• 【在前瞻性和回顾性心电图门控下使用快照冻结技术改善CTCA图像质量: 勘误表。】 复制标题 收藏 收藏
    DOI:10.1097/RCT.0000000000000768 复制DOI
    作者列表:
    BACKGROUND & AIMS:
    背景与目标:
  • 【CTCA-PRORECAD (冠状动脉疾病的计算机断层扫描冠状动脉血管造影预后注册) 的原理,设计和方法: 多中心和多供应商注册。】 复制标题 收藏 收藏
    DOI:10.1007/s11547-012-0912-9 复制DOI
    作者列表:Maffei E,Midiri M,Russo V,Rengo M,Tedeschi C,Spagnolo P,Seitun S,Francone M,Guaricci AI,Carrabba N,Malagò R,Cuocolo A,Arcadi T,Catalano OA,Cademartiri F
    BACKGROUND & AIMS: PURPOSE:This study was done to assess the prognostic value of computed tomography coronary angiography (CTCA) in a large multicentre population of patients with suspected coronary artery disease (CAD) and, in particular, its incremental value compared with traditional methods for risk stratification. MATERIALS AND METHODS:This is a retrospective observational study that began in January 2003 conducted on patients with suspected CAD assessed with CTCA on the basis of symptoms (chest pain, dyspnoea) and/or abnormal or equivocal stress test and/or a high cardiovascular risk profile. The participating centres will provide data obtained with CTCA performed with 16-slice or higher equipment. Exclusion criteria are renal insufficiency, allergy to iodinated contrast material, pregnancy and previous myocardial infarction or revascularisation (percutaneous coronary intervention and/or coronary artery bypass graft). All patients are stratified by means of clinical assessment and/or data retrieved from a clinical database. Risk factors considered are hypertension, dyslipidaemia, diabetes mellitus, smoking, family history and obesity. Symptoms are classified as absent, typical chest pain, atypical chest pain and dyspnoea. Primary endpoints are death, major adverse cardiovascular events (cardiac death, unstable angina requiring hospitalisation, acute myocardial infarction) and shifting of cardiovascular risk category on the basis of coronary plaque burden. The secondary endpoint is coronary revascularisation. Telephone interviews and/or clinical databases are used for the follow-up. The study will be conducted on a population >1,000 patients. CONCLUSIONS:The information collected from the Prognostic Registry for Coronary Artery Disease (PRORECAD) will provide insight into the prognostic value of CTCA in addition to demographic and clinical features. The results will allow for better use and interpretation of CTCA for prognostic purposes.
    背景与目标:
  • 【CT冠状动脉造影: 与滤波反投影相比,正弦图确定的迭代重建图像质量。】 复制标题 收藏 收藏
    DOI:10.1016/j.crad.2012.08.007 复制DOI
    作者列表:Wang R,Schoepf UJ,Wu R,Gibbs KP,Yu W,Li M,Zhang Z
    BACKGROUND & AIMS: AIM:To investigate image quality and potential for radiation dose reduction using sinogram-affirmed iterative reconstruction (SAFIRE) at computed tomography (CT) coronary angiography (CTCA) compared with filtered back-projection (FBP) reconstruction. MATERIALS AND METHODS:A water phantom and 49 consecutive patients were scanned using a retrospectively electrocardiography (ECG)-gated CTCA protocol on a dual-source CT system. Image reconstructions were performed with both conventional FBP and SAFIRE. The SAFIRE series were reconstructed image data from only one tube, simulating a 50% radiation dose reduction. Two blinded observers independently assessed the image quality of each coronary segment using a four-point scale and measured image noise (the standard deviation of Hounsfield values, SD), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). Radiation dose estimates were calculated. RESULTS:In the water phantom, image noise decreased at the same ratio as the tube current increased for both reconstruction algorithms. Despite an estimated radiation dose reduction from 7.9 ± 2.8 to 4 ± 1.4 mSv, there was no significant difference in the SD and SNR within the aortic root and left ventricular chamber between the two reconstruction methods. There was also no significant difference in the image quality between the FBP and SAFIRE series. CONCLUSION:Compared with traditional FBP, there is potential for substantial radiation dose reduction at CTCA with use of SAFIRE, while maintaining similar diagnostic image quality.
    背景与目标:
  • 【计算机断层扫描冠状动脉造影中口服伊伐布雷定的心率控制: 7.5 mg与5 mg方案的随机比较。】 复制标题 收藏 收藏
    DOI:10.1016/j.ijcard.2012.09.041 复制DOI
    作者列表:Guaricci AI,Maffei E,Brunetti ND,Montrone D,Di Biase L,Tedeschi C,Gentile G,Macarini L,Midiri M,Cademartiri F,Di Biase M
    BACKGROUND & AIMS: BACKGROUND:Heart rate (HR) reduction is essential to achieve optimal image quality and diagnostic accuracy with computed tomography coronary angiography (CTCA). Administration of oral ivabradine seems to be more effective than beta-blockade in reducing HR in patients referred for CTCA. METHODS:Two-hundred-fifty-nine consecutive patients referred for CTCA were prospectively enrolled. Patients not receiving beta-blocker at baseline (group 1) and those with beta-blocker therapy (group 2) were enrolled in the study. Each group was randomized into 3 parallel arms with 1:1:1 allocation. Patients who did not receive beta-blocker at baseline: underwent CTCA without beta blocker (n=49), and received ivabradine 5mg (n=48), or 7.5mg ivabradine (n=48). Patients with beta-blocker therapy: continued with the prior beta-blocker without any dose modification (n=38), and received ivabradine 5mg (n=38), or ivabradine 7.5mg (n=38). RESULTS:HR and blood pressure were assessed at admission (T0), immediately before CTCA (T1) and during CTCA (T2). Administration of ivabradine 7.5mg significantly reduced mean relative HR at T1 and T2 (p<0.01), the rate of patients not achieving target HR at T1 (p<0.001) and T2 (p<0.01), and the percentage of patients needing additional IV beta-blockade prior to CTCA (p<0.01). Results remained statistically significant even after correction for age, gender, ejection fraction, risk factors and HR at T0, in a multivariable analysis. CONCLUSIONS:Ivabradine 7.5mg is more effective than ivabradine 5mg in increasing the rate of patients at target HR in patients referred for CTCA.
    背景与目标:
  • 【心外膜脂肪组织体积和衰减的自然史: 一项长期前瞻性队列随访研究。】 复制标题 收藏 收藏
    DOI:10.1038/s41598-020-63135-z 复制DOI
    作者列表:Nerlekar N,Thakur U,Lin A,Koh JQS,Potter E,Liu D,Muthalaly RG,Rashid HN,Cameron JD,Dey D,Wong DTL
    BACKGROUND & AIMS: :Epicardial adipose tissue (EAT) is associated with cardiovascular risk. The longitudinal change in EAT volume (EATv) and density (EATd), and potential modulators of these parameters, has not been described. We prospectively recruited 90 patients with non-obstructive coronary atherosclerosis on baseline computed tomography coronary angiography (CTCA) performed for suspected coronary artery disease to undergo a repeat research CTCA. EATv in millilitres (mL) and EATd in Hounsfield units (HU) were analysed and multivariable regression analysis controlling for traditional cardiovascular risk factors (CVRF) performed to assess for any predictors of change. Secondary analysis was performed based on statin therapy. The median duration between CTCA was 4.3years. Mean EATv increased at follow-up (72 ± 33 mL to 89 ± 43 mL, p < 0.001) and mean EATd decreased (baseline -76 ± 6 HU vs. -86 ± 5 HU, p < 0.001). There were no associations between baseline variables of body mass index, age, sex, hypertension, hyperlipidaemia, diabetes or smoking on change in EATv or EATd. No difference in baseline, follow-up or delta EATv or EATd was seen in patients with (60%) or without baseline statin therapy. In this select group of patients, EATv consistently increased and EATd consistently decreased at long-term follow-up and these changes were independent of CVRF, age and statin use. Together with the knowledge of strong associations between EAT and cardiac disease, these findings may suggest that EAT is an independent parameter rather than a surrogate for cardiovascular risk.
    背景与目标: 心外膜脂肪组织 (EAT) 与心血管风险相关。尚未描述EAT体积 (EATv) 和密度 (EATd) 的纵向变化以及这些参数的潜在调节剂。我们前瞻性地招募了90例非阻塞性冠状动脉粥样硬化患者,对可疑冠状动脉疾病进行了基线计算机断层扫描冠状动脉造影 (CTCA),以进行重复研究CTCA。分析了毫升 (mL) 中的EATv和Hounsfield单位 (HU) 中的EATd,并进行了控制传统心血管危险因素 (CVRF) 的多变量回归分析,以评估变化的任何预测因素。在他汀类药物治疗的基础上进行了二次分析。CTCA之间的中位持续时间为4.3年。随访时平均EATv升高 (72  ±   33 ml至89  ±   43 ml,p  <  0.001),平均EATd降低 (基线-76  ±   6 HU vs. -86  ±   5 HU,p  <  0.001)。在EATv或EATd的变化中,体重指数,年龄,性别,高血压,高脂血症,糖尿病或吸烟的基线变量之间没有关联。在接受 (60%) 或不接受基线他汀类药物治疗的患者中,基线,随访或delta EATv或EATd无差异。在这个选定的患者组中,EATv在长期随访中持续升高,EATd持续降低,这些变化与CVRF,年龄和他汀类药物的使用无关。加上对EAT与心脏病之间强关联的了解,这些发现可能表明EAT是一个独立的参数,而不是心血管风险的替代参数。
  • 【计算机断层扫描诊断冠状动脉疾病: 辐射剂量的减少增加了适用性。】 复制标题 收藏 收藏
    DOI:10.1016/j.crad.2012.05.010 复制DOI
    作者列表:Gosling O,Morgan-Hughes G,Iyengar S,Strain W,Loader R,Shore A,Roobottom C
    BACKGROUND & AIMS: AIM:To assess the effects of dose-saving algorithms on the radiation dose in an established computed tomography coronary angiography (CTCA) clinical service. MATERIALS AND METHODS:A 3 year retrospective analysis of all patients attending for a clinically indicated CTCA was performed. The effective dose was calculated using a cardiac-specific conversion factor [0.028 mSv(mGy·cm)(-1)]. Patients were stratified by the advent of new scanning technology and dose-saving protocols. RESULTS:Between September 2007 and August 2010, 1736 examinations were performed. In the first 6 months, 150 examinations were performed with a mean effective dose of 29.6 mSv (99% CI 26.6-33 mSv). In March 2008 prospective electrocardiogram (ECG) gating was installed; reducing the effective dose to 13.6 mSv (99% CI 12.5-14.9 mSv). In March 2009, the scanner parameters were set to a minimal exposure time and 100 kV in patients with a body mass index (BMI) of <30. This reduced the mean dose to 7.4 mSv (99% CI 6.8-8 mSv). For the final six months the mean radiation dose for a cardiac scan was 5.9 mSv (99% CI 5.4-6.5 mSv) this figure incorporates all examinations performed irrespective of the protocol used. CONCLUSION:With the implementation of evidence-based protocols, the effective dose from cardiac CT has significantly reduced. As CTCA services develop dose-saving algorithms should be adopted to keep the radiation dose as low as reasonably practical.
    背景与目标:
  • 【320-MDCT容积扫描仪上单心跳和双心跳CTCA的自动曝光控制: 心率、曝光相位窗口设置和重建算法的影响。】 复制标题 收藏 收藏
    DOI:10.1016/j.ejmp.2013.10.003 复制DOI
    作者列表:Funama Y,Utsunomiya D,Taguchi K,Oda S,Shimonobo T,Yamashita Y
    BACKGROUND & AIMS: PURPOSE:To investigate whether electrocardiogram (ECG)-gated single- and dual-heartbeat computed tomography coronary angiography (CTCA) with automatic exposure control (AEC) yields images with uniform image noise at reduced radiation doses. MATERIALS AND METHODS:Using an anthropomorphic chest CT phantom we performed prospectively ECG-gated single- and dual-heartbeat CTCA on a second-generation 320-multidetector CT volume scanner. The exposure phase window was set at 75%, 70-80%, 40-80%, and 0-100% and the heart rate at 60 or 80 or corr80 bpm; images were reconstructed with filtered back projection (FBP) or iterative reconstruction (IR, adaptive iterative dose reduction 3D). We applied AEC and set the image noise level to 20 or 25 HU. For each technique we determined the image noise and the radiation dose to the phantom center. RESULTS:With half-scan reconstruction at 60 bpm, a 70-80% phase window- and a 20-HU standard deviation (SD) setting, the imagenoise level and -variation along the z axis manifested similar curves with FBP and IR. With half-scan reconstruction, the radiation dose to the phantom center with 70-80% phase window was 18.89 and 12.34 mGy for FBP and 4.61 and 3.10 mGy for IR at an SD setting SD of 20 and 25 HU, respectively. At 80 bpm with two-segment reconstruction the dose was approximately twice that of 60 bpm at both SD settings. However, increasing radiation dose at corr80 bpm was suppressed to 1.39 times compared to 60 bpm. CONCLUSION:AEC at ECG-gated single- and dual-heartbeat CTCA controls the image noise at different radiation dose.
    背景与目标:
  • 【通过计算机断层扫描评估有和没有糖尿病的患者的冠状动脉疾病和钙化的冠状动脉斑块负荷。】 复制标题 收藏 收藏
    DOI:10.1007/s00330-010-1996-z 复制DOI
    作者列表:Maffei E,Seitun S,Nieman K,Martini C,Guaricci AI,Tedeschi C,Weustink AC,Mollet NR,Berti E,Grilli R,Messalli G,Cademartiri F
    BACKGROUND & AIMS: PURPOSE:To compare the coronary atherosclerotic burden in patients with and without type-2 diabetes using CT Coronary Angiography (CTCA). METHODS AND MATERIALS:147 diabetic (mean age: 65 ± 10 years; male: 89) and 979 nondiabetic patients (mean age: 61 ± 13 years; male: 567) without a history of coronary artery disease (CAD) underwent CTCA. The per-patient number of diseased coronary segments was determined and each diseased segment was classified as showing obstructive lesion (luminal narrowing >50%) or not. Coronary calcium scoring (CCS) was assessed too. RESULTS:Diabetics showed a higher number of diseased segments (4.1 ± 4.2 vs. 2.1 ± 3.0; p < 0.0001); a higher rate of CCS > 400 (p < 0.001), obstructive CAD (37% vs. 18% of patients; p < 0.0001), and fewer normal coronary arteries (20% vs. 42%; p < 0.0001), as compared to nondiabetics. The percentage of patients with obstructive CAD paralleled increasing CCS in both groups. Diabetics with CCS ≤ 10 had a higher prevalence of coronary plaque (39.6% vs. 24.5%, p = 0.003) and obstructive CAD (12.5% vs. 3.8%, p = 0.01). Among patients with CCS ≤ 10 all diabetics with obstructive CAD had a zero CCS and one patient was asymptomatic. CONCLUSIONS:Diabetes was associated with higher coronary plaque burden. The present study demonstrates that the absence of coronary calcification does not exclude obstructive CAD especially in diabetics.
    背景与目标:
  • 【计算机断层扫描冠状动脉造影在临床实践中的阳性预测价值。】 复制标题 收藏 收藏
    DOI:10.1016/j.ijcard.2010.11.008 复制DOI
    作者列表:Groothuis JG,Beek AM,Meijerink MR,Brinckman SL,Heymans MW,van Kuijk C,van Rossum AC
    BACKGROUND & AIMS: BACKGROUND:Several studies have investigated the diagnostic performance of computed tomography coronary angiography (CTCA) for the detection of significant coronary artery disease (CAD). These studies were performed in patients that were already referred for invasive coronary angiography (ICA) and prevalence of significant CAD was high. Although the negative predictive value of CTCA was consistently high, a wide range of positive predictive values (PPVs) was reported. Thus, the PPV of CTCA in patients that undergo CTCA as part of a clinical diagnostic evaluation remains unclear. This study investigated the PPV of CTCA for the detection of significant CAD in clinical practice. METHODS:A total of 181 patients with low to intermediate pre-test probability CAD that were referred for non-invasive evaluation of chest pain underwent 64-slice CTCA. CTCA was scored per segment as normal, non-obstructive CAD or obstructive CAD (>50% diameter stenosis). All patients with obstructive CAD according to CTCA, underwent ICA. Significant CAD was defined as >50% diameter stenosis on ICA. RESULTS:According to CTCA, 65 (35.9%) patients had obstructive CAD. In 26 (14.4%) patients, significant CAD was found by ICA. The PPV for detection of significant CAD per patient, per vessel and per segment were 40.0% (26/65, 95% CI: 30.6-50.2%), 31.3% (36/115, 95% CI: 24.7-38.8%) and 25.5% (42/165; 95% CI: 20.3-31.4%), respectively. CONCLUSIONS:The PPV of CTCA for detection of significant CAD in patients with low to intermediate probability CAD that are clinically referred for non-invasive evaluation of chest pain is markedly lower than generally reported.
    背景与目标:
  • 【使用计算机断层扫描冠状动脉造影进行定量和定性冠状动脉斑块评估: 与血管内超声的比较。】 复制标题 收藏 收藏
    DOI:10.1016/j.hlc.2019.06.719 复制DOI
    作者列表:Munnur RK,Andrews J,Kataoka Y,Nerlekar N,Psaltis PJ,Nicholls SJ,Malaiapan Y,Cameron JD,Meredith IT,Seneviratne S,Wong DTL
    BACKGROUND & AIMS: BACKGROUND:To compare computed tomography coronary angiography (CTCA) with intravascular ultrasound (IVUS) in quantitative and qualitative plaque assessment. METHODS:Patients who underwent IVUS and CTCA within 3 months for suspected coronary artery disease were retrospectively studied. Plaque volumes on CTCA were quantified manually and with automated-software and were compared to IVUS. High-risk plaque features were compared between CTCA and IVUS. RESULTS:There were 769 slices in 32 vessels (27 patients). Manual plaque quantification on CTCA was comparable to IVUS per slice (mean difference of 0.06±0.07, p=0.44; Bland-Altman 95% limits of agreement -2.19-2.08 mm3, bias of -0.06mm3) and per vessel (3.1mm3 ± -2.85mm3, p=0.92). In contrast, there was significant difference between automated-software and IVUS per slice (2.3±0.09mm3, p<0.001; 95% LoA -6.78 to 2.25mm3, bias of -2.2mm3) and per vessel (33.04±10.3 mm3, p<0.01). The sensitivity, specificity, positive and negative predictive value of CTCA to detect plaques that had features of echo-attenuation on IVUS was 93.3%, 99.6%, 93.3% and 99.6% respectively. The association of ≥2 high-risk plaque features on CTCA with echo attenuation (EA) plaque features on IVUS was excellent (86.7%, 99.6%, 92.9% and 99.2%). In comparison, the association of high-risk plaque features on CTCA and plaques with echo-lucency on IVUS was only modest. CONCLUSION:Plaque volume quantification by manual CTCA method is accurate when compared to IVUS. The presence of at least two high-risk plaque features on CTCA is associated with plaque features of echo attenuation on IVUS.
    背景与目标:
  • 【钙评分为零的患者中冠状动脉粥样硬化的患病率和程度以及患者特征的影响。】 复制标题 收藏 收藏
    DOI:10.1532/HSF98.20121132 复制DOI
    作者列表:Oncel G,Oncel D
    BACKGROUND & AIMS: PURPOSE:Coronary artery calcium (CAC) is a specific indicator of and an independent risk factor for atherosclerosis; however, calcium scoring may miss noncalcified plaques, which may have clinical importance. The aim of this study was both to identify the presence and extent of coronary plaques during computed tomography coronary angiography (CTCA) in patients with a zero CAC score and to evaluate the effect of risk factors and symptom status on the presence of noncalcified plaques. MATERIALS AND METHODS:In this retrospective study, we analyzed the cases of 842 consecutive patients between October 2006 and November 2011. Of these patients, we included 357 with a zero calcium score in the study. Information regarding patient age, sex, coronary risk factors, and symptom status were recorded. Coronary calcium-scoring scans were followed by CTCA. The calcium scores were calculated, and the presence of noncalcified plaques and significant stenoses (>50% of vessel diameter) was evaluated. RESULTS:Of the 357 patients with a zero calcium score, 37 (10.36%) had atherosclerotic plaques; 9 patients (2.52%) had significant coronary stenosis. Among coronary risk factors, only diabetes mellitus was significantly correlated with any risk factors (presence of atherosclerosis and obstructive coronary artery disease; P = .030 and .013, respectively). CONCLUSION:Although CAC scoring is a safe and a reliable test to exclude obstructive coronary artery disease, the absence of CAC does not definitively exclude the presence of atherosclerosis. CTCA is a more appropriate method for determining the atheroma burden.
    背景与目标:
  • 【2型糖尿病患者冠状动脉外钙化与冠状动脉疾病的关系。】 复制标题 收藏 收藏
    DOI:10.1007/s00380-011-0205-6 复制DOI
    作者列表:Farrag A,Bakhoum S,Salem MA,El-Faramawy A,Gergis E
    BACKGROUND & AIMS: :Cardiovascular complications are the major cause of diabetes-associated morbidity and mortality. However, not all patients with diabetes are at increased risk for cardiovascular disease (CVD). Coronary artery calcification was found to be a powerful predictor of coronary artery disease (CAD). The presence of extracoronary cardiac calcification as a useful predictor of CAD is not yet established, especially in type 2 diabetes mellitus (T2DM). The aim of this study was to evaluate the relation between extracoronary calcification and extent of CAD in a group of T2DM patients who were scheduled for computed tomographic coronary angiography (CTCA). We prospectively studied 380 patients (151 had T2DM) under the age of 60 years who were scheduled for CTCA because of suspected CAD. Severity of CAD was assessed by Gensini score. Coronary artery calcium score (CACS) as well as calcium score in the aortic valve, mitral annulus, ascending aorta, and descending aorta were measured by a 256-row multidetector computed tomography scanner with dedicated software for calcium calculation. Patients with known CAD were excluded. Diabetic and nondiabetic patients had comparable age and gender distribution. However, the diabetic group had higher Gensini score, CACS, and extracoronary calcium score (ECCS). Logistic regression analyses identified male gender and ECCS as significant predictors for the presence of CAD in diabetic patients. Age, smoking, and ECCS were the significant predictors of CAD in nondiabetic patients. Type 2 diabetic patients had increased coronary and extracoronary calcification. ECCS was found to be a significant predictor of CAD in diabetic and nondiabetic patients only when CACS was not taken into account.
    背景与目标: 心血管并发症是糖尿病相关发病率和死亡率的主要原因。然而,并非所有糖尿病患者患心血管疾病 (CVD) 的风险都增加。发现冠状动脉钙化是冠状动脉疾病 (CAD) 的有力预测指标。冠状动脉外钙化作为CAD的有用预测指标的存在尚未确定,尤其是在2型糖尿病 (T2DM) 中。这项研究的目的是评估计划进行计算机断层冠状动脉造影 (CTCA) 的一组T2DM患者的冠状动脉外钙化与CAD程度之间的关系。我们前瞻性地研究了380例60岁以下因疑似CAD而被安排接受CTCA的患者 (151例患有T2DM)。通过Gensini评分评估CAD的严重程度。冠状动脉钙评分 (CACS) 以及主动脉瓣、二尖瓣环、升主动脉和降主动脉的钙评分是通过256排多探测器计算机断层扫描扫描仪测量的。排除已知CAD的患者。糖尿病和非糖尿病患者的年龄和性别分布相当。然而,糖尿病组的Gensini评分,CACS和冠状动脉外钙评分 (ECCS) 较高。Logistic回归分析确定男性和ECCS是糖尿病患者中CAD存在的重要预测因素。年龄,吸烟和ecc是非糖尿病患者CAD的重要预测指标。2型糖尿病患者冠状动脉和冠状动脉外钙化增加。仅当不考虑cac时,ECCS才被发现是糖尿病和非糖尿病患者CAD的重要预测指标。
  • 【计算机断层扫描冠状动脉造影的诊断性能,以检测和排除左主干和/或三支冠状动脉疾病。】 复制标题 收藏 收藏
    DOI:10.1007/s00330-013-2935-6 复制DOI
    作者列表:Dharampal AS,Papadopoulou SL,Rossi A,Meijboom WB,Weustink A,Dijkshoorn M,Nieman K,Boersma EH,de Feijter PJ,Krestin GP
    BACKGROUND & AIMS: OBJECTIVES:To determine the diagnostic performance of CT coronary angiography (CTCA) in detecting and excluding left main (LM) and/or three-vessel CAD ("high-risk" CAD) in symptomatic patients and to compare its discriminatory value with the Duke risk score and calcium score. MATERIALS AND METHODS:Between 2004 and 2011, a total of 1,159 symptomatic patients (61 ± 11 years, 31 % women) with stable angina, without prior revascularisation underwent both invasive coronary angiography (ICA) and CTCA. All patients gave written informed consent for the additional CTCA. High-risk CAD was defined as LM and/or three-vessel obstructive CAD (≥50 % diameter stenosis). RESULTS:A total of 197 (17 %) patients had high-risk CAD as determined by ICA. The sensitivity, specificity, positive predictive value, negative predictive value, positive and negative likelihood ratios of CTCA were 95 % (95 % CI 91-97 %), 83 % (80-85 %), 53 % (48-58 %), 99 % (98-99 %), 5.47 and 0.06, respectively. CTCA provided incremental value (AUC 0.90, P < 0.001) in the discrimination of high-risk CAD compared with the Duke risk score and calcium score. CONCLUSIONS:CTCA accurately excludes high-risk CAD in symptomatic patients. The detection of high-risk CAD is suboptimal owing to the high percentage (47 %) of overestimation of high-risk CAD. CTCA provides incremental value in the discrimination of high-risk CAD compared with the Duke risk score and calcium score. KEY POINTS:• Computed tomography coronary angiography (CTCA) accurately excludes high-risk coronary artery disease. • CTCA overestimates high-risk coronary artery disease in 47 %. • CTCA discriminates high-risk CAD better than clinical evaluation and coronary calcification.
    背景与目标:
  • 【局部心房电图在valsalva左肺窦标测时预测左主冠状动脉解剖距离的效用。】 复制标题 收藏 收藏
    DOI:10.1111/jce.14100 复制DOI
    作者列表:Dong X,Tang M,Sun Q,Zhang S
    BACKGROUND & AIMS: BACKGROUND:Ablation of right ventricular outflow tract (RVOT) ventricular arrhythmia (VA) within the left pulmonary sinus of Valsalva (LPSV) may increase the risk of left main coronary artery (LMCA) injury. PURPOSE:To delineate the anatomical characteristics between LMCA and LPSV and their association with atrial potential (AP) mapping in LPSV. METHODS:A total of 104 consecutive patients with RVOT-VA undergoing cardiac-gated computed tomography coronary angiography (CTCA) after ablation were retrospectively analyzed. RESULTS:The LMCA-LPSV anatomic relationship was classified into three types based on the CTCA measurements. Types 1 and 2 had a shorter LMCA-LPSV distance than that of type 3 (P < .001). The left atrial appendage (LAA)-LMCA distance and LAA-LPSV distance were associated with the incidence of AP in LPSV (odds ratio [OR] = 3.43, 95% confidence interval [CI]: 1.86-6.34, P < .001; OR = 1.196, 95% CI: 1.09-1.31, P < .001, respectively). Furthermore, the LMCA-LPSV distance showed a linear correlation with the LAA-LPSV distance (r2  = 0.93, P < .001). According to receiver operating characteristic (ROC) analysis, a LMCA-LPSV distance <5.4 mm could predict the possibility of AP during LPSV mapping (sensitivity 83%, specificity 81%, and area under the ROC curve 0.86). CONCLUSIONS:The presence of AP in the LPSV may be useful to predict a short distance from the LPSV to the LMCA and to identify patients at higher risk of LMCA injury. This information may contribute to efficient and safe ablation in this area but should be confirmed in future studies.
    背景与目标:
  • 【通过有创冠状动脉造影或计算机断层扫描冠状动脉造影确定的非阻塞性冠状动脉疾病患者与正常动脉的预后: 系统评价。】 复制标题 收藏 收藏
    DOI:10.1097/MD.0000000000003117 复制DOI
    作者列表:Huang FY,Huang BT,Lv WY,Liu W,Peng Y,Xia TL,Wang PJ,Zuo ZL,Liu RS,Zhang C,Gui YY,Liao YB,Chen M,Zhu Y
    BACKGROUND & AIMS: :Limited data exist regarding the outcomes of patients with nonobstructive coronary artery disease (CAD) detected by computed tomography coronary angiography (CTCA) or invasive coronary angiography (ICA). Our aim was to compare the prognosis of patients with nonobstructive coronary artery plaques with that of patients with entirely normal arteries. The MEDLINE, Cochrane Library, and Embase databases were searched. Studies comparing the prognosis of individuals with nonobstructive CAD versus normal coronary arteries detected by CTCA or ICA were included. The primary outcome was major adverse cardiac events (MACE) including cardiac death, nonfatal myocardial infarction, hospitalization due to unstable angina or revascularization. A fixed effects model was chosen to pool the estimates of odds ratios (ORs). Forty-eight studies with 64,905 individuals met the inclusion criteria. Patients in the nonobstructive CAD arm had a significantly higher risk of MACE compared to their counterparts in the normal artery arm (pooled OR, 3.17, 95% confidence interval, 2.77-3.63). When excluding revascularization as an endpoint, hard cardiac composite outcomes were also more frequent among patients with nonobstructive CAD (pooled OR, 2.10; 95%CI, 1.79-2.45). All subgroups (age, sex, follow-up duration, different outcomes, diagnostic modality, and CAD risk factor) consistently showed a poorer prognosis with nonobstructive CAD than with normal arteries. When dividing the studies into a CTCA and ICA group for further analysis based on the indications for diagnostic tests, we also found nonobstructive CAD to be associated with a higher risk of MACE in both stable and acute chest pain. Patients with nonobstructive CAD had a poorer prognosis compared with their counterparts with normal arteries.
    背景与目标: : 关于通过计算机断层扫描冠状动脉造影 (CTCA) 或侵入性冠状动脉造影 (ICA) 检测到的非阻塞性冠状动脉疾病 (CAD) 患者的预后数据有限。我们的目的是比较非阻塞性冠状动脉斑块患者与完全正常动脉患者的预后。搜索了MEDLINE,Cochrane库和Embase数据库。包括比较CTCA或ICA检测到的非阻塞性CAD患者与正常冠状动脉的预后的研究。主要结局是主要不良心脏事件 (MACE),包括心脏死亡,非致死性心肌梗死,因不稳定型心绞痛或血运重建而住院。选择了固定效应模型来汇集优势比 (ORs) 的估计值。有64,905人的48项研究符合纳入标准。非阻塞性CAD组的患者与正常动脉组的患者相比,MACE的风险显着更高 (合并OR,3.17,95% 置信区间,2.77-3.63)。当排除血运重建作为终点时,硬心脏复合结局在非阻塞性CAD患者中也更为常见 (合并OR,2.10; 95% CI,1.79-2.45).所有亚组 (年龄,性别,随访时间,不同结局,诊断方式和CAD危险因素) 均显示非阻塞性CAD的预后比正常动脉差。当根据诊断测试的适应症将研究分为CTCA和ICA组进行进一步分析时,我们还发现非阻塞性CAD与稳定和急性胸痛的MACE风险较高相关。与正常动脉的患者相比,非阻塞性CAD患者的预后较差。

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