Coronary CT angiography using 64 detector rows: methods and design of the multi-centre trial CORE-64

Miller, Julie M.; Dewey, Marc; Vavere, Andrea L.; Rochitte, Carlos Eduardo; Niinuma, Hiroyuki; Arbab‐Zadeh, Armin; Paul, Narinder; Hoe, John; Roos, Albert de; Yoshioka, Kunihiro; Lemos, Pedro A.; Bush, David E.; Lardo, Albert C.; Texter, John H.; Brinker, Jeffery; Cox, Christopher; Clouse, Melvin E.; Lima, João A.C.

doi:10.1007/s00330-008-1203-7

Cited by 109 publications

(114 citation statements)

References 62 publications

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“…The complete CORE-64 protocol and methods have been previously described ( 6,16 ). Inclusion criteria were symptomatic patients who were at least 40 years old, were scheduled for CCA, and were willing to provide written informed consent.…”

Section: Cardiac Imaging: Multidetector Ct Angiography Of Coronary Armentioning

confidence: 99%

Coronary Artery Stenoses: Accuracy of 64–Detector Row CT Angiography in Segments with Mild, Moderate, or Severe Calcification—A Subanalysis of the CORE-64 Trial

Vavere¹,

Arbab‐Zadeh²,

Rochitte³

et al. 2011

Radiology

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148

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Purpose:To evaluate the infl uence of cross-sectional arc calcifi cation on the diagnostic accuracy of computed tomography (CT) angiography compared with conventional coronary angiography for the detection of obstructive coronary artery disease (CAD). Materials and Methods:Institutional Review Board approval and written informed consent were obtained from all centers and participants for this HIPAA-compliant study. Overall, 4511 segments from 371 symptomatic patients (279 men, 92 women; median age, 61 years [interquartile range, 53-67 years]) with clinical suspicion of CAD from the CORE-64 multicenter study were included in the analysis. Two independent blinded observers evaluated the percentage of diameter stenosis and the circumferential extent of calcium (arc calcium). The accuracy of quantitative multidetector CT angiography to depict substantial ( Ն 50%) stenoses was assessed by using quantitative coronary angiography (QCA). Cross-sectional arc calcium was rated on a segment level as follows: noncalcifi ed or mild ( , 90°), moderate (90°-180°), or severe ( . 180°) calcifi cation. Univariable and multivariable logistic regression, receiver operation characteristic curve, and clustering methods were used for statistical analyses. Results:A total of 1099 segments had mild calcifi cation, 503 had moderate calcifi cation, 338 had severe calcifi cation, and 2571 segments were noncalcifi ed. Calcifi ed segments were highly associated ( P , .001) with disagreement between CTA and QCA in multivariable analysis after controlling for sex, age, heart rate, and image quality. The prevalence of CAD was 5.4% in noncalcifi ed segments, 15.0% in mildly calcifi ed segments, 27.0% in moderately calcifi ed segments, and 43.0% in severely calcifi ed segments. A signifi cant difference was found in area under the receiver operating characteristic curves (noncalcifi ed: 0.86, mildly calcifi ed: 0.85, moderately calcifi ed: 0.82, severely calcifi ed: 0.81; P , .05). Conclusion:In a symptomatic patient population, segment-based coronary artery calcifi cation signifi cantly decreased agreement between multidetector CT angiography and QCA to detect a coronary stenosis of at least 50%.

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Section: Cardiac Imaging: Multidetector Ct Angiography Of Coronary Armentioning

confidence: 99%

Coronary Artery Stenoses: Accuracy of 64–Detector Row CT Angiography in Segments with Mild, Moderate, or Severe Calcification—A Subanalysis of the CORE-64 Trial

Vavere¹,

Arbab‐Zadeh²,

Rochitte³

et al. 2011

Radiology

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148

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“…This observational evidence has now been corroborated by 2 multicenter clinical trials of the diagnostic accuracy of CCTA (26,27). In the former trial (26), 230 patients underwent CCTA and invasive coronary angiography (59% men; mean age, 57 y).…”

Section: Multicenter Clinical Trials With Cctamentioning

confidence: 84%

Risk Assessment and Predictive Value of Coronary Artery Disease Testing

Shaw

Narula²

2009

J Nucl Med

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This review highlights and compares risk assessment, predictive accuracy, and economic outcomes for 3 commonly applied cardiac imaging procedures: stress myocardial perfusion SPECT or PET and coronary CT angiography (CCTA). This review highlights an expansive evidence base for stress myocardial perfusion imaging and reveals a decided advantage for higher-risk patients, notably those who have established coronary artery disease (CAD). It is likely that the use of CCTA will continue to expand, particularly for patients with more atypical symptoms and patients with a lower likelihood of CAD. Despite a high level of evidence, comparative research is not available across modalities that could definitively drive utilization of cardiac imaging modalities. Evi dence about the accuracy of a variety of noninvasive imaging tests for the identification of at-risk patients with known and suspected coronary artery disease (CAD) has been evolving. Most of the early published research on noninvasive cardiology, from the 1980s and early 1990s, focused on the diagnostic accuracy of a test. More recent research has focused on evaluating the ensuing risk in patients with normal and abnormal cardiac imaging findings. Further exploration has been aimed at the graded or directly proportional relationships between the extent and the severity of imaging risk markers and major adverse cardiovascular events. These relationships highlight a common theme throughout the literature of ever-increasing and worsening cardiac event risk with more extensive and severe imaging abnormalities. More recent topics in the prognosis literature are the utility of new technology, such as coronary CT angiography (CCTA), and its accuracy compared with that of conventional testing, such as stress nuclear imaging. For this report, we compare risk assessment, predictive accuracy, and economic outcomes for 3 commonly applied cardiac imaging procedures: stress myocardial perfusion SPECT or PET and CCTA. We further highlight the potential value of hybrid imaging with PET/CT or even sequential imaging with SPECT plus CT. CORRELATION BETWEEN MYOCARDIAL ISCHEMIA AND CORONARY ANATOMYEarly research focused on the accuracy of stress nuclear imaging for detecting obstructive coronary stenosis. Lessons learned from these evaluations were that the detection of obstructive stenosis was related to the severity of the stenosis, collateral flow, and underlying endothelial function. Documentation of high rates of false-positive results (i.e., ischemia with no obstructive CAD) with stress myocardial perfusion may be related to vascular dysfunction, an early marker of atherosclerosis. In addition, normal stress perfusion results in patients with CAD are related to many factors, including collateral blood flow or prior coronary revascularization. It is for these reasons that much of the recent imaging research has focused on risk determination. However, for discussion purposes, it is helpful to understand the relationship between ischemia and coronary anatomy. INDUCIBLE ISCHEMIA D...

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“…A plenty of studies demonstrated the high diagnostic accuracy of CCT (Table 2) in the diagnostic workup of patients with suspected CAD (3)(4)(5)8,11,(79)(80)(81)(82)(83) and low to intermediate risk of CAD (6,84). CCT was also validated by several outcome studies that investigated risk stratification and prognostic value in registry data (85)(86)(87).…”

Section: Diagnostic Performancementioning

confidence: 95%

Infarct characterization using CT

Grutta

Toia

Maffei

et al. 2017

Cardiovasc. Diagn. Ther.

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Myocardial infarction (MI) is a major cause of death and disability worldwide. The incidence is not expected to diminish, despite better prevention, diagnosis and treatment, because of the ageing population in industrialized countries and unhealthy lifestyles in developing countries. Nowadays it is highly requested an imaging tool able to evaluate MI and viability. Technology improvements determined an expansion of clinical indications from coronary plaque evaluation to functional applications (perfusion, ischemia and viability after MI) integrating additional phases and information in the mainstream examination.Cardiac computed tomography (CCT) and cardiac MR (CMR) employ different contrast media, but may characterize MI with overlapping imaging findings due to the similar kinetics and tissue distribution of gadolinium and iodinated contrast media. CCT may detect first-pass perfusion defects, dynamic perfusion after pharmacological stress, and delayed enhancement (DE) of non-viable territories.

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Coronary CT angiography using 64 detector rows: methods and design of the multi-centre trial CORE-64

Cited by 109 publications

References 62 publications

Coronary Artery Stenoses: Accuracy of 64–Detector Row CT Angiography in Segments with Mild, Moderate, or Severe Calcification—A Subanalysis of the CORE-64 Trial

Coronary Artery Stenoses: Accuracy of 64–Detector Row CT Angiography in Segments with Mild, Moderate, or Severe Calcification—A Subanalysis of the CORE-64 Trial

Risk Assessment and Predictive Value of Coronary Artery Disease Testing

Infarct characterization using CT

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