Diagnostic Possibilities of Multislice Spiral Computed Tomography Coronary Angiography in Diseases of Coronary Arteries

In the Russian Federation, the death rate from cardiovascular disease is more than 56%. The main reason is atherosclerotic coronary artery disease, which leads to the development of coronary heart disease, and myocardial infarction. In the past, the only way to accurately diagnose coronary heart disease was invasive coronary angiography. This technique is deservedly referred to as the "gold standard" due to its high information content. However, coronary angiography is associated with the necessity of hospitalization in a hospital, as well as possible complications inherent in any invasive procedure. Having been in clinical practice multislice computed tomography has opened opportunities for the study of minimally invasive coronary artery status in patients with suspected coronary heart disease. The purpose of this work is to determine the diagnostic possibilities and optimization techniques of multi-detector computed tomographic coronary angiography. The study involved 38 patients with atherosclerotic coronary arteries, anomalies of the coronary arteries, and patients after stenting. The study was performed on a 64-slice “Aquilion 64” and 320-slice “Aquilion One” Toshiba computed tomographic machines. Analysis of the results of multi detector computed tomographic coronary angiography showed high diagnostic information value of this method in the assessment of coronary disease, in determining the type of blood supply distributed by the heart, in the visualization of the peripheral regions of the coronary arteries, and in the assessment of stents. Multi detector com-puted tomographic coronary angiography with 320-slice computed tomographic machine with one volume scan, shows a significant reduction of radiation exposure on the patient.

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Myocardial bridge and coronary artery fistulas in a patient with angina

Pediatrician (St Petersburg) ◽

10.17816/ped102137-141 ◽

2019 ◽

Vol 10 (2) ◽

pp. 137-141

Author(s):

Aleksandra A. Kholkina ◽

Yuriy R. Kovalev ◽

Vladimir A. Isakov ◽

Natal’ya O. Gonchar

Keyword(s):

Myocardial Infarction ◽

Coronary Heart Disease ◽

Heart Disease ◽

Coronary Artery ◽

Surgical Treatment ◽

Angina Pectoris ◽

Coronary Angiography ◽

Coronary Arteries ◽

Myocardial Bridge

Cardiovascular diseases (CVDs) are the leading cause of mortality among the population. At the core of the progression of the coronary heart disease is the atherosclerosis of the coronary arteries, which is found in majority of patients suffering from angina and in patients with myocardial infarction. However, in some cases, coronary angiography reveals, that patients with the mentioned clinical manifestations have their coronary arteries unchanged. This is treated as syndrome X or microvascular angina. Along with that, development or aggravation of the coronary heart disease may be based on the congenital peculiarities in the coronary arteries location and structure, such as muscular bridges and fistulas of the coronary artery. This is confirmed by a number of studies, which indicate the role of the above mentioned pathologies in the occurrence of angina and myocardial infarction. Nevertheless, there is also the opposite view, which is supported by a number of specialists. According to them, the presence of the mentioned peculiarities in the structure of the coronary channel is deemed as the patient-specific norm. Hence, the issue of the surgical treatment of the patients with the aforementioned coronary arteries anomalies remains controversial. The clinical case report of the patient with the symptoms of angina pectoris, in which the coronary angiography did not reveal the stenosis of the coronaries arteries, but located the myocardial bridge and the coronary fistula. The role of the congenital coronary vessels pathology in the angina pectoris is analyzed. The diagnosis guidelines and the tactics of the conservative and surgical treatment of patients with the above mentioned syndromes are discussed.

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The role and diagnostic value of assessing the degree of coronary arteries calcification for predicting the severity of coronary heart disease

Pathologia ◽

10.14739/2310-1237.2021.1.228855 ◽

2021 ◽

Vol 18 (1) ◽

pp. 39-43

Author(s):

A. O. Nykonenko ◽

A. L. Makarenkov ◽

H. S. Pidluzhnyi ◽

A. M. Materukhin

Keyword(s):

Computed Tomography ◽

Coronary Heart Disease ◽

Heart Disease ◽

Coronary Artery ◽

Coronary Arteries ◽

Pearson Correlation ◽

Diagnostic Value ◽

Agatston Score ◽

Syntax Score ◽

Stenotic Lesion

Coronary heart disease (CHD) is one of the leading mortality causes. According to the latest guidelines, coronary computed tomography angiography (CCTA) is one of the main non-invasive methods for diagnosis of CHD, which allows for quantification of stenosis severity and the characterization of stenotic lesions. Aim of the study. It is to study the role, diagnostic value and dependence of coronary artery calcification on the degree of stenotic lesion of the coronary arteries and anthropometric parameters in patients with coronary artery disease examined by computed tomography. Materials and methods. According to the purpose of the study, 46 patients were included: 32 (69.6 %) males and 14 (30.4 %) females. The average age of the patients was 59.0 ± 9.8 years, height – 172 ± 9 cm, weight – 85.6 ± 12.9 kg, body mass index (BMI) – 28.6 ± 4.13, body surface area (BSA) – 1.98 ± 0.17 m2. Demographic and clinical variables were analyzed using descriptive statistics. Independent t-tests were conducted between two groups of patients (Agatston index ≥400 and <400), using P < 0.05 as a significant value. Pearson correlation coefficient was employed to determine independent coronary calcium predictors using P < 0.05 as a significant value. Results. According to the results of the age analysis, significant differences were found among both groups of patients (P = 0.02). Notable differences in the number of affected coronary arteries between Groups 1 and 2 with an Agatston index ≥400 and <400 (P < 0.01) were found. During the correlation analysis, a significant moderate positive correlation of the SYNTAX score level with Agatston index (r = 0.69, P < 0.01) was revealed. Conclusions. The degree of coronary arteries calcification with Agatston score ≥400 is an independent predictor of severe coronary heart disease with multivessel lesion of the coronary arteries. The degree of calcification of coronary arteries with Agatston score ≥400 is more common in males. Height, weight, BMI and BSA do not influence the degree of coronary calcification arteries and Agatston score level.

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Optical coherent tomography for the diagnostic of non-obstructive coronary artery myocardial infarction

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.060 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

I Leonova ◽

S Boldueva ◽

V Feoktistova ◽

D Evdokimov

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Coronary Heart Disease ◽

Heart Disease ◽

Coronary Artery ◽

Coronary Angiography ◽

Atherosclerotic Plaque ◽

St Elevation ◽

Spontaneous Dissection

Abstract Funding Acknowledgements Type of funding sources: None. The widespread use of coronary angiography (CAG) in patients with acute coronary syndrome led to the understanding that in some patients myocardial infarction (MI) occurs against angiographically unchanged or slightly modified coronary arteries (CA). In such cases, the so-called "type 2 IM" is diagnosed in some patients, however, to determine the true cause of MI, a modern method of investigation such as optical coherence tomography (OCT) is needed to visualize the intima of the CA and detect a minimal atherosclerotic process. The purpose of the study was to establish the etiology of MI without obstructive coronary artery disease (MINOCA) using OCT. Materials and methods 160 conclusions of the OCT were analyzed. In 9 (6%) cases, the study was conducted in patients who underwent proven MI (mean age 43,1 ± 13,2, 8 males, 1 female) who had no hemodynamically significant CA stenosis according to CAG data. Results in 2 cases (22%) patients had ST-elevation MI, thrombotic occlusion of the CA (in one case, thrombaspiration was performed). In both patients, spontaneous dissection of the intima of the unmodified CA was detected in the OCT. The remaining 7 patients had non-ST-elevation MI, and in 2 cases, a diagnosis of type 2 MI was established: in both patients, the atherosclerotic plaque was visualized, narrowing the lumen of the CA less than 50%, in one case MI developed against a background of the hypertensive crisis, in another - against a background of spasm of CA. In the remaining 5 patients, OCT revealed subintimal atheromatous, with elements of local dissection of the intima. Thus, in 78% of patients atherosclerosis of CA of different severity (from the subintimal deposition of lipids to the development of atherosclerotic plaque, narrowing the clearance of the SC by less than 50%) was diagnosed. In the analysis of risk factors for coronary heart disease (CHD), 57% of patients with atheromatous CA had more than 2 risk factors for CHD: 3 (42%) smoked, 5 (71%) - obesity, 4 (57% ) - had arterial hypertension, 3 (42%) had dyslipidemia, 1 (14%) had type 2 diabetes. In the group of patients with spontaneous intima dissection of the CA, 1 patient (woman) did not have CHD risk factors, the 2-nd suffered from obesity and hypertension. For all patients a lifestyle correction was recommended; statins, antiplatelets were prescribed, patients with spontaneous dissection of CA had the recommendation of examination in the medical-genetic center. Conclusion Based on the results of the study, in most cases, the cause of IMBOC development was an atherosclerotic lesion of the coronary arteries, which is not always visualized with standard coronary angiography. Basically, the patients were young and middle-aged. Most patients had different risk factors for coronary heart disease.

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