336 have one or multiple MB-MCA (13.6%). Out of 389 MB-MCA segments, 235 sites were located in LAD2 (60.41%). The average diameter change of MCA in LAD2 from systole phase to diastole phase was 1.1 ± 0.4 mm, and 34.9% of MCA have more than 50% diameter stenosis in systole phase. This study suggested that 256-slice CTA multiple-phase reconstruction technique is a reliable method to determine the changes of MB-MCA from diastole to systole phase.

Sixty-Four–Slice Computed Tomography Angiography of Perigastric Veins With Image Fusion

The objective of this study was to assess the efficacy and clinical value of 64-slice computed tomography angiography (CTA) with image fusion for demonstrating the perigastric venous anatomy. Twenty-six patients with gastric cancer underwent abdominal CTA examinations. Computed tomography angiography of stomach and perigastric veins and arteries were reconstructed and fused using volume-rendering technique. The inflow and courses of perigastric veins as well as the spatial relationship among the perigastric veins, arteries, and stomach were compared with surgery. Compared with surgical findings, the visualization rate of the 7 perigastric veins on CTA was 90.9% to 100%. There was a statistically significant decrease in number of short gastric veins identified on CTA compared with surgery (P = 0.004). There was no statistically significant difference between the 2 modalities in detecting other perigastric veins including the left gastric vein, right gastric vein, right gastroepiploic vein, left gastroepiploic vein, posterior gastric vein, and gastrocolic trunk (P = 0.317, P = 0.157, P = 1, P = 1, P = 0.317, P = 1, respectively). Sixty-four-slice CTA with image fusion clearly depicts most of perigastric veins and their relationship with the stomach and perigastric arteries. It can facilitate gastrectomy.

Calcified Aorto–Right Ventricular Tunnel in a Patient With Multiple Lentigines Syndrome

From the *Department of Cardiology, C.S.M. Medical University (King George’s Medical College), Lucknow, Uttar Pradesh, India; and the †Department of Radiodiagnosis, C.S.M. Medical University (King George’s Medical College), Lucknow, Uttar Pradesh, India. Manuscript received June 5, 2012; revised manuscript received June 14, 2012, accepted June 26, 2012. A12-year old boy with multiple pigmented nevi and lentigines (A) presented to us with symptoms of effort dyspnea and recent onset cyanosis. He had mild thoracolumbar scoliosis, unilateral sensorineural hearing loss, and growth retardation. The 2-dimensional transthoracic echocardiogram revealed a circular echolucency lateral to the tricuspid annulus (B, Online Video 1) (LA left atrium; LV left ventricle; RA right atrium; RV right ventricle), and color Doppler echocardiogram showed a tunnel-like structure with turbulent jet filling the right ventricle (C, Online Video 2). Two-dimensional echocardiogram with continuous-wave Doppler showed severe valvular pulmonic stenosis (D), and contrast echocardiogram revealed right to left shunt across the foramen ovale (Online Video 3). Cardiac catheterization showed spiral calcification and catheter passage from the aorta to the RV (E, Online Video 4), and the aortogram revealed flow across the tunnel (Online Video 5). Sixty-four slice computed tomography angiography showed a dilated aortic root (DA) with a tortuous aorto–right ventricular tunnel (F). Computed tomography volume-rendered imaging showed a giant tunnel and single left coronary artery giving branches (Bs) to the RV (G), with massive dilation of the aortic root and presence of calcified bands at the origin of the tunnel (H). LAD left anterior descending artery; MPA main pulmonary artery; PA pulmonary artery; RAA right atrial appendage. Published by Elsevier Inc. http://dx.doi.org/10.1016/j.jacc.2012.06.066

Anatomical variations in branching pattern of arcus aorta: 64-slice CTA appearance

To review the 64-slice CTA (computed tomography angiography) appearance of anatomical variations in branching pattern of the arcus aorta, and to determine their prevalence in 1001 cases. 1001 cases that underwent carotid CTA (performed by a 64-slice scanner) were included in the study. Seven types of aortic arch were found. In 853 cases (853/1001, 85.2%) classical branching pattern of arcus aorta (three branches; TB, LCC, LS) was observed. Variations were present in 147 cases (147/1001, 14.7%). One case (1/1001, 0.1%) had right aortic arch. The most frequent variation was origination of LCC from TB (arch with 2 branches, TB with LCC and LS) which was observed in 78 cases (78/1001, 7.8%). Origination of LV directly from the aortic arch (four branches; TB, LCC, LV, LS or TB, LCC, LS, LV) was observed in 51 cases (51/1001, 5.1%). In two cases (2/1001, 0.2%) truncus bicaroticus (3 branches; RS, common trunk for carotids, LS) was present. In seven cases (7/1001, 0.7%) aortic arch had four branches in the order of RCC, RS, LCC and LS. In one case (1/1001, 0.1%) left truncus brachiocephalicus (three branches; RS, RCC, LTB) was present. Seven cases (7/1001, 0.7%) had aberrant RS (RCC, LCC, LS, RS). Variations in branching pattern of arcus aorta are not rare and being aware of them before surgical and interventional procedures of this region is important. CTA can depict the anatomical features of the aortic arch and is valuable as a road map.

Abstract 18376: Angiographic Graft Patency After Multivessel Minimally Invasive Coronary Artery Bypass Grafting: MICS CABG Patency Study

Objective: Previous publications from our institutions have shown that minimally invasive coronary artery bypass grafting (MICS CABG) is safe, widely applicable, and associated with fewer infections, less transfusions, and better recovery than standard CABG. However, graft patency rates are unknown. The MICS CABG Patency Study prospectively evaluated angiographic bypass graft patency at 6 months after MICS CABG. Methods: In this dual-center study, 61 patients were prospectively enrolled and underwent MICS CABG through a 4-7cm left thoracotomy approach, where the left internal thoracic artery (LITA), the ascending aorta for proximal anastomoses, and all distal coronary targets were accessed without endoscopic or robotic assistance. The primary outcome was graft patency at 6 months, using 64-slice CT angiography. Secondary outcomes included conversions to sternotomy and major adverse cardiovascular events (MACE). ( Clinical Trial Registration Unique identifier: NCT01334866 ) Results: Mean age was 64.1±8.1 years, the mean ejection fraction was 48.8±10.4%, and there were 8 females in the study (13.1%). Surgeries were performed off-pump in 52 patients (85.2%). Complete revascularization was achieved in all patients, and the median number of grafts was 3. There was no perioperative mortality, no conversion to sternotomy, and 1 reopening for bleeding. Transfusion occurred in 15 patients (24.6%).The median length of hospital stay was 4 days, and patients were followed-up to 6 months, with no mortality or MACE. At 6 months, overall CT angiographic graft patency was 91.2% for all grafts, and 100% for LITA grafts. Conclusions: MICS CABG is safe, feasible, and associated with excellent rates of graft patency at 6 months post-surgery.

Abstract 18899: Distribution of Low CT Number Area is Dominant and Wide in Vessel Containing Vulnerable Plaque - Vessel-wide Cross-sectional Scannning by Multi-detector Row Computed Tomography

Introduction. Lipid-rich plaque is shown to be dominant in the culprit by intravascular ultrasound and multidetector row computed tomography in acute coronary syndrome (ACS) than in stable angina pectoris (SAP). However, there were few reports compared the disposition of lipid-rich plaque in vessel-wide. Hypothesis We assessed the hypothesis that lipid-rich plaque is dominantly located in ACS patients by our original vessel-wide cross-sectional scanning. Methods One hundred eight patients (32 acute coronary syndrome (ACS), 38 stable angina pectoris (SAP), and 38 patients without plaque) underwent 64-slice computed tomography angiography. Cross-sectional images for 1mm-intervals were analyzed containing culprit lesion from the ostium. Areas and ratio of 0-50, 50-100, 100-150, 150-200, 200-250, 250-300, 300-350, 350-400, 400-450, &gt;450HU surrounding vessel were calculated for each cross-sectional images and continuously demonstrated as a graph (see figure). Results Analyzed cross-sectional images were averaged 52±18 images for 76 vessels. Fifty cross-sectional images for 38 vessels in patients without plaque were analyzed as control. The ratios of 0-50, 50-100 HU were statistically dominant in ACS patients compared to SAP patients or without plaque (34.7±14.4% vs. 19.6±4.1% vs. 14.8±3.6%, P&lt;0.0001; 22.3±5.5% vs.15.4±3.4% vs. 14.6±2.0%; P&lt;0.0001). The number of slices in which 0-50HU were dominant were higher in ACS than SAP (18±6 vs 12±4 slices, p&lt;0.01). The number of positive remodeling in the vessel was higher ACS than SAP (3.6±0.9 vs. 1.5±0.8, p&lt;0.001). The slices of 64 culprits (91%) were not the most distributed by 0-50HU in the vessels. Conclusions. In ACS patients, lipid-rich component, demonstrated as the area 0-50HU, distributed dominantly and wide on the vessel including the culprit.

Abstract 18410: Association Between Serum Uric Acid Level and the Presence of Coronary Vulnerable Plaques

Background: Uric acid may have effects on vascular remodeling and atherosclerosis. The purpose of this study was to evaluate the relationship between serum uric acid (SUA) levels and presence of coronary vulnerable plaque assessed by computed tomography angiography (CTA). Method: Five hundred twenty-nine patients with suspected coronary artery disease (CAD) underwent 64-slice CTA to evaluate the prevalence of CAD and plaque morphology. Coronary vulnerable plaque was defined as positive vessel remodeling (PR) (RI&gt;1.1) and low-attenuation plaques (LAP) (&lt;50 Hounsfield Unites). SUA level was divides into 4 groups: &lt;5, 5 to &lt;6, 6 to &lt;6.8, ≧6.8 mg/dl. Results: The higher SUA levels were associated with the higher prevalence of coronary vulnerable plaque (P&lt;0.001).The number of vulnerable plaques per patient was significantly higher in patients with higher SUA levels (Figure, P=0.002). In multivariate logistic analysis that adjusted for age, gender, smoking, hypertension, dyslipidemia, diabetes mellitus and estimated glomerular filtration rate, the patients whose SUA level 5 to &lt;6mg/dl, 6 to &lt;6.8mg/dl, and ≧6.8mg/dl had odds ratio (OR) of 1.194 (95% CI: 0.773-2.078, P=0.525), 1.306 (95% CI: 0.085-2.510, P=0.382), 2.622 (95% CI: 1.643-4.541, P=0.002) respectively, for prediction of coronary vulnerable plaque, compared with those whose SUA level was &lt;5 mg/dl. Conclusion: SUA level was associated with the presence of coronary vulnerable plaques. Assessment of SUA level may be useful to identify the high risk patients with suspected CAD, and SUA may have a pathophysiologic effect on atherosclerosis.