Multislice computed tomography in an asymptomatic high-risk population.

Approximately 50% of all acute coronary syndromes occur in previously asymptomatic patients. This study evaluated the value of multislice computed tomography for early detection of significant coronary artery disease (CAD) in high-risk asymptomatic subjects. One hundred sixty-eight asymptomatic subjects with >or=1 major risk factor (hypertension, diabetes, hypercholesterolemia, family history, or smoking) and an inconclusive or unfeasible noninvasive stress test result (stress electrocardiography, echocardiography, or nuclear scintigraphy) were evaluated in an outpatient setting. After clinical examination and laboratory risk analysis, all patients underwent multislice computed tomographic (MSCT) coronary angiography within 1 week. In all subjects, conventional coronary angiography was also carried out. Multislice computed tomography displayed single-vessel CAD in 16% of patients, 2-vessel CAD in 7%, and 3-vessel CAD in 4%. Selective coronary angiography confirmed the results of multislice computed tomography in 99% of all patients. Sensitivity and specificity of MSCT coronary angiography were 100% and 98%, respectively, with a positive predictive value of 95% and a negative predictive value of 100%. In conclusion, MSCT coronary angiography is an excellent noninvasive technique for early identification of significant CAD in high-risk asymptomatic patients with inconclusive or unfeasible noninvasive stress test results.

Limitations of four-slice multirow detector computed tomography in the detection of coronary stenosis.

BACKGROUND: Our aim was to compare 4-slice spiral computed tomography with conventional coronary angiography in the detection of significant (> 50%) coronary stenosis. METHODS: Sixty-two patients (41 males, 21 females, mean age 60 +/- 8 years) with suspected coronary artery disease were submitted to coronary angiography and then to multislice spiral computed tomography (GE Light Speed 4 slice) performed 12 +/- 5 days later. RESULTS: We excluded 25% of the patients from analysis because of a heart rate > 70 b/min or because of frequent ectopic beats. We also excluded from analysis 23% of all the angiographic segments judged not evaluable at multislice spiral computed tomography. Within these limits, the sensitivity was 65%, the specificity 98%, the positive predictive value 88%, and the negative predictive value 92%. CONCLUSIONS: By considering the intrinsic limitations such as its low temporal and spatial resolution, 4-slice spiral computed tomography has a limited applicability and has to be used with caution in the evaluation of native coronary arteries.

Correlations between personality factors and coronary artery disease: from type A behaviour pattern to type D personality.

During the last 50 years, many studies have analysed the correlations between personality factors, behavioural pattern, personality type, psychiatric disorders and coronary artery disease (CAD). Although consistent evidence of causal association between CAD and major depressive disorders does exist, the role and importance of personality factors and character traits in CAD development and manifestations are still debatable. We reported the most important studies from the literature on type A behaviour pattern (TABP), the first correlated to CAD. After the initial enthusiasms, large clinical trials raised doubts about the role of TABP as CAD risk factor. We reported subsequent researches aimed at extracting from TABP components predisposing to atherosclerosis, such as hostility and anger. Finally, we analysed a recent personality type (type D) introduced in 1995 and identified as a negative prognostic factor in CAD patients.

In-stent restenosis and multislice computed tomography: is the method ready to start?

We present two patients revascularized by coronary stents and evaluated by multislice computed tomography (CT). In first patient, angio-CT (16 slices/rotation scanner) detected a high-grade restenosis on the distal part of a drug-eluting stent; conventional coronary angiography confirmed the diagnosis. In second patient, angio-CT (64 slices/rotation) showed a tissue proliferation, non-flow-limiting, in the proximal part of a bare metal stent; conventional angiography confirmed the diagnosis. Blooming effects and partial volume averaging still limit the widespread application of this method. New scanners and the use of a special convolution kernel are likely to improve the accuracy of CT angiography in patients with stents.

Association between enhanced soluble CD40 ligand and proinflammatory and prothrombotic states in major depressive disorder: pilot observations on the effects of selective serotonin reuptake inhibitor therapy.

OBJECTIVE: Major depressive disorder (MDD) is associated with low-grade inflammation, and it is considered a risk factor for coronary artery disease (CAD). CD40 ligand (CD40L) plays an important role in inflammation, platelet activation, and clotting system activation. We investigated soluble CD40L (sCD40L) expression in MDD and assessed whether it may represent a molecular mechanism that links inflammation and a prothrombotic state and whether this condition may be modified by selective serotonin reuptake inhibitor (SSRI) therapy. METHOD: Levels of sCD40L, interleukin-1beta (IL-1beta), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), soluble P-selectin (sP-selectin), activated factor VII (FVIIa), and prothrombin fragment 1+2 (F1+2) were measured in 46 drug-naïve, first-episode MDD patients without conventional CAD risk factors and in 46 matched healthy controls. Participants were screened between March 2002 and November 2005. Twenty of the 46 MDD patients were then randomly assigned to either sertraline 100 mg/day (N = 10) or citalopram 20 mg/day (N = 10); the aforementioned variables were measured at baseline and after 6 weeks of treatment. RESULTS: Compared with control subjects, MDD patients had higher baseline levels of sCD40L, IL-1beta, IL-6, TNF-alpha, sP-selectin, FVIIa, and F1+2. In the clinical group, sCD40L levels, HAM-D total scores, and proinflammatory markers were strongly intercorrelated. In contrast, there were no significant correlations in the control group. Mood improvement achieved with SSRI therapy was associated with significant reduction in sCD40L, proinflammatory markers, and prothrombotic markers expression. (All p values < .0001.) CONCLUSIONS: This pilot study shows that CD40/ CD40L pathway up-regulation in MDD patients relates increased levels of sCD40L to a prothrombotic state and, preliminarily, indicates that SSRI therapy may significantly reduce sCD40L and CD40L levels associated with proinflammatory and prothrombotic states.

Accuracy of thin-slice computed tomography in the detection of coronary stenoses.

AIM: Our aim was to investigate the accuracy of multislice spiral computed tomography (MSCT) in the detection of significant (>50%) coronary stenosis using a scanner equipped for 16 x 0.625 mm collimation. METHODS: In 64 patients (59 male, mean age 58 +/- 5 years) with suspected coronary artery disease, MSCT (GE Light Speed-16, collimation: 16 x 0.625 mm) was performed 20 +/- 5 days before coronary angiography (CAG). Only angiographic segments >1.5 mm were considered for analysis. RESULTS: In all patients, MSCT was carried out without complications. Three patients were excluded from the analysis. Of 729 angiographic segments, 613 (84%) were judged evaluable by MSCT. Considering only the segments judged evaluable, the sensitivity was 89%, specificity 98%, positive predictive value 90%, and negative predictive value 98%. Including all segments in the analysis (evaluable and nonevaluable), sensitivity was 78%. CONCLUSIONS: Using a scanner with a collimation of 16 x 0.625 mm, our study confirms the potential role of MSCT in the detection of significant coronary stenosis with a sensitivity of 89% and a very high specificity (98%). Exclusion criteria and less than full evaluability of the coronary arteries must still be considered limitations of the method.