Valore prognostico della tomografia computerizzata multistrato in una popolazione di pazienti con sospetta cardiopatia ischemica

Background: La tomografia computerizzata (TC) multistrato coronarica permette l’identificazione di placche coronariche con elevate accuratezza diagnostica ed è caratterizzata da un elevato potere predittivo negativo per l’esclusione di malattia coronarica se confrontata con l’angiografia coronarica. Tuttavia il potere predittivo della metodica non è ancora noto. Lo scopo di questo studio è di valutare il potere predittivo della TC multistrato coronarica per eventi cardiaci maggiori in paziente con sospetta cardiopatia ischemica. Metodi: Sono stati sottoposti a TC 64 strati (Somatom Sensation 64, Siemens) 187 pazienti (119 uomini, età 62.5 ± 10.5 anni) con sospetta cardiopatia ischemica. I pazienti sono stati sottoposti a follow up ed è stata valutata l’incidenza di morte cardiaca, infarto miocardico non fatale e rivascolarizzazione miocardica. Risultati: Su un totale di 2822 segmenti coronarici, 42 (1.5%) sono risultati non valutabili a causa di artefatti da movimento. La frequenza cardiaca media durante l’esame è stata pari a 62.5 ± 10.2 bpm. In 65 (34.7%) pazienti la TC multistrato ha mostrato l’assenza di aterosclerosi coronarica, in 87 (46.5%) pazienti la TC multistrato ha identificato placche coronarica non ostruttive (placche coronarica ≤50%), in 35 (18.8%) pazienti la TC multistrato ha identificato placche ostruttive (>50%). Dopo un follow up medio di 24 mesi, si sono verificati 23 eventi cardiaci maggiori. (3 infarti miocardici, 19 rivascolarizzazioni cardiache, 1 ospedalizzazione per angina instabile). Si è inoltre verificata una morte non cardiaca. Nei pazienti con coronarie normali, il tasso di eventi è stato pari a 0%. Tre dei pazienti con coronaropatia non ostruttiva sono stati sottoposti a rivascolarizzazione miocardica. Fra i pazienti con coronaropatia ostruttiva, 3 pazienti hanno avuto un infarto miocardico, 16 pazienti sono stati sottoposti a rivascolarizzazione e un paziente ha avuto una ospedalizzazione per angina instabile. Conclusioni: La TC multistrato mostra un valore predittivo negativo pari al 100% per eventi cardiaci maggiori nei pazienti con arterie coronarie normali. L’incidenza di eventi cardiaci tende ad incrementare all’aumentare della severità della coronaropatia ed è maggiore nei pazienti con malattia coronarica ostruttiva

An unusual case of high central venous pressure

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Evaluation of Coronary Atherosclerosis by Multislice Computed Tomography in Patients With Acute Myocardial Infarction and Without Significant Coronary Artery Stenosis

Background— It is known that 9% to 31% of women and 4% to 14% of men with acute myocardial infarction have normal coronary arteries or nonsignificant coronary disease at angiography. These patients represent a diagnostic and therapeutic challenge. Multislice computed tomography (CT) can noninvasively identify the presence of coronary plaques even in the absence of significant coronary artery stenosis. This study evaluated the role of 64-slice CT, in comparison with coronary angiography, in detecting and characterizing coronary atherosclerosis in patients with acute myocardial infarction without significant coronary artery stenosis. Methods and Results— Thirty consecutive patients with acute myocardial infarction but without significant coronary stenosis at coronary angiography underwent 64-slice CT. All coronary segments were quantitatively analyzed by means of coronary angiography (CA-QCA) and 64-slice CT (CT-QCA). Forty-seven (10.4%) of the 450 coronary segments were not evaluable by CT. The mean proximal reference diameters at CT-QCA and CA-QCA were, respectively, 2.88�0.75 mm and 2.65�0.9 mm; the overall correlation between CT-QCA and CA-QCA for quantification of reference diameter was r s =0.77; P <0.001. The mean percent stenosis was 14.4�8.0% at CT-QCA and 4.0�11.0% at CA-QCA and the correlation was r s =0.11; P =0.03. Overall CT-QCA showed the presence of 50 plaques, of which only 11 were detected by CA-QCA. CT-QCA identified 25 plaques in infarct-related coronary arteries. Positive remodeling was present in 38 of the 50 plaques (76%), with a higher prevalence in the coronary plaques not visualized by CA-QCA (82.1% versus 54.5%). Conclusions— CT-QCA correlates well with CA-QCA in terms of coronary reference diameter analysis, but not stenosis quantification. Multislice CT can detect coronary atherosclerotic plaques in segments of nonstenotic coronary arteries that are underestimated by CA and may have an incremental diagnostic value for the diagnosis of acute myocardial infarction in patients without significant coronary stenosis at CA

Prevalence of anatomical variants and coronary anomalies in 543 consecutive patients studied with 64-slice CT coronary angiography

The aim of our study was to assess the prevalence of variants and anomalies of the coronary artery tree in patients who underwent 64-slice computed tomography coronary angiography (CT-CA) for suspected or known coronary artery disease. A total of 543 patients (389 male, mean age 60.5 ± 10.9) were reviewed for coronary artery variants and anomalies including post-processing tools. The majority of segments were identified according to the American Heart Association scheme. The coronary dominance pattern results were: right, 86.6%; left, 9.2%; balanced, 4.2%. The left main coronary artery had a mean length of 112 ± 55 mm. The intermediate branch was present in the 21.9%. A variable number of diagonals (one, 25%; two, 49.7%; more than two, 24%; none, 1.3%) and marginals (one, 35.2%; two, 46.2%; more than two, 18%; none, 0.6%) was visualized. Furthermore, CT-CA may visualize smaller branches such as the conus branch artery (98%), the sinus node artery (91.6%), and the septal branches (93%). Single or associated coronary anomalies occurred in 18.4% of the patients, with the following distribution: 43 anomalies of origin and course, 68 intrinsic anomalies (59 myocardial bridging, nine aneurisms), three fistulas. In conclusion, 64-slice CT-CA provides optimal visualization of the variable and complex anatomy of coronary arteries because of the improved isotropic spatial resolution and flexible post-processing tool

Prediction model to estimate presence of coronary artery disease: retrospective pooled analysis of existing cohorts

Objectives To develop prediction models that better estimate the pretest probability of coronary artery disease in low prevalence populations