The study of myocardial perfusion by cardiac volumetric computed tomography, combined with adenosine triphosphate test, in a patient with painless myocardial ischemia and atherosclerosis of the coronary arteries

The presented clinical observation demonstrates the diagnostic capabilities of cardiac volumetric computed tomography (CT) with a pharmacological test by a vasodilator adenosine triphosphate (ATP) in the simultaneous assessment of coronary anatomy and changes in left ventricular myocardial perfusion (LV) in a patient with painless myocardial ischemia and coronary atherosclerosis. A 68-year-old patient with coronary heart disease (CHD) and atherosclerotic changes in the coronary arteries underwent cardiac volumetric CT in combination with a ATP pharmacological test. The study was performed on a Aquilion ONE 640 Vision Edition computer tomograph (Toshiba, Japan). Assessment of LV myocardial perfusion was carried out in comparison with other clinical, laboratory and instrumental examination methods. The results of clinical and instrumental examination of a patient with a low pre-test probability of coronary heart disease are presented. From the standpoint of modern recommendations on stable coronary heart disease, false-negative results of single-photon emission computed tomography of the heart and stress-echocardiography are discussed. Clinical observation demonstrates the feasibility of diagnosing LV myocardial ischemia by cardiac volumetric CT combined with ATP pharmacological test, confirmed by an invasive determination of the fractional flow reserve. The given clinical example represents the advantage of cardiac volumetric CT, combined with the ATP pharmacological test, as a method for visualizing LV myocardial perfusion in detecting myocardial ischemia.

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Safety and Effectiveness of Volumetric Computed Tomography of the Heart in Combination with a PharmacologicaTest with Adenosine Triphosphate in the Diagnosis of Coronary Heart Disease

Kardiologiia ◽

10.18087/cardio.2020.11.n1258 ◽

2020 ◽

Vol 60 (11) ◽

pp. 57-65

Author(s):

A. A. Minasyan ◽

G. N. Soboleva ◽

S. A. Gaman ◽

M. A. Shariya ◽

S. K. Ternovoy ◽

...

Keyword(s):

Computed Tomography ◽

Heart Disease ◽

Myocardial Ischemia ◽

Adenosine Triphosphate ◽

Left Ventricular ◽

Bicycle Ergometry ◽

Noninvasive Methods ◽

Good Tolerability ◽

Pharmacological Test ◽

Volumetric Ct

Aim To evaluate safety and efficacy of sodium adenosine triphosphate (ATP) as a vasodilator in assessment of left ventricular (LV) myocardial perfusion and in verification of ischemia by cardiac volumetric computed tomography (CT).Material and methods The study included 58 patients with suspected ischemic heart disease (IHD). For all included patients, cardiac volumetric CT with a pharmacological ATP test was performed. The rate of adverse effects was analyzed during the ATP infusion. Results of the study were compared with data from using other noninvasive methods for IHD diagnosis by calculating Cohen’s kappa, the measure of agreement between two variables.Results The test performed during CT showed good tolerability of the ATP infusion, a low rate of moderate adverse reactions (8.6 %), and the absence of severe side effects. Results of diagnosing IHD with cardiac volumetric CT with the ATP pharmacological test were comparable with data from using other methods for noninvasive verification of LV myocardial ischemia (bicycle ergometry, treadmill test, stress echocardiography) in combination with coronarography or CT coronarography.Conclusion ATP appears a safe pharmacological agent for diagnosing transient LV myocardial ischemia. ATP can be recommended as a vasodilator for evaluation of perfusion using cardiac volumetric CT.

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Integration Between Computed Tomography and Nuclear Medicine for Non-invasive Assessment of Coronary Anatomy and Myocardial Perfusion

European Cardiology Review ◽

10.15420/ecr.2012.5.2.15 ◽

2009 ◽

Vol 5 (2) ◽

pp. 15

Author(s):

Wanda Acampa ◽

Mario Petretta ◽

Carmela Nappi ◽

Alberto Cuocolo ◽

◽

...

Keyword(s):

Computed Tomography ◽

Coronary Heart Disease ◽

Blood Flow ◽

Heart Disease ◽

Myocardial Perfusion ◽

Myocardial Blood Flow ◽

Imaging Techniques ◽

Emission Computed Tomography ◽

Coronary Anatomy ◽

Non Invasive

Many non-invasive imaging techniques are available for the evaluation of patients with known or suspected coronary heart disease. Among these, computed-tomography-based techniques allow the quantification of coronary atherosclerotic calcium and non-invasive imaging of coronary arteries, whereas nuclear cardiology is the most widely used non-invasive approach for the assessment of myocardial perfusion. The available single-photon-emission computed tomography flow agents are characterised by a cardiac uptake proportional to myocardial blood flow. In addition, different positron emission tomography tracers may be used for the quantitative measurement of myocardial blood flow and coronary flow reserve. Extensive research is being performed in the development of non-invasive coronary angiography and myocardial perfusion imaging using cardiac magnetic resonance. Finally, new multimodality imaging systems have recently been developed bringing together anatomical and functional information. This article provides a description of the available non-invasive imaging techniques in the assessment of coronary anatomy and myocardial perfusion in patients with known or suspected coronary heart disease.

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Myocardial perfusion assessed with cardiac computed tomography in women without coronary heart disease

Clinical Physiology and Functional Imaging ◽

10.1111/cpf.12542 ◽

2018 ◽

Vol 39 (1) ◽

pp. 65-77 ◽

Cited By ~ 2

Author(s):

Daria Frestad Bechsgaard ◽

Ida Gustafsson ◽

Jesper James Linde ◽

Klaus Fuglsang Kofoed ◽

Eva Prescott ◽

...

Keyword(s):

Computed Tomography ◽

Coronary Heart Disease ◽

Heart Disease ◽

Myocardial Perfusion ◽

Cardiac Computed Tomography

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Results of holter monitoring in patients with coronary heart disease depending on the severity of atherosclerotic lesions of the coronary arteries

ScienceRise Medical Science ◽

10.15587/2519-4798.2021.232642 ◽

2021 ◽

pp. 15-19

Author(s):

Tetiana Pylova

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Comparative Analysis ◽

Myocardial Ischemia ◽

Coronary Arteries ◽

Holter Monitoring ◽

Group I ◽

St Segment ◽

Stable Coronary Heart Disease ◽

Group Ii

The aim – to conduct a comparative analysis of the presence, frequency and duration of episodes of myocardial ischemia and arrhythmias based on the results of Holter monitoring in patients with coronary heart disease depending on the condition of the coronary arteries. Materials and methods. We examined 53 patients (group I) with stable coronary heart disease (CHD) and slightly altered coronary arteries (INOCA), who were hospitalized in the period from October 2018 to February 2021 at the “City Clinical Hospital № 8” of Kharkiv City Council. Group II included 52 patients with a diagnosis of stable coronary heart disease, and according to coronary angiography (CAG) had stenosis of coronary arteries (CA) more than 50 %. Results. According to the results of comparative analysis, it was found that in group I there were signs of myocardial ischemia – depression of the ST segment in 62.3 % (n=33) and elevation of the ST segment in 11.3 % (n=6), compared with group II -73 % (n=38) and 5.66 % (n=3), respectively. Ventricular arrhythmias (VA) have been reported in 52 patients of group I, and in 44 patients of group II. VA 4 and 5 type according to Laun, was significantly higher in group II compared with group I (p=0.0324). The occurrence of ventricular tachycardia was recorded in 5.7 % (n=3) of patients in group I and 9.3 % (n=5) patients of group II (p=0.347). In group II, there was a tendency to more episodes of ischemia compared with group I (p=0.072). The duration of ischemia was significantly longer in group I, compared with group II (p=0.042). Conclusions. The results of the study did not show significant differences in the development of the number of episodes of myocardial ischemia according to Holter monitoring depending on the condition of the coronary arteries. The duration of episodes of ischemia in patients with INOCA is significantly longer than in patients with obstructive atherosclerosis. In patients with coronary heart disease with obstructive coronary arteries, ventricular arrhythmia was statistically significantly more severe according to Lown

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

Journal of New Medical Technologies ◽

10.12737/7267 ◽

2014 ◽

Vol 21 (4) ◽

pp. 44-48 ◽

Cited By ~ 1

Author(s):

Вардиков ◽

D. Vardikov ◽

Яковлева ◽

E. Yakovleva

Keyword(s):

Computed Tomography ◽

Coronary Heart Disease ◽

Heart Disease ◽

Coronary Artery ◽

Coronary Angiography ◽

Coronary Arteries ◽

Optimization Techniques ◽

Information Value ◽

Computed Tomographic ◽

Computed Tomographic Coronary Angiography

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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Diagnostic Value of Multisliced Computed Tomography in Coronary Arteries Atherosclerotic Lesions Detection in the Patients with Coronary Heart Disease - a Comparative Study

Establishing Better Standards of Care in Doppler Echocardiography, Computed Tomography and Nuclear Cardiology ◽

10.5772/24518 ◽

2011 ◽

Author(s):

Maryna N. ◽

Sergey V. ◽

Natalia N.

Keyword(s):

Computed Tomography ◽

Coronary Heart Disease ◽

Heart Disease ◽

Comparative Study ◽

Coronary Arteries ◽

Diagnostic Value ◽

Atherosclerotic Lesions

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Myocardial perfusion imaging using computed tomography: Current status, clinical value and prognostic implications

Imaging ◽

10.1556/1647.2020.00009 ◽

2021 ◽

Author(s):

Borbála Vattay ◽

Melinda Boussoussou ◽

Sarolta Borzsák ◽

Milán Vecsey-Nagy ◽

Judit Simon ◽

...

Keyword(s):

Computed Tomography ◽

Heart Disease ◽

Myocardial Perfusion Imaging ◽

Myocardial Perfusion ◽

Myocardial Ischemia ◽

Ischemic Heart Disease ◽

Perfusion Imaging ◽

Current Status ◽

Myocardial Tissue ◽

Clinical Value

AbstractCombined anatomical and functional evaluation of coronary artery disease (CAD) using computed tomography (CT) has recently emerged as an accurate, robust, and non-invasive tool for the evaluation of ischemic heart disease. Cardiac CT has become a one-stop-shop imaging modality that allows the simultaneous depiction, characterization, and quantification of coronary atherosclerosis and the assessment of myocardial ischemia. Advancements in scanner technology (improvements in spatial and temporal resolution, dual-energy imaging, wide detector panels) and the implementation of iterative reconstruction algorithms enables the detection of myocardial ischemia in both qualitative and quantitative fashion using low-dose scanning protocols. The addition of CT perfusion (CTP) to standard coronary CT angiography is a reliable tool to improve diagnostic accuracy. CTP using static first-pass imaging enables qualitative assessment of the myocardial tissue, whereas dynamic perfusion imaging can also provide quantitative information on myocardial blood flow. Myocardial tissue assessment by CTP holds the potential to refine risk in stable chest pain or microvascular dysfunction. CTP can aid the detection of residual ischemia after coronary intervention. Comprehensive evaluation of CAD using CTP might therefore improve the selection of patients for aggressive secondary prevention therapy or coronary revascularization with high diagnostic certainty. In addition, prognostic information provided by perfusion CT imaging could improve patient outcomes by quantifying the ischemic burden of the left ventricle. The current review focuses on the clinical value of myocardial perfusion imaging by CT, current status of CTP imaging and the use of myocardial CTP in various patient populations for the diagnosis of ischemic heart disease.

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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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