A unique case of anomalous coronary origin detected by 64-row multislice computed tomography coronary angiography

The anomalous origin of the left coronary artery from the right sinus of valsalva is an anatomical abnormality that is usually associated with myocardial ischaemia and sudden death. We report on a case in which three different diagnostic techniques were used to find the cause of the ischaemic symptoms in a patient whose left coronary artery originated anomalously in the right sinus of valsalva and followed a course between the aorta and the pulmonary trunk. The techniques were treadmill exercise test for ischaemia, conventional angiography, which was used for the initial diagnosis, and 64-row multislice computerised tomography, used to determine the anomalous course of the artery.     

Double right coronary artery detected on coronary computed tomography angiography: A case report

Double right coronary artery is a relatively rare coronary anomaly. In this case report we aim to increase awareness of the importance of recognizing such anomaly and a brief literature review of similar cases and possible high risk features. Computed Tomography is well recognized modality to detect coronary anomaly and in our case we demonstrated this as well.     

The chance finding at multislice computed tomography coronary angiography of myocardial bridging

Myocardial bridging is present when a segment of a major epicardial coronary artery, the ‘tunnelled artery’, runs intramurally through the myocardium. With each systole, the coronary artery is compressed. The pathophysiology of myocardial bridging is incompletely understood. With each systole, the coronary artery is compressed. Moreover, intravascular ultrasound analysis revealed a delayed relaxation after systolic compression, which may extend significantly into diastole. This explains both the impaired coronary flow reserve and ischemia. Evidence indicates that the intima beneath the bridge is protected from atherosclerosis, and the proximal segment is more susceptible to the development of atherosclerotic lesions because of haemodynamic disturbances. Myocardial bridging is sometimes associated with overt pathology, as well as it can just be an incidental finding without any significance. Myocardial bridging may cause angina pectoris, myocardial infarction, life threatening arrhythmias and even sudden cardiac death but most of them are harmless. Furthermore depressed left ventricular function, myocardial stunning, early death after cardiac transplantation has been also reported. Although the exact management is not well known, beta blockers seem to be the first choice. Stenting is controversial and one must think “twice” before stenting the bridged coronary artery. We report a case of chance finding at multislice computed tomography coronary angiography of two myocardial bridging. Also this case focuses attention on myocardial bridging and it confirms that multislice computed tomography coronary angiography technology represents a useful, noninvasive imaging method of its assessment.     

Assessment of coronary artery abnormalities in a patient with Kawasaki disease by multislice computed tomography

The high spatial resolution of multislice computed tomography (MSCT) permits direct visualization of the coronary artery system. In this report, we describe coronary artery abnormalities in a young adult with Kawasaki disease. MSCT detected a giant coronary artery aneurysm, coronary artery stenosis in the first diagonal artery, and a multi-layered structure in the right coronary artery and the left circumflex artery. These findings corresponded well to those obtained by coronary angiography. MSCT has the potential to be the standard diagnostic tool for the follow-up evaluation of coronary artery disease in adolescents and young adults with Kawasaki disease.     

Association between postprandial triglycerides and coronary artery disease detected by coronary computed tomography angiography

Background

Studies have demonstrated the association of severe anatomical coronary artery disease (CAD) with postprandial triglycerides (TG) concentrations. Nevertheless the relationship between less severe atherosclerosis plaque burden and postprandial TG is less established.

Objective

to study the relationship between postprandial TG and CAD detected by coronary computed tomographic angiography (CTA).

Material and methods

130 patients who underwent an oral fat tolerance test were enrolled (85 with CAD detected by CTA and 45 without). Postprandial lipemia was studied by measuring TG from T0h to T6h with 2-h intervals, and analyzed the TG change over time using a longitudinal multivariable linear mixed effects model with the log normal of the TG as the primary outcome.

Results

The majority of individuals with CAD had non-obstructive disease (63.3%) Patients with CAD had a slower clearance of postprandial TG change from 4 h to 6 h (p < 0.05) compared to patients without CAD. These results remained significant after adjustment for fasting TG and glucose, age, gender, body mass index, and waist circumference. However, those differences did not reach statistical significance after adjustment for fasting HDL-C.

Conclusion

Patients with mild (<25% lumen obstruction) and moderate CAD (25–50% lumen obstruction) detected by coronary CTA had an impaired postprandial metabolism, with a delayed TG clearance, when compared to individuals with no CAD. This difference was partially explained by the lower HDL-C. Thus, though postprandial TG may contribute to the development of CAD, this association is partially related to low HDL-C.     

The prevalence of coronary artery anomalies in Qassim Province detected by cardiac computed tomography angiography

Background

Coronary artery anomalies (CAAs) affect about 1% of the general population based on invasive coronary angiography (ICA) data, computed tomography angiography (CTA) enables better visualization of the origin, course, relation to the adjacent structures, and termination of CAAs compared to ICA.

Spiral multislice computed tomography coronary angiography: a current status report

Multislice computed tomography coronary angiography (MSCT-CA) has emerged as a powerful noninvasive diagnostic modality to visualize the coronary arteries and to detect significant coronary stenoses. The latest generation 64-slice computed tomography (CT) scanners is a robust technique which allows high-resolution, isotropic, nearly motion-free coronary imaging. Coronary stenoses are detected with high sensitivity and a normal scan accurately rules out the presence of a coronary stenosis. With the introduction of further novel concepts in CT-technology one may expect that MSCT-CA will become a clinically used diagnostic tool.     

The impact of the menopause on coronary artery calcification examined by multislice computed tomography scanning

Background and aimsTo examine whether there is a difference in coronary artery calcification (CAC) scores between males and females aged above 50 years.Methods and resultsA total of 479 subjects aged between 40 and 70 years with no clinical or family history of cardiovascular disease (CVD) were enrolled for this study. All subjects were assessed by multislice CT scanning (MCTS), and the CAC scores obtained were assigned to one of four quartiles for further assessment and comparison. The main outcome evaluated was the percentage of high CAC scores and mean CAC scores, comparing males and females of different age groups.This study found that the percentage of high CAC scores increased markedly from 5% (40–49 age group) to 21.2% (50–59 age group) among females. The increase was significantly less when comparing males from different age groups (from 25% in the 40–49 age group to 31.2% in the 50–59 age group). Females had higher odds ratios (ORs) postmenopausally (4.3 in the 50–59 age group) than males in the same age group (1.6).ConclusionsThese initial findings seem to indicate that above 50 years of age, CAC is more dependent on age in females than in males, which might be due to the effect of the menopause.     

Anomalous coronary arteries in adults detected by multislice computed tomography: presentation of cases from multicenter registry and review of the literature

Anomalous coronary arteries are a rare condition, but they may cause myocardial ischemia, heart failure, and sudden death. We evaluated the prevalence and multislice computed tomographic (MSCT) findings of anomalous coronary arteries in a large number of patients from the multicenter registry. At four institutes, 29 (0.74%) out of 3910 patients were found to have anomalous coronary arteries by MSCT. They consisted of 15 patients with anomalous origins of the right coronary artery, 1 with right-sided origin of the left circumflex artery, 1 with right-sided origin of the left main coronary artery, 2 with double right coronary arteries, 2 with the absence of the left circumflex artery, 1 with absence of the right coronary artery, 6 with coronary artery fistulas, and 1 with Bland-White-Garland syndrome. Multislice computed tomography findings were consistent with those obtained by conventional coronary angiography in all 14 patients undergoing both diagnostic procedures. Multislice computed tomography permits three-dimensional comprehension of coronary arteries, which is suitable for the diagnosis of anomalous coronary arteries.     

Coronary angiography by computed tomography: coronary imaging evolves

Rapid technological advances have facilitated high-resolution noninvasive coronary angiography using multislice computed tomography. Appropriateness guidelines recently have been published in the Journal of the American College of Cardiology and endorsed by several imaging specialty societies. Clinical studies are now available supporting the use of this method in selected diagnostic situations, particularly when the exclusion of coronary artery disease is of paramount clinical concern.     

Assessment of coronary artery disease using coronary computed tomography angiography in patients with aortic valve stenosis referred for surgical aortic valve replacement

Background

In patients referred for aortic valve replacement (AVR) a pre-surgical assessment of coronary artery disease is mandatory to determine the possible need for additional coronary artery bypass grafting. The diagnostic accuracy of coronary computed tomography angiography (coronary CTA) was evaluated in patients with aortic valve stenosis referred for surgical AVR.

Methods

Between March 2008 and March 2010 a total of 181 consecutive patients were included. All patients underwent pre-surgical coronary CTA (64- or 320-detector CT scanner) and invasive coronary angiography (ICA). The analyses were performed blinded to each other.

Results

The mean ± SD age of the included patients was 71 ± 9 years and 59% were male. The prevalence of significant coronary artery stenosis > 70% by ICA was 36%. Average heart rate during coronary CTA was 65 ± 16 bpm. In a patient based analysis 94% of the patients (171/181) were considered fully evaluable. Coronary CTA had a sensitivity of 68%, a specificity of 91%, a positive predictive value of 81%, and a negative predictive value of 83%. Advanced age, obstructive lung disease, NYHA function class III/IV, and high Agatston score were found to be significantly associated with disagreement between ICA and coronary CTA in univariate analysis.

Conclusion

In patients with aortic valve stenosis referred for surgical AVR the diagnostic accuracy of coronary CTA to identify significant coronary artery disease is moderate. Coronary CTA may be used successfully in a subset of patients with low age, no chronic obstructive lung disease, NYHA function class < III and low coronary Agatston score.     

Diagnosis of anomalous origin of the right coronary artery using multislice computed tomography: evaluation of possible causes of myocardial ischemia

Anomalous origin of the right coronary artery (RCA) is a rare condition, but may cause myocardial ischemia and sudden death. Multislice computed tomography, which allows three-dimensional visualization of the coronary artery with high spatial resolution, may be the most promising imaging modality for diagnosing this anomaly. We describe a patient with anomalous origin of the RCA arising from the left sinus of Valsalva. Volume rendering, and axial and curved multiplanar images showed stenosis in the proximal portion of the RCA that coursed between the aorta and the pulmonary artery, and an acute angled take-off of the RCA from the aorta. Three-dimensional virtual angioscopic images showed a hypoplastic RCA orifice and luminal narrowing in the proximal portion of the RCA. Multislice computed tomography was thought to be useful for detecting anomalous origin of the RCA and for evaluating possible causes of myocardial ischemia.     

Coronary computed tomography angiography in coronary artery disease

AIM: To investigate the research directions of coronary computed tomography (CT) angiography in the diagnosis of coronary artery disease (CAD) based on a systematic review of the literature.METHODS: A search of articles on coronary CT angiography in the diagnosis of CAD was performed during a 6-year-period between 2005 and 2010 from f ive main radiology journals namely, Radiology, American Journal of Roentgenology, European Radiology, European Journal of Radiology and British Journal of Radiology. Analysis of the references was focused on the research directions of coronary CT angiography with regard to the type of studies in terms of diagnostic value, application of dose-reduction strategies and resultant effective radiation doses with use of these techniques.RESULTS: One hundred and forty two studies were identified which met the selection criteria and were included in the analysis. 64-slice CT (single source anddual-source CT) dominated 78% of the coronary CT angiography studies. Prior to 2007, research was focused on the diagnostic value of coronary CT angiography, but since 2008 more attention has been paid to radiation dose reduction. Radiation dose was reported in 64 studies, representing 45% of total studies published in the f ive radiology journals. Various dose-saving strategies have been implemented and prospective electrocardiography-triggering and high pitch techniques were found to be the most effective approaches for radiation dose reduction, with the corresponding mean effective dose being 3.5 ± 1.9 mSv and 1.7 ± 0.6 mSv, respectively.CONCLUSION: This review shows that the current research in coronary CT angiography has shifted from the previous focus on diagnostic accuracy in CAD to more emphasis on radiation dose reduction.     

Informative value of clinical research on multislice computed tomography in the diagnosis of coronary artery disease: A systematic review

Multislice Spiral Computed Tomography (MSCT) is an emerging non-invasive diagnostic modality to detect coronary artery disease, which may alter diagnostic pathways and change the current clinical role of conventional coronary angiography.

Aims

To retrieve and critically assess information from the available literature on MSCT (≥ 16-slice) concerning its diagnostic accuracy, safety, applicability, clinical impact and cost-effectiveness.

Methods and results

Articles published between January 2002 and March 2007 were identified through searches of the Cochrane Library, MEDLINE, and other websites of manufacturers, cardiac professional societies, guidelines and abstracts from conference meetings.We identified 1768 potentially relevant articles: 262 out of these were considered eligible for full evaluation and 150 were selected (57 assessed diagnostic accuracy, 130 applicability, 103 safety, 1 clinical impact and none cost-effectiveness).The pre test probability of coronary artery disease was 56.7% (95% Confidence Interval: 55.1%–58.3%). A positive MSCT finding (pooled LR+: 5.4 (4.4–6.7)) increased the probability of CAD to 87.7% (84.3%–90.3%), whereas a negative MSCT result (pooled LR−: 0.09 (0.07–0.12)) reduced the probability of CAD to 10.7% (7.9%–14.4%).

Conclusions

MSCT is a promising technology for the assessment of coronary artery stenosis. However, the available literature is of limited value in providing guidance to support the development of policies for its appropriate utilization in clinical practice.     

Regression of an atherosclerotic coronary artery plaque demonstrated by multislice spiral computed tomography in a patient with stable angina pectoris

Multislice spiral computed tomography (MSCT) permits direct visualization of not only coronary artery stenosis but also atherosclerotic plaques in patients with coronary artery disease. In this report, we describe a patient with stable angina in whom the regression of the plaque was documented by serial MSCT examinations. In the patient, a 46-year-old man with stable angina, MSCT revealed a stenotic lesion at the proximal portion of the left anterior descending artery. Axial, curved multiplanar reconstruction and cross-sectional images consistently depicted a protruding computed tomography low-signal mass suggesting an atherosclerotic plaque. Intracoronary ultrasound (ICUS) also documented an eccentric soft plaque with an echo-lucent mass suggesting a lipid core. Lipid-lowering therapy with pravastatin was started. Follow-up MSCT performed 7 months later documented an increase in the luminal area while the external vessel area remained unchanged. The regression of the plaque was also confirmed by a follow-up ICUS study. MSCT was thought to be feasible for serial evaluation of the plaque size and texture.     

Prevalence of coronary artery ectasia in older adults and the relationship with epicardial fat volume by cardiac computed tomography angiography

Objective Coronary artery ectasia (CAE) refers to abnormal dilation of coronary artery segments to 1.5 times of adjacent normal ones. Epicardial fat is associated with cardiovascular risk factors. The relationship between CAE and epicardial fat has not yet been investigated. This study aimed to assess the relationship between CAE and epicardial fat volume (EFV) in older people by dual-source computed tomography coronary angiography (CTCA). Methods We prospectively enrolled 1400 older adults who were scheduled for dual-source CTCA. Under reconstruction protocols, patients with abnormal segments 1.5 times larger than the adjacent segments were accepted as CAE. EFV was measured by semi-automated software. Traditional risk factors in CAE patients, as well as the extent of EFV, were analyzed and compared to non-CAE group. Results A total of 885 male and 515 female older patients were enrolled. CAE was identified by univariable analysis in 131 patients and significantly correlated to hypertension, smoking, hyperlipidemia, prior percutaneous coronary intervention and ascending aorta aneurysm. EFV was shown to be significantly higher in CAE patients than patients without ectasia. In multivariable analyses, EFV (P = 0.018), hypertension (P < 0.001) and hyperlipidemia (P < 0.001) were significantly correlated to CAE. There was a significant negative correlation between EFV and Markis classification. Conclusions CAE can be reliably recognized by dual-source CTCA. Epicardial fat might play a role in etiopathogenesis and progression of CAE, providing a new target for treating ectasia.     

Accuracy of thin-slice computed tomography in the detection of coronary stenoses.

AIM: Our aim was to investigate the accuracy of multislice spiral computed tomography (MSCT) in the detection of significant (>50%) coronary stenosis using a scanner equipped for 16 x 0.625 mm collimation. METHODS: In 64 patients (59 male, mean age 58 +/- 5 years) with suspected coronary artery disease, MSCT (GE Light Speed-16, collimation: 16 x 0.625 mm) was performed 20 +/- 5 days before coronary angiography (CAG). Only angiographic segments >1.5 mm were considered for analysis. RESULTS: In all patients, MSCT was carried out without complications. Three patients were excluded from the analysis. Of 729 angiographic segments, 613 (84%) were judged evaluable by MSCT. Considering only the segments judged evaluable, the sensitivity was 89%, specificity 98%, positive predictive value 90%, and negative predictive value 98%. Including all segments in the analysis (evaluable and nonevaluable), sensitivity was 78%. CONCLUSIONS: Using a scanner with a collimation of 16 x 0.625 mm, our study confirms the potential role of MSCT in the detection of significant coronary stenosis with a sensitivity of 89% and a very high specificity (98%). Exclusion criteria and less than full evaluability of the coronary arteries must still be considered limitations of the method.     

Coronary computed tomography angiography in a patient with atrial fibrillation, case report

Atrial fibrillation (AF) is the most common persistent arrhythmia. It is associated with wide range of cardiac clinical conditions. Because of variable duration of cardiac cycle resulting in reduced image quality, AF has been considered relative contraindication for performing coronary computed tomography angiography (CCTA). However, recent reports have suggested that newer dual source scanner with higher temporal resolution can be used in patients with AF ( [Oncel et al., 2007] , [Wolak et al., 2008] and [Rist et al., 2009] ). Image quality can be maintained if heart rate is lowered to less than 70 beats per minute. However, high heart rate can still be challenging. Mapping systolic phase with the use of absolute delay reconstruction algorithm has been shown to provide better image quality. In this article, we present a case of patient with chronic AF and in whom coronary examination was required before going to repair of aortic root dissection. CCTA, with the use of absolute delay reconstruction algorithm, provided diagnostic image quality of the coronary arteries.