scholarly journals Computed tomography-derived characterisation of pericoronary,epicardial and paracardial adipose tissue and its association with myocardial ischemia as assessed by computed and invasive fractional flow

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Goeller ◽  
H Duncker ◽  
M Moshage ◽  
D Dey ◽  
D Bittner ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Adipose Tissue ◽  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Multivariable Analysis ◽  
Fractional Flow ◽  
Circumflex Artery ◽  
Flow Reserve ◽  
Ct Attenuation ◽  
Significant Difference

Abstract Introduction Increased pericoronary adipose tissue (PCAT) computed tomography (CT) attenuation derived from coronary CT angiography (CTA) around the right coronary artery (RCA) reflects coronary inflammation and relates to cardiac mortality. Purpose We aimed to investigate the yet unclear association between CT-derived characterisation of different cardiac adipose tissue compartments and the presence of myocardial ischemia as assessed by fractional flow reserve (FFR). Methods 133 stable individuals (64 years, 74% male) with coronary artery disease (CAD) underwent CTA including computed FFR (FFR-CT) measurement followed by invasive angiography with FFR (invasive FFR) assessment. The CT attenuation (HU) and volume (mm3) of PCAT were quantified around the RCA (10 to 50 mm from RCA ostium), the proximal 40 mm of the left anterior descending artery (LAD) and the circumflex artery (LCX) with the help of semi-automated software. The per patient PCAT CT attenuation was calculated as followed: (PCAT CT attenuation of RCA+LAD+LCX)/3. Quantification of epicardial adipose tissue (EAT) and paracardial adipose tissue (PAT; all intrathoracic adipose tissue outside the pericardium) were performed in non-contrast cardiac CT data sets using a fully automated deep-learning based algorithm. Results Median FFR-CT was 0.86 [0.79, 0.91] and median invasive FFR was 0.87 [0.81, 0.93]. Patients with presence of myocardial ischemia (n=26) defined by a FFR-CT threshold of ≤0.75 showed a significant higher PCAT CT attenuation of RCA (−75.1 HU vs. −81.1 HU, p=0.011) and per patient (−74.5 HU vs. −77.7 HU, p=0.045) than individuals without myocardial ischemia (n=107). In multivariable analysis adjusted for age, BMI, gender and traditional risk factors, both RCA and per patient PCAT CT attenuation were significant predictors of myocardial ischemia as assessed by FFRCT ≤0.75. Between individuals with myocardial ischemia compared to individuals without myocardial ischemia there was no significant difference neither in the volume and CT attenuation of EAT and PAT nor in the PCAT volume of RCA, LAD, LCX and per patient PCAT volume. Conclusions Our observations suggest that PCAT CT attenuation instead of PCAT volume, EAT and PAT measures might be associated with the presence of myocardial ischemia as assessed by FFR. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): German Heart Foundation e.V.

Beta-Blockade in Intraseptal Anomalous Coronary Artery With Reversible Myocardial Ischemia

2021 ◽  
Vol 12 (1) ◽  
pp. 145-148
Author(s):  
Tam T. Doan ◽  
Athar M. Qureshi ◽  
Shagun Sachdeva ◽  
Cory V. Noel ◽  
Dana Reaves-O’Neal ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Dobutamine Stress ◽  
Medical Intervention ◽  
Beta Blockade ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Reversible Ischemia ◽  
Improve Patient

Anomalous aortic origin of a left coronary artery (L-AAOCA) with an intraseptal course is a rare anomaly and can be associated with myocardial ischemia and sudden cardiac death. No surgical or medical intervention is known to improve patient outcomes. A 7-year-old boy with intraseptal L-AAOCA presented with nonexertional chest pain, syncope, and had reversible myocardial ischemia on provocative testing. The patient was started on β-blockade, following which his symptoms improved and resolved over a period of six years. A follow-up dobutamine stress magnetic resonance imaging no longer showed reversible ischemia, and cardiac catheterization with fractional flow reserve did not show coronary flow compromise.

scholarly journals Physiological Evaluation of Anomalous Aortic Origin of a Coronary Artery Using Computed Tomography–Derived Fractional Flow Reserve

2021 ◽  
Author(s):  
Julien Adjedj ◽  
Fabien Hyafil ◽  
Xavier Halna du Fretay ◽  
Patrick Dupouy ◽  
Jean‐Michel Juliard ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Ct Angiography ◽  
Fractional Flow Reserve ◽  
Coronary Ct Angiography ◽  
Functional Evaluation ◽  
Fractional Flow ◽  
Coronary Ct ◽  
Flow Reserve

Background With the emergence of coronary computed tomography (CT) angiography, anomalous aortic origin of a coronary artery (ANOCOR) is more frequently diagnosed. Fractional flow reserve derived from CT (FFRCT) is a noninvasive functional test providing anatomical and functional evaluation of the overall coronary tree. These unique features of anatomical and functional evaluation derived from CT could help for the management of patients with ANOCOR. We aimed to retrospectively evaluate the physiological and clinical impact of FFRCT analysis in the ANOCOR registry population. Methods and Results The ANOCOR registry included patients with ANOCOR detected during invasive coronary angiography or coronary CT angiography between January 2010 and January 2013, with a planned 5‐year follow‐up. We retrospectively performed FFRCT analysis in patients with coronary CT angiography of adequate quality. Follow‐up was performed with a clinical composite end point (cardiac death, myocardial infarction, and unplanned revascularization). We obtained successful FFRCT analyses and 5‐year clinical follow‐up in 54 patients (average age, 60±13 years). Thirty‐eight (70%) patients had conservative treatment, and 16 (30%) patients had coronary revascularization after coronary CT angiography. The presence of an ANOCOR course was associated with a moderate reduction of FFRCT value from 1.0 at the ostium to 0.90±0.10 downstream the ectopic course and 0.82±0.11 distally. No significant difference in FFRCT values was identified between at‐risk and not at‐risk ANOCOR. After a 5‐year follow‐up, only one unplanned percutaneous revascularization was reported. Conclusions The presence of ANOCOR was associated with a moderate hemodynamic decrease of FFRCT values and associated with a low risk of cardiovascular events after a 5‐year follow‐up in this middle‐aged population.

scholarly journals Left Main Coronary Artery Thrombus Diagnosed and Managed With Coronary Computed Tomography Angiography and Fractional Flow Reserve Derived From Computed Tomography

2019 ◽  
Vol 13 ◽  
pp. 117954681989459
Author(s):  
Shone O Almeida ◽  
Nasih M Ahmed ◽  
Ronald P Karlsberg
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Fractional Flow Reserve ◽  
Computed Tomography Angiography ◽  
Left Main Coronary Artery ◽  
Coronary Computed Tomography Angiography ◽  
Left Main ◽  
Fractional Flow ◽  
Coronary Cta ◽  
Flow Reserve

Left main coronary artery thrombus (LMCA-T) is a rare disease state and diagnosed with invasive coronary angiography (ICA). We present a case of LMCA-T diagnosed with coronary computed tomography angiography (CTA) and treated without ICA in a patient who presented to a hospital in the middle of war zone in Erbil, Iraqi Kurdistan. Coronary CTA performed 1 month later demonstrated resolution of the thrombus. Fractional flow reserve computed from computed tomography (FFR-CT; HeartFlow, Redwood City, CA) performed retrospectively confirmed that the clot was not hemodynamically significant at the time of diagnosis. This case demonstrates the diagnostic capabilities of coronary CTA and FFR-CT when ICA is not readily available.

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