Search

Objectives This study was designed to compare the accuracy of 64-row contrast computed tomography (CT), invasive cineventriculography (CVG), 2-dimensional echocardiography (2D Echo), and 3-dimensional echocardiography (3D Echo) for left ventricular (LV) function assessment with magnetic resonance imaging (MRI). Background Cardiac function is an important determinant of therapy and is a major predictor for long-term survival in patients with coronary artery disease. A number of methods are available for assessment of function, but there are limited data on the comparison between these multiple methods in the same patients. Methods A total of 36 patients prospectively underwent 64-row CT, CVG, 2D Echo, 3D Echo, and MRI (as the reference standard). Global and regional LV wall motion and ejection fraction (EF) were measured. In addition, assessment of interobserver agreement was performed. Results For the global EF, Bland-Altman analysis showed significantly higher agreement between CT and MRI (p 0.8), whereas agreement was lower for CVG (intraclass correlation coefficient = 0.58). Conclusions 64-row CT may be more accurate than CVG, 2D Echo, and 3D Echo in comparison with MRI as the reference standard for assessment of global LV function.

Objectives The purpose of this study was to assess the impact of patient population characteristics on accuracy by computed tomography angiography (CTA) to detect obstructive coronary artery disease (CAD). Background The ability of CTA to exclude obstructive CAD in patients of different pre-test probabilities and in presence of coronary calcification remains uncertain. Methods For the CORE-64 (Coronary Artery Evaluation Using 64-Row Multidetector Computed Tomography Angiography) study, 371 patients underwent CTA and cardiac catheterization for the detection of obstructive CAD, defined as ≥50% luminal stenosis by quantitative coronary angiography (QCA). This analysis includes 80 initially excluded patients with a calcium score ≥600. Area under the receiver-operating characteristic curve (AUC) was used to evaluate CTA diagnostic accuracy compared to QCA in patients according to calcium score and pre-test probability of CAD. Results Analysis of patient-based quantitative CTA accuracy revealed an AUC of 0.93 (95% confidence interval [CI]: 0.90 to 0.95). The AUC remained 0.93 (95% CI: 0.90 to 0.96) after excluding patients with known CAD but decreased to 0.81 (95% CI: 0.71 to 0.89) in patients with calcium score ≥600 (p = 0.077). While AUCs were similar (0.93, 0.92, and 0.93, respectively) for patients with intermediate, high pre-test probability for CAD, and known CAD, negative predictive values were different: 0.90, 0.83, and 0.50, respectively. Negative predictive values decreased from 0.93 to 0.75 for patients with calcium score Conclusions Both pre-test probability for CAD and coronary calcium scoring should be considered before using CTA for excluding obstructive CAD. For that purpose, CTA is less effective in patients with calcium score ≥600 and in patients with a high pre-test probability for obstructive CAD.

The diagnostic accuracy of CT angiography (CTA) for assessing coronary stent patency is modest. CT myocardial stress perfusion imaging (CTP) is an evolving technique that may enhance the diagnostic accuracy of cardiac CT to evaluate coronary stents. We tested this hypothesis using data from the

Clinical studies suggest a potential role for epicardial fat in the pathogenesis of coronary artery disease (CAD). However, study results are mixed and most investigations include low risk individuals. We explored the relationship of epicardial fat volume (EFV) with the presence and severity of CAD

Objectives We sought to compare left ventricular (LV) function assessed with multislice computed tomography (MSCT), biplane cineventriculography (CVG), and transthoracic echocardiography (Echo), with magnetic resonance imaging (MRI) as the reference standard. Background With the same data as acquired for noninvasive coronary angiography, MSCT enables registration of myocardial function. Methods A total of 88 patients (64 men and 24 women) underwent MSCT with 16 × 0.5 mm detector collimation, CVG, and MRI, whereas Echo was retrospectively analyzed in a subset of 30 patients. Results Regarding the ejection fraction, the agreement was significantly superior for MSCT than for CVG (± 10.2% vs. ± 16.8%; p Conclusions Our results indicate that the assessment of global and regional LV function with MSCT is more accurate than with CVG, whereas MSCT is superior to Echo for global function. This suggests that MSCT allows reliable evaluation of global and regional LV function.

This study sought to determine whether adding myocardial computed tomography perfusion (CTP) to computed tomography angiography (CTA) improves diagnostic performance for coronary stents.CTA of coronary stents has been limited by nondiagnostic studies caused by metallic stent material and coronary motion.CTA and CTP were performed in 91 consecutive patients with stents before quantitative coronary angiography, the reference standard for obstructive stenosis (≥50%). If a coronary stent or vessel was nondiagnostic on CTA, adenosine stress CTP in the corresponding myocardial territory was read for combined CTA/CTP.Patients had an average of 2.5 ± 1.8 coronary stents (1 to 10), with a diameter of 3.0 ± 0.5 mm. Significantly more patients were nondiagnostic for stent assessment by CTA (22%; mainly due to metal artifacts [75%] or motion [25%]) versus CTP (1%; p0.001; severe angina precluded CTP in 1 case). The per-patient diagnostic accuracy of CTA/CTP for stents (87%, 95% confidence interval [CI]: 78% to 93%) was significantly higher than that of CTA alone (71%, 95% CI: 61% to 80%; p0.001), mainly because nondiagnostic examinations were significantly reduced (p0.001). In the analysis of any coronary artery disease, diagnostic accuracy and nondiagnostic rate were also significantly improved by the addition of CTP (p0.001). CTA/CTP (7.9 ± 2.8 mSv) had a significantly lower effective radiation dose than angiography (9.5 ± 5.1 mSv; p = 0.005). The area under the receiver-operating characteristic curve for CTA/CTP (0.82, 95% CI: 0.69 to 0.95) was superior to that for CTA (0.69, 95% CI: 0.57 to 0.82; p0.001) in identifying patients requiring stent revascularization.Combined coronary CTA and myocardial CTP improves diagnosis of CAD and in-stent restenosis in patients with stents compared with CTA alone. (Coronary Artery Stent Evaluation With 320-Slice Computed Tomography-The CArS 320 Study [CARS-320]; NCT00967876).

This study was designed to compare the accuracy of 64-row contrast computed tomography (CT), invasive cineventriculography (CVG), 2-dimensional echocardiography (2D Echo), and 3-dimensional echocardiography (3D Echo) for left ventricular (LV) function assessment with magnetic resonance imaging (MRI).Cardiac function is an important determinant of therapy and is a major predictor for long-term survival in patients with coronary artery disease. A number of methods are available for assessment of function, but there are limited data on the comparison between these multiple methods in the same patients.A total of 36 patients prospectively underwent 64-row CT, CVG, 2D Echo, 3D Echo, and MRI (as the reference standard). Global and regional LV wall motion and ejection fraction (EF) were measured. In addition, assessment of interobserver agreement was performed.For the global EF, Bland-Altman analysis showed significantly higher agreement between CT and MRI (p0.005, 95% confidence interval: ±14.2%) than for CVG (±20.2%) and 3D Echo (±21.2%). Only CVG (59.5 ± 13.9%, p = 0.03) significantly overestimated EF in comparison with MRI (55.6 ± 16.0%). CT showed significantly better agreement for stroke volume than 2D Echo, 3D Echo, and CVG. In comparison with MRI, CVG-but not CT-significantly overestimated the end-diastolic volume (p0.001), whereas 2D Echo and 3D Echo significantly underestimated the EDV (p0.05). There was no significant difference in diagnostic accuracy (range: 76% to 88%) for regional LV function assessment between the 4 methods when compared with MRI. Interobserver agreement for EF showed high intraclass correlation for 64-row CT, MRI, 2D Echo, and 3D Echo (intraclass correlation coefficient0.8), whereas agreement was lower for CVG (intraclass correlation coefficient = 0.58).64-row CT may be more accurate than CVG, 2D Echo, and 3D Echo in comparison with MRI as the reference standard for assessment of global LV function.

Objectives This study was designed to evaluate whether the absence of coronary calcium could rule out ≥50% coronary stenosis or the need for revascularization. Background The latest American Heart Association guidelines suggest that a calcium score (CS) of zero might exclude the need for coronary angiography among symptomatic patients. Methods A substudy was made of the CORE64 (Coronary Evaluation Using Multi-Detector Spiral Computed Tomography Angiography Using 64 Detectors) multicenter trial comparing the diagnostic performance of 64-detector computed tomography to conventional angiography. Patients clinically referred for conventional angiography were asked to undergo a CS scan up to 30 days before. Results In all, 291 patients were included, of whom 214 (73%) were male, and the mean age was 59.3 ± 10.0 years. A total of 14 (5%) patients had low, 218 (75%) had intermediate, and 59 (20%) had high pre-test probability of obstructive coronary artery disease. The overall prevalence of ≥50% stenosis was 56%. A total of 72 patients had CS = 0, among whom 14 (19%) had at least 1 ≥50% stenosis. The overall sensitivity for CS = 0 to predict the absence of ≥50% stenosis was 45%, specificity was 91%, negative predictive value was 68%, and positive predictive value was 81%. Additionally, revascularization was performed in 9 (12.5%) CS = 0 patients within 30 days of the CS. From a total of 383 vessels without any coronary calcification, 47 (12%) presented with ≥50% stenosis; and from a total of 64 totally occluded vessels, 13 (20%) had no calcium. Conclusions The absence of coronary calcification does not exclude obstructive stenosis or the need for revascularization among patients with high enough suspicion of coronary artery disease to be referred for coronary angiography, in contrast with the published recommendations. Total coronary occlusion frequently occurs in the absence of any detectable calcification. (Coronary Evaluation Using Multi-Detector Spiral Computed Tomography Angiography Using 64 Detectors [CORE-64]; NCT00738218)

We sought to compare left ventricular (LV) function assessed with multislice computed tomography (MSCT), biplane cineventriculography (CVG), and transthoracic echocardiography (Echo), with magnetic resonance imaging (MRI) as the reference standard.With the same data as acquired for noninvasive coronary angiography, MSCT enables registration of myocardial function.A total of 88 patients (64 men and 24 women) underwent MSCT with 16 x 0.5 mm detector collimation, CVG, and MRI, whereas Echo was retrospectively analyzed in a subset of 30 patients.Regarding the ejection fraction, the agreement was significantly superior for MSCT than for CVG (+/- 10.2% vs. +/- 16.8%; p0.001) and Echo (+/- 11.0% vs. +/- 21.2%; p0.001). For the end-diastolic and end-systolic volumes, the limits of agreement with CVG (p0.001) and Echo (p0.001 and p0.02, respectively) were also significantly larger than with MSCT. In comparison with MSCT, CVG significantly overestimated the end-diastolic and end-systolic volumes (p0.001). Intraobserver analysis of MSCT yielded limits of agreement for ejection fraction (+/- 4.8%), end-diastolic volume (+/- 15.6 ml) and end-systolic volume (+/- 8.0 ml), and myocardial mass (+/- 18.2 g). The accuracy in identifying patients and myocardial segments with abnormal regional function was significantly higher with MSCT (84% and 95%) than with CVG (63% and 90%; p0.002 and p0.001), whereas MSCT and Echo were not significantly different in identifying patients with abnormal regional function.Our results indicate that the assessment of global and regional LV function with MSCT is more accurate than with CVG, whereas MSCT is superior to Echo for global function. This suggests that MSCT allows reliable evaluation of global and regional LV function.

We read with great interest the paper about the DISCOVER-FLOW (Diagnosis of Ischemia-Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve) study, which compared fractional flow reserve (FFR) derived from coronary computed tomography angiography (CTA) with invasive FFR measurements ([1][

Peripheral artery disease (PAD) is common ([1][1]), and 70% of patients with significant stenoses of the abdominal, pelvic, or peripheral arteries also have significant coronary artery disease ([2][2]), further limiting their clinical prognosis. PAD affects 12% to 20% of Americans 60 years of age or

Single photon emission computed tomography (SPECT) and coronary CT angiography (CTA) are widely used tests for evaluating patients with coronary artery disease (CAD). We prospectively compared the diagnostic performance of SPECT and CTA for detecting obstructive CAD using invasive quantitative

The relationship between coronary arterial lesion severity by CT angiography (CTA) and myocardial perfusion abnormalities is generally modest. We hypothesized that this relationship can be improved in selected cases of vessels without diffuse disease or long lesions. We included 349 patients