scholarly journals 1173 Additional role of FFRct and stress CT perfusion in the management of patients with stable chest pain compared to cCTA alone

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Baggiano ◽  
M Guglielmo ◽  
G Muscogiuri ◽  
L Fusini ◽  
A Del Torto ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Invasive Technique ◽  
Functional Evaluation ◽  
Fractional Flow ◽  
Non Invasive ◽  
Artery Disease ◽  
Stable Chest Pain

Abstract Background Computed tomography-derived fractional flow reserve (FFRCT) and stress computed tomography perfusion (stress-CTP) are new techniques that combine anatomy and functional evaluation to improve assessment of coronary artery disease (CAD) using coronary computed tomography angiography (cCTA). Purpose This study sought to determine the effect of adding FFRCT and stress-CTP to cCTA alone for assessment of lesion severity and patient management of patients referred for chest pain. Methods 289 patients with stable chest pain scheduled for clinically indicated invasive coronary angiography (ICA) plus invasive FFR were evaluated with cCTA, FFRCT, and stress-CTP. Of 289 patients, 147 underwent static stress-CTP, while 142 were evaluated with dynamic stress-CTP. Management plan with optimal medical therapy (OMT) or percutaneous coronary intervention (PCI) for each patient according to results of each non-invasive technique was recorded, and then compared to what effectively applied according to results of reference standard technique (ICA + FFR). The primary endpoints for the study were the correct allocation of patients to OMT or PCI using cCTA, cCTA + FFRCT and cCTA + stress-CTP, and the correct assessment of non-invasive techniques for all three vessels in relation to angiographically and FFR-defined significance. Results Compared to cCTA alone, the addition of FFRCT and stress-CTP to cCTA alone increased the agreement in allocating patients to OMT from 24% to 38% and 44%, respectively, while the addition of FFRCT and stress-CTP to cCTA alone increased the agreement in allocating patients to PCI from 29% to 32% and 36%, respectively. Using ICA + FFR as standard reference, cCTA showed agreement for all three vessels in 56% of patients, while combined approaches of cCTA + FFRCT and cCTA + stress-CTP showed agreement in 66% and 82% of patients, respectively. Conclusions The addition of functional assessment with FFRCT or Stress-CTP to cCTA has a substantial effect on the evaluation of the relevance of coronary artery disease and therefore on the management of patients compared to cCTA alone.

scholarly journals Computed Tomography-Derived Fractional Flow Reserve for the Diagnosis of Coronary Artery Disease

2021 ◽  
Vol 1 (11) ◽  
Author(s):  
Yi-Sheng Chao ◽  
Jennifer Horton
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Fractional Flow Reserve ◽  
Adult Patients ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Artery Disease ◽  
Stable Chest Pain

Computed tomography-derived fractional flow reserve (CT-FFR) may predict coronary artery disease or flow-limiting stenosis in adult patients with stable chest pain better than coronary CT angiography alone, based on the relevant studies in 2 systematic reviews. CT-FFR is associated with a decreased need for invasive coronary angiography and revascularization in adult patients with stable chest pain, based on findings from 1 systematic review. In the US settings, CT-FFR was dominant (i.e., less costly and more effective) compared to stress testing for the evaluation of low-risk stable chest pain, based on findings from 1 cost-effectiveness study.

Computed tomography angiography and other applications of computed tomography

2016 ◽  
Author(s):  
Michiel A de Graaf ◽  
Arthur JHA Scholte ◽  
Lucia Kroft ◽  
Jeroen J Bax
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Computed Tomography Angiography ◽  
Coronary Computed Tomography Angiography ◽  
Acute Chest Pain ◽  
Coronary Computed Tomography ◽  
Non Invasive ◽  
Artery Disease

Patients presenting with acute chest pain constitute a common and important diagnostic challenge. This has increased interest in using computed tomography for non-invasive visualization of coronary artery disease in patients presenting with acute chest pain to the emergency department; particularly the subset of patients who are suspected of having an acute coronary syndrome, but without typical electrocardiographic changes and with normal troponin levels at presentation. As a result of rapid developments in coronary computed tomography angiography technology, high diagnostic accuracies for excluding coronary artery disease can be obtained. It has been shown that these patients can be discharged safely. The accuracy for detecting a significant coronary artery stenosis is also high, but the presence of coronary artery atherosclerosis or stenosis does not imply necessarily that the cause of the chest pain is related to coronary artery disease. Moreover, the non-invasive detection of coronary artery disease by computed tomography has been shown to be related with an increased use of subsequent invasive coronary angiography and revascularization, and further studies are needed to define which patients benefit from invasive evaluation following coronary computed tomography angiography. Conversely, the implementation of coronary computed tomography angiography can significantly reduce the length of hospital stay, with a significant cost reduction. Additionally, computed tomography is an excellent modality in patients whose symptoms suggest other causes of acute chest pain such as aortic aneurysm, aortic dissection, or pulmonary embolism. Furthermore, the acquisition of the coronary arteries, thoracic aorta, and pulmonary arteries in a single computed tomography examination is feasible, allowing ‘triple rule-out’ (exclusion of aortic dissection, pulmonary embolism, and coronary artery disease). Finally, other applications, such as the evaluation of coronary artery plaque composition, myocardial function and perfusion, or fractional flow reserve, are currently being developed and may also become valuable in the setting of acute chest pain in the future.

scholarly journals MRI perfusion in patients with stable chest-pain

2020 ◽  
Vol 93 (1113) ◽  
pp. 20190881 ◽  
Author(s):  
Marly van Assen ◽  
Dirk Jan Kuijpers ◽  
Juerg Schwitter
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Cardiac Events ◽  
Non Invasive ◽  
Cardiovascular Mr ◽  
Esc Guidelines ◽  
Artery Disease ◽  
Stable Chest Pain ◽  
Cmr Imaging

Perfusion-cardiovascular MR (CMR) imaging has been shown to reliably identify patients with suspected or known coronary artery disease (CAD), who are at risk for future cardiac events and thus, allows for guiding therapy including revascularizations. Accordingly, it is an ideal test to exclude prognostically relevant coronary artery disease. Several guidelines, such as the ESC guidelines, currently recommend CMR as non-invasive testing in patients with stable chest pain. CMR has as an advantage over the more conventional pathways as it lacks radiation and it potentially reduces costs.

Computed tomography angiography and other applications of computed tomography

2015 ◽  
Author(s):  
Michiel A de Graaf ◽  
Arthur JHA Scholte ◽  
Lucia Kroft ◽  
Jeroen J Bax
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Computed Tomography Angiography ◽  
Coronary Computed Tomography Angiography ◽  
Acute Chest Pain ◽  
Coronary Computed Tomography ◽  
Non Invasive ◽  
Artery Disease

Patients presenting with acute chest pain constitute a common and important diagnostic challenge. This has increased interest in using computed tomography for non-invasive visualization of coronary artery disease in patients presenting with acute chest pain to the emergency department; particularly the subset of patients who are suspected of having an acute coronary syndrome, but without typical electrocardiographic changes and with normal troponin levels at presentation. As a result of rapid developments in coronary computed tomography angiography technology, high diagnostic accuracies for excluding coronary artery disease can be obtained. It has been shown that these patients can be discharged safely. The accuracy for detecting a significant coronary artery stenosis is also high, but the presence of coronary artery atherosclerosis or stenosis does not imply necessarily that the cause of the chest pain is related to coronary artery disease. Moreover, the non-invasive detection of coronary artery disease by computed tomography has been shown to be related with an increased use of subsequent invasive coronary angiography and revascularization, and further studies are needed to define which patients benefit from invasive evaluation following coronary computed tomography angiography. Conversely, the implementation of coronary computed tomography angiography can significantly reduce the length of hospital stay, with a significant cost reduction. Additionally, computed tomography is an excellent modality in patients whose symptoms suggest other causes of acute chest pain such as aortic aneurysm, aortic dissection, or pulmonary embolism. Furthermore, the acquisition of the coronary arteries, thoracic aorta, and pulmonary arteries in a single computed tomography examination is feasible, allowing ‘triple rule-out’ (exclusion of aortic dissection, pulmonary embolism, and coronary artery disease). Finally, other applications, such as the evaluation of coronary artery plaque composition, myocardial function and perfusion, or fractional flow reserve, are currently being developed and may also become valuable in the setting of acute chest pain in the future.

scholarly journals Non-Invasive Computed Fractional Flow Reserve From Computed Tomography (CT) for Diagnosing Coronary Artery Disease

2015 ◽  
Vol 79 (2) ◽  
pp. 406-412 ◽  
Author(s):  
Toru Miyoshi ◽  
Kazuhiro Osawa ◽  
Hiroshi Ito ◽  
Susumu Kanazawa ◽  
Takeshi Kimura ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Fractional Flow Reserve ◽  
Fractional Flow ◽  
Non Invasive ◽  
Flow Reserve ◽  
Artery Disease

scholarly journals Efficiency of Multislice Computed Tomography in Diagnosis of Coronary Artery Disease compared to Cardiac Catheterization

2019 ◽  
Vol 4 (02) ◽  
Author(s):  
Nagwan Elhussein ◽  
Rania Mohammed Ahmed ◽  
Rawan AL-Thobity ◽  
Hadeel Al-Qurashi ◽  
Shahad AL-Sulimani ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Ct Scan ◽  
Cardiac Catheterization ◽  
Multislice Computed Tomography ◽  
Statistical Significance ◽  
Invasive Technique ◽  
Artery Disease

Coronary artery disease (CAD) is a leading cause of mortality and morbidity in developed countries, although percutaneous coronary intervention and coronary artery bypass grafting have developed recently, also multislice computed tomography has been accepted tool for diagnosing of (CAD). Objective: To assess the efficiency of multislice computed tomography in diagnosing coronary heart disease compared with cardiac catheterization. Method: This retrospective study was conducted at Alhada Military hospital in Taif City, Saudi Arabia, in radiology and cardiac catheterization departments during period from January to April 2018. The study was done by collecting of 51 patients reports of computed tomography and coronary artery catheterization most of them complain of chest pain. Data was analyzed using statistical package for social sciences program (SPSS) version 21.00. And achieved in tables and graphs in percentages according to the age, gender, patient history, symptoms, CT finding and catheterization finding, from the check list. Results: The most common affected age group was (61-80)y, male were (52.9%), the most complain was chest pain. CT scan positive findings were found to be in (72.5%) of the patients, while the cardiac catheterization diagnosed (CAD) in (68.6%) of the patients, there are statistical significance difference between the CT and cardiac catheterization finding (P=0.00), but there were no statistical significance difference between cardiac catheterization finding with age and gender among study sample. Conclusion: CT scan can accurately diagnose the coronary artery disease, which is an ideal non-invasive technique compared with cardiac catheterization.

Computed tomography angiography and other applications of computed tomography

2018 ◽  
Author(s):  
Michiel A de Graaf ◽  
Arthur JHA Scholte ◽  
Lucia Kroft ◽  
Jeroen J Bax
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Computed Tomography Angiography ◽  
Coronary Computed Tomography Angiography ◽  
Acute Chest Pain ◽  
Coronary Computed Tomography ◽  
Non Invasive ◽  
Artery Disease

Patients presenting with acute chest pain constitute a common and important diagnostic challenge. This has increased interest in using computed tomography for non-invasive visualization of coronary artery disease in patients presenting with acute chest pain to the emergency department; particularly the subset of patients who are suspected of having an acute coronary syndrome, but without typical electrocardiographic changes and with normal troponin levels at presentation. As a result of rapid developments in coronary computed tomography angiography technology, high diagnostic accuracies for excluding coronary artery disease can be obtained. It has been shown that these patients can be discharged safely. The accuracy for detecting a significant coronary artery stenosis is also high, but the presence of coronary artery atherosclerosis or stenosis does not imply necessarily that the cause of the chest pain is related to coronary artery disease. Moreover, the non-invasive detection of coronary artery disease by computed tomography has been shown to be related with an increased use of subsequent invasive coronary angiography and revascularization, and further studies are needed to define which patients benefit from invasive evaluation following coronary computed tomography angiography. Conversely, the implementation of coronary computed tomography angiography can significantly reduce the length of hospital stay, with a significant cost reduction. Additionally, computed tomography is an excellent modality in patients whose symptoms suggest other causes of acute chest pain such as aortic aneurysm, aortic dissection, or pulmonary embolism. Furthermore, the acquisition of the coronary arteries, thoracic aorta, and pulmonary arteries in a single computed tomography examination is feasible, allowing ‘triple rule-out’ (exclusion of aortic dissection, pulmonary embolism, and coronary artery disease). Finally, other applications, such as the evaluation of coronary artery plaque composition, myocardial function and perfusion, or fractional flow reserve, are currently being developed and may also become valuable in the setting of acute chest pain in the future.

Computed tomography angiography and other applications of computed tomography

2017 ◽  
Author(s):  
Michiel A de Graaf ◽  
Arthur JHA Scholte ◽  
Lucia Kroft ◽  
Jeroen J Bax
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Computed Tomography Angiography ◽  
Coronary Computed Tomography Angiography ◽  
Acute Chest Pain ◽  
Coronary Computed Tomography ◽  
Non Invasive ◽  
Artery Disease

Patients presenting with acute chest pain constitute a common and important diagnostic challenge. This has increased interest in using computed tomography for non-invasive visualization of coronary artery disease in patients presenting with acute chest pain to the emergency department; particularly the subset of patients who are suspected of having an acute coronary syndrome, but without typical electrocardiographic changes and with normal troponin levels at presentation. As a result of rapid developments in coronary computed tomography angiography technology, high diagnostic accuracies for excluding coronary artery disease can be obtained. It has been shown that these patients can be discharged safely. The accuracy for detecting a significant coronary artery stenosis is also high, but the presence of coronary artery atherosclerosis or stenosis does not imply necessarily that the cause of the chest pain is related to coronary artery disease. Moreover, the non-invasive detection of coronary artery disease by computed tomography has been shown to be related with an increased use of subsequent invasive coronary angiography and revascularization, and further studies are needed to define which patients benefit from invasive evaluation following coronary computed tomography angiography. Conversely, the implementation of coronary computed tomography angiography can significantly reduce the length of hospital stay, with a significant cost reduction. Additionally, computed tomography is an excellent modality in patients whose symptoms suggest other causes of acute chest pain such as aortic aneurysm, aortic dissection, or pulmonary embolism. Furthermore, the acquisition of the coronary arteries, thoracic aorta, and pulmonary arteries in a single computed tomography examination is feasible, allowing ‘triple rule-out’ (exclusion of aortic dissection, pulmonary embolism, and coronary artery disease). Finally, other applications, such as the evaluation of coronary artery plaque composition, myocardial function and perfusion, or fractional flow reserve, are currently being developed and may also become valuable in the setting of acute chest pain in the future.

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