Contrast Coronary Angiography Research Articles

Safety of ultra-low contrast coronary angiography in patients with acute kidney injury.

Ultra-low contrast administration during coronary angiography has been previously shown to be feasible and safe among patients with stable chronic kidney disease. In the present study, we investigate the safety of ultra-low contrast coronary angiography in patients with pre-existing acute kidney injury (AKI). The study was a retrospective single-center evaluation of hospitalized patients who had AKI and required coronary angiography. Ultra-low contrast use was defined as ≤18 mL of contrast media. The cohort consisted of a case series of eight inpatients with AKI who required coronary angiography. The mean age was 57 (±16) years and half were females. All patients had chronic kidney disease with a mean baseline estimated glomerular filtration rate of 34 (±17) mL/min/1.73 m2. The mean creatinine before angiography was 3 (±1) mg/dL and volume of contrast administered was 14 (±4) mL. One patient had a 0.1 mg/dL increase in creatinine during admission, and no patients had further AKI up to 1-week postprocedure. The current data suggest that ultra-low contrast coronary angiography can be safely performed in patients with pre-existing AKI The study should be viewed as hypothesis-generating due to its small sample size. A larger cohort is required to validate the results.

Historical and current aspects of angiovisualization methods in CАD (a literature review)

The aim of the work. To summarize and expand knowledge about current methods used for visualization of coronary arteries, their evolution, capabilities, effectiveness, indications for use, safety for patients, guided by the principles of evidence-based medicine. Coronary artery disease (CАD) is an extremely common clinical cardiovascular disease, which is caused by atherosclerosis of the subepicardial coronary arteries (CAs) and can have both acute and chronic course. The incidence of CАD is increasing every year and getting younger. CАD has not only a high morbidity rate, but also a high mortality rate. In Ukraine, mortality from CАD is the main cause of population mortality. Without timely diagnosis and effective treatment, myocardial infarction or sudden cardiac death may develop. It is possible to ascertain the etiological cause of myocardial ischemia only after visualization of the СAs. A practicing physician is able to visualize the СAs using X-ray contrast coronary angiography or contrast-enhanced computed tomography of the chest. СA visualization methods have been used in clinical practice for more than half a century. The hardware and software are constantly upgraded, the diagnostic options of these methods are improved and expanded, and recommendations regarding their use in general clinical practice are updated. The main task for clinicians is to confirm or rule out the presence of a СA atherosclerotic lesion, as well as to determine its localization, extent, degree of stenosis and its significance for coronary blood flow, the presence of СA calcification, collateral pathways, plaque composition and its internal structure. Only after identifying the anatomical and physiological aspects of the atherosclerotic process in СA, it is possible to choose the right strategy for the treatment of patients by a multidisciplinary heart team including pharmacological therapy, a method of cardiac revascularization, and measures for primary or secondary prevention. Conclusions. CАD is a common disease worldwide. Today, two methods of the CА visualization are available – invasive coronary angiography and non-invasive coronary CT angiography. Further research is needed on the efficacy and safety of different СA imaging methods in CAD. Better results of the diagnostic search depend on both the capabilities of the clinic hardware component and on the optimal sequence for diagnostic processes rationally constructed by physicians.

#2531 AGATSTON INDEX AS A PREDICTOR OF PREDICTION OF THE DEGREE OF HEART VASCULAR DAMAGE IN STAGE 5 CKD PATIENTS RECEIVING PROGRAM HEMODIALYSIS

Abstract Background and Aims Cardiovascular events (CVEs) are the leading cause of death in patients with chronic kidney disease (CKD). A retrospective analysis of the causes of death of a large group of nephrological patients shows that the mortality of patients from cardiovascular events is more than 4.1 higher than the number of deaths from all kidney diseases, including end-stage chronic kidney disease [1]. Aim of the study: to evaluate the possibility of CI for predicting the degree of damage to the coronary arteries of the heart in patients with CKD. Method In a prospective study for MSCT, 60 patients were selected (30 patients each from groups 1 and 2 (15 patients in subgroups) with CKD stage 5 of various etiologies receiving PG. The results of multispiral CT-coronary angiography in 60 consecutive patients/clients of a multidisciplinary clinic were analyzed. Among them were: 41 men (68.3%) and 19 women (31.6), the age ranged from 28 to 74 years (mean age - 53.4 ± 11.89 years). The mean age of the woman was 55.05 ± 11.92 years; men 52.63 ± 11.61 years old, there were no statistically significant differences between the age, heart rate, SBP and DBP of women and men, which indicates the representativeness of the groups. Results To assess coronary calcification, MSCT of the chest was performed to determine the mass and volume of coronary calcium. When compared in group 1 patients, in relation to group 2 patients in all coronary basins, there is a significant increase in the content of coronary calcium (p<0.05 for all indicators). The Agatston index in the examined patients ranged from 0 to 790 units (units). Patients with CI ranging from 101 to 400 units. were older - from 34 to 54 years (mean age 42.77 years). Among them, males clearly predominated. In 50% of patients, there was a multivascular lesion of the coronary arteries with significant stenosis in the anterior interventricular branch (LAD) and the right coronary artery (RCA), and without significant stenosis in the circumflex branch of the left coronary artery. With CI over 400 units. all 30 examined patients had multiple coronary artery stenoses, the maximum of which exceeded 70%. At the same time, 5 patients (8.3%) had 4 stenoses of the coronary arteries of the heart. This is consistent with evidence that increased cardiovascular risk is associated with total coronary artery calcium load. Taking into account the fact that according to the results of the study it was found that in many patients with coronary artery stenosis from 20 to 49%, belonging to the group of patients with high cardiovascular risk and with stenosis of more than 50%, to the group of very high risk, having an increased CI, then this indicator can be used as an additional indicator for cardiovascular risk stratification to predict cardiovascular events. Conclusion The Agatston index or CI, determined using multislice CT, can be used as a screening method for detecting coronary artery atherosclerosis and determining cardiovascular risk. With CI over 100 units. the vast majority of the surveyed revealed multiple stenoses of the coronary arteries, with an indicator of more than 400 units. hemodynamically significant arterial damage is expected. Such patients should undergo an additional examination: functional tests (bicycle ergometry, treadmill test, daily ECG monitoring) or contrast coronary angiography to verify the main diagnosis and to decide on further tactics for managing patients.

The impact of iodine contrast agent on radiation dose of heart and blood: a comparison between coronary CT angiography and cardiac calcium scoring CT.

Iodine contrast agent (CA) is widely used in cardiac computed tomography (CT). The CA can increase the organ radiation doses due to the photoelectric effect. To investigate the impact of CA on radiation dose in cardiac CT by comparing the radiation dose between contrast coronary CT angiography (CCTA) and non-contrast calcium scoring CT (CSCT). Radiation doses were computationally calculated for 30 individual patients who received CSCT and CCTA in the same exam session. The geometry and acquisition parameters were modeled in the simulations based on individual patient CT images and acquisitions. Doses in the presence and absence of CA were obtained in the aorta, left ventricle (LV), right ventricle (RV), and myocardial tissue (MT). The dose values were normalized by size-specific dose estimate (SSDE). The dose enhancement factors (DEFSSDE) were calculated as the ratio of doses in CCTA over doses in CSCT. Compared to the CSCT scans, doses increase in the CCTA scans in the aorta (DEFSSDE = 2.14 ± 0.20), LV (DEFSSDE = 1.78 ± 0.26), and RV (DEFSSDE = 1.31 ± 0.22). A linear relation is observed between the local CA concentrations and the dose increase in the heart; DEFSSDE = 0.07*I(mg/mL) + 0.80 (R2 = 0.8; p < 0.01). The DEFSSDE in the MT (DEFSSDE = 0.96 ± 0.08) showed no noticeable impact of CA on the dose in this tissue. In addition, patient variability in the dose distributions was observed. A linear causal relation exists between local CA concentration and increase in radiation dose in cardiac CT. For the same CT exposure, dose to the heart is on average 55% higher in contrast cardiac CT.

Zero contrast optical coherence tomography-guided percutaneous coronary intervention in patients with non-ST segment elevation myocardial infarction and chronic kidney disease.

To investigate a strategy for ultra-low volume contrast percutaneous coronary intervention (PCI) with the aims of preserving renal function and observing the 90-day clinical endpoint in patients with non-ST-elevated myocardial infarction (non-STEMI) and chronic kidney disease (CKD). The feasibility, safety, and clinical utility of PCI with ultra-low radio-contrast medium in patients with non-STEMI and CKD are unknown. A total of 29 patients with non-STEMI and CKD (estimated glomerular filtration rate [eGFR] of ≤60 ml/min/1.73 m2 ) were included. Ultra-low volume contrast PCI was performed after minimal contrast coronary angiography using zero contrast optical coherence tomography (OCT) guidance. Pre- and post-PCI angiographic measurements were performed using quantitative flow ratio (QFR) for pre-perfusion assessment and verifying improvement. The median creatinine level was 2.1 (inter-quartile range 1.8-3.3), and mean eGFR was 48 ± 8 ml/min/1.73 m2 pre-PCI. During the PCI procedure, OCT revealed 15 (52%) cases of abnormalities post-dilation. There was no significant change in the creatinine level and eGFR in the short- or long-term, and no major adverse events were observed. In non-STEMI patients with high-risk CKD who require revascularization, QFR and no contrast OCT-guided ultra-low contrast PCI may be performed safely without major adverse events.

TCT-30 Ultra-Low Contrast Coronary Angiography in Patients With Advanced Chronic Kidney Disease: Feasibility and Outcomes Compared With Conventional Angiography

The aim of this study was to examine the risk of contrast-induced nephropathy (CIN) and need for renal replacement therapy (RRT) in patients with advanced chronic kidney disease (CKD) who underwent ultra-low contrast angiography (ULCA) compared with conventional angiography (CA). This prospective

Ultra-low contrast coronary angiography and zero-contrast percutaneous coronary intervention for prevention of contrast-induced nephropathy: step-by-step approach and review.

Contrast-induced nephropathy is a serious complication after intravascular administration of iodinated contrast media and is associated with numerous adverse outcomes. Its prevalence is particularly high in patients with multiple comorbidities who undergo coronary angiography and percutaneous coronary intervention (PCI). Currently, the only effective method to prevent contrast-induced kidney injury is adequate hydration and a reduction of contrast volume during the intervention. Recently, new approaches aiming to minimize contrast usage have been proposed, i.e., ultra-low contrast angiography and zero-contrast PCI. However, neither tutorials for these techniques nor reviews of their outcomes exist in the literature, and therefore dissemination of these approaches among the interventional community may be limited. This article presents a step-by-step description on how to perform ultra-low coronary angiography and zero-contrast PCI, which should help invasive cardiologists to adopt these techniques in daily practice. A review of clinical studies, case series and single case reports regarding these methods is also provided. Despite the promising results, such procedures still require some improvements and confirmation of their effectiveness as well as safety in large clinical studies. This article aims to spread these new techniques throughout the interventional community, which is paramount for their further development and wider utilization.

Prediction of contrast induced acute kidney injury using novel biomarkers following contrast coronary angiography.

Chronic kidney disease (CKD) is a risk factor for contrast induced acute kidney injury (CI-AKI). Contrast angiography in CKD patients is a common procedure. Creatinine is a delayed marker of CI-AKI and delays diagnosis which results in significant morbidity and mortality. Early diagnosis of CI-AKI requires validated novel biomarkers. A prospective observation study of 301 consecutive CKD patients undergoing coronary angiography was performed. Samples for plasma neutrophil gelatinase-associated lipocalin (NGAL), serum liver fatty acid-binding protein (L-FABP), serum kidney injury marker 1, serum interleukin 18 and serum creatinine were taken at 0, 1, 2, 4, 6 and 48 h post-contrast. Urinary NGAL and urinary cystatin C were collected at 0, 6 and 48 h. Incidence of major adverse clinical events (MACE) was recorded at 1 year. CI-AKI was defined as an absolute delta rise in creatinine of ≥26.5 µmol/l or a 50% relative rise from baseline at 48 h following contrast. CI-AKI occurred in 28 (9.3%) patients. Plasma NGAL was most predictive of CI-AKI at 6 h. L-FABP performed best at 4 h. A combination of Mehran score > 10, 4 h L-FABP and 6 h NGAL improved specificity to 96.7%. MACE was statistically higher at 1 year in CI-AKI patients (25.0 vs. 6.2% in non-CI-AKI patients). Mehran risk score, 4 h serum L-FAPB and 6 h plasma NGAL performed best at early CI-AKI prediction. CI-AKI patients were four times more likely to develop MACE and had a trebling of mortality risk at 1 year.

TCT-474 Ultra-Low Contrast Coronary Angiography in Patients with Advanced Chronic Kidney Disease - Feasibility and Outcomes Compared to Standard Angiography

Patients with advanced chronic kidney disease (CKD) have avoided diagnostic coronary angiography due to concerns of precipitating the need for renal replacement therapy (RRT). Our objective was to establish the risk of contrast-induced nephropathy (CIN) and need for RRT in patients with advanced CKD

Myocardial Infarction in a Patient With Hypertrophic Cardiomyopathy but Normal Coronary Arteries

A 57-year-old man with a history of hypertrophic cardiomyopathy diagnosed by echocardiography experienced atypical chest pain and dyspnea for 6 months. A rest Tc-MIBI myocardial SPECT imaging and a F-FDG myocardial PET/CT imaging were performed, which showed multiple matched myocardial perfusion/metabolism defects in the left ventricle, indicating scar tissue. Surprisingly, subsequent contrast coronary angiography revealed no significant coronary artery stenosis.

TCT-377 Safety of Ultra-Low Contrast Coronary Angiography in Patients with Advanced Chronic Kidney Disease

Historically, patients with advanced chronic kidney disease (CKD) have avoided coronary angiography due to concerns of precipitating the need for renal replacement therapy (RRT). The objective of this study was to establish the risk of contrast-induced nephropathy (CIN) and need for RRT in patients

Novel Biomarkers of Acute Kidney Injury After Contrast Coronary Angiography.

Acute kidney injury (AKI), defined as a rise in serum creatinine of greater than 25% from baseline measured at 48 hours after renal insult, may follow iodinated contrast coronary angiography. Termed contrast-induced nephropathy, it can result in considerable morbidity and mortality. Measurement of serum creatinine as a functional biomarker of glomerular filtration rate is widely used for detection of AKI, but it lacks sensitivity for the early diagnosis of AKI (typically rising 24 hours after functional loss) and, as a solely functional marker of glomerular filtration rate, is unable to differentiate among the various causes of AKI. These intrinsic limitations to creatinine measurement and the recognition that improved clinical outcomes are linked to a more timely diagnosis of AKI, has led investigators to search for novel biomarkers of "early" kidney injury. Several studies have investigated the utility of renal injury biomarkers in a variety of clinical settings including angiography/percutaneous coronary intervention, coronary artery bypass graft surgery, sepsis in intensive care patients, and pediatric cardiac surgery. In this article, we discuss the use of iodinated contrast for coronary procedures and the risk factors for contrast-induced nephropathy, followed by a review the potential diagnostic utility of several novel biomarkers of early AKI in the clinical settings of coronary angiography/percutaneous coronary intervention. In particular, we discuss neutrophil gelatinase associated lipocalin in depth. If validated, such biomarkers would facilitate earlier AKI diagnosis and improve clinical outcomes.

Coronary calcium scoring from contrast coronary CT angiography using a semiautomated standardized method

BackgroundWhen coronary calcium scoring is performed in patients with suspected coronary artery disease, a separate noncontrast scan is acquired before contrast-enhanced coronary CT angiography (CTA). ObjectiveOur aim was to develop and validate an automated method for calculating the coronary calcium score (CCS) from coronary CTA. MethodsWe analyzed coronary CTA and noncontrast CT data sets of 84 patients (Agatston score >0). The CCS on noncontrast CT was measured using commercial methods. Coronary calcium volume was measured on coronary CTA using an automated standardized method with scan-specific calcium thresholds. Data sets were split into derivation (n = 40) and validation groups (n = 44). To calculate the CCS on coronary CTA, a conversion factor between calcium scores measured in noncontrast CT and the calcium volume measured on coronary CTA was derived by linear regression. ResultsIn the validation group, the median calculated CCS derived from CTA was 277 and 244 on noncontrast images (P = .12). This CCS showed an excellent correlation with the CCS from noncontrast images (Pearson, r = 0.95). In the validation group, 39 of 44 patients (88.6%) were classified into the same standard category (1–10, 11–100, 101–400, or >400) with an excellent agreement (weighted κ of 0.87). ConclusionCCSs can be accurately measured from contrast-enhanced coronary CTA by using an automated, standardized method, obviating the need for a noncontrast scan.

Septal and anterior reverse mismatch of myocardial perfusion and metabolism in patients with coronary artery disease and left bundle branch block.

The effects of left bundle branch block (LBBB) on left ventricular myocardial metabolism have not been well investigated. This study evaluated these effects in patients with coronary artery disease (CAD).Sixty-five CAD patients with complete LBBB (mean age, 61.8 ± 9.7 years) and 65 without LBBB (mean age, 59.9 ± 8.4 years) underwent single photon emission computed tomography, positron emission tomography, and contrast coronary angiography. The relationship between myocardial perfusion and metabolism and reverse mismatch score, and that between QRS length and reverse mismatch score and wall motion score were evaluated.The incidence of left ventricular septum and anterior wall reverse mismatching between the two groups was significantly different (P < 0.001 and P = 0.002, respectively). The incidences of normal myocardial perfusion and metabolism in the left ventricular lateral and inferior walls were also significantly different between the two groups (P < 0.001 and P < 0.001, respectively). The incidence of septal reverse mismatching in patients with mild to moderate perfusion was significantly higher among those with LBBB than among those without LBBB (P < 0.001). In CAD patients with LBBB, septal reverse mismatching was significantly more common among those with mild to moderate perfusion than among those with severe perfusion defects (P = 0.002). The correlation between the septal reverse mismatch score and QRS length was significant (P = 0.026).In patients with CAD and LBBB, septal and anterior reverse mismatching of myocardial perfusion and metabolism was frequently present; the septal reverse mismatch score negatively correlated with the QRS interval.

Can osteoprotegerin be used to identify the presence and severity of coronary artery disease in different clinical settings?

PurposeThe biomarker Osteoprotegerin (OPG) is associated with coronary artery disease (CAD). The main purpose of this study was to evaluate the diagnostic value of OPG in healthy subjects and in patients with suspected angina pectoris (AP). MethodsA total of 1805 persons were enrolled: 1152 healthy subjects and 493 patients with suspected AP. For comparison 160 patients with acute myocardial infarction (MI) were included. To uncover subclinical coronary atherosclerosis, a non-contrast cardiac-CT scan was performed in healthy subjects; while in patients with suspected AP a contrast coronary angiography was used to detect significant stenosis. OPG concentrations were analyzed and compared between groups. ROC-analyses were performed to estimate OPG cut-off values. ResultsOPG concentrations increased according to disease severity with the highest levels found in patients with acute MI. No significant difference (p = 0.97) in OPG concentrations was observed between subgroups of healthy subjects according to severity of coronary calcifications. A significant difference (p < 0.0001) in OPG concentrations was found between subgroups of patients with suspected stable AP according to severity of CAD. ROC-analysis showed an AUC of 0.62 (95% CI: 0.57–0.67). The optimal cut-off value of OPG (<2.29 ng/mL) had a sensitivity of 56.2% (95% CI: 49.2–63.0%) and a specificity of 62.9% (95% CI: 57.3–68.2%). ConclusionOPG cannot be used to differentiate between healthy subjects with low versus high levels of coronary calcifications. In patients with suspected AP a single OPG measurement is of limited use in the diagnosis of CAD.

Utility of late gadolinium enhancement cardiac MRI (LGE-CMRI) in troponin-positive chest pain with unobstructed coronary arteries

Background A surprising proportion of troponinpositive chest pain patients referred for contrast coronary angiography exhibit no or minor coronary arterial luminal narrowings at the time of presentation. We assessed whether the presence of late gadolinium enhancement (LGE) during cardiovascular magnetic resonance (CMR) forecasts adverse cardiovascular (CV) events in patient presenting with serum troponin elevations and chest pain but without obstructive coronary artery disease during contrast coronary angiography.

Double congenital fistulae with aneurysm diagnosed by combining imaging modalities.

Congenital coronary pulmonary artery fistula (CAF) is rare, and systemic-to-pulmonary artery fistula (SPAF) is even more so. Furthermore, congenital coronary pulmonary fistula associated with congenital SPAF is extremely rare. As far as we know, CAF and SPAF connected with an aneurysm have not been described very often. We described an 83-year-old woman with an aneurysm originating from a CAF connected to an aortopulmonary artery fistula. Chest radiography revealed a shadow at the left edge of the heart line. Multi-detector-row computed tomography (MDCT) with contrast enhancement and coronary cine angiography revealed that the shadow was an aneurysm connected to a tortuous fistula at the left anterior descending coronary artery. The aneurysm was formed by congenital coronary pulmonary and aortopulmonary artery fistulae. Echocardiography revealed predominantly systolic blood flow in the fistula from the left anterior descending coronary artery (LAD). Although neither MDCT, echocardiography nor coronary angiography alone could provide a comprehensive image of the anomaly, including the hemodynamics in the fistulae and their relationship with surrounding organs and tissues, their combination could provided important facts the led to a deeper understanding of this very uncommon occurrence.

Adenosine Stress Cardiovascular Magnetic Resonance–Observation Unit Management of Patients at Intermediate Risk for Acute Coronary Syndrome: A Possible Strategy for Reducing Healthcare-Related Costs

Although clear algorithms for diagnosis and treatment of patients with chest pain at low or high risk for an acute coronary syndrome (ACS) exist, they are less well delineated for patients presenting with chest pain with an intermediate risk for ACS. In patients presenting acutely or subacutely to emergency departments (EDs) at high risk for ACS, such as those with ST segment elevation on their 12-lead electrocardiogram (ECG), immediate contrast coronary angiography is performed. On the other hand, chest pain observation units (OUs) are recommended for managing those with chest pain at low risk for an ACS event. In this setting, these OUs are associated with lower healthcare resource utilization and improved cost-effectiveness. Cost-effective diagnosis and treatment options are important goals in healthcare delivery systems. The presentation of patients at intermediate risk for ACS represents an emerging source of resource utilization for EDs. These patients often exhibit pre-existing coronary artery disease, may have sustained prior myocardial infarction, and exhibit multiple comorbidities such as diabetes and hypercholesterolemia. Importantly, however, they will not have evidence of ST elevation on their 12-lead ECG nor will they exhibit serum markers (troponin or creatinine kinase elevations) indicative of ACS. As a consequence of existing co-morbidities, their management becomes time-consuming and may require inpatient monitoring, observation, and cardiac stress testing. Cardiovascular magnetic resonance (CMR) is a powerful tool for risk stratification and prognosis determination in patients in need of stress testing at intermediate risk of ACS. For those who present with acute chest pain syndromes, the combination of CMR in an OU setting represents a potentially attractive option for reducing healthcare-related expenditures without compromising patient outcomes. Recent study results from single centers suggest that CMR-OU care may result in fewer unnecessary hospital admissions and invasive procedures in those presenting with intermediate risk ACS. Further research utilizing stress CMR testing from multiple centers in OU settings is needed to determine if this model of care improves efficiency, reduces healthcare costs, and delivers optimum care in individuals presenting to EDs with chest pain at intermediate risk of ACS.

The comparative analysis of resting electrocardiogram and intravenous myocardial contrast coronary angiography for the diagnosis of heart disease

Objective To explore the diagnostic value of resting electrocardiogram (ECG) and intravenous myocardial contrast echocardiography (MCE) for the diagnosis of coronary heart disease and vascular lesions associated sites of the sensitivity,specificity and accuracy.Methods May 2009 to November 2010,selected 78 patients,39 ones were male and the others were female,aged f45-75,the average age was (50.8 ± 12.9) years (excluding cardiomyopathy,Hypertensive heart disease and diabetes)from the Department of Cardiology at Binzhou People' s Hospital.22 cases were diagnosed with coronary heart disease conbined with myocardial infarction,13 cases with angina pectoris (including one case of variant angina),23 cases were suspected with coronary artery disease,20 cases with unknown chest pain.The same period (＜2 weeks),carried out resting Electrocardiogram and cardiac ultrasound contrast and coronary on them.Results 1.There was statistically significant difference among MCE diagnosis of coronary artery disease susceptibility,resting ECG,and resting ECG + MCE (P＜0.05).There was statistically significant difference between resting ECG + MCE specific diagnosis of coronary artery disease and resting ECG,MCE e (P＜0.05).2.Using MCE,resting ECG,and resting ECG + MCE to speculate LAD,LCX had higher sensitivity(P＜0.05).There was statistically significant difference on the specificity between using resting ECG + MCE to speculate LAD,LCX and using resting ECG,MCE (P＜0.05).3.Among resting ECG,MCE,resting ECG + MCE RCA speculating on the sensitivity,specificity,and accuracy,the difference was not significant (P＞ 0.05).Conclusion 1.Resting ECG for the diagnosis of coronary heart disease and vascular diseases related to the judge has some limitations.2.MCE for the determination of coronary heart disease and coronary artery LAD,LCX has a higher sensitivity.3.Resting ECG + MCE for the exclusion of coronary heart disease and LAD,LCX lesions has some reference value.4.CAG for the diagnosis of coronary artery disease is the gold standard; it still is an irreplaceable method for the diagnosis of coronary heart disease. Key words: Resting electrocardiogram; Iintravenous myocardial contrast; Coronary angiography; Coronary heart disease

Current characteristics of congenital coronary artery fistulas in adults: A decade of global experience

To describe the characteristics of coronary artery fistulas (CAFs) in adults, including donor vessels and whether termination was cameral or vascular. A PubMed search was performed for articles between 2000 and 2010 to describe the current characteristics of congenital CAFs in adults. A group of 304 adults was collected. Clinical data, presentations, diagnostic modalities, angiographic fistula findings and treatment strategies were gathered and analyzed. With regard to CAF origin, the subjects were tabulated into unilateral, bilateral or multilateral fistulas and compared. The group was stratified into two major subsets according to the mode of termination; coronary-cameral fistulas (CCFs) and coronary-vascular fistulas (CVFs). A comparison was made between the two subsets. Fistula-related major complications [aneurysm formation, infective endocarditis (IE), myocardial infarction (MI), rupture, pericardial effusion (PE) and tamponade] were described. Coronary artery-ventricular multiple micro-fistulas and acquired CAFs were excluded as well as anomalous origin of the coronary arteries from the pulmonary artery (PA). A total of 304 adult subjects (47% male) with congenital CAFs were included. The mean age was 51.4 years (range, 18-86 years), with 20% older than 65 years of age. Dyspnea (31%), chest pain (23%) and angina pectoris (21%) were the prevalent clinical presentations. Continuous cardiac murmur was heard in 82% of the subjects. Of the applied diagnostic modalities, chest X-ray showed an abnormal shadow in 4% of the subjects. The cornerstone in establishing the diagnosis was echocardiography (68%), and conventional contrast coronary angiography (97%). However, multi-slice detector computed tomography was performed in 16%. The unilateral fistula originated from the left in 69% and from the right coronary artery in 31% of the subjects. Most patients (80%) had unilateral fistulas, 18% presented with bilateral fistulas and 2% with multilateral fistulas. Termination into the PA was reported in unilateral (44%), bilateral (73%) and multilateral (75%) fistulas. Fistulas with multiple origins (bilateral and multilateral) terminated more frequently into the PA (29%) than into other sites (10.6%) (P = 0.000). Aneurysmal formation was found in 14% of all subjects. Spontaneous rupture, PE and tamponade were reported in 2% of all subjects. In CCFs, the mean age was 46.2 years whereas in CVFs mean age was 55.6 years (P = 0.003). IE (4%) was exclusively associated with CCFs, while MI (2%) was only found in subjects with CVFs. Surgical ligation was frequently chosen for unilateral (57%), bilateral (51%) and multilateral fistulas (66%), but percutaneous therapeutic embolization (PTE) was increasingly reported (23%, 17% and 17%, respectively). Congenital CAFs are currently detected in elderly patients. Bilateral fistulas are more frequently reported and PTE is more frequently applied as a therapeutic strategy in adults.