An Evaluation of the Utility of Postmortem Computed Tomography in the Diagnosis of Lethal Coronary Artery Atherosclerosis and Hypertensive Heart Disease

Abstract Introduction Smoking and obesity are recognized as important modifiable risk factors for coronary artery disease (CAD). However, the general perception that smoking protects against obesity is a common reason for starting, and/or not quitting smoking. Purpose To detect the quantity, quality and relative distribution of subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) estimated by abdominal computed tomography in smokers versus non- smokers. Methods The abdominal muscular wall was traced manually to calculate SAT and VAT areas (cm2) (outside and inside abdominal muscular wall respectively) as well as SAT density [Hounsfield units (HU)] at L4-L5 in 409 consecutive patients referred for evaluation of chest pain by multi-slice computed tomography coronary angiography (MSCT-CA). Results 26% of the studied patients (n=107) were current smokers, while the remaining 74% (n=302) never smoked. Coronary artery atherosclerosis was more prevalent in smokers compared to non-smokers (64.5% vs 55.0%; p=0.09). Smokers had statistically significantly lower body mass index (BMI) (31.2±4.3 vs. 32.5±4.7 kg/m2; p=0.015), hip circumference (HC) (98.6±22.5 vs. 103.9±20.9 cm; p=0.031), total fat area (441.62±166.34 vs. 517.95±169.51cm2; p<0.001), and SAT area (313.07±125.54 vs. 390.93±143.28 cm2; p<0.001) as compared to non-smokers. However, smokers had statistically significantly greater waist-to-hip ratio (0.98±0.08 vs. 0.96±0.08; p=0.010), VAT/SAT area ratio (0.41±0.23 vs. 0.35±0.20; p=0.013), and denser SAT depot (−98.91±7.71 vs. −102.08±6.44 HU; p<0.001). Conclusion Smoking contributes to CAD and to the pathogenic redistribution of body fat towards VAT, through limiting SAT potential to expand. Funding Acknowledgement Type of funding source: None

Download Full-text

Abstract 11726: Novel Non-Invasive Method to Estimate Myocardial Mass at Risk Calculated From Cardiac Computed Tomography Data: Validation Study Using Angiographic Myocardial Jeopardy Scores in Patients With Single Vessel Disease

Circulation ◽

10.1161/circ.130.suppl_2.11726 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Seiko IDE ◽

Satoru Sumitsuji ◽

Kensuke Yokoi ◽

Masatoki Yoshida ◽

Isamu Mizote ◽

...

Keyword(s):

Computed Tomography ◽

At Risk ◽

Heart Disease ◽

Coronary Artery ◽

Cardiac Computed Tomography ◽

Myocardial Mass ◽

Non Invasive ◽

Vessel Disease ◽

Single Vessel ◽

Single Vessel Disease

Background: The myocardial mass at risk (MMAR), representing volume of myocardium distal to culprit lesion, is one of important factors for predicting adverse cardiac event in ischemic heart disease. However, current non-invasive cardiac imaging fails to quantify MMAR in patients with stable coronary artery disease. We have developed a new software calculating MMAR of any designated coronary artery by reconstructing the 3-dimensional-volume-data of cardiac computed tomography (CCT). The novel index, ratio of MMAR to whole left ventricular volume (%LV-MMAR), calculated with this software would be appealing to obtain MMAR objectively. This study aims to compare the %LV-MMAR with Bypass Angioplasty Revascularization Investigation (BARI) and modified Albert Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) scores, both of which are invasive angiographic methods widely used to estimate MMAR, in patients with single-vessel disease. Methods: Between April 2008 and March 2014, patients suspected of effort angina pectoris without history of previous myocardial infarction were assessed with CCT and invasive coronary angiography. Of those, 48 patients who were revealed single-vessel disease (left anterior descending artery (LAD): n=22, left circumflex artery (LCX): n=11 and right coronary artery (RCA): n=15) were included in this study. %LV-MMAR was calculated on the software. BARI and modified APPROACH score were calculated and compared with %LV-MMAR. Results: Mean %LV-MMAR was 27.6 [18.2-37.1] %. BARI and APPROACH scores showed a significant correlation (r=0.92, p<0.0001). Also, a significant correlation was observed between %LV-MMAR versus BARI and %LV-MMAR versus APPROACH (r=0.95, p<0.0001 and r=0.9, p<0.0001, respectively). %LV-MMAR showed significant correlation with BARI and APPROACH scores in all vessels; LAD (r=0.95, p<0.0001 and r=0.91, p<0.0001, respectively), LCX (r=0.91, p=0.0001 and r=0.83, p=0.0002, respectively) and RCA (r=0.92, p<0.0001 and r=0.85, p<0.0001, respectively). Conclusions: This study revealed %LV-MMAR, calculated from CCT data on novel software, to be a promising index for estimating perfusion territory noninvasively in good agreement with BARI and modified APPROACH score.

Download Full-text

Association of Periaortic Fat and Abdominal Visceral Fat with Coronary Artery Atherosclerosis in Chinese Middle Aged and Elderly Patients Undergoing Computed Tomography Coronary Angiography

Global Heart ◽

10.5334/gh.1078 ◽

2021 ◽

Vol 16 (1) ◽

pp. 74

Author(s):

Jingqi Zhu ◽

Zhangwei Yang ◽

Xiaolin Li ◽

Xiaoli Chen ◽

Jingjiang Pi ◽

...

Keyword(s):

Computed Tomography ◽

Coronary Artery ◽

Coronary Angiography ◽

Elderly Patients ◽

Visceral Fat ◽

Computed Tomography Coronary Angiography ◽

Middle Aged ◽

Coronary Artery Atherosclerosis ◽

Abdominal Visceral Fat ◽

Periaortic Fat

Download Full-text

Value of Coronary Artery Calcium Scanning by Computed Tomography for Predicting Coronary Heart Disease in Diabetic Subjects

Diabetes Care ◽

10.2337/diacare.26.3.905 ◽

2003 ◽

Vol 26 (3) ◽

pp. 905-910 ◽

Cited By ~ 68

Author(s):

W. Qu ◽

T. T. Le ◽

S. P. Azen ◽

M. Xiang ◽

N. D. Wong ◽

...

Keyword(s):

Computed Tomography ◽

Coronary Heart Disease ◽

Heart Disease ◽

Coronary Artery ◽

Coronary Artery Calcium

Download Full-text

Right ventricular crypts in a myocardial bridge: Relevance to surgical relief

Global Cardiology Science and Practice ◽

10.21542/gcsp.2019.21 ◽

2020 ◽

Vol 2019 (3) ◽

Author(s):

Magdi Yacoub ◽

Mohamed Nagy ◽

Hatem Hosny ◽

Ramy Doss ◽

Ahmed Afifi ◽

...

Keyword(s):

Heart Disease ◽

Coronary Artery ◽

Multimodality Imaging ◽

Hypertensive Heart Disease ◽

Myocardial Bridge ◽

Normal Individuals ◽

Before And After ◽

Thin Walled ◽

The Right ◽

First Time

Crypts are very thin walled invaginations from the cavity of the left ventricle into the compact myocardium. With the advent and increased application of multimodality imaging, crypts are being increasingly identified in both normal individuals and patients, with various conditions including HCM, before and after the development of LV hypertrophy, LV non-compaction and hypertensive heart disease. to date crypts have not been described in the right ventricle. We here describe for the first time, RV crypts which were extending into a myocardial bridge, in a patient with HCM and dynamic obstruction of the LAD coronary artery. We also document and discuss the serious complications which can arise from crypts, and highlight the importance of preoperative identification of crypts. Further studies are required to determine the fetal origin of crypts and their clinical significance

Download Full-text

Cardiac Computed Tomography for the Diagnosis of Coronary Artery Atherosclerosis

International Journal of Clinical Medicine ◽

10.4236/ijcm.2013.43032 ◽

2013 ◽

Vol 04 (03) ◽

pp. 183-189 ◽

Cited By ~ 1

Author(s):

Ryotaro Wake ◽

Hidetaka Iida ◽

Hirohito Ogata ◽

Hiroaki Takeshita ◽

Takanori Kusuyama ◽

...

Keyword(s):

Computed Tomography ◽

Coronary Artery ◽

Cardiac Computed Tomography ◽

Coronary Artery Atherosclerosis

Download Full-text

Abstract 13607: Seasonal Variation in the Attenuation of Epicardial Adipose Tissue on Cardiac Computed Tomography

Circulation ◽

10.1161/circ.142.suppl_3.13607 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

John M Archer ◽

Paolo Raggi ◽

Amin B Sagar ◽

Chao Zhang ◽

Varuna Gadiyaram ◽

...

Keyword(s):

Computed Tomography ◽

Adipose Tissue ◽

Seasonal Variation ◽

Coronary Artery ◽

Epicardial Adipose Tissue ◽

Subcutaneous Tissue ◽

Seasonal Temperature ◽

Clinical Factors ◽

Brown Adipose ◽

Coronary Artery Atherosclerosis

Introduction: The role of epicardial adipose tissue (EAT) in the development and vulnerability of coronary artery atherosclerosis has been the focus of extensive research for the past several years. EAT is visceral fat that surrounds the coronary arteries and it consists of beige adipose tissue that is functionally similar to brown adipose tissue and has a higher computed tomography (CT) attenuation than subcutaneous white adipose tissue. Given the brown-like composition of EAT, its attenuation may be affected by several factors including seasonal temperature variations and clinical factors. Hypothesis: We investigated the effect of season on EAT attenuation and additional clinical factors that may influence attenuation measurements. Methods: Single center, retrospective study of 597 cardiac CT exams performed for coronary artery calcium (CAC) scoring obtained on a single CT scanner during winter and summer months. Summer was defined as June, July, and August. Winter was defined as December, January, and February. EAT attenuation in Hounsfield units (HU) was measured in a region of interest near the right coronary artery ostium. Subcutaneous adipose tissue (SCAD) attenuation was measured in the thoracic subcutaneous tissue. Patients’ demographic and clinical characteristics were obtained by questionnaire and chart review. Results: The clinical and demographic characteristics of patients scanned during the summer (N=253) and the winter (N=344) months were similar. One third of patients were women, one quarter used statins and anti-hypertensive drugs each and 30% had a BMI>30. There was a significantly lower EAT attenuation measured during the summer than the winter months (-98.17±6.94 HUs vs -95.64±7.99 HUs; P<0.001). Additionally, gender, obesity, treatment with statins and anti-hypertensive agents significantly modulated the seasonal variation in EAT attenuation. SCAD attenuation was not affected by season or any other factor. Conclusions: Our study shows that the measurement of EAT attenuation is complex and is likely affected by season, demographics and clinical factors. Attempts to use EAT attenuation as a biomarker for risk of cardiovascular events should take these potential confounders into consideration.

Download Full-text