Relation of coronary plaque composition determined by 64-slice multidetector computed tomography in patients with suspected coronary heart disease.

Sixty-four-slice multidetector row computed tomography is a noninvasive method of assessing coronary artery stenosis and plaque composition. The aim of this study was to clarify the relation between plaque composition and coronary heart disease. Three hundred sixty consecutive patients and 1,085 plaques were evaluated using 64-slice multidetector row computed tomography. On axial or cross-sectional multiplanar reconstruction images, 3 regions of interest were randomly selected within each plaque. Soft plaques and calcified plaques were defined as having computed tomographic densities <50 and >130 Hounsfield units, respectively. The association between coronary risk factors and plaque composition was analyzed. The number of plaques and the mean computed tomographic density of plaques were significantly higher in men than in women (p = 0.002 and p = 0.04, respectively). Coronary plaques were more frequent in patients with stroke, diabetes, hypertension, and dyslipidemia than in patients without these conditions (all p values <0.001). Calcified plaques were more frequent in patients with hypertension (p = 0.02), and patients with calcified plaques also had significantly lower low-density lipoprotein cholesterol levels (p <0.001). Soft plaques were more frequent in patients with dyslipidemia (p <0.001). Patients with soft plaques had significantly higher low-density lipoprotein cholesterol levels (p = 0.02) and lower high-density lipoprotein cholesterol levels (p <0.001) than those without soft plaques. In conclusion, 64-slice multidetector row computed tomography is a useful noninvasive method for quantifying coronary plaques.

Heart rate recovery after exercise is a predictor of silent myocardial ischemia in patients with type 2 diabetes.

OBJECTIVE: Slow heart rate recovery (HRR) predicts all-cause mortality. This study investigated the relationship between silent myocardial ischemia (SMI) and HRR in type 2 diabetes. RESEARCH DESIGN AND METHODS: The study enrolled 87 consecutive patients with type 2 diabetes and no chest symptoms. They underwent treadmill exercise testing and single-photon emission computed tomography imaging with thallium scintigraphy. Patients with abnormal myocardial perfusion images also underwent coronary angiography. RESULTS: SMI was diagnosed in 41 patients (47%). The SMI group showed slower HRR than the non-SMI group (18 ± 6 vs. 30 ± 12 bpm; P < 0.0001). HRR was significantly associated with SMI (odds ratio 0.83 [95% CI 0.75-0.92]; P = 0.0006), even after adjustment for maximal exercise workload, resting heart rate, maximum heart rate, rate pressure product, HbA(1c), use of sulfonamides, and a history of cardiovascular disease. CONCLUSIONS: HRR can predict SMI in patients with type 2 diabetes.

A case of massive distal embolizations occluding every collateral network during percutaneous intervention for chronic iliac artery occlusion.

We describe a patient with right common iliac artery occlusion who presented with intermittent claudication and underwent percutaneous transluminal angioplasty. The angiogram showed 100% occluded right common iliac artery with bridged collateral flow. After initial ballooning to the artery, the occluding plaque detached from the artery and resulted in multiple embolizations, not only to the distal external iliac artery, but also to the internal iliac artery and its branches, which supplied collateral flow to the right femoral artery. Circulation in the collateral networks from internal iliac artery and its branching to the right femoral artery diminished from the multiple embolizations. Repeat aspiration and stenting to the portion of dislodged plaque was attempted, but repeat ballooning to open the external iliac artery was unsuccessful because of decreased collateral flows and distal displacement of the embolus to the right femoral artery. Finally, all blood flow to the right femoral artery was occluded. Surgical embolectomy was successfully performed, but the patient succumbed to myonephropathic metabolic syndrome. Multiple embolizations occluding numerous collateral arteries caused acute fatal ischemia to the right limb. This case report highlights potentially fatal complication in the percutaneous intervention for chronic iliac artery occlusion.

Absence of the right coronary artery detected by 64-detector-row multislice computed tomography.

The absence of the right coronary artery is an extremely rare variety of single coronary artery. We report a patient in whom the right coronary artery arose from the distal left circumflex artery. This is the first report describing images of this anomaly obtained by multislice computed tomography.

MDCT detection of double right coronary artery arising from a single ostium in the right sinus of Valsalva: report of 2 cases.

Double right coronary artery arising from a single ostium in the right sinus of Valsalva is an extremely rare coronary artery variation. Differentiating this variation from high take off of a large right ventricular branch is often difficult in conventional coronary angiography. In two cases, multidetector-row computed tomography (MDCT) identified double right coronary artery. MDCT allows three-dimensional comprehension of the coronary artery anatomy and it is thought to be useful to distinguish this variation from a large right ventricular branch.