Coronary Angiography For Detection Research Articles

DIAGNOSTIC ACCURACY OF CT CORONARY ANGIOGRAPHY.

Coronary Artery Disease (CAD) is an emerging and commonest type of heart disease resulting in morbidity and mortality globally. Coronary angiography is a diagnostic modality used to diagnose the coronary artery disease or the extent of blockage of coronary arteries. The multi-slice computed tomography (MSCT) technology such as 64-slice, 128-slice, 256-slice, and now 320-slice MSCT has produced a high diagnostic accuracy of CT coronary angiography. This prospective-cross sectional study was done in Department of Cardiology in Medanta, the Medicity, from November 2017 to December 2018 with the aim to evaluate the diagnostic accuracy of 256 slice CT coronary angiogram in measuring the percentage diameter stenosis compared to invasive angiography and to determine the sensitivity and specicity of CT coronary angiography in detection of coronary artery stenosis among symptomatic patients. A total of 60 patients presented with acute or chronic chest pain with risk for CAD were included. The mean age of the participants was 57.35±10.16 years and 88.3% participants were male and 11.7% participants were females. 56.6% participants had BMI >25, 11.7% were alcoholic, 40% were smoker, 16.7% had diabetes and 38.3% had hypertension. The study concluded that CCTA should be considered initial test of choice in patients presenting with chest pain with low to intermediate probability of CAD because the time required for diagnosis is signicantly shorter, high sensitivity, specicity, PPV and NPV on per vessel and per segment basis, determination of LVEF and has the ability to rule out causes of atypical chest pain including pulmonary embolism and aortic dissection.

Diagnostic Value of Multidetector Computer Tomography Coronary Angiography in Detection of Coronary Artery Stenosis

Diagnostic Value of Multidetector Computer Tomography Coronary Angiography in Detection of Coronary Artery Stenosis

Role of Cardiac Magnetic Resonance Imaging in Diagnosis of Myocardial Infarction

Introduction: Cardiac Magnetic Resonance Imaging provides an accurate and reproducible modality for the assessment of global ventricular volumes and function, and valuable in establishing a diagnosis of chronic and acute MI and distinguishing this condition from non-ischemic cardiomyopathies. Aim: To evaluate the role of cardiac Magnetic Resonance Imaging technique in diagnosis of myocardial infarction, assessment of myocardial viability. Subject and Method: The study was conducted over a period of 3 years at Assiut University Hospital. Fifty-six patients were recruited. All patients were subjected to full history taking and radiological evaluation using a 1.5-T MR system and echocardiography. Agreement regarding segmental wall motion was assessed by using Cohen’s Kappa statistics. Also ejection fraction measurement by both modalities was compared using bland-Altman plots. Agreement between Magnetic Resonance Imaging and conventional coronary angiography in detection of diseased coronary arteries was examined using Cohen’s kappa coefficient (κ). Results: It was found that ejection fraction detected by Echo were overestimated relative to Magnetic Resonance Imaging with statistically significant difference (p=0.004). While LV diameters detected by echocardiography were underestimated relative to Magnetic Resonance Imaging. Good agreement between Magnetic Resonance Imaging and Echo regarding segmental wall motion. There was positive very high correlation between the two modalities in evaluation of LV Functionality indices. Conclusion: CMR is superior to echo in evaluating left ventricular functionality indices with echo underestimating these indices except the ejection fraction which is overestimated by Echo. Moreover, CMR is better in evaluating post MI complications and associated cardiac abnormalities.

The Value of Longitudinal Strain versus Coronary Angiography in Detection of Coronary Artery Disease

The Value of Longitudinal Strain versus Coronary Angiography in Detection of Coronary Artery Disease

Correlation of fragmented QRS complexes with the severity of CAD (using Syntax score) in patients with non-ST elevation acute coronary syndromes

Abstract Background Fragmented QRS (f-QRS) complexes are novel electrocardiographic signals, which reflect myocardial conduction delays in patients with coronary artery disease (CAD). The significance of f-QRS complexes in non-ST elevation ACS patients for detection of the severity of CAD (correlation with Syntax score) was evaluated in this prospective study. Methods A total of 104 patients with non-ST-elevation ACS who underwent invasive coronary angiography for detection of coronary artery disease were recruited prospectively in this study, ECG was done to all patients, which showed f-QRS in 50 patients (f-QRS group) and inverted T wave or depressed ST in 54 patients (non f-QRS group). The significance of f-QRS complexes on 12-lead ECG for detection of the severity of the CAD (correlated with Syntax score) was assessed in this cohort of patients. Results Among the patients studied, elderly patients (age ⩾ 65 years), males, diabetics, smokers and those with dyslipidemia had a significantly higher frequency of fQRS complexes (with P value = 0.02, 0.01, 0.019, 0.005, 0.02 respectively). Also, the present study found a higher frequency of f-QRS in patients with multi-vessel disease, in those with more severe degree of coronary artery stenosis, in those with positive Troponin I level and in those with high Syntax score (with P value = 0.009, 0.000, 0.000 respectively). Conclusions The frequency of f-QRS complexes was found to be higher in elderly, diabetic, dyslipidemic, and male patients with NSTE-ACS. The higher frequency of (f-QRS) was correlated with the extent and severity of coronary lesions in patients with NSTE-ACS.

Diagnostic utility of Gadolinium enhanced Coronary CT Angiography compared to Conventional Invasive Coronary Angiography in detection of obstructive Coronary Artery Disease

Background: The current gold standard for assessment of coronary artery disease, Invasive Coronary Angiography (ICA), has inherent risks of an invasive procedure including that of death. In addition use of Iodinated contrasts in ICA and Coronary CT Angiography is often contraindicated due to its renal toxicity and hypersensitivity reactions. Gadolinium, though primarily an MRI contrast, has been shown to produce vascular luminal enhancement making it an attractive alternative contrast agent for use in angiography.Objectives: To assess the possibility of use of Gd-enhanced 64-slice cardiac CT (CCT) for the diagnosis of obstructive coronary artery disease in comparison to invasive coronary angiography.Methods: A total of 25 patients of CAD underwent Gadolinium Enhanced Coronary CT Angiography followed by Invasive Coronary Angiography. The data was analyzed by comparing coronary segments with ≥ 50% stenosis detected by ICA versus detection of the same by Gd-Enhanced CTA, as well as comparison on Per-Vessel basis.Results: Mean age of patients in our study was 53.52 years (range 41-70 years). The total number of coronary segments evaluated by invasive coronary angiography was 379 of which 57 showed ≥ 50% stenosis. Gd-Enhanced CTA detected 47 of these lesions. In comparison to ICA, on Per-segment basis, Gd- Enhanced CTA showed Sensitivity of 82.46%, Specificity of 97.50%, PPV of 85.45% and NPV of 96.95%. Weighted Kappa value was 1, suggestive of strong agreement between the two modalities, excluding agreement by chance.Conclusions: Our study shows Gadolinium Enhanced Coronary CT Angiography is safer alternative for assessment of CAD in patients who have a contraindication for ICA or Iodinated Contrasts with acceptable sensitivity and specificity. Results depend on BMI and coronary calcification.

TCTAP A-177 Multi-Slice Computed Tomography Coronary Angiography for Detection of Coronary Anomalies

Congenital coronary artery anomaly occurs infrequently in general population, and they are present at birth, but relatively few are symptomatic during childhood. Most coronary anomalies are discovered as incidental findings during coronary angiography. Their clinical relevance varies widely. They

Role of 320-slice multislice computed tomography coronary angiography in the assessment of coronary artery stenosis

ObjectiveTo evaluate the effectiveness of the multislice CT coronary angiography, as a non-invasive imaging tool in assessment of coronary artery stenosis. Patients and methodsThe study included 50 patients who were referred for MSCT coronary angiography followed by catheter coronary angiography. Patients with previous coronary bypass grafts and those with coronary stents were excluded. History of contrast allergy, renal impairment and severe chest conditions were exclusion criteria. The coronary angiographic CT studies were performed using a 320 CT scanner. The catheter coronary angiographic studies were performed via femoral arterial puncture. The results of CT angiography were compared with the gold standard catheter angiography. ResultsThe positive predictive value and negative predictive value of MSCT coronary angiography in detection of coronary artery stenosis were 94% and 100%, respectively. ConclusionIn conclusion, MSCT coronary angiography is a very helpful and rapid non-invasive coronary imaging modality that was able to detect and grade coronary artery stenosis better than other noninvasive examinations used to detect CAD, such as exercise stress testing. Due to its very high negative predictive value, it may eliminate the need for invasive coronary procedures in the presence of normal coronary imaging.

TCT-235 Accuracy of 320 computed tomography coronary angiography in detection of functionally significant stenoses - comparison with FFR

Fractional flow reserve assessment (FFR) may identify functionally significant coronary lesions which may benefit from revascularisation. It is predominantly performed upon identification of ≥50% stenosis on invasive angiography (ICA). The accuracy of 320-detector computed tomography coronary

64-MDCT Coronary Angiography of Patients With Atrial Fibrillation: Influence of Heart Rate on Image Quality and Efficacy in Evaluation of Coronary Artery Disease

The purpose of this study was to prospectively evaluate the effects of mean heart rate and heart rate variability on image quality at coronary 64-MDCT angiography of patients with atrial fibrillation and to determine the efficacy of coronary 64-MDCT angiography in the detection of significant (> 50%) coronary artery stenosis in patients with atrial fibrillation. Sixty patients (37 women, 23 men; mean age, 58.7 years) underwent both coronary 64-MDCT angiography and conventional coronary angiography. Heart rate variability was calculated as the SD from the mean heart rate during scanning. Image quality (good, moderate, or poor) and the presence of significant (> 50%) stenosis at coronary CT angiography were evaluated by two radiologists blinded to the results of conventional coronary angiography. The sensitivity, specificity, positive predictive value, and negative predictive value of coronary CT angiography were calculated with conventional angiography as the reference standard. Pearson's correlation analysis and chi-square tests were performed to compare image quality with mean heart rate and heart rate variability in each patient. Differences in detection of coronary artery stenosis between coronary 64-MDCT angiography and conventional coronary angiography were evaluated with McNemar's test, and agreement between techniques was calculated with kappa statistics. The mean heart rate was 90 +/- 13.1 beats/min with variability of 19.35 +/- 6.95 beats/min. Of 803 segments evaluated, 26 (3%) were considered to have poor image quality. Highly significant correlation was found between mean heart rate and image quality for all segments in each patient (r = 0.51, p < 0.001), for the right coronary artery (r = 0.43, p = 0.001), and for the distal portion of the coronary arteries (r = 0.50, p < 0.001). Heart rate variability also correlated in a highly significant way with image quality in all segments (r = 0.57, p < 0.001), the right coronary artery (r = 0.46, p < 0.001), and the middle (r = 0.44, p = 0.001) and distal (r = 0.41, p = 0.001) portions of the coronary arteries. The best diagnostic image quality was obtained in end systole (200-400 milliseconds). Image quality decreased significantly with a mean heart rate greater than 100 beats/min or with an SD of heart rate greater than 24 beats/min. The overall sensitivity, specificity, positive predictive value, and negative predictive value per segment level were 86.4%, 99.3%, 79.2%, and 99.6%. No significant difference was found between coronary 64-MDCT angiography and conventional coronary angiography in detection of significant stenosis. Excellent agreement between techniques was found. Coronary 64-MDCT angiography has diagnostic image quality within a wide range of heart rates and in patients with atrial fibrillation. Reducing average heart rate and heart rate variability in patients with atrial fibrillation is beneficial in improving image quality.

Coronary Artery Stenosis in High-risk Patients: 64–Section CT and Coronary Angiography—Prospective Study and Analysis of Discordance

To assess the diagnostic accuracy of multisection (64-section) computed tomography (CT) versus coronary angiography in detection of and assignment of grades for coronary artery stenoses in a high-risk population and to investigate causes for discordance between the two. The protocol was approved by the local ethics committee. Patients gave informed consent. The study included 114 patients (103 men, 11 women; mean age, 63 years +/- 8.2 [standard deviation]) with potential myocardial ischemia. Multisection CT images were interpreted independently by two radiologists with unequal experience in reading coronary CT angiograms. Diagnostic performance of 64-section CT in detection of stenoses of 50% or more was assessed per patient, per artery, and per segment. Interrater agreement was assessed by using the Cohen kappa coefficient. Agreement between 64-section CT and coronary angiography for assigning grades to stenoses was assessed by using Bland-Altman analysis. Sixty-eight percent of patients had stenoses of 50% or more. Good interrater agreement was found, with kappa values of 0.77-0.85. For the most experienced radiologist, the sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were 73.4%, 95.0%, 14.7, and 0.28 per segment, 95.2%, 94.7%, 18.0, and 0.05 per artery, and 100%, 89.2%, 9.26, and zero per patient, respectively. Discordance between 64-section CT and coronary angiography was related to either under- or overestimation of the degree of stenosis, anatomic misclassification, and coronary artery segments that were not assessable at 64-section CT. Bland-Altman analysis showed poor agreement, especially for intermediate stenosis (mean bias, 1.3%; 95% limits of agreement: -27.3%, 29.9%). Despite excellent sensitivity and negative likelihood ratios in a per-patient or per-vessel analysis, some coronary artery stenosis remained misdiagnosed with 64-section CT, resulting in limited sensitivity on a per-segment basis owing to anatomic discordance and failure to accurately quantify intermediate stenosis.

Complementary Utility of Multislice Computed Tomographic Coronary Angiography for Detection of High-Grade Lesions in Patients with Negative Stress Myocardial Perfusion Imaging

Myocardial perfusion imaging (MPI) is a highly sensitive and specific test for noninvasive detection of coronary artery disease. Therefore, in patients with negative MPI results, further noninvasive testing is usually not pursued. We report a series of patients with negative MPI results in whom 64-slice computed tomographic coronary angiography accurately predicted flow-limiting coronary lesions requiring subsequent revascularization.

836-4 Diagnostic value of adenosine stress magnetic resonance (MR) perfusion imaging and delayed MR hyperenhancement compared to Tl-201 SPECT and coronary angiography for detection of coronary artery disease and myocardial scar tissue

836-4 Diagnostic value of adenosine stress magnetic resonance (MR) perfusion imaging and delayed MR hyperenhancement compared to Tl-201 SPECT and coronary angiography for detection of coronary artery disease and myocardial scar tissue

P2291 Diagnostic value of adenosine stress magnetic resonance imaging in comparison to 201Tl single-photon emission computed tomography myocardial scintigraphy and coronary angiography for detection of coronary artery disease and myocardial scar tissue

P2291 Diagnostic value of adenosine stress magnetic resonance imaging in comparison to 201Tl single-photon emission computed tomography myocardial scintigraphy and coronary angiography for detection of coronary artery disease and myocardial scar tissue