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1.
Medicine (Baltimore) ; 98(38): e17014, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567938

RESUMO

The coronary collateral circulation (CCC) is an alternative source of blood supply when the original vessels fail to provide sufficient blood. The accurate detection of CCC is critical for the treatment of ischemic heart disease, especially when the stent surgery is not an option. The assessment of minute vessels such as coronary collateral arteries is challenging. The objective of this study was to assess the feasibility of detection and classification of CCC using the192-slice third-generation dual-source computed tomography angiography (192-slice DSCT CTA).Eight hundred patients (450 men and 350 women, mean age: 56 ±â€Š11 years) with complete or subtotal occlusion of at least 1 major coronary artery were enrolled for our study. February 2016 and September 2018, the patient both 192-slice DSCT CTA and conventional coronary angiography (CAG) were performed in all enrolled patients. The interval between two approaches for a given patient was 6.1 ±â€Š3.7 days (Range: 1-15). The diagnostic accuracy of 192-slice DSCT CTA was evaluated by comparing it with that of CAG. The identified CCC was graded according to the Rentrop classification.The prevalence among patients of having at least 1 CCC was 43.8%. The sensitivity for detecting CCC by 192-slice DSCT was 91.7% (95% CI: 88.3% to 94.3%), specificity was 95.5% (95% CI: 93.1% to 97.2%), positive predictive value was 94.3% (95% CI: 91.5% to 96.2%), and negative predictive value was 93.3% (95% CI: 90.9% to 95.3%). Cohen-Kappa analysis showed that the consistency of the correct classification of CCC using CAG and 192-slice DSCT was very high with the kappa coefficient (κ) of 0.94 (95% CI: 0.91-0.96, P value = .01). Additionally, the radiation dose for 192-slice DSCT was as low as 0.42 ±â€Š0.04 mSv (range, 0.35-0.43 mSv).The 192-slice DSCT CTA is a reliable and sensitive non-invasive method for the evaluation of CCC with low radiation doses.


Assuntos
Circulação Colateral , Angiografia por Tomografia Computadorizada/normas , Doença da Artéria Coronariana/diagnóstico por imagem , Circulação Coronária , Doença da Artéria Coronariana/classificação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade
2.
Medicine (Baltimore) ; 98(41): e17536, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593130

RESUMO

Recently, the monocyte count to high-density lipoprotein cholesterol ratio (MHR) was found to be associated with the SYNTAX score in patients with both stable coronary artery disease (CAD) and acute coronary syndrome (ACS). The MHR was significantly higher in male patients. However, the sex-specific association of MHR with SYNTAX score in stable CAD was not well explored. Thus, the present study aimed to investigate the association of MHR and presence and severity of CAD evaluated by coronary angiography and the SYNTAX score in males and females.In total, 873 patients who received selective coronary angiography between March 2017 and July 2018 were included in the present study. Patients were divided into 3 groups according to MHR tertiles. The MHR was calculated by dividing the monocyte count by the high-density lipoprotein cholesterol level. CAD was defined as at least 50% diameter stenosis of a major coronary artery, including the right coronary, left main coronary, left anterior descending, and left circumflex arteries. The SYNTAX score was calculated by 2 experienced interventional cardiologists. SYNTAX score ≥23 was defined as a high SYNTAX score.Males showed a significantly higher MHR (12.2 [8.9-15.5] vs 9.3 [6.2-12.1], P < .001), accompanied by a higher prevalence of CAD (68.1% vs 53.4%, P < .001). Male sex remained an independent predictor of elevated MHR after correction for confounding factors (adjusted odds ratio [OR] 3.102, P = .001). The association between MHR and SYNTAX score was confirmed only in male stable patients with CAD (r = 0.113, P = .036). Multivariate logistic regression analysis showed that MHR was an independent predictor of SYNTAX score ≥23 only in male patients with CAD. The receiver-operating characteristic curve showed a predictive value of MHR for high SYNTAX score only in males.A higher MHR in males and a positive correlation of MHR with SYNTAX score were observed only in male stable patients with CAD. Such an easily obtained index may help interventional cardiologists detect high-risk patients before coronary catheterization, but its application may be restricted to males.


Assuntos
HDL-Colesterol/sangue , Doença da Artéria Coronariana/sangue , Contagem de Leucócitos/métodos , Monócitos/citologia , Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/epidemiologia , Síndrome Coronariana Aguda/metabolismo , Idoso , Angina Estável/sangue , Angina Estável/epidemiologia , Angina Estável/metabolismo , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/metabolismo , Vasos Coronários/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Índice de Gravidade de Doença , Fatores Sexuais
3.
Int Heart J ; 60(5): 1037-1042, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484863

RESUMO

Although high-sensitivity C-reactive protein (hs-CRP) has been used to predict the risk of adverse cardiac events in patients with coronary artery disease (CAD) after percutaneous coronary interventions (PCIs), little is known about the association between hs-CRP and long-term outcomes in patients with preserved renal function.Here, we studied 1,153 patients with stable CAD and preserved renal function (estimated glomerular filtration rate: > 60 mL/minute/1.73 m2) who underwent their first PCI between 2000 and 2011. Those with available data on preprocedural hs-CRP were included. Patients were assigned to tertiles according to preprocedural hs-CRP levels. The incidence of major adverse cardiac events (MACE), including all-cause death and nonfatal myocardial infarction, was evaluated. During a median follow-up period of 7.5 years, Kaplan-Meier curves showed ongoing divergence in the rates of MACE among the hs-CRP tertiles (hs-CRP < 0.05 mg/L, 12.1%; 0.05-0.17 mg/L, 12.1%; > 0.17 mg/L, 21.6%; log-rank P = 0.003). After adjusting for the established cardiovascular risk factors, hs-CRP levels were found to be associated with a higher incidence of MACE (hazard ratio [HR]: 3.65, 95% confidence interval [CI]: 1.77-7.07; P = 0.0008) and a higher rate of all-cause mortality (HR: 5.14, 95% CI: 2.38-10.30; P < 0.0001).In conclusion, this long-term registry showed that preprocedural hs-CRP measurement is clinically useful for long-term risk assessments in patients with stable CAD and preserved renal function.


Assuntos
Angioplastia Coronária com Balão/mortalidade , Angioplastia Coronária com Balão/métodos , Proteína C-Reativa/metabolismo , Causas de Morte , Doença da Artéria Coronariana/terapia , Idoso , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Biomarcadores/sangue , Estudos de Coortes , Angiografia Coronária/métodos , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Taxa de Filtração Glomerular/fisiologia , Hospitais Universitários , Humanos , Japão , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento
4.
Int Heart J ; 60(5): 1043-1049, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484867

RESUMO

Acute coronary syndrome (ACS) is the major cause of out-of-hospital cardiac arrest (OHCA). The relationship between the findings from the study of coronary images and return of spontaneous circulation (ROSC) interval is still unknown. Hence, we investigated this relationship in ACS patients with OHCA.A cohort of 2779 patients was admitted to our emergency center due to cardiopulmonary arrest (CPA) between April 2011 and March 2015. We included ACS patients who had CPA with ventricular fibrillation (VF) as an initial rhythm, were successfully resuscitated, underwent coronary angiography (CAG), had a culprit lesion, and were diagnosed with ACS (n = 58; age, 63.7 ± 12.0 years; 93.1% male).We divided the 58 patients into two groups, an early ROSC group (ROSC ≤ 20 minutes: E-ROSC) and a late ROSC group (ROSC > 20 minutes: L-ROSC), and then analyzed their characteristics.The finding of a collateral artery for the culprit lesion location, Rentrop II-III, and TIMI III flow on CAG on arrival presented no significant differences between the two groups (Rentrop II-III: 25.0% versus 23.5%, P = 0.90; TIMI III: 33.3% versus 35.3%, P = 0.88). The incidence of multivessel coronary artery disease (MVD) was lower in the E-ROSC group than in the L-ROSC group (16.7% versus 58.8%, P = 0.001).Collateral and TIMI flow were not associated with ease of resuscitation, but MVD may have a negative impact on resuscitation, especially in VF patients.


Assuntos
Síndrome Coronariana Aguda/terapia , Reanimação Cardiopulmonar/métodos , Doença da Artéria Coronariana/terapia , Circulação Coronária/fisiologia , Parada Cardíaca Extra-Hospitalar/terapia , Intervenção Coronária Percutânea/métodos , Síndrome Coronariana Aguda/diagnóstico por imagem , Síndrome Coronariana Aguda/mortalidade , Idoso , Reanimação Cardiopulmonar/mortalidade , Causas de Morte , Estudos de Coortes , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Japão , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/mortalidade , Intervenção Coronária Percutânea/mortalidade , Prognóstico , Recuperação de Função Fisiológica/fisiologia , Estudos Retrospectivos , Medição de Risco , Estatísticas não Paramétricas , Análise de Sobrevida
5.
Vasc Health Risk Manag ; 15: 283-290, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31496717

RESUMO

Angiography remains a widely utilized imaging modality during vascular procedures. Angiography, however, has its limitations by underestimating the true vessel size, plaque morphology, presence of calcium and thrombus, plaque vulnerability, true lesion length, stent expansion and apposition, residual narrowing post intervention and the presence or absence of dissections. Intravascular ultrasound (IVUS) has emerged as an important adjunctive modality to angiography. IVUS offers precise imaging of the vessel size, plaque morphology and the presence of dissections and guides interventional procedures including stent sizing, assessing residual narrowing and stent apposition and expansion. IVUS-guided treatment has shown to yield superior outcomes when compared to angiography-only guided therapy. The cost-effectiveness of the routine use of IVUS during vascular procedures needs to be further studied.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/terapia , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/terapia , Ultrassonografia de Intervenção , Doença da Artéria Coronariana/fisiopatologia , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Humanos , Doença Arterial Periférica/fisiopatologia , Valor Preditivo dos Testes , Fatores de Risco , Índice de Gravidade de Doença , Stents , Resultado do Tratamento
6.
Br J Radiol ; 92(1103): 20190384, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31479307

RESUMO

OBJECTIVE: Evaluation of coronary CT image blur using multi segment reconstruction algorithm. METHODS: Cardiac motion was simulated in a Catphan. CT coronary angiography was performed using 320 × 0.5 mm detector array and 275 ms gantry rotation. 1, 2 and 3 segment reconstruction algorithm, three heart rates (60, 80 and 100bpm), two peak displacements (4, 8 mm) and three cardiac phases (55, 35, 75%) were used. Wilcoxon test compared image blur from the different reconstruction algorithms. RESULTS: Image blur for 1, 2 and 3 segments in: 60 bpm, 75% R-R interval and 8 mm peak displacement: 0.714, 0.588, 0.571 mm (1.18, 0.6, 0.4 mm displacement) 80 bpm, 35% R-R interval and 8 mm peak displacement: 0.869, 0.606, 0.606 mm (1.57, 0.79,0.52 mm displacement) 100 bpm, 35% R-R interval and 4 mm peak displacement: 0.645, 0.588, 0.571 mm (0.98, 0.49, 0.33 mm displacement). The median image blur overall for 1 and 2 segments was 0.714 mm and 0.588 mm respectively (p < 0.0001). CONCLUSION: Two-segment reconstruction significantly reduces image blur. ADVANCES IN KNOWLEDGE: Multisegment reconstruction algorithms during CT coronary angiography are a useful method to reduce image blur, improve visualization of the coronary artery wall and help the early detection of the plaque.


Assuntos
Angiografia por Tomografia Computadorizada/normas , Doença da Artéria Coronariana/diagnóstico por imagem , Algoritmos , Análise de Variância , Artefatos , Doença da Artéria Coronariana/fisiopatologia , Frequência Cardíaca/fisiologia , Humanos , Movimento , Imagens de Fantasmas , Projetos Piloto , Estudos Prospectivos , Intensificação de Imagem Radiográfica/métodos
7.
Br J Anaesth ; 123(5): 565-569, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31547970

RESUMO

This case series presents 10 patients undergoing vascular surgery with asymptomatic elevated high-sensitivity troponin T concentrations, measured at outpatient clinic before surgery. Patients were included in the RAVE (Rotterdam Antiplatelet therapy in Vascular patiEnts) pilot study. All included patients underwent coronary angiography before surgery to identify significant obstructive coronary artery disease. We identified five out of 10 patients with high-grade stenosis and high-risk angiographic features of left main and/or proximal left anterior descending coronary artery disease. The study was terminated prematurely before any subject reached the study endpoint of 1 yr follow-up. This case series provides more insight into the meaning of preoperative troponin elevation and coronary angiographic features in vascular surgery patients. TRIAL REGISTRY NUMBER: NL5803.


Assuntos
Angiografia Coronária/métodos , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/diagnóstico por imagem , Cuidados Pré-Operatórios/métodos , Troponina T/sangue , Procedimentos Cirúrgicos Vasculares , Idoso , Idoso de 80 Anos ou mais , Doença da Artéria Coronariana/cirurgia , Método Duplo-Cego , Feminino , Humanos , Masculino , Projetos Piloto , Fatores de Risco
8.
Expert Rev Cardiovasc Ther ; 17(8): 605-623, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31389276

RESUMO

Introduction: Atherosclerotic coronary artery disease, in particular acute myocardial infarction (AMI), is a leading cause of morbidity and mortality globally. Percutaneous coronary intervention (PCI) is the mainstay of treatment for obstructive coronary artery disease and AMI through the restoration of TIMI III flow. Despite good macrovascular flow, the myocardium can remain hypoperfusion due to poor microvascular perfusion, and this is referred to as 'no-reflow'. Various treatments have been studied with variable success in both prevention and treatment of no-reflow. Areas covered: This review outlines the cutting-edge diagnostic investigations which have been explored in no-reflow, allowing a deeper understanding of mechanism and microvascular pathological processes involved in its genesis. These include utility of novel MRI techniques and perfusion echo in conjunction with traditional approaches. Detailed review has been undertaken of both pharmacological and non-pharmacological techniques to prevent and manage microvascular dysfunction associated with no-reflow. Particular attention was paid to the evolution and successes of various mechanical protection devices. Expert opinion: Most promising innovations in the diagnosis and management of no-reflow are evaluated, and future outlook is explored. Emerging advances in acute coronary syndrome have their findings applied a role in modifying the pathophysiology of no-reflow.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Circulação Coronária , Infarto do Miocárdio/diagnóstico por imagem , Angiografia Coronária , Doença da Artéria Coronariana/tratamento farmacológico , Doença da Artéria Coronariana/cirurgia , Feminino , Humanos , Masculino , Infarto do Miocárdio/tratamento farmacológico , Infarto do Miocárdio/cirurgia , Intervenção Coronária Percutânea , Resultado do Tratamento
9.
J Comput Assist Tomogr ; 43(5): 811-816, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31453979

RESUMO

OBJECTIVE: Knowledge-based iterative model reconstruction (IMR) yields diagnostically acceptable image quality in low-dose static computed tomography (CT). We aimed to evaluate the feasibility of IMR in dynamic myocardial computed tomography perfusion (CTP). METHODS: We enrolled 24 patients who underwent stress dynamic CTP using a 256-slice CT. Images were reconstructed using filtered back projection (FBP), hybrid IR, and IMR. Image quality and hemodynamic parameters were compared among three algorithms. RESULTS: Qualitative image quality and contrast-to-noise ratio were significantly higher by IMR than by FBP or hybrid IR (visual score: 4.1 vs. 3.0 and 3.5; contrast-to-noise ratio: 12.4 vs. 6.6 and 8.4; P < 0.05). No significant difference was observed among algorithms in CTP-derived myocardial blood flow (1.68 vs. 1.73 and 1.70 mL/g/min). CONCLUSIONS: The use of knowledge-based iterative model reconstruction improves image quality without altering hemodynamic parameters in low-dose dynamic CTP, compared with FBP or hybrid IR.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/fisiopatologia , Hemodinâmica/fisiologia , Bases de Conhecimento , Tomografia Computadorizada Multidetectores/métodos , Idoso , Algoritmos , Técnicas de Imagem de Sincronização Cardíaca , Meios de Contraste , Teste de Esforço , Estudos de Viabilidade , Feminino , Humanos , Iopamidol , Masculino , Pessoa de Meia-Idade , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Estudos Retrospectivos
10.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(3 Supl): 291-296, jul.-set. 2019. tab, graf
Artigo em Português | LILACS | ID: biblio-1023081

RESUMO

Avaliar a eficácia diagnóstica da angiotomografia coronariana (AC) comparada com a cineangiocoronariografia (CAT). Material e Métodos: Foram avaliados retrospectivamente 146 pacientes submetidos a AC e CAT com angiografia coronariana quantitativa (ACQ), com intervalo médio de um mês entre os exames. O estudo foi realizado no Hospital Cardiológico Costantini. Foram avaliados os fatores de risco da amostra, a localização das lesões e o grau de severidade da obstrução coronariana nos grandes vasos (TCE, DA, CX e CD). Os resultados dos métodos diagnósticos foram comparados pelo coeficiente de correlação de Pearson. A partir dos achados positivos foi realizada a avaliação de correlação entre os métodos perante a severidade das lesões. Resultados: A amostra foi composta predominantemente por homens (73,97%), sendo a hipertensão arterial (HAS) (71,91%) o fator de risco mais frequente. A artéria mais acometida foi a DA. Quanto ao grau de severidade das lesões, os resultados foram os seguintes na comparação entre AC e CAT: lesões discretas com correlação r = 0,23; moderadas com r = 0,53 e severas com r = 0,70. Na comparação entre AC e ACQ: lesões discretas com correlação r = 0,45; moderadas com r = 0,70 e severas com r = 0,67. Conclusão: A AC apresentou moderada com ACQ e CAT em lesões moderadas e severas, e forte correlação na ausência de lesões quando comparada com ACQ


To evaluate the diagnostic efficacy of multislice CT coronary angiotomography compared with coronary cineangiography. Material and Methods: We retrospectively evaluated 146 patients submitted to MSCT and CA with quantitative coronary angiography (QCA), with a mean interval of one month between the exams. The study was carried out at the Costantini Cardiology Hospital. The risk factors for the sample, the location of the lesions and the degree of severity of the coronary obstruction in the large vessels (LCT, AD, CX and RC).The results of the diagnostic methods were compared using Pearson correlation coefficient. From the positive findings, a correlation evaluation was performed between the methods for the severity of the lesions. Results: The sample consisted predominantly of men (73.97%), and hypertension (SAH) (71.91%) was the most frequent risk factor. The most affected artery was AD. Regarding the degree of severity of the lesions, the results were as follows in the comparison between MSCT and CA: mild lesions with correlation r = 0.23, moderate with r = 0.53 and severe with r = 0.70. In the comparison between MSCT and QCA: mild lesions with correlation r = 0.45, moderate with r = 0.70 and severe with r = 0.67. Conclusion: MSCT showed moderate correlation with QCA and CA in moderate and severe lesions, and a strong correlation in the absence of lesions when compared with QCA


Assuntos
Humanos , Masculino , Feminino , Doença da Artéria Coronariana/diagnóstico por imagem , Angiografia/métodos , Angiografia Digital/métodos , Angiografia Coronária/métodos , Diagnóstico por Imagem/métodos , Doenças Cardiovasculares/mortalidade , Estudos Retrospectivos , Fatores de Risco , Angiografia por Ressonância Magnética/métodos , Angiografia por Tomografia Computadorizada/métodos , Hipertensão
11.
Medicine (Baltimore) ; 98(27): e15990, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277090

RESUMO

BACKGROUND: Recent studies have demonstrated that coronary microcirculation dysfunction (CMVD) is closely correlated with adverse clinical outcomes. In this study, quantitative stress myocardial contrast echocardiography (MCE) was used to evaluate the CMVD and to investigate its association with the prognosis of patients with nonobstructive coronary artery disease (CAD). MATERIAL AND METHODS: From 2006 to 2014, 227 consecutive patients with chest pain and a diagnostic coronary angiography without significant coronary artery stenosis (<50%) who underwent adenosine triphosphate disodium (ATP) stress MCE were enrolled. Quantitative MCE measurements were analyzed using replenishment curves. RESULTS: Median follow-up time of this study was 5.3 years. Predictors of impaired coronary flow reserve (CFR) were smoking, diabetes, high apolipoprotein B, high low-density lipoprotein, serum uric acid, and low apolipoprotein A. During follow-up, 22 patients were reported to have 30 cardiac events (21 unstable angina, 3 nonfatal myocardial infarctions, 6 percutaneous coronary interventions). Using multivariate analysis, abnormal ß reserve (≤1.6), impaired CFR (≤2.0), and diabetes were independent predictors of primary endpoint events in patients with nonobstructive CAD (P < .05). Multivariate analysis showed that CFR ≤2.0 (odds ratio [OR] =  25.21, 95% confidence interval [CI]: 3.01-182.32; P = .003), ß reserve ≤1.6 (OR = 29.96, 95% CI: 3.5-241.27; P = .002), and diabetic (OR = 33.11, 95% CI: 3.65-300.02; P = .002) significantly increased the risk of the primary endpoint events. CONCLUSIONS: ATP stress quantitative MCE is a feasible and effective method to evaluate microcirculation abnormalities in human coronary arteries and it can be used for the clinical analysis, risk stratification, and treatment of early CAD.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Ecocardiografia sob Estresse/métodos , Ecocardiografia/métodos , Microcirculação/fisiologia , Trifosfato de Adenosina/administração & dosagem , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Fatores de Risco
12.
Clin Nucl Med ; 44(8): e492-e494, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31274632

RESUMO

We present a 53-year-old woman who had shortness of breath and atypical chest pain and underwent Tc-sestamibi myocardial perfusion imaging to detect coronary artery disease. The raw data in cine format showed an incidental focus close to the heart, and SPECT/CT fused images revealed a focus of intense uptake in the left breast. The subsequent histopathologic findings and F-FDG PET/CT imaging confirmed the diagnosis as primary breast lymphoma. After 3 cycles of chemotherapy, previously visualized abnormal uptake in the left breast disappeared on the follow-up PET/CT.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Achados Incidentais , Linfoma/diagnóstico por imagem , Imagem de Perfusão do Miocárdio , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Tecnécio Tc 99m Sestamibi , Doença da Artéria Coronariana/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade
13.
Br J Radiol ; 92(1101): 20180945, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31322906

RESUMO

OBJECTIVE: This study aimed to evaluate the relationship between heart rate (HR) and optimal reconstruction phase in prospectively electrocardiogram (ECG)-triggered coronary CT angiography (CCTA) performed on a newly introduced 256-slice multidetector CT (MDCT). METHODS: All the cases were selected retrospectively from the patients scheduled for CCTA in our department between January and April 2017. The scanner selected the optimal exposure phase based on 10 s ECG recordings. To ensure the success of CCTA, the operator also checked patient's age, breathing control, emotional status and past medical history to decide whether the automatically selected scan phase needs manual adjustment or not. Images were reconstructed in 1% steps of the R-R interval to determine the cardiac phase with least coronary motion. If CCTA images showed moderate motion blurring or discontinuity in the course of coronary segments, a cardiac motion correction algorithm was applied to the reconstructed images. Subjective diagnostic image quality was evaluated with 4-point grading scale. RESULTS: A total of 87 consecutive CCTA examinations were investigated in this study. Diastolic reconstruction was applied to all vessel segments in patients with HR <63 bpm, where 36.5 and 77.8% of vessel segments were reconstructed with the use of motion correction in HR ≤57 and 58-62 bpm, respectively. As for patients with HR ≥63 bpm, 89.3 and 71.7% of vessel segments were reconstructed in diastole in HR 63-67 and ≥68 bpm, respectively, while 81 and 100% of vessel segments were reconstructed with the use of motion correction in the same HR groups. CONCLUSION: Based on our results, a HR less than 67 bpm can be used to identify appropriate patients for diastolic reconstruction. Although the motion correction algorithm is an effective approach to reduce the impact of cardiac motion in CCTA, HR control is still important to optimize the image quality of CCTA. The relationship between HR and optimal reconstruction phase established in this study could be further used to tailor the ECG pulsing window for dose reduction in patients undergoing CCTA performed on the 256-slice MDCT. ADVANCES IN KNOWLEDGE: The HR thresholds to identify patients who are the best suitable candidates for diastolic or systolic reconstruction are scanner specific. This study investigated the relationship between HR and optimal reconstruction phase in prospectively ECG-triggered CCTA for a newly introduced 256-slice MDCT. Once the relationship is established, it could be used to tailor the ECG pulsing window for radiation dose reduction.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Frequência Cardíaca/fisiologia , Tomografia Computadorizada Multidetectores/métodos , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença da Artéria Coronariana/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos
14.
N Engl J Med ; 380(25): 2418-2428, 2019 06 20.
Artigo em Inglês | MEDLINE | ID: mdl-31216398

RESUMO

BACKGROUND: In patients with stable angina, two strategies are often used to guide revascularization: one involves myocardial-perfusion cardiovascular magnetic resonance imaging (MRI), and the other involves invasive angiography and measurement of fractional flow reserve (FFR). Whether a cardiovascular MRI-based strategy is noninferior to an FFR-based strategy with respect to major adverse cardiac events has not been established. METHODS: We performed an unblinded, multicenter, clinical-effectiveness trial by randomly assigning 918 patients with typical angina and either two or more cardiovascular risk factors or a positive exercise treadmill test to a cardiovascular MRI-based strategy or an FFR-based strategy. Revascularization was recommended for patients in the cardiovascular-MRI group with ischemia in at least 6% of the myocardium or in the FFR group with an FFR of 0.8 or less. The composite primary outcome was death, nonfatal myocardial infarction, or target-vessel revascularization within 1 year. The noninferiority margin was a risk difference of 6 percentage points. RESULTS: A total of 184 of 454 patients (40.5%) in the cardiovascular-MRI group and 213 of 464 patients (45.9%) in the FFR group met criteria to recommend revascularization (P = 0.11). Fewer patients in the cardiovascular-MRI group than in the FFR group underwent index revascularization (162 [35.7%] vs. 209 [45.0%], P = 0.005). The primary outcome occurred in 15 of 421 patients (3.6%) in the cardiovascular-MRI group and 16 of 430 patients (3.7%) in the FFR group (risk difference, -0.2 percentage points; 95% confidence interval, -2.7 to 2.4), findings that met the noninferiority threshold. The percentage of patients free from angina at 12 months did not differ significantly between the two groups (49.2% in the cardiovascular-MRI group and 43.8% in the FFR group, P = 0.21). CONCLUSIONS: Among patients with stable angina and risk factors for coronary artery disease, myocardial-perfusion cardiovascular MRI was associated with a lower incidence of coronary revascularization than FFR and was noninferior to FFR with respect to major adverse cardiac events. (Funded by the Guy's and St. Thomas' Biomedical Research Centre of the National Institute for Health Research and others; MR-INFORM ClinicalTrials.gov number, NCT01236807.).


Assuntos
Angina Estável/diagnóstico , Angiografia Coronária , Reserva Fracionada de Fluxo Miocárdico , Angiografia por Ressonância Magnética , Adulto , Idoso , Angina Estável/complicações , Angina Estável/diagnóstico por imagem , Angina Estável/fisiopatologia , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
15.
BMJ ; 365: l1945, 2019 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-31189617

RESUMO

OBJECTIVE: To determine whether coronary computed tomography angiography (CTA) should be performed in patients with any clinical probability of coronary artery disease (CAD), and whether the diagnostic performance differs between subgroups of patients. DESIGN: Prospectively designed meta-analysis of individual patient data from prospective diagnostic accuracy studies. DATA SOURCES: Medline, Embase, and Web of Science for published studies. Unpublished studies were identified via direct contact with participating investigators. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Prospective diagnostic accuracy studies that compared coronary CTA with coronary angiography as the reference standard, using at least a 50% diameter reduction as a cutoff value for obstructive CAD. All patients needed to have a clinical indication for coronary angiography due to suspected CAD, and both tests had to be performed in all patients. Results had to be provided using 2×2 or 3×2 cross tabulations for the comparison of CTA with coronary angiography. Primary outcomes were the positive and negative predictive values of CTA as a function of clinical pretest probability of obstructive CAD, analysed by a generalised linear mixed model; calculations were performed including and excluding non-diagnostic CTA results. The no-treat/treat threshold model was used to determine the range of appropriate pretest probabilities for CTA. The threshold model was based on obtained post-test probabilities of less than 15% in case of negative CTA and above 50% in case of positive CTA. Sex, angina pectoris type, age, and number of computed tomography detector rows were used as clinical variables to analyse the diagnostic performance in relevant subgroups. RESULTS: Individual patient data from 5332 patients from 65 prospective diagnostic accuracy studies were retrieved. For a pretest probability range of 7-67%, the treat threshold of more than 50% and the no-treat threshold of less than 15% post-test probability were obtained using CTA. At a pretest probability of 7%, the positive predictive value of CTA was 50.9% (95% confidence interval 43.3% to 57.7%) and the negative predictive value of CTA was 97.8% (96.4% to 98.7%); corresponding values at a pretest probability of 67% were 82.7% (78.3% to 86.2%) and 85.0% (80.2% to 88.9%), respectively. The overall sensitivity of CTA was 95.2% (92.6% to 96.9%) and the specificity was 79.2% (74.9% to 82.9%). CTA using more than 64 detector rows was associated with a higher empirical sensitivity than CTA using up to 64 rows (93.4% v 86.5%, P=0.002) and specificity (84.4% v 72.6%, P<0.001). The area under the receiver-operating-characteristic curve for CTA was 0.897 (0.889 to 0.906), and the diagnostic performance of CTA was slightly lower in women than in with men (area under the curve 0.874 (0.858 to 0.890) v 0.907 (0.897 to 0.916), P<0.001). The diagnostic performance of CTA was slightly lower in patients older than 75 (0.864 (0.834 to 0.894), P=0.018 v all other age groups) and was not significantly influenced by angina pectoris type (typical angina 0.895 (0.873 to 0.917), atypical angina 0.898 (0.884 to 0.913), non-anginal chest pain 0.884 (0.870 to 0.899), other chest discomfort 0.915 (0.897 to 0.934)). CONCLUSIONS: In a no-treat/treat threshold model, the diagnosis of obstructive CAD using coronary CTA in patients with stable chest pain was most accurate when the clinical pretest probability was between 7% and 67%. Performance of CTA was not influenced by the angina pectoris type and was slightly higher in men and lower in older patients. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42012002780.


Assuntos
Angina Pectoris/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Angina Pectoris/etiologia , Doença da Artéria Coronariana/complicações , Estudos de Viabilidade , Humanos , Valor Preditivo dos Testes , Probabilidade
16.
Vasc Health Risk Manag ; 15: 123-135, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31190850

RESUMO

Purpose: Disturbed metabolism of cholesterol and triacylglycerols (TGs) carries increased risk for coronary artery calcification (CAC). However, the exact relationship between individual lipid species and CAC remains unclear. The aim of this study was to identify disturbances in lipid profiles involved in the calcification process, in an attempt to propose potential biomarker candidates. Patients and methods: We studied 70 patients at intermediate risk for coronary artery disease who had undergone coronary calcification assessment using computed tomography and Agatston coronary artery calcium score (CACS). Patients were divided into three groups: with no coronary calcification (NCC; CACS: 0; n=26), mild coronary calcification (MCC; CACS: 1-250; n=27), or severe coronary calcification (SCC; CACS: >250; n=17). Patients' serum samples were analyzed using liquid chromatography-mass spectrometry in an untargeted lipidomics approach. Results: We identified 103 lipids within the glycerolipid, glycerophospholipid, sphingolipid, and sterol lipid classes. After false discovery rate correction, phosphatidylcholine (PC)(16:0/20:4) in higher levels and PC(18:2/18:2), PC(36:3), and phosphatidylethanolamine(20:0/18:2) in lower levels were identified as correlates with SCC compared to NCC. There were no significant differences in the levels of individual TGs between the three groups; however, clustering the lipid profiles showed a trend for higher levels of saturated and monounsaturated TGs in SCC compared to NCC. There was also a trend for lower TG(49:2), TG(51:1), TG(54:5), and TG(56:8) levels in SCC compared to MCC. Conclusion: In this study we investigated the lipidome of patients with coronary calcification. Our results suggest that the calcification process may be associated with dysfunction in autophagy. The lipidomic biomarkers revealed in this study may aid in better assessment of patients with subclinical coronary artery disease.


Assuntos
Doença da Artéria Coronariana/sangue , Dislipidemias/sangue , Metabolômica/métodos , Fosfolipídeos/sangue , Calcificação Vascular/sangue , Idoso , Doenças Assintomáticas , Autofagia , Biomarcadores/sangue , Cromatografia Líquida de Alta Pressão , Angiografia por Tomografia Computadorizada , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/patologia , Dislipidemias/diagnóstico , Dislipidemias/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Espectrometria de Massas por Ionização por Electrospray , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/patologia
17.
Rev Col Bras Cir ; 46(3): e20192170, 2019 Jun 19.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31241686

RESUMO

OBJECTIVE: to investigate the impact of bariatric surgery on the coronary artery calcium score (CACS), and to establish predictors of progression of this score in patients with obesity. METHODS: prospective study that evaluated 18 obese patients before and after bariatric surgery. All patients were submitted to computed tomography scans and blood tests (total cholesterol, LDL, HDL, triglycerides, fasting plasma glucose, A1C, insulin, serum calcium, C-peptide and C-Reactive Protein) in order to determine CACS and Framingham risk score (FRS). RESULTS: the FRS decreased 50% between the pre and postoperative evaluations. The mean CACS increased significantly at the late postoperative period, going from 8.5 to 33.1. HDL levels had also increased between the pre and postoperative periods. All of the other quantitative variables reduced significantly at the postoperative evaluation. When dividing CACS into four degrees, it was observed that 22.2% presented CACS=0 at the postoperative evaluation. The prevalence of mild CACS decreased from 77.8% to 50%, while moderate CACS remained the same (11.1%). Severe CACS increased from 11.1% to 16.7%. Older ages were linked to CACS progression, and this was the only variable that presented statistical association with progression. CONCLUSION: bariatric surgery leads to positive cardiovascular outcomes, apparently regardless of CACS.


Assuntos
Cirurgia Bariátrica , Doença da Artéria Coronariana/etiologia , Obesidade/cirurgia , Calcificação Vascular/etiologia , Adolescente , Adulto , Idoso , Doença da Artéria Coronariana/diagnóstico por imagem , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Estudos Prospectivos , Medição de Risco , Tomografia Computadorizada por Raios X , Calcificação Vascular/diagnóstico por imagem , Adulto Jovem
18.
Eur J Radiol ; 116: 76-83, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31153577

RESUMO

OBJECTIVE: The purpose of this study is to assess the value of an automated model-based plaque characterization tool for the prediction of major adverse cardiac events (MACE). METHODS: We retrospectively included 45 patients with suspected coronary artery disease of which 16 (33%) experienced MACE within 12 months. Commercially available plaque quantification software was used to automatically extract quantitative plaque morphology: lumen area, wall area, stenosis percentage, wall thickness, plaque burden, remodeling ratio, calcified area, lipid rich necrotic core (LRNC) area and matrix area. The measurements were performed at all cross sections, spaced at 0.5 mm, based on fully 3D segmentations of lumen, wall, and each tissue type. Discriminatory power of these markers and traditional risk factors for predicting MACE were assessed. RESULTS: Regression analysis using clinical risk factors only resulted in a prognostic accuracy of 63% with a corresponding area under the curve (AUC) of 0.587. Based on our plaque morphology analysis, minimal cap thickness, lesion length, LRNC volume, maximal wall area/thickness, the remodeling ratio, and the calcium volume were included into our prognostic model as parameters. The use of morphologic features alone resulted in an increased accuracy of 77% with an AUC of 0.94. Combining both clinical risk factors and morphological features in a multivariate logistic regression analysis increased the accuracy to 87% with a similar AUC of 0.924. CONCLUSION: An automated model based algorithm to evaluate CCTA-derived plaque features and quantify morphological features of atherosclerotic plaque increases the ability for MACE prognostication significantly compared to the use of clinical risk factors alone.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Placa Aterosclerótica/diagnóstico por imagem , Algoritmos , Área Sob a Curva , Doença da Artéria Coronariana/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/patologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença
19.
Eur J Radiol ; 116: 90-97, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31153580

RESUMO

PURPOSE: To evaluate the diagnostic performance of coronary computed tomography angiography derived fractional flow reserve (CT-FFR) with invasive fractional flow reserve (FFR) in patients with coronary artery disease" before "with invasive fractional flow reserve serving as the reference standard. MATERIALS AND METHODS: CT-FFR values based on a machine learning algorithm (cFFRML) in 183 vessels of 136 patients from four centers were measured with invasive FFR as reference standard. The diagnostic performance from our multicenter study was combined into a meta-analysis following a literature search in Web of Science, PubMed, Cochrane library to identify studies comparing diagnostic performance of coronary computed tomography angiography (CCTA) and CT-FFR. Sensitivity, specificity, accuracy were analyzed on both per-vessel and per-patient basis for intermediate lesions and by algorithm. RESULTS: Our multicenter study demonstrated sensitivities, specificities, and accuracies of cFFRML and CCTA of 0.85, 0.94, 0.90, and 0.95, 0.28, 0.55 on a per-vessel basis, respectively. For our meta-analysis, pooled sensitivities, specificities, and accuracies of CT-FFR and CCTA were 0.85, 0.82, 0.82, and 0.85, 0.57, 0.65 with AUC of 0.86 (95%CI: 0.83˜0.89) and 0.83 (95%CI: 0.79˜0.86) on a per-vessel basis, respectively. The sensitivity, specificity and accuracy for intermediate lesions using cFFRML were 0.84, 0.92, and 0.89. No significant difference was found among different algorithms of CT-FFR (P < 0.001). CONSLUSION: This multicenter study with meta-analysis showed that CT-FFR had a high diagnostic accuracy in determining ischemia-specific lesions and intermediate lesions. There was no significant difference when comparing the combined diagnostic performance of different algorithms of CT-FFR with invasive FFR as the reference standard.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Reserva Fracionada de Fluxo Miocárdico/fisiologia , Isquemia Miocárdica/diagnóstico por imagem , Isquemia Miocárdica/fisiopatologia , Algoritmos , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/fisiopatologia , Feminino , Humanos , Aprendizado de Máquina , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/etiologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade
20.
Yonsei Med J ; 60(7): 619-625, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31250575

RESUMO

PURPOSE: To evaluate predictors of severe or moderate coronary artery disease (CAD) in individuals with zero or very low (<10) coronary artery calcium (CAC) scores. MATERIALS AND METHODS: The 1175 asymptomatic persons with zero or very low (<10) CAC scores were analyzed for CAD stenosis using coronary computed tomography angiography. Moderate and severe CADs were defined as having more than 50% and more than 70% stenosis in any of the major coronary arteries, respectively. Age, gender, body mass index, hypertension, type II diabetes, dyslipidemia, lipid profile, creatinine, and smoking status were evaluated as predictors for moderate and severe CAD. RESULTS: In the study population, moderate and severe CADs were found in 7.5% and 3.3%, respectively. Among evaluated risk factors, age [odds ratio (OR) 1.04, 95% confidence interval (CI) 1.02-1.07, p<0.001], current smoking status (OR 3.12, 95% CI 1.82-5.34, p<0.001), and CAC 1-9 (OR 1.80, 95% CI 1.08-3.00, p=0.024) were significantly associated with moderate CAD. Meanwhile, age (OR 1.05, 95% CI 1.02-1.08, p=0.003), low high density lipoprotein (HDL) (OR 0.96, 95% CI 0.93-0.99, p=0.003), and current smoking status (OR 2.34, 95% CI 1.14-5.30, p=0.022) were found to be significantly associated with severe CAD. Improvement of discrimination power for predicting severe CAD was observed when smoking and HDL cholesterol were serially added into the age model. CONCLUSION: Smoking showed significant correlations with moderate or severe CAD, and low HDL cholesterol also proved to be a predictor of severe CAD in asymptomatic individuals with extremely low CAC scores.


Assuntos
Doenças Assintomáticas , Cálcio/metabolismo , Doença da Artéria Coronariana/metabolismo , Vasos Coronários/metabolismo , Adulto , Idoso , Angiografia Coronária , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Fumar
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