Diagnostic Performance of CT-Derived Fractional Flow Reserve in Australian Patients Referred for Invasive Coronary Angiography.

Background: Non-invasive computed tomography (CT)-derived fractional flow reserve (FFR) is computed from standard coronary CT angiography (CTA) datasets and provides accurate vessel-specific ischaemia assessment of coronary artery disease (CAD). To date, the technique and its diagnostic performance has not been verified in the Australian clinical context. The aim of this study was to describe and compare the diagnostic performance of FFR and CTA for the detection of vessel-specific ischaemia as determined by invasive fractional flow reserve (FFR) in the Australian patient population.

Influence of operator expertise and coronary luminal segmentation technique on diagnostic performance, precision and reproducibility of reduced-order CT-derived fractional flow reserve technique.

Background: Onsite workstation-based CT-derived Fractional-Flow-Reserve (CT-FFR) is accurate in assessing hemodynamic-significance of coronary stenoses. We aim to describe the influence of operator expertise and luminal-segmentation technique on the diagnostic performance, precision and reproducibility of CT-FFR in identifying hemodynamically-significant stenosis (FFR≤0.8).

Non-invasive CT-derived fractional flow reserve and static rest and stress CT myocardial perfusion imaging for detection of haemodynamically significant coronary stenosis.

Computed tomography derived fractional flow reserve (FFR) and computed tomography stress myocardial perfusion imaging (CTP) are techniques to assess haemodynamic significance of coronary stenosis. To compare the diagnostic performance of FFR and static rest/stress CTP in detecting fractional flow reserve (FFR) defined haemodynamically-significant stenosis (FFR ≤ 0.8).

Prognostic Value and Risk Continuum of Noninvasive Fractional Flow Reserve Derived from Coronary CT Angiography.

Background Coronary CT angiography with noninvasive fractional flow reserve (FFR) predicts lesion-specific ischemia when compared with invasive FFR. The longer term prognostic value of CT-derived FFR (FFR) is unknown. Purpose To determine the prognostic value of FFR when compared with coronary CT angiography and describe the relationship of the numeric value of FFR with outcomes.

Performance of computed tomography-derived fractional flow reserve using reduced-order modelling and static computed tomography stress myocardial perfusion imaging for detection of haemodynamically significant coronary stenosis.

Aims: To compare the diagnostic performance of a reduced-order computed tomography-derived fractional flow reserve (CT-FFR) technique derived from luminal deformation and static CT stress myocardial perfusion (CTP).

Methods And Results: Forty-six patients (84 vessels) with suspected coronary artery disease from a single institution planned for elective coronary angiography prospectively underwent research indicated invasive fractional flow reserve (FFR) and 320-detector CT coronary angiography (CTA) and static CTP. Analyses were performed in separate blinded core laboratories for CT-FFR and CTP.

Fractional flow reserve and myocardial perfusion by computed tomography: a guide to clinical application.

The aim of this paper is to provide a guide to the clinical application of the functional computed tomography (CT) techniques fractional flow reserve (CT FFR) and myocardial perfusion (CTP) in patients presenting for the evaluation of coronary artery disease (CAD). Both techniques have recently been introduced to complement coronary CT angiography (CTA) with physiological information. Evidence supporting their diagnostic accuracy accumulates at a fast pace, and both techniques are moving from research tools to clinical applications for specific subgroups of patients.

Impact of heart rate on diagnostic accuracy of second generation 320-detector computed tomography coronary angiography.

Objective: To assess the impact of elevated heart rate (HR) on the diagnostic accuracy and image quality of second-generation 320-detector computed tomography coronary angiography (320-CTCA).

Methods: Consecutive patients with suspected coronary disease referred for invasive coronary angiography (ICA) were prospectively recruited and underwent 320-CTCA. Pre-scan beta-blockers were administered if native HR>80 bpm and post-scan cohorts stratified by traditional (HR ≤60 bpm) and elevated HR (61-80 bpm).

Epicardial adipose tissue and myocardial ischemia assessed by computed tomography perfusion imaging and invasive fractional flow reserve.

Background: Epicardial adipose tissue (EAT) is a metabolically active fat depot that is associated with incident coronary artery disease (CAD) and major adverse cardiovascular events. The relationship between EAT and myocardial ischemia remains unclear. This study investigated the relationship between EAT volume and the presence of perfusion defects on myocardial computed tomographic perfusion imaging (CTP) and functional stenoses on invasive fractional flow-reserve (FFR).

Noninvasive CT-Derived FFR Based on Structural and Fluid Analysis: A Comparison With Invasive FFR for Detection of Functionally Significant Stenosis.

Objectives: This study describes the feasibility and accuracy of a novel computed tomography (CT) fractional flow reserve (FFR) technique based on alternative boundary conditions.

Background: Techniques used to compute FFR based on images acquired from coronary computed tomography angiography (CTA) are described. Boundary conditions were typically determined by allometric scaling laws and assumptions regarding microvascular resistance.

Ethnic differences in coronary plaque and epicardial fat volume quantified using computed tomography.

Epidemiological studies observed a higher prevalence of coronary atherosclerosis in South Asians when compared to Caucasians, but quantitative computed tomography differences in aggregate plaque volume (APV) and epicardial fat volume (EFV) between South Asians, Southeast or East Asians (SEEAs) and Caucasians remain unknown. We aimed to compare APV and EFV quantified on computed-tomographic-coronary-angiography (CTCA) between South Asian, SEEA and Caucasian populations residing in Australia. Age, gender and body-mass-index matched subjects from three ethnic groups who underwent clinically indicated 320-detector CTCA were retrospectively analysed.

Clinical utility of multi-detector cardiac computed tomography in structural heart interventions.

In recent years, there have been major advances in structural interventional cardiology, which have revolutionized the practice of cardiology. Appropriate selection and follow-up of patients undergoing these structural heart interventions is vital. Multi-detector computed tomography (MDCT) has emerged as a key imaging modality in the peri-procedural assessment of patients undergoing multiple structural cardiac interventions.

Diagnostic Performance of Transluminal Attenuation Gradient and Noninvasive Fractional Flow Reserve Derived from 320-Detector Row CT Angiography to Diagnose Hemodynamically Significant Coronary Stenosis: An NXT Substudy.

Purpose: To compare the diagnostic performance of 320-detector row computed tomography (CT) coronary angiography-derived computed fractional flow reserve (FFR; FFRCT), transluminal attenuation gradient (TAG; TAG320), and CT coronary angiography alone to diagnose hemodynamically significant stenosis as determined by invasive FFR.

Materials And Methods: This substudy of the prospective NXT study (no. NCT01757678) was approved by each participating institution's review board, and informed consent was obtained from all participants.

Relationship between epicardial fat and quantitative coronary artery plaque progression: insights from computer tomography coronary angiography.

Epicardial fat volume (EFV) has been suggested to promote atherosclerotic plaque development in coronary arteries, and has been correlated with both coronary stenosis and acute coronary events. Although associated with progression of coronary calcification burden, a relationship with progression of coronary atheroma volume has not been previously tested. We studied patients who had clinically indicated serial 320-row multi-detector computer tomography coronary angiography with a median 25-month interval.

Coronary computed tomography angiography for the assessment of chest pain: current status and future directions.

Chest pain is one of the most common presenting symptoms leading to presentation to medical clinics and Emergency Departments worldwide. Defining the nature and etiology of chest pain can pose a diagnostic dilemma for clinicians, despite the availability of several diagnostic algorithms and guidelines to assist them in evaluating these patients. Most investigations in patients with acute chest pain are initially performed to either exclude or diagnose and manage potentially life-threatening conditions such as acute coronary syndrome, pulmonary embolism and aortic dissection.

Regional aortic distensibility and its relationship with age and aortic stenosis: a computed tomography study.

Aortic distensibility (AD) decreases with age and increased aortic stiffness is independently associated with adverse cardiovascular outcomes. The association of severe aortic stenosis (AS) with AD in different aortic regions has not been evaluated. Elderly subjects with severe AS and a cohort of patients without AS of similar age were studied.

The ASLA Score: A CT Angiographic Index to Predict Functionally Significant Coronary Stenoses in Lesions with Intermediate Severity-Diagnostic Accuracy.

Purpose: To identify computed tomographic (CT) coronary indexes independently associated with a fractional flow reserve (FFR) of 0.8 or less, to derive a score that combines CT indexes most predictive of an FFR of 0.8 or less, and to evaluate the diagnostic accuracy of the score in predicting an FFR of 0.

Epicardial adipose tissue: far more than a fat depot.

Epicardial adipose tissue (EAT) refers to the fat depot that exists on the surface of the myocardium and is contained entirely beneath the pericardium, thus surrounding and in direct contact with the major coronary arteries and their branches. EAT is a biologically active organ that may play a role in the association between obesity and coronary artery disease (CAD). Given recent advances in non-invasive imaging modalities such a multidetector computed tomography (MDCT), EAT can be accurately measured and quantified.

Superior CT coronary angiography image quality at lower radiation exposure with second generation 320-detector row CT in patients with elevated heart rate: a comparison with first generation 320-detector row CT.

Background: This study aims to compare the image quality of second generation versus first generation 320-computed tomography coronary angiography (CTCA) in patients with heart rate ≥65 bpm as it has not been specifically reported.

Methods: Consecutive patients who underwent CTCA using second-generation-320-detector-row-CT were prospectively enrolled. A total of 50 patients with elevated (≥65 bpm) heart rate and 50 patients with controlled (<65 bpm) heart rate were included.

Anatomic characteristics and outcome of adults with coronary arteries arising from an anomalous location detected with coronary computed tomography angiography.

We sought to determine the anatomic characteristics of coronary arteries arising from an anomalous location (CAAL) detected on coronary computed tomography angiography (CTA) and assess the impact of high-risk anatomic characteristics on patient management and outcomes. We reviewed 9,774 consecutive CTA studies performed in adults between 2008-2013 and identified 114 with CAAL. CTA examinations were analysed to determine CAAL type, CAAL course (pre-pulmonary, interarterial, septal or retroaortic) and whether additional high-risk anatomic characteristics were present (luminal compression, intramural course, slit-like ostium and acute takeoff angle).

Pre-procedural combined coronary angiography and stress myocardial perfusion imaging using 320-detector CT in unprotected left main and ostial left anterior descending artery intervention.

Pre-procedural anatomic and functional coronary assessment plays a crucial role in selection of patients suitable for unprotected left main percutaneous coronary intervention. Combined coronary computed tomography angiography and adenosine stress computed tomography myocardial perfusion imaging is a non-invasive technique which may provide this information. This is the first report describing its use to assist patient selection and procedural planning prior to elective left main and ostial left anterior descending artery coronary intervention.

Pacing and implantable cardioverter defibrillator lead perforation as assessed by multiplanar reformatted ECG-gated cardiac computed tomography and clinical correlates.

Introduction: We aimed to assess the utility of cardiac computed tomography (CT) in the evaluation of right atrial (RA) and right ventricular (RV) pacemaker and implantable cardiac defibrillator lead perforation.

Methods: Images from a 320-slice electrocardiogram-gated cardiac CT scanner were retrospectively independently analyzed by two reviewers for lead position, pericardial effusion, and perforation.Perforation results were correlated with pacing sensing, impedance, and threshold measurements.

Long-term outcome after CT angiography in patients with possible acute coronary syndrome.

Purpose: To assess the long-term outcome and hospital readmission rate associated with a computed tomographic (CT) angiography-guided strategy used to examine patients who present to the emergency department (ED) with symptoms of possible acute coronary syndrome (ACS).

Materials And Methods: The study was approved by the institutional review board, and all patients provided written informed consent. A total of 585 consecutive patients (mean age, 58 years ± 11 [standard deviation]; 58% were male) with ischemic-type chest pain and low to intermediate risk for ACS were evaluated prospectively.

Comparison of diagnostic accuracy of combined assessment using adenosine stress computed tomography perfusion + computed tomography angiography with transluminal attenuation gradient + computed tomography angiography against invasive fractional flow reserve.

Objectives: The goal of this study was to compare the diagnostic accuracy of combined computed tomography perfusion (CTP) + computed tomography angiography (CTA), transluminal attenuation gradient by 320-detector row computed tomography (TAG320) + CTA, and CTP + TAG320 + CTA (multidetector computed tomography-integrated protocol [MDCT-IP]) assessment in predicting significant fractional flow reserve (FFR).

Background: CTA has limited specificity for predicting functionally significant stenoses. Novel CT techniques, including adenosine stress CTP and TAG320, may improve the diagnostic accuracy of CTA.