scholarly journals Multi-Detector Coronary CT Imaging for the Identification of Coronary Artery Stenoses in a “Real-World” Population

2014 ◽  
Vol 8s4 ◽  
pp. CMC.S18223
Author(s):  
Amgad N. Makaryus ◽  
Sonia Henry ◽  
Lee Loewinger ◽  
John N. Makaryus ◽  
Lawrence Boxt
Keyword(s):  
Coronary Artery ◽  
Real World ◽  
Predictive Value ◽  
Daily Practice ◽  
Clinical Population ◽  
Conventional Coronary Angiography ◽  
World Population ◽  
Non Invasive ◽  
Coronary Ct ◽  
Coronary Stenoses

Background Multi-detector computed tomography (CT) has emerged as a modality for the non-invasive assessment of coronary artery disease (CAD). Prior studies have selected patients for evaluation and have excluded many of the “real-world” patients commonly encountered in daily practice. We compared 64-detector-CT (64-CT) to conventional coronary angiography (CA) to investigate the accuracy of 64-CT in determining significant coronary stenoses in a “real-world” clinical population. Methods A total of 1,818 consecutive patients referred for 64-CT were evaluated. CT angiography was performed using the GE LightSpeed VCT (GE® Healthcare). Forty-one patients in whom 64-CT results prompted CA investigation were further evaluated, and results of the two diagnostic modalities were compared. Results A total of 164 coronary arteries and 410 coronary segments were evaluated in 41 patients (30 men, 11 women, age 39-85 years) who were identified by 64-CT to have significant coronary stenoses and who thereafter underwent CA. The overall per-vessel sensitivity, specificity, positive predictive value, negative predictive value, and accuracy at the 50% stenosis level were 86%, 84%, 65%, 95%, and 85%, respectively, and 77%, 93%, 61%, 97%, and 91%, respectively, in the per-segment analysis at the 50% stenosis level. Conclusion 64-CT is an accurate imaging tool that allows a non-invasive assessment of significant CAD with a high diagnostic accuracy in a “real-world” population of patients. The sensitivity and specificity that we noted are not as high as those in prior reports, but we evaluated a population of patients that is typically encountered in clinical practice and therefore see more “real-world” results.

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

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.

scholarly journals P1436 Diagnostic yield and accuracy of CT coronary angiography compared to invasive coronary angiography: real world data from a district general hospital in the United Kingdom

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A M Masoud ◽  
W T Topping ◽  
M L Lynch
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Predictive Value ◽  
Invasive Coronary Angiography ◽  
District General Hospital ◽  
Ct Coronary Angiography ◽  
Non Invasive ◽  
Epicardial Coronary Artery ◽  
Luminal Stenosis ◽  
Clinically Significant

Abstract Background Cost-effectiveness is imperative for a sustainable healthcare service. Non-invasive testing is used to risk stratify patients and reduce the need for invasive investigations in cardiology. The National Institute for Health and Care Excellence (NICE) Clinical Guideline for evaluation of chest pain was updated in 2016 when NICE recommended CT coronary angiography (CTCA) as the first-line investigation for patients with suspected stable coronary artery disease (CAD). Purpose To evaluate the accuracy of CTCA in real life daily practice in a district general hospital outside the strict environment of clinical trials. Methods A retrospective analysis of all CTCA studies carried out between June and December 2017 was performed. Graft studies were excluded. Potentially obstructive CAD on CTCA was defined as any luminal stenosis ≥50% of a major epicardial coronary artery. On invasive coronary angiography (ICA), clinically significant CAD was defined as a luminal stenosis of ≥50% in the left main stem or a stenosis of ≥70% of any other major epicardial coronary artery. Results Out of a total of 528 CTCA studies, 109 patients (mean age 64.2 ± 10.4; 67.9% male) showed potentially significant CAD in at least one major epicardial coronary artery. The median calcium score was 379.7 (IQR = 86-929). 61 (56%) patients had ICA, 20 (18.3%) patients had non-invasive functional coronary assessment (19 stress echocardiogram and 1 stress perfusion cardiac magnetic resonance) and 3 (2.8%) patients had both. The remaining patients were managed medically without further investigation. Correlation between potentially obstructive CAD on CTCA and clinically significant CAD on ICA showed a sensitivity of 95.8% (95% CI: 85.8%-99.5%), specificity of 68.0% (95% CI: 61.0%-74.5%), positive predictive value of 42.2% (95% CI: 37.1%-47.4%), negative predictive value of 98.5% (95% CI: 94.5%-99.6%) and overall accuracy of 73.5% (95% CI: 67.5%-78.9%). Among patients who had ICA, 21 patients (34.4%) required coronary revascularization (16 percutaneous coronary intervention and 5 coronary artery bypass grafting) and 40 (65.6%) patients were treated medically. Only 1 patient (4.3% of 23 patients) showed evidence of inducible ischemia on non-invasive functional testing. Conclusion CTCA in a real world practice has high sensitivity and high negative predictive value compared to the gold standard ICA. CTCA improved patient selection for ICA to those most likely to have significant CAD.

P2699Comparison of fractional myocardial mass, a vessel-specific myocardial mass-at-risk, with coronary angiographic scoring systems for predicting myocardial ischemia

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H.-Y Kim ◽  
J.-H Choi ◽  
J.-H Doh ◽  
H.-S Lim ◽  
E.-S Shin ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Predictive Value ◽  
Validation Cohort ◽  
Invasive Coronary Angiography ◽  
Scoring Systems ◽  
Predictive Performance ◽  
Myocardial Mass ◽  
Derivation Cohort ◽  
Non Invasive

Abstract Aims The burden of coronary artery disease has been assessed by various semi-quantitative angiographic scores, which are frequently different each other. A non-invasive and quantitative modality may substitute angiographic sores for prognostic implication and decision of revascularization strategy. We compared fractional myocardial mass (FMM) with angiographic scores for predicting myocardial ischemia. Methods In this multicenter registry, 411 patients who underwent coronary computed tomography angiography (CCTA) were followed by invasive coronary angiography and FFR measurement. CCTA–derived %FMM with diameter stenosis ≥70% (%FMM-70) or ≥50% (%FMM-50) were compared with 9 angiographic scores (APPROACH, Duke Jeopardy, BARI, CASS, SYNTAX, Jenkins, BCIS-1, Leaman, Modified Duke) and were tested regarding their performance for predicting FFR ≤0.80. Predictive performance of %FMM or angiographic scores for FFR ≤0.80 established in derivation cohort (N=250) and tested in validation cohort (N=161). Results The performance of %FMM-70 and %FMM-50 were similar to most angiographic scores (%FMM-70, c-statistics=0.76; %FMM-50, 0.71; angiographic scores, 0.68–0.79). The frequency of FFR ≤0.80 increased consistently according to %FMM-70, %FMM-50, and all angiographic scores (p<0.001, all). The optimal cutoff of %FMM-50 and %FMM-70 for FFR ≤0.80 were ≥34.5% and ≥9.8%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of %FMM-50 were 83%, 56%, 73%, 70%, 72%, and of %FMM-70 were 72%, 78%, 75%, 75%, and 75% using these cutoffs. Validation cohort showed consistent results. Conclusion %FMM correlated well with angiographic scores and had a potential to be used as a non-invasive alternative to the angiographic scores. The integration of the severity of stenosis and the amount of subtended myocardium may improve the detection of clinically significant coronary artery stenosis.

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