Invasive Coronary Angiography For Detection Research Articles

Ferumoxytol-Enhanced Coronary Magnetic Resonance Angiography Compared to Invasive Coronary Angiography for Detection of Epicardial Coronary Artery Disease

Ferumoxytol-Enhanced Coronary Magnetic Resonance Angiography Compared to Invasive Coronary Angiography for Detection of Epicardial 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.

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.

Coronary computed tomography angiography predicts subsequent cardiac outcome events: results of the Visipaque CCTA registry study.

To evaluate the diagnostic performance and predictive value of coronary computed tomography angiography (CCTA) on subsequent cardiac outcomes. CCTA has been suggested as an alternative method to invasive coronary angiography for detection of and ruling out coronary artery disease (CAD). However, the usefulness of CCTA findings in predicting patient outcome in routine clinical practice is still uncertain. A prospective, multicenter registry study of CCTA with a Visipaque injection 320 mg I/ml was carried out in symptomatic patients suspected of having CAD as part of their medical care. CCTA findings were used to guide patient management decisions. Patient cardiac outcomes were followed at 1, 6, and 12 months after the CCTA procedure for the occurrence of major adverse cardiac event (MACE) (cardiac death, nonfatal myocardial infarction, or unstable angina requiring hospitalization). All cardiac outcome events or deaths were adjudicated independently. Of 874 patients (mean age=59 years; 51% men) who received Visipaque, 857 were included in the efficacy analysis. Using cardiac outcomes as the endpoint, the sensitivity of CCTA was 96.1, 95.8, and 94.7%, specificity was 84.5, 86.6, and 87.0%, and negative predictive value more than 99.0% at 1, 6, and 12 months, respectively. At 12 months, the rate of MACE was 5.7% (10/174) in patients with a positive CCTA (one or more ≥50% stenosis) and 0.1% (1/683) in patients with a negative CCTA (99.9% MACE-free survival rate). The Cox proportional hazards analysis with CCTA outcome, age, sex, reasons for CCTA, and cardiac risk factors as covariates showed a hazard ratio of 87.6 for positive versus negative CCTA (P=0.0001). CCTA is a highly accurate, noninvasive tool to detect or rule out subsequent cardiovascular events in patients with intermediate pretest probability of CAD or an uninterpretable/equivocal stress test. A positive CCTA finding contributed significantly toward the prediction of subsequent MACE whereas a negative CCTA carried excellent prognostic outcomes at 12 months.

Assessment of coronary ischaemia by myocardial perfusion dipyridamole stress technetium-99 m tetrofosmin, single-photon emission computed tomography, and coronary angiography in children with Kawasaki disease: pre- and post-coronary bypass grafting.

Coronary artery lesions in Kawasaki disease invasively assessed by coronary angiography. Evaluation of myocardial perfusion by single-photon emission computed tomography may identify the haemodynamic significance of coronary lesions. To evaluate diagnostic accuracy of dipyridamole stress technetium-99 m tetrofosmin, single-photon emission computed tomography as a possible alternative to invasive coronary angiography for detection and follow-up of myocardial ischaemia in patients with Kawasaki disease, and pre- and post-coronary bypass grafting. Coronary angiography and single-photon emission computed tomography were performed on 21 patients who were classified into three groups - group I (stenosis), group II (giant aneurysms), and group III (small aneurysms). Of the 21 patients, 16 (groups I and II) patients with myocardial perfusion defects, who underwent coronary bypass grafting, were followed up with single-photon emission computed tomography. In group I, all patients had significant coronary stenosis and 100% of them had perfusion defects in the anterior and septal walls. In group II, all patients had giant aneurysms and 83% of them had inferior and inferolateral perfusion defects. In group III, all patients had small aneurysms and 100% of them had normal perfusion. Pre-coronary bypass grafting myocardial ischaemic defects disappeared in all patients after surgery. Sensitivity, specificity, and accuracy of single-photon emission computed tomography were 94, 100, and 95%, respectively. Technetium-99 m tetrofosmin single-photon emission computed tomography can be applied as an accurate non-invasive diagnostic technique for detecting myocardial perfusion defects with coronary artery lesions, and to show improved or even normalised perfusion of the myocardium in patients after surgical revascularisation.

Noninvasive Coronary Angiography With Multislice Computed Tomography

Multislice computed tomography (MSCT) has recently evolved as a modality for noninvasive coronary imaging. To assess the accuracy and robustness of MSCT vs the criterion standard of invasive coronary angiography for detection of obstructive coronary artery disease. Prospective, single-center study conducted in a referral center setting in Germany and enrolling 103 consecutive patients (mean age, 61.5 [SD, 9.7] years) from November 2003-August 2004 who were undergoing both invasive coronary angiography and MSCT using a scanner with 16 detector rows. Blinded results for both modalities compared using the patient as the primary unit of analysis, with supplementary segment- and vessel-based analyses. One thousand three hundred eighty-four segments (> or =1.5 mm diameter) were identified by invasive coronary angiography; nondiagnostic image quality of MSCT was identified for only 88 (6.4%) of these segments, mainly due to faster heart rates. Compared with invasive coronary angiography for detection of significant lesions (>50% stenosis), segment-based sensitivity, specificity, and positive and negative predictive values of MSCT were 95%, 98%, 87%, and 99%, respectively. Quantitative comparison of MSCT and invasive coronary angiography showed good correlation (r = 0.87, P<.001), with MSCT systematically measuring greater-percentage stenoses (bias, +12%). In the patient-based analysis, the area under the receiver operating characteristic curve was 0.97 (95% confidence interval, 0.90-1.00), indicating high discriminative power to identify patients who might be candidates for revascularization (>50% left main artery stenosis and/or >70% stenosis in any other epicardial vessel). Threshold optimization allowed either detection of these patients with 100% sensitivity at a reasonable false-positive rate (specificity, 76.5%; MSCT stenosis, >66%) or optimization of both the sensitivity and specificity (>90%; MSCT stenosis, >76%). Multislice computed tomography provides high accuracy for noninvasive detection of suspected obstructive coronary artery disease. This promising technology has potential to complement diagnostic invasive coronary angiography in routine clinical care.