The Utility of CT Coronary Angiography in Chronic Total Occlusion Percutaneous Coronary Intervention.

Chronic total occlusion (CTO) of the coronary arteries is a relatively common finding in routine coronary angiography. Of late, there has been considerable improvement in the success rate of percutaneous intervention for coronary CTO, attributed to technological advancement and skills development. CT coronary angiogram (CTCA) is a simple, non-invasive, and cost-effective test that aids in the diagnosis and management of coronary artery disease, including CTOs. The development of multi-slice CT and the use of 3D volume rendering images has revolutionised the diagnostic abilities of CTCA, with improvements in imaging quality and detailed anatomical and morphological characterisation of the plaque disease. In CTO percutaneous intervention, CTCA is used in pre-procedural planning, applying scoring systems to predict the likely success of the intervention as well as the post-procedural evaluation and follow-up. This review examines the different uses of CTCA in CTO intervention, its impact on successful recanalisation and the areas for future consideration.

Chest Pain of Uncertain Aetiology: Role of Contrast Enhanced Computed Tomography in the Emergency Department.

There is increasing role of computed tomographic (CT) in the assessment of acute chest pain in the emergency department especially when the diagnosis is not clear. We report a case where non ECG gated contrast enhanced CT in the emergency department for rule-out of pulmonary embolus guided to the actual diagnosis, which was, acute coronary event, as evidenced by the presence of perfusion defect.

Imaging Aortic Regurgitation: The Incremental Benefit of Speckle Tracking Echocardiography.

Aortic regurgitation (AR) affects global left ventricular mechanics. However, limited literature is available on how it may affect regional longitudinal strain. We present a case where severe AR jet is thrashing the anterior-septal wall and reducing its overall longitudinal performance most likely secondary to increased wall shear stress in diastole. This new insight into patho-physiological process using deformation study may have supplementary impact in decision making for surgical intervention. Transthoracic echocardiography is the primary imaging modality for the assessment of AR as it offers evaluation of severity of AR, aetiology of AR, left ventricular (LV) dilatation, LV systolic function, left ventricular mass, diastolic function and global strain. This case highlights the regional disturbances in longitudinal strain in eccentric AR.

Distance between laser head and skin does not influence skin blood flow values recorded by laser speckle imaging.

BACKGROUND: Laser Speckle contrast imaging (LSCI) allows non-contact, real-time recording of cutaneous blood flow (CBF). Different distances from laser-head to skin (distances(L-S)) can be chosen by the operator to perform these recordings. We aimed to evaluate the impact of different Distances(L-S) on the analysis of rest blood flow and post-occlusive reactive hyperemia (PORH). METHODS: Four distances(L-S) (10, 15, 20, and 30 cm) were evaluated in a random order in 11 healthy subjects. We analyzed the concordance between each recording at each distance(L-S). We compared CBF results (absolute values and cutaneous vascular conductance (CBF divided by mean arterial pressure)) obtained for each distance(L-S). The intra-subject coefficients of variation due to distances(L-S) (intra-CV, in%) were also studied. RESULTS: The mean "r" (standard deviation) cross-correlation coefficient was 0.99 (0.00) between each CBF trace issued from different distance(L-S). Both kinds of CBF results, at rest and for PORH peak, show non-significant differences when the distance(L-S) is modified. The intra-CV varies from 5.9% to 8.6% at rest and from 5.6% to 9.1% for the PORH peak. CONCLUSION: Distance(L-S) neither influences SBFR at rest, nor at peak post-occlusive hyperemia in the 10-30 cm interval using LSCI.

Increasing the "region of interest" and "time of interest", both reduce the variability of blood flow measurements using laser speckle contrast imaging.

OBJECTIVE: Both spatial variability and temporal variability of skin blood flow are high. Laser speckle contrast imagers (LSCI) allow non-contact, real-time recording of cutaneous blood flow on large skin surfaces. Thereafter, the observer can define different sizes for the region of interest (ROI) in the images to decrease spatial variability and different durations over which the blood flow values are averaged (time of interest, TOI) to decrease temporal variability. We aimed to evaluate the impact of the choices of ROI and TOI on the analysis of rest blood flow and post occlusive reactive hyperemia (PORH). METHODS: Cutaneous blood flow (CBF) was assessed at rest and during PORH. Three different sizes of ROI (1mm(2), 10mm(2) and 100mm(2)), and three different TOI (CBF averaged over 1s, 15s, and 30s for rest, and over 1s, 5s and 10s for PORH peak) were evaluated. Inter-subjects and intra-subjects coefficient of variations (inter-CV and intra-CV) were studied. RESULTS: The inter-subject variability of CBF is about 25% at rest and is moderately improved when the size of the ROI increases (inter-CV=31%, for 1s and 1mm(2) versus inter-CV=23%, for 15s and 100mm(2)). However, increasing the TOI does not improve the results. The variability of the PORH peak is lower with an inter-CV varying between 11.4% (10s and 100mm(2)) and 21.6% (5s and 1mm(2)). The lowest intra-CV for the CBF at rest was 7.3% (TOI of 15s on a ROI of 100mm(2)) and was 3.1% for the PORH peak (TOI of 10s on a ROI of 100mm(2)). CONCLUSION: We suggest that a size of ROI larger than 10mm(2) and a TOI longer than 1s are required to reduce the variability of CBF measurements both at rest and during PORH peak evaluations at the forearm level. Many technical aspects such as comparison of laser speckle contrast imaging and laser Doppler imaging or the effect of skin to head distance on recorded values with LCSI are required to improve future studies using this fascinating clinical tool.