[Computed Tomography Coronary Angiography Possibilities in "High Risk" Plaque Identification in Patients with non-ST-Elevation Acute Coronary Syndrome: Comparison with Intravascular Ultrasound].

Aim      To evaluate structural characteristics of atherosclerotic plaques (ASP) by coronary computed tomography arteriography (CCTA) and intravascular ultrasound (IVUS).Material and methods  This study included 37 patients with acute coronary syndrome (ACS). 64-detector-row CCTA, coronarography, and grayscale IVUS were performed prior to coronary stenting. The ASP length and burden, remodeling index (RI), and known CT signs of unstable ASP (presence of dot calcification, positive remodeling of the artery in the ASP area, irregular plaque contour, presence of a peripheral high-density ring and a low-density patch in the ASP). The ASP type and signs of rupture or thrombosis were determined by IVUS.Results The IVUS study revealed 45 unstable ASP (UASP), including 25 UASP with rupture and 20 thin-cap fibroatheromas (TCFA), and 13 stable ASP (SASP). No significant differences were found between distribution of TCFA and ASP with rupture among symptom-associated plaques (SAP, n=28) and non-symptom-associated plaques (NSAP, n=30). They were found in 82.1 and 73.3 % of cases, respectively (p>0.05), which indicated generalization of the ASP destabilization process in the coronary circulation. However, the incidence of mural thrombus was higher for SAP (53.5 and 16.6 % of ASP, respectively; p<0.001). There was no difference between UASP and SASP in the incidence of qualitative ASP characteristics or in values of quantitative ASP characteristics, including known signs of instability, except for the irregular contour, which was observed in 92.9 % of UASP and 46.1 % of SASP (p=0.0007), and patches with X-ray density ≤46 HU, which were detected in 83.3 % of UASP and 46.1 % of SASP (р=0.01). The presence of these CT criteria 11- and 7-fold increased the likelihood of unstable ASP (odd ratio (OR), 11.1 at 95 % confidence interval (CI), from 2.24 to 55.33 and OR, 7.0 at 95 % CI, from 5.63 to 8.37 for the former and the latter criterion, respectively).Conclusion      According to IVUS data, two X-ray signs are most characteristic for UASP, the irregular contour and a patch with X-ray density ≤46 HU. The presence of these signs 11- and 7-fold, respectively, increases the likelihood of unstable ASP.

Multislice Computed Tomography Capabilities in Assessment of the Coronary Arteries Atherosclerotic Lesions.

Until today, there are no universally accepted methods for detection of unstable atherosclerotic plaques, even though many recent studies were devoted to this issue. In this article we present modern possibilities of computed tomography in visualization of atherosclerotic coronary lesion, including the detection of unstable lesions, whot in turn, can help in diagnosing subclinical exacerbation of ischemic heart disease and in the stratification of risks of acute coronary events.

[Myocardial Hypoenhancement on Multidetector Computed Tomography in Patients With Non-ST Elevation Acute Coronary Syndrome].

The purpose of our study was analysis of myocardial hypoenhancement areas (MHAs) found by multidetector computed tomography (MDCT) in patients with non-ST elevation acute coronary syndrome (NSTEACS) and comparison of these findings with results of standard methods of diagnostics of myocardial infarction and ischemia [electrocardiography (ECG) and echocardiography (ECHO)]. METHODS: MHAs were found in 18 of 21 patients with non-ST segment elevation myocardial infarction (NSTEMI) (85.7%) and only in 3 of 22 patients with unstable angina (UA) (13.6%, p.

[Computed Tomography in the Evaluation of Coronary Atherosclerotic Plaques: Comparison With Intravascular Ultrasound].

PURPOSE: Determination of computed tomography angiography (CTA) informativeness in assessment of state of atherosclerotic coronary plaque (ACP) and identification of signs of its instability compared with intravascular ultrasound (IVUS). MATERIALS AND METHODS: Coronary CTA was carried out in 52 patients with clinical presentation of non-ST elevation (NSTE) acute coronary syndrome on the first day of hospitalization. ACPs were identified in 32 of 52 patients (61.5%). IVUS was performed in 32 patients (mean age 58+/-11.4 years, 27 men, 5 women, 22 with unstable angina, 10 with NSTE myocardial infarction) and 50 plaques in 45 coronary arteries were characterized (39 with spectral analysis of IVUS data). All data were compared with the results of coronary CTA. RESULTS: Sensitivity and specificity of CTA in the detection of stenosis >50% were 97.67 and 71.40%, respectively. Correlation analysis showed a high comparability of methods in determining plaque burden (r=0.80, 95% confidence interval [CI] 0.67 - 0.88, p<0.0001), plaque length (r=0.75, 95%CI 0.60 - 0.85, p<0.0001), and remodeling index (r=0.62, 95%CI 0.40 - 0.77, p<0.0001). Threshold value for "low-density areas" of plaques typical for thin cap fibroatheroma was less or equal 41 Hounsfield units (sensitivity 82%; specificity 86%; area under the curve 0.824; 95% CI 0.615 - 0.947, p<0.0005). CONCLUSION: Coronary CT is a non-invasive method for rapid characterization of ACP. CT results correlate well with IVUS data, including identification of such important signs of plaque instability as presence of "low-density zone" and positive remodeling at the plague level.

[Vasorenal Hypertension and Primarily Contracted Kidney in a Man Aged 44 years: Is Invasive Intervention Needed?]

Presentation of a clinical case of vasorenal hypertension in a patient with chronic renal artery occlusion and primarily contracted kidney is accompanied by discussion of current recommendations concerning indications to invasive intervention in patients with vasorenal arterial hypertension.

[Assessment of Coronary Plaques in Patients With Acute Coronary Syndrome Without Persistent ST-Segment Elevation].

AIM: to analyze morphological features of atherosclerotic plaques in culprit and non-culprit coronary lesions in patients with non ST-elevation acute coronary syndrome (NSTE-ACS) by multidetector spiral computed tomography (MDCT). RESULTS. In culprit lesions (n = 70) compared to non-culprit lesions (n = 144) frequency of soft plaques (60 vs 43%, p = 0.003), positive remodeling (70.2 vs 54.3%, p = 0.03) and uneven contour (91.7 vs 68.7%, p = 0.0002) were significantly higher. Minimal plaque density was significantly lower and length of plaque was significantly higher in culprit coronary segments (40.1 ± 25.3 vs 74.1 ± 116.8 Hounsfield units [HU], p = 0.02 and 16.8 ± 13.4 vs 13.2 ± 6.9 mm, p = 0.01, respectively). Receiver-operator characteristic curve analysis identified optimal cutoff value of minimum plaque density and length for discrimination between culprit and non-culprit lesion as 40 HU and 13.5 mm, respectively. The combination of soft plaque with a minimal density < 40 HU and uneven contour occurred in one third of culprit lesions and almost two times less in non-culprit (31.67 and 17.91%, respectively, p = 0.04) and was characterized by high specificity (82.1%) and negative predictive value (72.7%). CONCLUSION: The most specific features of culprit lesions in patients with NSTE-ACS were positive vascular remodeling, length > 13.5 mm, minimal CT-density < 40 HU, soft plaque's type and presence of uneven contour, as well as a combination of the last 3 features.