scholarly journals Comparison of coronary CT angiography with conventional coronary angiography in the diagnosis of coronary artery disease

2014 ◽  
Vol 40 (1) ◽  
pp. 31-35
Author(s):  
N Mannan ◽  
MA Basher ◽  
J Mohammad ◽  
MU Jahan ◽  
NAM Momenuzzaman ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
High Sensitivity ◽  
Therapeutic Interventions ◽  
Conventional Coronary Angiography ◽  
Promising Alternative ◽  
Non Invasive ◽  
Coronary Ct ◽  
Coronary Imaging ◽  
Artery Disease

Noninvasive CT coronary angiography is a promising coronary imaging technique. In spite of the unprecedented temporal and spatial resolution and the inability to perform therapeutic interventions in the same session multi-detector computed tomography (MDCT) has been considering a promising alternative, non invasive tool for coronary artery imaging due to its high sensitivity and specificity for the detection of significant coronary artery stenosis. To evaluate the diagnostic accuracy of 64-slice MDCT for assessing haemodynamically significant stenoses of the coronary arteries in comparison with the conventional standard cardiac angiography. Fifty patients scheduled for conventional coronary angiography at the department of Radiology and Imaging, United Hospital, Dhaka were enrolled between July 2007 and June 2008. All patients underwent both conventional and MDCT angiography within mean 10.70 days. Overall sensitivity of 64-slice MDCT for the detection of stenosis ?50%, stenosis >50%, and stenosis >75% was 90.0%, 83.8%, and 80.7%, respectively, and specificity was 96.5%, 98.4%, and 98.3% respectively and accuracy was 96.0 %, 96.5%, and 96.6% respectively. Contrast-enhanced 64-slice MDCT allows the identification of coronary stenosis with excellent accuracy. Measurements of stenosis derived by MDCT correlated well with conventional angiogram. A major limitation is the insufficient ability of CT to exactly quantify the degree of stenosis. DOI: http://dx.doi.org/10.3329/bmrcb.v40i1.20334 Bangladesh Med Res Counc Bull 2014; 40: 31-35

scholarly journals Diagnostic and prognostic value of coronary artery calcium score of zero: is it time for guidelines to change?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Arbas Redondo ◽  
D Tebar Marquez ◽  
I.D Poveda Pinedo ◽  
R Dalmau Gonzalez-Gallarza ◽  
S.C Valbuena Lopez ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Artery Calcium ◽  
Cardiac Ct ◽  
Invasive Coronary Angiography ◽  
Agatston Score ◽  
Non Invasive ◽  
Artery Disease

Abstract Introduction Cardiac computed tomography (CT) use has progressively increased as the preferred initial test to rule out coronary artery disease (CAD) when clinical likelihood is low. Coronary artery calcium (CAC) detected by CT is a well-established marker for cardiovascular risk. However, it is not recommended for diagnosis of obstructive CAD. Absence of CAC, defined as an Agatston score of zero, has been associated to good prognosis despite underestimation of non-calcified plaques. Purpose To evaluate whether zero CAC score could help ruling out obstructive CAD in a safely manner. Methods Observational study based on a prospective database of patients (pts) referred to cardiac CT between 2017 and 2019. Pts with an Agatston score of zero were selected. Results We included 176 pts with zero CAC score and non-invasive coronary angiography performed. The median duration of follow-up was 23.9 months. Baseline characteristics of the population are shown in Table 1. In 117 pts (66.5%), cardiac CT was indicated as part of their chest pain evaluation. Mean age was 57.2 years old, 68.2% were women and only and 9.4% were active smokers. Normal coronary arteries were found in 173 pts (98.3%). Obstructive CAD, defined as ≥50% luminal diameter stenosis of a major vessel, was present in 1/176 (0.6%); while non-obstructive atherosclerotic plaques were found in 2 pts (1.1%). During follow-up, one patient died of out-of-hospital cardiac arrest. None either suffered from myocardial infarction or needed coronary revascularization. Conclusions In our cohort, a zero CAC score detected by cardiac CT rules out obstructive coronary artery disease in 98.3%, with only 1.7% of non-calcified atherosclerosis plaques and 0.6% of major adverse events. Although further research on this topic is needed, these results support the fact that non-invasive coronary angiography could be avoided in patients with low clinical likelihood of CAD and zero CAC score, facilitating the management of the increasing demand for coronary CT and reduction of radiation dose. Funding Acknowledgement Type of funding source: None

Anemia increases long-term mortality in patients undergoing conventional coronary angiography – the ECAT registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
B Balcer ◽  
I Dykun ◽  
S Hendricks ◽  
F Al-Rashid ◽  
M Totzeck ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Regression Analysis ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Conventional Coronary Angiography ◽  
Term Survival ◽  
Coronary Syndrome ◽  
Artery Disease

Abstract Background Anemia is a frequent comorbidity in patients with coronary artery disease (CAD). Besides a complemental effect on myocardial oxygen undersupply of CAD and anemia, available data suggests that it may independently impact the prognosis in CAD patients. We aimed to determine the association of anemia with long-term survival in a longitudinal registry of patients undergoing conventional coronary angiography. Methods The present analysis is based on the ECAD registry of patients undergoing conventional coronary angiography at the Department of Cardiology and Vascular Medicine at the University Clinic Essen between 2004 and 2019. For this analysis, we excluded all patients with missing hemoglobin levels at baseline admission or missing follow-up information. Anemia was defined as a hemoglobin level of <13.0g/dl for male and <12.0g/dl for female patients according to the world health organization's definition. Cox regression analysis was used to determine the association of anemia with morality, stratifying by clinical presentation of patients. Hazard ratio and 95% confidence interval are depicted for presence vs. absence of anemia. Results Overall, data from 28,917 patient admissions (mean age: 65.3±13.2 years, 69% male) were included in our analysis (22,570 patients without and 6,347 patients with anemia). Prevalence of anemia increased by age group (age <50 years: 16.0%, age ≥80 years: 27.7%). During a mean follow-up of 3.2±3.4 years, 4,792 deaths of any cause occurred (16.6%). In patients with anemia, mortality was relevantly higher as compared to patients without anemia (13.4% vs. 28.0% for patients without and with anemia, respectively, p<0.0001, figure 1). In univariate regression analysis, anemia was associated with 2.4-fold increased mortality risk (2.27–2.55, p<0.0001). Effect sizes remained stable upon adjustment for traditional risk factors (2.38 [2.18–2.61], p<0.0001). Mortality risk accountable to anemia was significantly higher for patients receiving coronary interventions (2.62 [2.35–2.92], p<0.0001) as compared to purely diagnostic coronary angiography examinations (2.31 [2.15–2.47], p<0.0001). Likewise, survival probability was slightly worse for patients with anemia in acute coronary syndrome (2.70 [2.29–3.12], p<0.0001) compared to chronic coronary syndrome (2.60 [2.17–3.12], p<0.0001). Interestingly, within the ACS entity, association of anemia with mortality was relevantly lower in STEMI patients (1.64 [1.10–2.44], p=0.014) as compared to NSTEMI and IAP (NSTEMI: 2.68 [2.09–3.44], p<0.0001; IAP: 2.67 [2.06–3.47], p<0.0001). Conclusion In this large registry of patients undergoing conventional coronary angiography, anemia was a frequent comorbidity. Anemia relevantly influences log-term survival, especially in patients receiving percutaneous coronary interventions. Our results confirm the important role of anemia for prognosis in patients with coronary artery disease, demonstrating the need for specific treatment options. Figure 1. Kaplan Meier analysis Funding Acknowledgement Type of funding source: None

Abstract 220: Magnetic Resonance Imaging in Children with Cardiac Complications of Kawasaki Disease: a Comparison with Echocardiography and Conventional Coronary Angiography

Circulation ◽  
2015 ◽  
Vol 131 (suppl_2) ◽  
Author(s):  
Michael Khoury ◽  
Cedric Manlhiot ◽  
Lars Grosse-Wortmann ◽  
Shi-Joon Yoo ◽  
Michael Seed ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Imaging Modality ◽  
Artery Bypass ◽  
Cardiac Complications ◽  
Conventional Coronary Angiography ◽  
Non Invasive ◽  
Collateral Artery ◽  
Perfusion Defects ◽  
Imaging Surveillance

Background: MRI is a potentially sensitive, specific, and non-invasive imaging modality that may be used in the detection and monitoring of KD cardiac complications. Its utility relative to the more commonly used imaging modalities of echocardiography and conventional coronary angiography has not been optimally established. Methods: We compared concomitant clinical data, echocardiography, MRI, and angiography findings for children with coronary artery aneurysms. Results: MRI and angiograms were performed within 1 month of each other for 15 patients (mean age 7 years, 80% male) at a mean of 4.2 years after diagnosis. Coronary artery bypass grafting (CABG) had been performed in 8 patients (53%). For 7 patients (47%), aneurysms were seen on MRI that were not seen on echocardiography. Wall motion abnormalities were reported in 7 subjects (47%). These were characterized on both echocardiography and MRI for all. MRI identified perfusion defects in 6 patients (40%) and evidence of myocardial scar in 9 patients (60%). Extra-cardiac aneurysms were identified in 5 patients (33%) on MRI. MRI showed strong correlation with angiograms regarding aneurysm location. MRI was limited in the assessment of bypass grafts in 4 of the 8 (50%) patients who had undergone CABG. Three patients (20%) had stenosis or thrombosis identified on angiography that were not appreciated on MRI. Angiograms provided added information regarding flow, stenoses, vascular morphology and/or calcification in 8 patients (53%). Collateral artery anatomy that was not appreciated on echo and MRI were reported on angiograms in 3 patients (20%). Conclusions: MRI provides a valuable and comprehensive assessment of the cardiac sequelae of KD, though is limited in its assessment of CABG, stenoses, and thrombosis. MRI may be an important component of non-invasive imaging surveillance of children with important coronary artery involvement.

Computerized tomography: coronary angiography and cardiac imaging

2021 ◽  
pp. 224-245
Author(s):  
Jeff M Smit ◽  
Mohammed El Mahdiui ◽  
Michiel A de Graaf ◽  
Arthur JHA Scholte ◽  
Lucia Kroft ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Pulmonary Embolism ◽  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Computerized Tomography ◽  
Acute Chest Pain ◽  
Non Invasive ◽  
Computerized Tomography Angiography ◽  
Artery Disease

Patients presenting with chronic and acute chest pain constitute a common and important diagnostic challenge. This has increased interest in using computerized tomography for non-invasive visualization of coronary artery disease in patients presenting with acute chest pain to the emergency department, particularly the subset of patients who are suspected of having an acute coronary syndrome, but without typical electrocardiographic changes and with normal troponin levels at presentation. As a result of rapid developments in coronary computerized tomography angiography technology, high diagnostic accuracies for excluding coronary artery disease can be obtained. It has been shown that these patients can be discharged safely. The accuracy for detecting a significant coronary artery stenosis is also high, but the presence of coronary artery atherosclerosis or stenosis does not imply necessarily that the cause of the chest pain is related to coronary artery disease. Moreover, non-invasive detection of coronary artery disease by computerized tomography has been shown to be related with an increased use of subsequent invasive coronary angiography and revascularization, and further studies are needed to define which patients benefit from invasive evaluation following coronary computerized tomography angiography. Conversely, implementation of coronary computerized tomography angiography can significantly reduce the length of hospital stay, with a significant cost reduction. Additionally, computerized tomography is an excellent modality in patients whose symptoms suggest other causes of acute chest pain such as aortic aneurysm, aortic dissection, or pulmonary embolism. Furthermore, acquisition of the coronary arteries, thoracic aorta, and pulmonary arteries in a single computerized tomography examination is feasible, allowing ‘triple rule-out’ (exclusion of aortic dissection, pulmonary embolism, and coronary artery disease). Finally, other applications, such as evaluation of coronary artery plaque composition, myocardial function and perfusion, and non-invasive assessment of fractional flow reserve from coronary computerized tomography angiography, are currently being developed and may also become valuable in the setting of chronic and acute chest pain in the future.

A Randomized Trial Comparing Dual Axis Rotational Versus Conventional Coronary Angiography in a Population with a High Prevalence of Coronary Artery Disease

2014 ◽  
Vol 27 (5) ◽  
pp. 456-464 ◽  
Author(s):  
RAFAEL S. O. GIUBERTI ◽  
ADRIANO CAIXETA ◽  
ANTÔNIO C. CARVALHO ◽  
MILTON M. SOARES ◽  
ERLON O. ABREU-SILVA ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Randomized Trial ◽  
Conventional Coronary Angiography ◽  
High Prevalence ◽  
Artery Disease

Abstract 15359: Cost-effectiveness of Different Strategies for the Diagnosis of Stable Coronary Artery Disease: Results from the Evinci Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Giuseppe Turchetti ◽  
Valentina Lorenzoni ◽  
Stefania Bellelli ◽  
Francesca Pierotti ◽  
Daniele Rovai ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Cost Effectiveness ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Stable Angina ◽  
Imaging Modalities ◽  
Fractional Flow ◽  
Stress Imaging ◽  
Non Invasive ◽  
Artery Disease

Introduction: In patients with suspected coronary artery disease (CAD) the comparative value of non invasive diagnostic imaging modalities or strategies is not yet defined. Hypothesis: We hypothesized that a comparative cost-effectiveness (CE) analysis of different non-invasive imaging strategies in a European population of patients with stable angina could identify the best approach for the diagnosis of significant CAD. Methods: In 475 pts (291 males, 60±9 yrs) with stable angina enrolled in the EVINCI multicenter study, CT coronary angiography (CTCA) and stress imaging were performed before invasive coronary angiography (ICA). Significant CAD was defined as >50% stenosis in the left main or >70% stenosis in a major coronary vessel or 30-70% stenosis with fractional flow reserve ≤0.8. Non-invasive imaging strategies included CTCA or stress imaging (ECHO, CMR, SPECT or PET) alone or in combination. Combinations were positive if both CTCA and the stress test were positive. CE analysis was performed using per patient data. Effectiveness was defined as percentage of correct diagnosis. Costs were calculated by country-specific reimbursements for each test considered plus ICA costs when non invasive tests were positive. Incremental cost-effectiveness ratios (ICERs) were obtained by regression analysis and using a propensity-score adjustment. Results: Significant CAD was diagnosed at ICA in 140 pts (29%). CTCA had the highest diagnostic performance among single imaging modalities and CTCA-PET among combinations (Table). At CE analysis, ECHO approach was the least costly but also the least effective, while CTCA alone or in combination with PET had increasingly higher effectiveness for a willingness to pay (WTP) exceeding 2,000 Euro and 5,000 Euro, respectively (Table). Conclusion: Stress ECHO is a cost-effective approach to diagnose stable CAD when the WTP is low. CTCA alone or combined with stress PET allows a more effective diagnostic workflow for higher WTP.

Echocardiography calcium score as predictive tools of severity of coronary artery disease

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Asmaa Ismail ◽  
Adham Abdeltawab ◽  
Alaa Roshdy
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Calcium Score ◽  
Syntax Score ◽  
Study Group ◽  
Non Invasive ◽  
Significant Difference ◽  
The Mean ◽  
Artery Disease

Abstract Background Coronary artery disease (CAD) represents a leading cause of death worldwide. Coronary angiography represents the gold standard for diagnosis and selection of the best treatment for the patients with coronary artery disease; however some efforts have been made to predict CAD severity and complexity using non-invasive methods in order to identify the patients at high risk for cardiovascular events with less risk to the patients and before doing coronary angiography. Characterization of coronaryartery calcification by computed tomography known as Coronary artery calcium score (CACS) is equivalent to the total coronary atherosclerosis load and is proven to be related to angiographically significant lesions. Echocardiographic calcium score is now validated against non-coronary calcium by computed tomography with lower cost and no irradiation safety issues for reclassification of cardiac risk. Aim and Objectives to determine the correlation of echocardiography calcium score to severity of coronary artery disease. Patients and Methods Patients coming to Ain Shams University Hospitals for elective coronary angiography were subjected to histoty taking, examination, blood samples and echocardiographic examination. The echocardiographic calcium score was correlated with syntax score of their coronary angiography films. Also syntax score was divided into three groups; low risk ≤ 18, intermediate risk 18-27 and high risk groups >27. Results The study included 45 patients; 21 of which were males representing 46.6% of the participants. The mean age of the whole group was 52.7 ± 8.18. The mean final calcium score of the whole study group was 4.95±1.29. The mean syntax score of the whole study group was 22.88±12.3. There was significant difference between the three subgroups of the syntax score regarding total calcium score (p value 0.013) and highly significant difference between the numerical values of syntax score and final calcium score. Conclusion Echocardiographic calcium score is correlated to syntax score and the severity of coronary artery disease. The low cost, availability and the radiation free nature of echocardiography make it an attractive candidate for the on-going research regarding the non-invasive tools for prediction of CAD.

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