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1.
IntroductionIntravascular ultrasound (IVUS) studies have shown that biomechanical variables, particularly endothelial shear stress (ESS), add synergistic prognostic insight when combined with anatomic high-risk plaque features. Non-invasive risk assessment of coronary plaques with coronary computed tomography angiography (CCTA) would be helpful to enable broad population risk-screening.AimTo compare the accuracy of ESS computation of local ESS metrics by CCTA vs IVUS imaging.MethodsWe analyzed 59 patients from a registry of patients who underwent both IVUS and CCTA for suspected CAD. CCTA images were acquired using either a 64- or 256-slice scanner. Lumen, vessel, and plaque areas were segmented from both IVUS and CCTA (59 arteries, 686 3-mm segments). Images were co-registered and used to generate a 3-D arterial reconstruction, and local ESS distribution was assessed by computational fluid dynamics (CFD) and reported in consecutive 3-mm segments.ResultsAnatomical plaque characteristics (vessel, lumen, plaque area and minimal luminal area [MLA] per artery) were correlated when measured with IVUS and CCTA: 12.7 ​± ​4.3 vs 10.7 ​± ​4.5 ​mm2, r ​= ​0.63; 6.8 ​± ​2.7 vs 5.6 ​± ​2.7 ​mm2, r ​= ​0.43; 5.9 ​± ​2.9 vs 5.1 ​± ​3.2 ​mm2, r ​= ​0.52; 4.5 ​± ​1.3 vs 4.1 ​± ​1.5 ​mm2, r ​= ​0.67 respectively. ESS metrics of local minimal, maximal, and average ESS were also moderately correlated when measured with IVUS and CCTA (2.0 ​± ​1.4 vs 2.5 ​± ​2.6 ​Pa, r ​= ​0.28; 3.3 ​± ​1.6 vs 4.2 ​± ​3.6 ​Pa, r ​= ​0.42; 2.6 ​± ​1.5 vs 3.3 ​± ​3.0 ​Pa, r ​= ​0.35, respectively). CCTA-based computation accurately identified the spatial localization of local ESS heterogeneity compared to IVUS, with Bland-Altman analyses indicating that the absolute ESS differences between the two CCTA methods were pathobiologically minor.ConclusionLocal ESS evaluation by CCTA is possible and similar to IVUS; and is useful for identifying local flow patterns that are relevant to plaque development, progression, and destabilization.  相似文献   

2.
ObjectivesTo investigate potential differences in plaque progression (PP) between in East Asians and Caucasians as well as to determine clinical predictors of PP in East Asians.BackgroundStudies have demonstrated differences in cardiovascular risk factors as well as plaque burden and progression across different ethnic groups.MethodsThe study comprised 955 East Asians (age 60.4 ?± ?9.3 years, 50.9% males) and 279 Caucasians (age 60.4 ?± ?8.6 years, 74.5% males) who underwent two serial coronary computed tomography angiography (CCTA) studies over a period of at least 24 months. Patients were enrolled and analyzed from the PARADIGM (Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography IMaging) registry. After propensity-score matching, plaque composition and progression were compared between East Asian and Caucasian patients. Within East Asians, the plaque progression group (defined as plaque volume at follow-up CCTA minus plaque volume at baseline CCTA> 0) was compared to the no PP group to determine clinical predictors for PP in East Asians.ResultsIn the matched cohort, baseline volumes of total plaque as well as all plaque subtypes were comparable. There was a trend towards increased annualized plaque progression among East Asians compared to Caucasians (18.3 ?± ?24.7 ?mm3/year vs 16.6 ?mm3/year, p ?= ?0.054). Among East Asians, 736 (77%) had PP. East Asians with PP had more clinical risk factors and higher plaque burden at baseline (normalized total plaque volume of144.9 ?± ?233.3 ?mm3 vs 36.6 ?± ?84.2 ?mm3 for PP and no PP, respectively, p ?< ?0.001). Multivariate logistic regression analysis showed that baseline normalized plaque volume (OR: 1.10, CI: 1.10–1.30, p ?< ?0.001), age (OR: 1.02, CI: 1.00–1.04, p ?= ?0.023) and body mass index (OR: 2.24, CI: 1.01–1.13, p ?= ?0.024) were all predictors of PP in East Asians. Clinical events, driven mainly by percutaneous coronary intervention, were higher among the PP group with a total of 124 (16.8%) events compared to 22 (10.0%) in the no PP group (p ?= ?0.014).ConclusionEast Asians and Caucasians had comparable plaque composition and progression. Among East Asians, the PP group had a higher baseline plaque burden which was associated with greater PP and increased clinical events.  相似文献   

3.
Background and aimsDifferent methodologies to report whole-heart atherosclerotic plaque on coronary computed tomography angiography (CCTA) have been utilized. We examined which of the three commonly used plaque burden definitions was least affected by differences in body surface area (BSA) and sex.MethodsThe PARADIGM study includes symptomatic patients with suspected coronary atherosclerosis who underwent serial CCTA >2 years apart. Coronary lumen, vessel, and plaque were quantified from the coronary tree on a 0.5 mm cross-sectional basis by a core-lab, and summed to per-patient. Three quantitative methods of plaque burden were employed: (1) total plaque volume (PV) in mm3, (2) percent atheroma volume (PAV) in % [which equaled: PV/vessel volume * 100%], and (3) normalized total atheroma volume (TAVnorm) in mm3 [which equaled: PV/vessel length * mean population vessel length]. Only data from the baseline CCTA were used. PV, PAV, and TAVnorm were compared between patients in the top quartile of BSA vs the remaining, and between sexes. Associations between vessel volume, BSA, and the three plaque burden methodologies were assessed.ResultsThe study population comprised 1479 patients (age 60.7 ± 9.3 years, 58.4% male) who underwent CCTA. A total of 17,649 coronary artery segments were evaluated with a median of 12 (IQR 11–13) segments per-patient (from a 16-segment coronary tree). Patients with a large BSA (top quartile), compared with the remaining patients, had a larger PV and TAVnorm, but similar PAV. The relation between larger BSA and larger absolute plaque volume (PV and TAVnorm) was mediated by the coronary vessel volume. Independent from the atherosclerotic cardiovascular disease risk (ASCVD) score, vessel volume correlated with PV (P < 0.001), and TAVnorm (P = 0.003), but not with PAV (P = 0.201). The three plaque burden methods were equally affected by sex.ConclusionsPAV was less affected by patient's body surface area then PV and TAVnorm and may be the preferred method to report coronary atherosclerotic burden.  相似文献   

4.
BackgroundThe association of age with coronary plaque dynamics is not well characterized by coronary computed tomography angiography (CCTA).MethodsFrom a multinational registry of patients who underwent serial CCTA, 1153 subjects (61 ± 5 years old, 61.1% male) were analyzed. Annualized volume changes of total, fibrous, fibrofatty, necrotic core, and dense calcification plaque components of the whole heart were compared by age quartile groups. Clinical events, a composite of all-cause death, acute coronary syndrome, and any revascularization after 30 days of the initial CCTA, were also analyzed. Random forest analysis was used to define the relative importance of age on plaque progression.ResultsWith a 3.3-years’ median interval between the two CCTA, the median annual volume changes of total plaque in each age quartile group was 7.8, 10.5, 10.8, and 12.1 mm3/year and for dense calcification, 2.5, 4.6, 5.4, and 7.1 mm3/year, both of which demonstrated a tendency to increase by age (p-for-trend = 0.001 and < 0.001, respectively). However, this tendency was not observed in any other plaque components. The annual volume changes of total plaque and dense calcification were also significantly different in the propensity score-matched lowest age quartile group versus the other age groups as was the composite clinical event (log-rank p = 0.003). In random forest analysis, age had comparable importance in the total plaque volume progression as other traditional factors.ConclusionsThe rate of whole-heart plaque progression and dense calcification increases depending on age. Age is a significant factor in plaque growth, the importance of which is comparable to other traditional risk factors.Clinical trial registrationURL: http://www.clinicaltrials.gov. Unique identifiers: NCT02803411.  相似文献   

5.
BackgroundDiabetes mellitus is a major risk factor for coronary artery disease (CAD) and may provoke structural and functional changes in coronary vasculature. The coronary volume to left ventricular mass (V/M) ratio is a new anatomical parameter capable of revealing a potential physiological imbalance between coronary vasculature and myocardial mass. The aim of this study was to examine the V/M derived from coronary computed tomography angiography (CCTA) in patients with diabetes.MethodsPatients with clinically suspected CAD enrolled in the ADVANCE (Assessing Diagnostic Value of Non-invasive FFRCT in Coronary Care) registry and known diabetic status were included. Coronary artery volume and left ventricular myocardial mass were analyzed from CCTA and the V/M ratio was calculated and compared between patients with and without diabetes.ResultsOf the 3053 patients (age 66 ?± ?10 years; 66% male) with known diabetic status, diabetes was present in 21.9%. Coronary volume was lower in patients with diabetes compared to those without diabetes (2850 ?± ?940 ?mm3 vs. 3040 ?± ?970 ?mm3, p ?< ?0.0001), whereas the myocardial mass was comparable between the 2 groups (122 ?± ?33 ?g vs. 122 ?± ?32 ?g, p ?= ?0.70). The V/M ratio was significantly lower in patients with diabetes (23.9 ?± ?6.8 ?mm3/g vs. 25.7 ?± ?7.5 ?mm3/g, p ?< ?0.0001). Among subjects with obstructive CAD (n ?= ?2191, 24.0% diabetics) and non-obstructive CAD (16.7% diabetics), the V/M ratio was significantly lower in patients with diabetes compared to those without (23.4 ?± ?6.7 ?mm3/g vs. 25.0 ?± ?7.3 ?mm3/g, p ?< ?0.0001 and 25.6 ?± ?6.9 ?mm3/g vs. 27.3 ?± ?7.6 ?mm3/g, respectively, p ?= ?0.006).ConclusionThe V/M ratio was significantly lower in patients with diabetes compared to non-diabetics, even after correcting for obstructive coronary stenosis. The clinical value of the reduced V/M ratio in diabetic patients needs further investigation.  相似文献   

6.
7.
《Radiography》2017,23(1):77-79
PurposeInvestigate the influence of adaptive statistical iterative reconstruction (ASIR) and the model-based IR (Veo) reconstruction algorithm in coronary computed tomography angiography (CCTA) images on quantitative measurements in coronary arteries for plaque volumes and intensities.MethodsThree patients had three independent dose reduced CCTA performed and reconstructed with 30% ASIR (CTDIvol at 6.7 mGy), 60% ASIR (CTDIvol 4.3 mGy) and Veo (CTDIvol at 1.9 mGy). Coronary plaque analysis was performed for each measured CCTA volumes, plaque burden and intensities.ResultsPlaque volume and plaque burden show a decreasing tendency from ASIR to Veo as median volume for ASIR is 314 mm3 and 337 mm3–252 mm3 for Veo and plaque burden is 42% and 44% for ASIR to 39% for Veo. The lumen and vessel volume decrease slightly from 30% ASIR to 60% ASIR with 498 mm3–391 mm3 for lumen volume and vessel volume from 939 mm3 to 830 mm3. The intensities did not change overall between the different reconstructions for either lumen or plaque.ConclusionWe found a tendency of decreasing plaque volumes and plaque burden but no change in intensities with the use of low dose Veo CCTA (1.9 mGy) compared to dose reduced ASIR CCTA (6.7 mGy & 4.3 mGy), although more studies are warranted.  相似文献   

8.
BackgroundThe ability to characterize and to quantify the extent of coronary artery disease has the potential to improve the prognostic capability of coronary computed tomography angiography. Although reproducible techniques have been described in those with mild coronary disease, this has yet to be assessed in patients with advanced disease.MethodsTwenty patients with known multivessel disease underwent repeated computed tomography coronary angiography, 2 weeks apart. Coronary artery segments were analysed using semi-automated software by two trained observers to determine intraobserver, interobserver and interscan reproducibility.ResultsOverall, 149 coronary arterial segments were analysed. There was excellent intraobserver and interobserver agreement for all plaque volume measurements (Lin’s coefficient 0.95 to 1.0). There were no substantial interscan differences (P ?> ?0.05 for all) for total (2063 ?± ?1246 ?mm3, mean of differences ?35.6 ?mm3), non-calcified (1795 ?± ?910 ?mm3, mean of differences ?4.3 ?mm3), calcified (298 ?± ?425 ?mm3, mean of differences ?31.3 ?mm3) and low-attenuation (13 ?± ?13 ?mm3, mean of differences ?2.6 ?mm3) plaque volumes. Interscan agreement was highest for total and noncalcified plaque volumes. Calcified and low-attenuation plaque (?236.6 to 174 ?mm3 and -15.8 to 10.5 ?mm3 respectively) had relatively wider 95% limits of agreement reflecting the lower absolute plaque volumes.ConclusionIn the presence of advanced coronary disease, semi-automated plaque quantification provides excellent reproducibility, particularly for total and non-calcified plaque volumes. This approach has major potential to assess change in disease over time and optimize risk stratification in patients with established coronary artery disease.  相似文献   

9.
BackgroundAssociations of epicardial fat volume (EFV) measured on noncontrast cardiac CT (NCT) include coronary plaque, myocardial ischemia, and adverse cardiac events.ObjectivesThis study aimed to define the relationship of EFV to coronary plaque type, severe coronary stenosis, and the presence of high-risk plaque features (HRPFs).MethodsWe retrospectively evaluated 402 consecutive patients, with no prior history of coronary artery disease, who underwent same day NCT and coronary CT angiography (CTA). EFV was measured on NCT with the use of validated, semiautomated software. The coronary arteries were evaluated for coronary plaque type (calcified [CP], noncalcified [NCP], or partially calcified [PCP]) and coronary stenosis severity ≥70% with the use of coronary CTA. For patients with NCP and PCP, 2 high-risk plaque features were evaluated: low-attenuation plaque and positive remodeling.ResultsThere were 402 patients with a median age of 66 years (range, 23–92 years) of whom 226 (56%) were men. The EFV was greater in patients with CP (112 ± 55 cm3 vs 89 ± 39 cm3), PCP (110 ± 57 cm3 vs 98 ± 45 cm3), and NCP (115 ± 44 cm3 vs EFV 100 ± 52 cm3). In the 192 patients with PCP or NCP, on multivariable analysis, after adjusting for conventional cardiovascular risk factors, EFV was an independent predictor of ≥70% coronary artery stenosis (odds ratio [OR], 3.0; 95% CI, 1.3–6.6; P = 0.008), any high-risk plaque features (OR, 1.7; 95% CI, 0.9–3.4; P = 0.04), and low attention plaque (OR, 2.4; 95% CI, 1.1–5.1; P = 0.02) but not of positive remodeling.ConclusionsEFV is greater in patients with CP, PCP, and NCP. In patients with NCP and PCP, EFV is significantly associated with severe coronary stenosis, high-risk plaque features, and low attenuation plaque.  相似文献   

10.

Objective

We evaluated the performance of manual measures of coronary plaque volumes and atherosclerotic plaque features from coronary CT angiography (CTA), using intravascular ultrasound (IVUS) as the reference.

Methods

Thirty individual coronary plaques with suitable fiduciary markers were identified. Plaque volumes on coronary CTA were manually quantified by two observers and compared to IVUS plaque volumes as interpreted by an independent laboratory. The presence of adverse plaque characteristics—low attenuation plaque (LAP), positive remodelling (PR) and spotty calcification (SC)—on coronary CTA was evaluated and compared to IVUS.

Results

High correlation in plaque volumes was detected between observers (r?=?0.94, P?<?0.0001; 95 % limits of agreement <48.7 mm3, bias 6.6 mm3). Excellent correlation (r?=?0.95, P?<?0.0001) was noted in plaque volume between independent observers and IVUS (95 % limits of agreement <40.6 mm3, bias ?4.4 mm3) and did not differ from IVUS (105.0?±?56.7 vs. 109.4?±?60.7 mm3, P?=?0.2). The frequency of LAP (10 % vs. 17 %), PR (7 % vs. 10 %) and SC (27 % vs. 33 %) was similar between coronary CTA and IVUS (all P?=?NS).

Conclusions

Plaque volume on coronary CTA determined by manual methods demonstrates high correlation and modest agreement to IVUS. Further, coronary CTA demonstrates high accuracy for the identification of adverse plaque characteristics, including LAP, PR and SC.

Key Points

? Coronary CT angiography is a non-invasive test that enables coronary plaque assessment ? Plaque quantification by coronary CT angiography correlates well with intravascular ultrasound findings ? Coronary CT angiography can identify adverse plaque characteristics  相似文献   

11.
ObjectivesTo evaluate the feasibility of coronary computed tomography angiography (CCTA) in patients with free-breathing using 16-cm z-coverage CT with motion correction algorithm.Methods616 patients underwent CCTA without heart rate control. 325 examinations were performed during breath-holding (group A), and the remaining 291 were performed during free-breathing (group B). The image quality scores were defined as 1 (excellent), 2 (good), 3 (adequate), and 4 (poor). 22 patients in group A and 24 in group B underwent invasive coronary angiography (ICA) after CCTA within two weeks. The image quality score, diagnostic accuracy using ICA as reference, signal-to-noise ratio (SNR), and effective dose (ED) were compared between the two groups.ResultsMean heart rate during scanning was 70.8 ± 13.8 bpm in group A and 70.7 ± 13.2 bpm in group B (P = .950). No significant differences were observed in SNR and image quality score (1.49 ± 0.62 vs. 1.53 ± 0.67; P = .647) between the breath-holding and free-breathing groups. ED (1.99 ± 0.83 mSv vs. 2.01 ± 0.88 mSv) was not significantly different between the two groups (P = .975). In a segment-based analysis, the sensitivity, specificity and diagnostic accuracy in the detection of coronary stenosis of more than 50% were 82.1%, 96.8% and 92.2%, respectively in the breath-holding group and 82.2%, 96.6% and 92.2%, respectively in the free-breathing group with no significant differences for these parameters between the two groups.ConclusionsCCTA for patients without heart rate control and during free-breathing using 16-cm z-coverage CT with motion correction algorithm showed no significant difference in image quality and diagnostic performance compared with CCTA during breath-holding.  相似文献   

12.
IntroductionAngina, myocardial ischemia, and coronary artery physiology in hypertrophic cardiomyopathy (HCM) are poorly understood. However, coronary computed tomography angiography (CCTA) with fractional flow reserve from CT (FFRCT) analysis offers a non-invasive method for evaluation of coronary artery volume to myocardial mass ratio (V/M) that may provide insight into such mechanisms. Thus, we sought to investigate changes in V/M in HCM.MethodsA retrospective analysis was performed on 37 HCM patients and 37 controls matched for age, sex, and cardiovascular risk factors; CCTA-derived coronary artery lumen volume (V) and myocardial mass (M) were used to determine V/M. FFRCT values were calculated for the left anterior descending (LAD), left circumflex (LCx) and right coronary (RCA) arteries as well as the 3-vessel cumulative FFRCT values.ResultsHCM patients had significantly increased myocardial mass (176 ± 84 vs. 119 ± 27 g, p < 0.0001) and total coronary artery luminal volume (4112 ± 1139 vs. 3290 ± 924 mm3, p < 0.0001) that resulted from increases in segmented luminal volumes of both the left and right coronary artery systems. However, HCM patients had significantly decreased V/M (23.8 ± 5.9 vs. 26.5 ± 5.3 mm3/g; p = 0.026) which was further decreased when restricting V/M analysis to those HCM patients with septal hypertrophy (22.4 mm3/g, p = 0.01) that was mild-moderately predictive of HCM (AUC = 0.68). HCM patients also showed significantly lower nadir FFRCT values in the LCx (0.87 ± 0.06 vs. 0.91 ± 0.06, p = 0.02), and cumulative 3-vessel FFRCT values (2.58 ± 0.18 vs. 2.63 ± 0.14, p = 0.006).ConclusionsHCM patients demonstrate significantly greater coronary volume. Despite this, HCM patients suffer from decreased V/M. Further prospective studies evaluating the relationship between V/M, angina, and heart failure in HCM are needed.  相似文献   

13.
BackgroundCoronary CT angiography (CTA) is generally not established as a screening tool for asymptomatic individuals. However, it is controversial whether this test may have a role for screening asymptomatic individuals with diabetes mellitus (DM) due to the high prevalence of asymptomatic coronary artery disease (CAD) in this subgroup.MethodsWe searched PubMed and EMBASE through May 2017 for studies that reported on the association between findings at coronary CTA and future cardiac events in asymptomatic individuals with DM. Summary hazard ratios for the presence of obstructive CAD (≥50% stenosis), presence of non-obstructive plaque (<50% stenosis), segment involvement score, and segment stenosis score were derived using a random effects regression model. I2 was calculated to quantify between-study heterogeneity and causing factors were identified using meta-regression.ResultsA total of 10 studies reporting on 5012 individuals with DM (median age: 62.3 years, median proportion of women: 40.5%) were included in the analysis. The presence of obstructive CAD on coronary CTA (vs. non-obstructive or no CAD) was associated with a significantly elevated risk for adverse events (summary HR: 4.07, 95% CI: 2.30 to 7.21). The estimated summary HR for non-obstructive plaque (vs. no CAD) was 2.17 (95% CI: 1.11 to 4.25). The pooled HRs per unit for segment stenosis score and segment involvement score were 1.44 (95% CI: 0.98 to 2.12), and 1.73 (95% CI: 1.07 to 2.80) respectively. On meta-regression analysis, we observed a trend towards a higher risk estimate in studies with a higher proportion of females (p = 0.1063).ConclusionThe presence and extent of CAD on coronary CTA are strong, independent predictors of cardiovascular events in asymptomatic individuals with DM despite heterogeneity between studies in endpoints, study population and length of follow-up.  相似文献   

14.
BackgroundAdvances in coronary computed tomography angiography (CCTA) reconstruction algorithms are expected to enhance the accuracy of CCTA plaque quantification. We aim to evaluate different CCTA reconstruction approaches in assessing vessel characteristics in coronary atheroma using intravascular ultrasound (IVUS) as the reference standard.MethodsMatched cross-sections (n ?= ?7241) from 50 vessels in 15 participants with chronic coronary syndrome who prospectively underwent CCTA and 3-vessel near-infrared spectroscopy-IVUS were included. Twelve CCTA datasets per patient were reconstructed using two different kernels, two slice thicknesses (0.75 ?mm and 0.50 ?mm) and three different strengths of advanced model-based iterative reconstruction (IR) algorithms. Lumen and vessel wall borders were manually annotated in every IVUS and CCTA cross-section which were co-registered using dedicated software. Image quality was sub-optimal in the reconstructions with a sharper kernel, so these were excluded. Intraclass correlation coefficient (ICC) and repeatability coefficient (RC) were used to compare the estimations of the 6 CT reconstruction approaches with those derived by IVUS.ResultsSegment-level analysis showed good agreement between CCTA and IVUS for assessing atheroma volume with approach 0.50/5 (slice thickness 0.50 ?mm and highest strength 5 ADMIRE IR) being the best (total atheroma volume ICC: 0.91, RC: 0.67, p ?< ?0.001 and percentage atheroma volume ICC: 0.64, RC: 14.06, p ?< ?0.001). At lesion-level, there was no difference between the CCTA reconstructions for detecting plaques (accuracy range: 0.64–0.67; p ?= ?0.23); however, approach 0.50/5 was superior in assessing IVUS-derived lesion characteristics associated with plaque vulnerability (minimum lumen area ICC: 0.64, RC: 1.31, p ?< ?0.001 and plaque burden ICC: 0.45, RC: 32.0, p ?< ?0.001).ConclusionCCTA reconstruction with thinner slice thickness, smooth kernel and highest strength advanced IR enabled more accurate quantification of the lumen and plaque at a segment-, and lesion-level analysis in coronary atheroma when validated against intravascular ultrasound. Clinicaltrials.gov (NCT03556644)  相似文献   

15.
ObjectiveTo assess the clinical safety and effectiveness of coronary revascularization in patients who underwent coronary artery bypass grafting (CABG) based exclusively on coronary computed tomography angiography (CCTA) results.Methods53 patients (62.3 ± 7.1 years) underwent CCTA before a CABG surgery without prior invasive coronary angiography (ICA). Primary endpoints were all-cause mortality and major adverse cardiovascular events (MACE). The secondary endpoint was quality of life (QoL) assessed with the Minnesota Living with Heart Failure Questionnaire (MLHFQ). All were collected one year after the surgery.ResultsCCTA revealed multivessel coronary artery disease (CAD) in 52 patients. Indication for bypass surgery was made exclusively based on CCTA results. 136 distal anastomoses were performed. Assessment at 1 year (13.3 ± 1.4 months) was completed in 98.1% of the patients. MACE and mortality rates were 0%. The MLHFQ total score was 21.8 ± 8.7, and active lifestyle was maintained in all patients.ConclusionsIn this proof of concept prospective pilot study, we observed that non-invasive coronary angiography may provide adequate anatomic detail to guide CABG surgery. Further study of this concept is warranted.  相似文献   

16.
BackgroundThe aim of this prospective, randomized trial was to evaluate whether the use of coronary computed tomography angiography (CCTA) as the first-line anatomical test in patients with suspected significant coronary artery disease (CAD) may reduce the number of coronary invasive angiographies (ICA), and expand the use of CCTA in patients currently diagnosed invasively.Methods120 patients (age:60.6 ± 7.9 years, 35% female) with indications to ICA were randomized 1:1 to undergo CCTA versus direct ICA. Outcomes were evaluated during the diagnostic and therapeutic periods.ResultsThe number of invasively examined patients was reduced by 64.4% in the CCTA group as compared to the direct ICA group (21vs59,p < 0.0001). The number of patients with ICAs not followed by coronary intervention was reduced by 88.1% with the CCTA strategy (5vs42,p < 0.0001). Over the diagnostic and therapeutic course there were no significant differences regarding the median volume of contrast (CCTA 80.3 ml[65.0–165.0] vs ICA 90.0 ml[55.0–100.0], p = 0.099), while a non-significant trend towards higher radiation dose in the CCTA group was observed (9.9 mSv[7.0–22.1] vs 9.4 mSv[5.2–14.0], p = 0.05). There were no acute cardiovascular events.ConclusionsCCTA may hypothetically act as an effective ‘gatekeeper’ to the catheterization laboratory in the diagnosis of stable patients with current indications for ICA. This strategy may result in non-invasive, outpatient-based triage of two thirds of individuals without actionable CAD, obviating unnecessary invasive examinations. However, the longer follow-up is indispensable.ClinicalTrials.gov numberNCT02591992  相似文献   

17.
BackgroundWe evaluated the accuracy of commonly used thresholds for vessel area evaluation on coronary CT angiography (CTA) and assessed ability of CTA to image the adventitial border.MethodsWe evaluated 137 paired (coronary CTA and intravascular ultrasound [IVUS]) coronary artery cross-sections in 30 patients. CTA analysis included measurements of external vessel border area defined at Hounsfield unit (HU) thresholds of 0 (presumed adventitia), 50, and 70 (presumed external elastic membrane [EEM]). IVUS analysis included measurements of lumen, EEM, and outer border of the highly echogenic area adjacent to EEM (presumed adventitia area).ResultsHigh correlation was found between CTA and IVUS measurements for EEM areas (R2 = 0.65, P < .001 and R2 = 0.60, P < .001 for CTA thresholds of 50 and 70 HU, respectively). CTA and IVUS measurements of adventitia areas were significantly correlated (R2 = 0.74; P < .001), with no significant difference between the 2 methods (20.2 ± 6.4 mm2 vs 19.8 ± 6.4 mm2, respectively; P = .278). Cross-sectional coronary lumen radiodensity on CTA images and plaque burden measured on IVUS significantly affected the accuracy of CTA in assessment of the EEM area but not the presumed adventitial area.ConclusionsWe have demonstrated that use of a 50-HU threshold for vessel area determination by CTA led to its significant overestimation, whereas 70-HU threshold was close to that of EEM on IVUS. CTA may accurately delineate the coronary adventitial border by using a 0-HU threshold.  相似文献   

18.
BackgroundThe present study aimed to assess the reliability and reproducibility of coronary computed tomography angiography (CCTA) for the serial quantitative assessment of plaque volume.MethodsPatients who underwent repeated CCTA scans within 90 days were retrospectively screened and enrolled. Clinical data and CCTA imaging data were collected. Paired CCTA scans were analyzed using the quantitative method by separate observers blinded to the other paired CCTA scans. Results were compared between the index CCTA and follow-up CCTA.ResultsPaired CT scans of 95 patients (61 ± 13 years; 56.8% men) with same tube voltages (kVp) at both CCTAs and 24 patients (57 ± 19 years; 48.3% men) with different kVp at two CCTAs were analyzed. In patients with same kVp at both CCTAs, there were no difference in PV and PVs of each components in per-segment analysis and per-lesion analysis (all p > 0.05). In per-lesion analysis of CCTAs from patients who used different kVp between two CCTAs, lesion length, area and diameter stenosis, and PVs were not different between index and follow-up CCTAs (all p > 0.05). Segment length and PV were also showed no difference between two serial CCTAs in per-segment analysis.ConclusionWe showed the reproducibility and reliability of quantitative analysis of CCTA for assessment of coronary plaques. CCTA can be applied for the serial quantitative assessment of coronary artery disease progression, regardless of differences in the image acquisition protocol.  相似文献   

19.
BackgroundAlthough sex- and age-specific differences in coronary plaque features detected by coronary computed tomography angiography (CCTA) are known, insufficient information regarding the long-term prognostic value of these findings exists.MethodsA total of 1615 patients with suspected but not previously diagnosed coronary artery disease (CAD) were examined by CCTA and coronary plaque features were assessed. The median follow-up period was 10.5 (IQR 9.2–11.4) years. Cox proportional-hazards analysis was used for the combined endpoint of cardiac death or nonfatal myocardial infarction.ResultsThe endpoint occurred more often in patients older than 65 years (5.66% vs. 2.05%; p = 0.00029) but similarly between female (3.34%) and male (3.07%) patients (p = 0.76). Both sexes displayed a similar prevalence for noncalcified (female vs. male: 0.77 ± 1.38 vs. 0.89 ± 1.41; p = 0.098) and low-attenuation (female vs. male: 2.6% vs. 4.37%; p = 0.096) plaques. As assessed by p for interaction CADRADS (p for interaction = 0.013), noncalcified plaques (p for interaction = 0.022) and low-attenuation plaques (p for interaction = 0.045) had a better primary endpoint association in women than in men. Concerning age, no difference in outcome association was apparent as evaluated by p for interaction.ConclusionCCTA demonstrates excellent long-term prognostic value irrespective of sex and age and independent from the higher prevalence of atherosclerotic plaques in men and patients older than 65 years. Although similarly prevalent in both sexes, noncalcified and low-attenuation plaques exhibit a better prognostic value in women.  相似文献   

20.
BackgroundHigh-risk coronary atherosclerosis features evaluated coronary CT angiography (CCTA) were suggested to have a prognostic role. The present study aimed to evaluate the association of circulating biomarkers with high-risk plaque features assessed by CCTA.MethodsA consecutive cohort of subjects who underwent CCTA because of suspected CAD was screened for inclusion in the CAPIRE study. Based on risk factors (RF) burden patients were defined as having a low clinical risk (0–1 RF with the exclusion of patients with diabetes mellitus as single RF) or an high clinical risk (≥3 RFs). In all patients, measurement of inflammatory biomarkers and CCTA analysis focused on high-risk plaque features were performed. Univariate and multivariate logistic regression analysis were used to evaluate the relationship between clinical and biological variables with CCTA advanced plaque features.Results528 patients were enrolled in CAPIRE study. Older age and male sex appeared to be predictors of qualitative high-risk plaque features and associated with the presence of elevated total, non-calcified and low-attenuation plaque volume. Among circulating biomarkers only hs-CRP was found to be associated with qualitative high-risk plaque features (OR 2.02, p = 0.004 and 2.02, p = 0.012 for LAP and RI > 1.1, respectively) with borderline association with LAP-Vol (OR 1.52, p = 0.076); HbA1c and PTX-3 resulted to be significantly associated with quantitative high-risk plaque features (OR 1.71, p = 0.003 and 1.04, p = 0.002 for LAP-Vol, respectively).ConclusionsOur results support the association between inflammatory biomarkers (hs-CRP, PTX- 3), HbA1c and high-risk atherosclerotic features detected by CCTA. Male sex and older age are significant predictors of high-risk atherosclerosis.  相似文献   

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