Coronary Artery Computed Tomography Angiography Research Articles

An elevated level of soluble suppression of tumorigenicity 2, but not galectin-3, is associated with the presence of coronary artery disease in hypertensive patients.

We investigated whether there were associations between coronary artery disease (CAD) and soluble suppression of tumorigenicity (sST2) and galectin-3 levels at the time of coronary artery computed tomography angiography (CCTA) for CAD screening. The subjects consisted of 429 patients who underwent CCTA examination. CAD was diagnosed when there was 50% or more stenosis in the coronary artery. Patient backgrounds were collected and plasma levels of sST2 and galectin-3 were measured. The presence or absence of CAD and factors that contributed to CAD were analyzed for all patients and for those with or without hypertension (HTN). The CAD group had significantly higher sST2 levels than the non-CAD group, whereas there was no significant difference in galectin-3 levels. The number of patients in the non-HTN and HTN groups was 174 and 255, respectively. In the HTN group, the CAD group was significantly older than the non-CAD group and had higher sST2 levels. Multivariate analysis showed that the factors that contributed to CAD in the HTN group were age and sST2 levels. On the other hand, in the non-HTN group, the CAD group was significantly older than the non-CAD group, and had a higher proportion of males and higher sST2 levels, while the contributing factors for the CAD group were age and male gender, but not sST2. In conclusion, a higher level of sST2, but not galectin-3, was a contributing factor for CAD in HTN patients. However, in non-HTN patients, a high level of sST2 was not a contributing factor for CAD.

Association Between Pericoronary Fat Attenuation Index as Evaluated by Coronary Artery CT Angiography and Clinical Interventions in Lipid Management Among Patients with Coronary Artery Disease.

This study aims to evaluate the relationship between the pericoronary fat attenuation index (FAI), derived from coronary artery computed tomography angiography, and post-lipid management levels of low-density lipoprotein cholesterol in patients with coronary artery disease (CAD). Additionally, the study investigates coronary inflammation across different lipid management strategies. We selected a cohort comprising 521 CAD patients who met the inclusion criteria. Patients were categorized into well-managed (LDL-C<2.6mmol/L) and poorly managed (LDL-C≥2.6mmol/L) groups based on lipid management efficacy. We collected anthropometric measures (height, weight, body mass index, and body surface area) and clinical indicators, including Gensini score, and FAI-related parameters for coronary atherosclerotic lesions. We analyzed the interrelations along these parameters and lipid management using statistical methods and assessed diagnostic value via receiver operating characteristic (ROC) curve analysis of these parameters was assessed through. The poorly managed group exhibited significantly higher levels of total cholesterol, triglycerides, and lower levels of high-density lipoprotein compared to the well-managed group (P < 0.05). Significant differences were observed between the groups in terms of lesion length in the proximal segment of the left anterior descending artery, FAI value in the proximal segment of lesions in the right coronary artery (RCA), volume thickness in the middle segment of RCA lesions, and lesion length in the distal segment of RCA (P < 0.05). ROC curve analysis revealed areas under the curve ranging from 0.484 to 0.660 for the parameters, indicating limited diagnostic efficacy. The FAI in the RCA varies with lipid management strategies, suggesting it as a valuable metric for monitoring both perivascular inflammation and lipid status in CAD patients. However, its current diagnostic efficacy is limited, indicating the need for further research to improve its clinical utility.

Evaluation of Pericoronary Fat Attenuation Index to Better Identify Culprit Lesions in Acute Coronary Syndrome According to Stenosis Severity.

To investigate the incremental value of pericoronary fat attenuation index (FAI) in routine coronary artery computed tomography angiography (CCTA) to identify culprit lesions in acute coronary syndrome (ACS). We reviewed the CCTA data from 80 ACS patients and 40 individuals with stable coronary atherosclerosis. ACS patient plaques were categorized into culprit and nonculprit groups. The plaque-specific pericoronary FAI was assessed using the Perivascular Fat Analysis Tool. We applied a default prespecified window of -190 to -30 Hounsfield units (HU) and a broader prespecified window of -190 to 20 HU. FAI values within these prespecified windows and the types and severity of plaque stenosis were compared across the 3 groups. Additionally, we investigated high-risk characteristics of plaques in the ACS group and their correlation with FAI. The effectiveness and worthiness of FAI in identifying culprit lesions were analyzed based on the receiver operating characteristic curve. The FAI values under the 2 prespecified windows were higher in the culprit group than in the nonculprit and control groups (all P < 0.001). The culprit group showed the most mixed plaques and the most severe stenosis (all P < 0.001). In the ACS group, the FAI value was significantly lower around calcified lesions (-85.00 ± 9.97 HU) than around noncalcified (-78.00 ± 11.52 HU) and mixed plaques (-78.00 ± 9.24 HU) (both P < 0.001). The culprit group had more high-risk plaques, and high-risk plaques had higher FAI values than those without high-risk characteristics (-70.00 ± 7.67 HU vs -82.00 ± 10.16 HU, P < 0.001). The efficacy of FAI under the default prespecified window in identifying culprit lesions was higher compared than that under the broader prespecified window (area under the curve = 0.799 vs 0.761, P = 0.042), and the diagnostic cutoff values were -77 versus -58 HU. The FAI under the default prespecified window exhibited an incremental value for identifying culprit lesions, as compared with stenosis severity (area under the curve = 0.970 vs 0.939, P < 0.001). The culprit lesions have higher FAI than the nonculprit lesions and the controls. FAI is a worthy parameter for identifying culprit lesions in routine CCTA according to stenosis severity, and the default prespecified window is a better option.

Effect of KAP-Based Nursing Intervention on Patients Undergoing Coronary Artery Computed Tomography Angiography Review after Percutaneous Coronary Intervention

Objective: This study aimed to analyze the impact of nursing intervention based on knowledge, belief, and action theory (KAP) on patients undergoing coronary computed tomography angiography (CTA) review after percutaneous coronary intervention (PCI). Methods: The research subjects were post-PCI patients who underwent coronary CTA review in our hospital from July 2021, to July 2023. A total of 123 review patients were divided into two groups in accordance with whether they had experienced KAP-based care. The observation and control groups consisted of 65 and 58 cases, respectively (n = 58). The self-rating anxiety scale (SAS), heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP), CTA image quality, examination cooperation, and nursing satisfaction were compared between the two groups. Results: Compared with those of before nursing, the SAS scores of both groups after nursing were significantly reduced (p &lt; 0.05). Compared with the control group, the observation group had significantly reduced SAS scores (p &lt; 0.05). Compared with those before nursing, the HR, SBP, and DBP of both groups after nursing were significantly reduced (p &lt; 0.05). Compared with the control group, the observation group showed significantly reduced HR, SBP, and DBP (p &lt; 0.05). The grade I rate of the observation group significantly increased, the grade III rate was significantly reduced, and the image quality significantly improved compared with those of the control group (p &lt; 0.05). No statistically significant difference was observed in the incidence of grade II between the two groups (p &gt; 0.05). The total cooperation degree of the observation group was 93.86% (61/65), which was significantly increased compared with the total cooperation degree of 81.03% (47/58) in the control group (p &lt; 0.05). The total satisfaction of patients in the observation group was 96.92% (63/65), which was significantly increased compared with the total satisfaction of 74.14% (43/58) in the control group (p &lt; 0.001). Conclusion: Nursing based on the KAP model during coronary CTA review after PCI can significantly alleviate patients' negative emotions and improve CTA image quality. It can also improve patients' examination cooperation and nursing satisfaction.

Considering the Possible Role of Pharmacists According to the Presence or Absence of Lifestyle-Related Diseases at the Time of Coronary CT Examination and Trends of Medication Use for These Diseases by Medical Doctors.

Because patients often already have coronary artery disease (CAD) at the time of a coronary artery computed tomography angiography (CCTA) examination, we examined the medications prescribed by medical doctors for lifestyle-related diseases and investigated what possible role pharmacists can play in prescribing. Patients (n = 1357) who underwent CCTA examination were divided into two groups according to the presence or absence of lifestyle-related diseases [hypertension (HTN), dyslipidemia (DL) and diabetes mellitus (DM)], and the relationship between the presence or absence of CAD was examined. The rate of CAD was significantly higher in patients with HTN, DL or DM than in patients without these diseases. The blood pressure in the HTN group was 140 ± 20/79 ± 13 mmHg, the low-density lipoprotein cholesterol value in the DL group was 119 ± 35 mg/dL, and the hemoglobin A1c value in the DM group was 7.0 ± 1.1%, all of which were poorly controlled. Anti-hypertensive drugs were used at low rates in the HTN group, statins were used in 47% and ezetimibe was used in 4% of the DL group, and dipeptidyl peptidase-4 inhibitors were used in 41% of the DM group. Since the rate of CAD (+) was high and control of the three major lifestyle-related diseases was poor, pharmacists should advise medical doctors to use combinations of drugs.

A hybrid convolutional and transformer network for segmentation of coronary computed tomography angiographic slices

AbstractCoronary artery three‐dimensional reconstruction is essential for preventing, diagnosing, and treating coronary heart disease. This study introduces SegUnet, a lightweight hybrid CNN‐Transformer network for pixel‐level segmentation of coronary artery computed tomography angiography (CTA) slices to enhance the precision of coronary artery reconstruction. The overall SegUnet adopts a U‐shaped encoder‐decoder structure, with a hierarchical Transformer structure serving as the encoder to extract global contextual information; the decoder is enhanced with spatial attention mechanism (SAM) and residual structure to improve its perception and adaptive adjustment abilities for coronary artery vessels. In contrast to other methods, we propose an interpolation‐based multi‐feature fusion bridge to integrate multi‐scale features between encoder levels, capturing their semantic dependencies. Experimental results show that SegUnet achieves a prediction accuracy of 97.23% on the test set of coronary arteries 2D slices. Moreover, the network exhibits excellent performance on Synapse Multi‐Organ Segmentation, highlighting the superiority, effectiveness, and robustness of our proposed method. The outstanding performance of SegUnet in coronary artery segmentation has elevated the quality of three‐dimensional reconstruction of the coronary arteries, exerting a positive impact on the enhancement of diagnosis and treatment of coronary artery diseases.

Association between Major Adverse Cardiovascular Events and the Liver Fibrosis Score in Patients with and without Coronary Artery Disease: From the FU-CCTA Registry.

The liver fibrosis score reflects the degree of hepatic scarring and has been reported to be associated with cardiovascular disease. Using a coronary artery computed tomography angiography registry at the Fukuoka University Hospital (FU-CCTA registry), we investigated the association between major adverse cardiovascular events (MACEs) and the liver fibrosis score (fibrosis-4 index (FIB-4I)) in 612 patients who underwent CCTA to screen for coronary artery disease and performed a prognosis survey for up to 5 years. The primary endpoint was MACEs (all-cause mortality, acute myocardial infarction, ischemic stroke, coronary revascularization). FIB-4I in all patients and in patients with hypertension (HTN) was significantly higher in the MACE group than in the non-MACE group. The event-free survival rate of MACEs targeting only patients with HTN was significantly lower in patients with a high risk of liver fibrosis (FIB-4I values of 2.67 or higher) than in those with a low or intermediate risk (less than 2.67). However, no significant difference was observed in all patients or in patients without HTN. Finally, FIB-4I and body mass index were independent factors associated with MACEs in patients with HTN. In conclusion, the liver fibrosis score may be an independent predictor of MACEs in hypertensive patients undergoing CCTA.

A new predictor of coronary artery disease in acute ischemic stroke or transient ischemic attack patients: pericarotid fat density.

The study aims to evaluate the incremental predictive value of pericarotid fat density (PFD) on head and neck computed tomography angiography (CTA) for the obstructive coronary artery disease (CAD) (≥ 50% stenosis) relative to a clinical risk model (Framingham risk score (FRS)) and the degree of carotid artery stenosis and plaque type in acute ischemic stroke (AIS) or transient ischemic attack (TIA) patients without a known history of CAD. In a cohort of 134 consecutive stable patients diagnosed with AIS or TIA undergoing head and neck CTA between January 2010 and December 2021, pericarotid adipose tissue density (PFD) was quantified using a dedicated software. We collected demographic and clinical data, assessed the risk of CAD using the FRS, and analyzed coronary and carotid artery CTA images. Univariate and multivariate logistic regression analyses were performed to assess associations between FRS, PFD, CTA variables, and obstructive CAD risk. Four prediction models were established to evaluate the incremental predictive value of PFD relative to FRS, stenosis degree, and plaque types. Receiver operating characteristic (ROC) curves were generated, and the areas under the curves (AUC) were compared. Increasing FRS, stenosis degree, and PFD values were positively correlated with obstructive CAD (all p < 0.05). In the predictive models for obstructive CAD, the model incorporating carotid stenosis exhibited superior predictive performance compared to FRS alone (p < 0.05). Moreover, the predictive model integrating PFD demonstrated enhanced performance and yielded the highest AUC of the receiver operator characteristic curve (AUC = 0.783), with sensitivity and specificity values of 86.89% and 65.75%, respectively. CTA-derived PFD measurements offer supplementary predictive value for obstructive CAD beyond FRS and stenosis, thereby facilitating improved risk stratification of TIA or stroke patients without a history of CAD history. CTA-derived PFD provides incremental predictive value for obstructive coronary artery disease in acute ischemic stroke or transient ischemic attack patients without CAD history, beyond Framingham risk score and carotid artery stenosis degree, improving risk stratification. • Pericarotid fat density is associated with obstructive coronary artery disease in acute ischemic stroke or transient ischemic attack patients. • Higher pericarotid fat density corresponds to an increased risk of obstructive coronary artery disease. • Estimation of pericarotid fat density using computed tomography angiography imparts additional predictive value for obstructive CAD in risk stratification of acute ischemic stroke or transient ischemic attack patients.

Basing on the machine learning model to analyse the coronary calcification score and the coronary flow reserve score to evaluate the degree of coronary artery stenosis

AimTo obtain the coronary artery calcium score (CACS) for each branch in coronary artery computed tomography angiography (CCTA) examination combined with the flow fraction reserve (FFR) of each branch in the coronary artery detected by CT and apply a machine learning model (ML) to analyse and predict the severity of coronary artery stenosis. MethodsAll patients who underwent coronary computed tomography angiography (CCTA) from January 2019 to April 2022 in the HOSPITAL (T.C.M) AFFILIATED TO SOUTHWEST MEDICAL UNIVERSITY) were retrospectively screened, and their sex, age, characteristics of lipid-containing lesions, coronary calcium score (CACS) and CT-FFR values were collected. Five machine learning models, random forest (RF), k-nearest neighbour algorithm (KNN), kernel logistic regression, support vector machine (SVM) and radial basis function neural network (RBFNN), were used as predictive models to evaluate the severity of coronary stenosis. ResultsAmong the five machine learning models, the SVM model achieved the best prediction performance, and the prediction accuracy of mild stenosis was up to 90%. Second, age and male sex were important influencing factors of increasing CACS and decreasing CT-FFR. Moreover, the critical CACS value of myocardial ischemia >200.70 was calculated. ConclusionThrough computer machine learning model analysis, we prove the importance of CACS and FFR in predicting coronary stenosis, especially the prominent vector machine model, which promotes the application of artificial intelligence computer learning methods in the field of medical analysis.

Using a machine learning-based risk prediction model to analyze the coronary artery calcification score and predict coronary heart disease and risk assessment

ObjectivesTo calculate the coronary artery calcification score (CACS) obtained from coronary artery computed tomography angiography (CCTA) examination and combine it with the influencing factors of coronary artery calcification (CAC), which is then analyzed by machine learning (ML) to predict the probability of coronary heart disease(CHD). MethodsAll patients who were admitted to the Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University from January 2019 to March 2022, suspected of CHD, and underwent CCTA inspection were retrospectively selected. The degree of CAC was quantified based on the Agatston score. To compare the correlation between the CACS and clinical-related factors, we collected 31 variables, including hypertension, diabetes, smoking, hyperlipidemia, among others. ML models containing the random forest (RF), radial basis function neural network (RBFNN),support vector machine (SVM),K-Nearest Neighbor algorithm (KNN) and kernel ridge regression (KRR) were used to assess the risk of CHD based on CACS and clinical-related factors. ResultsAmong the five ML models, RF achieves the best performance about accuracy (ACC) (78.96%), sensitivity (SN) (93.86%), specificity(Spe) (51.13%), and Matthew's correlation coefficient (MCC) (0.5192).It also has the best area under the receiver operator characteristic curve (ROC) (0.8375), which is far superior to the other four ML models. ConclusionComputer ML model analysis confirmed the importance of CACS in predicting the occurrence of CHD, especially the outstanding RF model, making it another advancement of the ML model in the field of medical analysis.

Coronary Artery Computed Tomography Angiography for Preventing Cardio-Cerebrovascular Disease: Observational Cohort Study Using the Observational Health Data Sciences and Informatics' Common Data Model.

BackgroundCardio-cerebrovascular diseases (CVDs) result in 17.5 million deaths annually worldwide, accounting for 46.2% of noncommunicable causes of death, and are the leading cause of death, followed by cancer, respiratory disease, and diabetes mellitus. Coronary artery computed tomography angiography (CCTA), which detects calcification in the coronary arteries, can be used to detect asymptomatic but serious vascular disease. It allows for noninvasive and quick testing despite involving radiation exposure.ObjectiveThe objective of our study was to investigate the effectiveness of CCTA screening on CVD outcomes by using the Observational Health Data Sciences and Informatics’ Observational Medical Outcomes Partnership Common Data Model (OMOP-CDM) data and the population-level estimation method.MethodsUsing electronic health record–based OMOP-CDM data, including health questionnaire responses, adults (aged 30-74 years) without a history of CVD were selected, and 5-year CVD outcomes were compared between patients undergoing CCTA (target group) and a comparison group via 1:1 propensity score matching. Participants were stratified into low-risk and high-risk groups based on the American College of Cardiology/American Heart Association atherosclerotic cardiovascular disease (ASCVD) risk score and Framingham risk score (FRS) for subgroup analyses.ResultsThe 2-year and 5-year risk scores were compared as secondary outcomes between the two groups. In total, 8787 participants were included in both the target group and comparison group. No significant differences (calibration P=.37) were found between the hazard ratios of the groups at 5 years. The subgroup analysis also revealed no significant differences between the ASCVD risk scores and FRSs of the groups at 5 years (ASCVD risk score: P=.97; FRS: P=.85). However, the CCTA group showed a significantly lower increase in risk scores at 2 years (ASCVD risk score: P=.03; FRS: P=.02).ConclusionsAlthough we could not confirm a significant difference in the preventive effects of CCTA screening for CVDs over a long period of 5 years, it may have a beneficial effect on risk score management over 2 years.

Congenital Anomalous Origin of Coronary Artery Disease in Children With Syncope: A Case Series.

ObjectiveThis study is aimed to analyze the characteristics of congenital anomalous origin of coronary artery in pediatric patients with syncope.MethodsA total of eight patients were retrospectively analyzed from August 2018 to August 2020 who were admitted to the Peking University First Hospital with the complaint of syncope and were diagnosed with congenital coronary artery disease.ResultsIn total, eight patients were included in the study with a median age of 12.5 ± 2.7 (8–16) years. In total, four of them were males, and four were females. Six of the eight patients were diagnosed with right anomalous coronary artery from the opposite sinus (R-ACAOS), while two patients were diagnosed with left anomalous coronary artery from the opposite sinus (L-ACAOS). The most frequent inducement was exercise, and the commonest prodromes were dizziness and blurred vision. Serum cardiac markers and exercise electrocardiography test (EET) were normal in seven of the patients. The majority of cases had abnormal electrocardiograms (ECGs), but only two of them manifested elevated/depressed ST-T segments. In total, seven patients had positive head-up tilt test (HUT). Echocardiography and coronary artery computed tomography angiography (CTA) were performed to aid the diagnosis. Coronary unroofing procedures were conducted in four patients, and none of them reported syncope after the surgery. The other four patients received routine medical treatment for vasovagal-like syncope. In total, two patients out of them became asymptomatic, and in the other two patients, episodes of syncope were reduced, but they still required medical treatment.ConclusionCongenital coronary artery anomalies in children with syncope need prompt attention. Though ECG and echocardiography are the common methods for investigating cardiac syncope, they have limited ability to find coronary artery anomalies. When coronary artery anomalies are suspected, coronary CTA should be considered.

Characteristics of coronary artery disease in patients with subclinical hypothyroidism: evaluation using coronary artery computed tomography angiography

BackgroundSubclinical hypothyroidism (SCH) has recently been acknowledged as an independent risk factor for coronary artery disease (CAD). However, the characteristics of CAD in patients with SCH are not fully understood. This study aims to evaluate the features of CAD in patients with SCH using coronary computed tomographic angiography (CCTA).Materials and methodsFrom 1 April, 2018 to 30 June, 2020, 234 consecutive SCH patients with coronary plaques identified on CCTA were included retrospectively. They were further subdivided into different degree of SCH groups (mild SCH vs. moderate SCH vs. severe SCH: 143 vs 62 vs 28) and different gender groups (men with SCH vs. women with SCH:116 vs 118). The distributions and types of plaques, luminal narrowing, segment involvement scores (SIS) and segment stenosis scores (SSS) were evaluated and compared among the different groups.ResultsPatients with severe SCH had fewer calcified plaques (0.7 ± 0.9 vs. 2.0 ± 1.9, p < 0.001) and more non-calcified plaques (0.9 ± 1.0 vs. 0.3 ± 0.5, p < 0.001) than those with mild SCH. As the SCH condition worsened, the proportion of non-calcified plaques significantly increased. Whereas there were no significant discrepancies in SIS and SSS among patients with different grades of SCH (all p > 0.05). Men with SCH had higher SIS (3.9 ± 2.3 vs. 3.0 ± 2.3, p = 0.004) and SSS (7.8 ± 5.4 vs. 5.4 ± 3.0, p = 0.002) than women. Multivariate logistic and linear regression analysis demonstrated that grades of SCH (Moderate SCH, odds ratio [OR] 2.11; 95% CI 1.03–4.34, p = 0.042; severe SCH, OR: 10.00; 95% CI 3.82–26.20, p < 0.001, taken mild SCH as a reference) was independently associated with the presence of non-calcified plaques, whereas sex (B: 1.67; 95% CI 0.27–3.10, p = 0.009) was independently associated with SSS.ConclusionsSevere SCH is associated with non-calcified plaques, and men with SCH have higher total plaque burden than women. We suggest that it is important to evaluate for coronary plaque in SCH patients, especially those with severe SCH and men with SCH.

Anatomical correlation between left atrium pulmonary vein ablation targets of atrial fibrillation and adjacent bronchi and pulmonary arteries by MSCT

BackgroundThe ablation targets of atrial fibrillation (AF) are adjacent to bronchi and pulmonary arteries (PAs). We used computed tomography (CT) to evaluate the anatomical correlation between left atrium (LA)-pulmonary vein (PV) and adjacent structures.MethodsData were collected from 126 consecutive patients using coronary artery CT angiography. The LA roof was divided into three layers and nine points. The minimal spatial distances from the nine points and four PV orifices to the adjacent bronchi and PAs were measured. The distances from the PV orifices to the nearest contact points of the PVs, bronchi, and PAs were measured.ResultsThe anterior points of the LA roof were farther to the bronchi than the middle or posterior points. The distances from the nine points to the PAs were shorter than those to the bronchi (5.19 ± 3.33 mm vs 8.62 ± 3.07 mm; P < .001). The bilateral superior PV orifices, especially the right superior PV orifices were closer to the PAs than the inferior PV orifices (left superior PV: 7.59 ± 4.14 mm; right superior PV: 4.43 ± 2.51 mm; left inferior PV: 24.74 ± 5.26 mm; right inferior PV: 22.33 ± 4.75 mm) (P < .001).ConclusionsThe right superior PV orifices were closer to the bronchi and PAs than other PV orifices. The ablation at the mid-posterior LA roof had a higher possibility to damage bronchi. CT is a feasible method to assess the anatomical adjacency in vivo, which might provide guidance for AF ablation.

Comparative effectiveness of coronary screening in heart valve surgery: Computed tomography versus conventional coronary angiography

BackgroundAlthough conventional coronary angiography (CAG) is considered the gold standard for coronary artery disease (CAD) screening in the setting of heart valve surgery, coronary artery computed tomography angiography (CCTA) has emerged as an alternative modality. This study was conducted to evaluate the clinical outcomes of CCTA compared with conventional CAG for CAD screening in patients undergoing heart valve surgery. MethodsA total of 3150 consecutive patients aged >40 years or with coronary risk factors undergoing elective valve operations between 2001 and 2015 were evaluated. Of these, 1402 patients underwent CCTA (CT group) and 1748 patients underwent conventional CAG (CAG group) for CAD screening. ResultsThe 30-day mortality rates were similar in the 2 groups (2.1% in the CT group vs 1.7% in the CAG group; P = .463); however, the incidence of low cardiac output syndrome was higher in the CT group (2.3% vs 1.0%; P = .008). The final rate of detection of significant CAD (≥50% stenosis) (4.9% vs 9.7%; P < .001) and proportion of receiving coronary bypass grafting (CABG) (2.9% vs 4.3%; P = .041) were lower in the CT group. After adjustment by propensity score matching (563 pairs), the main findings of our crude analyses did not change, with lower rates of CAD detection (odds ratio [OR], 0.56; 95% confidence interval [CI], 0.36-0.85) and CABG (OR, 0.47; 95% CI, 0.26-0.81), a similar risk of early mortality (OR, 1.51; 95% CI, 0.54-4.52), but a higher risk of low cardiac output syndrome (OR, 3.30; 95% CI, 1.16-11.78) in the CT group compared with the CAG group. ConclusionsThe detection of significant CAD and identification of candidates for CABG were inferior with CCTA compared with conventional CAG in patients scheduled for elective heart valve operations.

Impact of advanced modeled iterative reconstruction on interreader agreement in coronary artery measurements

ObjectivesTo evaluate the influence of advanced modeled iterative reconstruction (ADMIRE) on coronary artery computed tomography angiography (cCTA) measurements in comparison to filtered back projection (FBP). Material and methodsPhantom scans and coronary CTA studies of 27 patients were acquired with a third generation dual-source CT scanner. Images were reconstructed using FBP and ADMIRE. Phantom measurements were used as reference standard. In patient studies, representative axial slices of each coronary artery segment without (n=308) and with coronary plaques (n=40) were assessed in identical positions for comparison of FBP and ADMIRE reconstructions. Image analyses included quality assessment, phantom and coronary artery measurements, plaque analysis, and interreader agreement of two independent and blinded readers. ResultsMean image noise was lower on ADMIRE reconstructions with 31.3±9.9 HU compared to 55.9±15.7 HU on FBP reconstructions (p<0.001). Measurement precision and interreader agreement of both observers were assessed satisfactorily on phantom images in comparison to the full width half maximum method. In patients, correlation of lumen diameters of both observers improved using ADMIRE with a Pearson’s r=0.987 (95% confidence interval [CI], 0.983–0.989; p<0.001) compared to FBP images with r=0.939 (95% CI, 0.924–0.951; p<0.001). Applying ADMIRE, agreement of both observers for lumen diameter measurements significantly increased (p<0.001). This was also observed for the degree of stenosis (p<0.001) with r=0.560 using FBP (95% CI, 0.301–0.742) and with r=0.818 using ADMIRE (95% CI, 0.680–0.900). Plaque density measurements correlated closely with a Pearson’s r of 0.951 in FBP (95% CI, 0.909–0.974) and 0.967 in ADMIRE (95% CI, 0.939–0.983). ConclusionsAdvanced modeled iterative reconstruction significantly improves coronary artery assessment in coronary CTA in comparison to FBP by improved image quality due to image noise removal. This renders improved interobserver agreement for coronary lumen diameter and degree of stenosis measurements without influencing mean plaque attenuation.

Morphological features of the left atrial appendage in consecutive coronary computed tomography angiography patients with and without atrial fibrillation.

The majority of intracardiac thrombi form in the left atrial appendage (LAA). Enlargement of this structure, together with certain morphological features, may indicate a predisposition to the formation of thrombi and subsequent cardioembolic stroke. Thus far, studies on LAA morphology have largely focused on those patients with atrial fibrillation (AF). Taking a different approach, we investigated the variation in LAA morphology in a consecutive patient population with and without AF. We evaluated 808 consecutive patients (529 females; mean age 52.5±9.9 years) who underwent coronary artery computed tomography angiography (CCTA), the majority of whom (749) had no history of AF. We assessed the length, lobe number, and morphological classification of their LAAs. Demographic data and medical histories were collated from medical records and then correlated with LAA morphology. The proportions of each of the four morphological classes of LAA for the overall vs. non-AF population were: WindSock, 62.3/61.5%; Cactus, 18.6/18.8%; ChickenWing, 10.0/10.0%; and CauliFlower, 9.2/9.6%. Age (p<0.001; r = 0.156) and female gender (p<0.001) were both found to be associated with an increased body surface area (BSA)-related LAA length. Male patients were more likely to manifest multi-lobed (p = 0.003) LAAs, and overweight patients with a greater number of multi-lobed LAA morphological classes (p = 0.010). No associations with morphological LAA features could be found for patients with diabetes, hypertension, or dyslipidemia. Nor did the size of the left atrium exhibit any correlation with BSA-related LAA length. In the overall and non-AF populations, aging and female gender were associated with longer BSA-indexed LAAs.

Effect of Coronary Artery Calcification Score by Lifestyle and Correlation With Coronary Artery Stenosis by Multidetector Computed Tomography.

This study examined the effect of coronary artery calcification score by lifestyle and correlation with coronary artery stenosis in persons who underwent coronary artery computed tomography (CT) angiography among health examinees for heart diseases in Korea. The study included 506 subjects (256 men and 250 women) who underwent coronary artery CT angiography among health examines for heart diseases at the Incheon Branch of the Korea Association of Health Promotion between January 2, 2014, and December 31, 2014. The demographical variables of the subjects were determined by frequency analysis, and the difference by sex was compared and analyzed using χ independence test. Independent 2-sample t test was performed to determine any difference in main factors by coronary artery calcification. According to the results, 175 (34.6%) had calcification, men showed statistically higher scores than women, and calcification seemed higher in those who were older, taller, heavier, and thicker in waist. Regarding blood pressure, calcification was shown if contraction phase and relaxation blood pressure was higher, blood sugar before meal was higher, and neutral fat was higher. By lifestyle, calcification seemed to be higher in those with more alcohol drinking per week, long past smoking years, and higher smoking amount per day in the past and present. In addition, coronary artery stenosis rate showed statistical correlation with calcification from the left anterior descending artery, right coronary artery, left circumflex artery, and left main coronary artery in sequence. In conclusion, coronary artery calcification score CT is deemed to be a suitable method for the estimation of coronary artery stenosis with short examination time, low radiation exposure, and noninvasive method.

320-row-detector CT angiography findings in a case with myocardial bridging in the three main coronary arteries.

A 46-year-old man with the complaining of palpitation was admitted to our hospital. Polymorphic ventricular early beats were observed on electro cardiography, The patient was referred to our department for coronary artery computed tomography angiography (CTA) for a probable congenital anomaly. On coronary CTA performed by a 320-Row-Detector scanner; left main coronary artery was short. The myocardial bridging (MB) causes approximately 75% luminal stenosis in a 2.5-cm segment was observed in the middle segment of left anterior descending artery (Fig. A, white arrow). The circumflex artery was continuing as the first obtus margin artery and this branch was separating to four branches in the middle part. All of these branches were coursing subepicardially in the middle and distal part (Fig. B, white arrowheads). The right main coronary artery was separating to two branches in the proximal part, and the thinner one was showing MB in its middle part (Fig. C, black arrow). This branch had a subepicardial course as well, in its distal part along the right atrium (Fig. C, black arrowheads). Eventually, all the cardiologic examinations and imaging findings were reevaluated. Based on those findings, antiarrhythmic drug therapy was prescribed by cardiology department, and the patient was called for regular follow-up.

Upward Displacement of Prosthetic Aortic Valved Conduit after Modified Bentall Procedure for Type A Acute Aortic Dissection

Aim: Role of non-invasive coronary artery computed tomography (CACT) in diagnosis of complications of aortic root surgery in patients with chest pain. Introduction: Dehiscence of an aortic valved conduit or pseudoaneurysm development is a rare, but serious and potentially life-threatening complication after aortic root surgery. Case Presentation: We report an interesting case of a 61-year-old man with chest pain and dyspnea, previous history of modified Bentall procedure for type A acute aortic dissection and coronary stenting, that shows a complete detachment and upward displacement of a composite tubular graft with mechanical valve prosthesis detected by a CACT angiography. Discussion: Generally, in the few survivors, the diagnosis is made by means of echocardiography. This is the first case of CACT diagnosis of a prosthetic aortic valved conduit displacement after a