Non-invasive diagnosis of coronary artery disease with 16-slice computed tomography.

BACKGROUND: The gold standard for the diagnosis of coronary artery disease (CAD) is catheter angiography. However, catheter angiography is invasive and may not always be followed by interventional therapy. We report our results with the use of multislice computed tomography (MSCT) as a non-invasive diagnostic tool for CAD. METHODS: Thirty-one patients (26 with chronic stable angina, 5 with coronary anomalies) underwent 16-slice MSCT and catheter angiography. Vessels < 1.5 mm in diameter were excluded. The ability of MSCT to detect obstructive CAD (stenosis > or =50% of the diameter) was evaluated in pre-defined vessel segments. The association of calcium score with obstructive CAD, and the effect of heart rate on distal vessel visibility were also studied. RESULTS: There were 29 men and 2 women (age range: 36-80 years; mean [SD]: 53 [11] years). Of the 403 vessel segments, 391 were > 1.5 mm in diameter and 321 were interpretable on both modalities. The non-interpretability rates were 7% (26/391) for catheter angiography and 14% (54/ 391) for MSCT, with distal location (64%; 34), motion artifacts (29%; 16) and calcification (7%; 4) being chiefly responsible in case of the latter technique. The sensitivity, specificity, positive and negative predictive values of MSCT were 85% (95% confidence interval [CI]: 73-93), 94% (95% CI: 90-96), 76% (95% CI: 64-85) and 96% (95% CI: 93-98), respectively. MSCT correctly classified patients with no, single-, double- and triple-vessel disease in 87% of cases. One patient was incorrectly excluded on MSCT; catheter angiography showed 50%-70% stenosis in this case. Patients with obstructive CAD had a higher Agatston score equivalent (p=0.03). There was no significant effect of heart rate on distal segment visibility. MSCT correctly identified all coronary anomalies. CONCLUSION: MSCT has a good potential for the detection of coronary stenosis, and may be most useful for excluding CAD (due to its high negative predictive value). It accurately delineates coronary anomalies.

An infant with "dying spells".

A 45-day-old infant presented with the unusual and intriguing symptom of episodic crying and loss of consciousness. The infant was discovered to have a vascular compression of the trachea by the innominate artery, almost serendipitously. He was cured of his symptoms by anterior suspension of the innominate artery.

Isolation of the left subclavian artery.

Two cases of isolation of the left subclavian artery from the aortic arch are reported for the rarity of this lesion. One patient was diagnosed clinically, the other after angiography. The isolated left subclavian artery was reimplanted in one patient. This rare anomaly has clinical and surgical relevance and should be diagnosed by diligent clinical and angiographic evaluation.

Chlamydia pneumoniae infection and nonspecific aortoarteritis: search for a link with a nonatherosclerotic inflammatory arterial disease.

BACKGROUND: The association between Chlamydia pneumoniae infection and atherosclerosis has gained recognition. However, the nature of this association is controversial. The infective link may not be specific for atherosclerosis and may also exist in other nonatherosclerotic arterial diseases. We investigated patients with nonspecific aortoarteritis for serological evidence of prior Chlamydia pneumoniae infection. METHODS AND RESULTS: Fifty patients each of nonspecific aortoarteritis and coronary artery disease with angiographic evidence of significant (>70%) coronary artery lesions were tested for the presence of IgG antibodies against Chlamydia pneumoniae by micro-immunofluorescence assay and compared with 50 age- and sex-matched normal healthy controls. The number of patients with nonspecific aortoarteritis who tested positive for Chlamydia pneumoniae antibodies (IgG) was not significantly different from controls (8 v. 7, p=ns). The mean titer amongst positive subjects in the two groups was also similar (1:40+/-40 v. 1:50+/-25; p=ns). Patients with coronary artery disease were significantly older than patients with nonspecific aortoarteritis and controls (53.2+/-5.8 v. 21.2+/-9.9 years and 24.5+/-5.2 years, p<0.01 for both) and showed a higher seroprevalence of prior Chlamydia pneumoniae infection (18 v. 8 and 7, p < 0.05 for both). The mean IgG titers of patients with coronary artery disease who tested positive were also significantly higher than the other two groups (1:98+/-34 v. 1:40+/-40, p<0.001 and 1:98+/-34 v. 1:50+/-25, p<0.01, respectively). CONCLUSIONS: In patients with nonspecific aortoarteritis, the seroprevalence of prior Chlamydia pneumnoniae infection is not more than that in healthy individuals of the same age group, but is significantly lesser than that in patients with coronary artery disease. Thus Chlamydia pneumoniae infection may not be associated with all forms of chronic inflammatory arterial lesions.