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1.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2671-2674, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018556

RESUMO

The ongoing advances in the field of cardiovascular modelling during the past years have allowed for the creation of accurate three-dimensional models of the major coronary arteries. The aforementioned 3D models can accurately mimic the human coronary vasculature if they are combined with sophisticated computational fluid dynamics algorithms and shed light to non-trivial issues that concern the clinicians. One of these issues is to define whether a coronary lesion is more dangerous to present with ischemia if it is at a proximal or a distal part of the vessel. In this work, we aim to investigate the aforementioned issue by reconstructing in 3D a coronary arterial model from a healthy subject using Computed Tomography Coronary Angiography images and by editing it to create eight diseased arterial models that contain one or two lesions of different severities. After carrying out the appropriate blood flow simulations using the finite element method, we observed that the distal lesions are more dangerous than the proximal ones in terms of hemodynamic significance. Moreover, the distal severe stenosis (i.e. 70% diameter reduction) present with the highest peak Wall Shear Stress (WSS) values in comparison to the proximal ones.


Assuntos
Estenose Coronária , Vasos Coronários , Animais , Angiografia por Tomografia Computadorizada , Estenose Coronária/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Coração , Hemodinâmica , Humanos
2.
Radiol Med ; 125(11): 1186-1199, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32946002

RESUMO

Artificial intelligence (AI) is entering the clinical arena, and in the early stage, its implementation will be focused on the automatization tasks, improving diagnostic accuracy and reducing reading time. Many studies investigate the potential role of AI to support cardiac radiologist in their day-to-day tasks, assisting in segmentation, quantification, and reporting tasks. In addition, AI algorithms can be also utilized to optimize image reconstruction and image quality. Since these algorithms will play an important role in the field of cardiac radiology, it is increasingly important for radiologists to be familiar with the potential applications of AI. The main focus of this article is to provide an overview of cardiac-related AI applications for CT and MRI studies, as well as non-imaging-based applications for reporting and image optimization.


Assuntos
Algoritmos , Inteligência Artificial , Coração/diagnóstico por imagem , Radiologia/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Humanos , Processamento de Imagem Assistida por Computador , Imagem por Ressonância Magnética , Prognóstico , Calcificação Vascular/diagnóstico por imagem , Fluxo de Trabalho
3.
Br J Radiol ; 93(1113): 20200349, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32783626

RESUMO

The aim of this review is to provide an overview of different functional cardiac CT techniques which can be used to supplement assessment of the coronary arteries to establish the significance of coronary artery stenoses. We focus on cine-CT, CT-FFR, CT-myocardial perfusion and how developments in machine learning can supplement these techniques.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Aprendizado de Máquina , Imagem de Perfusão do Miocárdio/métodos , Tomografia Computadorizada por Raios X/métodos , Ensaios Clínicos como Assunto , Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Reserva Fracionada de Fluxo Miocárdico , Humanos , Volume Sistólico , Calcificação Vascular/diagnóstico por imagem , Função Ventricular Esquerda
4.
PLoS One ; 15(8): e0237024, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32764787

RESUMO

BACKGROUND: Thrombin, a key enzyme of the clotting system, is involved in thrombus formation, platelet activation, and atherosclerosis, thereby possessing a central role in the pathogenesis of ischemic heart disease. Studies have shown an association between thrombin generation (TG) and cardiovascular morbidity and mortality, but results have been equivocal. Our aim was to study the predictive ability of TG assay in evaluating coronary stenosis severity. METHODS: In this prospective study we recruited patients with acute coronary syndrome (ACS) or acute chest pain (without evidence of myocardial injury) planned for coronary angiography. Thrombin generation was evaluated by Calibrated Automated Thrombogram (CAT) prior to angiography. Primary end points were significant coronary stenosis and the Syntax I score evaluated by coronary angiography. RESULTS: From April 2018 through September 2019, we recruited 128 patients. In the primary analysis there was no significant association between TG and significant coronary stenosis nor between TG and syntax I score, however, there was a positive correlation between peak height and troponin peak (Spearman correlation coefficient 0.194, P-value = 0.035). In sub-group analysis, the chest pain group bare no association between TG and coronary stenosis. In unstable angina group there was an association between peak height and significant coronary stenosis (P-value = 0.029), and in non ST-elevation myocardial infarction group, TG values possessed a relatively good predictive ability of significant coronary stenosis (area under the receiver operating characteristic curve of ~65%) and a positive correlation between both lag time and ttpeak with the syntax I score was noticed (Spearman correlation coefficient 0.31, P-value = 0.099 and Spearman correlation coefficient 0.37, P-value = 0.045 respectively). CONCLUSION: In patients with acute chest pain, TG values, evaluated by CAT, do not predict severity of coronary stenosis, nor do they possess prognostic value. Yet, in ACS patients, TG may have the ability to predict coronary disease severity.


Assuntos
Doença da Artéria Coronariana/sangue , Trombina/biossíntese , Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/diagnóstico por imagem , Adulto , Idoso , Angina Instável/sangue , Angina Instável/diagnóstico por imagem , Biomarcadores/sangue , Dor no Peito/sangue , Dor no Peito/diagnóstico por imagem , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/sangue , Estenose Coronária/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/sangue , Infarto do Miocárdio sem Supradesnível do Segmento ST/sangue , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico por imagem , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença
5.
PLoS One ; 15(8): e0236951, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790754

RESUMO

AIMS: Immune endothelial inflammation, underlying coronary heart disease (CHD) related phenotypes, could provide new insight into the pathobiology of the disease. We investigated DNA methylation level of the unique CpG island of HLA-G gene in CHD patients and evaluated the correlation with cardiac computed tomography angiography (CCTA) features. METHODS: Thirty-two patients that underwent CCTA for suspected CHD were enrolled for this study. Obstructive CHD group included fourteen patients, in which there was a stenosis greater than or equal to 50% in one or more of the major coronary arteries detected; whereas subjects with Calcium (Ca) Score = 0, uninjured coronaries and with no obstructive CHD (no critical stenosis, NCS) were considered as control subjects (n = 18). For both groups, DNA methylation profile of the whole 5'UTR-CpG island of HLA-G was measured. The plasma soluble HLA-G (sHLA-G) levels were detected in all subjects by specific ELISA assay. Statistical analysis was performed using R software. RESULTS: For the first time, our study reported that 1) a significant hypomethylation characterized three specific fragments (B, C and F) of the 5'UTR-CpG island (p = 0.05) of HLA-G gene in CHD patients compared to control group; 2) the hypomethylation level of one specific fragment of 161bp (+616/+777) positively correlated with coronary Ca score, a relevant parameter of CCTA (p<0.05) between two groups evaluated and was predictive for disease severity. CONCLUSIONS: Reduced levels of circulating HLA-G molecules could derive from epigenetic marks. Epigenetics phenomena induce hypomethylation of specific regions into 5'UTR-CpG island of HLA-G gene in CHD patients with obstructive non critical stenosis vs coronary stenosis individuals.


Assuntos
Doença das Coronárias/genética , Doença das Coronárias/imunologia , Metilação de DNA , Antígenos HLA-G/genética , Regiões 5' não Traduzidas , Adulto , Idoso , Cálcio/metabolismo , Estudos de Casos e Controles , Angiografia por Tomografia Computadorizada , Doença das Coronárias/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/genética , Estenose Coronária/imunologia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/imunologia , Vasos Coronários/metabolismo , Ilhas de CpG , Epigênese Genética , Feminino , Antígenos HLA-G/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Placa Aterosclerótica/diagnóstico por imagem
6.
AJR Am J Roentgenol ; 215(4): 828-833, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32783558

RESUMO

OBJECTIVE. The purpose of this study was to evaluate the feasibility, image quality, and radiation dose of high-pitch coronary CT angiography (CCTA) in orthotopic heart transplant (OHT) recipients. SUBJECTS AND METHODS. Twenty-two consecutive OHT recipients (16 men, six women; median age, 66.5 years [interquartile range, 51.3-70.3 years]; median heart rate, 91 beats/min [interquartile range, 79.3-97.3 beats/min]) underwent CCTA with a third-generation dual-source CT scanner in high-pitch mode to rule out coronary allograft vasculopathy. Data acquisition was triggered at 30% of the R-R interval. Two independent observers blindly assessed image quality on a per-segment, per-vessel, and per-patient basis using a 4-point scale (4, excellent; 1, not evaluative). Scores 2-4 indicated diagnostic quality. Studies were compared with previously performed retrospective ECG-gated examinations, when available. Interobserver agreement on the image quality was assessed with kappa statistics. Radiation dose was recorded. RESULTS. A total of 322 coronary segments were evaluated. Diagnostic image quality was observed in 97.5% of the segments. Interobserver agreement for image quality assessment was very good on a per-patient (κ = 0.82), per-vessel (κ = 0.83), and per-segment basis (κ = 0.89). The median per-patient image quality score was 4.0 (3.0-4.0) for the entire coronary tree. A comparison of image quality scores between high-pitch and retrospective ECG-gated CCTA examinations showed no significant differences, but the estimated mean radiation dose was significantly lower for the high-pitch mode (median dose-length product, 31.6 mGy × cm [interquartile range, 23.1-38.8 mGy × cm] vs 736.5 mGy × cm [interquartile range, 655.5-845.7 mGy × cm], p < 0.001). CONCLUSION. Performing single-heartbeat high-pitch CCTA during the systolic phase of the cardiac cycle in OHT recipients results in diagnostic image quality in coronary angiograms at very low radiation dose.


Assuntos
Angiografia por Tomografia Computadorizada , Estenose Coronária/diagnóstico por imagem , Transplante de Coração/efeitos adversos , Processamento de Imagem Assistida por Computador , Idoso , Estudos de Coortes , Estenose Coronária/etiologia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doses de Radiação , Reprodutibilidade dos Testes , Sístole
7.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 49(1): 76-81, 2020 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-32621414

RESUMO

OBJECTIVE: To investigate the prognosis of patients with vulnerable plaque indicated by coronary CT angiography (CCTA). METHODS: Totally 1963 patients underwent CCTA from February 2nd 2015 to September 13th 2015, and 2728 coronary borderline lesions (stenosis of 50%-70%) were detected. Among them 804 patients had vulnerable plaques and 1159 patients had stable plaques. The primary endpoint was major cardiac adverse events (MACE), including cardiac death, acute myocardial infarction and target lesion revascularization. RESULTS: Patients were followed up for a mean follow-up of 27.4±2.3 months. The incidence of MACE in the vulnerable plaque group was significantly higher than that in the stable plaque group (10.8%vs 2.3%, P < 0.01). After adjusting for age, gender, smoking, hypertension, diabetes, hyperlipidemia, the MACE hazard ratio (HR) in the vulnerable plaque group was 5.022 (95% CI:3.254-7.751, P < 0.01).Subgroup analysis showed that in the vulnerable plaque group, the incidence of MACE in patients taking antiplatelet and statin ≤3 months and those taking antiplatelet and statin > 3 months was 17.0%and 5.8%, respectively (HR=3.149, 95% CI:1.987-4.992, P < 0.01); but the difference did not seen in stable plaque group (HR=1.721, 95% CI:0.798-3.712, P>0.05). CONCLUSIONS: This study confirmed the risk of MACE in patients with vulnerable plaque detected by CCTA and the drug treatment may reduce the risk for patients with vulnerable plaque.


Assuntos
Angiografia por Tomografia Computadorizada , Angiografia Coronária , Placa Aterosclerótica , Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Humanos , Lactente , Placa Aterosclerótica/diagnóstico por imagem , Placa Aterosclerótica/patologia , Prognóstico , Fatores de Risco
9.
Methodist Debakey Cardiovasc J ; 16(2): 77-85, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32670467

RESUMO

Cardiac computed tomography angiography (CCTA) has evolved into a versatile imaging modality that can depict atherosclerosis burden, determine functional significance of a stenotic lesion, and guide the management and treatment of stable coronary artery disease.1 With newer-generation scanners, diagnostic CCTA can be obtained in the majority of patients with a very acceptable radiation dose. We discuss the ability of CCTA to provide comprehensive assessment of a patient with suspected CAD, including functional techniques of stress-rest myocardial perfusion assessment using a vasodilator and a purely post-processing approach that assesses fractional flow reserve derived by CCTA. In addition, recent data validated the role of CCTA in managing stable patients with chest pain and suspected CAD, serving as a gatekeeper for invasive coronary angiogram as well as optimizing the preprocedural planning of percutaneous coronary revascularization and coronary artery bypass surgery.


Assuntos
Angiografia por Tomografia Computadorizada , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Reserva Fracionada de Fluxo Miocárdico , Imagem de Perfusão do Miocárdio , Tomada de Decisão Clínica , Ponte de Artéria Coronária , Doença da Artéria Coronariana/fisiopatologia , Doença da Artéria Coronariana/terapia , Estenose Coronária/fisiopatologia , Estenose Coronária/terapia , Humanos , Intervenção Coronária Percutânea , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Índice de Gravidade de Doença
10.
Angiology ; 71(10): 942-947, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32720510

RESUMO

We evaluated the safety and efficacy of second-generation drug-eluting stents (DES) fully covering a coronary artery aneurysm (CAA) and stenosis lesion. Patients (n = 33) with CAA and stenosis lesion (>60%) were enrolled between January 2014 and December 2017. Baseline characteristics and biochemical variables were recorded during hospital admission. Changes in CAA resolution (the reduction on CAA size), minimal lumen diameter (MLD), and diameter stenosis (DS) were determined before, just after, and 1 year after percutaneous coronary intervention (PCI). After DES implantation, MLD and DS after PCI were improved compared with those before PCI (P < .01). Also, thrombolysis in myocardial infarction blood flow was significantly enhanced after PCI (P < .01). One year after PCI, maximal CAA diameter in patients with CAA and stenosis lesion was significantly reduced compared with those just after PCI (P < .01). Meanwhile, CAA resolution ratio in these patients were more than those just after PCI (P < .01). Furthermore, there was a significant reduction about CAA length in these patients (P < .01). Last, there were no clinical events (including cardiac death, myocardial infarction, and revascularization) in the study. Second-generation DES implantation fully covering CAA and stenosis lesion was safe and effective.


Assuntos
Aneurisma Coronário/terapia , Estenose Coronária/terapia , Stents Farmacológicos , Intervenção Coronária Percutânea , Idoso , Estudos de Coortes , Aneurisma Coronário/complicações , Aneurisma Coronário/diagnóstico por imagem , Angiografia Coronária , Estenose Coronária/complicações , Estenose Coronária/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento
11.
Eur J Vasc Endovasc Surg ; 60(3): 411-420, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32709470

RESUMO

OBJECTIVE: Patients undergoing peripheral vascular surgery have increased risk of death and myocardial infarction (MI), which may be due to unsuspected (silent) coronary ischaemia. The aim was to determine whether pre-operative diagnosis of silent ischaemia using coronary computed tomography (CT) derived fractional flow reserve (FFRCT) can facilitate multidisciplinary care to reduce post-operative death and MI, and improve survival. METHODS: This was a single centre prospective study with historic controls. Patients with no cardiac symptoms undergoing lower extremity surgical revascularisation with pre-operative coronary CTA-FFRCT testing were compared with historic controls with standard pre-operative testing. Silent coronary ischaemia was defined as FFRCT ≤ 0.80 distal to coronary stenosis with FFRCT ≤ 0.75 indicating severe ischaemia. End points included cardiovascular (CV) death, MI, and all cause death through one year follow up. RESULTS: There were no statistically significant differences between CT angiography (CTA-FFRCT) (n = 135) and control (n = 135) patients with regard to age (66 ± 8 years), sex, comorbidities, or surgery performed. Coronary CTA showed ≥ 50% stenosis in 70% of patients with left main stenosis in 7%. FFRCT revealed silent coronary ischaemia in 68% of patients with severe ischaemia in 53%. The status of coronary ischaemia was unknown in the controls. At 30 days, CV death and MI in the CTA-FFRCT group were not statistically significantly different from controls (0% vs. 3.7% [p = .060] and 0.7% vs. 5.2% [p = .066], respectively). Post-operative coronary revascularisation was performed in 54 patients to relieve silent ischaemia (percutaneous coronary intervention in 47, coronary artery bypass graft in seven). At one year, CTA-FFRCT patients had fewer CV deaths (0.7% vs. 5.9%; p = .036) and MIs (2.2% vs. 8.1%; p = .028) and improved survival (p = .018) compared with controls. CONCLUSION: Pre-operative diagnosis of silent coronary ischaemia in patients undergoing lower extremity revascularisation surgery can facilitate multidisciplinary patient care with selective post-operative coronary revascularisation. This strategy reduced post-operative death and MI and improved one year survival compared with standard care.


Assuntos
Angiografia por Tomografia Computadorizada , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Extremidade Inferior/irrigação sanguínea , Infarto do Miocárdio/prevenção & controle , Doença Arterial Periférica/cirurgia , Procedimentos Cirúrgicos Vasculares , Idoso , Doenças Assintomáticas , Estudos de Casos e Controles , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/terapia , Estenose Coronária/complicações , Estenose Coronária/mortalidade , Estenose Coronária/terapia , Feminino , Reserva Fracionada de Fluxo Miocárdico , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/mortalidade , Doença Arterial Periférica/diagnóstico por imagem , Valor Preditivo dos Testes , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/mortalidade
12.
Nutr Metab Cardiovasc Dis ; 30(10): 1662-1672, 2020 09 24.
Artigo em Inglês | MEDLINE | ID: mdl-32684363

RESUMO

BACKGROUND AND AIMS: Current epidemiologic data suggest beneficial cardiovascular effects of fermented dairy products (FDP). However, the relationship between FDP consumption and angiographic coronary status has not been previously studied. Furthermore, the role of novel metabolomic biomarkers of cardiovascular risk in this context is unclear. We hypothesize that short-chain acylcarnitines (SCA) reflect the link between FDP intake and angiographic extent of stable coronary artery disease (CAD). METHODS AND RESULTS: We recruited 1185 patients admitted for suspected CAD [median age 62 years (interquartile range: 54-69); 714 men (60.3%)]. Prior to coronary angiography, each patient completed a validated Food Frequency Questionnaire. In addition, venous blood was collected from each patient for whole blood metabolomic analysis, using targeted mass-spectrometry. CAD was defined by the presence of ≥1 coronary stenosis ≥50%. Patients with CAD (n = 441) reported lower median FDP intake [86.8 g/day (IQR: 53.4-127.6)] than patients without CAD [n = 744; 103.9 g/day (IQR: 62.9-152.7); p < 0.001]. Upon adjustment for relevant confounders, increased circulating SCA, particularly level of acetylcarnitine (C2) associated with both higher CAD probability [SCA:ß(SE) = 0.584 (0.235), p = 0.013; C2:ß(SE) = 0.575 (0.242), p = 0.017] and decreased FDP consumption [SCA:ß/100 g FDP-increment/day (SE) = -0.785 (0.242), p = 0.001; C2:ß(SE) = -0.560 (0.230), p = 0.015]. By mediation analysis, neither SCA nor C2 showed relevant mediator effect linking FDP consumption to the risk of CAD. CONCLUSION: Increased consumption of fermented milk was associated with lower prevalence of CAD and correlated inversely with circulating SCA, in particular with acetylcarnitine. No substantial mediator effect of SCA linking fermented milk intake with risk of CAD was found. CLINICAL TRIAL REGISTRY: NCT00497887.


Assuntos
Carnitina/análogos & derivados , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Produtos Fermentados do Leite , Idoso , Biomarcadores/sangue , Carnitina/sangue , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/prevenção & controle , Estenose Coronária/sangue , Estenose Coronária/epidemiologia , Estenose Coronária/prevenção & controle , Estudos Transversais , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Fatores de Proteção , Fatores de Risco , Índice de Gravidade de Doença
13.
J Card Surg ; 35(10): 2785-2793, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32697006

RESUMO

BACKGROUND: Fractional flow reserve (FFR) is a well-established method for the evaluation of coronary artery stenosis before percutaneous coronary intervention. However, whether FFR assessment should be routinely used before coronary artery bypass graft surgery (CABG) remains unclear. A meta-analysis of prospectively randomized controlled trials (PRCTs) was carried out to compare the outcomes of FFR-guided CABG vs coronary angiography (CAG)-guided CABG. METHOD: The meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two PRCTs (the FARGO and GRAFFITI trials) were found and included reporting data on 269 patients with 6 and 12 month follow-up. Primary endpoints were rates of overall death, MACCE, target vessel revascularization, and spontaneous myocardial infarction (MI). Secondary endpoints were overall graft patency and patency of arterial and venous grafts. RESULTS: There were no significant differences between the FFR-guided and CAG-guided groups in the rates of overall death, MACCE, target vessel revascularization, spontaneous MI and graft patency. Meta-analysis of FARGO and GRAFFITI PRCTs showed that FFR-guided CABG and CAG-guided CABG produced similar clinical outcomes with similar graft patency rates up to a year postoperatively. CONCLUSION: Currently available PRCTs showes no sufficient evidence to support the use FFR in CABG.


Assuntos
Angiografia Coronária/métodos , Ponte de Artéria Coronária/métodos , Estenose Coronária/diagnóstico , Estenose Coronária/cirurgia , Reserva Fracionada de Fluxo Miocárdico , Resultados Negativos , Ensaios Clínicos Controlados Aleatórios como Assunto , Cirurgia Assistida por Computador/métodos , Angiografia Coronária/mortalidade , Ponte de Artéria Coronária/mortalidade , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/mortalidade , Seguimentos , Humanos , Cirurgia Assistida por Computador/mortalidade , Taxa de Sobrevida , Resultado do Tratamento
14.
Int J Cardiovasc Imaging ; 36(10): 2039-2050, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32488454

RESUMO

To explore the superiority of radiomics analysis in the diagnostic performance of coronary computed tomography angiography (CCTA) for identifying myocardial ischaemia and predicting major adverse cardiovascular events (MACE). A total of 105 lesions from 88 patients who underwent CCTA and invasive fractional flow reserve measurement were collected as the training set, and another 31 patients with CCTA and clinical outcome information were used as the validation set. Conventional CCTA features included the stenosis diameter, length, Agatston score and high-risk plaque characteristics. After extracting and selecting radiomics features, the robustness of the radiomics features was examined, and then conventional and radiomics models were established using logistic regressions. The area under the receiver operating characteristic (ROC) curve (AUC) and Net Reclassification Index (NRI) were analysed to compare the discrimination and classification abilities between the two models in both the training and validation sets. A total of 1409 radiomics features were extracted, and three wavelet features were finally screened out. The robustness test showed good stability for the refined radiomics features. Compared with the conventional model, the radiomics model displayed a significantly improved diagnostic performance in the training set (AUC 0.762 vs. 0.631, 95% confidence interval [CI] 0.671-0.853 vs. 0.519-0.742, P = 0.058) but a slightly improved diagnostic performance in the validation set (AUC 0.671 vs. 0.592, 95% CI 0.466-0.875 vs. 0.519-0.742, P = 0.448). The NRI of the radiomics model was increased in both the training and validation sets (NRI 0.198 and 0.238, respectively). Quantitative radiomics analysis was feasible and might help to improve the diagnostic performance of CCTA but is still controversial for predicting MACE.


Assuntos
Angiografia por Tomografia Computadorizada , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Reserva Fracionada de Fluxo Miocárdico , Interpretação de Imagem Radiográfica Assistida por Computador , Idoso , Doença da Artéria Coronariana/fisiopatologia , Estenose Coronária/fisiopatologia , Vasos Coronários/fisiopatologia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Índice de Gravidade de Doença , Análise de Ondaletas
15.
J Cardiovasc Magn Reson ; 22(1): 40, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32475355

RESUMO

BACKGROUND: In recent years, substantial advances have been made in noninvasive cardiac imaging, including cardiac computed tomography (CT) and cardiovascular magnetic resonance (CMR). The purpose of this study was to prospectively compare the diagnostic performance of contrast-enhanced whole heart coronary CMR angiography (CCMRA) to dual-source coronary CT angiography (CCTA) for the diagnosis of significant coronary stenoses (≥50%) in patients with known or suspected coronary artery disease (CAD) referred for conventional x-ray coronary angiography. METHODS: Our objective was to directly compare the diagnostic accuracy of contrast-enhanced whole-heart CCMRA (CE-CCMRA) to dual-source CCTA (DS-CCTA) for the detection of CAD. We prospectively studied 57 symptomatic patients with suspected or known CAD who were scheduled for conventional x-ray coronary angiography. Significant CAD was defined as an x-ray defined diameter reduction of ≥50% in a coronary artery with a reference diameter of ≥1.5 mm. RESULTS: CE-CCMRA and DS-CCTA were completed in 51 (89%) of 57 patients without complications. The acquisition times of CE-CCMRA and DS-CCTA, respectively, were 9.5 ± 3.1 min and 8.3 ± 1.4 s. On patient-based analysis, the sensitivity, specificity, positive and negative predictive value of CE-CCMRA and DS-CCTA were 93.5% versus 93.5%(P > 0.05), 85% versus 90%(P > 0.05), 90.6% versus 93.5%(P > 0.05), and 89.4% versus 90%(P > 0.05), respectively. The area under the curve (AUC) was 0.89 (95% CI: 0.79 to 0.99) for CE-CCMRA and 0.92 (95% CI: 0.83 to 1.00) for DS-CCTA. CONCLUSIONS: DS-CCTA was found to be superior to CE-CCMRA in the diagnosis of significant coronary stenoses (≥50%) in patients with suspected or known CAD scheduled for conventional x-ray coronary angiography, owing to shorter scanning times and higher spatial resolution. However, CE-CCMRA and DS-CCTA have similar diagnostic accuracies.


Assuntos
Angiografia por Tomografia Computadorizada , Angiografia Coronária , Estenose Coronária/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Angiografia por Ressonância Magnética , Imagem Cinética por Ressonância Magnética , Humanos , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Índice de Gravidade de Doença
16.
Nutr Metab Cardiovasc Dis ; 30(8): 1281-1288, 2020 07 24.
Artigo em Inglês | MEDLINE | ID: mdl-32522470

RESUMO

BACKGROUND AND AIMS: In Portugal, The Azores Archipelago has the highest standardized mortality rate for CAD. Therefore, the aim of this study was to evaluate conventional risk factors, as well as plasma and erythrocyte aminothiol concentration in high-risk Azorean patients undergoing elective coronary angiography and to investigate whether any aminothiol was associated with CAD risk and severity. METHODS AND RESULTS: 174 subjects with symptomatic CAD (age 56±9y; 68% men) submitted to coronary angiography were split into 2 groups: one formed by CAD patients (≥50% stenosis in at least one major coronary vessel) and the other by non-CAD patients (<50% stenosis). Both groups were age-, sex- and BMI-matched. Plasma and erythrocyte aminothiol profiles were evaluated by RP-HPLC/FLD. CAD patients significantly exhibited both higher concentrations of plasma Cys and hypercysteinemia (Cys ≥ 300 µM) prevalence than those in the non-CAD group (261 ± 58 µM vs. 243 ± 56 µM; 22% vs. 10%, respectively). No differences were observed between groups regarding plasma Hcy levels or hyperhomocysteinemia prevalence. After adjustment for several confounders (including Hcy), subjects in the highest quartile of plasma Cys had a 3.31 (95% CI, 1.32-8.30, p = 0.011) fold risk for CAD, compared with those in the lowest quartiles. Furthermore, plasma Cys levels (but not Hcy) tended to increase with the number of stenotic vessels (1VD: 253 ± 64 µM; 2VD: 262 ± 52 µM; 3VD: 279 ± 57 µM, p = 0.129). CONCLUSION: Hypercysteinemia revealed to be a better predictor of CAD than hyperhomocysteinemia. Moreover, plasma Cys showed to be a useful biomarker for CAD both in primary and secondary preventions, seeming to resist better than Hcy to oral medication therapy.


Assuntos
Doença da Artéria Coronariana/sangue , Estenose Coronária/sangue , Cisteína/sangue , Homocisteína/sangue , Hiper-Homocisteinemia/sangue , Adulto , Idoso , Biomarcadores/sangue , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/prevenção & controle , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/epidemiologia , Feminino , Humanos , Hiper-Homocisteinemia/diagnóstico , Hiper-Homocisteinemia/tratamento farmacológico , Hiper-Homocisteinemia/epidemiologia , Masculino , Pessoa de Meia-Idade , Portugal/epidemiologia , Valor Preditivo dos Testes , Prevalência , Prevenção Primária , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Prevenção Secundária , Índice de Gravidade de Doença
17.
Int J Cardiovasc Imaging ; 36(11): 2281-2289, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32535842

RESUMO

To investigate the correlation of epicardial adipose tissue (EAT) characteristics and high-risk plaque features characterized by coronary CT angiography (CCTA) for identifying the presence of thin-cap fibroatheroma (TCFA). Patients who underwent both CCTA and intravascular ultrasound (IVUS) within 4 weeks were retrospectively included. CT-derived quantitative and qualitative parameters, including diameter stenosis, low attenuation plaque (LAP), napkin-ring sign (NRS), positive remodeling and spotty calcification, were recorded. EAT volume and density were also measured. TCFA lesions and non-TCFA lesions were determined by IVUS. Multivariate regression analysis was used to determine the independent predictors of TCFA lesions. Sixty-eight patients (mean age: 68.6 ± 9.7 years; 40 males) with 91 lesions were finally included in our study. For CT-derived plaque features, LAP (77.8% versus 25%, p < 0.001) and NRS (40.7% versus 9.4%, p < 0.001) was more frequently presented in TCFA lesions than was in non-TCFA lesions. For EAT characteristics, EAT volume (110 ± 14 cm3 versus 98 ± 12 cm3, p < 0.001) was significantly larger whereas EAT density (-77 ± 4 HU versus -80 ± 5, p = 0.003) was markedly higher in TCFA lesions. According to multivariate logistic regression analysis, LAP, EAT volume and EAT density were significant predictors (odds ratio: 9.758, 1.095 and 1.202, all p value < 0.05) for the presence of TCFA lesions. EAT volume and density was greater in patients with TCFA lesions whereas LAP and NRS was more frequently presented. In addition, EAT characteristics and LAP were independent predictors of vulnerable plaques as determined by IVUS.


Assuntos
Tecido Adiposo/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Pericárdio/diagnóstico por imagem , Placa Aterosclerótica , Ultrassonografia de Intervenção , Idoso , Progressão da Doença , Feminino , Fibrose , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Ruptura Espontânea
18.
Vascular ; 28(6): 808-815, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32493182

RESUMO

BACKGROUND: Coronary artery disease requiring coronary artery bypass graft (CABG) frequently coexists with critical carotid stenosis. The most optimized strategy for treating concomitant carotid and coronary artery disease remains debatable. OBJECTIVE: The aim of this meta-analysis was to compare synchronous CAS and CABG versus staged CAS and CABG for patients with concomitant coronary artery disease and carotid artery stenosis in terms of peri-operative (30-day) and long-term clinical outcomes. METHODS: This study was performed according to the PRISMA guidelines. Eligible studies were identified through a search of PubMed, Scopus and Cochrane database until December 2019. A meta-analysis was conducted with the use of a random effects model. The I-square statistic was used to assess heterogeneity. RESULTS: Four studies comprising 357 patients were included in this meta-analysis. Patients who were treated with the synchronous approach had a statistically significant higher risk for peri-operative stoke (OR: 3.71; 95% CI: 1.00-13.69; I2 = 0%) compared tο the staged group. Peri-operative mortality (OR: 4.50; 95% CI: 0.88-23.01; I2 = 0%), myocardial infarction (MI) (OR: 1.54; 95% CI: 0.18- 13.09; I2 = 0%), postoperative bleeding (OR: 0.27;95% CI: 0.02-3.12; I2 = 0%), transient ischemic attacks (TIA) (OR: 0.60; 95% CI: 0.04- 9.20; I2 = 0.0%), acute kidney injury (AKI) (OR: 0.34; 95% CI: 0.03-4.03; I2 = 0.0%) and atrial fibrillation rates (OR:0.27; 95% CI: 0.02-3.12; I2 = 0.0%) were similar between the two groups. Synchronous CAS-CABG and staged CAS followed by CABG were associated with similar rates of late mortality (OR: 3.75; 95% CI: 0.50-27.94; I2 = 0.0%), MI (OR: 0.33; 95% CI: 0.01-12.03; I2 = 0.0%) and stroke (OR:3.58; 95% CI:0.84-15.20; I2 = 0.0%) after a mean follow-up of 47 months. CONCLUSION: The simultaneous approach was associated with an increased risk of 30-day stroke compared to staged CAS and CABG. However, no statistically significant difference was found in long-term results of mortality, MI and stroke between the two approaches. Future studies are warranted to validate our results.


Assuntos
Estenose das Carótidas/terapia , Ponte de Artéria Coronária , Estenose Coronária/cirurgia , Procedimentos Endovasculares/instrumentação , Idoso , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/mortalidade , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/mortalidade , Estenose Coronária/complicações , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/mortalidade , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Stents , Fatores de Tempo , Resultado do Tratamento
19.
J Cardiothorac Surg ; 15(1): 124, 2020 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-32498681

RESUMO

BACKGROUND: Woven coronary artery (WCA) is an extremely rare congenital anomaly in which a part of epicardial coronary artery is divided into thin channels, that twist along the axis of the coronary arteries and then merge again as the main coronary lumen. This anomaly is regarded as a benign condition because the blood flow is normal. Very few cases of WCA have been reported. CASE PRESENTATION: Herein we report a case of a 44-year-old man who was admitted to our hospital due to 20 years of repeated episodes of heart palpitations, 2 years of shortness of breath after activity, and the symptoms were aggravated for 1 month. He had history of inferior myocardial infarction and atrial fibrillation. Color Doppler echocardiography revealed rheumatic heart disease, severe mitral regurgitation, mild-moderate tricuspid regurgitation, moderate pulmonary hypertension. Coronary angiography revealed 60-85% diffuse stenosis in the middle of left anterior descending artery, 60-90% diffuse stenosis in the middle of left circumflex artery, 30-40% diffuse stenosis in the proximal segment of right coronary artery, and WCA anomaly in the middle, and distal segments of right coronary artery. CONCLUSION: The patient successfully underwent prosthetic valve replacement and left anterior descending coronary artery bypass grafting, and had a good recovery after surgery. Further studies are needed to fully understand the disease and determine appropriate treatment options.


Assuntos
Estenose Coronária/diagnóstico por imagem , Anomalias dos Vasos Coronários/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico por imagem , Infarto do Miocárdio/etiologia , Cardiopatia Reumática/diagnóstico por imagem , Adulto , Angiografia Coronária , Ponte de Artéria Coronária , Estenose Coronária/complicações , Estenose Coronária/cirurgia , Anomalias dos Vasos Coronários/complicações , Ecocardiografia Doppler em Cores , Implante de Prótese de Valva Cardíaca , Humanos , Hipertensão Pulmonar/complicações , Masculino , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/cirurgia , Cardiopatia Reumática/complicações , Cardiopatia Reumática/cirurgia , Insuficiência da Valva Tricúspide/complicações , Insuficiência da Valva Tricúspide/diagnóstico por imagem
20.
Int J Cardiovasc Imaging ; 36(7): 1249-1260, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32405734

RESUMO

This study aimed to clarify the diagnostic and prognostic potential of strain rate in patients with suspected stable angina pectoris (SAP). Strain rate by 2-dimensional speckle tracking echocardiography (2DSTE) has been suggested to be able to diagnose coronary artery disease (CAD) and predict cardiovascular events in various patient groups. Prospectively enrolled patients (n = 296) with suspected SAP, no previous cardiac disease, and normal left ventricular ejection fraction were examined by 2DSTE, exercise ECG, and coronary angiography. Obstructive CAD was defined as stenosis ≥ 70% in ≥ 1 coronary artery on coronary angiography (n = 107). Major adverse cardiac events (MACE) included myocardial infarction, heart failure, atrial fibrillation, and stroke. In multivariable analysis adjusted for baseline data, conventional echocardiography, and Duke score, early diastolic strain rate (SRe) was independently associated with significant CAD with a 1.35 increased risk of having CAD per 0.1 decrease in SRe (OR = 1.35, 95% CI 1.03-1.76, P = 0.027). Peak velocity of early diastolic filling (E)/SRe was not associated with significant CAD (OR = 1.14, 95% CI 0.81-1.62, P = 0.445). MACE occurred in 34 patients (12%) during follow-up (median 3.5 years) and both SRe (HR 1.26, 95% CI (1.07-1.49), P = 0.006) and E/SRe (HR 1.24, 95% CI (1.04-1.47), P = 0.017) were independent predictors after multivariable adjustment. In patients with suspected SAP, SRe by 2DSTE was independently associated with presence of CAD. In addition, SRe and E/SRe provided independent and incremental prognostic value for predicting future MACE.


Assuntos
Angina Estável/diagnóstico por imagem , Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Ecocardiografia , Função Ventricular Esquerda , Idoso , Angina Estável/fisiopatologia , Doença da Artéria Coronariana/fisiopatologia , Estenose Coronária/fisiopatologia , Diástole , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo
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