Feasibility of point-of-care cardiac ultrasound performed by clinicians at health centers in Tanzania.

Background: Point-of-care cardiac ultrasound (cardiac POCUS) has potential to become a useful tool for improving cardiovascular care in Tanzania. We conducted a pilot program to train clinicians at peripheral health centers to obtain and interpret focused cardiac POCUS examinations using a hand-held portable device.

Methods: Over a 5-day period, didactic and experiential methods were used to train clinicians to conduct a pre-specified scanning protocol and recognize key pathologies.

Coronary computed tomographic angiography in clinical practice: state of the art.

In patients with stable chest pain, coronary CT angiography (CCTA) has demonstrated high accuracy in excluding coronary artery disease and CCTA findings carry prognostic significance for the occurrence of future cardiovascular events. Increasingly, CCTA has been adopted as a triage tool in patients with acute chest pain. In specific clinical scenarios, CCTA further represents a useful tool to exclude an ischemic etiology in patients with cardiac arrhythmias or newly diagnosed heart failure.

Computer-aided stenosis detection at coronary CT angiography: effect on performance of readers with different experience levels.

Objectives: To evaluate the effect of a computer-aided detection (CAD) algorithm for coronary CT angiography (cCTA) on the performance of readers with different experience levels.

Methods: We studied 50 patients (18 women, 58 ± 11 years) who had undergone cCTA and quantitative coronary angiography (QCA). Eight observers with varying experience levels evaluated all studies for ≥50 % coronary artery stenosis.

Influence of observer experience and training on proficiency in coronary CT angiography interpretation.

Purpose: To assess the influence of experience and training on the proficiency in coronary CT angiography (CCTA) interpretation of practitioners with different levels of experience.

Methods And Materials: Nine radiologist and cardiologist observers with varying prior CCTA experience ranging from novice to expert independently analyzed two case series of 50 catheter-correlated CCTA studies for coronary artery stenosis (0%, ≤49%, 50-74%, 75-99%, or 100%). Results of the first case series were unblinded and presented along with catheter angiography results to each reader before proceeding to the second series.

Can coronary artery anomalies be detected on CT calcium scoring studies?

Purpose: To determine whether coronary artery anomalies can be detected on noncontrast computed tomography (CT) coronary artery calcium scoring (CCS) studies.

Materials And Methods: A total of 126 patients (mean age 62 years; 35 women) underwent noncontrast CCS and contrast enhanced coronary CT angiography (cCTA). Thirty-three patients were diagnosed with a coronary anomaly on cCTA, whereas coronary anomalies were excluded in 93.

Coronary CT angiography versus conventional cardiac angiography for therapeutic decision making in patients with high likelihood of coronary artery disease.

Purpose: To assess the efficacy of coronary computed tomographic (CT) angiography for therapeutic decision making in patients with high likelihood of coronary artery disease (CAD)-specifically the ability of coronary CT angiography to help differentiate patients without and patients with a need for revascularization and determine the appropriate revascularization procedure.

Materials And Methods: The study protocol was approved by institutional review board, with written informed consent from all patients. The study was conducted in compliance with HIPAA.

Evaluation of heavily calcified vessels with coronary CT angiography: comparison of iterative and filtered back projection image reconstruction.

Purpose: To prospectively compare traditional filtered back projection (FBP) and iterative image reconstruction for the evaluation of heavily calcified arteries with coronary computed tomography (CT) angiography.

Materials And Methods: The study had institutional review board approval and was HIPAA compliant. Written informed consent was obtained from all patients.

Can non-calcified coronary artery plaques be detected on non-contrast CT calcium scoring studies?

Rationale And Objectives: Coronary computed tomographic (CT) angiography has been shown to detect noncalcified coronary artery plaque. Depending on tissue composition, noncalcified plaque differs in CT attenuation from blood and epicardial fat. The aim of this study was to determine whether noncalcified plaque can be visually detected on non-contrast-enhanced CT calcium scoring studies.

Coronary CT angiography: image quality, diagnostic accuracy, and potential for radiation dose reduction using a novel iterative image reconstruction technique-comparison with traditional filtered back projection.

Objectives: To compare image noise, image quality and diagnostic accuracy of coronary CT angiography (cCTA) using a novel iterative reconstruction algorithm versus traditional filtered back projection (FBP) and to estimate the potential for radiation dose savings.

Methods: Sixty five consecutive patients (48 men; 59.3 ± 7.

Accuracy of coronary artery stenosis detection with CT versus conventional coronary angiography compared with composite findings from both tests as an enhanced reference standard.

Objective: To prospectively compare the accuracy of coronary CT angiography (CCTA) and conventional coronary angiography (CCA) for stenosis detection using composite findings from both tests as an enhanced reference standard.

Methods: One hundred thirteen patients underwent CCTA and CCA. Per-segment and per-patient accuracy of CCTA compared with initial CCA interpretation were determined.

Relationship between coronary artery disease and epicardial adipose tissue quantification at cardiac CT: comparison between automatic volumetric measurement and manual bidimensional estimation.

Rationale And Objectives: The aim of this study was to compare the reproducibility of bidimensional and volumetric quantification of epicardial adipose tissue (EAT) on cardiac computed tomography (CT) and evaluate their relationship with the extent of coronary artery disease (CAD).

Materials And Methods: Forty-five individuals underwent cardiac dual-source CT and conventional coronary angiography for suspicion of CAD. Nonenhanced images acquired to assess calcium score were used to quantify EAT.

Automated computer-aided stenosis detection at coronary CT angiography: initial experience.

Objective: To evaluate the performance of a computer-aided algorithm for automated stenosis detection at coronary CT angiography (cCTA).

Methods: We investigated 59 patients (38 men, mean age 58 +/- 12 years) who underwent cCTA and quantitative coronary angiography (QCA). All cCTA data sets were analyzed using a software algorithm for automated, without human interaction, detection of coronary artery stenosis.

Correlation of regional distribution and morphological pattern of calcification at CT coronary artery calcium scoring with non-calcified plaque formation and stenosis.

Objective: To investigate whether regional calcification patterns at CT coronary artery calcium scoring (CCS) correlate with stenosis and non-calcified plaque formation.

Methods: We studied 106 patients with quantitative catheter angiography (QCA), CCS, and coronary CT angiography (cCTA). CCS was determined globally and for each artery separately.

Cardiac CT in the assessment of acute chest pain in the emergency department.

Objective: The purpose of this article is to describe the current role of ECG-synchronized CT in the evaluation of patients with acute chest pain (triple rule-out) in the emergency department. We discuss clinical contexts of the chest pain algorithm, technical improvements that have enabled CT to attain its current role for this application, scan protocols and radiation considerations, the evidence base regarding diagnostic and prognostic performance, and initial data on the cost-effectiveness of this promising emerging test.

Conclusion: Currently available evidence suggests that CT-based approaches with modern scan technology are safe, accurate, and potentially cost-saving, although large-scale clinical trials are needed to ascertain the precise role of CT in the evaluation of acute chest pain.

Comparison of dual-energy computed tomography of the heart with single photon emission computed tomography for assessment of coronary artery stenosis and of the myocardial blood supply.

To evaluate the performance of dual-energy computed tomography (CT) for integrative imaging of the coronary artery morphology and the myocardial blood supply, 36 patients (15 women, mean age 57 +/- 11 years) with equivocal or incongruous single photon emission CT (SPECT) results were investigated by a single-contrast medium-enhanced, retrospectively electrocardiographic-gated dual-energy CT (DECT) scan with simultaneous acquisition of high and low x-ray spectra. Thirteen patients subsequently underwent invasive coronary angiography (ICA). The DECT data were used to reconstruct anatomic coronary CT angiographic images and to map the myocardial iodine distribution within the left ventricular myocardium.

Barriers to clopidogrel adherence following placement of drug-eluting stents.

Background: Nonadherence to clopidogrel after drug-eluting stent (DES) placement is associated with in-stent thrombosis and adverse cardiac events.

Objective: To identify the incidence of and barriers associated with nonadherence to clopidogrel in patients receiving DES.

Methods: Patients who received a DES between March 1, 2004, and August 31, 2005, from a single academic medical center were eligible.

Impact of right ventricular contrast attenuation on the accuracy of right ventricular function analysis at cardiac multi-detector-row CT.

Purpose: To investigate the impact of right ventricle (RV) contrast attenuation on the accuracy of RV function analysis at cardiac CT performed for coronary imaging.

Materials And Methods: We analyzed multi-phase cardiac dual-source CT studies of 40 consecutive patients (mean age 60.9+/-12.

Dual-energy CT of the heart--principles and protocols.

The introduction of coronary CT angiography (cCTA) has reinvigorated the debate whether management of patients with suspected coronary artery disease (CAD) should be primarily based on physiological versus anatomical testing. Anatomical testing (i.e.

Dual-energy CT of the heart for diagnosing coronary artery stenosis and myocardial ischemia-initial experience.

We aimed to evaluate the feasibility of diagnosing coronary stenosis and myocardial ischemia with a single dual-energy CT (DECT) acquisition. Thirty-five patients underwent contrast-enhanced, ECG-gated DECT of the heart while independently operating the two tubes of a dual-source CT system at high- and low-energy X-ray spectra. From the same raw data, coronary CTA (cCTA) studies were reconstructed for stenosis detection, and the myocardial blood-pool was analyzed by determining the tissue iodine content.

Significant coronary artery stenosis: comparison on per-patient and per-vessel or per-segment basis at 64-section CT angiography.

Purpose: To prospectively evaluate the accuracy of 64-section computed tomographic (CT) coronary angiography for assessing significant stenosis on a global and segmental level, by using conventional coronary artery angiography as the reference standard.

Materials And Methods: This study was HIPAA compliant and had local institutional review board approval. Patients gave informed consent.

Does two-segment image reconstruction at 64-section CT coronary angiography improve image quality and diagnostic accuracy?

Purpose: To prospectively evaluate the effect of single- versus two-segment image reconstruction on image quality and diagnostic accuracy at 64-section multidetector computed tomographic (CT) coronary angiography by using conventional coronary angiography as the reference standard.

Materials And Methods: The study design was approved by a human research committee; patients gave informed consent. The study was HIPAA compliant.

Coronary CT angiography.

Owing to ongoing technical refinements and intense scientific and clinical evaluations, computed tomography (CT) of the heart has left the research realm and matured into a clinical application that is about to fulfill its promise to replace invasive cardiac catheterization in selected patient populations. CT coronary angiography is technically more challenging than other CT applications owing to the nature of its target, the continuously moving heart. Rapid technical developments in this field require constant adaptation of acquisition protocols.

CT of cardiac function.

Multidetector computed tomography (MDCT) can play a role in diagnosis of coronary artery disease and in the assessment of left ventricle (LV) and right ventricle global function, with initial good correlation results with standard modalities. With the latest scanners, regional LV contractility with both qualitative and quantitative assessment has become possible. MDCT function evaluation by specific postprocessing software can be performed considering simultaneously different parameters plus the subjective visual perception of anomalies on 2-dimensional and 3-dimensional cine-loop models.