Subsequent Angiography Research Articles

Residual ischemia location after STEMI by CMR and association with non-culprit coronary artery disease

Abstract Background Many ST-segment elevation myocardial infarction (STEMI) patients present with non-culprit coronary artery disease. In cases with incomplete revascularization, stress cardiac magnetic resonance (sCMR) could help detect and locate residual ischemia. Purpose We aim to evaluate the usefulness of sCMR to detect and locate residual ischemia in STEMI patients after discharge and correlate the findings with angiographical non-culprit coronary lesions, if any. Methods Reperfused, stable STEMI patients submitted to undergo sCMR within the first year after STEMI were included in the cohort. Index coronary angiography was revised, culprit and non-culprit coronary artery disease were registered, and significant stenoses were defined as ≥50% by visual assessment. Residual ischemia on sCMR (by first-pass vasodilator stress perfusion) was analysed and categorized as either absent or present in anterior, lateral, and inferior territories. Unrevascularized non-culprit coronary lesions were correlated with territories with residual ischemia on sCMR and lesions in subsequent coronary angiography. A p-value <0.05 was considered statistically significant. Results The study group was made up of 234 patients who underwent sCMR within the first year after STEMI (mean age 58.95±11.85 years, 78.2% male, 48.7% anterior infarction). Residual ischemia by sCMR was noted in 63 (26.9%) patients. In the 95 patients (40.6%) who underwent complete revascularization during index admission, residual ischemia by sCMR was seldom detected (n=14, 14.7%) and distributed on anterior (n=8), lateral (n=3) and inferior (n=4) territories. More than half of the cohort (n=139, 59.4%) depicted unrevascularized non-culprit coronary lesions, and residual ischemia was detected in 49 (35.3%) patients. Non-culprit lesions on left anterior descendent artery (n=62) associated with ischemia in 38.7% of cases (n=24), most commonly in the anterior territory (n=17, 70.8%). Similar findings were noted for lesions on circumflex artery (n=66), which depicted residual ischemia in 34.8% (n=23) of cases and most frequently in the lateral territory (n=13, 56.5%); and lesions in right coronary artery (n=45), which depicted residual ischemia in 42.2% (n=19) of cases, most commonly in the inferior territory (n=13, 68.4%). Significant coronary stenosis was found in most patients who underwent subsequent coronary angiography after residual ischemia detection (41 out of 47, 87.2%). Conclusions One third of STEMI patients with incomplete revascularization and non-culprit coronary artery disease depict residual ischemia on sCMR, the location of which generally correlates with index coronary anatomy and significant stenosis in subsequent coronary angiography. Residual ischemia is infrequent in patients with complete revascularization, but not inexistent. sCMR should be considered in selected STEMI patients according to coronary anatomy and/or symptoms to guide therapy.Stress CMR and ischemia location

How to predict myocardial injury in patients with large ischaemic burden identified during stress echocardiography?

Abstract Background/Introduction Stress echocardiography (SE) is well established diagnostic tool in coronary artery disease (CAD) with broadly agreed consensus for the indications and protocols. There is, however, no clear non-invasive SE parameter in identifying high risk features in patients with large burden of inducible regional wall motion abnormalities (RWMA) that would require prompt treatment or urgent admission. Purpose To identify high risk features during SE associated with myocardial injury following a positive SE with large amount of RWMA. Methods All consecutive patients referred for SE from June 2019 to November 2022 to diagnose coronary artery disease were assessed for inducible RWMAs using a hybrid protocol (low dose Dobutamine and exercise on supine bike with 3 min increments of workload of 25W). Those with ≥4/17 segments of inducible RWMAs underwent measurement of Troponin level 1 hour after the test termination. Somatometric characteristics, risks factors, symptoms, haemodynamic pre- and during SE and results of subsequent coronary angiography were recorded. Results 631 patients were referred for assessment of CAD. 87 patients had ≥4/17 inducible RWMAs out of 152 patients with positive SE. 61/87 who had Troponin measurements were included in the analysis. Mean age was 65 ± 13 yo, 61% were male. There was high prevalence of known CAD (77%) and cardiovascular risks factors as hypertension (59%) and hyperlipidaemia (61%). The median exercise time was 9 minutes, 46% developed chest pain (CP), 49% - ECG changes, 39% - left ventricular (LV) dilatation and 74% - reduction in LVEF. Troponin was positive in 25/61 patients. Invasive coronary angiography confirmed clinical CAD in 51/61 patients. 5 patients had either normal angiogram or non-obstructive CAD, 5 patients were awaiting diagnostic test. The severity of CAD appears to be associated with magnitude of Troponin release (1 vessel disease - 16.5 ng/L, 2 vessels disease - 39.9 ng/L, 3 vessels disease – 58.2 ng/L). All patients (6/61) with higher troponin values (>90ng/L) had multivessel disease involving the left anterior descending (LAD) artery. Interestingly, 2/5 patients without CAD had elevated Troponin suggesting possible ongoing myopathic process. The only non-invasive SE parameters that were significantly related to troponin increase were recovery time (P=0.001) and exercise time (P<0.05) whereas symptoms, BP response and LVEF reduction showed a trend which did not achieve significance. Conclusions In patient with positive SE with large burden of inducible RWMAs prolonged recovery time and low threshold for ischaemia appear to be the most reliable characteristic to identify patients with potential myocardial injury and should be used as a triaging tool for admission or early invasive assessment.

Diagnostic Performance and Clinical Impact of Photon-Counting Detector Computed Tomography in Coronary Artery Disease.

Photon-counting detector-computed tomography (PCD-CT) has emerged as a promising technology, offering improved spatial resolution. This study aimed to evaluate the clinical impact and diagnostic performance of PCD-CT vs conventional energy-integrating detector computed tomography (EID-CT) for obstructive coronary artery disease (CAD). From 2022 to 2023, we retrospectively identified 7,833 consecutive patients who underwent clinically indicated coronary computed tomography angiography (CCTA) at a single center, with either PCD-CT (n=3,876; NAEOTOM Alpha [Siemens Healthineers]) or EID-CT (n=3,957; Revolution Apex 256 [GE HealthCare] or Aquilion ONE ViSION 320 [Canon Medical Systems]) scanners. Subsequent invasive coronary angiography (ICA) and percutaneous or surgical revascularization were performed as part of routine clinical care. Among those referred for ICA after coronary CTA, the presence of obstructive CAD in each vessel was determined by coronary CTA (severe stenosis on visual assessment per the Coronary Artery Disease Reporting and Data System) and ICA (≥50% diameter stenosis on quantitative coronary angiography) in a blinded fashion. The diagnostic performance of EID-CT and PCD-CT was compared by using quantitative coronary angiography as the reference standard. Patients who underwent PCD-CT were less frequently referred to subsequent ICA than those undergoing EID-CT (9.9% vs 13.1%; P< 0.001). Among those who underwent ICA, revascularization was more frequently performed in the PCD-CT group than in the EID-CT group (43.4% vs 35.5%; P=0.02). In the vessel-level analysis (n=1,686), specificity (98.0% vs 93.0%; P< 0.001), positive predictive value (83.3% vs 63.0%; P=0.002), and diagnostic accuracy (97.2% vs 92.8%; P< 0.001) were improved by PCD-CT. Sensitivity (90.9% vs 90.7%; P=0.95) and negative predictive value (98.9% vs 98.7%; P=0.83) for obstructive CAD were similar between the PCD-CT and EID-CT groups, respectively. PCD-CT exhibited excellent diagnostic performance for detecting obstructive CAD. Compared with patients undergoing conventional EID-CT, fewer patients were referred to ICA after PCD-CT, but those referred were more likely to undergo revascularization.

Specific calcium deposition on pre-procedural CCTA at the time of percutaneous coronary intervention predicts in-stent restenosis in symptomatic patients

PurposeTo characterize preprocedural coronary atherosclerotic lesions derived from CCTA and assess their association with in-stent restenosis (ISR) after percutaneous coronary intervention (PCI). Materials and methodsThis retrospective cohort-study included patients who underwent CCTA for suspected coronary artery disease, subsequent index angiography including PCI and surveillance angiography within 6–8 months after the index procedure. We performed a plaque analysis of culprit lesions on CCTA using a dedicated plaque analysis software including assessment of the surrounding pericoronary fat attenuation index (FAI) and compared findings between lesions with and without ISR at surveillance angiography after stenting. ResultsOverall 278 coronary lesions in 209 patients were included. Of these lesions, 43 (15.5 ​%) had ISR at surveillance angiography after stenting while 235 (84.5 ​%) did not. Likewise, plaque composition such as volume of calcification [129.8 mm3 (83.3–212.6) vs. 94.4 mm3 (60.4–160.5) p ​= ​0.06] and lipid-rich and fibrous plaque volume [38.4 mm3 (19.4–71.2) vs. 38.0 mm3 (14.0–59.1), p ​= ​0.11 and 50.4 mm3 (26.1–77.6) vs. 42.1 mm3 (31.1–60.3), p ​= ​0.16] between lesion with and without ISR were not statistically significant. However lesions associated with ISR were more eccentric (n ​= ​37, 86.0 ​% versus n ​= ​159, 67,7 ​%; p ​= ​0.03) and more frequently demonstrated calcified portions on opposite sides on the vessel wall on cross-sectional datasets (n ​= ​24, 55.8 ​% versus n ​= ​55, 23.4 ​%, p ​= ​0.001). FAIlesion was significantly different in lesions with ISR as compared to those without ISR [-76.5 (−80.1 to −73.6) vs. −80.9 (−88.9 to −74.0), p ​= ​0.02]. There was no difference with respect to FAIRCA between the two groups [-77.4 (−81.9 to −75.6) vs. −78.5 (−86.0 to −71.0), p ​= ​0.41]. ConclusionCoronary lesions associated with ISR at surveillance angiography demonstrated differences in the arrangement of calcified portions as well as an increased lesion-specific pericoronary fat attenuation index at baseline CCTA. This latter finding suggests that perivascular inflammation at baseline may play a major role in the development of in-stent restenosis.

ANGIOGRAPHIC PATTERNS AND CLINICAL OUTCOMES OF IN-STENT RESTENOSIS IN DIABETIC PATIENTS FOLLOWING PERCUTANEOUS CORONARY INTERVENTION: A RETROSPECTIVE ANALYSIS

In-stent restenosis (ISR) remains a significant complication after percutaneous coronary intervention (PCI), particularly in diabetic patients. Introducing drug-eluting stents (DES) has substantially reduced restenosis rates compared to bare-metal stents (BMS), yet diabetic patients continue to exhibit higher ISR rates due to their distinct vascular biology. Understanding the angiographic patterns and associated clinical outcomes of ISR in this population is crucial for optimizing treatment strategies. Objective: This study aims to evaluate the angiographic patterns of ISR in diabetic patients and compare the clinical outcomes of these patients to non-diabetic controls following PCI. Methods: A retrospective analysis was conducted on 1,452 patients who underwent coronary stenting and subsequent repeat angiography at a tertiary care centre between January 2021 and December 2023. The study population included 726 diabetic patients and 726 non-diabetic controls. Based on angiographic findings, ISR patterns were classified as focal, diffuse, proliferative, or occlusive. Clinical outcomes, including procedural success of repeat interventions and major adverse cardiovascular events (MACE) within 12 months, were compared between the two groups. Data were analysed using multivariate logistic regression to identify predictors of diffuse ISR patterns. Results: Diabetic patients exhibited significantly higher rates of diffuse ISR (46.3%) compared to nondiabetic patients (34.5%) (p&lt;0.001). Focal ISR was more prevalent in non-diabetics (40.5% vs. 31.1%, p&lt;0.001). Diabetic patients also had a higher incidence of MACE within 12 months (23.4% vs. 15.2%, p&lt;0.001), with myocardial infarction being the most frequent event. Conclusion: Diffuse ISR is more common in diabetic patients and is associated with worse clinical outcomes compared to non-diabetic patients. These findings underscore the need for tailored interventions and close follow-up in diabetic patients post-PCI.

Management of traumatic scalp arteriovenous fistula: Case report and literature review.

Blunt traumatic arteriovenous fistula (AVF) of scalp, are uncommon and most of them can be secured by simple embolization or surgical ligation of the feeders. Our goal in writing this paper is to show patients with traumatic scalp AVFs how to prevent complications and the likelihood of recurrence. Complete treatment and reduce the recurrence rate of traumatic AVF on the scalp. Traumatic scalp AVF. Transarterial embolization and surgical resection. Complete resection of the AVF and subsequent angiography showed resolution of the contralateral lesion. Combination of endovascular embolization with subsequent surgical removal may reduce intraoperative blood loss compared with surgery alone. In addition, a well-designed scalp flap can be performed based on the angiography findings after embolization.

Long-term risk of right coronary artery injury after catheter ablation of cavotricuspid isthmus–dependent flutter

BackgroundRadiofrequency ablation (RFA) of cavotricuspid isthmus (CTI)–dependent atrial flutter requires ablation of the tricuspid annulus overlying the right coronary artery (RCA). Although it is considered safe, reports of acute and subacute RCA injury in human and animal studies raise the possibility of late RCA stenosis. ObjectiveThe objective of this study was to compare the incidence and severity of angiographic RCA stenoses in patients who have undergone CTI RFA with a control group to assess the long-term risk of RCA damage. MethodsA 2-center retrospective case-cohort study was performed including all patients from 2002 to 2018 undergoing atrial fibrillation (AF) with CTI ablation (CTI + AF) or AF ablation alone with subsequent coronary angiography (CAG). The AF alone group served as controls because of anticipated similarity of baseline characteristics. Coronary arteries that are anatomically remote to the CTI were examined as prespecified falsification end points. CAG was scored by a blinded observer. ResultsThere were 156 patients who underwent pulmonary vein isolation with subsequent CAG (CTI + AF, n = 81; AF alone, n = 75) with no difference in baseline characteristics including age, sex, comorbidities, and medications. Mean time from ablation to CAG was similar (CTI + AF, 5.0 ± 3.7 years; AF alone, 5.4 ± 3.9 years; P = .5). The mid and distal RCA showed no difference in the average number of angiographic stenoses or lesion severity. In regression analysis, CTI ablation was not a predictor of RCA stenosis severity (P = .6). There was no difference in coronary disease at sites remote to the CTI ablation (P = NS for all). ConclusionThere was no observed relationship between CTI RFA and the number or severity of angiographically apparent RCA stenoses in long-term follow-up.

Posterior fossa Hodgkin's lymphoma radiographically mimicking an arteriovenous malformation: illustrative case.

Intracranial Hodgkin's lymphoma (HL) is an exceedingly rare condition that is at an increased risk of misdiagnosis and mismanagement, especially when initial radiographic evidence points to an alternative pathology. The authors describe the case of a 75-year-old female who presented with a posterior fossa lesion initially concerning for a vascular malformation on computed tomography imaging due to perilesional hypervascularity. Subsequent angiography revealed a developmental venous anomaly (DVA) but no arteriovenous shunting. The patient's clinical history combined with magnetic resonance imaging findings prompted a tissue biopsy, which demonstrated a rare case of central nervous system (CNS) HL. The neoangiogenesis of this CNS HL with an adjacent DVA contributed to the original radiographic misdiagnosis of an arteriovenous malformation. HL's angiogenic potential, coupled with the proangiogenic environment induced around DVAs, may have contributed to this rare CNS HL metastasis to the cerebellum. The potential misdiagnosis of posterior fossa CNS HL has also been seen in several prior cases reviewed herein. Hypervascular tumors, especially when associated with an adjacent DVA, should also be considered when first evaluating suspected intracranial vascular lesions. Although rare, CNS HL should be included in the differential diagnosis for patients with a prior history of HL. https://thejns.org/doi/10.3171/CASE24238.

Vascular Plugs Improve Pulmonary Arteriovenous Malformation Occlusion over Coil Embolization Alone: A Proof-of-Concept Study Using Dual-Energy CT

PurposeTo evaluate effectiveness of pulmonary arteriovenous malformation (PAVM) embolization using dual-energy computed tomography (CT) and spectral curve analysis by characterizing contrast enhancement and vascular perfusion as a surrogate of the degree of vascular occlusion after embolotherapy. Materials and MethodsNine consecutive adult patients underwent embolization for 21 PAVMs (size range, 0.4–2.0 cm; 15/21 simple angioarchitecture) and subsequent postembolization chest dual-energy CT angiography. Twelve PAVMs were treated with vascular plugs with or without coils, whereas 9 PAVMs were treated with coils alone. Virtual spectral curves were generated using dual-energy image postprocessing in order to measure embolization effectiveness. ResultsComplete occlusion of target PAVM was achieved in all cases on digital subtraction angiography (DSA) at the end of the embolization procedure. With a median follow-up of 12.7 months, the vascular plug group demonstrated significantly less vascular opacification compared with the coils-only group, as measured by opacification between upstream feeding artery and different downstream vasculature locations (Δslope1: median 79.1 vs 28.6; P = .003; Δslope2: 76.4 vs 28.6; P = .0197; Δslope3: 78.9 vs 28.6; P = .004). Persistence occurred in 3 PAVMs based on size criteria, which demonstrated higher vascular opacification by dual-energy CT (Δslope1: 72 vs 28.6; P = .253; Δslope2: 65.1 vs 32.7; P = .326; Δslope3: 72.9 vs 53.5; P = .733), although statistical significance was not reached. ConclusionsSimilar to emerging literature, dual-energy CT showed improved occlusion in PAVMs treated with vascular plugs compared with those treated with coils alone.

Coronary artery intramural hematoma causing myocardial infarction mimicking pseudoaneurysm or dissection from trauma: A case report

Key Clinical MessageBlunt chest trauma caused ST‐segment elevation myocardial infarction. Diagnosis of intramural hematoma (IMH) using computed tomography was confirmed using electrocardiography, cardiac marker tests, and subsequent coronary angiography. After conservative treatment, the hematoma was completely resolved 1 year later. Differentiating IMH from other arterial injuries is critical for appropriate management.

Successful treatment of iatrogenic internal carotid artery pseudoaneurysm following carotid endarterectomy with thrombin injection: a case report

BackgroundIatrogenic pseudoaneurysms arising from the internal carotid artery subsequent to carotid endarterectomy are exceptionally infrequent. Herein, we present a case detailing an internal carotid artery pseudoaneurysm that manifested subsequent to a hybrid carotid endarterectomy and endovascular therapy intervention. Our approach to managing this condition involved a novel technique wherein thrombin was directly injected into the luminal cavity of the pseudoaneurysm under the guidance of a C-arm.Case presentationA 66-year-old male patient of Chinese ethnicity exhibited a 4-month history of headache and a 20-day history of gait disturbance. Digital subtraction angiography revealed occlusion in the cervical region of the left carotid artery. Following a hybrid surgical procedure, the patient reported mild pain and bruising surrounding the incision site of the left internal carotid artery endarterectomy. Subsequent angiography identified the presence of a carotid artery pseudoaneurysm. Utilizing C-arm guidance, thrombin was then directly injected into the luminal cavity of the pseudoaneurysm, resulting in complete healing during follow-up.ConclusionFor the management of pseudoaneurysms arising post carotid endarterectomy, the direct injection of thrombin into the aneurysm cavity under the guidance of a C-arm is deemed both safe and efficacious.

Color Duplex Ultrasonography for the Evaluation of Innominate, Subclavian, and Common Carotid Artery Stenosis.

This study aimed to validate the efficiency of Doppler ultrasonography for predicting the innominate, subclavian, and common carotid artery stenosis. This retrospective multicenter study between 2013 and 2022 enrolled 636 patients who underwent carotid Doppler ultrasonography and subsequent digital subtraction angiography. And 58 innominate artery stenosis, 147 common carotid artery stenosis, and 154 subclavian artery stenosis were included. The peak systolic velocity at innominate, subclavian, and common carotid artery, and velocity ratios of innominate artery to common carotid artery, innominate artery to subclavian artery, and common carotid artery to internal carotid artery were measured or calculated. The threshold values were determined using receiver operating characteristic analysis. The threshold values of innominate artery stenosis were peak systolic velocity >206 cm/s (sensitivity: 82.8%; specificity: 91.4%) to predict ≥50% stenosis and >285 cm/s (sensitivity: 89.2%; specificity: 94.9%) to predict ≥70% stenosis. The threshold values of common carotid artery stenosis were peak systolic velocity >175 cm/s (sensitivity: 78.2%; specificity: 91.9%) to predict ≥50% stenosis and >255 cm/s (sensitivity: 87.1%; specificity: 87.2%) to predict ≥70% stenosis. The threshold values of subclavian artery stenosis were peak systolic velocity >200 cm/s (sensitivity: 68.2%; specificity: 84.4%) to predict ≥50% stenosis and >305 cm/s (sensitivity: 57.9%; specificity: 91.4%) to predict ≥70% stenosis. Symptomatic patients with ultrasonic parameters of velocity at innominate artery ≥206 cm/s, velocity at common carotid artery ≥175 cm/s, or velocity at subclavian artery ≥200 cm/s need to be considered for further verification and whether revascularization is necessary.

Initial experience with ablation of ventricular arrhythmias using a pulsed-field system

Abstract Introduction Catheter ablation using radiofrequency (RF) current is a well-established method of treatment of ventricular arrhythmias (VA). However, RF ablation may fail to eliminate deeply located arrhythmogenic substrate. Pulsed-field (PF) is a novel energy source with a potential to create deeper lesions, especially in scar tissue. Purpose This study aims to present the data on safety and efficacy (acute outcome data) of VA ablation using PF. Methods The population consists of 15patients (5 women, age: 61 ± 19years) after previously failed RF ablation of VA. The underlying condition was nonischemic cardiomyopathy (53%), coronary artery disease (13%), and congenital heart disease (13%), respectively. No structural heart disease was present in 20% of cases. The mean left ventricular ejection fraction was 39 ± 13%. Eighty percent of patients had sustained VA, the remaining patients presented with frequent ventricular ectopy. Ablation was performed using a conventional irrigated 4-mm tip catheter in a combination with commercially available PF generator. Peripheral venous blood samples for the assessment of the plasmatic levels of high-sensitivity troponin T (hsTnT) were obtained the next day (usually 18-24hours) after the procedure. Results A mean of 17±12 PF applications (25A) per patient were delivered. In 5 patients (33%), an additional RF ablation (4±9 applications) was performed. Acute success as assessed by non-inducibility of VA or elimination of ectopic focus was achieved in all but one patient (93%). In 4 cases (27%), PF energy was applied within the great cardiac vein and subsequent coronary angiography did not reveal any abnormality. On the other hand, transient conduction system block occurred in 3 cases (20%) during PF application on the lateral LV wall remotely from the LV septum (complete AV block in one, LBBB in two patients). These events resolved in all cases within one hour. Ablation using PF did not result in excessive increase of hsTnT (657±482ng/l, with upper reference level of 14ng/l). Conclusion Initial experience with PF for the treatment of VA indicates high acute efficacy. The long-term effect is to be determined. PF applications in the ventricle may be associated with unexpected but transient conduction system damage, even when applications are performed remotely from the interventricular septum. The postprocedural increase in plasma troponin levels is only moderate.

DISCOVERING PALPITATIONS

Abstract NA is a 51 years old dyslipidemic man without previous cardiovascular history. It’s been for 2 years that occasionally transient palpitations appear but nothing has been made. He came to ED for palpitations after vomiting: the ECG showed sinus rhythm with transient NSVT then sinus rhythm again and SVT with ST alteration. Metoprolol 2.5mg ev and MRA ev were administered because of mild hypokalemia with benefit. Echocardiogram and chest X–ray were normal without drugs intake. During hospitalization we started bisoprolol 2.5mg po and anti–dyslipidemic therapy but we observed very frequently PVC and PSVC and symptomatic wide QRS complex sustained tachycardia paroxysms at 180 bpm without loss of consciousness, hypotension or electrolytic abnormalities and SVT 170 bpm unresponsive to BB and amiodarone. The stress test without BB evidenced early wide QRS complex sustained tachycardia at 220 bpm well hemodynamically tolerated: metoprolol 10mg ev administration showed a brief sinus rhythm and then a narrow QRS complex sustained tachycardia at 160 bpm with significantly ST underleveled so flecainide 150mg ev was given with cardioversion to sinus rhythm and slowly ST abnormality regression. Subsequent coronary angiography and cardiac magnetic resonance resulted normal. The electrophysiological study demonstrated AVRT with a left lateral pathway retroconduction with and without LBBB and subsequent short AF paroxysms: the left lateral pathway was ablated without complications but the high atrial electrical vulnerability with reproducible SVT and triggered AF paroxysms lead to ILR implantation. The patient was discharged without antiarrhythmic and anticoagulant therapy: during the follow up there’s no arrhythmic relapses evidence and the patient is asymptomatic. Never give up to looking for solutions about palpitations: accessory pathway happens when you least expect it.

The Relationship between Renal Resistive Index and Complexity of Coronary Lesions in Patients with Stable Coronary Artery Diseases.

The most common cause of coronary artery diseases (CAD) is atherosclerosis. The synergy between percutaneous coronary intervention with TAXUS™ and cardiac surgery (SYNTAX) score was used to assess complex CAD lesions. The renal resistive index (RRI) is a Doppler ultrasound parameter calculated to assess renal haemodynamics. The direct relationship between CAD complexity and RRI was not yet investigated. The aim of our study was to investigate this relationship between RRI and SYNTAX score in stable CAD patients. This study included 214 patients with stable CAD and subsequent coronary angiography done at our institution. Regarding CAD complexity, these patients were classified into 166 patients with low SYNTAX score (SYNTAX 22), and 48 patients with high SYNTAX score (SYNTAX 22). The demographic, laboratory, clinical, echocardiographic data and renal Doppler parameters; including RRI, were recorded. Multivariate logistic regression analysis demonstrated that RRI (odds ratio, OR = 4.440, 95% (confidence interval) CI: 1.418-13.903, p = 0.010) was a novel independent predictor of high SYNTAX score in patients with stable CAD, in addition to other traditional predictors as diabetes mellitus (OR = 4.401, 95% CI: 1.081-17.923, p = 0.04), low-density lipoprotein cholesterol (LDL-C) (OR = 2.957, 95% CI: 1.920-8.995, p = 0.027), multi-vessel CAD (OR = 2.113, 95% CI: 1.241-2.280, p = 0.001) and Gensini score (OR = 6.539, 95% CI: 1.977-21.626, p = 0.002). Receiver operator characteristic curve analysis showed that RRI 0.655 (sensitivity of 80%, specificity of 73.6%) was the best cut-off value for predicting high SYNTAX score. The non-invasively measured RRI is closely associated with high SYNTAX score in stable CAD patients.

[15O]H2O myocardial perfusion positron emission tomography: Added value of relative stress perfusion deficit in the prediction of significant coronary artery stenosis in a mixedpopulation

BackgroundIt remains unknown whether estimation of the relative stress perfusion deficit offers added value in the prediction of significant coronary artery stenosis in myocardial perfusion imaging with [15O]H2O positron emission tomography (PET) in a population with high prevalence of established cardiac disease. MethodsDuring eight months, we consecutively included all patients undergoing [15O]H2O PET and subsequent invasive coronary angiography (ICA). Significant stenosis was defined from ICA as fractional flow reserve ≤.8 or coronary artery narrowing of ≥70%. We calculated absolute and relative total perfusion deficits (aTPD and rTPD, respectively) as semiquantitative measures of the extent and severity of reduced stress perfusion. A multivariate logistic regression analysis was performed to test the adjusted associations (odds ratio (OR) with 95% CI) with significant coronary artery stenosis. ResultsOf 800 patients undergoing [15O]H2O PET, 144 underwent ICA, where 142 patients had aTPD of ≥3% and 79 (55%) of these had at least one significant stenosis. In an adjusted analysis, rTPD (OR10% increase = 2.12 (1.44-3.12), P < .001), previous coronary artery bypass grafting (CABG) (OR = .11 (.03-.36), P < .001) and reduced left ventricular ejection fraction (LVEF) (OR = .25 (.08-.84), P = .02) were independently associated with significant stenosis, whereas the association with aTPD (OR10% increase = 1.14 (.98-1.32), P = .08) was modest. ConclusionsIn the presence of an absolute perfusion deficit (aTPD of ≥3%), rTPD may improve the prediction of significant stenosis in a heterogeneous population of patients examined with [15O]H2O PET. Furthermore, previous CABG and reduced LVEF are associated with nonstenotic perfusion deficiencies, suggesting caution when interpreting myocardial perfusion imaging in such patients.

Complete surgical repair for enlarging coronary aneurysm with coronary-pulmonary artery fistula.

A 46-year-old male patient was referred to our hospital due to the presence of a coronary aneurysm showing a tendency to enlarge. Subsequent coronary angiography revealed a diagnosis of coronary aneurysm with a concomitant coronary-pulmonary artery fistula. The patient underwent a successful surgical repair, and postoperatively, experienced an uneventful recovery with no residual shunt or aneurysm.

Super-resolution deep learning reconstruction to improve image quality of coronary CT angiography

Abstract Purpose To compare the objective and subjective image quality and diagnostic performance for coronary stenosis of normal-dose model-based iterative reconstruction and reduced-dose super-resolution deep learning reconstruction in coronary CT angiography. Materials and Methods This single-center retrospective study included 52 patients (mean age, 68 years ± 10 [SD]; 41 men) who underwent serial coronary CT angiography and subsequent invasive coronary angiography between January and November 2022. The first 25 patients were scanned with a standard dose using model-based iterative reconstruction. The last 27 patients were scanned with a reduced dose using super-resolution deep learning reconstruction. Per-patient objective and subjective image qualities were compared. Diagnostic performance of model-based iterative reconstruction and super-resolution deep learning reconstruction to diagnose significant stenosis on coronary angiography was compared per-vessel using receiver operating characteristics curve analysis. Results The median tube current of super-resolution deep learning reconstruction was lower than that of model-based iterative reconstruction (median [IQR], 890 mA [680, 900] vs. 900 mA [895, 900], P = 0.03). Image noise of super-resolution deep learning reconstruction was lower than that of model-based iterative reconstruction (14.6 Hounsfield units ± 1.3 vs. 22.7 Hounsfield units ± 4.4, P &amp;lt; .001). Super-resolution deep learning reconstruction improved the overall subjective image quality compared with model-based iterative reconstruction (median [IQR], 4 [3, 4] vs 3 [3, 3], P = .006). No difference in the area under the receiver operating characteristic curve in diagnosing coronary stenosis using super-resolution deep learning reconstruction (0.96; 95% CI, 0.92-0.99) and model-based iterative reconstruction (0.96; 95% CI, 0.92-0.98; P = .98) was observed. Conclusion Our exploratory analysis suggests that super-resolution deep learning reconstruction could improve image quality with lower tube current settings than model-based iterative reconstruction with similar diagnostic performance to diagnose coronary stenosis in coronary CT angiography.

Association Between Red Blood Cell Distribution Width and Coronary Calcification in Patients Referred for Invasive Coronary Angiography.

This study aimed to determine whether red cell distribution width (RDW) is associated with coronary calcification. A total of 4796 patients who underwent coronary computed tomography angiography and subsequent invasive coronary angiography were consecutively enrolled. Coronary artery calcium score (CACS), demographic, clinical, and laboratory data were collected from electronic medical records. RDW were expressed in two forms, as a coefficient of variation (CV) or as a standard deviation (SD). Multivariable ordinal logistic regression was used to investigate the association of RDW with CACS grades (CACS 0-99, 100-399, 400-999, and >1000). A significant association was found between elevated RDW-SD and higher CACS grades after full adjustment (adjusted OR per 1-SD increase: 1.11, 95% CI: 1.05-1.18; P < .001), while no significant association was found between RDW-CV and CACS grades. When RDW-SD was analyzed as a categorical variable, it was primarily the 4th quartile of RDW-SD that was associated with elevated CACS grades compared with the 1st quartile (adjusted OR: 1.25, 95% CI: 1.07-1.46; P = .006), while the 2nd and 3rd quartiles showed no significantly higher risk. RDW-SD is a more robust biomarker for coronary calcification compared with RDW-CV.

Difference in one-year late lumen loss between high- and low-dose paclitaxel-coated balloons for femoropopliteal disease

The objective of the study is to investigate the difference in 1-year late lumen loss (LLL) between the high- (IN.PACT Admiral) and low-dose (Lutonix) paclitaxel-coated balloon (PCB). Although a recent randomized clinical trial demonstrated no difference in efficacy endpoint between high- and low-dose PCB, it remains unclear whether high-dose PCB was superior to low-dose PCB in actual clinical practice. We enrolled 64 patients with 67 de novo femoropopliteal lesions who underwent PCB angioplasty at Kokura Memorial Hospital from May 2014 to March 2020 and subsequent follow-up angiography after 1 year. The primary endpoint was 1-year LLL, whereas the secondary endpoints were binary restenosis and clinically driven target lesion revascularization (CD-TLR) after 1 year. The high- and low-dose PCB groups had 45 and 22 lesions, respectively. Although the low-dose PCB group had higher rates of coronary artery disease, hemodialysis, and chronic limb-threatening ischemia than the high-dose PCB group, the latter had a longer lesion length and more lesions with a TASC classification C or D than the former. The high-dose PCB group had a significantly lower LLL than the low-dose PCB group (0.40 ± 1.05 vs. 1.19 ± 1.03 mm; P = 0.003, respectively). Moreover, the high-dose PCB group had significantly lower rates of binary restenosis at 1 year than the low-dose PCB group (22.2% vs. 50.0%; P = 0.02, respectively). Moreover, negative LLL was only observed in the high-dose PCB group (33.3% vs. 0%, P = 0.005). The high-dose PCB group had a significantly lower LLL than the low-dose PCB group.