Use of coronary physiology to guide revascularization in clinical practice: results of the F(FR) registry.

Background: Despite the recommendation of coronary physiology to guide revascularization in angiographically intermediate stenoses without established correlation to ischemia, its uptake in clinical practice is slow.

Aims: This study aimed to analyze the use of coronary physiology in clinical practice.

Methods: Based on a multicenter registry (Fractional Flow Reserve Fax Registry, F(FR), ClinicalTrials.

Coronary computed tomography angiography (CCTA) in patients with suspected stable coronary artery disease (CAD): diagnostic impact and clinical consequences in the German Cardiac CT Registry depending on stress test results.

To evaluate diagnostic impact of clinical use of coronary computed tomography angiography (CCTA) in patients with suspected stable coronary artery disease (CAD) and its consequences in daily practice for patient management, depending on stress test results in daily practice. Between 2009 and 2014 of a total population of 1352 patients of the German Cardiac Computed Tomography (CT) Registry who had previously undergone stress tests, CCTA visualizations were carried out on the coronary arteries with suspected stable CAD. Patients were divided into three groups according to stress test results: Group 1 with inconclusive (n = 178, 13.

German cardiac CT registry: indications, procedural data and clinical consequences in 7061 patients undergoing cardiac computed tomography.

Cardiac computed tomography permits quantification of coronary calcification as well as detection of coronary artery stenoses after contrast enhancement. Moreover, cardiac CT offers high-resolution morphologic and functional imaging of cardiac structures which is valuable for various structural heart disease interventions and electrophysiology procedures. So far, only limited data exist regarding the spectrum of indications, image acquisition parameters as well as results and clinical consequences of cardiac CT examinations using state-of-the-art CT systems in experienced centers.

Declining radiation dose of coronary computed tomography angiography: German cardiac CT registry experience 2009-2014.

Background: Coronary computed tomography angiography (CTA) is increasingly used as a test to rule out coronary artery disease (CAD) in patients with a low to intermediate pre-test probability of the disease. We used the database of the German CT registry, collected between 2009 and 2014 in a broad patient population, to analyze contemporary radiation dose associated with coronary CTA in clinical practice.

Patients And Methods: The prospective observational registry included a total of 7061 patients ≥18 years, referred to 12 participating centers for a clinically indicated cardiac CT examination.

Safety, efficacy, and indications of beta-adrenergic receptor blockade to reduce heart rate prior to coronary CT angiography.

For selected indications, coronary computed tomographic (CT) angiography is an established clinical technology for evaluation in patients suspected of having or known to have coronary artery disease. In coronary CT angiography, image quality is highly dependent on heart rate, with heart rate reduction to less than 60 beats per minute being important for both image quality and radiation dose reduction, especially when single-source CT scanners are used. β-Blockers are the first-line option for short-term reduction of heart rate prior to coronary CT angiography.

One-year clinical outcomes with abciximab in acute myocardial infarction: results of the BRAVE-3 randomized trial.

Purpose: In the Bavarian Reperfusion Alternatives Evaluation (BRAVE)-3 study upstream administration of abciximab additional to 600 mg clopidogrel loading did not reduce the infarct size in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary interventions. The aim of this study was to investigate 1-year clinical outcomes in the BRAVE-3 study patients.

Methods: A total of 800 patients with acute STEMI within 24 h from symptom onset, all treated with 600 mg of clopidogrel were randomized in a double-blind fashion to receive either abciximab (n = 401) or placebo (n = 399) in the intensive care unit before being sent to the catheterization laboratory.

Abciximab in patients with acute ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention after clopidogrel loading: a randomized double-blind trial.

Background: The glycoprotein IIb/IIIa receptor inhibitor abciximab has improved the efficacy of primary percutaneous coronary interventions in patients with acute myocardial infarction. However, it is not known whether abciximab remains beneficial after adequate clopidogrel loading in patients with acute ST-segment-elevation myocardial infarction.

Methods And Results: A total of 800 patients with acute ST-segment-elevation myocardial infarction within 24 hours from symptom onset, all treated with 600 mg clopidogrel, were randomly assigned in a double-blind fashion to receive either abciximab (n=401) or placebo (n=399) in the intensive care unit before being sent to the catheterization laboratory.

Effect of intensive versus standard lipid-lowering treatment with atorvastatin on the progression of calcified coronary atherosclerosis over 12 months: a multicenter, randomized, double-blind trial.

Background: Recent clinical trials have suggested that intensive versus standard lipid-lowering therapy provides for additional benefit. Electron-beam computed tomography provides the opportunity to quantify the progression of coronary artery calcification (CAC) in serial measurements.

Methods And Results: In a multicenter, randomized, double-blind trial, 471 patients (age 61+/-8 years) who had no history of coronary artery disease and no evidence of high-grade coronary stenoses (>50% diameter reduction) were randomized if they had > or =2 cardiovascular risk factors and moderate calcified coronary atherosclerosis as evidenced by a CAC score > or =30.

[Detection of coronary calcifications by electron beam tomography and multislice spiral CT: clinical relevance].

Coronary calcifications can be detected and quantified using electron beam tomography (EBT) or newer generation multi-slice spiral CT (MSCT) scanners. An abundance of data has been acquired by EBT. It could be shown that the amount of coronary calcium correlates to the coronary plaque burden.

Coronary calcifications in young patients with first, unheralded myocardial infarction: a risk factor matched analysis by electron beam tomography.

Objective: To compare the presence and extent of coronary calcifications in young patients with first, unheralded acute myocardial infarction with matched controls without a history of coronary artery disease.

Methods: In 102 patients under 60 years of age (19-59 years, mean 41 years; 88% male), electron beam tomography was done 1-14 days after acute myocardial infarction, before any coronary intervention. Coronary calcifications were quantified using the Agatston score.

Diagnostic value of maximum intensity projections versus source images for assessment of contrast-enhanced three-dimensional breath-hold magnetic resonance coronary angiography.

Rationale And Objectives: We compared maximum intensity projections (MIP) versus original source images (SI) in respect to detection of coronary artery stenoses by means of magnetic resonance (MR) coronary angiography.

Methods: MR coronary angiography was performed on 61 patients. MIP and SI were independently evaluated as to presence of significant stenoses in the proximal and midcoronary segments and compared with x-ray angiography.

Multicentre study of fetal cardiac time intervals using magnetocardiography.

Objective: A database with reference values of the durations of the various waveforms in a magnetocardiogram of fetuses in uncomplicated pregnancies is assessed. This database will be of help to discriminate between pathologic and healthy fetuses. A fetal magnetocardiogram is a recording of the magnetic field in a location near the maternal abdomen and reflects the electric activity within the fetal heart.

Comparison of contrast-enhanced breath-hold and free-breathing respiratory-gated imaging in three-dimensional magnetic resonance coronary angiography.

Suppression of respiratory motion is one of the major challenges of magnetic resonance (MR) coronary angiography. Two approaches to compensate for respiratory motion have often been proposed: breath-hold (BH) and free-breathing respiratory-gated (FBRG) imaging. So far, however, these approaches have never been directly compared.

Influence of lipid-lowering therapy on the progression of coronary artery calcification: a prospective evaluation.

Background: Coronary calcification measured by fast computed tomography techniques is a surrogate marker of coronary atherosclerotic plaque burden. In a cohort study, we prospectively investigated whether lipid-lowering therapy with a cholesterol synthesis enzyme inhibitor reduces the progression of coronary calcification.

Methods And Results: In 66 patients with coronary calcifications in electron beam tomography (EBT), LDL cholesterol >130 mg/dL, and no lipid-lowering treatment, the EBT scan was repeated after a mean interval of 14 months and treatment with cerivastatin was initiated (0.

A direct comparison of noninvasive coronary angiography by electron beam tomography and navigator-echo-based magnetic resonance imaging for the detection of restenosis following coronary angioplasty.

Rationale And Objectives: To compare electron beam tomography (EBT) with MR imaging (MRI) for detection of restenosis after coronary angioplasty (PTCA).

Methods: One hundred eighteen patients after PTCA were investigated. By EBT, 50 axial images were acquired (3-mm slice thickness, 120-160 mL radiographic contrast agent).

Progression of aortic valve calcification: association with coronary atherosclerosis and cardiovascular risk factors.

Background: Recent studies demonstrated an influence of atherosclerotic risk factors on the progression of aortic valve stenosis. The extent of aortic valve calcification (AVC) was also found to be a strong predictor of stenosis progression. We investigated the influence of the LDL cholesterol level (LDL), other standard cardiovascular risk factors, and the extent of coronary calcification (CC) on the progression of AVC quantified by electron beam tomography (EBT).

Recommendations for standardization of EBT and MSCT scanning.

Background: The detection and quantification of coronary calcifications by electron beam tomography (EBT) permits to diagnose coronary atherosclerosis in an early stage. Initial reports indicate that multislice spiral CT (MSCT) also permits the quantification of coronary calcium, while equivalency to EBT has not been definitely proven. Since image acquisition, reconstruction and evaluation parameters influence the results of calcium quantification with CT techniques, standardization of the investigation is mandatory to make results comparable.

Noninvasive coronary angiography by magnetic resonance imaging, electron-beam computed tomography, and multislice computed tomography.

In recent years, several techniques for noninvasive imaging of the coronary artery lumen (noninvasive coronary angiography) have been developed. These techniques include magnetic resonance imaging, electron-beam computed tomography, and, most recently, multislice computed tomography. Each of these techniques has specific advantages and disadvantages.

Overlapping cross-sections significantly improve the reproducibility of coronary calcium measurements by electron beam tomography: a phantom study.

Purpose: We conducted phantom studies to investigate whether overlapping cross-sections and volumetric scoring would significantly improve interscan reproducibility of electron beam tomography (EBT) for coronary artery calcium quantification.

Method: Fifteen phantoms simulating various amounts of coronary calcification were scanned in five different positions with a slice thickness of 3.0 mm and a table feed of 3.