Coronary Stenosis Detection by 16-Slice Computed Tomography in Heart Transplant Patients: Comparison With Conventional. Angiography and Impact on Clinical Management

Romeo, G; Houyel, Lucile; Angel, Claude; Brenot, Philippe; Riou, J.Y.; Paul, Jean-François

doi:10.1016/j.accreview.2005.09.038

Cited by 39 publications

(66 citation statements)

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“…[10][11][12][13][14][15][16][17][18][19] Although those results seem similar, there are some important differences in the patient populations. Indeed, those studies consisted of selected series of patients.…”

Section: Discussionmentioning

confidence: 82%

“…To date, many investigators have evaluated the accuracy of MSCT for detecting significant coronary stenosis and in most of the published studies the sensitivity is approximately 80% and the specificity approximately 90%. [10][11][12][13][14][15][16][17][18][19] The results appear promising, but those studies did not consist of consecutive patients, including those with unsatisfactory images for interpretation. Besides, cases with severe calcification, high heart rates (>70 beats/min), or previous revascularization, were excluded from most of the studies.…”

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confidence: 97%

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Diagnostic Accuracy of 64-Slice Computed Tomography for Detecting Angiographically Significant Coronary Artery Stenosis in an Unselected Consecutive Patient Population Comparison With Conventional Invasive Angiography

Ehara

Surmely

Kawai

et al. 2006

Circ J

199

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oronary artery disease (CAD) and its thrombotic complications are the leading cause of morbidity and mortality in the industrialized countries. Over the past 30 years, invasive coronary angiography (ICAG) has been the gold standard method for the visualization and detection of coronary stenosis. Recently, efforts have been made to develop reliable noninvasive diagnostic methods that would allow a broader use, as well as decreasing the risks linked to an invasive examination.Multislice computed tomography (MSCT), which started with a 4-slice scanner in 1998, was the beginning of visualizing the coronary arteries noninvasively, 1-9 and with the development of 16-slice MSCT, this desire has been realized to some extent. To date, many investigators have evaluated the accuracy of MSCT for detecting significant coronary stenosis and in most of the published studies the sensitivity is approximately 80% and the specificity approximately 90%. [10][11][12][13][14][15][16][17][18][19] The results appear promising, but those studies did not consist of consecutive patients, including those with unsatisfactory images for interpretation. Besides, cases with severe calcification, high heart rates (>70 beats/min), or previous revascularization, were excluded from most of the studies.In daily practice, however, we often encounter patients with advanced CAD, having severely calcified arteries, or patients who are post percutaneous coronary intervention (PCI) using different treatment modalities such as stenting, plain old balloon dilatation, or debulking.The new 64-slice MSCT (64-MSCT), which provides a 0.4 mm isotropic resolution and less than 165 ms temporal resolution, has the potential to overcome image-degrading artifacts related to motion, pixel noise, calcification or coronary stents to some extent. 20,21 The aim of our study was to evaluate the diagnostic accuracy of 64-MSCT in various types of patients, including those with severely calcified arteries or post-PCI, as Background Multislice computed tomography (MSCT) is a promising noninvasive method of detecting coronary artery disease (CAD). However, most data have been obtained in selected series of patients. The purpose of the present study was to investigate the accuracy of 64-slice MSCT (64 MSCT) in daily practice, without any patient selection. Methods and ResultsUsing 64-slice MSCT coronary angiography (CTA), 69 consecutive patients, 39 (57%) of whom had previously undergone stent implantation, were evaluated. The mean heart rate during scan was 72 beats/min, scan time 13.6 s and the amount of contrast media 72 mL. The mean time span between invasive coronary angiography (ICAG) and CTA was 6 days. Significant stenosis was defined as a diameter reduction of >50%. Of 966 segments, 884 (92%) were assessable. Compared with ICAG, the sensitivity of CTA to diagnose significant stenosis was 90%, specificity 94%, positive predictive value (PPV) 89% and negative predictive value (NPV) 95%. With regard to 58 stented lesions, the sensitivity, specificity, PPV and NPV were 93...

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Section: Discussionmentioning

confidence: 82%

mentioning

confidence: 97%

Diagnostic Accuracy of 64-Slice Computed Tomography for Detecting Angiographically Significant Coronary Artery Stenosis in an Unselected Consecutive Patient Population Comparison With Conventional Invasive Angiography

Ehara

Surmely

Kawai

et al. 2006

Circ J

199

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“…Bu çalışmada nakil hastalarında koroner arter hastalığının araştırılması için BT kullanımı önerilmektedir. [15] von Ziegler ve ark. [16] bu yıl yayınlanan çalışmalarında 51 kalp nakli hastasında çift kaynaklı (dual source) BT anjiyografi ile konvansiyonel anjiyografiyi karşılaştırmış ve bu yeni teknoloji ile invazif koroner anjiyografiye gerek kalmadan bu hastaların izlenebileceğini belirtmişlerdir.…”

Section: Discussionunclassified

Evaluation of allograft vasculopathy by computed tomography coronary angiography in cardiac transplant recipients

Küçüker¹

2013

Turk Gogus Kalp Dama

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Amaç: Bu çalışmada kalp nakli yapılmış hastalarda bilgisayarlı tomografi (BT) koroner anjiyografinin allogreft vaskü-lopati tanısındaki etkinliği araştırıldı.Ça lış m apla nı:Kalp nakli sonrası iki yılını doldurmuş ve son üç ay içerisinde kontrol koroner anjiyografisi yapıl-mış 10 hasta (9 erkek, 1 kadın; ort. yaş 41±9.2 yıl; dağılım 17-59 yıl) çalışmaya alındı. Bu hastalara BT koroner anjiyografi yapıldı. Tüm hastaların standart anjiyografileri aynı araştırmacı tarafından değerlendirildi. Ardından BT koroner anjiyogramlar, bu değerlendirmelerden habersiz ikinci bir araştırmacı tarafından değerlendirdi. Her iki değerlendirme sonucu, üçüncü bir araştırmacı tarafından karşılaştırıldı. Bul gu lar:Bilgisayarlı tomografi koroner anjiyografide sekiz hastada önemli bir patoloji gözlenmezken, iki hastada sol ön inen koroner arterde yaklaşık %50'lik darlık saptadı. Standart koroner anjiyografide de aynı hastalarda aynı yerleşimde ve benzer oranda sol ön inen koroner arter lezyonları saptandı. Tüm hastalarda standart koroner anjiyografi ve BT koroner anjiyografi sonuçları birbiriyle uyumluydu.So nuç: Bilgisayarlı tomografi koroner anjiyografi daha az invaziv olup, hasta için daha az risk taşımaktadır. Uygulama kolaylığı ve etkin maliyet gibi bazı avantajlara da sahiptir. Hastaneye yatış gerektirmez. Kalp nakli alıcılarında koroner allogreft vaskülopatinin rutin takibinde BT koroner anjiyografi, standart koroner anjiyografiye alternatif olarak kullanı-labilir.Anah tar söz cük ler: Allogreft vaskülopati; kalp nakli; bilgisayarlı tomografi koroner anjiyografi.Background: This study aims to investigate the efficacy of computed tomography (CT) coronary angiography for the diagnosis of allograft vasculopathy.

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“…However, in this study, slightly less than 20% of coronary segments (mainly distal) could not been analysed due to poor image quality (probably in relation with elevated heart rate) [18] . Recent studies showed that dual source MDCT allows good image quality of vessel lumen [94,95] and, when validated against IVUS, high diagnostic accuracy [96] . A small study, just under 20 patients, demonstrated that MDCT, using 64-slices, was superior to angiography for the identification of non-obstructive vessel wall disease.…”

Section: Multidetector Computed Tomographymentioning

confidence: 99%

Diagnosis and management of coronary allograft vasculopathy in children and adolescents

Dedieu

Greil

Wong

et al. 2014

WJT

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Coronary allograft vasculopathy remains one of the leading causes of death beyond the first year post transplant. As a result of denervation following transplantation, patients lack ischaemic symptoms and presentation is often late when the graft is already compromised. Current diagnostic tools are rather invasive, or in case of angiography, significantly lack sensitivity. Therefore a non-invasive tool that could allow early diagnosis would be invaluable.This paper review the disease form its different diagnosis techniques,including new and less invasive diagnostic tools to its pharmacological management and possible treatments. DEFINITION AND PHYSIOPATHOLOGYIn children, coronary allograft vasculopathy (CAV) remains the main limiting survival factor after heart transplantation and the major cause of mortality after the first year post transplant leading ultimately to graft loss [1,2] . One elegant etiological description of CAV is that of "immunologic mechanisms operating in a milieu of nonimmunologic risk factors" [3] . The process is believed to start off as a response to endothelial injury in the graft, originated by a complex interaction of multiple donor and recipient factors. The resulting endothelial dysfunction, leads to altered endothelial permeability and subsequent intimal hyperplasia as a consequence of the vascular remodeling originated by the inflammatory response. The immunologic events constitute the original trigger and noninflammatory events such as cytomegalovirus infection, ischemic time (reperfusion injury), increased donor age and classical cardiovascular risk factors (i.e., diabetes, dyslipidemias, smoking and hypertension), perpetuate the inflammatory response and increase the endothelial injury [4] . Typical lesions (Figures 1 and 2) consist of diffuse intimal proliferation leading to the development of luminal stenosis and small vessels occlusion which then limits blood supply to the graft causing chronic vascular injury and ultimately myocardial ischemia [5] . The lesions develop earlier and quicker than atherosclerotic lesions. REVIEW 276December 24, 2014|Volume 4|Issue 4|

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Coronary Stenosis Detection by 16-Slice Computed Tomography in Heart Transplant Patients: Comparison With Conventional. Angiography and Impact on Clinical Management

Cited by 39 publications

References 0 publications

Diagnostic Accuracy of 64-Slice Computed Tomography for Detecting Angiographically Significant Coronary Artery Stenosis in an Unselected Consecutive Patient Population Comparison With Conventional Invasive Angiography

Diagnostic Accuracy of 64-Slice Computed Tomography for Detecting Angiographically Significant Coronary Artery Stenosis in an Unselected Consecutive Patient Population Comparison With Conventional Invasive Angiography

Evaluation of allograft vasculopathy by computed tomography coronary angiography in cardiac transplant recipients

Diagnosis and management of coronary allograft vasculopathy in children and adolescents

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