scholarly journals Coronary Artery Disease and Gallbladder Inflammatory Pseudopolyps

Diagnostics ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. 155
Author(s):  
Margherita Fosio ◽  
Giulia Cherobin ◽  
Roberto Stramare ◽  
Matteo Fassan ◽  
Chiara Giraudo
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Malignant Tumors ◽  
Acute Chest Pain ◽  
Acalculous Cholecystitis ◽  
Acute Acalculous Cholecystitis ◽  
Mr Image ◽  
Gallbladder Polyps ◽  
Artery Disease ◽  
Clinical Conditions

Axial MR image demonstrating multiple small gallbladder polypoid lesions characterized by contrast enhancement in a 78-year-old male hospitalized for acute chest pain due to coronary artery disease who showed fever and emesis during hospitalization and had signs of acute acalculous cholecystitis at computed tomography. Given the overall clinical conditions and the MR features, the inflammatory origin of the polyps was considered. The patient underwent cholecystectomy and the histological diagnosis of gallbladder inflammatory pseudopolyps was confirmed. This rare entity represents 5–10% of all gallbladder polyps, and their differentiation from benign and malignant tumors might be challenging especially in acalculous patients, thus surgery is often performed.

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.

Computed tomography angiography and other applications of computed tomography

2016 ◽  
Author(s):  
Michiel A de Graaf ◽  
Arthur JHA Scholte ◽  
Lucia Kroft ◽  
Jeroen J Bax
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Computed Tomography Angiography ◽  
Coronary Computed Tomography Angiography ◽  
Acute Chest Pain ◽  
Coronary Computed Tomography ◽  
Non Invasive ◽  
Artery Disease

Patients presenting with acute chest pain constitute a common and important diagnostic challenge. This has increased interest in using computed 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 computed 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, the non-invasive detection of coronary artery disease by computed 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 computed tomography angiography. Conversely, the implementation of coronary computed tomography angiography can significantly reduce the length of hospital stay, with a significant cost reduction. Additionally, computed 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, the acquisition of the coronary arteries, thoracic aorta, and pulmonary arteries in a single computed tomography examination is feasible, allowing ‘triple rule-out’ (exclusion of aortic dissection, pulmonary embolism, and coronary artery disease). Finally, other applications, such as the evaluation of coronary artery plaque composition, myocardial function and perfusion, or fractional flow reserve, are currently being developed and may also become valuable in the setting of acute chest pain in the future.

Abstract 224: Obesity Paradox in Coronary Artery Disease in Patients With Acute Chest Pain

Hypertension ◽  
2013 ◽  
Vol 62 (suppl_1) ◽  
Author(s):  
Kongkiat Chaikriangkrai ◽  
Mahwash Kassi ◽  
Sayf Khaleel bala ◽  
Su Min Chang
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Artery Calcium ◽  
Coronary Artery Calcium Score ◽  
Calcium Score ◽  
Acute Chest Pain ◽  
P Value ◽  
Artery Disease ◽  
Severe Calcification

Introduction Obesity has been inconsistently linked with coronary artery calcium score (CACS) as a surrogate of coronary artery disease (CAD) in asymptomatic subjects. Our aim was to examine whether there is relationship between obesity defined by BMI≥30kg/m 2 and presence and severity of CAD defined by CACS in patients with acute chest pain. Methods In this cross-sectional study, 1030 consecutive patients without reported history of coronary artery disease who presented with acute chest pain were included. CACS by non-contrast CT scan and BMI were collected. Patients were categorized by CACS classifications and BMI. Results The population with mean age of 54±13 years, 33% (338 of 1030) of patients being overweight and 46% (477 of 1030) being obese consisted of 60.6% (624 of 1030) patients with zero CACS, 21.7% (223 of 1030) with mild calcification (0<CACS<100) and 17.8% (183 of 1030) with moderate-to-severe calcification (CACS≥100). Compared to non-overweight/non-obese group, obese group had less patients with moderate-to-severe calcification (69 of 477; 14.5% VS 50 of 215; 22.6% p-value=0.016) despite more patients with hypertension (311 of 477; 65.2% VS 98 of 215; 45.6% p-value<0.001), diabetes (98 of 477; 20.5% VS 11 of 215; 5.1% p-value<0.001) and hyperlipidemia(174 of 477; 36.5% VS 57 of 215; 26.5% p-value=0.010). Obesity is INVERSELY associated with presence of CACS and moderate-to-severe calcification in multivariable logistic regression analysis (table 1). Conclusion Obesity defined by body mass index ≥ 30kg/m 2 is INVERSELY associated with presence and severity of coronary artery disease defined by coronary artery calcium score in patients with acute chest pain.

Abstract 128: A Precision Medicine Test Accurately Rules Out Obstructive Coronary Artery Disease Among Non-Diabetic Patients Presenting to Emergency Department With Acute Chest Pain

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Khurram Nasir ◽  
Shozab S Ali ◽  
Anshul Saxena ◽  
Gowtham Grandhi ◽  
Usman Siddiqui ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Emergency Department ◽  
Chest Pain ◽  
Coronary Artery ◽  
Obstructive Coronary Artery Disease ◽  
Acute Chest Pain ◽  
Diabetic Patients ◽  
High Grade ◽  
Intermediate Risk ◽  
Artery Disease

Background: An age, sex, and blood gene expression score (ASGES) has been previously validated to detect obstructive coronary artery disease (CAD) in non-diabetic patients presenting with stable chest pain in the outpatient setting. However, the diagnostic performance of this test in ruling out obstructive CAD in patients presenting with acute chest pain (ACP) to the emergency department (ED) is unknown. Methods: In an ongoing study, 371 low-intermediate risk patients with ACP and no prior history of CAD (TIMI risk score ≤ 2, negative troponins and normal/non-diagnostic ECG) underwent coronary CT angiography (CCTA) using institutional protocols. Patients were classified based on severity of stenosis (obstructive CAD, >50%; high grade stenosis, >70%) and ASGES. The ASGES blood test sample was drawn before ED discharge and analyzed in a commercial reference laboratory (Redwood City, CA). We excluded 23 (6%) patients with unreportable ASGES and 47 (13%) diabetics from this primary analysis. Results: 301 (53±10 years, 45% males, 78% Hispanics) non-diabetic ACP patients undergoing CCTA in an ED setting were included in this analysis. No plaque was detected in 183 (60%) patients, and 22 (7%) patients had obstructive CAD. In this population, 51% of patients had scores below the previously defined threshold of ASGES≤ 15. This threshold yielded sensitivity, specificity, NPV, and PPV of 71% (52-86%), 53% (47-59%), 97% (93-98%), and 12% (9-14%) for obstructive CAD. Furthermore, ASGES≤15 yielded a 100% sensitivity and NPV for patients with high grade stenosis (n=7, 2%). In a multivariable analysis including patient demographics and clinical covariates, ASGES ≤15 was significantly associated with obstructive CAD (OR: 0.15, 95% CI: 0.04-0.62). As a continuous variable, increasing ASGES was positively correlated with the presence of obstructive CAD and CCTA-defined plaque burden (p<0.0001). Conclusions: This is the first study validating the use of this blood-based precision medicine test to rule out obstructive CAD among low-intermediate risk non-diabetic patients presenting with ACP in ED setting. 30-day follow-up is underway to evaluate the prognostic implications of these findings.

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