Cardiac Computed Tomography for the Diagnosis of Coronary Artery Atherosclerosis

Abstract Background Appropriate use criteria (AUC) have been developed in response to growth in cardiac imaging utilization and concern regarding associated costs. Cardiac computed tomography angiography (CCTA) has emerged as an important modality in the evaluation of coronary artery disease, however its appropriate utilization in actual practice is uncertain. Our objective was to determine the appropriate utilization of CCTA in a large quaternary care institution and to compare appropriate utilization pre and post publication of the 2013 AUC guidelines. We hypothesized that the proportion of appropriate CCTA utilization will be similar to those of other comparable cardiac imaging modalities and that there would be a significant increase in appropriate use post AUC publication. Methods We employed a retrospective cohort study design of 2577 consecutive patients undergoing CCTA between January 1, 2012 and December 30, 2016. An appropriateness category was assigned for each CCTA. Appropriateness classifications were compared pre- and post- AUC publication via the chi-square test. Results Overall, 83.5% of CCTAs were deemed to be appropriate based on the AUC. Before the AUC publication, 75.0% of CCTAs were classified as appropriate whereas after the AUC publication, 88.0% were classified as appropriate (p < 0.001). The increase in appropriate utilization, when extrapolated to the Medicare population of the United States, was associated with potential cost savings of approximately $57 million per year. Conclusions We report a high rate of appropriate use of CCTA and a significant increase in the proportion of CCTAs classified as appropriate after the AUC publication.

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Role of smoking on body fat distribution and coronary artery disease

European Heart Journal ◽

10.1093/ehjci/ehaa946.1420 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M Sabet ◽

S Elkaffas ◽

S.W.G Bakhoum ◽

H Kandil

Keyword(s):

Computed Tomography ◽

Coronary Artery Disease ◽

Adipose Tissue ◽

Coronary Artery ◽

Body Fat ◽

Fat Distribution ◽

Relative Distribution ◽

Coronary Artery Atherosclerosis ◽

Total Fat ◽

Artery 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

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Coronary artery and aortic valve calcification evaluated with cardiac computed tomography in patients with chest pain: Prognostic value in clinical practice

International Journal of Cardiology ◽

10.1016/j.ijcard.2016.06.013 ◽

2016 ◽

Vol 219 ◽

pp. 247-250 ◽

Cited By ~ 2

Author(s):

Ana Revilla‐Orodea ◽

Jairo A. Toro-Gil ◽

Teresa Sevilla ◽

Israel Sánchez‐Lite ◽

L. Renier Goncalves-Ramírez ◽

...

Keyword(s):

Computed Tomography ◽

Clinical Practice ◽

Chest Pain ◽

Coronary Artery ◽

Aortic Valve ◽

Prognostic Value ◽

Cardiac Computed Tomography ◽

Aortic Valve Calcification ◽

Valve Calcification

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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.

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