MDCT and detection of coronary artery disease

2015 ◽  
pp. 271-285
Author(s):  
Stephan Achenbach
Keyword(s):  
Coronary Artery ◽  
Predictive Value ◽  
Acute Chest Pain ◽  
Intermediate Risk ◽  
Coronary Cta ◽  
Improve Risk Stratification ◽  
Coronary Atherosclerotic Plaque ◽  
High Negative Predictive Value ◽  
Artery Disease ◽  
Asymptomatic Individuals

Coronary CT angiography (coronary CTA) with multi-detector row CT (MDCT) systems permits visualization of the coronary arteries and detection of stenoses. Image quality depends on a low and stable heart rate, so patients need to be selected and adequately prepared. Due to a very high negative predictive value, coronary CTA is useful to rule out coronary artery stenosis, especially in low-to-intermediate risk patients with stable or acute chest pain. Imaging of patients with coronary artery stents and patients after bypass surgery is challenging and only in selected situations considered appropriate. Coronary CTA can visualize non-stenotic coronary atherosclerotic plaque, the presence and extent of which is associated with cardiovascular events, but there is no indication to perform coronary CTA for screening of asymptomatic individuals at low-intermediate risk. Coronary calcium, on the other hand, has a well-established predictive value and can be considered to improve risk stratification in asymptomatic individuals with a low to intermediate cardiovascular risk profile.

Abstract 2333: Coronary Magnetic Resonance Angiography with Whole Heart Coverage for The Detection of Coronary Arery Stenoses: A Multicenter Study

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Yasutaka Ichikawa ◽  
Hajime Sakuma ◽  
Yasuyuki Kobayashi ◽  
Masaki Ishida ◽  
Kazuhiro Katahira ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Negative Predictive Value ◽  
Multicenter Study ◽  
Predictive Value ◽  
X Ray ◽  
Coronary Mra ◽  
Coronary Magnetic Resonance ◽  
High Negative Predictive Value ◽  
Artery Disease ◽  
Whole Heart

Background: Previous single center studies demonstrated that coronary magnetic resonance angiography (MRA) with whole heart coverage allows for noninvasive detection of coronary artery disease. In this prospective, multicenter study, we investigated the accuracy of whole heart coronary MRA in patients with suspected coronary disease. Methods: The subjects were recruited from five institutions. Free-breathing coronary MRA covering the entire heart were obtained in fifty eight patients by using a 3-dimensional, segmented steady-state free precession sequence without contrast injection. Coronary MRA was interpreted by 3 independent observers. Conventional X-ray coronary angiography was analyzed by a separate blinded reviewer. The diagnostic accuracy of coronary MRA was determined in all segments with reference diameter of 2 mm or more on X-ray coronary angiography regardless of the image quality of MRA. Results: Acquisition of coronary MRA was completed in all patients with an averaged imaging time of 9.8 ± 4.8 min. On patient based analysis, coronary MRA showed the sensitivity of 79.4% (range 64.7–88.2%), the specificity of 70.1% (65.9–80.5%), and the negative predictive value of 89.6% (84.6–93.1%). The sensitivity, specificity and negative predictive value in the segmental analysis were 60.6% (53.8–65.4%), 95.5% (94.2–97.6%) and 97.7% (97.4–98.1%). Conclusions: Coronary MRA with whole heart coverage can provide detection of luminal narrowing of the coronary artery with moderate sensitivity, high specificity and high negative predictive value. The high negative predictive value observed in this multicenter study indicates that noninvasive MRA approach is useful in ruling out significant coronary artery disease.

Abstract 128: A Precision Medicine Test Accurately Rules Out Obstructive Coronary Artery Disease Among Non-Diabetic Patients Presenting to Emergency Department With Acute Chest Pain

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Khurram Nasir ◽  
Shozab S Ali ◽  
Anshul Saxena ◽  
Gowtham Grandhi ◽  
Usman Siddiqui ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Emergency Department ◽  
Chest Pain ◽  
Coronary Artery ◽  
Obstructive Coronary Artery Disease ◽  
Acute Chest Pain ◽  
Diabetic Patients ◽  
High Grade ◽  
Intermediate Risk ◽  
Artery Disease

Background: An age, sex, and blood gene expression score (ASGES) has been previously validated to detect obstructive coronary artery disease (CAD) in non-diabetic patients presenting with stable chest pain in the outpatient setting. However, the diagnostic performance of this test in ruling out obstructive CAD in patients presenting with acute chest pain (ACP) to the emergency department (ED) is unknown. Methods: In an ongoing study, 371 low-intermediate risk patients with ACP and no prior history of CAD (TIMI risk score ≤ 2, negative troponins and normal/non-diagnostic ECG) underwent coronary CT angiography (CCTA) using institutional protocols. Patients were classified based on severity of stenosis (obstructive CAD, >50%; high grade stenosis, >70%) and ASGES. The ASGES blood test sample was drawn before ED discharge and analyzed in a commercial reference laboratory (Redwood City, CA). We excluded 23 (6%) patients with unreportable ASGES and 47 (13%) diabetics from this primary analysis. Results: 301 (53±10 years, 45% males, 78% Hispanics) non-diabetic ACP patients undergoing CCTA in an ED setting were included in this analysis. No plaque was detected in 183 (60%) patients, and 22 (7%) patients had obstructive CAD. In this population, 51% of patients had scores below the previously defined threshold of ASGES≤ 15. This threshold yielded sensitivity, specificity, NPV, and PPV of 71% (52-86%), 53% (47-59%), 97% (93-98%), and 12% (9-14%) for obstructive CAD. Furthermore, ASGES≤15 yielded a 100% sensitivity and NPV for patients with high grade stenosis (n=7, 2%). In a multivariable analysis including patient demographics and clinical covariates, ASGES ≤15 was significantly associated with obstructive CAD (OR: 0.15, 95% CI: 0.04-0.62). As a continuous variable, increasing ASGES was positively correlated with the presence of obstructive CAD and CCTA-defined plaque burden (p<0.0001). Conclusions: This is the first study validating the use of this blood-based precision medicine test to rule out obstructive CAD among low-intermediate risk non-diabetic patients presenting with ACP in ED setting. 30-day follow-up is underway to evaluate the prognostic implications of these findings.

scholarly journals Clinical comparison of sub-mm high-resolution non-contrast coronary CMR angiography against coronary CT angiography in patients with low-intermediate risk of coronary artery disease: a single center trial

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Reza Hajhosseiny ◽  
Imran Rashid ◽  
Aurélien Bustin ◽  
Camila Munoz ◽  
Gastao Cruz ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
High Resolution ◽  
Image Quality ◽  
Diagnostic Performance ◽  
Diagnostic Image Quality ◽  
Intermediate Risk ◽  
Coronary Cta ◽  
Diagnostic Image ◽  
Artery Disease

Abstract Background The widespread clinical application of coronary cardiovascular magnetic resonance (CMR) angiography (CMRA) for the assessment of coronary artery disease (CAD) remains limited due to low scan efficiency leading to prolonged and unpredictable acquisition times; low spatial-resolution; and residual respiratory motion artefacts resulting in limited image quality. To overcome these limitations, we have integrated highly undersampled acquisitions with image-based navigators and non-rigid motion correction to enable high resolution (sub-1 mm3) free-breathing, contrast-free 3D whole-heart coronary CMRA with 100% respiratory scan efficiency in a clinically feasible and predictable acquisition time. Objectives To evaluate the diagnostic performance of this coronary CMRA framework against coronary computed tomography angiography (CTA) in patients with suspected CAD. Methods Consecutive patients (n = 50) with suspected CAD were examined on a 1.5T CMR scanner. We compared the diagnostic accuracy of coronary CMRA against coronary CTA for detecting a ≥ 50% reduction in luminal diameter. Results The 50 recruited patients (55 ± 9 years, 33 male) completed coronary CMRA in 10.7 ± 1.4 min. Twelve (24%) had significant CAD on coronary CTA. Coronary CMRA obtained diagnostic image quality in 95% of all, 97% of proximal, 97% of middle and 90% of distal coronary segments. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were: per patient (100%, 74%, 55%, 100% and 80%), per vessel (81%, 88%, 46%, 97% and 88%) and per segment (76%, 95%, 44%, 99% and 94%) respectively. Conclusions The high diagnostic image quality and diagnostic performance of coronary CMRA compared against coronary CTA demonstrates the potential of coronary CMRA as a robust and safe non-invasive alternative for excluding significant disease in patients at low-intermediate risk of CAD.

Computed tomography myocardial perfusion

ESC CardioMed ◽  
2018 ◽  
pp. 556-560
Author(s):  
Amita Singh ◽  
Noreen Nazir ◽  
Victor Mor-Avi ◽  
Amit R. Patel
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Myocardial Perfusion ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Single Photon ◽  
Photon Emission ◽  
High Negative Predictive Value ◽  
Artery Disease

Coronary computed tomography angiography (CTA) has been widely adopted as a non-invasive tool for the evaluation of coronary artery disease. Given its high negative predictive value, it is an accurate modality to rule out obstructive coronary artery disease in the setting of chest pain. While the sensitivity and derived negative predictive value of coronary CTA are excellent, the specificity and positive predictive value are lower due to the difficult image interpretation in the presence of heavy coronary calcification, stents, coronary bypass grafts, motion artefacts, and arrhythmias. Vasodilator computed tomography myocardial perfusion (CTP) is an emerging technique with the ability to identify myocardial segments perfused by haemodynamically significant coronary stenoses. A growing number of studies have demonstrated the feasibility and diagnostic accuracy of CTP in comparison to a number of reference standards, including single-photon emission computed tomography, cardiovascular magnetic resonance imaging, and invasive coronary angiography with and without fractional flow reserve testing. This chapter summarizes the current state of CTP.

Kann das CT die Katheterangiografie für die Koronardiagnostik ersetzen? – Ja!

2017 ◽  
Vol 142 (21) ◽  
pp. 1604-1605
Author(s):  
Helen Ullrich ◽  
Tommaso Gori
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Invasive Coronary Angiography ◽  
Stable Coronary Artery Disease ◽  
Accurate Information ◽  
Coronary Cta ◽  
Invasive Approach ◽  
Computed Tomographic ◽  
High Negative Predictive Value ◽  
Artery Disease

AbstractThe guidelines on the management of stable coronary artery disease (SCAD) recommend the use of coronary computed tomography angiography (CTA) in the process of diagnosing coronary artery disease in patients with low intermediate pre-test probability for SCAD. Particularly in cases where stress electrocardiogram or stress imaging provides unclear results, a computed tomographic examination can be considered as a reliable alternative to invasive coronary angiography. Due to its high negative predictive value, coronary CTA can provide accurate information on the presence of coronary artery stenosis and thus coronary artery disease can be reliably excluded without the risks associated with invasive procedures. Similarly, patients with unstable angina or chest pain without typical alterations in the electrocardiogram and without an elevation of troponin can also benefit from a non-invasive coronary CTA-based diagnostics as first approach as it allows ruling out the presence of disease or planning an intervention without the risks associated with a potentially inappropriate invasive approach.

scholarly journals Accuracy of MSCT Coronary Angiography with 64 Row CT Scanner—Facing the Facts

2010 ◽  
Vol 4 ◽  
pp. CMC.S3864 ◽  
Author(s):  
M. Wehrschuetz ◽  
E. Wehrschuetz ◽  
H. Schuchlenz ◽  
G. Schaffler
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Diagnostic Potential ◽  
Coronary Artery Stenoses ◽  
Artery Disease ◽  
Msct Angiography

Improvements in multislice computed tomography (MSCT) angiography of the coronary vessels have enabled the minimally invasive detection of coronary artery stenoses, while quantitative coronary angiography (QCA) is the accepted reference standard for evaluation thereof. Sixteen-slice MSCT showed promising diagnostic accuracy in detecting coronary artery stenoses haemodynamically and the subsequent introduction of 64-slice scanners promised excellent and fast results for coronary artery studies. This prompted us to evaluate the diagnostic accuracy, sensitivity, specificity, and the negative und positive predictive value of 64-slice MSCT in the detection of haemodynamically significant coronary artery stenoses. Thirty-seven consecutive subjects with suspected coronary artery disease were evaluated with MSCT angiography and the results compared with QCA. All vessels were considered for the assessment of significant coronary artery stenosis (diameter reduction ≥ 50%). Thirteen patients (35%) were identified as having significant coronary artery stenoses on QCA with 6.3% (35/555) affected segments. None of the coronary segments were excluded from analysis. Overall sensitivity for classifying stenoses of 64-slice MSCT was 69%, specificity was 92%, positive predictive value was 38% and negative predictive value was 98%. The interobserver variability for detection of significant lesions had a κ-value of 0.43. Sixty-four-slice MSCT offers the diagnostic potential to detect coronary artery disease, to quantify haemodynamically significant coronary artery stenoses and to avoid unnecessary invasive coronary artery examinations.

Abdominal Aortic Intima-Media Thickness Predicts Coronary Artery Disease Severity in Patients With Stable Angina Pectoris: A Prospective Study

Angiology ◽  
2021 ◽  
pp. 000331972199885
Author(s):  
Omer Faruk Cirakoglu ◽  
Ayşe Gül Karadeniz ◽  
Ali Riza Akyüz ◽  
Cihan Aydın ◽  
Sinan Şahin ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Angina Pectoris ◽  
Predictive Value ◽  
Intima Media Thickness ◽  
Stable Angina Pectoris ◽  
Coronary Artery Disease Severity ◽  
Abdominal Aortic ◽  
Artery Disease ◽  
Aortic Intima

Accurately identifying coronary artery disease (CAD) is the key element in guiding the work-up of patients with suspected angina. Thickening of the arterial wall is a hallmark of atherosclerosis. Therefore, the main purpose of this study was to determine whether abdominal aortic intima-media thickness (AAIMT), which is the earliest zone of atherosclerotic manifestations, has a predictive value in CAD severity. A total of 255 consecutive patients who were referred for invasive coronary angiography due to suspected stable angina pectoris were prospectively included in the study. B-mode ultrasonography was used to determine AAIMT before coronary angiography. Coronary artery disease severity was assessed with the SYNTAX score (SS). A history of hypertension, age, dyslipidemia, and higher AAIMT (odds ratio: 2.570; 95%CI 1.831-3.608; P < .001) were independent predictors of intermediate or high SS. An AAIMT <1.3 mm had a negative predictive value of 98% for the presence of intermediate or high SS and 83% for obstructive CAD. In conclusion, AAIMT showed a significant and independent predictive value for intermediate or high SS. Therefore, AAIMT may be a noninvasive and useful tool for decision-making by cardiologists (eg, to use a more invasive approach).

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