RESUMO
BACKGROUND: Atrial fibrillation (AF) can occur even after the correction of mitral valve (MV) pathology in patients who have pre-operative sinus rhythm and undergo MV surgery. However, the factors associated with the occurrence of AF after MV surgery are still unclear. The aim of this retrospective study was to investigate the factors determining the occurrence of permanent AF after MV surgery in patients with preoperative sinus rhythm who underwent MV surgery. METHODS: Four hundred and forty-two patients (mean age 46 ± 12, 190 men) who underwent MV surgery and sinus rhythm were investigated retrospectively. Transthoracic echocardiography was performed before and after MV surgery at the time of dismissal. RESULTS: Permanent post-operative AF occurred in 81 (18%) patients even after successful MV surgery and preoperative sinus rhythm. It was more common in rheumatic etiology, a presence of mitral stenosis, lower pre- and post-operative left ventricular ejection fraction, higher post-operative mean diastolic pressure gradient across mitral prosthesis, larger post-operative left atrial volume index (LAVI) and lesser degrees of reduction in LAVI after surgery. In multiple regression analysis, post-operative LAVI was found to be an independent predictor for occurrence of AF. Post-operative LAVI > 39 ml/m2 was the cut-off value for best prediction of new onset permanent AF (sensitivity: 79%, AUC: 0.762, SE: 0.051, p < 0.001). CONCLUSION: New-onset permanent post-operative AF is not uncommon, even after successful MV surgery despite pre-operative sinus rhythm. Larger post-operative LAVI was an independent predictor for the occurrence of AF.
Assuntos
Fibrilação Atrial/diagnóstico por imagem , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Átrios do Coração/diagnóstico por imagem , Doenças das Valvas Cardíacas/cirurgia , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Tamanho do Órgão , Adulto , Fibrilação Atrial/etiologia , Fibrilação Atrial/fisiopatologia , Ecocardiografia , Feminino , Átrios do Coração/fisiopatologia , Doenças das Valvas Cardíacas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos RetrospectivosRESUMO
Although increased carotid intima-media thickness (IMT) is a well-known risk factor for stroke, carotid IMT alone is not sufficient for risk stratification. The assessment of arterial properties using velocity vector imaging (VVI) represents a new method for quantifying structural changes. We sought to investigate the characteristics and the clinical value of carotid arterial mechanics using VVI in patients with stroke. Fifty male patients (55 ± 5 years) with stroke, 30 healthy age-matched volunteers (54 ± 8 years), and 30 healthy young male volunteers (29 ± 5 years) were evaluated. The peak circumferential strain, strain rate, and the standard deviation of the time to peak strain and strain rate, representing the synchronicity of the arterial expansion, were analyzed using VVI of the left common carotid artery. The circumferential strain and strain rate significantly decreased with age, and patients with stroke showed the lowest degree of strain and strain rate compared with healthy age-matched volunteers. In addition, patients with stroke showed decreased strain and strain rate even in participants with a normal carotid IMT (< 0.8 mm). Although carotid IMT did not improve the incremental predictive value of stroke over that of multiple clinical risk factors (diabetes mellitus, hypertension, coronary artery disease, smoking), adding carotid arterial strain and strain rate provided an incremental predictive value over both multiple risk factors and carotid IMT for stroke. Along with assessment of conventional risk factors, VVI analysis could provide improved risk stratification for stroke.
Assuntos
Aterosclerose/diagnóstico por imagem , Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Adulto , Aterosclerose/complicações , Aterosclerose/fisiopatologia , Fenômenos Biomecânicos , Artérias Carótidas/fisiopatologia , Doenças das Artérias Carótidas/fisiopatologia , Espessura Intima-Media Carotídea , Estudos Transversais , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Medição de Risco , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/fisiopatologia , Ultrassonografia/métodos , Adulto JovemRESUMO
BACKGROUND: There are no previous data on serial changes in neutrophil gelatinase-associated lipocalin (NGAL) levels in ST-segment elevation myocardial infarction (STEMI) patients before and after a primary percutaneous coronary intervention (pPCI). The aim of the present study was to evaluate the prognostic value of serial NGAL measurements in patients with STEMI treated by pPCI. MATERIALS AND METHODS: We identified 169 STEMI patients who underwent pPCI within 12 h of symptom onset and had plasma NGAL measurements before (pre-NGAL) and 6 h after (post-NGAL) pPCI. The primary endpoint was 30-day all-cause mortality, including cardiac death, whereas the secondary endpoint was the change in NGAL levels from before to after pPCI. RESULTS: The mean pre-NGAL and post-NGAL levels were 109.2±76.1 and 93.3±83.8 ng/ml, respectively. Thirty-day mortality occurred in 12 (7.1%) patients. In terms of changes in serial NGAL levels, post-NGAL levels were decreased in 132 (79%) patients. Patients with elevated post-NGAL levels showed increased mortality compared with patients with decreased post-NGAL levels (P=0.005). Multivariate analyses indicated that old age and high post-NGAL levels were independent risk factors for 30-day mortality. CONCLUSION: In a large percentage of STEMI patients, plasma post-pPCI NGAL levels were decreased compared with pre-pPCI NGAL levels, even with the administration of potentially nephrotoxic contrast medium. Post-NGAL levels seemed to be superior to pre-NGAL levels for the prediction of 30-day mortality outcome.
Assuntos
Lipocalina-2/sangue , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST/sangue , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Idoso , Área Sob a Curva , Biomarcadores/sangue , Distribuição de Qui-Quadrado , Meios de Contraste/administração & dosagem , Meios de Contraste/efeitos adversos , Angiografia Coronária , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/mortalidade , Valor Preditivo dos Testes , Curva ROC , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Fatores de Tempo , Resultado do Tratamento , Regulação para CimaRESUMO
RATIONALE: An intracardiac cystic mass is a rare type of mass found in the left atrium. The differential diagnosis of an intracardiac cystic mass includes hydatid cysts, bronchogenic cysts, intracardiac varices, and hemorrhages in some tumor types, including myxoma. PATIENT CONCERNS: We present the case of a 68-year-old woman who presented with episodic dyspnea. DIAGNOSES-INTERVENTIONS-OUTCOMES: Transthoracic echocardiography (TTE) revealed the presence of a left atrial mass mimicking myxoma. However, in postoperative findings, it was determined that the mass was actually a hemorrhagic cyst. Eighteen months later, the patient presented with recurrent exertional dyspnea and TTE revealed the recurrence of a left atrial mass. Computed tomography showed that the mass extended into the right atrium, inferior vena cava, and coronary sinus. After re-operation, the final histological diagnosis was determined to be an undifferentiated pleomorphic sarcoma in the left atrium. LESSONS: An intracardiac hemorrhagic cyst was suspected during the operation of a benign-looking LA mass. As such, we recommend that other rare etiologies be considered and more biopsies be performed when possible.
Assuntos
Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/patologia , Mixoma/diagnóstico , Recidiva Local de Neoplasia/diagnóstico , Sarcoma/diagnóstico , Idoso , Diagnóstico Diferencial , Ecocardiografia , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/cirurgia , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Humanos , Mixoma/diagnóstico por imagem , Mixoma/patologia , Mixoma/cirurgia , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Reoperação , Sarcoma/diagnóstico por imagem , Sarcoma/patologia , Sarcoma/cirurgia , Tomografia Computadorizada por Raios XRESUMO
Small noncoding microRNAs (miRNAs) are not only important for heart and vascular development but are also important in cardiovascular pathophysiology and diseases, such as ischemia and atherosclerosisrelated diseases. However, the effect of miR146a, miR149, miR196a2 and miR499 polymorphisms on coronary artery disease (CAD) susceptibility remain unknown. The aim of the present study was to examine the genotype frequencies of miR146a, miR149, miR196a2 and miR499 polymorphisms in patients with CAD, and assess their clinical applications for diagnosing and monitoring CAD. Using polymerase chain reactionamplified DNA, microRNA polymorphisms were analyzed in 522 patients with CAD and 535 control subjects. The miR149 rs2292832 C>T and miR196a2 rs11614913 T>C polymorphisms were shown to be significantly associated with CAD prevalence. In subgroup analyses according to disease severity, the miR146a rs2910164GG genotype was significantly associated with CAD risk in the stent ≥2 group. In addition, miR146aG/149T/196a2C/499 G allele combination was significantly associated with CAD prevalence (GTCG and GCCG of miR146a/149/196a2/499). The combination genotypes of miR146aGG/149TC+CC and miR149CC/196a2TC were significantly associated with CAD incidence. In subgroup analyses, miR146a rs2910164 C>G increased the risk of developing CAD in nonsmoking, hypertensive and nondiabetic subgroups. Furthermore, miR149 rs2292832 C>T and miR196a2 rs11614913 T>C was shown to increase CAD risk in females and patients aged >63 years old. The miR149T allele, miR196a2C allele and miR146aG/149T/196a2C/499 G allele combination were associated with CAD pathogenesis. The combined effects of environmental factor and genotype combination of miRNA polymorphisms may contribute to CAD prevalence.
Assuntos
Doença da Artéria Coronariana/genética , Predisposição Genética para Doença , MicroRNAs/genética , Polimorfismo de Nucleotídeo Único , Idoso , Alelos , Biomarcadores , Estudos de Casos e Controles , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/terapia , Epistasia Genética , Feminino , Frequência do Gene , Estudos de Associação Genética , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Intervenção Coronária Percutânea , Fatores de Risco , Índice de Gravidade de DoençaRESUMO
AIM: We investigated the prognostic value of preoperative N-terminal pro-brain natriuretic peptide (NT-proBNP) in non-cardiac surgery in elderly patients who showed normal left ventricular function on preoperative echocardiography. METHODS: We analyzed 1459 patients aged older than 70 years who had consulted a cardiologist for the evaluation of cardiovascular risk for non-cardiac surgery. Of the 721 patients who simultaneously underwent echocardiography and NT-proBNP assessments, 506 who showed normal left ventricular systolic function were included. The predictive power of NT-proBNP for the risk of major adverse cardiac and cerebrovascular events (MACCE) was evaluated. RESULTS: MACCE occurred in 40 (7.9%) of the 506 patients, and the median value of NT-proBNP was higher in patients with complications than in those without (MACCE group: 1700.5 pg/mL vs non MACCE group: 206.35 pg/mL; P < 0.001). The area under the receiver operating characteristic curve was 0.804 (P < 0.001), with an optimal cut-off of 425.3 pg/mL. Multivariate analysis showed that increased NT-proBNP (>425.3 pg/mL; odds ratio 6.381; P < 0.001) was the only independent risk factor for the prediction of MACCE. CONCLUSIONS: In elderly patients who showed normal left ventricular systolic function on echocardiography, measurement of preoperative NT-proBNP concentration might be a useful test for predicting the occurrence of MACCE after non-cardiac surgery. Geriatr Gerontol Int 2016; 16: 1109-1116.
Assuntos
Doenças Cardiovasculares/diagnóstico , Peptídeo Natriurético Encefálico/sangue , Cuidados Pré-Operatórios/métodos , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Função Ventricular Esquerda/fisiologia , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Doenças Cardiovasculares/epidemiologia , Estudos de Coortes , Ecocardiografia/métodos , Feminino , Humanos , Masculino , Análise Multivariada , Razão de Chances , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Valor Preditivo dos Testes , Prognóstico , Curva ROC , Medição de Risco , Procedimentos Cirúrgicos Operatórios/métodos , Disfunção Ventricular Esquerda/diagnóstico por imagemRESUMO
BACKGROUND: There are few studies that investigated the correlation between insulin resistance (IR) and the coronary artery remodeling. The aim of the study is to investigate the association of IR measured by homeostasis model assessment of insulin resistance (HOMA-IR) and coronary artery remodeling evaluated by intravascular ultrasound (IVUS). METHODS: A total of 298 consecutive patients who received percutaneous coronary interventions under IVUS guidance were retrospectively enrolled. The value of HOMA-IR more than 2.5 was considered as IR positive. Metabolic syndrome was classified according to NCEP ATP III guidelines. The remodeling index was defined as the ratio of the external elastic membrane (EEM) area at the lesion site to the EEM area at the proximal reference site. RESULTS: A total of 369 lesions were analyzed (161 lesions in HOMA-IR positive and 208 lesions in HOMA-IR negative). Remodeling index was significantly higher in the HOMA-IR positive group compared with the negative group (HOMA-IR positive vs. negative: 1.074 ± 0.109 vs. 1.042 ± 0.131, p = 0.013). There was a significant positive correlation between remodeling index and HOMA-IR (p = 0.010). Analysis of HOMA-IR according to remodeling groups showed increasing tendency of HOMA-IR, and it was statistically significant (p = 0.045). Multivariate analysis revealed that only HOMA-IR was an independent predictor of remodeling index (r = 0.166, p = 0.018). CONCLUSION: Increased IR estimated by HOMA-IR was significantly associated with a higher remodeling index and positive coronary artery remodeling.
Assuntos
Doença da Artéria Coronariana/cirurgia , Vasos Coronários/diagnóstico por imagem , Resistência à Insulina , Remodelação Vascular , Idoso , Estudos de Coortes , Doença da Artéria Coronariana/diagnóstico por imagem , Feminino , Humanos , Masculino , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Análise Multivariada , Intervenção Coronária Percutânea , Estudos Retrospectivos , Stents , Cirurgia Assistida por Computador , Ultrassonografia de IntervençãoRESUMO
A 54-year-old male presented with symptoms of dyspnoea, and oedema of the lower extremities. Transthoracic echocardiography (TTE) revealed secondum-type atrial septal defect (ASD). He successfully received a 30-mm Amplatzer ASD closure device percutaneously. Echocardiography immediately after the procedure and the next day showed a well-positioned device. He was discharged the next day on 100 mg aspirin daily and warfarinisation due to atrial fibrillation. A month later, he revisited the hospital due to recurrence of dyspnoea and a grade 2 systolic murmur was heard on the left parasternal border. A chest X-ray showed abnormal location of the closure device and TTE revealed re-appearance of the ASD and an embolised Amplatzer device in the left ventricular outflow tract (LVOT) with partial obstruction. He requested surgery to remove the Amplatzer device and received an ASD patch repair, tricuspid valve repair and modified Maze operation concurrently. He is now in routine follow up without any other complications.
Assuntos
Cateterismo Cardíaco/instrumentação , Comunicação Interatrial/cirurgia , Dispositivo para Oclusão Septal/efeitos adversos , Disfunção Ventricular Esquerda/fisiopatologia , Ecocardiografia/métodos , Seguimentos , Comunicação Interatrial/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
BACKGROUND: Not infrequently, chordae tendineae rupture, which was not recognized preoperatively using echocardiography, was found during mitral valve (MV) surgery in patients with severe mitral regurgitation (MR) diagnosed with MV prolapse. We evaluated the incidence and predictors of echocardiographically-unrecognized chordae tendineae rupture in patients with severe MR because of MV prolapse. METHODS: We enrolled 124 patients undergoing MV surgery for severe MR because of nonrheumatic MV prolapse. Patients with MR because of infective endocarditis, ischemic heart disease, or echocardiographically-detected chordal rupture were excluded. The study sample was divided into 2 groups: surgically-proven chordae tendineae rupture (n = 51), and no chordae rupture (n = 73). RESULTS: Echocardiographically-unrecognized chordae tendineae rupture was found in 51 (41%) of 124 patients undergoing MV surgery because of MR. It was more common in patients with posterior or single-leaflet prolapse. Although the severity of MR was greater in patients with chordal rupture, left atrial volume index was smaller compared with those without. In a multivariate analysis, involvement of posterior leaflet (odds ratio [OR], 2.80; 95% confidence interval [CI], 1.15-6.84) or single leaflet (OR, 3.18; 95% CI, 1.07-9.45), MR severity (OR, 4.76; 95% CI, 1.96-11.59), and left atrial volume index (OR, 0.98; 95% CI, 0.96-0.99) were independently associated with chordal rupture (P < 0.05 for all). CONCLUSIONS: Unrecognized chordae tendineae rupture is a common unrecognized contributor to severe MR necessitating valve replacement in MV prolapse patients. Earlier recognition and more specific management might contribute to improved prognosis for such patients.
Assuntos
Cordas Tendinosas , Diagnóstico Tardio/estatística & dados numéricos , Doenças das Valvas Cardíacas/epidemiologia , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Mitral/epidemiologia , Insuficiência da Valva Mitral/cirurgia , Prolapso da Valva Mitral/epidemiologia , Prolapso da Valva Mitral/cirurgia , Adulto , Idoso , Comorbidade , Estudos Transversais , Ecocardiografia , Ecocardiografia Transesofagiana , Feminino , Doenças das Valvas Cardíacas/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/diagnóstico , Prolapso da Valva Mitral/diagnóstico , República da Coreia , Ruptura EspontâneaRESUMO
BACKGROUND/AIMS: Although magnetic resonance imaging (MRI) is a good visual modality for the evaluation of pituitary lesions, it has limited value in the diagnosis of mixed nodules and some cystic lesions. We evaluated the usefulness of (18)F-fluorodeoxyglucose positron emission tomography (FDG PET) for patients with pituitary lesions. METHODS: (18)F-FDG PET and MRI were performed simultaneously in 32 consecutive patients with pituitary lesions. The relationships between FDG uptake patterns in PET and MRI findings were analyzed. RESULTS: Of 24 patients with piuitary adenomas, 19 (79.2%) showed increased uptake of (18)F-FDG in the pituitary gland on PET scans. All patients with pituitary macroadenomas showed increased (18)F-FDG uptake on PET scans. Meanwhile, only five (50%) of the 10 patients with pituitary microadenomas showed positive PET scans. Interestingly, of two patients with no abnormal MRI findings, one showed increased (18)F-FDG uptake on PET. For positive (18)F-FDG uptake, maximum standardized uptake values (SUV(max)) > 2.4 had 94.7% sensitivity and 100% specificity. In addition, SUV(max) increased in proportion to the size of pituitary adenomas. Most cystic lesions did not show (18)F-FDG uptake on PET scans. CONCLUSIONS: About 80% of pituitary adenomas showed positivity on PET scans, and SUV(max) was related to the size of the adenomas. PET may be used as an ancillary tool for detection and differentiation of pituitary lesions.
Assuntos
Adenoma/diagnóstico por imagem , Fluordesoxiglucose F18 , Hipófise/diagnóstico por imagem , Neoplasias Hipofisárias/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Adenoma/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Hipófise/patologia , Neoplasias Hipofisárias/patologia , Valor Preditivo dos Testes , Carga Tumoral , Adulto JovemRESUMO
BACKGROUND: The clinical outcomes and predictors of outcomes in isolated tricuspid regurgitation (TR) are poorly defined. The aim of this study was to investigate the determinants of outcomes in severe isolated TR. METHODS: Seventy-four patients (mean age, 63 ± 12 years; 34 men) with severe isolated TR who satisfied the criteria of (1) TR jet area > 30% of right atrial area or TR jet area > 10 cm(2) and (2) a plethora of inferior vena cava or systolic flow reversal of the hepatic vein were retrospectively analyzed. The primary end points were hospitalization for worsening heart failure, tricuspid valve (TV) surgery, and cardiovascular death. RESULTS: During the median follow-up period of 53 months, 25 events occurred (three cardiovascular deaths, nine TV surgeries, and 13 hospitalizations for worsening heart failure). Univariate Cox analysis showed that younger age, female gender, larger effective regurgitant orifice, vena contracta width (VCW), and increased right atrial and right ventricular size were associated with cardiovascular events. Increased TV tethering distance and tethering area were also associated with cardiovascular events. In multivariate Cox regression analysis, larger VCW (hazard ratio, 1.72; 95% confidence interval, 1.15-2.57, P < 0.01) was an independent predictor of cardiovascular events. Compared with patients with VCW ≤ 7 mm, those with VCW > 7 mm had poorer long-term outcomes (adjusted hazard ratio, 19.9; P < .01). Increased VCW was also an independent predictor of cardiovascular death and TV surgery (hazard ratio, 1.2; 95% confidence interval, 1.00-1.45; P = .04). CONCLUSIONS: In severe isolated TR, VCW is a powerful independent predictor of adverse outcomes. Adverse outcomes were considerable for VCW > 7 mm, which suggests that quantification of TR by Doppler echocardiography is crucial for estimating prognosis. TV surgery might be considered for patients with severe isolated TR with VCW > 7 mm.
Assuntos
Ecocardiografia Doppler em Cores/métodos , Átrios do Coração/diagnóstico por imagem , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Veia Cava Inferior/diagnóstico por imagem , Função Ventricular Direita/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Feminino , Seguimentos , Átrios do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Modelos de Riscos Proporcionais , República da Coreia/epidemiologia , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Insuficiência da Valva Tricúspide/mortalidade , Insuficiência da Valva Tricúspide/fisiopatologia , Veia Cava Inferior/fisiopatologiaRESUMO
BACKGROUND: The ability of 64-slice computed tomography (CT) angiography to differentiate plaque types remains unclear. We evaluated whether the density of noncalcified coronary plaques by 64-slice CT angiography correlates with plaque components assessed by integrated backscatter intravascular ultrasound (IB-IVUS). METHODS: Eighty-six patients [stable angina/acute coronary syndrome (ACS) 67/19, mean age 62+/-11 years] who showed significant coronary artery stenosis (> or =50% diameter stenosis) by 64-slice CT angiography underwent coronary angiography and were evaluated using IB-IVUS. RESULTS: A total of 92 noncalcified coronary plaques on CT angiography were evaluated with IB-IVUS. There was a positive correlation between CT density and calcified tissue content (r=0.41, P<0.001). However, the CT density of plaques did not correlate with other tissue components. Patients with ACS showed more lipid (43.1+/-13.2 vs. 35.8+/-13.5, P=0.03) and less soft fibrous tissue (50.5+/-11.7 vs. 56.5+/-12.0, P=0.05) by IB-IVUS than those with stable angina. However, the mean CT density of plaques in ACS was not different from that in stable angina (140.6+/-88.5 vs. 113.1+/-80.9, P=0.19). CONCLUSION: Except for calcified tissue, CT angiography failed to differentiate plaque types of noncalcified tissue. Therefore, the role of 64-slice CT angiography in identifying lipid-rich plaques remains limited.