Whole heart coronary magnetic resonance angiography for the detection of coronary artery stenosis and atherosclerotic coronary artery plaque in a patient with unstable angina.

Whole heart coronary magnetic resonance angiography (MRA) has been established as a totally noninvasive diagnostic modality for the assessment of coronary artery disease. We report a case with unstable angina, in whom coronary artery stenosis with an atherosclerotic plaque was detected by whole heart coronary MRA. Intravascular ultrasound in the stenotic lesion revealed a soft plaque containing focal calcification, corresponding to a low-signal mass containing a no-signal mass on MRA. Whole heart coronary MRA can become a useful diagnostic tool for the diagnosis of acute coronary syndrome.

Coronary artery dissection after blunt chest trauma: depiction at multidetector-row computed tomography.

Coronary artery dissection after blunt chest trauma has rarely been reported in traumatic cardiac injuries, but it may cause fatal or nonfatal myocardial infarction. We report a case of dissection of the left main coronary artery, which resulted in acute myocardial infarction 5 weeks after blunt chest trauma. Multidetector-row computed tomography performed prior to the onset of infarction depicted intimal flap and dissected cavities.

Left ventricular aneurysm associated with isolated noncompaction of the ventricular myocardium.

A 66-year-old woman was admitted to our hospital because of left ventricular failure and nonsustained ventricular tachycardia. Two-dimensional echocardiography demonstrated prominent trabeculations and deep intertrabecular recesses, findings consistent with noncompaction of the ventricular myocardium. Myocardial perfusion scintigraphy demonstrated a defect in the anterobasal left ventricular segment. Coronary angiogram was normal, but the left ventriculogram showed an aneurysm in the anterior myocardial segments. This is the first reported case with isolated noncompaction of the ventricular myocardium associated with left ventricular aneurysm.

Does high-power computed tomography scanning equipment affect the operation of pacemakers?

BACKGROUND: Computed tomography (CT) is widely used in clinical practice, but there has not been a detailed report of its effect on the functioning of pacemakers. METHODS AND RESULTS: During CT, ECGs were recorded in 11 patients with pacemakers and the electromagnetic field in the CT room was also measured. The effect of CT on a pacemaker was also investigated in a human body model with and without shielding by rubber or lead. Transient malfunctions of pacemakers during CT occurred in 6 of 11 patients. The model showed that malfunctioning of the pacemaker was induced by CT scanning and this was prevented by lead but not by rubber. The alternating electrical field was 150 V/m on the CT scanning line, which was lower than the level influencing pacemaker functions. The alternating magnetic field was 15 muT on the CT scanning line, which was also lower than the level influencing pacemaker functions. CONCLUSIONS: Malfunctions of the pacemaker during CT may be caused by diagnostic radiant rays and although they are transient, the possibility of lethal arrhythmia cannot be ignored.

Cardioverter defibrillator implantation in an adult with isolated noncompaction of the ventricular myocardium.

Isolated noncompaction of the ventricular myocardium is an unclassified cardiomyopathy and is thought to be due to arrest of myocardial morphogenesis. Fatal ventricular arrhythmias may occur in approximately half of the patients and account for half of the death in this disorder. In this report, we describe a patient with isolated noncompaction of the ventricular myocardium in whom implantation of automatic cardioverter defibrillator was thought to be effective to prevent the risk of sudden cardiac death.

Relationship between heart-type fatty acid-binding protein levels and the risk of death in patients with serious condition on arrival at the emergency department.

OBJECTIVE: Although heart-type fatty acid-binding protein (H-FABP) is a cardiac marker useful for early diagnosis of acute myocardial infarction (AMI), few data are available on its prognostic value. The objective of this study is to clarify the prognostic value of H-FABP in patients with a serious condition. METHODS AND PATIENTS: We conducted a prospective study of 617 patients who presented to the emergency department with a serious condition. The H-FABP levels on arrival at the emergency department were divided into four groups using their quartiles. The endpoint was death from any causes in-hospital. RESULTS: H-FABP ranged from 1.2 to 2,300 ng/ml, with a median of 19.9 ng/ml, a 25%-value of 6.7 ng/ml and 75%-value of 54.0 ng/ml. The unadjusted rate of the mortality increased progressively with increasing H-FABP quartile point (11% for quartile-I, 22% for quartile-II, 36% for quartile-III, and 38% for quartile-IV; p<0.001). After adjustment for age, gender, systolic blood pressure and the presence or absence of cardiovascular disease, H-FABP was the independent factor to predict the mortality. CONCLUSION: H-FABP has proven to be an independent factor for prognosis in patients with a serious condition on arrival at the emergency department.

Diagnosis of anomalous origin of the right coronary artery using multislice computed tomography: evaluation of possible causes of myocardial ischemia.

Anomalous origin of the right coronary artery (RCA) is a rare condition, but may cause myocardial ischemia and sudden death. Multislice computed tomography, which allows three-dimensional visualization of the coronary artery with high spatial resolution, may be the most promising imaging modality for diagnosing this anomaly. We describe a patient with anomalous origin of the RCA arising from the left sinus of Valsalva. Volume rendering, and axial and curved multiplanar images showed stenosis in the proximal portion of the RCA that coursed between the aorta and the pulmonary artery, and an acute angled take-off of the RCA from the aorta. Three-dimensional virtual angioscopic images showed a hypoplastic RCA orifice and luminal narrowing in the proximal portion of the RCA. Multislice computed tomography was thought to be useful for detecting anomalous origin of the RCA and for evaluating possible causes of myocardial ischemia.

Efficacy of multislice computed tomography for the detection of acute coronary syndrome in the emergency department.

BACKGROUND: The diagnosis of acute coronary syndrome (ACS), especially non-ST-elevation myocardial infarction and unstable angina in the emergency department (ED) still remains a challenge. Multislice computed tomography (MSCT) allows assessment of not only coronary artery stenoses and occlusions, but also assessment of coronary artery plaques and myocardial perfusion status. METHODS AND RESULTS: MSCT was performed in 31 patients who were admitted to the ED because of chest pain persisting at least 30 min and non-diagnostic ECG changes and normal serum enzyme concentrations. Using MSCT, ACS was defined by coronary artery stenosis > or = 75% accompanied by computed tomography (CT)-low-density plaques, and/or by the presence of myocardial perfusion defects. ACS was confirmed by coronary stenosis > or = 75% by coronary angiography and/or subsequent elevation of troponin I concentration. In total, 22 patients were diagnosed as having ACS. MSCT detected stenoses with CT-low-density plaques in 21 and non-transmural myocardial perfusion defect in 3 patients. There was 1 false-positive and 1 false-negative result. The sensitivity and specificity of MSCT to identify ACS was 95.5% and 88.9%, respectively. CONCLUSION: MSCT provides diagnostic operating characteristics suitable for triage of patients with ACS in the ED.

Computed tomography assessment of the regression of an atherosclerotic coronary artery plaque.

Multislice spiral computed tomography (MSCT) permits the noninvasive visualization of coronary artery stenoses and occlusions, as well as atherosclerotic plaques, in patients with coronary artery disease. This report describes a patient with stable angina pectoris in whom the regression of the plaque and coronary artery remodeling was documented by serial MSCT.

[The clinical usefulness of a newly rapid diagnosis kit, detection of respiratory syncytial virus].

ImmunoCard STAT! RSV (Meridian Bioscience, Inc, USA) is a rapid immunoassay method newly developed for detection of respiratory syncytial virus (RSV) by immunochromatography. We carried out an evaluation of the ImmunoCard STAT! RSV. One hundred fifty-nine nasal wash samples and nasopharyngeal aspirates from patients were used to evaluate three different kits, which are ImmunoCard STAT! RSV, RSV testpack (Abbott JAPAN) and Directigen EZ RSV (Nippon Becton, Dickinson and Company) . One hundred twenty-eight samples showed equivalent results. When nested reversed transcription-PCR (nested RT-PCR) results for 31 samples showing discrepancies among three kits, 10 samples were positive, and 21 samples were negative by nested RT-PCR. Compared to Nested RT-PCR results, ImmunoCard STAT! RSV showed a sensitivity of 90.5% (19/21) and a specificity of 80.0% (8/10), as well as RSV testpack showed a sensitivity of 10.0% (2/21) and a specificity of 100% (10/10), Directigen EZ RSV showed 95.2% (20/21) and 0.0% (0/ 10), respectively. Furthermore, the detection limits were also evaluated by using ACTT No. VR1540 for RSV A-2 strain, and ACTT No. VR1401 for Wash strain. The detection limit of ImmunoCard STAT! RSV was 5.15 x 10(6) TCID50/mL in subgroup A strain and was 7.58 x 10(5) TCID50/mL in subgroup B strain. This result was similar to RSV testpack, and was better than the detection limit of Directigen EZ RSV. It is concluded that ImmunoCard STAT! RSV is useful in detecting RSV in a clinical setting with equivalent performance to conventional other detecting kits.

Incremental value of regional wall motion analysis immediately after exercise for the detection of single-vessel coronary artery disease: study by separate acquisition, dual-isotope ECG-gated single-photon emission computed tomography.

BACKGROUND: Although the detection of wall motion abnormalities gives incremental value to myocardial perfusion single-photon emission computed tomography (SPECT) in the diagnosis of extensive coronary artery disease (CAD) and high-grade single-vessel CAD, whether or not it is useful in the diagnosis of mild, single-vessel CAD has not been studied previously. METHODS AND RESULTS: Separate acquisition, dual isotope ECG-gated SPECT was performed in 97 patients with a low likelihood of CAD (Group 1) and 46 patients with single-vessel CAD (Group 2). Mild CAD was defined by stenosis of 50-75% (Group 2a, n=22) and moderate to severe CAD was defined by stenosis >/=76% (Group 2b, n=24). Myocardial perfusion and wall motion were graded by a 5 point-scale, 20-segment model. The sensitivity of myocardial perfusion alone was 50% for Group 2a, 83% for Group 2b and 67% for Group 2 as a whole. The overall specificity was 90%. When the wall motion analysis was combined, the sensitivity was increased to 82% in Group 2a and 92% in Group 2b. CONCLUSION: The ability to detect a wall motion abnormality immediately after exercise gives incremental diagnostic value to myocardial perfusion SPECT in the identification of mild, single-vessel CAD.

Detection of anomalous origins of the coronary artery by means of multislice computed tomography.

BACKGROUND: Anomalous origins of the coronary artery are rare, but may cause myocardial ischemia and sudden death. Thus, their reliable identification is crucial for any imaging method that attempts coronary artery visualization and of those available multislice computed tomography (MSCT), which provides excellent spatial resolution, may be the most promising. METHODS AND RESULTS: In consecutive 1,153 patients, MSCT identified 5 patients (0.43 %) with an anomalous origin of the coronary artery. The left circumflex artery (LCX) originated from the right sinus of Valsalva in 1 patient, and the right coronary artery originated from the left sinus of Valsalva and coursed between the aortic root and the pulmonary artery in 3 patients. In 1 patient, MSCT identified the absence of the LCX and high-grade atherosclerotic stenosis in the right coronary artery. CONCLUSION: MSCT can detect the anomalous origin and course of the coronary artery in relation to the great vessels. It is also useful for identifying atherosclerotic coronary artery disease superimposed on the anomalous vascular system.