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Introduction Negative T waves at ECG represent a common diagnostic dilemma in athletes. These subjects, often asymptomatic, undergo ECG screening every year before practicing competitive sports. The clinical meaning of these ECG abnormalities is often unclear and a comprehensive diagnostic evaluation is needed. Echocardiography is the first step test in all these cases, but the advent of cardiac MRI in the clinical field empowers the diagnostic capability for the identification of cardiovascular disease at a very early stage, even when transthoracic echocardiography is normal. The aim of the present study is to define the prevalence of positive cardiac MRI among athletes with negative T waves at ECG and normal echocardiography and to define the clinical predictors of pathological cardiac MRI or cardiac CT Material and Methods A consecutive cohort of athletes with negative T waves at ECG and normal findings at transthoracic echocardiography were enrolled. All athletes underwent 24h ECG monitoring, ECG exercise test and cardiac MRI; cardiac CT was performed only if clinically indicated and in all subjects with >35 years old of age. The type of sport practiced was recorded and stratified according to intensity into low- mid- and high-intensity. The site of negative T waves was recorded and T waves were defined as “deep” if wider than 2 mm. The presence of any arrhythmias during the 24-ECG monitor or exercise ECG test was recorded as well. The primary end-point of the study was the identification of diagnostic criteria for any structural heart disease at cardiac MRI or cardiac CT Results A total of 55 athletes (50 male, 90%) were enrolled with a mean age of 27 ± 14 years-old. Most of them practiced high-intensity sports activity (47 athletes, 85.4%). Anterior T waves were the most common type (29 athletes, 52.7%) and 8 athletes (14.5%) had more than isolated ventricular ectopic beats at 24-hours ECG monitoring. Among the entire cohort, 16 athletes (29.1%) had cardiac MRI or cardiac CT diagnostic for specific structural heart disease. Of interest, the presence of deep negative t waves (OR 8.1 95%CI 1.4–49.5, p Conclusions Our results identified a prevalence of 29% of structural heart disease among athletes with negative T waves at ECG even when transthoracic echocardiography was normal. Of interest deep negative T waves and arrhythmias more complex than isolated ventricular ectopic beats were significative associated with structural heart disease. Thus, according to our results, advanced cardiovascular imaging techniques (cardiac MRI or cardiac CT) should be considered in athletes with negative T waves at ECG even in the presence of normal transthoracic echocardiography especially if complex ventricular arrhythmias of deep negative T waves are present.

Introduction To the best of our knowledge, there are no previous univocal data on how CCT can accurately describe morphological variants and subtypes of congenital coronary artery abnormalities. Taking into consideration the extensive application of CCT in clinical practice in the last decades, it is not uncommon to have a congenital coronary artery anomaly detected at CCT. Thus, the study aim is to evaluate the diagnostic and prognostic impact of specific cardiac CT parameters in subjects with a diagnosis of congenital coronary artery anomalies. Material and Methods This is an intermediate evaluation of a prospective clinical registry on a population of subjects who underwent a cardiac computed tomography imaging evaluation in the period between January 2007 and October 2015 and were diagnosed to have a congenital coronary abnormality. For the present preliminary analysis only coronary anomalies of origin have been considered and 92 patients have been included. Follow-up have been collected either through a structured telephonic interview or through the evaluation of clinical records of subsequent hospitalization or ambulatory visits. Results The population enrolled in the present study has an average age of 63,0 ± 12,8 years (range 34 to 85 years), with a male prevalence of 69,6%. The left main artery is missing in 46 individuals (50%), with separate origin of LAD and LCX. Only two duplications (2.2%), one for the left coronary artery and one for the right coronary artery, have been discovered. Six participants (6.5%) had a non-coronary artery origin abnormalities and pulmonary artery was the site of origin in the majority of cases. 51 subjects (55,4%) have an anomalous origin of the coronary artery from a different coronary sinus and 50 subjects had also an anomalous course with the retro-aortic being the most common (30,4%). 11 participants (12,0%) displayed also an intramural segment and 16 (17,4%) had abnormal ostial morphology. The high take-off of the vessel was uncommon (3,3%). Age appears to be the only relevant characteristic; indeed, it displays a significant correlation both to MACE (OR 95% CI 1.03, 1.01-1.07; p=0.0349) and to all-cause of death (OR 95% CI 1.14, 1.02-1.27; p=0.0151). None of the traditional cardiovascular risk factors were found to be significantly linked with adverse outcomes in this study sample of coronary anomalies. Conclusions The result of this intermediate evaluation is that cardiac CT can be successfully used to define the anatomy and features of CAA. However, it demonstrated that in middle-aged patients, the tomographic finding of an abnormality of coronary origin might not have a meaningful, strong negative prognostic value in terms of major cardiovascular events and all-cause of death. This means that probably, in the majority of the cases, once the diagnosis is performed later on in life, no further systematic assessment is needed but a personalized approach should be suggested.

Aims To compare the diagnostic performance of adenosine-stress dynamic myocardial perfusion assessed by CT (CTP) as compared with that of coronary CT angiography (CCTA) alone by using invasive fractional flow reserve (FFR) and index of microvascular resistance (IMR) as standard of reference. Diagnostic performance of CCTA for in-stent restenosis (ISR) detection is still challenging. Recently, CTP demonstrated additional specificity and diagnostic accuracy over CCTA alone in patients with previous stent implantation and suspected IRS or progression of coronary artery disease (CAD). However, no data are available in this clinical setting on the performance of CTP by using a new technique allowing for a non-invasive adjudication of regional myocardial blood flow (dynamic CTP) and to assess both macrovascular and microvascular disease status. Moreover, dynamic CTP was never compared vs. a comprehensive assessment of invasive coronary physiology (FFR and IMR). Methods and results We enrolled consecutive stable patients with previous coronary stenting referred for invasive coronary angiography (ICA) for clinical indication. All patients underwent dynamic stress myocardial CTP and rest CTP+CCTA by using a last generation scanner characterized by a 16-cm Z-axis coverage and fast (0.28 s) gantry rotation time. Invasive FFR and IMR were performed during ICA according to the standard practice. The diagnostic rate and diagnostic accuracy of CCTA and CTP were evaluated in a territory-based analyses vs. quantitative coronary angiography (QCA), FFR, and IMR. In 67 enrolled patients (55 men, mean age: 63.1 ± 8.2 years), the diagnostic rate (number of territories interpretable/number of territories evaluated) of CTP was significantly higher than that of CCTA (302/307 = 98.4% vs. 290/307 = 94.4%, P = 0.009). The interpretability of the combined CCTA/CTP approach was 99.7% (306/307 territories). When QCA was used as gold standard, CTP diagnostic accuracy was significantly higher than that of CCTA (84.4% vs. 80.1%, P = 0.01). When coronary physiology metrics were used as gold standard, CTP diagnostic accuracy was significantly higher than that of CCTA vs. both FFR (84.3% vs. 72.2%, P = 0.02) and IMR (83.3% vs. 70.2%, P = 0.02). The radiation exposure of CCTA+CTP was 8.7 ± 2.5 mSv. Conclusions In patients with coronary stents, dynamic CTP significantly improves diagnostic rate and accuracy of CCTA alone in comparison with both FFR and IMR. The non-invasive assessment of ISR is still challenging. The comprehensive assessment by cardiac CT provides anatomical combined to functional evaluation of coronary arteries in revascularized patients with good agreement with invasive physiological evaluation.