Prognostic Value of Renal Function for Cardiac Events in Patients Without Significant Stenosis on Coronary Computed Tomography Angiography

This study was conducted to determine clinical parameters predicting future major adverse cardiovascular events (MACEs) in patients without significant stenosis on coronary computed tomographic angiography (CCTA). A total of 625 patients with suspected coronary artery disease (CAD) who underwent CCTA that revealed insignificant (< 50%) CAD was reviewed in three cardiac centers. The MACEs including cardiac death, non-fatal myocardial infarction (MI), unstable angina and late (> 90 days after CCTA) revascularization were assessed. During the mean follow-up period of 819 ± 529 days (median 837 days), there were 28 cases of MACEs (4.5%). In multivariable Cox regression analysis, independent predictors for MACEs were male sex (hazard ratio [HR], 2.40; 95% confidence interval [CI], 1.01-5.69; P = 0.046) and low estimated creatinine clearance (eCCr) (< 60 mL/min/1.73 m²) (HR, 3.07; 95% CI, 1.22-7.74; P = 0.017). Low eCCr was the only independent predictor for hard events including cardiac death and MI (HR, 17.6, 95% CI, 1.44-215.7; P = 0.025). In conclusion, renal function is an independent predictor for cardiovascular events among patients without significant CAD by CCTA. Careful monitoring and preventive strategy are warranted in patients with impaired renal function even without significant CAD.

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Quantification of tricuspid regurgitation using two-dimensional velocity encoding cine: optimal plane and reproducibility

To determine the optimal plane of two-dimensional velocity-encoding cine (VENC) magnetic resonance (MR) imaging at the tricuspid annulus for quantification of tricuspid regurgitation (TR) and to assess the reproducibility of VENC tricuspid flow measurements. We conducted a retrospective review of MR images of 25 consecutive patients (M:F = 8:17; mean age, 58.5 ± 10.5 years) with TR. VENC was performed twice orthogonal to the tricuspid annulus plane during the end-diastolic (ED) and end-systolic (ES) phases. The TR fraction was quantified at each plane as retrograde flow/antegrade flow and additionally as retrograde flow of the ED plane/antegrade flow of the ES plane (combined plane method). The conventional method to determine the TR amount [right ventricular stroke volume (RVSV)—pulmonary antegrade flow] and TR fraction (TR amount/RVSV) was used as the reference standard. There were no differences between TR amount and retrograde flow of the ED plane (65.3 ± 43.4 vs. 70.5 ± 36.1 ml, P = 0.361) between the RVSV and the antegrade flow of the ES phase (124.2 ± 46.1 vs. 128.0 ± 45.0 ml, P = 0.612) or in TR fraction between the conventional and combined plane methods (48.8 ± 19.2 vs. 56.3 ± 24.3 %, P = 0.08). The retrograde flow of the ED phase was best correlated with TR amount [intraclass correlation coefficient (ICC) = 0.859] and antegrade flow of ES with RVSV (ICC = 0.808). The TR fraction of the combined plane method was best correlated with the conventional method (ICC = 0.694). Interobserver agreement of VENC flow measurements was excellent (ICC, 0.939–0.993). The optimal method for quantification of TR using tricuspid annular VENC was the combined plane method, which divides the retrograde flow of the ED plane by the antegrade flow of the ES plane. Tricuspid flow measurements using VENC showed excellent reproducibility.     

Diagnostic yield of coronary angiography in patients with acute chest pain: role of noninvasive test

Objectives

This study investigated the diagnostic yield of invasive coronary angiography (CAG) and the impact of noninvasive test (NIV) in patients presented to emergency department (ED) with acute chest pain.

Methods

Patients 50 years or older who visited ED with acute chest pain and underwent CAG were identified retrospectively. Those with ischemic electrocardiogram, elevated cardiac enzyme, known coronary artery disease (CAD), history of cardiac surgery, renal failure, or allergy to radiocontrast were excluded. Diagnostic yields of CAG to detect significant CAD or differentiate the need for revascularization were analyzed according to whether NIV was performed and its result.

Results

Among the total 375 consecutive patients, significant CAD was observed in 244 (65.1%). Diagnostic yields of CAG were higher in patients who underwent NIV before CAG, but the discriminative effect was modest (59.7% vs 70.7% [P = .026] for detection of CAD; 45.0% vs 50.5% [P = .285] for revascularization). Positive results of NIV were significantly associated with the presence of CAD and the need for revascularization, when compared with patients without NIV or patients with negative results (P < .001, respectively).

Conclusion

The diagnostic yield of CAG was only 65% in low- to intermediate-risk ED patients with acute chest pain. Performing of NIV provided only modest improvement in diagnostic yield of CAG. The unexpectedly low diagnostic yield might be attributable to the underuse of NIV and misinterpretation of physicians. We suggest the use of NIV as a gatekeeper to discriminate patients who require CAG and/or revascularization, and for this, better risk stratification and appropriate application of NIV are required.     

Noncontrast Myocardial T1 Mapping by Cardiac Magnetic Resonance Predicts Outcome in Patients With Aortic Stenosis

Objectives

The aim of this study was to evaluate whether native T1 value of the myocardium on cardiac magnetic resonance (CMR) could predict clinical events in patients with significant aortic stenosis (AS).