Non-invasive computed tomography coronary angiography as a gatekeeper for invasive coronary angiography.

To determine the rate of subsequent invasive coronary angiography (ICA) and revascularization in relation to computed tomography coronary angiography (CTA) results. In addition, independent determinants of subsequent ICA and revascularization were evaluated. CTA studies were performed using a 64-row (n = 413) or 320-row (n = 224) multidetector scanner.

Prognostic value of coronary vessel dominance in relation to significant coronary artery disease determined with non-invasive computed tomography coronary angiography.

Aims: Limited information is available regarding the relationship between coronary vessel dominance and prognosis. Therefore, the purpose of this study was to determine the prognostic value of coronary vessel dominance in relation to significant coronary artery disease (CAD) in patients referred for computed tomography coronary angiography (CTA).

Methods And Results: The study population consisted of 1425 patients (869 men, 57 ± 12 years) referred for CTA.

The maximum necrotic core area is most often located proximally to the site of most severe narrowing: a virtual histology intravascular ultrasound study.

Previous angiographic studies have shown that almost two-thirds of vulnerable plaques are located in non-obstructive lesions. Possibly, the maximum necrotic core (Max NC) area is not always identical to the site of most severe stenosis. Therefore, the purpose of this study was to evaluate the potential difference in location between the maximum necrotic core area and the site of most severe narrowing as assessed by virtual histology intravascular ultrasound (VH IVUS).

Automated quantification of coronary plaque with computed tomography: comparison with intravascular ultrasound using a dedicated registration algorithm for fusion-based quantification.

Aims: Previous studies have used semi-automated approaches for coronary plaque quantification on multi-detector row computed tomography (CT), while an automated quantitative approach using a dedicated registration algorithm is currently lacking. Accordingly, the study aimed to demonstrate the feasibility and accuracy of automated coronary plaque quantification on cardiac CT using dedicated software with a novel 3D coregistration algorithm of CT and intravascular ultrasound (IVUS) data sets.

Methods And Results: Patients who had undergone CT and IVUS were enrolled.

Age- and gender-specific differences in the prognostic value of CT coronary angiography.

Objective: To evaluate the potential age- and gender-specific differences in the incidence and prognostic value of coronary artery disease (CAD) in patients undergoing CT coronary angiography (CTA).

Design And Patients: In this multicentre prospective registry study, 2432 patients (mean age 57 ± 12, 56% male) underwent CTA for suspected CAD. Patients were stratified into four groups according to age <60 or ≥60 years and, male or female gender.

Prognostic value of renal dysfunction for the prediction of outcome versus results of computed tomographic coronary angiography.

Chronic kidney disease (CKD) is associated with cardiovascular (CV) events caused by advanced atherosclerosis. Computed tomographic coronary angiography (CTA) can accurately diagnose coronary artery disease (CAD) and predict CV outcomes. The aim of the present study was to evaluate whether moderate CKD provides prognostic information for CV events in patients undergoing CTA.

Comprehensive assessment of spotty calcifications on computed tomography angiography: comparison to plaque characteristics on intravascular ultrasound with radiofrequency backscatter analysis.

Background: The purpose of the study was to systematically compare calcification patterns in plaques on computed tomography angiography (CTA) with plaque characteristics on intravascular ultrasound with radiofrequency backscatter analysis (IVUS-VH).

Methods And Results: In total, 108 patients underwent CTA and IVUS-VH. On CTA, calcification patterns in plaques were classified as non-calcified, spotty or dense calcifications.

Diagnostic performance of 320-slice multidetector computed tomography coronary angiography in patients after coronary artery bypass grafting.

Objectives: To evaluate the diagnostic performance of 320-slice computed tomography coronary angiography (CTA) in the evaluation of patients with prior coronary artery bypass grafting (CABG). Invasive coronary angiography (ICA) served as the standard of reference, using a quantitative approach.

Methods: CTA studies were performed using CT equipment with 320 detector-rows, each 0.

Comparison of the relation between the calcium score and plaque characteristics in patients with acute coronary syndrome versus patients with stable coronary artery disease, assessed by computed tomography angiography and virtual histology intravascular ultrasound.

A considerable number of patients with an acute coronary syndrome (ACS) who present with a 0 or low calcium score (CS) still demonstrate coronary artery disease (CAD) and significant stenosis. The aim of the present study was to evaluate the relation between the CS and the degree and character of atherosclerosis in patients with suspected ACS versus patients with stable CAD obtained by computed tomography angiography and virtual histology intravascular ultrasound (VH IVUS). Overall 112 patients were studied, 53 with ACS and 59 with stable CAD.

A clinical prediction rule for the diagnosis of coronary artery disease: validation, updating, and extension.

Aims: The aim was to validate, update, and extend the Diamond-Forrester model for estimating the probability of obstructive coronary artery disease (CAD) in a contemporary cohort.

Methods And Results: Prospectively collected data from 14 hospitals on patients with chest pain without a history of CAD and referred for conventional coronary angiography (CCA) were used. Primary outcome was obstructive CAD, defined as ≥ 50% stenosis in one or more vessels on CCA.

Usefulness of hypertriglyceridemic waist phenotype in type 2 diabetes mellitus to predict the presence of coronary artery disease as assessed by computed tomographic coronary angiography.

The present study tested whether in patients with type 2 diabetes mellitus (DM) the combination of increased waist circumference and increased plasma triglyceride (TG) levels can predict the presence of coronary artery disease (CAD) as assessed by multidetector computed tomographic coronary angiography (CTA). In 202 patients with type 2 DM who were clinically referred for CTA, waist circumference and TG levels were measured. Patients were divided into 4 groups according to waist circumference measurements and TG levels.

Diagnostic performance of non-invasive multidetector computed tomography coronary angiography to detect coronary artery disease using different endpoints: detection of significant stenosis vs. detection of atherosclerosis.

Aims: The positive predictive value of multidetector computed tomography angiography (CTA) for detecting significant stenosis remains limited. Possibly CTA may be more accurate in the evaluation of atherosclerosis rather than in the evaluation of stenosis severity. However, a comprehensive assessment of the diagnostic performance of CTA in comparison with both conventional coronary angiography (CCA) and intravascular ultrasound (IVUS) is lacking.

Incremental prognostic value of left ventricular function analysis over non-invasive coronary angiography with multidetector computed tomography.

Background: The purpose of this study was to determine the prognostic value of computed tomography coronary angiography (CTA)-derived left ventricular (LV) function analysis and to assess its incremental prognostic value over the detection of significant stenosis using CTA.

Methods: In 728 patients (400 males, mean age 55 ± 12 years) with known or suspected CAD, the presence of significant stenosis (≥ 50% stenosis) and LV function were assessed using CTA. LV end-systolic volume (LVESV), LV end-diastolic volume (LVEDV), and LV ejection fraction (LVEF) were calculated.

Predictive value of multislice computed tomography variables of atherosclerosis for ischemia on stress-rest single-photon emission computed tomography.

Background: previous studies have shown that the presence of stenosis alone on multislice computed tomography (MSCT) has a limited positive predictive value for the presence of ischemia on myocardial perfusion imaging (MPI). The purpose of this study was to assess which variables of atherosclerosis on MSCT angiography are related to ischemia on MPI.

Methods And Results: both MSCT and MPI were performed in 514 patients.

Automated quantification of stenosis severity on 64-slice CT: a comparison with quantitative coronary angiography.

Objectives: This study sought to demonstrate the feasibility of a dedicated algorithm for automated quantification of stenosis severity on multislice computed tomography in comparison with quantitative coronary angiography (QCA).

Background: Limited information is available on quantification of coronary stenosis, and previous attempts using semiautomated approaches have been suboptimal.

Methods: In patients who had undergone 64-slice computed tomography and invasive coronary angiography, the most severe lesion on QCA was quantified per coronary artery using quantitative coronary computed tomography (QCCTA) software.

Evaluation of stents and grafts.

In the management of patients with obstructive coronary artery disease (CAD), percutaneous coronary intervention (PCI) with stent implantation is routinely performed. In patients with left main or three-vessel disease, however, coronary artery bypass grafting (CABG) may be the preferred therapeutic strategy. Importantly, both after PCI or CABG a small but non-negligible risk of restenosis remains.

Diagnostic accuracy of 320-row multidetector computed tomography coronary angiography to noninvasively assess in-stent restenosis.

Objectives: Percutaneous coronary intervention with stent implantation is routinely performed to treat patients with obstructive coronary artery disease. However, thus far, noninvasive assessment of in-stent restenosis has been challenging. Recently, 320-row multidetector computed tomography coronary angiography (CTA) was introduced, allowing volumetric image acquisition of the heart in a single heart beat or gantry rotation.

Diagnostic accuracy of 64-slice computed tomography coronary angiography for the detection of in-stent restenosis: a meta-analysis.

Background: We sought to evaluate the diagnostic accuracy of 64-slice multi-detector row computed tomography (MDCT) compared with invasive coronary angiography for in-stent restenosis (ISR) detection.

Methods: MEDLINE, Cochrane library, and BioMed Central database searches were performed until April 2009 for original articles. Inclusion criteria were (1) 64-MDCT was used as a diagnostic test for ISR, with >50% diameter stenosis selected as the cut-off criterion for significant ISR, using invasive coronary angiography and quantitative coronary angiography as the standard of reference; (2) absolute numbers of true positive, false positive, true negative, and false negative results could be derived.

Evaluation of contraindications and efficacy of oral Beta blockade before computed tomographic coronary angiography.

Multidetector computed tomographic coronary angiography (CTA) image quality is inversely related to the heart rate (HR). As a result beta-blocking medication is routinely administered before investigation. In the present study, the use, contraindications, and efficacy of prescan beta blockade with regard to HR reduction and CTA image quality were assessed.

Diagnostic accuracy of 320-row multidetector computed tomography coronary angiography in the non-invasive evaluation of significant coronary artery disease.

Aims: Multidetector computed tomography coronary angiography (CTA) has emerged as a feasible imaging modality for non-invasive assessment of coronary artery disease (CAD). Recently, 320-row CTA systems were introduced, with 16 cm anatomical coverage, allowing image acquisition of the entire heart within a single heart beat. The aim of the present study was to assess the diagnostic accuracy of 320-row CTA in patients with known or suspected CAD.

Assessment of global left ventricular function and volumes with 320-row multidetector computed tomography: A comparison with 2D-echocardiography.

Background: Multidetector computed tomography (MDCT) has been demonstrated as a feasible imaging modality for noninvasive assessment of coronary artery disease and left ventricular (LV) function. Recently, 320-row systems have become available with 16 cm anatomical coverage allowing image acquisition of the entire heart within a single heartbeat. The purpose of this study was to evaluate the accuracy of 320-row MDCT in the assessment of global LV function compared to two-dimensional (2D) echocardiography as the standard of reference.