RESUMO
BACKGROUND: Cardiac computed tomography angiography (CCTA) is precise in noninvasive coronary atherosclerosis characterization but its value in the diagnosis of intracoronary thrombus remains unknown. Therefore, our aim was to evaluate CCTA for intracoronary thrombus and stenosis detection in patients with acute coronary syndromes with high thrombus burden selected for a deferred stenting strategy. METHODS: We systematically performed a CCTA in consecutive patients following a deferred stenting strategy, 24 h before the scheduled repeated coronary angiography including optical coherence tomography (OCT) imaging. Intracoronary thrombus and residual stenosis were blindly and independently evaluated by both techniques. Agreement was determined per lesion using the weighted Kappa ( K ) coefficient and absolute intraclass correlation coefficient (ICC). A stratified analysis according to OCT-detected thrombus burden was also performed. RESULTS: Thirty lesions in 28 consecutive patients were analyzed. Concordance between CCTA and repeated coronary angiography in thrombus detection was good ( K = 0.554; P < 0.001), but both showed poor agreement with OCT. CCTA needed >11.5% thrombus burden on OCT to obtain adequate diagnostic accuracy. The lesions detected by angiography were more frequently classified as red thrombus (76.5 vs. 33.3%; P = 0.087) on OCT. CCTA showed an excellent concordance with coronary angiography in diameter measurement (ICC = 0.85; P < 0.001) and was able to identify all the patients with severe residual stenosis. CONCLUSIONS: Although CCTA showed just a good concordance with angiography in intracoronary thrombus detection, the agreement in residual stenosis was excellent. Thus, in patients with a high-thrombus burden selected for a deferred stenting strategy CCTA may substitute repeat angiography.
Assuntos
Doença da Artéria Coronariana , Estenose Coronária , Trombose Coronária , Humanos , Angiografia por Tomografia Computadorizada , Estudos Prospectivos , Constrição Patológica , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/terapia , Angiografia Coronária/métodos , Trombose Coronária/diagnóstico por imagem , Trombose Coronária/terapia , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/terapia , Valor Preditivo dos TestesRESUMO
The potential use of Gold Nanoparticles (GNPs) as contrast agents for clinical intracoronary frequency domain Optical Coherence Tomography (OCT) is here explored. The OCT contrast enhancement caused by GNPs of different sizes and morphologies has been systematically investigated and correlated with their optical properties. Among the different GNPs commercially available with plasmon resonances close to the operating wavelength of intracoronary OCT (1.3 µm), Gold Nanoshells (GNSs) have provided the best OCT contrast due to their largest scattering cross section at this wavelength. Clinical intracoronary OCT catheters are here demonstrated to be capable of three dimensional visualization and real-time tracking of individual GNSs. Results here included open an avenue to novel application of intravascular clinical OCT in combination with GNPs, such as real time evaluation of intravascular obstructions or pressure gradients.
Assuntos
Vasos Coronários/diagnóstico por imagem , Ouro/análise , Nanopartículas Metálicas/análise , Tomografia de Coerência Óptica , Meios de Contraste/análise , HumanosRESUMO
Cardiac imaging continues to reveal new anatomical and functional insights into heart disease. In echocardiography, both transesophageal and transthoracic three-dimensional imaging have been fully developed and optimized, and the value of the techniques that have increased our understanding of cardiac mechanics and ventricular function is well established. At the same time, the healthcare industry has released new devices onto the market which, although they are easier to use, have limitations that restrict their use for routine assessment. Tomography's diagnostic and prognostic value in coronary artery disease continues to increase while radiation exposure becomes progressively lower. With cardiac magnetic resonance imaging, myocardial injury and recovery in ischemic heart disease and following acute coronary syndrome can be monitored in exquisite detail. The emergence of new combined tomographic and gamma camera techniques, exclusively developed for nuclear cardiology, have improved the quality of investigations and reduced radiation exposure. The hybrid or fusion images produced by combining different techniques, such as nuclear cardiology techniques and tomography, promise an exciting future.
Assuntos
Técnicas de Imagem Cardíaca/tendências , Cardiopatias/diagnóstico , Doença da Artéria Coronariana/diagnóstico , Ecocardiografia/tendências , Ecocardiografia Tridimensional/tendências , Cardiopatias/diagnóstico por imagem , Doenças das Valvas Cardíacas/diagnóstico , Doenças das Valvas Cardíacas/diagnóstico por imagem , Humanos , Angiografia por Ressonância Magnética , Imageamento por Ressonância Magnética , Isquemia Miocárdica/diagnóstico , Tomografia Computadorizada de Emissão de Fóton Único , Tomografia Computadorizada por Raios X , Ultrassonografia de Intervenção , Disfunção Ventricular/diagnóstico , Disfunção Ventricular/fisiopatologiaRESUMO
This review of progress in cardiac imaging techniques summarizes the most significant development reported in the last year on different echocardiographic techniques and their application in a range of settings, from the treatment of heart failure to their use in intraoperative monitoring and guiding interventional procedures. Large sections are devoted to recent developments in three-dimensional imaging and, because of its clinical importance, to magnetic resonance imaging. Finally, there is a comprehensive update on the use of multidetector computed tomography in cardiology.