Computed tomography coronary angiography: Is radiation a concern for the gold standard test for anomalous coronary arteries?

Summary Primary aldosteronism (PA) is characterised by aldosterone hypersecretion and represents a common cause of secondary hypertension. During diagnostic evaluation, it is essential to determine the aetiology of PA since the treatment of unilateral and bilateral disease differs significantly. Adrenal vein sampling (AVS) has been implemented as a gold standard test for the diagnosis of PA subtype. However, due to the AVS complexity, costs and limited availability, many patients with PA are being treated based on the computed tomography (CT) findings. In this article, we present two patients with discrepant CT and AVS results, demonstrating that AVS is the only reliable method for localising the source of aldosterone excess. Learning points: CT is an unreliable method for distinguishing aldosterone-producing adenoma (APA) from bilateral adrenal hyperplasia (BAH). CT can be misleading in defining lateralisation of the aldosterone excess in case of unilateral disease (APA). AVS is the gold standard test for defining the PA subtype.

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Computed Tomography-based Patient-specific Biomechanical and Fluid Dynamic Study of Anomalous Coronary Arteries with Origin from the Opposite Sinus and Intramural Course

Heart International ◽

10.17925/hi.2020.14.2.105 ◽

2020 ◽

Vol 14 (2) ◽

pp. 105

Author(s):

Gianluca Rigatelli ◽

Marco Zuin ◽

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Keyword(s):

Computed Tomography ◽

Coronary Arteries ◽

Fluid Dynamic ◽

Dynamic Study ◽

Patient Specific ◽

Anomalous Coronary ◽

Anomalous Coronary Arteries

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Sex associations and computed tomography coronary angiography-guided management in patients with stable chest pain

European Heart Journal ◽

10.1093/eurheartj/ehz903 ◽

2019 ◽

Vol 41 (13) ◽

pp. 1337-1345 ◽

Cited By ~ 8

Author(s):

Kenneth Mangion ◽

Philip D Adamson ◽

Michelle C Williams ◽

Amanda Hunter ◽

Tania Pawade ◽

...

Keyword(s):

Computed Tomography ◽

Chest Pain ◽

Coronary Angiography ◽

Coronary Arteries ◽

Standard Care ◽

Absolute Risk ◽

Risk Difference ◽

Computed Tomography Coronary Angiography ◽

Open Label ◽

Normal Coronary Arteries

Abstract Aims The relative benefits of computed tomography coronary angiography (CTCA)-guided management in women and men with suspected angina due to coronary heart disease (CHD) are uncertain. Methods and results In this post hoc analysis of an open-label parallel-group multicentre trial, we recruited 4146 patients referred for assessment of suspected angina from 12 cardiology clinics across the UK. We randomly assigned (1:1) participants to standard care alone or standard care plus CTCA. Fewer women had typical chest pain symptoms (n = 582, 32.0%) when compared with men (n = 880, 37.9%; P < 0.001). Amongst the CTCA-guided group, more women had normal coronary arteries [386 (49.6%) vs. 263 (26.2%)] and less obstructive CHD [105 (11.5%) vs. 347 (29.8%)]. A CTCA-guided strategy resulted in more women than men being reclassified as not having CHD {19.2% vs. 13.1%; absolute risk difference, 5.7 [95% confidence interval (CI): 2.7–8.7, P < 0.001]} or having angina due to CHD [15.0% vs. 9.0%; absolute risk difference, 5.6 (2.3–8.9, P = 0.001)]. After a median of 4.8 years follow-up, CTCA-guided management was associated with similar reductions in the risk of CHD death or non-fatal myocardial infarction in women [hazard ratio (HR) 0.50, 95% CI 0.24–1.04], and men (HR 0.63, 95% CI 0.42–0.95; Pinteraction = 0.572). Conclusion Following the addition of CTCA, women were more likely to be found to have normal coronary arteries than men. This led to more women being reclassified as not having CHD, resulting in more downstream tests and treatments being cancelled. There were similar prognostic benefits of CTCA for women and men.

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