Non-invasive assessment of coronary artery bypass graft patency using 16-slice computed tomography angiography

<p>Abstract</p> <p>Background</p> <p>Invasive coronary angiography is the gold standard means of imaging bypass vessels and carries a small but potentially serious risk of local vascular complications, including myocardial infarction, stroke and death. We evaluated computed tomography as a non-invasive means of assessing graft patency.</p> <p>Methods</p> <p>Fifty patients with previous coronary artery bypass surgery who were listed for diagnostic coronary angiography underwent contrast enhanced computed tomography angiography using a 16-slice computed tomography scanner. Images were retrospectively gated to the electrocardiogram and two dimensional axial, multiplanar and three dimensional reconstructions acquired. Sensitivity, specificity, positive and negative predictive value, accuracy and level of agreement for detection of graft patency by multidetector computed tomography.</p> <p>Results</p> <p>A total of 116 grafts were suitable for analysis. The specificity of CT for the detection of graft patency was 100%, with a sensitivity of 92.8%, positive predictive value 100%, negative predictive value 85.8% and an accuracy of 94.8%. The kappa value of agreement between the two means of measuring graft patency was 0.9. Mean radiation dose was 9.0 ± 7.2 mSv for coronary angiography and 18.5 ± 4 mSv for computed tomography. Pooled analysis of eight studies, incorporating 932 grafts, confirmed a 97% accuracy for the detection of graft patency by multidetector computed tomography.</p> <p>Conclusion</p> <p>Computed tomography is an accurate, rapid and non-invasive method of assessing coronary artery bypass graft patency. However, this was achieved at the expense of an increase in radiation dose.</p

Luci ed ombre della terapia ormonale sostitutiva nella prevenzione cardiovascolare.

MONOGRAFIA MENOPAUS

Calcificazioni coronariche nei pazienti affetti da diabete mellito

The use of noninvasive imaging techniques like electron beam and multislice computed tomography, to measure coronary artery calcium, is becoming increasingly accepted for risk stratification in both symptomatic and asymptomatic populations. The National Cholesterol Education Panel guidelines indicate that measurement of coronary calcium is an option for advanced risk assessment in appropriately selected persons. Because of the recognized high risk for cardiovascular events in patients with diabetes, they belong to the same high-risk category previously reserved for patients with known coronary heart disease. Diabetic patients might benefit from risk stratification with these noninvasive techniques. Indeed, absence of coronary calcium might indicate a low risk for events, while the presence of moderate to high calcium scores may help physicians to better gauge the intensity of medical therapy provided to their patients

Subclinical coronary artery atherosclerosis in healthy women with nonalcoholic fatty liver disease

Subclinical coronary artery atherosclerosis in healthy women with nonalcoholic fatty liver diseas

Follow-up of coronary artery bypass graft patency by multislice computed tomography

Fifty-two consecutive asymptomatic patients with a total of 166 bypass grafts were investigated by 16-slice computed tomography (CT) 15 +/- 5 days before invasive coronary angiography. Overall, 165 grafts (99.40%) were assessable with multislice CT (MSCT). Coronary angiography showed that 111 grafts (67%) were patent and 54 (33%) were occluded. of the patent grafts, 22 had high-grade stenoses. MSCT correctly classified 1 grafts as patent and 54 as occluded. Of the patent grafts, 16-slice CT correctly detected 21 bypass stenoses (95%). These results yielded 100% sensitivity and specificity of 16-slice CT for detecting bypass grafts occlusion and 96% sensitivity and 100% specificity for detecting high-grade stenoses in patent grafts

Three-Tesla cardiac magnetic resonance imaging in a Marfan patient with asymptomatic aortic dissection.

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Early aggressive versus conservative managment on one year outcome in octogenarians patients with unstable angina and non-st-elevation myocardial infarction

Early aggressive versus conservative managment on one year outcome in octogenarians patients with unstable angina and non-st-elevation myocardial infarctio

Subclinical coronary artery atherosclerosis in patients with erectile dysfunction

OBJECTIVES The purpose of our study was to assess the prevalence and extent of coronary artery atherosclerosis in asymptomatic patients with vascular erectile dysfunction (ED). BACKGROUND An association between ED and ischemic heart disease has been suggested, but it is unknown if it represents a marker of subclinical coronary atherosclerosis. METHODS We studied 70 consecutive patients with vascular ED, evaluated by penile Doppler, and 73 control subjects with no history of coronary artery disease. We measured traditional coronary risk factors, circulating levels of C-reactive protein (CRP), endothelial function by ultrasound of brachial artery, and coronary artery calcification by multi-slice computed tomography. RESULTS The patients and the control group were similar for age, race, and coronary risk score. Patients with ED had significantly higher high-sensitivity C-reactive protein levels (2.62 vs. 1.03 mg/l, p < 0.001). Flow-mediated dilation of the brachial artery was more impaired in patients with ED than in controls (2.36 vs. 3.92, p < 0.001). Coronary artery calcification was more frequent in individuals with ED than in control subjects (p = 0.01). Multiple logistic regression analysis showed that patients with ED had an overall odds ratio of 3.68 for having calcium score above the 75th percentile, compared to the controls. CONCLUSIONS Coronary atherosclerosis is more severe in patients with vascular ED; ED predicts the presence and extent of subclinical atherosclerosis independent of traditional risk factors for cardiovascular disease. Thus, ED may be considered an additional, early warning sign of coronary atherosclerosis