Non-Invasive Coronary Angiography With Multislice CT: at Last an Alternative to Conventional Coronary Angiography?

Abstract Introduction Cardiac computed tomography (CT) use has progressively increased as the preferred initial test to rule out coronary artery disease (CAD) when clinical likelihood is low. Coronary artery calcium (CAC) detected by CT is a well-established marker for cardiovascular risk. However, it is not recommended for diagnosis of obstructive CAD. Absence of CAC, defined as an Agatston score of zero, has been associated to good prognosis despite underestimation of non-calcified plaques. Purpose To evaluate whether zero CAC score could help ruling out obstructive CAD in a safely manner. Methods Observational study based on a prospective database of patients (pts) referred to cardiac CT between 2017 and 2019. Pts with an Agatston score of zero were selected. Results We included 176 pts with zero CAC score and non-invasive coronary angiography performed. The median duration of follow-up was 23.9 months. Baseline characteristics of the population are shown in Table 1. In 117 pts (66.5%), cardiac CT was indicated as part of their chest pain evaluation. Mean age was 57.2 years old, 68.2% were women and only and 9.4% were active smokers. Normal coronary arteries were found in 173 pts (98.3%). Obstructive CAD, defined as ≥50% luminal diameter stenosis of a major vessel, was present in 1/176 (0.6%); while non-obstructive atherosclerotic plaques were found in 2 pts (1.1%). During follow-up, one patient died of out-of-hospital cardiac arrest. None either suffered from myocardial infarction or needed coronary revascularization. Conclusions In our cohort, a zero CAC score detected by cardiac CT rules out obstructive coronary artery disease in 98.3%, with only 1.7% of non-calcified atherosclerosis plaques and 0.6% of major adverse events. Although further research on this topic is needed, these results support the fact that non-invasive coronary angiography could be avoided in patients with low clinical likelihood of CAD and zero CAC score, facilitating the management of the increasing demand for coronary CT and reduction of radiation dose. Funding Acknowledgement Type of funding source: None

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Abstract 220: Magnetic Resonance Imaging in Children with Cardiac Complications of Kawasaki Disease: a Comparison with Echocardiography and Conventional Coronary Angiography

Circulation ◽

10.1161/circ.131.suppl_2.220 ◽

2015 ◽

Vol 131 (suppl_2) ◽

Author(s):

Michael Khoury ◽

Cedric Manlhiot ◽

Lars Grosse-Wortmann ◽

Shi-Joon Yoo ◽

Michael Seed ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Angiography ◽

Imaging Modality ◽

Artery Bypass ◽

Cardiac Complications ◽

Conventional Coronary Angiography ◽

Non Invasive ◽

Collateral Artery ◽

Perfusion Defects ◽

Imaging Surveillance

Background: MRI is a potentially sensitive, specific, and non-invasive imaging modality that may be used in the detection and monitoring of KD cardiac complications. Its utility relative to the more commonly used imaging modalities of echocardiography and conventional coronary angiography has not been optimally established. Methods: We compared concomitant clinical data, echocardiography, MRI, and angiography findings for children with coronary artery aneurysms. Results: MRI and angiograms were performed within 1 month of each other for 15 patients (mean age 7 years, 80% male) at a mean of 4.2 years after diagnosis. Coronary artery bypass grafting (CABG) had been performed in 8 patients (53%). For 7 patients (47%), aneurysms were seen on MRI that were not seen on echocardiography. Wall motion abnormalities were reported in 7 subjects (47%). These were characterized on both echocardiography and MRI for all. MRI identified perfusion defects in 6 patients (40%) and evidence of myocardial scar in 9 patients (60%). Extra-cardiac aneurysms were identified in 5 patients (33%) on MRI. MRI showed strong correlation with angiograms regarding aneurysm location. MRI was limited in the assessment of bypass grafts in 4 of the 8 (50%) patients who had undergone CABG. Three patients (20%) had stenosis or thrombosis identified on angiography that were not appreciated on MRI. Angiograms provided added information regarding flow, stenoses, vascular morphology and/or calcification in 8 patients (53%). Collateral artery anatomy that was not appreciated on echo and MRI were reported on angiograms in 3 patients (20%). Conclusions: MRI provides a valuable and comprehensive assessment of the cardiac sequelae of KD, though is limited in its assessment of CABG, stenoses, and thrombosis. MRI may be an important component of non-invasive imaging surveillance of children with important coronary artery involvement.

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Comparison of coronary CT angiography with conventional coronary angiography in the diagnosis of coronary artery disease

Bangladesh Medical Research Council Bulletin ◽

10.3329/bmrcb.v40i1.20334 ◽

2014 ◽

Vol 40 (1) ◽

pp. 31-35

Author(s):

N Mannan ◽

MA Basher ◽

J Mohammad ◽

MU Jahan ◽

NAM Momenuzzaman ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Angiography ◽

High Sensitivity ◽

Therapeutic Interventions ◽

Conventional Coronary Angiography ◽

Promising Alternative ◽

Non Invasive ◽

Coronary Ct ◽

Coronary Imaging ◽

Artery Disease

Noninvasive CT coronary angiography is a promising coronary imaging technique. In spite of the unprecedented temporal and spatial resolution and the inability to perform therapeutic interventions in the same session multi-detector computed tomography (MDCT) has been considering a promising alternative, non invasive tool for coronary artery imaging due to its high sensitivity and specificity for the detection of significant coronary artery stenosis. To evaluate the diagnostic accuracy of 64-slice MDCT for assessing haemodynamically significant stenoses of the coronary arteries in comparison with the conventional standard cardiac angiography. Fifty patients scheduled for conventional coronary angiography at the department of Radiology and Imaging, United Hospital, Dhaka were enrolled between July 2007 and June 2008. All patients underwent both conventional and MDCT angiography within mean 10.70 days. Overall sensitivity of 64-slice MDCT for the detection of stenosis ?50%, stenosis >50%, and stenosis >75% was 90.0%, 83.8%, and 80.7%, respectively, and specificity was 96.5%, 98.4%, and 98.3% respectively and accuracy was 96.0 %, 96.5%, and 96.6% respectively. Contrast-enhanced 64-slice MDCT allows the identification of coronary stenosis with excellent accuracy. Measurements of stenosis derived by MDCT correlated well with conventional angiogram. A major limitation is the insufficient ability of CT to exactly quantify the degree of stenosis. DOI: http://dx.doi.org/10.3329/bmrcb.v40i1.20334 Bangladesh Med Res Counc Bull 2014; 40: 31-35

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