RESUMEN
Background: Multi-Slice cardiac CT has evolved as a noninvasive imaging technique for evaluation of stenosis in the coronary arteries by what is called Coronary Computed Tomographic Angiography (CCTA), but it is also widely used in quantitative plaque assessments through Coronary Artery Calcium (CAC) scoring and plaque type identification ( soft or Mixed VS calcific) . Evaluation of aortic distensibility and aortic stiffness can also be performed through Multi-Slice Computed Tomography (MSCT) by calculating Aortic Distensibility Index (ADI) and Pulse Wave Velocity (PWV). Aim: To evaluate whether impaired Aortic Distensibility Index (ADI) and Aortic Stiffness measured by Cardiac CT is correlating with the severity of coronary artery disease and coronary calcium scoring in at-risk individuals (assessed by CCTA). Patients and Methods: We included 180 patients. Patients were classified into four groups according to their CAC score and according to the degree of stenosis based on CCTA. All patients in this study have underwent full history taking, short clinical examination including B.P. and H.R. measurements, standard ECG, routine laboratory investigations, and Multi-Slice CT Coronary Angiography (MSCT-CA). All patients underwent coronary artery calcium (CAC) scanning and CCTA, and their ADI and Aortic Stiffness were measured. Maximum systolic and maximum diastolic cross sectional-area (CSA) of ascending-aorta (AAo) was measured 15-mm above the left main coronary ostium. ADI was defined as: [(Systolic CSA –Diastolic CSA)/ (Diastolic CSA in X systemic-pulse-pressure) X 103]. Aortic stiffness was measured as PWV using Bramwell-Hill equation [1] [(3.57/ ?distensibility)]. Results: There were strong correlation between Aortic distensibility and Aortic stiffness (PWV) with degree of stenosis and coronary artery calcium. In patients stratified based on the degree of calcium scoring (CAC score), there was a statistically significant negative correlation between calcium scoring and the ADI (Pearson's r= -0.771, p<?.001), and a statistically significant positive correlation between calcium scoring and PWV (Pearson's r=0.817, p<?.001). In patients stratified based on the degree of stenosis, there was a statistically significant negative correlation between ADI and the Degree of stenosis (Pearson's r=-0.707, p<?.001), and there was a statistically significant positive correlation between PWV and the Degree of stenosis (Pearson's r=0.697, p<?.001). Conclusion: Impaired aortic distensibility strongly correlates with the severity of coronary atherosclerosis, degree of stenosis and coronary artery calcium. Addition of ADI to CAC and traditional risk factors provides incremental value to predict at-risk individuals.
RESUMEN
Background: Coronary Artery Anomalies (CAAs) presenting in adulthood are rare and associated with adverse cardiac events, including sudden cardiac death. Coronary artery anomaly is the second most common cause of Sudden Cardiac Death (SCD) in young athletes. Cardiac Computed Tomographic Angiography (CTA) is a readily available non-invasive imaging modality that provides high-resolution anatomical information of the coronary arteries. Multi-detector row CT is superior to conventional angiography in defining the ostial origin and proximal path of anomalous coronary branches.Methods: This was a prospective study included 186 patients who underwent coronary CTA from December 2018 to November 2019 in Government medical College, Srinagar on a 256 slice CT. The indications for coronary CTA were an equivocal, or non-diagnostic stress test, atypical chest pain, suspected anomalous coronary, as well as the evaluation of cardiac cause of syncope.Results: Ramus intermedius was the most common anatomical variant seen in 25 patients (13.4%). The prevalence of coronary anomalies in this study was 5.66% including myocarding bridging. The most common anomaly was high take off of coronary artery from sinotubular junction accounting for 1.6%.Conclusions: Coronary Computed Tomographic angiography is much superior in detecting coronary artery anomalies than invasive coronary angiography because of the absence of soft tissue information like as is needed in myocardial bridging. Proper knowledge of the anomalies and their clinical significance is highly important in planning treatment and easing hardships of cardiologists in dealing with them.
RESUMEN
BACKGROUND: To evaluate the association between retinal artery occlusion (RAO) and subclinical coronary artery disease (CAD). METHODS: We studied 41 patients with non-arteritic RAO without any history or symptoms of CAD, who had undergone coronary computed tomographic angiography (CCTA) for systemic atherosclerotic evaluation between 2007 and 2012. The age- and gender-matched control group comprised 4-fold subjects who were randomly selected from asymptomatic subjects who underwent CCTA during general health evaluation. Medical records and CCTA findings were compared between RAO patients and control groups. Multiple logistic regression analysis was carried out to assess the risk factors associated with CAD. RESULTS: Cardiovascular risk factors were not significantly different between RAO patients and control groups. RAO patients showed higher coronary artery calcium score than did control subjects (267.9 ± 674.9 vs. 120.2 ± 289.5). On CCTA, the prevalence of obstructive CAD (diameter stenosis ≥ 50%) in RAO patients was significantly higher than that in controls (29% vs. 15%; odds ratio [OR], 3.0). RAO patients demonstrated a significantly higher segment-involvement score (SIS) (2.6 ± 3.0 vs. 1.6 ± 2.4) and segment-stenosis score (SSS) (3.6 ± 4.8 vs. 2.0 ± 3.3) than did controls. After adjustment of associated factors, RAO showed significant association (OR, 3.0) with obstructive CAD and extensive CAD (SIS > 4: OR, 2.8; SSS > 8: OR, 3.4). CONCLUSION: Patients with RAO had a higher prevalence of subclinical obstructive CAD with a more extensive and heavier burden of coronary artery plaques than did age- and gender-matched controls. Physicians should understand the potential risk of CAD in RAO patients.