scholarly journals P1436 Diagnostic yield and accuracy of CT coronary angiography compared to invasive coronary angiography: real world data from a district general hospital in the United Kingdom

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A M Masoud ◽  
W T Topping ◽  
M L Lynch
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Predictive Value ◽  
Invasive Coronary Angiography ◽  
District General Hospital ◽  
Ct Coronary Angiography ◽  
Non Invasive ◽  
Epicardial Coronary Artery ◽  
Luminal Stenosis ◽  
Clinically Significant

Abstract Background Cost-effectiveness is imperative for a sustainable healthcare service. Non-invasive testing is used to risk stratify patients and reduce the need for invasive investigations in cardiology. The National Institute for Health and Care Excellence (NICE) Clinical Guideline for evaluation of chest pain was updated in 2016 when NICE recommended CT coronary angiography (CTCA) as the first-line investigation for patients with suspected stable coronary artery disease (CAD). Purpose To evaluate the accuracy of CTCA in real life daily practice in a district general hospital outside the strict environment of clinical trials. Methods A retrospective analysis of all CTCA studies carried out between June and December 2017 was performed. Graft studies were excluded. Potentially obstructive CAD on CTCA was defined as any luminal stenosis ≥50% of a major epicardial coronary artery. On invasive coronary angiography (ICA), clinically significant CAD was defined as a luminal stenosis of ≥50% in the left main stem or a stenosis of ≥70% of any other major epicardial coronary artery. Results Out of a total of 528 CTCA studies, 109 patients (mean age 64.2 ± 10.4; 67.9% male) showed potentially significant CAD in at least one major epicardial coronary artery. The median calcium score was 379.7 (IQR = 86-929). 61 (56%) patients had ICA, 20 (18.3%) patients had non-invasive functional coronary assessment (19 stress echocardiogram and 1 stress perfusion cardiac magnetic resonance) and 3 (2.8%) patients had both. The remaining patients were managed medically without further investigation. Correlation between potentially obstructive CAD on CTCA and clinically significant CAD on ICA showed a sensitivity of 95.8% (95% CI: 85.8%-99.5%), specificity of 68.0% (95% CI: 61.0%-74.5%), positive predictive value of 42.2% (95% CI: 37.1%-47.4%), negative predictive value of 98.5% (95% CI: 94.5%-99.6%) and overall accuracy of 73.5% (95% CI: 67.5%-78.9%). Among patients who had ICA, 21 patients (34.4%) required coronary revascularization (16 percutaneous coronary intervention and 5 coronary artery bypass grafting) and 40 (65.6%) patients were treated medically. Only 1 patient (4.3% of 23 patients) showed evidence of inducible ischemia on non-invasive functional testing. Conclusion CTCA in a real world practice has high sensitivity and high negative predictive value compared to the gold standard ICA. CTCA improved patient selection for ICA to those most likely to have significant CAD.

scholarly journals Validation of the diagnostic performance of ‘HeartMedi V.1.0’, a novel CT-derived fractional flow reserve measurement, for patients with coronary artery disease: a study protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e037780
Author(s):  
Soo-Hyun Kim ◽  
Si-Hyuck Kang ◽  
Woo-Young Chung ◽  
Chang-Hwan Yoon ◽  
Sang-Don Park ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Fractional Flow Reserve ◽  
Predictive Value ◽  
Diagnostic Performance ◽  
Invasive Coronary Angiography ◽  
Fractional Flow ◽  
Non Invasive ◽  
Link Type ◽  
Flow Reserve

IntroductionCoronary CT angiography (CCTA) is widely used for non-invasive coronary artery evaluation, but it is limited in identifying the nature of functional characteristics that cause ischaemia. Recent computational fluid dynamic (CFD) techniques applied to CCTA images permit non-invasive computation of fractional flow reserve (FFR), a measure of lesion-specific ischaemia. However, this technology has limitations, such as long computational time and the need for expensive equipment, which hinder widespread use.Methods and analysisThis study is a prospective, multicentre, comparative and confirmatory trial designed to evaluate the diagnostic performance of HeartMedi V.1.0, a novel CT-derived FFR measurement for the detection of haemodynamically significant coronary artery stenoses identified by CCTA, based on invasive FFR as a reference standard. The invasive FFR values ≤0.80 will be considered haemodynamically significant. The study will enrol 184 patients who underwent CCTA, invasive coronary angiography and invasive FFR. Computational FFR (c-FFR) will be analysed by CFD techniques using a lumped parameter model based on vessel length method. Blinded core laboratory interpretation will be performed for CCTA, invasive coronary angiography, invasive FFR and c-FFR. The primary objective of the study is to compare the area under the receiver–operator characteristic curve between c-FFR and CCTA to non-invasively detect the presence of haemodynamically significant coronary stenosis. The secondary endpoints include diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value and correlation of c-FFR with invasive FFR.Ethics and disseminationThe study has ethic approval from the ethics committee of Seoul National University Bundang Hospital (E-1709/420-001) and informed consent will be obtained for all enrolled patients. The result will be published in a peer-reviewed journal.Trial registration numberKCT0002725; Pre-results.

scholarly journals Diagnostic and prognostic value of coronary artery calcium score of zero: is it time for guidelines to change?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Arbas Redondo ◽  
D Tebar Marquez ◽  
I.D Poveda Pinedo ◽  
R Dalmau Gonzalez-Gallarza ◽  
S.C Valbuena Lopez ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Artery Calcium ◽  
Cardiac Ct ◽  
Invasive Coronary Angiography ◽  
Agatston Score ◽  
Non Invasive ◽  
Artery Disease

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

scholarly journals CT Coronary Angiography versus Coronary Angiography to Detect Specificity and Sensitivity of CT Coronary

2019 ◽  
pp. 1-6
Author(s):  
Sheref M Zaghloul ◽  
Walid Hassan ◽  
Ashraf M Reda ◽  
Ghada M Sultan ◽  
Mohamed A Salah ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Present Report ◽  
Invasive Coronary Angiography ◽  
Ct Coronary Angiography ◽  
Point Of View ◽  
Stent Restenosis ◽  
Specificity And Sensitivity ◽  
Artery Disease

Background: Various diagnostic tests including conventional invasive coronary angiography and non-invasive Computed Tomography (CT) coronary angiography are used in the diagnosis of Coronary Artery Disease (CAD). Objective: The present report aims to evaluate the specificity and sensitivity of CT coronary angiography in diagnosis of coronary artery disease compared to the standard invasive coronary angiography. Methods: A retrospective study was done over 2 years started from May of 2015 up to May of 2017. The medical evaluation was based on systematic reviews of diagnostic studies with invasive coronary angiography and those with CT coronary angiogram. Data on special indications (bypass grafts, in-stent-restenosis) were also included in the evaluation. The CT scanners used with 320 slices. The study included patients with diabetes, hypertension, and data included age, glomerular filtration rate and ejection fraction. Results: Of the 99 patients included in the study, sensitivity of the total lesions were 87.1% which was highest for the graft lesions (100% sensitivity) and lowest for the Left Main (LM) lesions (83.3% sensitivity), on the other hand the specificity of the total lesion were high (98.1% specificity) which also was highest for the graft lesions (100% specificity) and lowest for the Left Anterior Descending (LAD) lesions (95% specificity). Regarding accuracy, CT coronary was 96.6% accurate for the whole lesions. Conclusions: From a medical point of view, CT coronary angiography using scanners with at least 320 slices should be recommended as a test to rule in obstructive coronary stenosis in order to avoid inappropriate invasive coronary angiography in patients with an intermediate pretest probability of CAD. Multi detector CT (MDCT) has reasonably high accuracy for detecting significant obstructive CAD when assessed at artery level.

scholarly journals The central role of CT coronary angiography in postcardiac arrest care in the young adult

2019 ◽  
Vol 12 (12) ◽  
pp. e232104
Author(s):  
Ayisha Mehtab Khan-Kheil ◽  
Alexandra Sophie Moss ◽  
Leanne Stephens ◽  
Jamal Nasir Khan
Keyword(s):  
Coronary Angiography ◽  
Invasive Coronary Angiography ◽  
Young Patients ◽  
Population Group ◽  
Ct Coronary Angiography ◽  
Successful Resuscitation ◽  
Cardioverter Defibrillator ◽  
Non Invasive ◽  
Tertiary Centre ◽  
Artery Disease

A 32-year-old man with no medical history went into ventricular fibrillation while running at the gym. He was transferred to our tertiary centre post successful resuscitation where admission electrocardiography and echocardiography were unremarkable. The initial cause of cardiac arrest was suspected arrhythmogenic and he was admitted for further investigations including exercise testing, ajmaline challenge, CT coronary angiography (CTCA) and cardiovascular MRI, with the likely outcome of cardioverter-defibrillator implantation. CTCA, however, revealed significant stenosis in the proximal left anterior descending artery as the likely cause for his arrest. Invasive coronary angiography confirmed this and facilitated successful stent implantation, avoiding the need for implantable cardioverter-defibrillator implantation. This case highlights the importance of CTCA, a non-invasive and readily-available test in the investigation of young patients postcardiac arrest, who require active exclusion of coronary artery disease and anomalous coronary anatomy, though they represent a low-risk population group.

scholarly journals The HASTE Protocol: a standardised CT Coronary Angiography service operated from a District General Hospital

Open Heart ◽  
2018 ◽  
Vol 5 (2) ◽  
pp. e000817
Author(s):  
Iain Thomas Parsons ◽  
Clare Bannister ◽  
John Badelek ◽  
Mark Ingram ◽  
Emma Wood ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
General Hospital ◽  
Cardiac Ct ◽  
Invasive Coronary Angiography ◽  
District General Hospital ◽  
Ct Coronary Angiography ◽  
Coronary Calcium ◽  
Diagnostic Quality ◽  
Invasive Angiography ◽  
Patient Preparation

IntroductionCT coronary angiography (CTCA) has excellent sensitivity but lacks specificity when compared with invasive coronary angiography (ICA) particularly in patients with a high coronary calcium burden. CTCA has been shown in large trials to decrease the requirement for diagnostic ICA and provide diagnostic clarity. We describe the methodology used to provide a standardised CTCA service established in a District General Hospital, which may assist other hospitals aiming to develop a cardiac CT service.MethodsScan request forms, authorisation and patient instruction were recorded. Patient preparation prior to CTCA as well as exclusion and inclusion criteria were documented. Scans were interpreted using a multidisciplinary team (MDT) approach in order to organise follow-up, medication and further investigation.ResultsOver 6 months, 157 consecutive scans were performed. CTCA was completed in 88% (n=138/157) and considered of diagnostic quality in 82% (n=129/157). The median radiation dose was 3.42 mSv. Overall, 64% of patients had evidence of coronary calcium. Following MDT review, 72% (n=113/157) of patients were discharged without requiring invasive angiography. 15% (n=24/157) of patients went on to have invasive angiography showing non-obstructive disease and 13% (20/157) of patients underwent percutaneous coronary intervention (11%) or bypass surgery (1%).DiscussionAppropriate referrals, patient preparation and scan quality remain significant factors in running a CTCA service. Despite this, the vast majority of patients can be discharged on the basis of the CTCA alone. An MDT approach is key to the delivery of a cardiac CT service.

Coronary artery disease: from atherosclerosis to obstructive disease, inducible ischaemia, and the ischaemic cascade

ESC CardioMed ◽  
2018 ◽  
pp. 1331-1339
Author(s):  
Jeroen J. Bax
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Atherosclerosis ◽  
Imaging Techniques ◽  
Invasive Coronary Angiography ◽  
Non Invasive ◽  
Anatomical Imaging ◽  
Artery Disease ◽  
Ischaemic Cascade

The inclusion or exclusion of coronary artery disease is important for patient management, both from a diagnostic and prognostic view, as well as from a therapeutic view. Various detection techniques are available, including invasive (coronary angiography) or non-invasive imaging techniques. The techniques can also be divided into anatomical imaging or functional imaging, where anatomical imaging detects coronary atherosclerosis and stenosis (invasive coronary angiography, but also non-invasive coronary angiography—performed with multidetector computed tomography), while functional imaging (nuclear imaging, stress echocardiography, and cardiovascular magnetic resonance) detects ischaemia: the haemodynamic consequences of the atherosclerosis/stenosis. The early phase of atherosclerotic coronary artery disease is often asymptomatic (and anatomical imaging can be used to detect/exclude coronary atherosclerosis), whereas with progression of atherosclerotic disease, symptoms occur related to myocardial ischaemia. Non-invasive imaging can facilitate in the detection of both early (asymptomatic) and more advanced (symptomatic, ischaemic) coronary artery disease. The pathophysiological cascade of cardiac abnormalities that occur once ischaemia is induced is referred to as the ischaemic cascade. The ischaemic cascade consists of chronological development of perfusion abnormalities, followed by diastolic dysfunction, then systolic dysfunction, and finally electrocardiographic abnormalities. In this chapter, the variety of the different non-invasive imaging techniques to assess the different phases of the non-ischaemic part and the ischaemic part (ischaemic cascade) of coronary artery disease are described.

P2699Comparison of fractional myocardial mass, a vessel-specific myocardial mass-at-risk, with coronary angiographic scoring systems for predicting myocardial ischemia

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H.-Y Kim ◽  
J.-H Choi ◽  
J.-H Doh ◽  
H.-S Lim ◽  
E.-S Shin ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Predictive Value ◽  
Validation Cohort ◽  
Invasive Coronary Angiography ◽  
Scoring Systems ◽  
Predictive Performance ◽  
Myocardial Mass ◽  
Derivation Cohort ◽  
Non Invasive

Abstract Aims The burden of coronary artery disease has been assessed by various semi-quantitative angiographic scores, which are frequently different each other. A non-invasive and quantitative modality may substitute angiographic sores for prognostic implication and decision of revascularization strategy. We compared fractional myocardial mass (FMM) with angiographic scores for predicting myocardial ischemia. Methods In this multicenter registry, 411 patients who underwent coronary computed tomography angiography (CCTA) were followed by invasive coronary angiography and FFR measurement. CCTA–derived %FMM with diameter stenosis ≥70% (%FMM-70) or ≥50% (%FMM-50) were compared with 9 angiographic scores (APPROACH, Duke Jeopardy, BARI, CASS, SYNTAX, Jenkins, BCIS-1, Leaman, Modified Duke) and were tested regarding their performance for predicting FFR ≤0.80. Predictive performance of %FMM or angiographic scores for FFR ≤0.80 established in derivation cohort (N=250) and tested in validation cohort (N=161). Results The performance of %FMM-70 and %FMM-50 were similar to most angiographic scores (%FMM-70, c-statistics=0.76; %FMM-50, 0.71; angiographic scores, 0.68–0.79). The frequency of FFR ≤0.80 increased consistently according to %FMM-70, %FMM-50, and all angiographic scores (p<0.001, all). The optimal cutoff of %FMM-50 and %FMM-70 for FFR ≤0.80 were ≥34.5% and ≥9.8%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of %FMM-50 were 83%, 56%, 73%, 70%, 72%, and of %FMM-70 were 72%, 78%, 75%, 75%, and 75% using these cutoffs. Validation cohort showed consistent results. Conclusion %FMM correlated well with angiographic scores and had a potential to be used as a non-invasive alternative to the angiographic scores. The integration of the severity of stenosis and the amount of subtended myocardium may improve the detection of clinically significant coronary artery stenosis.

scholarly journals Diagnostic Test Squatting Stress Echocardiography and Coronary Angiography in Diagnosing Coronary Heart Disease

2017 ◽  
pp. 190-8
Author(s):  
Andy Rahman ◽  
Mefri Yanni ◽  
Masrul Syafri
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Unstable Angina ◽  
Predictive Value ◽  
Stress Echocardiography ◽  
Coronary Artery Stenosis ◽  
Non Invasive ◽  
Sensitivity Specificity

Background: In patients with significant coronary heart disease (CHD), increased preload and afterload during a squat can cause wall motion abnormalities (WMA) which can be detected on echocardiography. This study was conducted to determine the diagnostic value of stress echocardiography squatting as a non-invasive examination of a relatively simple, inexpensive, and safe in the detection of coronary artery stenosis in stable CHD and unstable angina patients.Methods: This study was a cross-sectional design. The subjects were all patients with stable CHD and unstable angina whom were treated in Instalasi Pusat Jantung Rumah Sakit Dr. M. Djamil Padang from May to July 2016. Subjects underwent squatting stress echocardiography procedures followed by coronary angiography. Diagnostic test was used to determine the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of squatting stress echocardiography.Results: The sensitivity, specificity, and accuracy of squatting echocardiography for diagnosis of CAD were 90.3%, 88.9% and 89.7%, respectively.Conclusion: Squatting stress echocardiography can be proposed as a non-invasive examination which is relatively simple, inexpensive and safe to detect coronary artery stenosis on patients with stable CHD and unstable CHD.

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