Detection Of Coronary Artery Stenosis Research Articles

Evaluation of Left Atrial Strain Parameter in Coronary Artery Stenosis: A New Tool to Predict LCX Stenosis

Introduction: Speckle tracking echocardiography (STE) based on frame-to-frame tracking of acoustic speckles is a novel angle-independent method, used for evaluating myocardial deformation and recently to assess left atrium (LA) function.Aim: To the best of our knowledge, there is no investigation evaluating the predictor role of LA strain parameters in detection of coronary artery stenosis in ischemic heart disease. In this study, we assessed this parameter for predicting the culprit artery in patients underwent selective coronary angiography (SCA) in Mashhad, Iran. Patients and Methods: This was a case-control study, which was performed in Imam Reza and Quaem Hospitals in Mashhad, Iran between 2017 and 2018 in patients referred for SCA. Subjects with two or three- vessel diseases were excluded .Sixty-five cases were included in the study and divided into four groups according to the vessel involved : Group (1): normal coronary artery subjects (n=36); group (2): patients with left anterior descending (LAD) artery stenosis (n=12); group (3): patients with left circumflex artery (LCX) stenosis (n= 7) and group 4: patients with right coronary artery (RCA) stenosis (n=10). Patients underwent routine TTE and Speckle Tracking Imaging.Results: The mean age of participants was 56.72± 10.69 years old. The male/female ratio was 0.96. Mean absolute value of LA strain was 24.74% in normal subjects, while in groups with stenotic coronary artery disease, less values were defined as 18.63%, 16.03% and 19.05%, respectively (p value=0.05). The amounts of left ventricle end systolic volume (LVESV), LV global longitudinal strain (GLS) and Em of septal annulus were significantly different between normal group and those with LCX stenosis. Among different echocardiographic parameters, LA strain, LVESV and Em of septal annulus were defined as predictors of LCX occlusion with regression analysis. Conclusion: LA strain in subjects with coronary artery stenosis was lower than the strain in normal group and could predict isolated LCX occlusion.

Comparison of compressed sensing and conventional coronary magnetic resonance angiography for detection of coronary artery stenosis

PurposeThis study aimed to compare the efficacy of compressed sensing (CS) and conventional coronary magnetic resonance angiography (CMRA) in detecting coronary artery stenosis. MethodTwenty-eight patients underwent 3 T contrast-enhanced CS and conventional CMRA; for late gadolinium enhancement (LGE) imaging, 0.1 mmol/kg gadolinium medium was infused. CS CMRA was scanned within the LGE waiting time. After the LGE image acquisition, conventional CMRA was performed. The diagnostic performance of both CMRA for the detection of significant stenosis was evaluated using coronary angiography as a reference. The analysis was conducted to examine the three main coronary artery vessels: left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA). These arteries were subdivided into 8 segments (LAD; main, proximal, and middle, LCX; proximal and distal, RCA; proximal, middle, and distal). Of these, hypoplastic segments and vessels after coronary stent implantation were excluded. The acquisition time of CS CMRA was compared with that of conventional CMRA. ResultsThe coronary arteries were evaluated in 197 segments. The sensitivity, specificity, and accuracy of CS CMRA in detecting significant stenosis were 85.2 %, 82.5 %, and 83.2 %, respectively, on a per-segment basis. Those of conventional CMRA were 85.2 %, 86.7 %, and 86.3 %, respectively. The acquisition time was 207 s (range, 144–258 s) for CS and 975 s (range, 787–1226s) for conventional CMRA (p < 0.001). ConclusionsSimilar to conventional CMRA, CS CMRA has shown potential for the detection of significant coronary artery stenosis.

Automatic detection of coronary artery stenosis by convolutional neural network with temporal constraint

Coronary artery disease (CAD) is a major threat to human health. In clinical practice, X-ray coronary angiography remains the gold standard for CAD diagnosis, where the detection of stenosis is a crucial step. However, detection is challenging due to the low contrast between vessels and surrounding tissues as well as the complex overlap of background structures with inhomogeneous intensities. To achieve automatic and accurate stenosis detection, we propose a convolutional neural network-based method with a novel temporal constraint across X-ray angiographic sequences. Specifically, we develop a deconvolutional single-shot multibox detector for candidate detection on contrast-filled X-ray frames selected by U-Net. Based on these static frames, the detector demonstrates high sensitivity for stenoses yet unacceptable false positives still exist. To solve this problem, we propose a customized seq-fps module that exploits the temporal consistency of consecutive frames to reduce the number of false positives. Experiments are conducted with 148 X-ray angiographic sequences. The results show that the proposed method outperforms existing stenosis detection methods, achieving the highest sensitivity of 87.2% and positive predictive value of 79.5%. Furthermore, this study provides a promising tool to improve CAD diagnosis in clinical practice.

A direct comparison of 3\u2009T contrast-enhanced whole-heart coronary cardiovascular magnetic resonance angiography to dual-source computed tomography angiography for detection of coronary artery stenosis: a single-center experience

BackgroundIn recent years, substantial advances have been made in noninvasive cardiac imaging, including cardiac computed tomography (CT) and cardiovascular magnetic resonance (CMR). The purpose of this study was to prospectively compare the diagnostic performance of contrast-enhanced whole heart coronary CMR angiography (CCMRA) to dual-source coronary CT angiography (CCTA) for the diagnosis of significant coronary stenoses (≥50%) in patients with known or suspected coronary artery disease (CAD) referred for conventional x-ray coronary angiography.MethodsOur objective was to directly compare the diagnostic accuracy of contrast-enhanced whole-heart CCMRA (CE-CCMRA) to dual-source CCTA (DS-CCTA) for the detection of CAD. We prospectively studied 57 symptomatic patients with suspected or known CAD who were scheduled for conventional x-ray coronary angiography. Significant CAD was defined as an x-ray defined diameter reduction of ≥50% in a coronary artery with a reference diameter of ≥1.5 mm.ResultsCE-CCMRA and DS-CCTA were completed in 51 (89%) of 57 patients without complications. The acquisition times of CE-CCMRA and DS-CCTA, respectively, were 9.5 ± 3.1 min and 8.3 ± 1.4 s. On patient-based analysis, the sensitivity, specificity, positive and negative predictive value of CE-CCMRA and DS-CCTA were 93.5% versus 93.5%(P > 0.05), 85% versus 90%(P > 0.05), 90.6% versus 93.5%(P > 0.05), and 89.4% versus 90%(P > 0.05), respectively. The area under the curve (AUC) was 0.89 (95% CI: 0.79 to 0.99) for CE-CCMRA and 0.92 (95% CI: 0.83 to 1.00) for DS-CCTA.ConclusionsDS-CCTA was found to be superior to CE-CCMRA in the diagnosis of significant coronary stenoses (≥50%) in patients with suspected or known CAD scheduled for conventional x-ray coronary angiography, owing to shorter scanning times and higher spatial resolution. However, CE-CCMRA and DS-CCTA have similar diagnostic accuracies.

관상동맥 조영 영상에서 심장 협착증 진단 알고리즘

관상동맥 조영 영상에서 심장 협착증 진단 알고리즘

MRI assessment of left ventricle myocardial viability in patients with chronic coronary artery disease in comparison with single photon emission computed tomography

Background: Coronary artery disease (CAD) is highly prevalent in developed countries and is a leading cause of death. Diagnostic imaging plays an important role in the proper assessment and management of CAD. Myocardial perfusion is evaluated by SPECT in most patients today; however, this technique exposes patients to radiation and its diagnostic accuracy is sometimes limited by relatively low spatial resolution and artifacts from photon scatter and tissue attenuation. Scintigraphy defects may not be apparent until 10 g of tissue is infarcted. Thus, because a sizable threshold of damage is required, SPECT may miss small or subendocardial MI. Advances in rapid magnetic resonance imaging technology and its application to cardiac imaging have shown that MR imaging has tremendous potential for evaluation of cardiac disease. Practical advantages of cardiac MRI include the lack of ionizing radiation, a shortened examination time (25 to 40 min), good safety and tolerability profile, and detection of small subendocardial infarcts. Aim: assessment of myocardial viability in patients with chronic coronary artery disease by magnetic resonance imaging in comparison with single photon emission computed tomography (SPECT). Patients and Methods: This prospective study include examination of 10 adult patients (each patient has 3 coronary arteries, so we examined 30 coronary arteries and their myocardial territories) known to have chronic ischemic heart disease in Cairo university by MRI and SPECT with conventional angiography as a standard reference. MRI done by using 1.5T machine, using SENSE (sensitivity encoding) cardiac coil (6 element phased-array coil, receive only), functional cine images, first pass perfusion images and delayed enhancement images were acquired. SPECT study was done by 2-day exercise/rest gated SPECT imaging with Tc–99m sestamibi. Conventional coronary angiography was done using a trans-femoral approach to selectively inject the left and right coronary systems sequentially. The results of cardiac MRI subdivided into three groups: (a) Myocardial ischemia was defined as: either 1- Cardiac segment with motion abnormality or perfusion deficit at first-pass perfusion MR imaging consistent with no hyper-enhancement at delayed-enhancement MR imaging. Or 2- Cardiac segment of subendocardial enhancement (25 % thickness scar) with motion abnormality. (b) Myocardial scarring is defined as: either 1- Cardiac segment with myocardial delayed enhancement having ≥ 75% thickness scar. Or 2- Myocardial thickness less than 6 mm in diastole. (c) Mixed myocardial ischemia and scarring is defined as: Cardiac segment with myocardial delayed enhancement of near 50 % (>25% and <75%) thickness scarring. The results of SPECT were obtained by comparison between resting and exercise images to detect areas with fixed defects (scar) and those with reversible defects (ischemia). A defect was considered to be fixed (scarred) when there was no change between the stress and rest images, partially reversible (mixed ischemia and scar) when there was an improvement in tracer uptake of at least 1 grade between stress and rest images, totally reversible (ischemic) when there was normalization of uptake at rest images. In coronary angiography a reduction of the luminal diameter 70% or more in a major epicardial coronary artery or the major branches was considered to be a relevant stenosis. The angiographic results were classified as one-, two-, or three-vessel disease. Results:Both CMR and SPECT are accurate in detection of diseased coronary arteries with statistically significant P values. The overall patient based sensitivity, specificity, PPV, NPV and accuracy of cardiac MRI for the detection of diseased coronary artery were 94% (15 of 16 territories), 100% (14 of 14), 100% (15 of 15), 93% (14 of 15) and 97% (29 out of 30) respectively while the overall sensitivity, specificity, PPV, NPV and accuracy of SPECT for the detection of coronary artery stenosis were 88% (14 of 16), 93% (13 of 14), 93% (14 of 15), 87% (13 of 15) and 90% (27 out of 30) respectively. Both modalities CMR and SPECT show no statistically significant difference in detection of ischemic and scarred left ventricle myocardial segments although the sensitivity of MRI was higher than SPECT in detection of transmural scarring. As regard detection of complications CMR detected 1 intraventricular thrombus that was missed by SPECT. Conclusion: CMR is an accurate tool for assessment of coronary artery disease and myocardial viability as regard ischemia, scarring with great capability for detection of transmural extension of scarring and prediction of recovery. MRI can detect complications like ventricular thrombus that was missed by SPECT. Other advantages of MRI are time saving, lack of ionizing radiation and detection of left ventricular volumetrics and wall motion abnormalities. *= radiodiagnosis department, ^=internal medicine department- faculty of medicine-sohag unevirsity.

VOLUMETRIC DYNAMIC 640-SLICE CT OF CORONARY ARTERIES

Purpose. Evaluation of diagnostic efficiency and safety of volumetric dynamic 640-slice CT in the detection of stenotic lesions of the coronary arteries.Materials and methods. In University clinic N1 in 2016–2017 years we investigated 86 patients with ischemic heart disease or valvular heart disease. All patients were fulfilled volumetric dynamic 640-slice CT-coronarography with retrospective ECG-synchronization and subsequent multiparametric reconstruction and evaluation of the coronary vessels. We determinate the degree of stenosis of the coronary arteries. The results are compared with data of the standard coronarography. 22 patients previously had stenting coronary arteries. In 12 cases, patients have atrial fibrillation. The selection criterion for the study was the absence of progression of the disease for at least 6 weeks and a minimum period of 3 months of optimal medical therapy. The study did not include patients with acute coronary syndrome and patients with aortic-coronary bypass surgery in history. All patients were performed CT-angiography on 640-slice CT Aquilion One (Toshiba, Japan). Contrast agent (Ultravist-370) of room temperature was injected into the cubital vein via catheter 18G at a speed of 4.5 ml/s.Results. Statistical criteria in the detection of coronary artery stenosis at MSCT-coronarography were as follows: sensitivity – 94.3%, specificity – 93.5%, accuracy – 92.8%, positive prognostic value – 96.4%, negative prognostic value – 87.3%. Spearman rank correlation coefficient in the evaluation of coronary artery lesions according to these methods was 0.68.Conclusion. Volumetric dynamic 640-slice CT-angiography is a highly sensitive safe non-invasive method of examination of patients with different cardiovascular diseases, which is characterized by low radiation dose and high security.

Diagnostic performance of low-radiation-dose and low-contrast-dose (double low-dose) coronary CT angiography for coronary artery stenosis.

The aim of the present study was to evaluate the diagnostic accuracy of low-radiation-dose and low-contrast-dose (double low-dose) coronary computed tomography angiography (CTA) for coronary artery stenosis in patients with suspected coronary artery disease (CAD).Totally 88 patients with suspected CAD were divided in the routine and double low-dose groups. Subjective image quality (IQ) was scored and diagnostic performance for detecting ≥50% stenosis was determined with the invasive coronary angiography. IQ and diagnostic performance were analyzed and compared between the 2 groups.There was no significant difference in the IQ of coronary artery between the routine and double low-dose groups, with good inter-observer agreement for the IQ. There were no significant differences in the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy on the per-patient, per-vessel, or per-segment level between the routine and double low-dose groups. The contrast medium injection volume in the double low-dose group was reduced by 37.1% compared with the routine-dose group. The effective dose in the double low dose was reduced by 44.5% compared with the routine-dose group.Double low-dose coronary CTA with IR can acquire satisfactory IQ and have high diagnostic sensitivity, specificity, and accuracy for the detection of coronary artery stenosis.

Diagnostic accuracy of 64 slice ct coronary angiography for diagnosing significant coronary artery stenosis

Objective: To determine the diagnostic accuracy of 64 slice CT angiography in the detection of significant coronary artery stenosis in patients suspected to have coronary artery disease keeping invasive conventional coronary angiography as gold standard. Methods: The cross-sectional study was conducted at KRL Hospital, Islamabad and data was obtained during the period of six months from April 2014 to October 2014. All the patient of either gender from the age of 35 to 70years who had H/O angina and without any known CAD were included. CCTA and conventional invasive angiography (CIA) findings were recorded in every patient. Occlusion of &gt;50% in coronary artery considered as positive angiography. Results: Among 135 patients 82.2% (n=111) of patients were males and 17.8% n=(24) were females. 63.7% (n=86) of patients were CCTA positive and 65.9% (n=89) of patients had disease on CIA. Sensitivity, specificity, PPV, NPV and accuracy were found to be 91.1%, 89.1%, 94.2%, 83.7% and 90.4% respectively. Conclusion: CCTA with improved spatial resolution and premedication with oral beta-blockade permits detection of coronary artery stenosis with high accuracy. Further large scale studies are needed in our setup to validate this technique in routine clinical practice.

Association between number of institutions with coronary computed tomography angiography and regional mortality ratio of acute myocardial infarction: a nationwide ecological study using a spatial Bayesian model

BackgroundCoronary computed tomography angiography (CTA) has demonstrated high diagnostic accuracy for detection of coronary artery stenosis, and healthcare providers can detect coronary artery disease in earlier stages before it develops into more serious clinical conditions such as acute myocardial infarction (AMI). We hypothesized that the mortality ratio of AMI in regions with a higher density of coronary CTA is lower than that in regions with a lower density of coronary CTA.MethodsThis ecological and cross-sectional study using secondary data targeted all secondary medical service areas (SMSAs) in Japan (n = 349). We obtained the numbers of cardiologists, institutions with coronary CTA, and institutions with a cardiac catheterization laboratory (CCL) as medical resources, socioeconomic factors, lifestyle factors, exercise habit factors, and AMI mortality data from a Japanese national database. We evaluated the association between the number of these medical resources and the standardized mortality ratio (SMR) of AMI in each SMSA using a hierarchical Bayesian model accounting for spatial autocorrelation (i.e., a conditional autoregressive model). We assumed a Poisson distribution for the observed number of AMI-related deaths and set the expected number of AMI-related deaths as the offset variable.ResultsThe number of institutions with coronary CTA was negatively and significantly associated with the SMR of AMI (relative risk [RR] 0.900; 95% credible interval [CI] 0.848–0.953), while the SMR in each SMSA was not significantly associated with the number of either cardiologists (RR 0.997; 95% CI 0.988–1.004) or institutions with a CCL (RR 1.026; 95% CI 0.963–1.096).ConclusionsWe observed a significant association between the number of institutions with coronary CTA and the SMR of AMI. Effective allocation of coronary CTA in each region is recommended, and it would be important to clarify the standing position of coronary CTA in regional networking for AMI treatment in the future.

German cardiac CT registry: indications, procedural data and clinical consequences in 7061 patients undergoing cardiac computed tomography.

Cardiac computed tomography permits quantification of coronary calcification as well as detection of coronary artery stenoses after contrast enhancement. Moreover, cardiac CT offers high-resolution morphologic and functional imaging of cardiac structures which is valuable for various structural heart disease interventions and electrophysiology procedures. So far, only limited data exist regarding the spectrum of indications, image acquisition parameters as well as results and clinical consequences of cardiac CT examinations using state-of-the-art CT systems in experienced centers. Twelve cardiology centers with profound expertise in cardiovascular imaging participated in the German Cardiac CT Registry. Criteria for participation included adequate experience in cardiac CT as well of the availability of a 64-slice or newer CT system. Between 2009 and 2014, 7061 patients were prospectively enrolled. For all cardiac CT examinations, patient parameters, procedural data, indication and clinical consequences of the examination were documented. Mean patient age was 61 ± 12 years, 63% were males. The majority (63%) of all cardiac CT examinations were performed in an outpatient setting, 37% were performed during an inpatient stay. 91% were elective and 9% were scheduled in an acute setting. In most examinations (48%), reporting was performed by cardiologists, in 4% by radiologists and in 47% of the cases as a consensus reading. Cardiac CT was limited to native acquisitions for assessment of coronary artery calcification in 9% of patients, only contrast-enhanced coronary CT angiography was performed in 16.6% and combined native and contrast-enhanced coronary CT angiography was performed in 57.7% of patients. Non-coronary cardiac CT examinations constituted 16.6% of all cases. Coronary artery calcification assessment was performed using prospectively ECG-triggered acquisition in 76.9% of all cases. The median dose length product (DLP) was 42mGycm (estimated effective radiation dose of 0.6mSv). Coronary CT angiography was performed using prospectively ECG-triggered acquisition in 77.3% of all cases. Tube voltage was 120kV in 67.8% of patients and 100kV in 30.7% of patients, with a resultant median DLP of 256mGycm (estimated effective dose of 3.6mSv). Clinical consequences of cardiac CT were as follows: in 46.8% of the cases, invasive coronary angiography could be avoided; ischemia testing was recommended in 4.7% of the cases, invasive coronary angiography was recommended in 16.4% of the cases and change in medication in 21.6% of the examinations. Cardiac CT is performed in the majority of patients for non-invasive evaluation of the coronary arteries. CT frequently resulted in medication change, and otherwise planned downstream testing including invasive angiography could be avoided in a high percentage of patients. Radiation exposure in experienced centers is relatively low.

Diagnostic Efficacy of Coronary Artery Three-Dimensional Steady-State Free Precession Magnetic Resonance Angiography in Comparison with Invasive Coronary Angiography for Detecting Coronary Artery Disease.

To assess the diagnostic value of three-dimensional steady-state free precession magnetic resonance angiography (3D-SSFP MRA) for detecting coronary artery disease (CAD). Patients suspected of CAD based on clinical evaluation, underwent invasive coronary angiography (CAG) and Cardiac MRA (CMRA). Collected data in favor of any CAD findings in CMRA were compared to CAG results as the standard diagnostic method in CAD detection. Analysis was performed on per-patient, per-vessel and per-segment bases. A total of 30 patients (mean age: 43 ± 10 years, 19 men) were enrolled for analysis. On per-patient analysis, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under receiver operator characteristic (ROC) curve of CMRA for detection of coronary artery stenosis were 100% (CI95%: 75% - 100%), 50% (CI95%: 18% - 81%), 73.33% (CI95%: 46% - 90%), 100% (CI95%: 47% - 100%) and 0.827, respectively. On per-vessel analysis, CMRA had a sensitivity of 89.29% (CI95%: 71%-97%), specificity of 80.56% (CI95%: 63% - 91%), PPV of 78.13% (CI95%: 60% - 90%), NPV of 90.63% (CI95%: 74% - 98%) and area under ROC curve of 0.845. On per-segment analysis, sensitivity, specificity, PPV and NPV of CMRA for segmental stenosis detection were 77.78% (CI95%: 60% - 89%), 87% (CI95%: 81% - 92%), 62% (CI95%: 46% - 76%), and 93.89% (CI95%: 88% - 97%), respectively. Area under ROC curve was 0.835 on per-segment analysis. 3D SSFP CMRA provides a promising non-invasive diagnostic tool for assessing coronary artery disease.

Diagnostic Test Squatting Stress Echocardiography and Coronary Angiography in Diagnosing Coronary Heart Disease

Background: In patients with significant coronary heart disease (CHD), increased preload and afterload during a squat can cause wall motion abnormalities (WMA) which can be detected on echocardiography. This study was conducted to determine the diagnostic value of stress echocardiography squatting as a non-invasive examination of a relatively simple, inexpensive, and safe in the detection of coronary artery stenosis in stable CHD and unstable angina patients.Methods: This study was a cross-sectional design. The subjects were all patients with stable CHD and unstable angina whom were treated in Instalasi Pusat Jantung Rumah Sakit Dr. M. Djamil Padang from May to July 2016. Subjects underwent squatting stress echocardiography procedures followed by coronary angiography. Diagnostic test was used to determine the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of squatting stress echocardiography.Results: The sensitivity, specificity, and accuracy of squatting echocardiography for diagnosis of CAD were 90.3%, 88.9% and 89.7%, respectively.Conclusion: Squatting stress echocardiography can be proposed as a non-invasive examination which is relatively simple, inexpensive and safe to detect coronary artery stenosis on patients with stable CHD and unstable CHD.

Semi‐automatic detection of coronary artery stenosis in 3D CTA

Detection of coronary artery stenosis, from 3D computed tomography angiography (CTA), is applicable for inspecting heart diseases. In this study, a semi-automatic method is proposed which its stages include 3D CTA pre-processing, vessel enhancement, coronary artery segmentation, centreline extraction, arteries cross-section diameter estimation, and stenosis detection. In contrast to conventional methods, this study is proposed in which the slices are rescaled from original size to smaller size and then returned to the original size, in order to reduce processing time in the centreline extracting step. To optimise final results, a semi-automatic method is proposed to adjust seed points for coronary arteries segmentation using 3D region growing method for reducing human interventions. The authors consider two types of evaluations for stenosis detecting, more than 50%, on 18 real data. The first type is patient-based analysis and the second type is segment-based analysis. In the first type, a sensitivity of 88.89% and a positive predictive value (PPV) of 88.89% are obtained, and in the second type, a sensitivity of 44.2%, and a PPV of 34.27% is achieved. Moreover, the average execution time for stenosis detecting in a 3D CTA is approximately 8.5 min.

Cardiac SPECT/CT Imaging: CT Attenuation Correction and SPECT/CT Hybrid Imaging

Cardiac single photon emission computed tomography (SPECT)/computed tomography (CT) imaging is facilitated by the dissemination of SPECT/CT hybrid systems and dedicated image fusion software. The combined approach of SPECT and CT has various advantages when compared with stand-alone imaging. CT attenuation correction can correct attenuation artifacts in myocardial SPECT and improves diagnostic accuracy for patients with coronary artery disease (CAD). Cardiac SPECT/CT hybrid imaging allows detection of coronary artery stenoses and abnormalities in myocardial perfusion and fatty-acid metabolism in patients with cardiac disease. It has been reported that this modality improves diagnostic accuracy in the detection of CAD compared to the individual imaging techniques. Furthermore, this approach facilitates the detection of hemodynamically significant coronary artery stenoses and the management of revascularization procedures. These abilities of cardiac hybrid SPECT/CT imaging will be further refined validating a range of clinical applications in large-scale clinical trials.

Effect of chronic inflammation on coronary arteries in renal amyloidosis: More than renal dysfunction

Effect of chronic inflammation on coronary arteries in renal amyloidosis: More than renal dysfunction

Combined arteriosclerotic assessment of ankle-brachial index and maximum intima-media thickness via CCTA is useful for predicting coronary artery stenosis in patients with type 2 diabetes

AimsPatients with diabetes mellitus (DM) are likely to develop asymptomatic myocardial infarction as a complication. However, coronary artery lesions are difficult to assess in internal medicine. This study aimed to develop a prediction formula for coronary artery stenosis, as determined by coronary computed tomographic angiography (CCTA), by analyzing risk factors in patients with type 2 DM. MethodsA prediction formula was developed based on a multivariate analysis of common factors in patients with ⩾50% coronary artery stenosis in a cohort of 327 patients with type 2 DM who underwent CCTA between 2007 and 2009, and cutoff values were calculated (derivation study). The validity of the optimal cutoff value was confirmed in a separate cohort of 317 patients with type 2 DM who underwent CCTA between 2010 and 2011 (validation study). ResultsIn the derivation study, five predictive factors (presence/absence of hypertension, estimated glomerular filtration rate, maximum intima-media thickness [max-IMT], ankle-brachial index [ABI], and use/nonuse of diabetic medication) were used to develop a prediction formula. In the validation study, positive predictive value (PPV) and negative predictive value (NPV) of the cutoff value derived from the prediction formula were 53% and 73%, respectively. ConclusionsWe developed a novel formula to predict coronary artery stenosis using five predictive factors. This formula is useful for determining whether computed tomography (CT) examination is necessary, even in clinical settings without CCTA equipment. Early detection of coronary artery stenosis in patients with DM may also lead to better health outcomes.

Effect of heart rate on the diagnostic accuracy of 256-slice computed tomography angiography in the detection of coronary artery stenosis: ROC curve analysis.

The aim of the present study was to investigate the effect of heart rate (HR) on the diagnostic accuracy of 256-slice computed tomography angiography (CTA) in the detection of coronary artery stenosis. Coronary imaging was performed using a Philips 256-slice spiral CT, and receiver operating characteristic (ROC) curve analysis was conducted to evaluate the diagnostic value of 256-slice CTA in coronary artery stenosis. The HR of the research subjects in the study was within a certain range (39-107 bpm). One hundred patients suspected of coronary heart disease underwent 256-slice CTA examination. The cases were divided into three groups: Low HR (HR <75 bpm), moderate HR (75≤ HR <90 bpm) and high HR (HR ≥90 bpm). For the three groups, two observers independently assessed the image quality for all coronary segments on a four-point ordinal scale. An image quality of grades 1-3 was considered diagnostic, while grade 4 was non-diagnostic. A total of 97.76% of the images were diagnostic in the low-HR group, 96.86% in the moderate-HR group and 95.80% in the high-HR group. According to the ROC curve analysis, the specificity of CTA in diagnosing coronary artery stenosis was 98.40, 96.00 and 97.60% in the low-, moderate- and high-HR groups, respectively. In conclusion, 256-slice coronary CTA can be used to clearly show the main segments of the coronary artery and to effectively diagnose coronary artery stenosis. Within the range of HRs investigated, HR was found to have no significant effect on the diagnostic accuracy of 256-slice coronary CTA for coronary artery stenosis.

The Emerging Roles of Coronary Computed Tomographic Angiography: Acute Chest Pain Evaluation and Screening for Asymptomatic Individuals.

Coronary computed tomographic angiography (CCTA) has been widely available since 2004. After that, the diagnostic accuracy of CCTA has been extensively validated with invasive coronary angiography for detection of coronary arterial stenosis. In this paper, we reviewed the updated evidence of the role of CCTA in both scenarios including acute chest pain and screening in asymptomatic adults. Several large-scale studies have been conducted to evaluate the diagnostic value of CCTA in the context of acute chest pain patients. CCTA could play a role in delivering more efficient care. For risk stratification of asymptomatic patients using CCTA, latest studies have revealed incremental benefits. Future studies evaluating the totality of plaque characteristics may be useful for determining the role of noncalcified plaque for risk stratification in asymptomatic individuals. Acute chest pain • Computed tomography • Coronary artery disease • Health screening • Stable angina.

Diagnostic Accuracy of Dual-Source Computerized Tomography Coronary Angiography in Symptomatic Patients Presenting to a Referral Cardiovascular Center During Daily Clinical Practice.

BackgroundThere are numerous studies that address the diagnostic value of dual-source computed tomography (DSCT) as an alternative to conventional coronary angiography (CCA). However, the benefit of application of DSCT in a real world clinical setting should be evaluated.ObjectivesTo determine the diagnostic accuracy of DSCT technique compared with CCA as the gold standard method in detection of coronary artery stenosis among symptomatic patients who are presented to a referral cardiovascular center during daily clinical practice.Patients and MethodsEvaluating the medical records of a tertiary care referral cardiovascular center, 47 patients who had undergone DSCT and CCA, and also met the inclusion and exclusion criteria of the study were selected. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios (LRs) of the DSCT imaging technique were calculated.ResultsIn total, 97.8% of the segments (628/642) could be visualized with diagnostic image quality via DSCT coronary angiography. The mean heart rate during DSCT was 69.2 ± 12.2 bpm (range: 39 - 83 bpm), and the mean Agatston score was 507.7 ± 590.5 (range: 0 - 2328). Per segment analysis of the findings revealed that the sensitivity, specificity, PPV, NPV, positive LR (PLR) and negative LR (NLR) of DSCT technique for evaluation of patients with coronary artery disease were 93.7%, 96.8%, 92.7%, 97.2%, 29.4, and 0.066, respectively. Also per vessel, analysis of the findings showed a sensitivity of 97.1%, a specificity of 94.0%, PPV of 95.3%, NPV of 96.3%, PLR of 16.1, and NLR of 0.030.ConclusionOur results indicate that DSCT coronary angiography provides high diagnostic accuracy for the evaluation of CAD patients during daily routine practice of a referral cardiovascular setting.