Occurrence Of Sudden Cardiac Death Research Articles

Sudden Cardiac Death in Patients With Silent Myocardial Ischemia After Myocardial Infarction (from the Swiss Interventional Study on Silent Ischemia Type II [SWISSI II

The occurrence of sudden cardiac death (SCD) in patients with silent ischemia after myocardial infarction (MI) and the factors facilitating SCD are unknown. This study aimed to determine the factors facilitating SCD in patients with silent ischemia after MI. In the Swiss Interventional Study on Silent Ischemia Type II (SWISSI II), 201 patients with silent ischemia after MI were randomized to percutaneous coronary intervention (PCI) or medical management. The main end point of the present analysis was SCD. Multivariable regression models were used to detect potential associations between baseline or follow-up variables and SCD. During a mean follow-up of 10.3 +/- 2.6 years, 12 SCDs occurred, corresponding to an average annual event rate of 0.6%. On multivariate regression analysis, the decline in the left ventricular ejection fraction (LVEF) during follow-up was the only independent predictor of SCD (p = 0.011), other than age; however, the baseline LVEF was not. The decline in LVEF was greater in patients receiving medical management than in those who had received PCI (p <0.001), as well as in patients with residual myocardial ischemia or recurrent MI compared with patients without these findings (p = 0.038 and p <0.001, respectively). Compared with medical management, PCI reduced the rate of residual myocardial ischemia (p <0.001) and recurrent MI (p = 0.001) during follow-up. In conclusion, patients with silent ischemia after MI are at a substantial risk of SCD. The prevention of residual myocardial ischemia and recurrent MI using PCI resulted in better long-term LVEF and a reduced SCD incidence.

Determinants of Prolonged QT Interval and Their Contribution to Sudden Death Risk in Coronary Artery Disease

In a recent cohort study, prolongation of the corrected QT interval (QTc) was associated with an independent increased risk of sudden cardiac death (SCD). We evaluated determinants of prolonged QTc and the relationship of prolonged QTc to SCD risk among patients with coronary artery disease in the general population. A case-control design was used. Cases were SCD patients with coronary artery disease among a metropolitan area of 1 000 000 residents (2002 to 2006); controls were area residents with coronary artery disease but no history of SCD. All cases were required to have an ECG suitable for QTc analysis before and unrelated to the occurrence of SCD. A total of 373 cases and 309 controls met criteria for analysis. Mean QTc was significantly longer in cases than in controls (450+/-45 versus 433+/-37 ms; P<0.0001). In a multivariate model, gender, diabetes mellitus, and QTc-prolonging drugs were significant determinants of QTc prolongation in controls. In a logistic regression model predicting SCD, diabetes mellitus (odds ratio, 1.97; 95% confidence interval, 1.32 to 2.96) and use of QTc-prolonging drugs (odds ratio, 2.90; 95% confidence interval, 1.92 to 4.37) were significant predictors of SCD among subjects with normal or borderline QTc. However, abnormally prolonged QTc in the absence of diabetes and QT-prolonging medications was the strongest predictor of SCD (odds ratio, 5.53; 95% confidence interval, 3.20 to 9.57). Diabetes mellitus and QTc-affecting drugs determined QTc prolongation and were predictors of SCD in coronary artery disease. However, idiopathic abnormal QTc prolongation was associated with 5-fold increased odds of SCD. A continued search for novel determinants of QTc prolongation such as genomic factors is likely to enhance risk stratification for SCD in coronary artery disease.

Sympathetic overactivity and sudden cardiac death among hemodialysis patients with left ventricular hypertrophy

Background We prospectively investigated whether cardiac autonomic imbalance is associated with sudden cardiac death (SCD) among a group of hemodialysis patients with left ventricular hypertrophy (LVH). Methods In a prospective cohort study, we enrolled 196 asymptomatic patients on chronic hemodialysis who had LVH as determined by echocardiography and had undergone twenty-four-hour ambulatory Holter electrocardiography between dialysis sessions (males/females, 114/82; mean age, 65 ± 12 years) to analyze heart rate variability. We calculated the percentage difference between adjacent NN intervals more than 50 ms (pNN50) and high-frequency component (HF, 0.15–0.40 Hz) as parameters of cardiac parasympathetic activity, and the low-frequency component (LF, 0.04–0.15 Hz)/HF component ratio as a parameter of sympathetic activity. Results During 4.5 ± 1.9-year follow-up, 21 patients who had undergone coronary revascularization within 60 days of enrollment were excluded from the analysis. Among the remaining 175 patients (male/female, 105/70; 66 ± 12 years), SCD was recognized in 23 patients. On stepwise Cox hazard analysis, SCD was positively associated with age and LF/HF ratio, and tended to be inversely associated with pNN50. On Kaplan–Meier analysis, SCD-free survival rates at 5 years were 29.4% and 98.1% in patients with LF/HF ratios of 1.9 or more and below 1.9, respectively. Conclusions The presence of cardiac sympathetic overactivity may predict the occurrence of SCD in the asymptomatic hemodialysis patients with LVH.

Single-Photon Emission Computed Tomography Myocardial Perfusion Defects Are Associated With an Increased Risk of All-Cause Death, Cardiovascular Death, and Sudden Cardiac Death

Background— Single-photon emission computed tomography myocardial perfusion imaging defects are associated with increased all-cause mortality and cardiovascular death. However, it is unknown whether single-photon emission computed tomography myocardial perfusion imaging can identify patients at increased risk of sudden cardiac death (SCD). Methods and Results— We analyzed a cohort of 6383 patients with angiographically documented coronary artery disease who underwent single-photon emission computed tomography imaging. Cox proportional hazards modeling was used to examine the relationship between patient characteristics and SCD. Among patients who died, the median time to SCD was 2.7 years (25 th , 75 th percentiles 0.9, 4.9, respectively). The incidence of SCD was 3.4% (n=215) over 6.1 years (25 th , 75 th percentiles 3.7, 9.2, respectively) of follow-up. Patients with SCD had more severe heart failure symptoms, greater comorbidity (Charlson index), and higher summed stress perfusion scores (all P &lt;0.001). After adjusting for left ventricular ejection fraction and other clinical factors in the multivariable model, the summed stress perfusion score (fixed plus reversible defects) remained significantly associated with the occurrence of SCD: summed stress perfusion score (hazard ratios per 3 U: 1.16 [95% CI, 1.08 to 1.25], P &lt;0.001), left ventricular ejection fraction (hazard ratios per 5 U: 0.90 [95% CI, 0.85 to 0.95], P &lt;0.001), and Charlson index (hazard ratios 1.35 [95% CI, 1.23 to 1.49], P &lt;0.001). Conclusions— Myocardial perfusion imaging is a significant predictor of SCD and provides information independent of clinical history and left ventricular ejection fraction. Gated single-photon emission computed tomography imaging, which evaluates both myocardial perfusion and function, may represent a more effective means of risk stratification than solitary left ventricular ejection fraction determination and should be evaluated in prospective trials.

Expanding the phenotype of sudden cardiac death—An unusual presentation of a family with a Lamin A/C mutation

Familial occurrence of sudden cardiac death (SCD) is related to a variety of clinical conditions, which can be delineated in up to 40% of families through a combination of cardiovascular examination and genetic studies. Patients with Lamin A/C gene mutations are at increased risk for SCD, but “laminopathies” are not included into clinical algorithms of SCD. Here we present a family with SCD in the absence of left ventricular dysfunction, related to a Lamin A/C mutation.

Prognosis of patients removed from a transplant waiting list for medical improvement: Implications for organ allocation and transplantation for status 2 patients

To address the present controversy regarding optimal management of status 2 heart transplant candidates, we studied the short- and long-term fate of medically improved patients removed from our transplant waiting list to assess return of heart failure and occurrence of sudden cardiac death, identify interventions to improve outcomes, and compare their survival with that of similar transplanted patients. From January 1985 to February 2004, 100 status 2 patients were delisted for medical improvement (median on-list duration, 314 days). Return of heart failure, sudden cardiac death, and all-cause mortality were determined from follow-up (mean, 7.7 +/- 3.9 years among survivors; 10% followed >12 years). Hazard function modeling, competing-risks analyses, simulation, and propensity matching to equivalent patients undergoing transplantation were used to analyze and compare outcomes and predict benefit of interventions. Freedom from return of heart failure was 77% at 5 years. The most common mode of death was sudden cardiac death, with risk peaking at 2.5 years after delisting but remaining at 3.5% per year thereafter. Event-free survival at 1, 5, and 10 years was 94%, 55%, and 28%, respectively; simulation demonstrated that implantable cardioverter-defibrillators could have improved this to 45% at 10 years. Overall survival after delisting was better than that of matched status 2 patients who underwent transplantation, but was demonstrably worse after 30 months. Status 2 patients, including those delisted, require vigilant surveillance and optimal medical management, implantable cardioverter-defibrillators, and a revised approach to transplantation timing, such that overall salvage is maximized while allocation of scarce organs is optimized.

Reduction of complex ventricular ectopy and improvement in exercise capacity with flecainide therapy in Andersen-Tawil syndrome

Andersen-Tawil syndrome (ATS) is a rare inherited autosomal disorder characterized by the clinical triad of ventricular arrhythmias, hypokalaemic periodic paralyses, and skeletal developmental abnormalities, resulting in dysmorphic features. Although ATS patients have a high incidence of ventricular arrhythmias, the occurrence of sudden cardiac death is rare. In this report, we describe the successful use of flecainide in an ATS patient with a considerable ventricular arrhythmia burden who had not demonstrated any response to conventional beta-blocker therapy used in conjunction with potassium (K(+)) supplementation.

A Community-Based Evaluation of Sudden Death Associated with Therapeutic Levels of Methadone

Background Published case reports have associated the therapeutic use of methadone with the occasional occurrence of sudden cardiac death. Because of the established utility of this drug and with the eventual goal of enhancing safety of use, we performed a community-based study to evaluate this association. Methods During a 4-year period, we prospectively evaluated all patients who consecutively had sudden cardiac death and underwent investigation by the medical examiner in the metropolitan area of Portland, Ore. Case subjects of interest were those with a therapeutic blood level of methadone (<1 mg/L), and case comparison subjects were those with no methadone identified. Patients with recreational drug use or any drug overdose were excluded from either group. Detailed autopsies were conducted, including the detection and quantification of all substances in the blood. Results A total of 22 sudden cardiac death cases with therapeutic levels of methadone (mean 0.48 ± 0.22 mg/L; range 0.1-0.9 mg/L) were identified (mean age 37.0 ± 10 years, 68% were male) and compared with 106 consecutive sudden cardiac death cases without evidence of methadone (mean age 42 ± 13 years, 69% were male). The most common indication for methadone use was pain control (n = 12, 55%). Among cases receiving methadone therapy, sudden death-associated cardiac abnormalities were identified in only 23% (n = 5), with no clear cause of sudden cardiac death in the remaining 77% (n = 17). Among cases with no methadone, sudden death-associated cardiac abnormalities were identified in 60% (n = 64, P = .002). Conclusion The significantly lower prevalence of cardiac disease in the case group implicates methadone, even at therapeutic levels, as a likely cause of sudden death. These findings point toward an association between methadone and occurrence of sudden death in the community. Clinical safeguards and further prospective studies specifically designed to enhance safety of methadone use are warranted.

CrossRef Listing of Deleted DOIs

The increasing use of automated external defibrillators (AEDs), coupled with methods to improve cardiopulmonary resusitation and implementation of early defibrillation, have significantly improved survival from sudden cardiac death (SCD) in the prehospital setting. This article reviews the evidence and principles of management of SCD in the sports setting. It is noted that ventricular fibrillation is the most common arrhythmia causing SCD in athletes. When it occurs, survival is reduced by 7% to 10% per minute pending defibrillation. This statistic is true for athletes as well as nonathletes, and underscores the critical need for a rapid defibrillation response. Use of the AED in the sports setting and suggestions on whether to implement an AED program are reviewed. Despite increasing application of this technology, outcomes data on the use of AEDs in the sports arena are lacking, partly due to the relatively rare occurrence of SCD therein. New evidence on pharmacotherapy in SCD is also reviewed. Although drug administration in SCD is unlikely to be required in the sports setting, clinicians are updated on some of the newer considerations. Finally, selected articles from the recent literature on advanced cardiac life support are provided to guide the team physician in using the most current approach to the management of SCD.

Interleukin-18 promoter polymorphism associates with the occurrence of sudden cardiac death among Caucasian males: The Helsinki Sudden Death Study

Objective The increased plasma concentrations of pro-atherogenic and cardiomyocyte hypertrophic cytokine interleukin 18 (IL-18) predict mortality in patients with coronary heart disease (CHD) in addition to predicting the outcome of heart failure. The IL-18 gene has a functional −137 G/C polymorphism (rs187238) in the promoter region. The C allele carriage is associated with attenuated IL-18 production. The effect of IL-18 genotype on SCD is unknown. We studied the association of the IL-18 gene −137 G/C polymorphism with the occurrence of sudden cardiac death (SCD). Methods Using the TaqMan 5′ nuclease assay, we genotyped two independent consecutive and prospective autopsy series which were included in the Helsinki Sudden Death Study. Results Of the 663 men, 359 (54.1%) had the wild-type GG-genotype, 261 (39.4%) were heterozygotes (CG) and 43 (6.5%) were CC homozygotes. Compared to the GG homozygotes, the C allele carriers (i.e. subjects having CC or CG genotypes) had a lower adjusted risk for SCD from any cause (odds ratio [OR] 0.49; 95% confidence interval [CI], 0.31–0.77, p = 0.002), for SCD due to CHD (OR 0.51; 95% CI, 0.32–0.82, p = 0.005), and for SCD caused by non-coronary heart diseases (OR 0.34; 95% CI 0.13–0.90, p = 0.030). Conclusion IL-18 promoter −137 G/C polymorphism, which regulates the expression of IL-18, is an important predictor of SCD from any cause as well as SCD in patients with and without underlying CHD.

Drug Insight: aldosterone-receptor antagonists in heart failure—the journey continues

Aldosterone is an important mediator in the pathogenesis of heart failure, and increased plasma aldosterone levels are associated with a poor prognosis. Aldosterone-receptor blocking drugs can slow the progression of left ventricular remodeling and reduce the occurrence of sudden cardiac death. Two widely publicized clinical trials provide data demonstrating survival benefits with spironolactone and eplerenone in chronic and postinfarction heart failure. The publication of these trials has generated widespread enthusiasm for spironolactone and eplerenone, leading to the more frequent and sometimes unbridled use of these drugs in the medical community. We herein describe the likely mechanisms of action of aldosterone-receptor antagonists, discuss the existing clinical evidence supporting their use, and provide practical advice on their use in the management of patients with heart failure.

Hospital arrivals of emergency transfers due to sudden death follow a diurnal variation

Purpose: The aim of the study was to assess the diurnal variation of hospital arrivals of emergency transfers due to sudden cardiac death (SD). Such variation closely reflects circadian variations in the occurrence of SD. Methods: We studied 259 patients (mean age 67±16 years, 177 males) transferred to the emergency department of our hospital with SD from 01/01/2002 to 30/11/2005. Only patients with warning signs and symptoms occurring within 1h before collapse were included. Patients with end stage chronic disease were excluded from the study.

Torsades de Pointes as a Cause of Sudden Death in a Patient with Aortic Stenosis and Atrial Fibrillation

The occurrence of sudden cardiac death during Holter monitoring in patients with aortic stenosis has been reported previously. In the majority of the reported cases, the cause of death was a malignant ventricular tachyarrhythmia. The presence of a strong association between frequency and complexity of ventricular arrhythmias and sudden death in patients with aortic stenosis has been proposed. We report the case of a 77-year-old woman with aortic stenosis and atrial fibrillation who had an episode of torsades de pointes that degenerated into ventricular fibrillation during Holter monitoring. A short-long-short sequence, but not increased ventricular ectopics, precipitated torsades de pointes and sudden death in this case which is strongly indicative of triggered activity as the underlying mechanism of the lethal arrhythmia.

P1-33: Complete revascularization after acute myocardial infarction is associated with the extreme low occurrence of sudden cardiac death

P1-33: Complete revascularization after acute myocardial infarction is associated with the extreme low occurrence of sudden cardiac death

Circadian Rhythm in Sudden Cardiac Death: A Retrospective Study of 2,665 Cases

Several studies have reported a circadian variation in sudden cardiac death. The aim of this study was to determine whether in northern Greece sudden cardiac death shows a circadian rhythm and/or a weekly and seasonal distribution. We studied 2,665 sudden deaths due to coronary heart disease from 13,832 sudden deaths that merited autopsy; 1,429 (53.6%) of them were due to acute myocardial infarction (AMI) and 1,236 (46.4%) to chronic ischemic heart disease (IHD). The time of death was determined on the basis of autopsy results and witness interviews. There was a circadian rhythm of sudden cardiac death (p<0.010), with a low incidence during the hours 04.00-08.00 (13.1%) and an increased incidence during 20.00-24.00 (19.8%) (p<0.05). Women did not show the same significant circadian variation. Time of occurrence of sudden cardiac death attributed either to AMI or to IHD showed a similar 24-hour distribution (lowest incidence during 04.00-08.00 hours, 12.8% and 13.5%, respectively, and higher during 20.00-24.00, 19.5% and 20.3%, respectively). Weekday distribution of sudden cardiac death showed a significant statistical variation (p<0.005) with the highest frequency on Monday (21.1%) and the lowest on Sunday (7.5%). The same distribution was observed in men, whereas in women the lower frequency was also on Sunday but the higher was on Tuesday. Sudden cardiac death was evenly distributed over the months of the year, with the highest incidence in summer (27.3%) and the lowest in autumn (22%). Sudden cardiac death shows a circadian rhythm and a significant variation during the week.

Population-Based Analysis of Sudden Cardiac Death With and Without Left Ventricular Systolic Dysfunction: Two-Year Findings from the Oregon Sudden Unexpected Death Study

We sought to evaluate the contribution of left ventricular (LV) dysfunction toward occurrence of sudden cardiac death (SCD) in the general population, and to identify distinguishing characteristics of SCD in the absence of LV dysfunction. Patients who manifest warning symptoms and signs are more likely to undergo evaluation before SCD. Although prevalence of LV dysfunction in this subgroup may overestimate the prevalence in overall SCD, this is the only means of assessment in the general population. All cases of SCD in Multnomah County, Oregon (population 660,486; 2002 to 2004) were prospectively ascertained in the ongoing Oregon Sudden Unexpected Death Study. We retrospectively assessed LV ejection fraction (LVEF) among subjects who underwent evaluation of LV function before SCD (normal: > or =55%; mildly to moderately reduced: 36% to 54%; and severely reduced: < or =35%). Of a total of 714 SCD cases (annual incidence 54 per 100,000), LV function was assessed in 121 (17%). The LVEF was severely reduced in 36 patients (30%), mildly to moderately reduced in 27 (22%), and normal in 58 (48%). Patients with normal LVEF were distinguishable by younger age (66 +/- 15 years vs. 74 +/- 10 years; p = 0.001), higher proportion of females (47% vs. 27%; p = 0.025), higher prevalence of seizure disorder (14% vs. 0%; p = 0.002), and lower prevalence of established coronary artery disease (50% vs. 81%; p < 0.001). In this community-wide study, only one-third of the evaluated SCD cases had severe LV dysfunction meeting current criteria for prophylactic cardioverter-defibrillator implantation. The SCD cases with normal LV function had several distinguishing clinical characteristics. These findings support the aggressive development of alternative screening methods to enhance identification of patients at risk.

Prediction of sudden cardiac death after acute myocardial infarction: role of Holter monitoring in the modern treatment era

Current treatment may have changed the risk profiles of survivors of acute myocardial infarction (AMI). We evaluated the utility of Holter-based risk variables in the prediction of sudden cardiac death (SCD) among survivors of AMI treated with modern therapy. A total of 2130 AMI patients (mean age 59 +/- 10 years) were included. The patients were treated with modern therapeutic strategies, for example, 94% were on beta-blocking therapy and 70% underwent coronary revascularization. Various risk parameters from Holter monitoring were analysed. During a median follow-up of 1012 days (interquartile range: 750-1416 days), cardiac mortality was 113/2130, including 52 SCDs. All Holter variables predicted the occurrence of SCD (P<0.01), but only reduced post-ectopic turbulence slope (TS) (P<0.001) and non-sustained ventricular tachycardia (P<0.01) remained as marked SCD predictors after adjustment for age, diabetes, and ejection fraction (EF). In a subgroup analysis, none of the Holter variables predicted SCD among those with an EF < or = 0.35, but many variables predicted SCD among those with an EF >0.35, particularly TS (hazard ratio 5.9; 95% CI 2.9-11.7, P<0.001). Among the post-AMI patients treated according to the current guidelines, the incidence of SCD is low. Various Holter variables still predict the occurrence of SCD, particularly among the patients with preserved left ventricular function.

Apoptosis as a prognostic indicator of long-term mortality and sudden cardiac death in patients with dilated cardiomyopathy undergoing palliative surgical treatment

Background: Cardiomyocyte apoptosis has been described in dilated cardiomyopathies, but its clinical relevance remains unclear. In this study, we investigated if preoperative clinical variables and if the presence of cellular apoptosis in left ventricle fragments resected during partial left ventriculectomy had any influence on long-term survival after this palliative surgical procedure. Methods: Partial left ventriculectomy, associated when necessary with mitral insufficiency correction, was performed in 43 patients with idiopathic dilated cardiomyopathy. Eighteen patients were in NYHA functional class III and 25 in class IV. Left ventricular apoptotic cardiomyocytes and apoptotic interstitial cells were quantified using the Tunel assay. Multivariable Cox proportional-hazards analysis was performed with respect to three outcome end points: all deaths, deaths due to heart failure progression and deaths due to arrhythmia related events. Results: Nine patients (20.9%) died during the hospital period and the surviving patients were followed up for a mean of 43 32 months. Other 24 patients died at late follow-up. Causes of late deaths were equally divided between heart failure progression and arrhythmia related events. Actuarial survival rates were 58 7% at 1 year, 48 7% at 2 years, 39 7% at 4 years and 23 6% at 6 years of follow-up. Preoperative NYHA class IV and cardiomyocyte apoptosis were identified as independent predictors of poor long term survival (p 0.003). Functional class IV and elevated nor epinephrine levels were associated with heart failure progression (p 0.002), while arrhythmia related deaths were only predicted by the level of cardiomyocyte apoptosis (p 0.009). Conclusion: The results of palliative surgical treatment of dilated cardiomyopathies are limited by patients’ preoperative clinical condition and by the occurrence of sudden cardiac death, which may be associated with myocardial cells intrinsic compromise.

The Acute Effects of Cigarette Smoking on the Heterogeneity of Ventricular Repolarization in Healthy Subjects: The Relationship between QT Dispersion and Coronary Flow Reserve

Background and Objectives：Although cigarette smoking is a known risk factor for sudden cardiac death, little is known about the effects of smoking on the heart. The QT interval and QT dispersion prolongation have been associated with a lower ventricular fibrillation threshold and the occurrence of sudden cardiac death. Smoking has an unfavorable influence on the autonomic balance and myocardial blood flow. The objective of the current study was to evaluate the relationship between the QT dispersion and coronary flow reserve (CFR) in healthy young male subjects. Subjects and Methods：The study included a sample of 30 healthy young male cigarette smokers. The catecholamines level, QTc dispersion, heart rate variability and myocardial blood flow were measured, immediately before and 5 minutes after and during the smoking of 3 cigarettes. Results：Short-term smoking caused significant increases in the serum cortisol (10.9±4.9 vs. 15.0±7.0 μg/dL, p<0.01), serum epinephrine (0.038±0.026 vs. 0.046±0.026 ng/mL, p=0.044), heart rate (78±9 vs. 85±8 beats/min, p< 0.01), maximal QTc interval (412±22 vs. 435±20 ms, p<0.01), QTc dispersion (43±14 vs. 62±17 ms, p<0.01), LFnu (68±9 vs. 78±6%, p<0.01), LF/HF (3.25±2.15 vs. 5.22±1.89, p<0.01) and peak diastolic velocity (21.7±3.9 vs. 23.9±5.5 cm/sec, p=0.005), and a decrease in the CFR (3.71±0.56 vs. 3.42±0.76, p=0.024). The change in the QTc dispersion was closely related to the change in the CFR (r=-0.357, p=0.043). Conclusion：The present study is the first to demonstrate that the impaired coronary flow reserve after smoking may contribute to the increased inhomogeneity of ventricular repolarization in healthy young male smokers. (Korean Circulation J 2005;35:448-453)

Detection, visualization and evaluation of anomalous coronary anatomy on 16-slice multidetector-row CT.

Early identification and evaluation of relatively frequent anomalous coronary anatomy is quite relevant because of the occurrence of sudden cardiac death or related symptoms of myocardial ischemia. Selective coronary angiography (CAG) is invasive, expensive and cannot always provide the required information adequately. Recently, non-invasive imaging techniques such as magnetic resonance imaging and multidetector-row computed tomography (MDCT) have been shown to provide a good anatomical view of the coronary artery tree. This study aims to demonstrate the value of 16-MDCT for evaluation of anomalous coronary anatomy. In 13 patients scanned using 16-MDCT, six different coronary anomalies were diagnosed [two absent left main, one single vessel left coronary artery (LCA), three LCA originating from the right (two with interarterial course), six right coronary artery originating from the left, one double left anterior descending (LAD)]. Mean diagnostic quality, recorded by two observers using a 5-point scale (1= non-diagnostic to 5= excellent diagnostic quality), resulted in a mean score of 3.73 (SD 1.19) without any non-diagnostic result. MDCT offers an accurate diagnostic modality to visualize the origin and course of anomalous coronary arteries by a three-dimensional display of anatomy. Shortcomings in CAG can be overcome by the use of contrast-enhanced MDCT.