Current status and prospect of preoperative assessment of heart disease risk in liver transplant recipients / 器官移植

With the changes of the disease spectrum of liver transplantation and organ allocation system, more and more patients complicated with cardiovascular complications have entered the waiting list for liver transplantation. However, surgical stress, severe infection and adverse reactions of immunosuppressive drugs will significantly increase the risk of postoperative cardiac complications and affect the short-and long-term survival of the recipients. Therefore, comprehensive evaluation of cardiac structure and function of the recipients before liver transplantation is of significance for improving clinical prognosis of the recipients. In this article, the main causes for the increased risk of heart disease during the perioperative period of liver transplantation, the time and methods of heart disease risk assessment for liver transplant recipients were reviewed, and existing assessment approaches for common heart diseases before liver transplantation were illustrated, aiming to provide reference for further reducing the incidence of heart complications after liver transplantation, improving the survival rates of grafts and recipients and enhancing clinical prognosis.

Impact of Coronary Plaque on the Precision of Computational Fractional Flow Reserve Derived from CTA / 中山大学学报(医学科学版)

ObjectiveThe fractional flow reserve （FFR） computed from coronary computed tomographic （CT） angiograms makes it possible to noninvasively assess coronary artery disease， but the impact of plaque on FFR derived from computed tomography angiography （CTA） is still unknown. The study used invasive FFR as the reference standard to analyze the impact of plaque on coronary computed tomography angiography （CCTA）-based quantitative flow ratio （CT-QFR）. MethodsThe retrospective study included 108 patients with suspected coronary heart disease （CHD） who underwent both CCTA and FFR within 60 days. CCTA images were analyzed by the software. We obtained the CT-QFR of target vessels， perfomed the quantitative and qualitative analyses on target vascular plaques， including total plaque volume （TPV）， plaque burden， calcified plaque volume （CPV）， fibrous plaque volume （FPV）， lipid plaque volume （LPV）， and the presence or absence of high-risk plaque. ResultsAccording to the difference between CT-QFR and FFR at blood vessel level， 137 target vessels of 108 patients were divided into the overestimated group （difference＞0.03， n＝29）， reference group （-0.03≤difference≤0.03， n＝88） and underestimated group （difference＜-0.03， n＝20）. The underestimated group （14.81mm3） presented higher LPV than overestimated group （1.97mm3， P < 0.05）. There was a negative correlation between LPV and the difference （P＜0.05）. ConclusionsWhen CT-QFR is used to estimate hemodynamics of coronary artery stenosis， the presence of lipid plaque may underestimate the virtual FFR.

Future Directions in Coronary CT Angiography: CT-Fractional Flow Reserve, Plaque Vulnerability, and Quantitative Plaque Assessment

Coronary computed tomography angiography (CCTA) is a well-validated and noninvasive imaging modality for the assessment of coronary artery disease (CAD) in patients with stable ischemic heart disease and acute coronary syndromes (ACSs). CCTA not only delineates the anatomy of the heart and coronary arteries in detail, but also allows for intra- and extraluminal imaging of coronary arteries. Emerging technologies have promoted new CCTA applications, resulting in a comprehensive assessment of coronary plaques and their clinical significance. The application of computational fluid dynamics to CCTA resulted in a robust tool for noninvasive assessment of coronary blood flow hemodynamics and determination of hemodynamically significant stenosis. Detailed evaluation of plaque morphology and identification of high-risk plaque features by CCTA have been confirmed as predictors of future outcomes, identifying patients at risk for ACSs. With quantitative coronary plaque assessment, the progression of the CAD or the response to therapy could be monitored by CCTA. The aim of this article is to review the future directions of emerging applications in CCTA, such as computed tomography (CT)-fractional flow reserve, imaging of vulnerable plaque features, and quantitative plaque imaging. We will also briefly discuss novel methods appearing in the coronary imaging scenario, such as machine learning, radiomics, and spectral CT.

MSCT evaluates the correlation between epicardial adipose tissue volume and coronary atherosclerosis in patients with type 2 diabetes mellitus / 医学研究生学报

ObjectiveEpicardial adipose tissue directly affects coronary arteries and myocardium due to its special anatomical position and physiological function, but its exact effects in patients with type 2 diabetes mellitus (T2DM) have yet to be confirmed. In this paper, the epicardial adipose tissue volume (EATV) was quantitatively measured by Multi-slice spiral computed tomography (MSCT) to evaluate the correlation between EATV and coronary atherosclerosis in patients with T2DM.MethodsThe clinical data of 172 patients with coronary heart disease and coronary artery computed tomographic angiography (CCTA) were retrospectively analyzed in the first affiliated hospital of Anhui medical university from December 2015 to March 2018. According to the diagnostic criteria for CHD and T2DM, the patients included in the study were divided into the CHD group (45 cases), the T2DM group (44 cases), the T2DM group (42 cases) and the control group (41 cases). The clinical data was measured and recorded such as gender, age, blood pressure, body mass index (BMI), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and other relevant clinical data in each group. EATV was measured by CT post-processing workstation. Compared the differences of related data between groups, it was analyzed the risk factors of diabetes mellitus complicated with coronary heart disease by Logistic regression. The degree of coronary artery stenosis was quantified by Gensini, and analyzed its correlation with EATV. The receiver operating characteristic (ROC) curve was used to determine the suspicious value range of EATV.ResultsIn the CHD group, the diabetes group and the diabetic CHD group, EATV, LDL-C and TC were all higher than those in the control group respectively [(150.10±31.64)cm3, (145.56±37.89)cm3, (167.07±40.00)cm3 vs (115.44±27.95）cm3;（2.44±0.88) mmol/L, (2.47±0.86）mmol/L, （2.50±0.97) mmol/L vs (1.90±0.59) mmol/L; (4.19±0.99) mmol/L, (4.43±0.95）mmol/L,（4.32±1.57）mmol/L vs （3.70±0.59）mmol/L], with statistically significant differences (P<0.05). TG level in the diabetes group was higher than that in the control group [（2.18±1.54）mmol/L vs （1.32±0.61）mmol/L] (P<0.05). Multivariate Logistic regression analysis showed that EATV, age and BMI were independent risk factors for diabetes mellitus with coronary heart disease. The Gensini integral of coronary artery stenosis was positively correlated with EATV (r=0.528, P=0.000). The ROC curve showed that EATV had a high predictive value for coronary heart disease in diabetic patients (AUC=0.767).ConclusionEATV was positively correlated with the severity of coronary heart disease in diabetic patients. The determination of EATV by MSCT has good repeatability and is worthy of clinical promotion.

MSCT evaluates the correlation between epicardial adipose tissue volume and coronary atherosclerosis in patients with type 2 diabetes mellitus / 医学研究生学报

ObjectiveEpicardial adipose tissue directly affects coronary arteries and myocardium due to its special anatomical position and physiological function, but its exact effects in patients with type 2 diabetes mellitus (T2DM) have yet to be confirmed. In this paper, the epicardial adipose tissue volume (EATV) was quantitatively measured by Multi-slice spiral computed tomography (MSCT) to evaluate the correlation between EATV and coronary atherosclerosis in patients with T2DM.MethodsThe clinical data of 172 patients with coronary heart disease and coronary artery computed tomographic angiography (CCTA) were retrospectively analyzed in the first affiliated hospital of Anhui medical university from December 2015 to March 2018. According to the diagnostic criteria for CHD and T2DM, the patients included in the study were divided into the CHD group (45 cases), the T2DM group (44 cases), the T2DM group (42 cases) and the control group (41 cases). The clinical data was measured and recorded such as gender, age, blood pressure, body mass index (BMI), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and other relevant clinical data in each group. EATV was measured by CT post-processing workstation. Compared the differences of related data between groups, it was analyzed the risk factors of diabetes mellitus complicated with coronary heart disease by Logistic regression. The degree of coronary artery stenosis was quantified by Gensini, and analyzed its correlation with EATV. The receiver operating characteristic (ROC) curve was used to determine the suspicious value range of EATV.ResultsIn the CHD group, the diabetes group and the diabetic CHD group, EATV, LDL-C and TC were all higher than those in the control group respectively [(150.10±31.64)cm3, (145.56±37.89)cm3, (167.07±40.00)cm3 vs (115.44±27.95）cm3;（2.44±0.88) mmol/L, (2.47±0.86）mmol/L, （2.50±0.97) mmol/L vs (1.90±0.59) mmol/L; (4.19±0.99) mmol/L, (4.43±0.95）mmol/L,（4.32±1.57）mmol/L vs （3.70±0.59）mmol/L], with statistically significant differences (P<0.05). TG level in the diabetes group was higher than that in the control group [（2.18±1.54）mmol/L vs （1.32±0.61）mmol/L] (P<0.05). Multivariate Logistic regression analysis showed that EATV, age and BMI were independent risk factors for diabetes mellitus with coronary heart disease. The Gensini integral of coronary artery stenosis was positively correlated with EATV (r=0.528, P=0.000). The ROC curve showed that EATV had a high predictive value for coronary heart disease in diabetic patients (AUC=0.767).ConclusionEATV was positively correlated with the severity of coronary heart disease in diabetic patients. The determination of EATV by MSCT has good repeatability and is worthy of clinical promotion.

Coronary Computed Tomography Angiography for the Diagnosis of Vasospastic Angina: Comparison with Invasive Coronary Angiography and Ergonovine Provocation Test

OBJECTIVE: To investigate the diagnostic validity of coronary computed tomography angiography (cCTA) in vasospastic angina (VA) and factors associated with discrepant results between invasive coronary angiography with the ergonovine provocation test (iCAG-EPT) and cCTA. MATERIALS AND METHODS: Of the 1397 patients diagnosed with VA from 2006 to 2016, 33 patients (75 lesions) with available cCTA data from within 6 months before iCAG-EPT were included. The severity of spasm (% diameter stenosis [%DS]) on iCAG-EPT and cCTA was assessed, and the difference in %DS (Δ%DS) was calculated. Δ%DS was compared after classifying the lesions according to pre-cCTA-administered sublingual nitroglycerin (SL-NG) or beta-blockers. The lesions were further categorized with %DS ≥ 50% on iCAG-EPT or cCTA defined as a significant spasm, and the diagnostic performance of cCTA on identifying significant spasm relative to iCAG-EPT was assessed. RESULTS: Compared to lesions without SL-NG treatment, those with SL-NG treatment showed a higher Δ%DS (39.2% vs. 22.1%, p = 0.002). However, there was no difference in Δ%DS with or without beta-blocker treatment (35.1% vs. 32.6%, p = 0.643). The significant difference in Δ%DS associated with SL-NG was more prominent in patients who were aged < 60 years, were male, had body mass index < 25 kg/m2, and had no history of hypertension, diabetes, or dyslipidemia. Based on iCAG-EPT as the reference, the per-lesion-based sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of cCTA for VA diagnosis were 7.5%, 94.0%, 60.0%, 47.1%, and 48.0%, respectively. CONCLUSION: For patients with clinically suspected VA, confirmation with iCAG-EPT needs to be considered without completely excluding the diagnosis of VA simply based on cCTA results, although further prospective studies are required for confirmation.

Correlation between chronic hepatitis B virus infection and coronary heart disease / 第二军医大学学报

Objective To investigate the correlation between chronic hepatitis B virus (HBV) infection and coronary heart disease (CHD), so as to provide basis for decision-making in the prevention of CHD. Methods A total of 759 healthy volunteers without history of CHD, who received coronary computed tomography angiography (CTA) examination between Jan. 2013 and Jun. 2017 in our hospital, were included in the study. According to the levels of hepatitis B virus surface antigen (HBsAg), they were divided into HBV infection group (38 cases, all had chronic HBV infection) and control group (721 cases). Then we compared coronary artery lesions between the two groups, and analyzed the correlation between chronic HBV infection and CHD. Results Coronary CTA examination results showed that there was no significant difference in the prevalence of CHD between the two groups (21.05%[8/38] vs 28.02%[202/721], P>0.05). In addition, there were no significant differences in the number of coronary artery lesions, the type of plaque lesions or the distribution of diseased vessels with plaque between the HBV infection group and the control group (all P>0.05). Bivariate correlation analysis showed that there was no correlation between chronic HBV infection and CHD (r=0.034, P>0.05). Conclusion There is no clinical correlation between chronic HBV infection and CHD.

Congenital coronary artery anomaly in an adult: Double Barrel Left Coronary System and Coronary Artery Fistula Connecting a giant left circumflex artery to the coronary sinus

Introduction@#Coronary anomalies are rare congenital anatomic patterns affecting approximately one percent of the general population. Most of the cases may be asymptomatic and are never detected. Rarely, they result in severe life threatening consequences, thus, the diagnostic challenge is recognizing the abnormality early. Cardiac imaging modalities such as echocardiography, coronary computed tomography angiography (CTA), and coronary angiography can help us in the diagnosis.@*Case@#A 49-year-old female who initially presented with dyspnea and managed as rheumatic heart disease and hypertension. An echocardiogram finding prompted further investigation with coronary CTA and coronary angiography which identified the coronary artery anomalies. She was advised surgery but was unable to comply. Accordingly, medical management of her heart failure symptoms was pursued. She eventually succumbed to multiorgan failure as the complications of the fistula set in, three years after she had her initial presentation.@*Discussion@#The normal coronary anatomy consists of the the right and left coronary arteries that originate from the aorta. Our patient has two coronary artery anomalies: one is the double barrel left coronary system - her left anterior descending artery and left circumflex artery (LCX) originate directly from the aorta instead of from the left coronary artery. Second, is the coronary artery fistula (CAF), with her LCX draining into the right atrium through the coronary sinus. CAFs tend to grow with age, and if untreated, can cause clinical symptoms in older patients. The consequences of the patient’s abnormal connection may have caused volume overload to the right sided chambers resulting to heart failure. In adults with a congenital heart disease such as the CAF, it is recommended that if a continuous murmur is present, it should be defined either by echocardiography, magnetic resonance imaging, CTA, or cardiac catheterization.@*Conclusion@#A high level of suspicion for a CAF as a cause of an adult patient’s progressive heart failure can lead to timely diagnosis and optimal interventions.

Thyrotropin and free thyroxine levels and coronary artery disease: cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Data on the association between subclinical thyroid dysfunction and coronary artery disease (CAD) is scarce. We aimed to analyze the association between thyroid function and CAD using baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). We included subjects with normal thyroid function (0.4-4.0 mIU/L, and normal free thyroxine, FT4, or 0.8 to 1.9 ng/dL), subclinical hypothyroidism (SCHypo; TSH>4.0 mIU/L and normal FT4), and subclinical hyperthyroidism (SCHyper; TSH<0.4 mIU/L and normal FT4) evaluated by coronary computed tomography angiography. We excluded individuals using medications that interfere in thyroid function or with past medical history of cardiovascular disease. Logistic regression models evaluated the presence of CAD, segment involvement score (SIS) >4, and segment severity score (SSS) >4 of coronary arteries as the dependent variables, and quintiles of TSH and FT4 as the independent variables, adjusted for demographical data and cardiovascular risk factors. We included 767 subjects, median age 58 years (IQR=55-63), 378 (49.3%) women, 697 euthyroid (90.9%), 57 (7.4%) with SCHypo, and 13 (1.7%) with SCHyper. No association between TSH and FT4 quintiles and CAD prevalence was noted. Similarly, no association between TSH levels and the extent or severity of CAD, represented by SIS>4 and SSS>4 were seen. Restricting analysis to euthyroid subjects did not alter the results. TSH levels were not significantly associated with the presence, extent, or severity of CAD in a middle-aged healthy population.

Assessment of Myocardial Bridge by Cardiac CT: Intracoronary Transluminal Attenuation Gradient Derived from Diastolic Phase Predicts Systolic Compression

OBJECTIVE: To study the predictive value of transluminal attenuation gradient (TAG) derived from diastolic phase of coronary computed tomography angiography (CCTA) for identifying systolic compression of myocardial bridge (MB). MATERIALS AND METHODS: Consecutive patients diagnosed with MB based on CCTA findings and without obstructive coronary artery disease were retrospectively enrolled. In total, 143 patients with 144 MBs were included in the study. Patients were classified into three groups: without systolic compression, with systolic compression < 50%, and with systolic compression ≥ 50%. TAG was defined as the linear regression coefficient between intraluminal attenuation in Hounsfield units (HU) and length from the vessel ostium. Other indices such as the length and depth of the MB were also recorded. RESULTS: TAG was the lowest in MB patients with systolic compression ≥ 50% (−19.9 ± 8.7 HU/10 mm). Receiver operating characteristic curve analysis was performed to determine the optimal cutoff values for identifying systolic compression ≥ 50%. The result indicated an optimal cutoff value of TAG as −18.8 HU/10 mm (area under curve = 0.778, p < 0.001), which yielded higher sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy (54.1, 80.5, 72.8, and 75.0%, respectively). In addition, the TAG of MB with diastolic compression was significantly lower than the TAG of MB without diastolic compression (−21.4 ± 4.8 HU/10 mm vs. −12.7 ± 8 HU/10 mm, p < 0.001). CONCLUSION: TAG was a better predictor of MB with systolic compression ≥ 50%, compared to the length or depth of the MB. The TAG of MB with persistent diastolic compression was significantly lower than the TAG without diastolic compression.

Characteristics Detected on Computed Tomography Angiography Predict Coronary Artery Plaque Progression in Non-Culprit Lesions

OBJECTIVE: This study sought to determine whether variables detected on coronary computed tomography angiography (CCTA) would predict plaque progression in non-culprit lesions (NCL). MATERIALS AND METHODS: In this single-center trial, we analyzed 103 consecutive patients who were undergoing CCTA and percutaneous coronary intervention (PCI) for culprit lesions. Follow-up CCTA was scheduled 12 months after the PCI, and all patients were followed for 3 years after their second CCTA examination. High-risk plaque features and epicardial adipose tissue (EAT) volume were assessed by CCTA. Each NCL stenosis grade was compared visually between two CCTA scans to detect plaque progression, and patients were stratified into two groups based on this. Logistic regression analysis was used to evaluate the factors that were independently associated with plaque progression in NCLs. Time-to-event curves were compared using the log-rank statistic. RESULTS: Overall, 34 of 103 patients exhibited NCL plaque progression (33%). Logistic regression analyses showed that the NCL progression was associated with a history of ST-elevated myocardial infarction (odds ratio [OR] = 5.855, 95% confidence interval [CI] = 1.391–24.635, p = 0.016), follow-up low-density lipoprotein cholesterol level (OR = 6.832, 95% CI = 2.103–22.200, p = 0.001), baseline low-attenuation plaque (OR = 7.311, 95% CI = 1.242–43.028, p = 0.028) and EAT (OR = 1.015, 95% CI = 1.000–1.029, p = 0.044). Following the second CCTA examination, major adverse cardiac events (MACEs) were observed in 12 patients, and NCL plaque progression was significantly associated with future MACEs (log rank p = 0.006). CONCLUSION: Noninvasive assessment of NCLs by CCTA has potential prognostic value.

Coronary artery calcium score and coronary computed tomography angiography for patients with asymptomatic polyvascular (non-coronary) atherosclerosis

<p><b>INTRODUCTION</b>The primary endpoint of this study was to determine the prevalence of coronary artery disease (CAD) and coronary artery calcium score (CACS) using coronary computed tomography angiography (CCTA) among patients with polyvascular atherosclerosis (PVA). Secondary endpoints were to evaluate the prevalence of cardiovascular risk factors and determine the predictors of PVA.</p><p><b>METHODS</b>The presence of atherosclerotic disease was assessed using ultrasonographic vascular examination in 515 asymptomatic patients. All patients with presence of stenosis over 50% and moderate-to-severe cardiovascular risk profile underwent CCTA to identify atherosclerotic coronary disease.</p><p><b>RESULTS</b>Among 515 participants, 143 patients had no evidence of atherosclerotic plaque. Of the 372 patients with atherosclerotic plaque, 184 patients had single-vessel disease, 111 patients had double-vessel disease and 77 patients had triple-vessel disease; among these patients, those who also presented with stenosis > 50% underwent CCTA. Coronary stenosis categories included: normal (6.4%); haemodynamically insignificant (34.6%); intermediate (28.7%); significant (26.6%); and total artery occlusion (3.7%). Based on the coronary vessel involved, the patients were categorised as having single- (41.0%), double- (42.0%) or triple- (17.0%) coronary disease. CACS was significantly higher in patients with double- or triple-vessel disease when compared to those with single-vessel disease.</p><p><b>CONCLUSION</b>Our study confirmed not only the high sensitivity of CCTA for highlighting CAD, but also its negative predictive value for excluding the presence of coronary stenosis or ischaemia. We found good correlation between PVA and CACS, and were able to confirm the risk factors for PVA.</p>

Coronary computed tomography angiography for risk stratification before noncardiac surgery.

Background: Currently, there are limited available data for coronary computed tomography angiography (CCTA) in the setting of the risk stratification before noncardiac surgery. The main purpose of this study is to investigate the role of CCTA in cardiac risk stratification before noncardiac surgery. Materials and Methods: Ninety‑three patients underwent CCTA in the assessment of cardiac risk before noncardiac surgery. Patients with normal or mildly abnormal CCTA (<50% stenosis) underwent surgery without any further testing (Group 1). Patients with abnormal CCTA (17 patients) (more than 50% stenosis) and nondiagnostic CCTA (5%) underwent either stress myocardial perfusion scintigraphy or conventional coronary angiography, Group 2. Results: Group one consists of 71 patients who went for surgery without any further testing. 59 of 71 (83%) patients had no complications in the postoperative period, 9 patients had noncardiac complications, 1 had a cardiac complication (new onset atrial fibrillation), and 2 patients died in the postoperative period due to noncardiac complications. Group 2 comprises 22 (26%) patients, 16 patients had no postoperative complications, 5 patients had noncardiac complications, and one patient developed postoperative acute heart failure. Conclusions: CCTA is diagnostic in up to 95% in the preoperative setting, and it provides a comprehensive cardiac examination in the risk stratification before intermediate and high‑risk noncardiac surgery. Therefore, CCTA may be considered as an alternative test for already established imaging techniques for preoperative cardiac risk stratification before noncardiac surgery.

Clinical application value of serum lipoprotein associated phospholipaseA2 in coronary atherosclerotic heart diseases / 国际检验医学杂志

Objective To investigate the clinical application value of serum lipoprotein associated phospholipase A2(Lp‐PLA2) in coronary atherosclerotic heart diseases(CAD) .Methods Using the case‐control study ,790 patients with coronary computed tomography angiography (CTA) in our hospital from October 2013 to June 2015 were selected and divided into the CAD group (352 cases) and control group (438 cases) according to the results of coronary artery CTA .According to the number of coronary artery lesion vessels the CAD group was re‐divided into three subgroups :single branch coronary artery lesion (118 cases) ,double branch coronary arterial lesions(n=107) and multiple branch coronary arterial lesions(132 cases) .The levels of Lp‐PLA2 ,hs‐CRP , TG ,TC ,HDL‐C ,LDL‐C ,glucose ,HbA1c and other indexes were measured and comprehensively analyzed .The t test or variance a‐nalysis was used to compare the means between or among groups .The correlation of different indicators was analyzed with the Pearson linear correlation analysis .Results Compared with the control group ,the CAD group was significantly higher than the con‐trols in the levels of Lp‐PLA2 ,hs‐CRP ,age ,GLU ,HbA1c and ApoB ,the differences were statistically significant(P0 .05) .Conclusion Serum Lp‐PLA2 level increase is a risk factor of CAD and could be used to assess coronary arterial atherosclerosis and number of coronary arterial lesions .

Role of Coronary Artery Calcium Scoring in Detection of Coronary Artery Disease according to Framingham Risk Score in Populations with Low to Intermediate Risks

Current guidelines recommend that coronary artery calcium (CAC) screening should only be used for intermediate risk groups (Framingham risk score [FRS] of 10%-20%). The CAC distributions and coronary artery disease (CAD) prevalence in various FRS strata were determined. The benefit to lower risk populations of CAC score-based screening was also assessed. In total, 1,854 participants (aged 40-79 years) without history of CAD, stroke, or diabetes were enrolled. CAC scores of > 0, ≥ 100, and ≥ 300 were present in 33.8%, 8.2%, and 2.9% of the participants, respectively. The CAC scores rose significantly as the FRS grew more severe (P 20% strata were 3.4%, 6.7%, 9.0%, and 11.6% (P 20%; P < 0.05). In conclusion, the yield of screening for significant CAC and occult CAD is low in the very low risk population but it rises in low and intermediate risk populations.

Coronary anomalies: what the radiologist should know / Artérias coronárias anômalas: o que o radiologista precisa saber

AbstractCoronary anomalies comprise a diverse group of malformations, some of them asymptomatic with a benign course, and the others related to symptoms as chest pain and sudden death. Such anomalies may be classified as follows: 1) anomalies of origination and course; 2) anomalies of intrinsic coronary arterial anatomy; 3) anomalies of coronary termination. The origin and the proximal course of anomalous coronary arteries are the main prognostic factors, and interarterial course or a coronary artery is considered to be malignant due its association with increased risk of sudden death. Coronary computed tomography angiography has become the reference method for such an assessment as it detects not only anomalies in origination of these arteries, but also its course in relation to other mediastinal structures, which plays a relevant role in the definition of the therapeutic management. Finally, it is essential for radiologists to recognize and characterize such anomalies.

ResumoAs anomalias coronarianas incluem diversos grupos de malformações, algumas assintomáticas e com curso benigno e outras relacionadas a sintomas, como precordialgia e morte súbita. Podem ser classificadas em: 1) anomalias de origem e de trajeto; 2) anomalias intrínsecas; 3) anomalias de terminação. A origem e o trajeto proximal das artérias coronárias anômalas são os principais fatores prognósticos, sendo o trajeto interarterial considerado maligno, pois está associado a maior risco de morte súbita. A angiotomografia computadorizada tem-se tornado o método de referência para esta avaliação, uma vez que detecta não apenas a anomalia na origem destas artérias, mas também seu trajeto e relação com as demais estruturas mediastinais, que são importantes para a conduta terapêutica. Desta forma, é fundamental que o radiologista saiba reconhecer e caracterizar estas anomalias.

Evaluation of coronary stent by gemstone spectral imaging or high-definition scan:a phantom study / 天津医药

Objective To compare the displayed inner diameter of coronary stent by high definition(HD)and gem?stone spectral imaging(GSI)using dynamic cardiac and coronary artery phantom. Methods Five different types of coro?nary stents(internal diameter, 3.10 mm±0.55 mm;strut thickness, 0.12 mm±0.04 mm)were placed into a pulsating cardiac phantom(ALPHA 1-VT PC, Fuyo Corporation, Japan). The stent phantom was scanned by 3 systems, gemstone spectral im?aging(GSI), spiral scan(S)and HD. All the spectral imaging data were analyzed using GSI viewer to reconstruct the VMS (monochromic spectral) images(60-140 keV). Image noise(N), signal-to-noise ratio(SNR), contrast-to-noise ratio(CNR) and inner diameter were compared between images acquired through these 3 systems. Results SNRs in images of S and HD were higher than that of GSI(P0.05). The visible diameter(%)measurements of HD(0.85 ± 0.06)was significant higher than that of the other 2 scan systems and most close to the width of those stent’s actual size.(GSI:0.40±0.16, 0.48±0.13, 0.50±0.14, 0.51±0.13, 0.45±0.05,0.52±0.13, 0.53±0.13, 0.53±0.13, 0.53±0.13, S:0.53±0.14, P<0.05). Conclusion There was no significant dif?ferences in image quality among the images acquired by these 3 systems when the heart rate was set to 60 beats per min. Comparing to GSI and S, HD can produce best represent images to the known inner diameter of coronary stent.

Differential Prognostic Value of Coronary Computed Tomography Angiography in Relation to Exercise Electrocardiography in Asymptomatic Subjects

BACKGROUND: To explore the prognostic performance of coronary computed tomography angiography (CCTA) and exercise electrocardiography (XECG) in asymptomatic subjects. METHODS: We retrospectively enrolled 812 (59 +/- 9 years, 60.8% male) asymptomatic subjects who underwent CCTA and XECG concurrently from 2003 through 2009. Subjects were followed-up for major adverse cardiac events (MACE) including cardiac death, nonfatal myocardial infarction, unstable angina, and revascularization after 90 days from index CCTA. RESULTS: The prevalence of occult coronary artery disease (CAD) detected by CCTA was 17.5% and 120 subjects (14.8%) had positive XECG. During a mean follow-up of 37 +/- 16 months, nine subjects experienced MACE. In multivariable Cox-regression analysis, only the presence of CAD by CCTA independently predicted future MACE (p = 0.002). Moreover, CAD by CCTA improved the predictive value when added to a clinical risk factor model using the likelihood ratio test (p < 0.001). Notably, the prognostic value of CCTA persisted in the moderate-to-high-risk group as classified by the Duke treadmill score (p = 0.040), but not in the low-risk group (p = 0.991). CONCLUSION: CCTA provides incremental prognostic benefit over and above XECG in an asymptomatic population, especially for those in a moderate-to-high-risk group as classified by the Duke treadmill score. Risk stratification using XECG may prove valuable for identifying asymptomatic subjects who can benefit from CCTA.

Comparison of the Diagnostic Power of Computed Tomography Coronary Angiography and Exercise Electrocardiography as a First Screening Test in Real-World Practice: Is It Ready for Clinical Use? / 대한내과학회지

Exercise electrocardiography (XECG) is a widely used noninvasive test for screening coronary artery disease that is endorsed by current clinical guidelines. However, its clinical use is limited by its modest diagnostic accuracy. Coronary computed tomographic angiography (CCTA) has emerged as a new tool for screening coronary artery disease. In this issue, CCTA performed better diagnostically than XECG when invasive coronary angiography was used as the diagnostic standard. In addition, invasive coronary angiography was chosen based on CCTA, rather than XECG. Although this study suffers from the lack of an appropriate diagnostic standard, the clinical course identified implies that clinical practice might be influenced by sophisticated anatomical imaging to a considerably greater extent than by a simple physiological assessment.