Coronary computed tomography angiography

Chang, Su-Min; Bhatti, Sabha; Nabi, Faisal

doi:10.1097/hco.0b013e32834938c6

Cited by 21 publications

(10 citation statements)

References 52 publications

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“…Data from the most motion-free phase (diastasis usually occurs in mid-diastole) are then reconstructed for analysis. By contrast, prospective EKG triggering involves axial acquisition (table intermittently advances, usually with each heart beat) with the X-ray tube on during diastasis only [3].…”

Section: Introductionmentioning

confidence: 99%

“…The gold standard is invasive right-heart catheterization, but non-invasive imaging modalities include echocardiography, cardiac magnetic resonance imaging, and cardiac computed tomography (CT) [1,2]. CT coronary angiography (CTCA) uses electrocardiogram-gated image acquisition after contrast administration when a predetermined level of contrast opacification is reached to obtain high-resolution, three-dimensional depictions of both the cardiac structures and the coronary vessels [3]. Depending on the scanner, two acceptable methods exist: automatic bolus tracking or the timing bolus method for determining the contrast transit time.…”

Section: Introductionmentioning

confidence: 99%

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Validation of a Novel Method for Cardiac Output Estimation by CT Coronary Angiography

Mehta¹,

Choi²,

Sanai³

et al. 2012

ACT

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Background: Cardiac output can be estimated during retrospectively gated CT coronary angiography by anatomically determining left ventricular volumes; prospective triggering to minimize radiation precludes this methodology. We propose an alternative method for cardiac output estimation based on preclinical models suggesting that cardiac output may be inversely related to contrast washout from the aortic root during timing bolus scanning, as measured by peak aortic root contrast attenuation. Methods: 34 patients had CT coronary angiography timing bolus performed with 20 ml iodixanol at 5.5 ml/s followed by 20 ml normal saline at 5.5 ml/s through an 18-Ga antecubital catheter. Peak aortic root contrast attenuation was correlated to cardiac output calculated by echocardiography using heart rate stroke volume from biplane Simpson's method. Results: Mean age was 58 ± 13 years; body surface area, 2.0 ± 0.5 m 2 . 53% were women. Stroke volume, cardiac output and cardiac index were 67 ± 19 ml, 4.5 ± 1.6 L/min, and 2.2 ± 0.7 L/min/m 2 , respectively. Peak aortic root contrast attenuation was 207 ± 46 HU and correlated to cardiac output and cardiac index with r = -0.64, p < 0.0001 and r = -0.55, p < 0.001, respectively. Regression analysis estimates cardiac output = -0.02 peak aortic root contrast attenuation +9.1. Conclusion: This novel method for cardiac output estimation by CTCA appears feasible. The CT physiologic parameters using the timing test-bolus data moderately correlated with echocardiographic assessment of cardiac output. The calculation of cardiac output adds important hemodynamic data to anatomic information provided by CTCA, and further development of this method may preserve assessment of left ventricular performance in prospective triggering.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Validation of a Novel Method for Cardiac Output Estimation by CT Coronary Angiography

Mehta¹,

Choi²,

Sanai³

et al. 2012

ACT

View full text Add to dashboard Cite

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“…59 However, the role of calcium scoring alone in ACS risk stratification in the ED continues to be debated. Prior studies have shown that noncalcified plaques are more likely to be present in younger cohorts, [59][60][61] in diabetic patients, 62 and in patients with ACS compared with those with stable CAD. 63 A calcium score of zero may not predict the absence of CAD.…”

Section: Coronary Calcium Scoringmentioning

confidence: 96%

Coronary and Cardiac Computed Tomography in the Emergency Room

Cook

Galperin-Aizenberg²,

Litt³

2013

Journal of Thoracic Imaging

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In the United States, chest pain is the second leading reason for patients to present to an emergency department (ED). Previously, those patients suspected to have acute coronary syndrome were monitored for 24 hours to determine the presence of serum biomarkers consistent with myocardial injury. However, more recently, imaging has been used to more efficiently triage these individuals and even discharge them directly from the ED. There are multiple cardiac imaging modalities; however, cardiac computed tomography now plays a significant role in the evaluation of patients with suspected acute coronary syndrome who present to the ED. In this review, we discuss the available state-of-the-art techniques for evaluating this cohort of patients, including clinical evaluation, serum biomarkers, and imaging options. Further, we analyze in detail evidence for the use of coronary computed tomography angiography to determine whether these patients can safely be discharged from the ED. Finally, we review some of the related future techniques that may become part of the accepted clinical management of these patients in the future.

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“…Plaque component analysis based on the CT number is becoming popular, but it still needs further validation or improvement to be reliably used as an outcome measure. 29 The strength of this article is that we have a large clinical population that underwent repeat CCTA after a prior CCTA excluding significant stenosis. This is partly because of the high availability of CT devices in Japan with 97.3 scanners per million individuals, 3 times the ratio in the United States.…”

Section: Discussionmentioning

confidence: 99%

Repeat Coronary Computed Tomographic Angiography in Patients With a Prior Scan Excluding Significant Stenosis

Kumamaru

Kondo

Kumamaru

et al. 2014

Circ: Cardiovascular Imaging

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Computed Tomography (AUC2010) does not incorporate prior coronary computed tomographic angiography (CCTA) results in the appropriateness of a CCTA examination. The purpose of this study was to explore the criteria for forgoing repeat CCTA among patients with clinical scenarios suggesting CCTA as appropriate after prior CCTA excluding coronary artery disease. Methods and Results-Among patients from a single center (February 2006 to April 2013) who underwent appropriate CCTA based on AUC2010, consecutive 555 CCTAs, which had a prior CCTA excluding significant stenosis (>50% stenosis in diameter), were selected. The median time difference between the studies was 34.2 (Q1-Q3, 22.9-50.1) months. Significant stenosis was detected at the time of repeat scan (by CCTA or subsequent catheter angiography) in 13.3% (74 of 555). A multivariable logistic model (C-statistic, 0.74; bootstrapped overfitting bias, 0.8%) identified 3 predictors of significant stenosis: time difference between the studies >3 years (adjusted odds ratio, 2.1; 95% confidence interval, 1.2-3.5), diabetes mellitus (odds ratio, 2.4; 95% confidence interval,1.4-4.3), and 26% to 50% stenosis on the initial CCTA (odds ratio, 5.6; 95% confidence interval, 3.2-9.6). When these 3 factors were all absent (corresponding to 31.9% of the population), the probability of significant stenosis was 4.5% (95% confidence interval, 2.7-7.4%), whereas 17.1% of patients had significant stenosis among those with at least 1 positive variable. When coronary arteries were completely normal at the initial scan, the prevalence of significant stenosis was only 1.8% irrespective of other factors, and no patient underwent revascularization. Conclusions-Nondiabetic patients with a prior CCTA <3 years showing no or ≤25% stenosis had a <5% prevalence of significant stenosis.

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Coronary computed tomography angiography

Abstract: When used appropriately, CCTA has been established as a valid noninvasive imaging alternative to ICA in selected patients at low to intermediate risk of CAD.

Cited by 21 publications

References 52 publications

Validation of a Novel Method for Cardiac Output Estimation by CT Coronary Angiography

Validation of a Novel Method for Cardiac Output Estimation by CT Coronary Angiography

Coronary and Cardiac Computed Tomography in the Emergency Room

Repeat Coronary Computed Tomographic Angiography in Patients With a Prior Scan Excluding Significant Stenosis

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