Assessment of Myocardial Viability in Chronic Myocardial Infarction Using the Dual-Energy Computed Tomography Myocardial Extracellular Volume Fractionation Technique: A Case Report.

Assessment of myocardial viability in patients with myocardial infarction is critical to identify residual ischemic tissue in areas of reduced function and to determine the need for revascularization. We present the case of an 80-year-old man with chest pain and a history of hypertension. Initial evaluation revealed abnormal electrocardiogram findings, and subsequent studies suggested chronic anteroseptal myocardial infarction with reduced cardiac function. Dual-energy cardiac computed tomography was performed to evaluate the coronary arteries and myocardium. Late iodine enhancement images obtained by dual-energy computed tomography showed mixed plaques and severe proximal left anterior descending artery stenosis. Conventional late iodine enhancement imaging was inconclusive, prompting extracellular volume fraction analysis using iodine density imaging. Extracellular volume fraction assessment indicated viable anterior myocardium, leading to successful coronary revascularization. Follow-up demonstrated improved wall motion and ejection fraction. Our study highlights the utility of late iodine enhancement with dual-energy computed tomography in assessing myocardial viability as a noninvasive alternative to magnetic resonance imaging, particularly in patients with contraindications to magnetic resonance imaging. This approach aids in treatment planning, evaluation of efficacy and determination of prognosis in cases of ischemic heart disease.

Perivascular fat attenuation index measured by coronary computed tomography angiography as a tool for assessment of ischaemia-causing lesions: a case report.

BACKGROUND: It can be difficult to diagnose coronary artery disease in patients with acute coronary syndrome if coronary angiography does not identify stenosis. Coronary inflammation, which can contribute to the pathogenesis of coronary artery disease and acute coronary syndrome, can be quantified using the perivascular fat attenuation index. Furthermore, the perivascular fat attenuation index is a marker for all-cause mortality, cardiac-related mortality and impaired global coronary flow reserve. CASE PRESENTATION: Here we report a case of a patient presenting with symptoms of acute coronary syndrome. The patient had hypokinesis of the lateral-posterior wall of the left ventricle, decreased myocardial perfusion in the posterior wall myocardium and elevated myocardial troponin-T and creatine phosphokinase levels. However, coronary computed tomography angiography did not identify arterial stenosis. The patient did have an increased perivascular fat attenuation index, indicating coronary inflammation. Moreover, the fat attenuation index was higher around the left circumflex artery than around the right coronary artery or left anterior descending artery. Intravascular ultrasonography identified an intramural haematoma, leading to a diagnosis of type 3 spontaneous coronary artery dissection in the left circumflex artery. CONCLUSIONS: Perivascular fat attenuation index may be a useful tool to help identify and localise disease-causing lesions, and to direct further testing to confirm a diagnosis of spontaneous coronary artery dissection in acute coronary syndrome patients without significant arterial stenosis.

Evaluation of coronavirus-2019-related arterial thrombosis in noncontrast spectral computed tomography with electron density imaging.

Thrombosis can be associated with coronavirus disease 2019 infection. Computed tomography is essential for the diagnosis of pneumonia in these patients and conventionally contrast agents are required for the assessment of thrombus. In this study, we report a patient with coronavirus disease 2019 who was diagnosed with thrombosis using spectral noncontrast computed tomography with electron density imaging. The patient was a 76-year-old man who presented with a 2-day history of lower-leg pain. Tachycardia and atrial fibrillation were identified, with elevated D-dimer, N-terminal pro-B-type natriuretic peptide, creatine kinase, and C-reactive protein levels. Polymerase chain reaction testing for severe acute respiratory syndrome coronavirus-2 was positive. Conventional computed tomography showed pulmonary changes consistent with coronavirus disease 2019 and no changes in the aorta, but spectral computed tomography with electron density imaging of noncontrast computed tomography showed a thrombus in the right external iliac artery. Spectral computed tomography with electron density imaging provides more data compared with conventional computed tomography and has the potential to depict thrombus without the use of contrast media.

Aortic calcification is associated with coronary artery calcification and is a potential surrogate marker for ischemic heart disease risk: A cross-sectional study.

Coronary artery calcification, an established marker of atherosclerotic plaque burden associated with increased risk of coronary artery disease, is routinely evaluated using electron beam computerized tomography or multidetector computed tomography (CT). However, aortic calcification, which is also a risk factor for adverse cardiac events, is not frequently assessed, despite being easily detected via standard chest radiography. We therefore sought to clarify the association between aortic calcification and significant coronary artery calcification to determine the feasibility of performing chest radiography to evaluate the risk of future cardiovascular events. Data from 682 consecutive patients who underwent cardiac CT scanning at our institution from May to September 2012 were included in this cross-sectional analysis. Electrocardiographic-gated CT was used to qualitatively evaluate calcification in 6 aortic segments. Cardiac contrast-ehnanced CT was performed to identify significant calcification of the coronary artery. Calcification was quantified by calculating the Agatston score, and the relationship between significant coronary artery calcification and calcification at each aortic site was evaluated. Among the aortic sites, calcification was most commonly observed in the aortic arch (77.4% of patients). Significant coronary artery calcification was observed in 267 patients (39.1%). Calcification in the ascending aorta, aortic arch, descending aorta, abdominal aorta, and aortic valve were significantly associated with the presence of coronary artery calcification after adjustment for cardiovascular risk factors and statin use (odds ratios [95% confidence intervals] 4.21 [2.55, 6.93], 1.65 [1.01, 2.69], 2.14 [1.36, 3.36], 2.87 [1.83, 4.50], and 3.32 [2.02, 5.46], respectively). Mitral valve calcification was weakly but nonsignificantly associated with coronary artery calcification (odds ratio 1.84 [95% confidence interval 0.94, 3.62]). Calcification of each aortic segment assessed was significantly associated with Agatston score ≥ 100. Aortic calcification was associated with coronary artery calcification. Calcification of the aortic arch, which can be readily detected by routine chest radiography, may be associated with coronary artery calcification and its assessment should therefore be considered to identify patients at increased risk of cardiovascular events. Further studies are warranted to confirm these findings.

Longitudinal effect of myocardial fat deposition on left ventricular diastolic function: a retrospective cohort study.

There is a known correlation between myocardial steatosis and heart function, but it is unclear how left ventricular diastolic function worsens over time in the myocardial steatosis setting. We sought to investigate whether intramyocardial fat deposition affects diastolic function over time. This was a retrospective analysis of patients who had undergone 1-3 echocardiography assessments between April 2011 and April 2017. Patients were divided into two groups: those with the presence of myocardial fat deposition in the left ventricular myocardium (assessed by having tissue within any 10-mm2 region with computed tomography values between - 190 and - 30 Hounsfield units; + MF), and those with absence of deposition not meeting the threshold (- MF). The rates of change of the standard early diastolic mitral annulus velocity (e') and the transmitral early peak velocity (E)/e' ratio at the second and third echocardiograph assessments were calculated relative to baseline. In total, 125 patients were eligible (+ MF, n = 39; - MF, n = 86) for inclusion. Compared with the - MF group, e' was significantly lower and E/e' was significantly higher in the + MF group at each scan timepoint, even when adjusted for body mass index and sex. A significant average decrease in e' and increase in E/e' was also observed in the + MF group across all scans compared with the - MF group. Myocardial steatosis was associated with an acceleration of decreased left ventricular diastolic function over time.

Low Consultation Rate of General Population with Atrial Fibrillation.

In order to prevent ischemic stroke, it is important to identify and treat patients with atrial fibrillation (AF) who do not consult a doctor in a medical institution. The aim of this study was to determine the consultation rate at medical institutions for patients with AF in group medical examinations conducted in a city in western Japan. Of 6101 examinees of group medical examinations (40 years of age or older) conducted in Ibara City, Okayama Prefecture, Japan, from 2012 to 2014, 4338 participants (71.1%) who were evaluated by electrocardiogram (ECG) gave written informed consent and responded to surveys in the form of questionnaires through a personal interview conducted by nurses were included in the Ibara-AF study. A cumulative total of 82 subjects were diagnosed as having AF by ECG (prevalence of AF = 1.89%), and 51 individuals had AF during the three-year period.15 (29.4%) of the 51 patients with AF did not regularly visit medical institutions. Among them, 46.7% (n = 7) and 53.3% (n = 8) of the patients were symptomatic and asymptomatic, respectively, and 73.3% of the patients had a CHADS2 score of more than one point. There were no significant differences in patients' characteristics between regular and non-regular visit groups. In conclusion, about one-third of the patients with AF did not regularly see a doctor in a medical institution and most of them had a CHADS2 score of more than one point in a Japanese rural area. Educating the public about the risks of AF is required.