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The prognostic efficacy of a coronary computed tomography angiography (CCTA)-derived myocardial radiomics model in patients with chronic myocardial infarction (MI) is unclear. In this retrospective study, a cohort of 236 patients with chronic MI who underwent both CCTA and cardiac magnetic resonance (CMR) examinations within 30 days were enrolled and randomly divided into training and testing datasets at a ratio of 7:3. The clinical endpoints were major adverse cardiovascular events (MACE), defined as all-cause death, myocardial reinfarction and heart failure hospitalization. The entire three-dimensional left ventricular myocardium on CCTA images was segmented as the volume of interest for the extraction of radiomics features. Five models, namely the clinical model, CMR model, clinical+CMR model, CCTA-radiomics model, and clinical+CCTA-radiomics model, were constructed using multivariate Cox regression. The prognostic performances of these models were evaluated through receiver operating characteristic curve analysis and the index of concordance (C-index). Fifty-one (20.16%) patients experienced MACE during a median follow-up of 1439.5 days. The predictive performance of the CCTA-radiomics model surpassed that of the clinical model, CMR model, and clinical+CMR model in both the training (area under the curve (AUC) of 0.904 vs. 0.691, 0.764, 0.785; C-index of 0.88 vs. 0.71, 0.75, 0.76, all p values <0.001) and testing (AUC of 0.893 vs. 0.704, 0.851, 0.888; C-index of 0.86 vs. 0.73, 0.85, 0.85, all p values <0.05) datasets. The CCTA-based myocardial radiomics model is a valuable tool for predicting adverse outcomes in chronic MI, providing incremental value to conventional clinical and CMR parameters. • The CCTA-based myocardial radiomics model improved adverse outcomes prediction in chronic myocardial infarction (MI) patients. • The predictive value of the CCTA-based myocardial radiomics model outperformed that of the conventional clinical and MR models. • The clinical+CCTA-radiomics model may serve as a widely used method for reliable risk stratification for chronic MI patients. [ABSTRACT FROM AUTHOR]

Pericoronary adipose tissue attenuation expressed by fat attenuation index (FAI) on coronary CT angiography (CCTA) reflects pericoronary inflammation and is associated with cardiac mortality. The aim of this study was to define the sub-phenotypes of coronary CCTA-defined plaque and whole vessel quantification by unsupervised machine learning (ML) and its prognostic impact when combined with pericoronary inflammation. A total of 220 left anterior descending arteries (LAD) with intermediate stenosis who underwent fractional flow reserve (FFR) measurement and CCTA were studied. After removal of outcome and FAI data, the phenotype heterogeneity of CCTA-defined plaque and whole vessel quantification was investigated by unsupervised hierarchical clustering analysis based on Ward's method. Detailed features of CCTA findings were assessed according to the clusters (CS1 and CS2). Major adverse cardiac events (MACE)-free survivals were assessed according to the stratifications by FAI and the clusters. Compared with CS2 (n = 119), CS1 (n = 101) were characterized by greater vessel size, increased plaque volume, and high-risk plaque features. FAI was significantly higher in CS1. ROC analyses revealed that best cut-off value of FAI to predict MACE was −73.1. Kaplan-Meier analysis revealed that lesions with FAI ≥ -73.1 had a significantly higher risk of MACE. Multivariate Cox proportional hazards regression analysis revealed that age, FAI ≥ -73.1, and the clusters were independent predictors of MACE. Unsupervised hierarchical clustering analysis revealed two distinct CCTA-defined subgroups and discriminated by high-risk plaque features and increased FAI. The risk of MACE differs significantly according to the increased FAI and ML-defined clusters. • This study applied unsupervised machine learning (ML) to define subpopulations with coronary artery disease (CAD). • ML-defined two subgroups were discriminated by high-risk plaque features. • ML-defined two subgroups were discriminated by increased fat attenuation index (FAI). • The risk of major adverse cardiac events differs according to the increased FAI and clusters. [ABSTRACT FROM AUTHOR]

Myocardial bridge (MB) may cause angina in patients with no obstructive coronary artery disease (CAD). We previously reported a novel stress echocardiography (SE) pattern of focal septal buckling with apical sparing in the end-systolic to early-diastolic phase that is associated with the presence of an MB. We evaluated the diagnostic accuracy of this pattern, and prospectively validated our results. The retrospective cohort included 158 patients with angina who underwent both SE and coronary CT angiography (CCTA). The validation cohort included 37 patients who underwent CCTA in the emergency department for angina, and prospectively underwent SE. CCTA was used as a reference standard for the presence/absence of an MB, and also confirmed no obstructive CAD. In the retrospective cohort, an MB was present in 107 (67.7%). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 91.6%, 70.6%, 86.7% and 80%, respectively. On logistic regression, focal septal buckling and Duke treadmill score were associated with an MB. In the validation cohort, an MB was present in 31 (84%). The sensitivity, specificity PPV and NPV were 90.3%, 83.3%, 96.5% and 62.5%, respectively. On logistic regression, focal septal buckling was associated with an MB. Presence of focal septal buckling with apical sparing on SE is an accurate predictor of an MB in patients with angina and no obstructive CAD. This pattern can reliably be used to screen patients who may benefit from advanced non-invasive/invasive testing for an MB as a cause of their angina. • Focal septal buckling with apical sparing on stress echo accurately predicts an MB. • This pattern can help identify an MB as a potential cause of angina. • And can be useful to screen patients who may benefit from further testing for an MB. [ABSTRACT FROM AUTHOR]

Background The number of patients presenting to the emergency department (ED) with suspected acute coronary syndrome (ACS) is substantial. We tested whether identification of coronary artery calcium (CAC) can improve the negative predictive value (NPV) of clinical risk assessment for ACS in patients with acute chest pain. Methods and results We included 826 consecutive patients (mean age: 53 ± 11 years; 42% female) without known coronary artery disease (CAD) or initially elevated serum biomarkers, whom underwent non-contrast CT, to assess the CAC score, and CT angiography (CTA), to detect coronary stenosis. We analyzed the diagnostic performance of CAC and the Thrombolysis In Myocardial Infarction (TIMI) risk score for our primary outcomes (ACS and obstructive CAD). No CAC was found in 54% (n = 444) of all patients, 63% (n = 524) had a TIMI score of 0 and 40% (n = 328) had both. The prevalence of obstructive CAD was 16% for ≥ 50% stenosis and 8.7% for ≥ 70% stenosis. The incidence of ACS was 7.9%, (MI = 11, UAP = 54). The NPV of CAC = 0 was 99.5% for ACS. The NPV of a combination of TIMI score = 0 and no CAC was 89% for any CAD (any plaque or stenosis) and 99.7% for ≥ 50% stenosis. A 100% NPV was found for ≥ 70% stenosis and ACS, correctly identifying 328 (40%) patients. Conclusions The exclusion of CAC, in combination with clinical risk assessment, has high clinical value in patients with acute chest pain, as it identifies patients at low risk for ACS and obstructive CAD more accurately as compared to clinical risk assessment alone. [ABSTRACT FROM AUTHOR]

Background Non-obstructive coronary artery disease (CAD) identified by coronary computed tomography angiography (CCTA) demonstrated prognostic value. CT-adapted Leaman score (CT-LeSc) showed to improve the prognostic stratification. Aim of the study was to evaluate the capability of CT-LeSc to assess long-term prognosis of patients with non-obstructive (CAD). Methods From 17 centers, we enrolled 2402 patients without prior CAD history who underwent CCTA that showed non-obstructive CAD and provided complete information on plaque composition. Patients were divided into a group without CAD and a group with non-obstructive CAD (< 50% stenosis). Segment-involvement score (SIS) and CT-LeSc were calculated. Outcomes were non-fatal myocardial infarction (MI) and the combined end-point of MI and all-cause mortality. Results Patient mean age was 56 ± 12 years. At follow-up (mean 59.8 ± 13.9 months), 183 events occurred (53 MI, 99 all-cause deaths and 31 late revascularizations). CT-LeSc was the only multivariate predictor of MI (HRs 2.84 and 2.98 in two models with Framingham and risk factors, respectively) and of MI plus all-cause mortality (HR 2.48 and 1.94 in two models with Framingham and risk factors, respectively). This was confirmed by a net reclassification analysis confirming that the CT-LeSc was able to correctly reclassify a significant proportion of patients (cNRI 0.28 and 0.23 for MI and MI plus all-cause mortality, respectively) vs. baseline model, whereas SIS did not. Conclusion CT-LeSc is an independent predictor of major acute cardiac events, improving prognostic stratification of patients with non-obstructive CAD. [ABSTRACT FROM AUTHOR]

Background Preliminary data suggests the absence of coronary artery calcification (CAC) excludes ischemic etiologies of cardiomyopathy. We prospectively validate and perform a systematic review to determine the utility of an Agatston score = 0 to exclude the diagnosis of ischemic cardiomyopathy. Methods and results Patients with newly diagnosed LV dysfunction were prospectively enrolled. Patients underwent CAC imaging and were followed until an etiologic diagnosis of cardiomyopathy was made. Eighty-two patients were enrolled in the study and underwent CAC imaging with 81.7% patients having non-ischemic cardiomyopathy. An Agatston score = 0 successfully excluded an ischemic etiology for cardiomyopathy with a specificity of 100% (CI: 74.7–100%) and a positive predictive value of 100% (CI: 85.0%–100%). A systematic literature review was performed and studies were deemed suitable for inclusion if: 1) patients with CHF, cardiomyopathy or LV dysfunction were enrolled, 2) underwent CAC imaging and patients were assessed for an Agatston score = 0 or the absence of CAC, and 3) the final etiologic diagnosis (ischemic or non-ischemic) was provided. Eight studies provided sufficient information to calculate operating characteristics for an Agatston score = 0 and were combined with our validation cohort for a total of 754 patients. An Agatston score = 0 excluded ischemic cardiomyopathy with specificity and positive predictive values of 98.4% (CI: 95.6–99.5%), and 98.3% (CI: 95.5–99.5%), respectively. Conclusions In patients with cardiomyopathy of unknown etiology, an Agatston score = 0 appears to rule out an ischemic etiology. A screening CAC may be a simple and cost-effective method of triaging patients, identifying those who do and do not need additional CAD investigations. [ABSTRACT FROM AUTHOR]

Objectives Current clinical models predict the pre-test probability of obstructive coronary artery disease, but these models do not predict the presence of high-risk plaques. Thus the objective of this study was to propose a model to predict high-risk plaque assessed by coronary computed tomography (CT) angiography. Methods This study was a retrospective cross-sectional study. A clinical model was derived from 2392 patients and verified by 733 patients who underwent coronary CT suspected of coronary artery disease. High-risk plaque was defined as a plaque with positive remodeling (remodeling index > 1.1), low attenuation (< 30 Hounsfield units) and napkin-ring sign. The risk score was calculated from the following 6 variables with a maximum of 24 points: age, sex, hemoglobin A1c, systolic blood pressure, high-density lipoprotein and smoking status. Results The proportion of patients with high-risk plaque was 11% and 17% in the derivation and validation cohort, respectively. The area under the receiver operation characteristic curve was 0.71 (95% confidence interval (CI): 0.68 to 0.74) in the derivation cohort and 0.75 (95% CI: 0.70 to 0.79) in the validation cohort. The frequency of high-risk plaques was 4% in the low-risk group (≤ 8 points) while it was 53% in the high-risk group (≥ 17 points) of the derivation cohort. Conclusions We propose a scoring system to detect high-risk plaque assessed by coronary CT. Patients in the high-risk group have a high prevalence of high-risk plaque and might benefit from lipid lowering therapy. [ABSTRACT FROM AUTHOR]

Background Downstream resource utilization and its impact on outcomes after a canceled CCTA have not been well studied. We sought to understand downstream resource utilization and patient outcomes after canceled CCTA. Methods and results Consecutive patients were prospectively enrolled into an institutional cardiac CT registry. Patients who had the CCTA study canceled because of severe coronary calcification were followed for downstream resource utilization and the composite of all-cause mortality and non-fatal myocardial infarction (MI). 463 patients had their CCTA canceled due to severe coronary calcification and follow-up was available for 453 (97.8%) patients (median follow-up = 36.0 months). There were a total of 62 events (41 all-cause deaths and 21 non-fatal MI) with an annualized event rate of 4%. Three hundred and twenty patients underwent downstream CAD (ICA or MPI or EST) investigations. Age, NCEP/ATP III risk, beta-blocker use, Agatston and downstream CAD testing were associated with the primary outcome. There were fewer events in those that received downstream CAD testing (30 (9.7%) versus 32 (22.4%)). The annualized event rates for those who did and did not receive downstream CAD testing were 2.8% and 6.2%, respectively. Multivariable analysis confirmed that downstream CAD testing was an independent predictor of event-free survival and that the absence of additional CAD testing was associated with worse outcome (HR: 2.58 (95% CI: 1.54–4.31)). Conclusions Patients with canceled CCTA due to severe and/or extensive CAC have high rates of death and non-fatal MI. The use of additional CAD testing appears to be associated with improved outcomes. [ABSTRACT FROM AUTHOR]

Background Current guidelines recommend the use of the Modified Diamond-Forrester (MDF) method to assess the pre-test likelihood of obstructive coronary artery disease (CAD). We aimed to compare the performance of the MDF method with two contemporary algorithms derived from multicenter trials that additionally incorporate cardiovascular risk factors: the calculator-based ‘CAD Consortium 2’ method, and the integer-based CONFIRM score. Methods We assessed 1069 consecutive patients without known CAD undergoing coronary CT angiography (CCTA) for stable chest pain. Obstructive CAD was defined as the presence of coronary stenosis ≥ 50% on 64-slice dual-source CT. The three methods were assessed for calibration, discrimination, net reclassification, and changes in proposed downstream testing based upon calculated pre-test likelihoods. Results The observed prevalence of obstructive CAD was 13.8% (n = 147). Overestimations of the likelihood of obstructive CAD were 140.1%, 9.8%, and 18.8%, respectively, for the MDF, CAD Consortium 2 and CONFIRM methods. The CAD Consortium 2 showed greater discriminative power than the MDF method, with a C-statistic of 0.73 vs. 0.70 (p < 0.001), while the CONFIRM score did not (C-statistic 0.71, p = 0.492). Reclassification of pre-test likelihood using the ‘CAD Consortium 2’ or CONFIRM scores resulted in a net reclassification improvement of 0.19 and 0.18, respectively, which would change the diagnostic strategy in approximately half of the patients. Conclusions Newer risk factor-encompassing models allow for a more precise estimation of pre-test probabilities of obstructive CAD than the guideline-recommended MDF method. Adoption of these scores may improve disease prediction and change the diagnostic pathway in a significant proportion of patients. [ABSTRACT FROM AUTHOR]

Purpose To investigate the diagnostic confidence of Coronary Computed Tomography Angiography (CCTA) and the effect of patient-related factors on CCTA image quality using a second-generation 320-slice scanner. Methods and results 200 consecutive patients (mean age 60 ± 12 years; 109 men) prospectively underwent CCTA. The mean body mass index (BMI) was 27.1 ± 4.9 kg/m 2 ; the median heart rate (HR) was 60.0 (interquartile range (IQR), 53.9–66.1) beats per minute (bpm). The median segment's diameter was 2.8 (IQR, 2.2–3.4) mm. For each coronary segment ≥ 1.5 mm in diameter, two readers scored: diameter narrowing as < or ≥ 50%, overall diagnostic confidence and motion-related image quality, with interobserver agreement kappa-values of 0.89, 0.91 and 0.61 respectively. Seventy-nine of the 2505 evaluated segments (3.2%) had non-diagnostic image quality because of coronary calcifications (66/79; 83.5%), stent- (6/79; 7.5%), pacemaker- (2/79; 2.5%) or motion-related artifacts (5/79; 6.5%). The effect of patient-related factors on motion-related image quality was investigated by multinomial logistic regression in 181 patients with calcium score (IQR, 0–446.5). Increasing coronary diameter was the most improving image quality factor (odds ratio (OR), 1.8637; p < 0.001), marginally followed by lower HR (OR, 0.9547; p < 0.001) and calcium score (OR, 0.9997; p = 0.04). Gender (p = 0.70), age (p = 0.24) and BMI (p = 0.45) did not affect image quality. Conclusion Using a second-generation 320-slice scanner, CCTA diagnostic confidence is predominantly affected by coronary calcifications, whereas motion-related image quality is non-diagnostic only in exceptional cases and mainly influenced by the coronary diameter. For future developments, our study findings therefore suggest greater requirements concerning spatial resolution and calcium-related artifact removal than concerning temporal resolution, especially to improve diagnostic confidence in patient groups with smaller coronary diameters. [ABSTRACT FROM AUTHOR]

Background To investigate the diagnostic value of coronary CT angiography (CCTA) by bifurcation angle measurement in the assessment of calcified plaques compared to conventional coronary lumen analysis. Methods Fifty-three patients with calcified plaques identified on CCTA in the left coronary artery were included in the study. Minimal lumen diameter (MLD) and bifurcation angle between the left anterior descending (LAD) and left circumflex (LCx) arteries were measured and compared between CCTA and invasive coronary angiography (ICA), while the areas under the curves (AUCs) by receiver-operating characteristic curve analysis (ROC) were compared between CCTA and ICA with regard to the diagnostic value of using bifurcation angle as a criterion. Results On a per-vessel assessment, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) and 95% confidence interval (CI) with the use of bifurcation angle for determining coronary stenosis were 100% (86%, 100%), 79% (59%, 92%), 81% (62%, 92%), and 100% (85%, 100%) for CCTA, and 100% (86%, 100%), 82% (63%, 94%), 83% (65%, 94%), and 100% (85%, 100%) for ICA, respectively. While the sensitivity and NPV remained unchanged, the specificity and PPV of CCTA by MLD were 33% (21%, 47%) and 43% (31%, 56%). The AUCs by ROC curve analysis for CCTA and ICA bifurcation angle measurements demonstrated no significant difference (p > 0.05, 0.79 vs 0.86, and 0.70 vs 0.68 at the LAD and LCx assessment, respectively). Conclusion Coronary CT angiography by bifurcation angle measurement shows significant improvement in the diagnosis of calcified plaques with diagnostic value comparable to invasive coronary angiography. [ABSTRACT FROM AUTHOR]

Background The slow flow (SF) phenomenon is more prevalent in patients with acute coronary syndrome (ACS), who frequently exhibit vulnerable plaques in remote coronary arteries. We aimed to clarify the impact of nonculprit plaque characteristics on the occurrence of SF using multidetector computed tomography (MDCT). Methods The study population comprised 180 consecutive patients with non-ST-segment elevation ACS (NSTE-ACS) who underwent MDCT before intervention. The characteristics of culprit and nonculprit lesions were compared between patients with and without SF. Results SF was observed in 43 (23.8%) of the 180 patients. The prevalence of positive remodeling (PR), low-attenuation plaque (LAP), and napkin-ring sign (NRS) in culprit lesion was significantly higher in the SF group than in the non-SF group (86.1% vs. 39.4%; p < 0.001, 81.4% vs. 18.3%; p < 0.001, and 65.1% vs. 16.1%; p < 0.001, respectively). The same result was observed for nonculprit lesions (58.1% vs. 14.6%; p < 0.001, 45.2% vs. 6.6%; p < 0.001, and 14.3% vs. 4.9%; p < 0.04, respectively). Multivariate analysis revealed LAP [odds ratio (OR), 12.8; 95% confidence interval (CI), 3.7-54.7; p < 0.001], and NRS (OR, 5.1; 95% CI, 1.3-25.3; p = 0.03) in culprit lesions and PR (OR, 4.7; 95% CI, 1.1-22.2; p = 0.04) in nonculprit lesions were independently associated with SF. Conclusions The plaque characteristics of nonculprit lesions are associated with the occurrence of SF during percutaneous coronary intervention. Assessment of plaque characteristics of both culprit and nonculprit lesions using MDCT may be useful for the prediction of SF. [ABSTRACT FROM AUTHOR]

Abstract: Background: The value of ≥64-slice coronary CT angiography (CCTA) to determine odds of cardiac death or non-fatal myocardial infarction (MI) needs further clarification. Methods: We performed a systematic review and meta-analysis using publications reporting events/severity of coronary artery disease (CAD) in patients with suspected CAD undergoing CCTA. Patients were divided into: no CAD, non-obstructive CAD (maximal stenosis <50%), and obstructive CAD (≥50% stenosis). Odds ratios with 95% confidence intervals were calculated using a fixed or random effects model. Heterogeneity was assessed using the I 2 index. Results: We included thirty-two studies comprising 41,960 patients with 363 all-cause deaths (15.0%), 114 cardiac deaths (4.7%), 342 MI (14.2%), 69 unstable angina (2.8%), and 1527 late revascularizations (63.2%) over 1.96 (SD 0.77) years of follow-up. Cardiac death or MI occurred in 0.04% without, 1.29% with non-obstructive, and 6.53% with obstructive CAD. OR for cardiac death or MI was: 14.92 (95% CI, 6.78 to 32.85) for obstructive CAD, 6.41 (95% CI, 2.44 to 16.84) for non-obstructive CAD versus no CAD, and 3.19 (95% CI, 2.29 to 4.45) for non-obstructive versus obstructive CAD and 6.56 (95% CI, 3.07 to 14.02) for no versus any CAD. Similar trends were noted for all-cause mortality and composite major adverse cardiovascular events. Conclusions: Increasing CAD severity detected by CCTA is associated with cardiac death or MI, all-cause mortality, and composite major adverse cardiovascular events. Absence of CAD is associated with very low odds of major adverse events, but non-obstructive disease significantly increases odds of cardiac adverse events in this follow-up period. [Copyright &y& Elsevier]

Abstract: Background: To determine the comparative effectiveness and costs of a CT-strategy and a stress-electrocardiography-based strategy (standard-of-care; SOC-strategy) for diagnosing coronary artery disease (CAD). Methods: A decision analysis was performed based on a well-documented prospective cohort of 471 outpatients with stable chest pain with follow-up combined with best-available evidence from the literature. Outcomes were correct classification of patients as CAD− (no obstructive CAD), CAD+ (obstructive CAD without revascularization) and indication for Revascularization (using a combination reference standard), diagnostic costs, lifetime health care costs, and quality-adjusted life years (QALY). Parameter uncertainty was analyzed using probabilistic sensitivity analysis. Results: For men (and women), diagnostic cost savings were €245 (€252) for the CT-strategy as compared to the SOC-strategy. The CT-strategy classified 82% (88%) of simulated men (women) in the appropriate disease category, whereas 83% (85%) were correctly classified by the SOC-strategy. The long-term cost-effectiveness analysis showed that the SOC-strategy was dominated by the CT-strategy, which was less expensive (−€229 in men, −€444 in women) and more effective (+0.002 QALY in men, +0.005 in women). The CT-strategy was cost-saving (−€231) but also less effective compared to SOC (−0.003 QALY) in men with a pre-test probability of ≥70%. The CT-strategy was cost-effective in 100% of simulations, except for men with a pre-test probability ≥70% in which case it was 59%. Conclusions: The results suggest that a CT-based strategy is less expensive and equally effective compared to SOC in all women and in men with a pre-test probability <70%. [Copyright &y& Elsevier]

Abstract: Background: While patients with coronary artery disease (CAD) and cerebrovascular disease share similar risk factor profiles, data on whether IS can be considered a “CAD equivalent” are limited. We aimed to determine whether ischemic stroke is an independent predictor of CAD by using cardiac computed tomography angiography (CTA). Methods: We analyzed the CTA in 392 patients with no history of CAD (24 patients with acute IS and 368 patients with acute chest pain). Extent of plaque burden was additionally dichotomized into 0–4 versus >4 segments. Results: Patients with IS had a near 5-fold increase odds of having coronary artery plaque (odds ratio [OR] 4.9, P <0.01) as compared to those without IS. After adjustment for age, gender, and traditional cardiac risk factors, there remained a near 4-fold increase odds for coronary plaque (adjusted OR 3.7, P =0.04). When stratified by extent of plaque, patients with IS had over 18-fold increase odds of having >4 segments of plaque than 0–4 segments as compared to patients without stroke (OR 18.3, P <0.01), which remained significantly associated in adjusted analysis (adjusted OR 12.1, P <0.001). Conclusion: Acute IS is independently associated with higher risk and greater extent of CAD compared to patients with acute chest pain at low-to-intermediate risk for acute coronary syndrome. [Copyright &y& Elsevier]

Abstract: Purpose: We aimed to report incidental noncoronary findings of coronary MSCT angiography and to evaluate the feasibility of scanning the entire thorax on Ca score imaging. Methods: 514 patients underwent cardiac MSCT. Instead of scanning just the heart, 124 of them were scanned extensively from the lung apex to the base in order to evaluate the entire thorax for additional findings. Furthermore, we calculated dose length product (DLP) in order to determine mean increase of radiation exposure resulting from lengthened scan field. Results: Coronary artery disease were established in 122 patients (24%) and 273 noncoronary findings were identified in 189 patients (37%). 37 pulmonary nodules (PN) ≥5 mm, 6 of which were over the level of pulmonary trunk, were detected. The mean age (62±8 vs.49±10, respectively; p <0.0001) and the smoking rate (74% vs. 56%, respectively; p <0.05) of the patients with PN were significantly higher than subjects without PN. All patients with PN over the level of pulmonary artery were smokers >50 of age. On Ca score imaging, radiation exposure of widely scanned group was significantly higher than the others (221.3±35.2 mGy cm vs.145.3±11.7 mGy cm of DLP, respectively; p <0.0001). Conclusion: Since MSCT data contain also information about the other structures in the thorax, the images should be evaluated by radiologist in addition to cardiologist. It seems reasonable to scan the entire thorax on Ca score imaging for smokers over 50 in order to detect pulmonary nodules having malignancy potential. [Copyright &y& Elsevier]

Abstract: Anomalous coronary arteries are a rare but recognized cause of myocardial ischemia and sudden death. Most patients with coronary anomalies remain asymptomatic because the anomaly either does not produce any symptoms during life or the first manifestation is sudden death. Noninvasive imaging plays crucial role in diagnosis of the potentially life threatening coronary anomalies. [Copyright &y& Elsevier]

Background: The slow flow (SF) phenomenon is more prevalent in patients with acute coronary syndrome (ACS), who frequently exhibit vulnerable plaques in remote coronary arteries. We aimed to clarify the impact of nonculprit plaque characteristics on the occurrence of SF using multidetector computed tomography (MDCT)., Methods: The study population comprised 180 consecutive patients with non-ST-segment elevation ACS (NSTE-ACS) who underwent MDCT before intervention. The characteristics of culprit and nonculprit lesions were compared between patients with and without SF., Results: SF was observed in 43 (23.8%) of the 180 patients. The prevalence of positive remodeling (PR), low-attenuation plaque (LAP), and napkin-ring sign (NRS) in culprit lesion was significantly higher in the SF group than in the non-SF group (86.1% vs. 39.4%; p<0.001, 81.4% vs. 18.3%; p<0.001, and 65.1% vs. 16.1%; p<0.001, respectively). The same result was observed for nonculprit lesions (58.1% vs. 14.6%; p<0.001, 45.2% vs. 6.6%; p<0.001, and 14.3% vs. 4.9%; p<0.04, respectively). Multivariate analysis revealed LAP [odds ratio (OR), 12.8; 95% confidence interval (CI), 3.7-54.7; p<0.001], and NRS (OR, 5.1; 95% CI, 1.3-25.3; p=0.03) in culprit lesions and PR (OR, 4.7; 95% CI, 1.1-22.2; p=0.04) in nonculprit lesions were independently associated with SF., Conclusions: The plaque characteristics of nonculprit lesions are associated with the occurrence of SF during percutaneous coronary intervention. Assessment of plaque characteristics of both culprit and nonculprit lesions using MDCT may be useful for the prediction of SF., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Abstract: We describe a 33-year-old male with angina pectoris who was found to have abnormal origin and course of right coronary artery from left aortic cusp. The abnormal origin was identified by conventional coronary angiography but the abnormal course of the vessel between ascending aorta and the main pulmonary artery was precisely delineated by high resolution CT angiography. Patient underwent successful surgical transposition of the anomalous vessel with complete resolution of symptoms. [Copyright &y& Elsevier]