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1.
《Journal of Cardiovascular Computed Tomography》2020,14(2):155-161
BackgroundObjective was to assess if coronary calcium score (CCS) zero (<1.0AU) reliably rules out coronary artery disease (CAD) by coronary CTA; and if a difference between CCS zero and ultralow CCS (0.1–0.9AU) exists.Methods6439 low-to-intermediate ASCVD-risk patients (57.9 ± 11.1 years; 44.4% females) who underwent CTA and CCS were enrolled. Coronary CTAs were evaluated for: (1) stenosis severity (CADRADS: <25%, 25–49%, 50–69%, 70–99%, and 100%), (2) mixed-plaque burden, and (3) high-risk-plaque-(HRP)-criteria. Primary endpoints were all-cause and cardiovascular (CV) mortality, secondary endpoint MACE.ResultsOverall 1451 (22.5%) had CCS<1.0 AU. Among them, 1289 had CCS zero and 162 ultralow CCS (0.1–0.9AU). In CCS zero patients, 25.9% had CAD, 5.1% > 50% and 20.8% less than 50% stenosis, 6.8% had HRP with min 2 criteria, respectively. LAP<30HU, LAP<60HU, Napkin-Ring-Sign, Spotty calcification and PR were found in 1.3%, 3.7%, 2.8%, 2.3% and 8.2%.CAD prevalence was with 87.7% markedly higher in the ultralow CCS (p < 0.001) group, >50% stenosis (16.6%), total plaque burden (p < 0.001) and HRP-criteria rates were higher (up to 19.1%) (p < 0.001, respectively).All-cause mortality was similar (2.7% and 1.9%) in CCS 0 and ultralow patients (mean follow-up 6.6 ± 4.2 years). Composite MACE (n = 7, 0.48%) was higher than CV-mortality (n = 1, 0.06%, p = 0.038, OR 1.08–1.6). More HRP were found on 128-slice-dual-source-CTA compared to 64-slice (p < 0.001). There were no differences in CTA findings between patients with and without chest pain, but more females were symptomatic.ConclusionEarly signs of CAD on CTA are frequent in CCS zero and even present in the majority of ultralow CCS (0.1–0.9AU) patients, who should not be downgraded to CCS zero patients. High-risk plaque and >50% stenosis rate is low but not negligible; and MACE rate very low. 相似文献
2.
Riccardo Marano Francesco De Cobelli Irene Floriani Christoph Becker Christopher Herzog Maurizio Centonze Giovanni Morana Gian Franco Gualdi Guido Ligabue Gianluca Pontone Carlo Catalano Dante Chiappino Massimo Midiri Giovanni Simonetti Filippo Marchisio Lucio Olivetti Rossella Fattori Lorenzo Bonomo Alessandro Del Maschio 《European radiology》2009,19(5):1114-1123
This was a prospective, multicenter study designed to evaluate the utility of MDCT in the diagnosis of coronary artery disease
(CAD) in patients scheduled for elective coronary angiography (CA) using different MDCT systems from different manufacturers.
Twenty national sites prospectively enrolled 367 patients between July 2004 and June 2006. Computed tomography (CT) was performed
using a standardized/optimized scan protocol for each type of MDCT system (≥16 slices) and compared with quantitative CA performed
within 2 weeks of MDCT. A total of 284 patients (81%) were studied by 16-slice MDCT systems, while 66 patients (19%) by 64-slice
MDCT scanners. The primary analysis was on-site/off-site evaluation of the negative predictive value (NPV) on a per-patient
basis. Secondary analyses included on-site evaluation on a per-artery and per-segment basis. On-site evaluation included 327
patients (CAD prevalence 58%). NPV, positive predictive value (PPV), sensitivity, specificity, and diagnostic accuracy (DA)
were 0.91 (95% CI 0.85–0.95), 0.91 (95% CI 0.86–0.95), 0.94 (95% CI 0.89–0.97), 0.88 (95% CI 0.81–0.93), and 0.91 (95% CI
0.88–0.94), respectively. Off-site analysis included 295 patients (CAD prevalence 56%). NPV, PPV, sensitivity, specificity,
and DA were 0.73 (95% CI 0.65–0.79), 0.93 (95% CI 0.87–0.97), 0.73 (95% CI 0.65–0.79), 0.93 (95% CI 0.87–0.97), and 0.82 (95%
CI 0.77–0.86), respectively. The results of this study demonstrate the utility of MDCT in excluding significant CAD even when
conducted by centers with varying degrees of expertise and using different MDCT machines. 相似文献
3.
Gaemperli O Valenta I Schepis T Husmann L Scheffel H Desbiolles L Leschka S Alkadhi H Kaufmann PA 《European radiology》2008,18(6):1162-1173
The aim of this study was to assess the prognostic value of 64-slice CT angiography (CTA) in patients with known or suspected
coronary artery disease (CAD). Sixty-four-slice coronary CTA was performed in 220 patients [mean age 63 ± 11 years, 77 (35%)
female] with known or suspected CAD. CTA images were analyzed with regard to the presence and number of coronary lesions.
Patients were followed-up for the occurrence of the following clinical endpoints: death, nonfatal myocardial infarction, unstable
angina, and coronary revascularization. During a mean follow-up of 14 ± 4 months, 59 patients (27%) reached at least one of
the predefined clinical endpoints. Patients with abnormal coronary arteries on CTA (i.e., presence of coronary plaques) had
a 1st-year event rate of 34%, whereas in patients with normal coronary arteries no events occurred (event rate, 0%, p < 0.001).
Similarly, obstructive lesions (≥50% luminal narrowing) on CTA were associated with a high first-year event rate (59%) compared
to patients without stenoses (3%, p < 0.001). The presence of obstructive lesions was a significant independent predictor
of an adverse cardiac outcome. Sixty-four-slice CTA predicts cardiac events in patients with known or suspected CAD. Conversely,
patients with normal coronary arteries on CTA have an excellent mid-term prognosis. 相似文献
4.
Accuracy of dual-source CT coronary angiography: first experience in a high pre-test probability population without heart rate control 总被引:41,自引:12,他引:41
Scheffel H Alkadhi H Plass A Vachenauer R Desbiolles L Gaemperli O Schepis T Frauenfelder T Schertler T Husmann L Grunenfelder J Genoni M Kaufmann PA Marincek B Leschka S 《European radiology》2006,16(12):2739-2747
The aim of this study was to assess the diagnostic accuracy of dual-source computed tomography (DSCT) for evaluation of coronary artery disease (CAD) in a population with extensive coronary calcifications without heart rate control. Thirty patients (24 male, 6 female, mean age 63.1±11.3 years) with a high pre-test probability of CAD underwent DSCT coronary angiography and invasive coronary angiography (ICA) within 14±9 days. No beta-blockers were administered prior to the scan. Two readers independently assessed image quality of all coronary segments with a diameter ≥1.5 mm using a four-point score (1: excellent to 4: not assessable) and qualitatively assessed significant stenoses as narrowing of the luminal diameter >50%. Causes of false-positive (FP) and false-negative (FN) ratings were assigned to calcifications or motion artifacts. ICA was considered the standard of reference. Mean body mass index was 28.3±3.9 kg/m2 (range 22.4–36.3 kg/m2), mean heart rate during CT was 70.3±14.2 bpm (range 47–102 bpm), and mean Agatston score was 821±904 (range 0–3,110). Image quality was diagnostic (scores 1–3) in 98.6% (414/420) of segments (mean image quality score 1.68±0.75); six segments in three patients were considered not assessable (1.4%). DSCT correctly identified 54 of 56 significant coronary stenoses. Severe calcifications accounted for false ratings in nine segments (eight FP/one FN) and motion artifacts in two segments (one FP/one FN). Overall sensitivity, specificity, positive and negative predictive value for evaluating CAD were 96.4, 97.5, 85.7, and 99.4%, respectively. First experience indicates that DSCT coronary angiography provides high diagnostic accuracy for assessment of CAD in a high pre-test probability population with extensive coronary calcifications and without heart rate control. 相似文献
5.
Pirich C Leber A Knez A Bengel FM Nekolla SG Haberl R Schwaiger M 《European journal of nuclear medicine and molecular imaging》2004,31(5):663-670
Electron-beam computed tomography (EBCT) allows non-invasive imaging of coronary calcification and has been promoted as a screening tool for coronary artery disease (CAD) in asymptomatic high-risk subjects. This study assessed the relation of coronary calcifications to alterations in coronary vascular reactivity by means of positron emission tomography (PET) in asymptomatic subjects with a familial history of premature CAD. Twenty-one subjects (mean age 51±10 years) underwent EBCT imaging for coronary calcifications expressed as the coronary calcium score (CCS according to Agatston) and rest/adenosine-stress nitrogen-13 ammonia PET with quantification of myocardial blood flow (MBF) and coronary flow reserve (CFR). The mean CCS was 237±256 (median 146, range 0–915). The CCS was <100 in eight subjects and >100 units in 13. As defined by age-related thresholds, 15 subjects had an increased CCS (>75th percentile). Overall mean resting and stress MBF and CFR were 71±16 ml 100 g–1 min–1, 218±54 ml 100 g–1 min–1 and 3.20±0.77, respectively. Three subjects with CCS ranging from 114 to 451 units had an abnormal CFR (<2.5). There was no relation between CCS and resting or stress MBF or CFR (r=0.17, 0.18 and 0.10, respectively). In asymptomatic subjects a pathological CCS was five times more prevalent than an abnormal CFR. The absence of any close relationship between CCS and CFR reflects the fact that quantitative myocardial perfusion imaging with PET characterises the dynamic process of vascular reactivity while EBCT is a measure of more stable calcified lesions in the arterial wall whose presence is closely related to age. 相似文献
6.
The aim of this meta-analysis was to calculate the sensitivity of contrast-enhanced multi-detector computed tomography (MDCT) compared with coronary angiography (CAG) in incident patients suspected of coronary artery disease (CAD). We searched PubMed, Embase, bibliographies of original papers and reviews to identify original papers including ≥20 patients. Two independent reviewers selected papers and judged eligible papers on quality. Heterogeneity was assessed and homogeneous subgroups were pooled. Of the 15 included studies, ten provided moderately homogeneous patient-based analyses with absolute diagnostic numbers (n=630 patients). Pooled sensitivity was 89% (95% confidence interval: 85–92%). Scanners with 16 detectors (n=4) had higher sensitivities (pooled sensitivity: 91%) than four-detector scanners (n=6; pooling not possible due to heterogeneity). Seven studies reported sensitivity for a proximal stenosis, but different definitions were used making pooling impossible; sensitivities ranged from 75 to 100%. The sensitivity of four- and 16-detector MDCT is not sufficient to rule out any stenosis in patients suspected of CAD. No conclusions can be drawn with respect to the sensitivity for clinically relevant or proximal stenoses. 相似文献
7.
Optimal image reconstruction intervals for non-invasive coronary angiography with 64-slice CT 总被引:16,自引:12,他引:4
Leschka S Husmann L Desbiolles LM Gaemperli O Schepis T Koepfli P Boehm T Marincek B Kaufmann PA Alkadhi H 《European radiology》2006,16(9):1964-1972
The reconstruction intervals providing best image quality for non-invasive coronary angiography with 64-slice computed tomography (CT) were evaluated. Contrast-enhanced, retrospectively electrocardiography (ECG)-gated 64-slice CT coronary angiography was performed in 80 patients (47 male, 33 female; mean age 62.1±10.6 years). Thirteen data sets were reconstructed in 5% increments from 20 to 80% of the R-R interval. Depending on the average heart rate during scanning, patients were grouped as <65 bpm (n=49) and ≥65 bpm (n=31). Two blinded and independent readers assessed the image quality of each coronary segment with a diameter ≥1.5 mm using the following scores: 1, no motion artifacts; 2, minor artifacts; 3, moderate artifacts; 4, severe artifacts; and 5, not evaluative. The average heart rate was 63.3±13.1 bpm (range 38–102). Acceptable image quality (scores 1–3) was achieved in 99.1% of all coronary segments (1,162/1,172; mean image quality score 1.55±0.77) in the best reconstruction interval. Best image quality was found at 60% and 65% of the R-R interval for all patients and for each heart rate subgroup, whereas motion artifacts occurred significantly more often (P<0.01) at other reconstruction intervals. At heart rates <65 bpm, acceptable image quality was found in all coronary segments at 60%. At heart rates ≥65 bpm, the whole coronary artery tree could be visualized with acceptable image quality in 87% (27/31) of the patients at 60%, while ten segments in four patients were rated as non-diagnostic (scores 4–5) at any reconstruction interval. In conclusion, 64-slice CT coronary angiography provides best overall image quality in mid-diastole. At heart rates <65 bpm, diagnostic image quality of all coronary segments can be obtained at a single reconstruction interval of 60%. 相似文献
8.
目的:研究CT冠状动脉成像在冠心病早期诊断冠状动脉狭窄定性定量判读的作用。方法:对34例临床未发生急性冠脉综合征的冠心病患者,先后进行冠状动脉造影、128排双源CT冠状动脉成像。以冠状动脉造影为"金标准",计算CT冠状动脉成像敏感性、特异性、阳性预测值、阴性预测值。结果:①与冠状动脉造影相比,CT冠状动脉成像的敏感性为68%,特异性为97%,阳性预测值为89%,阴性预测值为90%。②CT冠状动脉成像有65个血管段图像质量差,约占12%,造成图像质量差的原因主要为钙化,心跳、呼吸伪影,少部分为管腔显示不良。结论:冠心病早期诊断中,CT冠状动脉成像可用作冠状动脉造影前筛选,CT冠状动脉成像阴性的患者不必行冠状动脉造影检查;CT冠状动脉成像阳性的患者,可行冠状动脉造影进一步确认病变。 相似文献
9.
BACKGROUND: The prognoses of patients with false-negative test results by myocardial single photon emission computed tomography (SPECT) and by stress echocardiography are known to be different; the prognosis with false-negative SPECT is better in suspected and proven coronary artery disease (CAD). METHODS AND RESULTS: Three strategies by which to diagnose CAD were compared for their cost-effectiveness when considering the prognostic value of false-negative results: (1) stress myocardial SPECT by dipyridamole or adenosine followed by coronary angiography (CAG), (2) exercise stress echocardiography followed by CAG, and (3) dobutamine stress echocardiography followed by CAG. Delta quality-adjusted life-year (QALY) was calculated for the three strategies separately when annual mortality and infarction rates were 0.5% and 0.5% for myocardial SPECT and 2% and 2% for stress echocardiography, respectively. Costs were estimated and costs per DeltaQALY were calculated according to the pretest likelihood of CAD (pCAD). The myocardial SPECT followed by CAG strategy was the most cost-effective in the patients with a pCAD of 0.3 or greater, and the dobutamine echocardiography followed by CAG strategy was the most cost-effective in patients with a pCAD of 0.2 or lower. This was the case when we assumed that the nondiagnostic test rate of dobutamine echocardiography was 9% (in contrast to 0% by myocardial SPECT and 18% by exercise echocardiography). Sensitivity analysis showed that the cost-effectiveness of dobutamine echocardiography followed by CAG was best only if the prognosis of false-negative results of dobutamine echocardiography was better. The cost-effectiveness of exercise echocardiography was dubious because of the high nondiagnostic rate with inadequate exercise. CONCLUSIONS: When the lower event rates of (false) negative SPECT were considered, the relatively expensive myocardial SPECT strategy was more cost-effective than the cheaper stress echocardiography strategy in patients with a pCAD of 0.3 or greater. According to sensitivity analysis, the prognostic value of false-negative results and the nondiagnostic test rate were important determinants of stress myocardial study cost-effectiveness. 相似文献
10.
Accuracy of 64-slice CT angiography for the detection of functionally relevant coronary stenoses as assessed with myocardial perfusion SPECT 总被引:3,自引:0,他引:3
Gaemperli O Schepis T Koepfli P Valenta I Soyka J Leschka S Desbiolles L Husmann L Alkadhi H Kaufmann PA 《European journal of nuclear medicine and molecular imaging》2007,34(8):1162-1171
Purpose CT angiography (CTA) offers a valuable alternative for the diagnosis of CAD but its value in the detection of functionally
relevant coronary stenoses remains uncertain. We prospectively compared the accuracy of 64-slice CTA with that of myocardial
perfusion imaging (MPI) using 99mTc-tetrofosmin-SPECT as the gold standard for the detection of functionally relevant coronary artery disease (CAD).
Methods MPI and 64-slice CT were performed in 100 consecutive patients. CTA lesions were analysed quantitatively and area stenoses
≥50% and ≥75% were compared with the MPI findings.
Results In 23 patients, MPI perfusion defects were found (12 reversible, 13 fixed). A total of 399 coronary arteries and 1,386 segments
was analysed. Eighty-four segments (6.1%) in 23 coronary arteries (5.8%) of nine patients (9.0%) were excluded owing to insufficient
image quality. In the remaining 1,302 segments, quantitative CTA revealed stenoses ≥50% in 57 of 376 coronary arteries (15.2%)
and stenoses ≥75% in 32 (8.5%) coronary arteries. Using a cut-off at ≥75% area stenosis, CTA yielded the following sensitivity,
specificity, negative (NPV) and positive predictive value (PPV), and accuracy for the detection of any (fixed and reversible)
MPI defect: by patient, 75%, 90%, 93%, 68% and 87%, respectively; by artery, 76%, 95%, 99%, 50% and 94%, respectively.
Conclusion Sixty-four-slice CTA is a reliable tool to rule out functionally relevant CAD in a non-selected population with an intermediate
pretest likelihood of disease. However, an abnormal CTA is a poor predictor of ischaemia. 相似文献
11.
平板运动试验与冠状动脉造影的对照分析 总被引:3,自引:0,他引:3
目的:通过平板运动试验与冠状动脉造影的对比分析,评价运动试验诊断冠心病的准确性.方法:拟诊冠心病患者59例分别行冠状动脉造影术和活动平板运动试验,将两种检查结果对比分析.结果:冠状动脉造影阳性病例25例中,运动试验阳性19例,阴性6例.冠状动脉造影阴性病例34例中,运动试验阳性13例,阴性21例.平板运动试验诊断冠心病的敏感性为76%、特异性为61.8%、预测准确性为57.6%;冠状动脉单支病变较多支病变者易出现平板运动试验假阴性;女性平板运动试验假阳性率高于男性(P<0.01);心电图不同导联缺血性变化对冠脉造影有一定的预测定位作用.结论:平板运动试验是冠心病诊断的一项筛选试验,与冠脉造影结合起来可以提高冠心病诊断的准确性. 相似文献
12.
Satoshi Hida MD Taishiro Chikamori MD FACC Hirokazu Tanaka MD Yuko Igarashi MD Tsuguhisa Hatano MD Yasuhiro Usui MD Manabu Miyagi MD Akira Yamashina MD 《Journal of nuclear cardiology》2009,16(1):20-27
Background Although transient left ventricular (LV) dilation is a well-known marker for extensive coronary artery disease (CAD), few
studies performed quantitative analysis of LV function of post adenosine triphosphate (ATP) stress and at rest to detect extensive
CAD.
Methods One hundred nineteen patients with suspected CAD underwent post-stress and resting gated single-photon emission computed tomography
(SPECT). Myocardial perfusion was assessed with a 20-segment model, and the changes in LV volume and function with ATP were
analyzed. In addition, the stress-induced volume ratio (SIVR), defined as stress-to-rest ratios (end-systolic volume × 5 + end-diastolic
volume), was calculated. All the patients underwent coronary angiography within 3 months of gated SPECT.
Results In the 62 patients with multi-vessel CAD, the summed stress score (SSS) (16.6 ± 8.7 vs 11.5 ± 9.1; P < .002), summed difference score (SDS) (9.6 ± 5.8 vs 3.9 ± 4.2; P < .0001), the post-stress increase in end-diastolic volume (EDV) (7.7 ± 7.9 vs 2.2 ± 5.3 mL; P < .0001), the post-stress increase in end-systolic volume (ESV) (9.4 ± 6.0 vs 2.7 ± 4.0 mL; P < .0001), and the (SIVR) (1.21 ± 0.14 vs 1.06 ± 0.10; P < .0001) were greater than in the 57 patients with insignificant or single-vessel CAD, whereas the post-stress increase in
ejection fraction (EF) was less (−6.0 ± 4.9 vs −2.0 ± 4.4%; P < .0001). In the detection of multi-vessel CAD, an SSS of ≥14 and an SDS of ≥9 showed sensitivities of 57% and 52%, respectively,
and specificities of 63% and 88%, respectively, while increase in EDV of ≥6 mL, increase in ESV of ≥6 mL, decrease in EF of
≥5% after stress, and SIVR of ≥1.13 demonstrated sensitivities of 60%, 81%, 60%, and 74% and specificities of 74%, 77%, 77%,
and 79%, respectively. The multivariate discriminant analysis revealed that the combination of post-stress increase in ESV
and the SDS best identified multi-vessel CAD, with 81% sensitivity and 77% specificity (χ2 = 63.6), whereas the SDS alone showed 52% sensitivity and 88% specificity (χ2 = 22.4).
Conclusions The addition of “post-ATP stress” and “at rest” LV functional analysis using gated SPECT to conventional perfusion analysis
helps to better identify patients with multi-vessel CAD. 相似文献
13.
《Journal of Cardiovascular Computed Tomography》2019,13(3):34-40
BackgroundWhile exercise has been associated with favorable coronary artery disease (CAD) outcomes, the relationship between endurance exercise levels and CAD findings has not been well explored.PurposeTo evaluate the relationship of endurance exercise to CAD findings by coronary computed tomographic angiography (CCTA).MethodsWe evaluated consecutive patients referred to CCTA who filled out a survey instrument between 2015 and 2017, and who graded their level of weekly endurance exercise as: none, low (1–2 times per week), moderate (3–5 times per week) or high (5–7 times per week); along with the number of hours per week engaged in exercise as: low (<30 min), moderate (1 h) or high (>1–3 h).CCTAanalysis included measurement of maximum per-patient, per-vessel and per-segment stenosis severity, which was judged as minimal (<25%), mild (<50%), moderate (50–70%), and severe (>70%). CAD extent and severity was also summated CADRADS score, plaque burden by segment involvement score (SIS), and non-calcified plaque score (G-score). High-risk plaque (HRP), as defined by the presence of low attenuation plaque, positive arterial remodelling, spotty calcifications and napkin ring signs, was assessed. Finally, coronary artery calcium scores (CCS), as determined by Agatston units, were quantified.ResultsThe study cohort comprised 252 patients (55.3y ±10.1, 39.7% females) with 97 inactives, 87 with low and 68 with moderate-to-high recreational endurance exercise levels (>=3x/week ≥ 1 h) included.Prevalence of subclinical CAD was 57.4%. Prevalence of >50% stenosis was with 13.2% lower at moderate-to-high exercise levels as compared to inactives (p = 0.04). Stenosis severity score (p = 0.04), total (p = 0.036) non-calcified plaque burden were lower (p = 0.026) in athletes, and in the absence of confounding risk factors, the effect strenghtened (SIS and G-score, p = 0.012 and 0.008). There was no difference in the CCS. High-risk plaque prevalence was higher in controls as compared to athletes with moderate-to-high exercise levels (13.4% vs 0%, p = 0.002), and HDL was lower (p < 0.001), respectively. MACE rate was 0%, and ICA rate of >50% stenosis 3.5% at 1 year follow-up.ConclusionRegular moderate-to-high endurance exercise results in lower total and non-calcified plaque burden and less high-risk plaque. 相似文献
14.
15.
《Journal of Cardiovascular Computed Tomography》2018,12(2):118-124
BackgroundTo investigate the incremental prognostic value of low-attenuation plaque volume (LAPV) from coronary CT angiography datasets.MethodsQuantification of LAPV was performed using dedicated software equipped with an adaptive plaque tissue algorithm in 1577 patients with suspected CAD. A combination of death and acute coronary syndrome was defined as primary endpoint. To assess the incremental prognostic value of LAPV, parameters were added to a baseline model including clinical risk and obstructive coronary artery disease (CAD), a baseline model including clinical risk and calcium scoring (CACS) and a baseline model including clinical risk and segment involvement score (SIS).ResultsPatients were followed for 5.5 years either by telephone contact, mail or clinical visits. The primary endpoint occurred in 30 patients. Quantified LAPV provided incremental prognostic information beyond clinical risk and obstructive CAD (c-index 0.701 vs. 0.767, p < .001), clinical risk and CACS (c-index 0.722 vs. 0.771, p < .01) and clinical risk and SIS (c-index 0.735 vs. 0.771, p < .01. A combined approach using quantified LAPV and clinical risk significantly improved the stratification of patients into different risk categories compared to clinical risk alone (categorical net reclassification index 0.69 with 95% CI 0.27 and 0.96, p < .001). The combined approach classified 846 (53.6%) patients as low risk (annual event rate 0.04%), 439 (27.8%) patients as intermediate risk (annual event rate 0.5%) and 292 (18.5%) patients as high risk (annual event rate 0.99%).ConclusionQuantification of LAPV provides incremental prognostic information beyond established CT risk patterns and permits improved stratification of patients into different risk categories. 相似文献
16.
Daniel S. Berman Piotr J. Slomka Ling de Yang Sean W. Hayes Guido Germano 《Journal of nuclear cardiology》2007,14(4):521-528
Background There have been limited data regarding the value of gated single photon emission computed tomography (SPECT) myocardial perfusion
imaging (MPI) for the detection of left main coronary artery disease (CAD).
Methods and Results We studied 101 patients with angiographic left main CAD (≥50% stenosis) and no prior myocardial infarction or coronary revascularization
who underwent gated exercise or adenosine stress technetium 99m sestamibi SPECT MPI. By perfusion assessment alone, high-risk
disease with moderate to severe defects (>10% myocardium at stress) was identified in only 56% of patients visually and 59%
quantitatively. Absence of significant perfusion defect (≥5% myocardium) was seen in 13% of patients visually and 15% quantitatively.
However, by combining visual perfusion data and nonperfusion variables, especially transient ischemic dilation, 83% of patients
were identified as high risk.
Conclusions The findings of this study demonstrate that assessment of perfusion data alone by visual or quantitative SPECT MPI analysis
underestimates the magnitude of left main CAD. The combination of perfusion and nonperfusion abnormalities on gated MPI identifies
high risk in most patients with left main CAD.
This study was presented in part at the American College of Cardiology 56th Annual Scientific Session, March 24–27, 2007,
New Orleans, La.
This work was supported in part by grants from Bristol-Myers Squibb Medical Imaging, Billerica, Mass, and Astellas, Deerfield,
Ill. 相似文献
17.
O. Morel P. Pézard A. Furber J. J. Le Jeune B. Vielle B. Denizot P. Jallet 《European journal of nuclear medicine and molecular imaging》1999,26(6):640-646
The aim of this study was to correlate lung thallium-201 uptake on exercise with 201Tl single-photon emission tomography (SPET) myocardial perfusion imaging, rest and exercise equilibrium radionuclide angiographic
and coronary angiographic findings in patients with coronary artery disease (CAD) using a simple, reproducible lung/heart
(L/H) ratio that would be easy to use in clinical practice. L/H ratio was defined on the anterior planar image obtained during
exercise 201Tl SPET acquisition as the mean counts per pixel in an entire right lung field region of interest divided by the mean counts
per pixel in the hottest myocardial wall region of interest. We studied 103 patients. Fifty-nine patients (group I) with <5%
likelihood of CAD were used as a reference group. In 44 CAD patients (group II), L/H ratio was compared with 201Tl SPET, radionuclide angiographic and coronary angiographic variables. The group I L/H ratio of 0.35±0.05 (mean ±1 SD) was
significantly lower (P<0.001) than the group II L/H ratio of 0.45±0.10. An L/H ratio >0.45 (mean + 2 SD in group I) was considered abnormal. In
group II, L/H ratio showed a significant correlation with stress and rest 201Tl perfusion defect size (r
= 0.39 and r
= 0.42, P<0.01, respectively), but not with extent of ischaemic myocardium. The mean L/H ratio was 0.41±0.10 in patients with one-vessel
disease (n = 15), 0.46±0.08 in those with two-vessel disease (n = 17) and 0.47±0.12 in those with three-vessel disease (n = 12), but no significant difference was found between the three subgroups. L/H ratio showed a significant inverse relation
with rest and exercise left ventricular ejection fraction (r = –0.37 and r = –0.50, P<0.05 and P<0.001, respectively). Using stepwise multiple regression analysis, exercise left ventricular ejection fraction and previous
history of hypertension were the sole two variables independently predictive of the L/H ratio. In conclusion, although lung
thallium uptake is usually found to correlate with extent and severity of CAD, increased L/H ratio should primarily be considered
as a marker of exercise-induced left ventricular systolic and perhaps diastolic dysfunction, probably independent of the underlying
cardiac disease.
Received 14 January and in revised form 22 February 1999 相似文献
18.
目的:评价冠状动脉CT血管成像(CCTA)和运动平板试验(TET)对冠心病的诊断价值。方法:以常规冠状动脉造影(CAG)为诊断冠心病(冠脉狭窄≥50%)的"金标准",对同期先后行TET、CCTA和CAG 3种检查的75例疑似冠心病患者进行回顾性分析,将其TET和CCTA的结果与CAG进行比较。结果:TET和CCTA诊断冠心病的敏感度分别为45.2%和90.5%,特异度为69.7%和93.9%,阳性预测值为65.5%和95.0%,阴性预测值为50.0%和88.6%,准确率为56.0%和92.0%,P<0.01。在冠状动脉血管水平CCTA对右冠状动脉、左主干、前降支、回旋支狭窄诊断的准确率分别为86.7%、100.0%、88.0%和76.0%。冠心病患者中TET诊断阳性率与病变血管支数呈正相关(r=0.440,P=0.004);冠心病患者TET诊断结果阳性与阴性仅与血管狭窄程度≥75%狭窄的节段数目有统计学差异(P=0.016)。结论:CCTA诊断冠心病较TET有更高的诊断准确性和较低的诊断假阳性和假阴性,对有症状的疑诊冠心病患者CCTA的诊断具有更重要作用。 相似文献
19.
超声评价冠心病患者血管内皮依赖性舒张功能 总被引:2,自引:0,他引:2
目的:探讨肱动脉内皮依赖性舒张功能(EDD)对冠心病(CAD)的诊断价值。方法:对189例连续冠脉造影(CAG)受检者术前利用高频超声进行肱动脉EDD检查,并与CAG结果进行相关性研究。结果:CAD单支病变组、多支病变组肱动脉EDD明显低于对照组(P〈0.01);多支病变组EDD显著低于单支病变组(P〈0.01)。结论:CAD患者及具有其危险因素人群中,进行EDD检查,可间接反映冠状动脉情况,不仅为早期发现、预防和治疗CAD患者提供依据,还可作为监测和评估病情变化的指标。 相似文献
20.
Summary
Background: Electron beam CT (EBCT) can acquire rapid, multiple thin-section tomograms of the beating heart in synchrony with the electrocardiogram
and quantify coronary calcification without intravenous contrast. Coronary calcification is an active process exclusively
associated with atherosclerotic plaque formation and regulated in a manner similar to the calcification of bone. Clinical
studies have demonstrated that EBCT coronary calcification (1) follows a pattern similar to the epidemiology of coronary artery
disease (CAD), (2) has a high sensitivity (90–95 %) for coronary plaque and significant angiographic coronary stenoses, and
(3) has the potential to assess the prognosis of patients with coronary atherosclerotic disease. Coronary calcium area or
“score” correlates best with overall plaque burden within the coronary system. However, coronary calcium is of limited value
in distinguishing coronary stenosis on a segment-by-segment basis.
EBCT and CAD: Due to spiraling health care costs, there is a need for cost-efficient strategies in the diagnosis and stratification of
patients with known or suspected CAD. There are two major patient groups in which EBCT calcium scanning has a potential for
cost-efficient application: (1) in asymptomatic, high-risk patients, identification of significant plaque burden may direct
judicious use of long-term drug therapy or further investigation to those individuals most likely to benefit from an aggressive
risk factor modification and medical program; (2) in patients with chest pain syndromes but no prior CAD, EBCT calcium scanning
compares favorably with conventional diagnostic methods. In particular, using receiver operating characteristic analysis,
the sensitivity and specificity of an EBCT calcium score of 80 in detecting obstructive CAD are both about 85 %. Using a theoretical
model, EBCT calcium scanning was found to be the most cost-effective approach to diagnosis in populations with a low-to-moderate
likelihood of obstructive CAD when compared with treadmill exercise, stress thallium, and stress echocardiography.
Conclusions: EBCT calcium scanning is not a substitute for coronary angiography, but it has clear advantages over other more traditional
diagnostic methods for CAD. In particular, it can be performed conveniently and inexpensively in most patients. Additionally,
the site and extent of calcification are intimately related to the atherosclerotic plaque burden. The analyses presented suggest
that it may also provide a cost-effective clinical alternative in specific subsets of the population.
Eingegangen am 15. Januar 1996 Angenommen am 27. Februar 1996 相似文献