Diagnostic performance of coronary computed tomography angiography stenosis score for coronary stenosis.

BACKGROUND: Coronary computed tomography angiography stenosis score (CCTA-SS) is a proposed diagnosis score that considers the plaque characteristics, myocardial function, and the diameter reduction rate of the lesions. This study aimed to evaluate the diagnostic performance of the CCTA-SS in seeking coronary artery disease (CAD). METHODS: The 228 patients with suspected CAD who underwent CCTA and invasive coronary angiography (ICA) procedures were under examination. The diagnostic performance was evaluated with the receiver operating curve (ROC) for CCTA-SS in detecting CAD (defined as a diameter reduction of ≥ 50%) and severe CAD (defined as a diameter reduction of ≥ 70%). RESULTS: The area under ROC (AUC) of CCTA-SS was 0.909 (95% CI: 0.864-0.943), which was significantly higher than that of CCTA (AUC: 0.826; 95% CI: 0.771-0.873; P = 0.0352) in diagnosing of CAD with a threshold of 50%. The optimal cutoff point of CCTA-SS was 51% with a sensitivity of 90.66%, specificity of 95.65%, positive predictive value of 98.80%, negative predictive value of 72.13%, and accuracy of 91.67%, whereas the optimal cutoff point of CCTA was 55%, and the corresponding values were 87.36%, 93.48%, 98.15%, 65.15%, and 88.60%, respectively. With a threshold of 70%, the performance of CCTA-SS with an AUC of 0.927 (95% CI: 0.885-0.957) was significantly higher than that of CCTA with an AUC of 0.521 (95% CI: 0.454-0.587) (P < 0.0001). CONCLUSIONS: CCTA-SS significantly improved the diagnostic accuracy of coronary stenosis, including CAD and severe CAD, compared with CCTA.

Imaging characteristics and ECG distribution of coronary fistulas: The first large-scale study.

BACKGROUND: The proportion of abnormal electrocardiogra (ECG) in patients with coronary artery fistula (CAF) is relatively high, but the correlation between CAF and arrhythmia is mostly reported in individual case studies. This paper analyzes the correlation between imaging features and ECG features. OBJECTIVE: This paper aims to analyze the incidence and distribution characteristics of abnormal ECG in patients with CAF and further explore the difference in ECG characteristics between coronary-cameral fistula (CCF) and coronary-pulmonary artery fistula (CPAF). METHOD: A total of 144,448 patients who underwent coronary computerized tomography angiography (CTA) examination from January 2016 to December 2022 were included in this study, and 284 patients with CAF (excluding coronary atherosclerosis) were selected for analysis of their ECG and image characteristics. And divided them into the CPAF (221 cases) and CCF (63 cases) groups, the differences in ECG between the two groups was compared. The changes in the ECG after the operation were analyzed. RESULTS: The incidence of abnormal ECG in patients with CAF was approximately 72.9%. There were significant differences in the proportion of ECG block, myocardial ischemia and structural ECG changes between the CPAF group and CCF group (P < 0.05). CCF was more likely to cause conduction block and ischemic and structural ECG changes. A total of 53 patients with CAF underwent surgical treatment, 28 patients with improved ECG (52%). CONCLUSION: CCF especially CCF patients often have abnormal ECG findings such as conduction block, myocardial ischemia, and structural changes, which can often be restored to normal through surgery.

Multiple systemic arterial aneurysms in large-vessel vasculitis.

Large-vessel vasculitis (LVVs) is a rare inflammatory disease that predominantly affects young females' aorta and its main branches, coronary arteries, and pulmonary arteries. Clinical manifestations result from vascular stenosis, occlusion, and dilation, sometimes complicated by aneurysm rupture or dissection. Early diagnosis and treatment of LVVs are paramount to reducing the risk of ischemic complications such as visual loss and strokes, vascular stenosis and occlusion, and aortic aneurysm formation. The diagnosis of LVVs is often challenging because the presenting clinical features are nonspecific in many cases and are often shared by different types of autoimmune and inflammatory diseases including other systemic vasculitides. Prompt identification of vasculitides is important because they are associated with an increased risk of mortality. Left undiagnosed or mismanaged, these conditions may result in serious adverse outcomes that might otherwise have been avoided or minimized. We report a rare case of the LVVs with multisystemic vascular aneurysms and catastrophic complications of ruptured abdominal aortic aneurysm. Our case highlights that an early diagnosis of the diverse manifestations of vasculitis and a high index of clinical suspicion is essential to avoid delays in disease recognition that may result in permanent or life-threatening morbidity.