scholarly journals The Role of 64/128-Slice Multidetector Computed Tomography to Assess the Progression of Coronary Atherosclerosis

2015 ◽  
Vol 9 ◽  
pp. CMC.S20606 ◽  
Author(s):  
Sherif W. Ayad ◽  
Eman M. Elsharkawy ◽  
Salah M. Eltahan ◽  
Mohamed A. Sobhy ◽  
Reem H. Laymouna
Keyword(s):  
Risk Factors ◽  
Computed Tomography ◽  
Chest Pain ◽  
Multidetector Computed Tomography ◽  
Coronary Atherosclerosis ◽  
Plaque Progression ◽  
Plaque Composition ◽  
History Of ◽  
Over Time

Objectives We studied the progression of coronary atherosclerosis over time as detected by multidetector computed tomography (MDCT) in relation to risk factors and plaque composition. Background Studies using MDCT are limited to the assessment of the degree of stenosis without taking into consideration the plaque composition that is seen by MDCT. Methods This study included 200 patients, complaining of chest pain and referred to do 64/128-contrast–enhanced MDCT for the second time, and both studies were retrieved and evaluated for the presence of plaque, plaque type, vessel wall remodeling, percent area, and diameter stenosis and compared in both studies. Plaque progression over time and its association with risk factors were determined. Results We included 200 patients, and 348 plaques were detected by 64/128 MDCT. The duration between follow-up and baseline studies was 25.9 ± 19.2 month. In all, 200 plaques showed progression (57.47%), 122 were stable (35.06%), and 26 regressed (7.47%). In longitudinal regression analysis, the presence of history of diabetes mellitus and dyslipidemia and the absence of intraplaque calcium deposits were independently associated with plaque progression over time ( P < 0.0001). Conclusion Coronary plaque burden of patients with chest pain and no history of acute coronary syndrome significantly increased over time. Progression is dependent on plaque composition and cardiovascular risk factors. Larger studies and longer follow-up period are needed to confirm the determinant factors for plaque progression.

scholarly journals Chest Pain and Exercise Induced Ischemia with Angiographically Insignificant Coronary Arterial Disease: Clinical Presentation and Follow-Up

1970 ◽  
Vol 6 (1) ◽  
pp. 27-31
Author(s):  
Md Khurshed Ahmed ◽  
Mohammad Salman ◽  
Md Ashraf Uddin Sultan ◽  
Md Abu Siddique ◽  
KMHS Sirajul Haque ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Chest Pain ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Coronary Angiogram ◽  
Ecg Changes ◽  
History Of

Angiography of patients with typical chest pain reveals normal epicardial coronary arteries in about 15-20%. ECG changes suggestive of myocardial ischemia during exercise also can be demonstrated in this subset of the patients. Total 58 patients (42 females) with mean age 42±7 years who were undergoing coronary angiogram in the Department of Cardiology, University Cardiac Center, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2005 to December 2009 were evaluated. The patients were recruited on the basis of presence of history of chest pain, with normal resting ECG and ischemia like ECG changes during exercise stress test. 32.8% patients had hypertension and 15.5% were diabetics, 19.0% had dyslipidemia and 6.9% had family history of ischemic heart disease. All the patients were having positive exercise stress test. Angiographic findings showed luminal irregularities in 29.3% patients, 15.5% patients had luminal stenosis less than 30% and rest had normal coronary angiogram. Follow up of the patients after one and six months of angiogram was done. After one month 63.8% patients remained symptomatic and after six months 63.3% patients remained symptomatic despite maximum medical management. The pathophysiology and appropriate management of this subset of the patients still remained a challenge for physicians. Optimum management of cardiovascular risk factors is very important issue in this group of patients.Key words: Angiography; Epicardial coronary arteries; Exercise stress test; Cardiovascular risk factors. DOI: 10.3329/uhj.v6i1.7187University Heart Journal Vol.6(1) 2010 pp.27-31

Adult Victimization over Time

2018 ◽  
pp. 171-174
Author(s):  
Mary C. Zanarini
Keyword(s):  
Risk Factors ◽  
Sexually Abused ◽  
Female Gender ◽  
Physical Assault ◽  
Clinical Implications ◽  
Axis Ii ◽  
Borderline Patients ◽  
History Of ◽  
Over Time

At baseline, borderline patients reported higher rates of adult rape and physical assault by a partner than Axis II comparison subjects. Four risk factors were found to significantly predict whether borderline patients had an adult history of being a victim of physical and/or sexual violence before their index admission: female gender, a substance use disorder that began before the age of 18, childhood sexual abuse, and emotional withdrawal by a caretaker (a form of neglect). At six-year and 10-year follow-up, borderline patients reported higher rates of being verbally, emotionally, physically, and sexually abused or assaulted than did Axis II comparison subjects. However, each of these forms of abuse declined significantly over time. The clinical implications of these prevalence and predictive findings are discussed.

Relationship between patient presentation and morphology of coronary atherosclerosis by quantitative multidetector computed tomography

2018 ◽  
Vol 20 (11) ◽  
pp. 1221-1230 ◽  
Author(s):  
Martina C de Knegt ◽  
Jesper J Linde ◽  
Andreas Fuchs ◽  
Michael H C Pham ◽  
Andreas K Jensen ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Chest Pain ◽  
Coronary Atherosclerosis ◽  
Acute Chest Pain ◽  
Coronary Plaque ◽  
Plaque Composition ◽  
Plaque Volume ◽  
Clinical Risk ◽  
Asymptomatic Individuals ◽  
Patient Presentation

Abstract Aims Quantitative computed tomography (QCT) allows assessment of morphological features of coronary atherosclerosis. We aimed to test the hypothesis that clinical patient presentation is associated with distinct morphological features of coronary atherosclerosis. Methods and results A total of 1652 participants, representing a spectrum of clinical risk profiles [787 asymptomatic individuals from the general population, 468 patients with acute chest pain without acute coronary syndrome (ACS), and 397 patients with acute chest pain and ACS], underwent multidetector computed tomography. Of these, 274 asymptomatic individuals, 254 patients with acute chest pain without ACS, and 327 patients with acute chest pain and ACS underwent QCT to assess coronary plaque volumes and proportions of dense calcium (DC), fibrous, fibro fatty (FF), and necrotic core (NC) tissue. Furthermore, the presence of vulnerable plaques, defined by plaque volume and tissue composition, was examined. Coronary plaque volume increased significantly with worsening clinical risk profile [geometric mean (95% confidence interval): 148 (129–166) mm3, 257 (224–295) mm3, and 407 (363–457) mm3, respectively, P < 0.001]. Plaque composition differed significantly across cohorts, P < 0.0001. The proportion of DC decreased, whereas FF and NC increased with worsening clinical risk profile (mean proportions DC: 33%, 23%, 23%; FF: 50%, 61%, 57%; and NC: 17%, 17%, 20%, respectively). Significant differences in plaque composition persisted after multivariable adjustment for age, gender, body surface area, hypertension, statin use at baseline, diabetes, smoking, family history of ischaemic heart disease, total plaque volume, and tube voltage, P < 0.01. Conclusion Coronary atherosclerotic plaque volume and composition are strongly associated to clinical presentation.

scholarly journals Carotid Atherosclerotic Plaque Progression and Change in Plaque Composition Over Time: A 5-Year Follow-Up Study Using Serial CT Angiography

2012 ◽  
Vol 33 (7) ◽  
pp. 1267-1273 ◽  
Author(s):  
M.J. van Gils ◽  
D. Vukadinovic ◽  
A.C. van Dijk ◽  
D.W.J. Dippel ◽  
W.J. Niessen ◽  
...  
Keyword(s):  
Ct Angiography ◽  
Atherosclerotic Plaque ◽  
Plaque Progression ◽  
Carotid Atherosclerotic Plaque ◽  
Plaque Composition ◽  
Follow Up Study ◽  
Serial Ct ◽  
Over Time

scholarly journals Sex differences in coronary plaque changes assessed by serial computed tomography angiography

2021 ◽  
Author(s):  
Mohammed El Mahdiui ◽  
Jeff M. Smit ◽  
Alexander R. van Rosendael ◽  
Danilo Neglia ◽  
Juhani Knuuti ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Sex Differences ◽  
Computed Tomography Angiography ◽  
Coronary Plaque ◽  
Intermediate Risk ◽  
Plaque Progression ◽  
Coronary Cta ◽  
Over Time

AbstractLong-term data on sex-differences in coronary plaque changes over time is lacking in a low-to-intermediate risk population of stable coronary artery disease (CAD). The aim of this study was to evaluate the role of sex on long-term plaque progression and evolution of plaque composition. Furthermore, the influence of menopause on plaque progression and composition was also evaluated. Patients that underwent a coronary computed tomography angiography (CTA) were prospectively included to undergo a follow-up coronary CTA. Total and compositional plaque volumes were normalized using the vessel volume to calculate a percentage atheroma volume (PAV). To investigate the influence of menopause on plaque progression, patients were divided into two groups, under and over 55 years of age. In total, 211 patients were included in this analysis, 146 (69%) men. The mean interscan period between baseline and follow-up coronary CTA was 6.2 ± 1.4 years. Women were older, had higher HDL levels and presented more often with atypical chest pain. Men had 434 plaque sites and women 156. On a per-lesion analysis, women had less fibro-fatty PAV compared to men (β -1.3 ± 0.4%; p < 0.001), with no other significant differences. When stratifying patients by 55 years age threshold, fibro-fatty PAV remained higher in men in both age groups (p < 0.05) whilst women younger than 55 years demonstrated more regression of fibrous (β -0.8 ± 0.3% per year; p = 0.002) and non-calcified PAV (β -0.7 ± 0.3% per year; p = 0.027). In a low-to-intermediate risk population of stable CAD patients, no significant sex differences in total PAV increase over time were observed. Fibro-fatty PAV was lower in women at any age and women under 55 years demonstrated significantly greater reduction in fibrous and non-calcified PAV over time compared to age-matched men. (ClinicalTrials.gov number, NCT04448691.)

Looking for ischemia in patients with stable atypical chest pain: useful or useless?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Cosmi ◽  
B Mariottoni ◽  
F Cosmi
Keyword(s):  
Risk Factors ◽  
Chest Pain ◽  
Coronary Angiography ◽  
Functional Tests ◽  
Stress Tests ◽  
Atypical Chest Pain ◽  
History Of ◽  
Coronary Events ◽  
Nuclear Stress Testing

Abstract Introduction Patients with stable atypical chest pain (SACP) represent more than half of those with chest pain who require an outpatient evaluation. It's not clear if in these patients the prognosis is linked more to the optimal control of risk factors and to the research and treatment of any unfavorable anatomical alterations (common trunk obstruction, proximal involvement of VAT, multivessel disease with systolic dysfunction of the left ventricle) rather than to ischemia assessment with functional tests. Methods In the past 20 years we have evaluated the lifestyles of 40,422 outpatient patients. 9% (3,638) had a history of stable chest pain with no history of previous cardiovascular events. In the 1,322 patients (36%) with non-anginal chest pain, no diagnostic examination was performed after the electrocardiogram (ECG) and the echocardiogram. 462 patients (13%) had typical chest pain, and 422 of them performed a coronary angiography. The other 1,854 (51%) patients with SACP underwent functional testing for ischemia (exercise ECG, ecostress, nuclear stress testing). They were also stratified according to the presence of 4 main modifiable lifestyles (cigarette smoking, diet, physical activity, obesity) and the 3 main cardiovascular risk factors (hypercholesterolemia, hypertension, diabetes). Results In the SACP group, the search for ischemia was positive in 192 patients (10.4%); 178 of them underwent coronary angiography, which demonstrated the presence of lesions with indication to revascularization to improve the prognosis, according to the ESC 2018 guidelines (Class IA), in 21 patients (11.7%). In the remaining 1,662 patients functional tests were negative. We performed one-year follow-up. Major coronary events (fatal and non-fatal infarction, sudden death) occurred in 22 patients (1.3%) with negative stress tests and at least 3 risk factors or bad lifestyles (especially smoking, diabetes, high LDL). In patients with positive stress tests, there were 3 events, (1.5%), that occurred among patients with at least 3 risk factors, too. No events occurred in patients with fewer than 3 risk factors or lifestyles in either group. Conclusions In patients with SACP and negative functional test the risk of major coronary events remains 1.3% at 1 year of follow-up; the events occurr in patients with 3 or more factors or lifestyle at risk (especially smoking, diabetes, elevated LDL). The prognosis is similar to those with positive ischemia research. The improvement of the outcomes should be entrusted more to a close control of the risk factors, to an optimal improvement of the lifestyles and to an anatomical evaluation (coronary CT) for the evaluation of those lesions that improve the prognosis rather than the search for ischemia which appears futile from a diagnostic and prognostic point of view as well as a source of economic waste. Funding Acknowledgement Type of funding source: None

scholarly journals Spontaneous pneumomediastinum presenting as rhinolalia and chest pain

2012 ◽  
Vol 94 (8) ◽  
pp. e12-e14 ◽  
Author(s):  
RWF Breakey ◽  
G Walker ◽  
W Oldfield
Keyword(s):  
Computed Tomography ◽  
Differential Diagnosis ◽  
Chest Pain ◽  
Complete Resolution ◽  
Intrathoracic Pressure ◽  
Detailed History ◽  
Spontaneous Pneumomediastinum ◽  
History Of ◽  
Voice Symptoms

This report discusses a case of spontaneous pneumomediastinum in a 25-year-old medical student. The patient presented with chest pain and a tonal change in voice. Symptoms occurred after an episode of stretching and were exacerbated by coughing. There was no history of underlying respiratory disease and he was a non-smoker. Management was conservative. At the four-week follow-up appointment, bronchoscopy and computed tomography of the thorax demonstrated complete resolution. Spontaneous pneumomediastinum is uncommon, with rhinolalia being a rare presenting feature. It should be considered as a differential diagnosis in patients with chest pain associated with a change in voice. A detailed history may reveal preceding activities associated with raised intrathoracic pressure.

Cavernous sinus aneurysms: risk of growth over time and risk factors

2020 ◽  
Vol 132 (1) ◽  
pp. 22-26 ◽  
Author(s):  
Giovanni Vercelli ◽  
Thomas J. Sorenson ◽  
Ahmad Z. Aljobeh ◽  
Roanna Vine ◽  
Giuseppe Lanzino
Keyword(s):  
Risk Factors ◽  
Internal Carotid ◽  
Limited Information ◽  
Benign Lesions ◽  
Risk Of Rupture ◽  
History Of ◽  
Aneurysm Growth ◽  
Over Time ◽  
New Onset

OBJECTIVECavernous internal carotid artery (ICA) aneurysms are frequently diagnosed incidentally and the benign natural history of these lesions is well known, but there is limited information assessing the risk of growth in untreated patients. The authors sought to assess and analyze risk factors in patients with cavernous ICA aneurysms and compare them to those of patients with intracranial berry aneurysms in other locations.METHODSData from consecutive patients who were diagnosed with a cavernous ICA aneurysm were retrospectively reviewed. The authors evaluated patients for the incidence of cavernous ICA aneurysm growth and rupture. In addition, the authors analyzed risk factors for cavernous ICA aneurysm growth and compared them to risk factors in a population of patients diagnosed with intracranial berry aneurysms in locations other than the cavernous ICA during the same period.RESULTSIn 194 patients with 208 cavernous ICA aneurysms, the authors found a high risk of aneurysm growth (19.2% per patient-year) in patients with large/giant aneurysms. Size was significantly associated with higher risk of growth. Compared to patients with intracranial berry aneurysms in other locations, patients with cavernous ICA aneurysms were significantly more likely to be female and have a lower incidence of hypertension.CONCLUSIONSAneurysms of the cavernous ICA are benign lesions with a negligible risk of rupture but a definite risk of growth. Aneurysm size was found to be associated with aneurysm growth, which can be associated with new onset of symptoms. Serial follow-up imaging of a cavernous ICA aneurysm might be indicated to monitor for asymptomatic growth, especially in patients with larger lesions.

Sex differences in the natural history of plaque progression by serial coronary computed tomography angiography

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M El Mahdiui ◽  
J.M Smit ◽  
A.R Van Rosendael ◽  
D Neglia ◽  
J Knuuti ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Computed Tomography Angiography ◽  
Age Groups ◽  
Funding Source ◽  
Age Group ◽  
Plaque Progression ◽  
Plaque Composition ◽  
Coronary Cta ◽  
Males And Females

Abstract Background Sex related differences exist for coronary artery disease (CAD). Women tend to be older when presenting with CAD and have lower rates of obstructive disease. Invasive intravascular ultrasound studies have shown differences in plaque composition between males and females. However, these studies were performed in a high risk population needing invasive imaging. Coronary computed tomography angiography (CTA) allows for a fast and non-invasive quantification of CAD in low risk patients. Sex differences and quantitative analysis of plaque progression and changes in plaque composition have not been studied intensively. Purpose To evaluate the role of sex on long term plaque progression and on the change of plaque composition in a population with low-intermediate risk. Methods Patients that received a coronary CTA were prospectively included in the SMARTool study to receive a follow-up coronary CTA. In total, 275 patients from 5 European countries were recruited in 7 centers. Baseline and follow-up coronary CTA were quantitative analyzed on a per-lesion basis using dedicated software package. Patients without coronary plaques at follow-up or with uninterpretable coronary CTA results were excluded. Total plaque volume and compositional volumes, calcified or non-calcified (defined as fibrous, fibro-fatty or necrotic core), were normalized using the vessel volume to calculate a percentage atheroma volume (PAV). Lesions between males and females were compared using linear mixed models. We further classified patients into age groups &lt;55 and ≥55 years to evaluate the influence of menopause on plaque progression. Results In total, 211 patients were included in this analysis, 146 (69%) were male and 65 (31%) were female. Mean interscan period was 6.2±1.4 years. Females were older (64±7 vs 61±8 years; p&lt;0.001), had higher HDL levels (56±15 vs 49±15 mg/dL; p=0.003) and presented more often with atypical chest pain (62 vs 38%; p=0.017). Males had 434 plaque sites and females 156. On a per-lesion analysis females had less fibro-fatty PAV compared to males (β −1.3±0.4%; p&lt;0.001), no other differences were seen (p&gt;0.05). When stratifying the patients in above and below 55 years old, females still had less fibro-fatty PAV compared to males in both age groups (p&lt;0.05). However, females in the age group &lt;55 years showed more regression of fibrous PAV compared to males (β −0.8±0.3% per year; p=0.002) and non-calcified plaque PAV (β −0.7±0.3% per year; p=0.027) (Figure). Conclusions Males have larger fibro-fatty PAV compared to females, however the rate of change did not differ. Younger women showed more regression of fibrous PAV and non-calcified PAV compared to males. No differences in the rate of plaque progression or plaque composition changes were seen between males and females in the older age group. Figure plaque progression and sex diff Funding Acknowledgement Type of funding source: Public grant(s) – EU funding. Main funding source(s): EU H2020 research and innovation program

P4987Long term follow up after comparison of two strategies in a chest pain unit: exercise echocardiography and multidetector computed tomography

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Pineiro-Portela ◽  
J Peteiro-Vazquez ◽  
A Bouzas-Mosquera ◽  
D Martinez-Ruiz ◽  
J C Yanez-Wronenburger ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Multidetector Computed Tomography ◽  
Peak Exercise ◽  
Exercise Echocardiography ◽  
Chest Pain Unit ◽  
Coronary Syndrome ◽  
Global Cost

Abstract Introduction and objectives Up to 5% patients with acute chest pain present an acute coronary syndrome (ACS). This study aimed to compare peak exercise echocardiography (ExE) and multidetector computed tomography (MCT) in patients referred to a chest pain unit. Methods 203 patients with ≥1 cardiovascular risk factors, no ischemic ECG changes and negative biomarkers were randomized to ExE (n=103) or MCT (n=100). The endpoints were hard events (cardiovascular death and non-fatal myocardial infarction), combined events (hard events and revascularizations), and combined events plus readmissions during follow-up. Cost of either strategy was also investigated. Results Mean age was 64±11 years and 131 patients were male. Hypertension was seen in 71%, hypercholesterolemia in 74%, diabetes mellitus in 28%, and smoking in 21%. Most of the patients had a low TIMI risk score (68% TIMI I and 32% TIMI II). Mean follow-up was 4,7±2,7 years. Invasive angiography due to positive/nonconclusive results was performed in 34 of the patients, 103 submitted to SE and in 27 of the 100 submitted to MCT (33% vs. 27%, p=0.15). A final diagnosis of acute coronary syndrome was achieved in 53 patients (30 [88%] in the ExE group and 23 [85%] in the MCT group, p=0.12). There were no significant differences between groups in hard events (5 [5%] patients in the ExE group and 7 [7%] in the MCT group, p=0,42), combined events (35 patients [34%] in the ExE group and 29 [29%] in the MCT group), and combined events plus readmissions (43 [42%] patients in the ExE group and 41 [41%] in the MCT). The median stay in hospital was 7 (5–10) days in the ExE group and 8 (5–10,25) in the MCT group (p=NS). For patients with negative results by either technique the mean stay was less than 8 hours. There were no differences in the global cost, although it was lower for patients with negative ExE (557 € vs. 706 €, p<0,02) as compared to those with negative TCM. Conclusions Both MCT and ExE are equally effective for the stratification of patients with low to moderate probability of ACS admitted to a chest pain unit. The cost was similar with both strategies, although significant lower in ExE when negative studies were compared.

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