10 research outputs found
Dual energy imaging and intracycle motion correction for CT coronary angiography in patients with intermediate to high likelihood of coronary artery disease
We explored whether intracycle motion correction algorithms (MCAs) might be applicable to dual energy computed tomography coronary angiography in patients with intermediate to high likelihood of coronary artery disease. MCA reconstructions were associated with higher interpretability rates (96.7% vs 87.9%, P < .001), image quality scores (4.12±0.9 vs. 3.76±1.0; P < .0001), and diagnostic performance [area under the curve of 0.95 (95% confidence interval [CI] 0.92-0.97) vs 0.89 (95% CI 0.86-0.92); P < .0001] compared to conventional reconstructions. In conclusion, application of intracycle MCA reconstructions to dual energy computed tomography acquisitions was feasible and resulted in significantly higher image quality scores, interpretability, and diagnostic performance.Fil: Carrascosa, Patricia. Diagnóstico Maipú; ArgentinaFil: Deviggiano, Alejandro. Diagnóstico Maipú; ArgentinaFil: Leipsic, Jonathon A.. St. Paul's Hospital; CanadáFil: Capunay, Carlos. Diagnóstico Maipú; ArgentinaFil: De Zan, Macarena C.. Diagnóstico Maipú; ArgentinaFil: Goldsmit, Alejandro. Sanatorio Güemes; ArgentinaFil: Rodriguez Granillo, Gaston Alfredo. Diagnóstico Maipú; Argentina. Consejo Nacional de Investigaciones CientÃficas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Cardiológicas. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Cardiológicas; Argentin
TCT-300 Role of Dual Energy in contrast load reduction in the evaluation of coronary artery disease
Effect of Intracycle Motion Correction Algorithm on Image Quality and Diagnostic Performance of Computed Tomography Coronary Angiography in Patients with Suspected Coronary Artery Disease
Rationale and objectives: We sought to explore the impact of intracycle motion correction algorithms (MCA) in the interpretability and diagnostic accuracy of computed tomography coronary angiography (CTCA) performed in patients suspected of coronary artery disease (CAD) referred to invasive coronary angiography. Materials and Methods: Patients with suspected CAD referred to invasive coronary angiography previously underwent CTCA. Patients under rate-control medications were advised to withhold for the previous 24hours. The primary end point of the study was to evaluate image interpretability and diagnostic performance of MCA compared to conventional reconstructions in patients referred to invasive angiography because of suspected CAD. Results: Thirty-five patients were prospectively included in the study protocol. The mean age was 61.4±9.4years. Twenty-seven (77%) patients were men. A total of 533 coronary segments were evaluated using conventional and MCA reconstructions. MCA reconstructions were associated to higher interpretability rates (525 of 533, 98.5% vs. 515 of 533, 96.6 %; P<.001) and image quality scores (3.88±0.54 vs. 3.78±0.76; P<.0001) compared to conventional reconstructions. Although only mild, a significant difference was observed regarding the diagnostic performance between reconstruction modes, with an area under the curve of 0.90 (0.87-0.92) versus 0.89 (0.86-0.92), respectively, for MCA and conventional reconstructions (. P=.0447). Conclusions: In this pilot investigation, MCA reconstructions performed in patients with suspected CAD were associated to higher interpretability rates and image quality scores compared to conventional reconstructions, although only mild differences were observed regarding the diagnostic performance between reconstruction modes.Fil: Carrascosa, Patricia. Sanatorio Güemes; Argentina. Diagnóstico Maipú; ArgentinaFil: Deviggiano, Alejandro. Sanatorio Güemes; Argentina. Diagnóstico Maipú; ArgentinaFil: Capunay, Carlos. Sanatorio Güemes; Argentina. Diagnóstico Maipú; ArgentinaFil: De Zan, Macarena C.. Sanatorio Güemes; Argentina. Diagnóstico Maipú; ArgentinaFil: Goldsmit, Alejandro. Sanatorio Güemes; Argentina. Diagnóstico Maipú; ArgentinaFil: Rodriguez Granillo, Gaston Alfredo. Diagnóstico Maipú; Argentina. Sanatorio Güemes; Argentina. Consejo Nacional de Investigaciones CientÃficas y Técnicas; Argentin
Monochromatic image reconstruction by dual energy imaging allows half iodine load computed tomography coronary angiography
Purpose: To compare image interpretability and diagnostic performance of dual-energy CT coronary angiography (DE-CTCA) performed with 50% iodine load reduction versus single energy acquisitions (SE-CTCA) with full iodine load. Materials and methods: The present prospective study involved patients with suspected coronary artery disease (CAD) clinically referred for CTCA. DE-CTCA with 50% iodine volume load was performed first, and after heart rate returned to baseline SE-CTCA was performed using full iodine volume load. The primary endpoint was to compare image interpretability between groups. DE-CTCA was performed by rapid switching between low and high tube potentials (80–140 kV) from a single source, allowing the generation of monochromatic image reconstructions ranging from 40 to 140 keV. Image quality assessment was performed using a 5-point Likert scale. Results: Thirty-six patients constituted the study population. The mean heart rate before the CT scan (DE-CTCA 57.3 ± 10.7 bpm vs. SE-CTCA 58.5 ± 11.2 bpm, p = 0.29) and the mean effective radiation dose (3.5 ± 1.9 mSv vs. 3.8 ± 0.9 mSv, p = 0.48) did not differ between groups. Likert image quality scores were similar between groups (DE-CTCA 4.42 ± 0.98 vs. SE-CTCA 4.43 ± 0.84, p = 0.67). Signal-to-noise and contrast-to-noise ratios were significantly lower with DE-CTCA, driven by lower signal density levels at 60 keV compared to SE-CTCA. The sensitivity and specificity for the detection of stenosis >50% was indistinguishable between groups (DE-CTCA 84.4% (69.9–93.0%), 87.1% (81.6–91.2%); SE-CTCA 84.4% (69.9–93.0%), 87.1% (81.6–91.2%). Conclusions: In this pilot, prospective study, dual energy CTCA imaging with half iodine load achieved comparable interpretability than full iodine load with single energy CTCA.Fil: Carrascosa, Patricia. Diagnostico Maipu; ArgentinaFil: Leipsic, Jonathon A.. St. Paul's Hospital; CanadáFil: Capunay, Carlos. Diagnostico Maipu; ArgentinaFil: Deviggiano, Alejandro. Diagnostico Maipu; ArgentinaFil: Vallejos, Javier. Diagnostico Maipu; ArgentinaFil: Goldsmit, Alejandro. Sanatorio Güemes; ArgentinaFil: Rodriguez Granillo, Gaston Alfredo. Diagnostico Maipu; Argentina. Consejo Nacional de Investigaciones CientÃficas y Técnicas; Argentin
Invasive coronary angiography findings across the CAD-RADS classification spectrum
The recently introduced coronary artery disease reporting and data system (CAD-RADS) evaluated by computed tomography and based on stenosis severity, might not adequately reflect the complexity of CAD. We explored the relationship between CAD-RADS and the spatial distribution, burden, and complexity of lesions by invasive coronary angiography (ICA). Stable patients who underwent coronary computed tomography angiography (CCTA) and ICA comprised the study population. Patients were classified according to the CAD-RADS: 0, No plaque; 1, 1–24% stenosis; 2, 25–49%; 3, 50–69%; 4A, 70–99%; 4B, left main stenosis or 3-vessel obstructive disease; and 5, total occlusion. Based on ICA findings, we calculated the SYNTAX score and the CAD extension index. Ninety-one patients were included, with a mean age of 61.4 ± 10.5 years (74% male). We found significant relationships between CAD-RADS and both the SYNTAX score (p 5. Of the 30 patients with CAD-RADS 5, 9 (30%) affected distal segments or secondary branches, and 9 (30%) had concomitant severe non-extensive disease at ICA. Regarding the spatial distribution of the non-occluded most severe lesions, 27 (44%) comprised distal segments or secondary branches. In the present study including a high-risk population, we identified diverse coronary anatomy complexity scenarios and relevant differences in spatial distribution sharing the same CAD-RADS classification.Fil: Rodriguez Granillo, Gaston Alfredo. Consejo Nacional de Investigaciones CientÃficas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Cardiológicas. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Cardiológicas; Argentina. Diagnóstico Maipú; ArgentinaFil: Carrascosa, Patricia. Diagnóstico Maipú; ArgentinaFil: Goldsmit, Alejandro. Sanatorio Guemes Sociedad Anonima.; ArgentinaFil: Arbab Zadeh, Armin. University Johns Hopkins; Estados Unido
Extensión y distribución espacial de la carga ateroesclerótica mediante imágenes monocromáticas virtuales derivadas de tomografÃa computarizada de doble energÃa
Introduction and objectives
We explored the differences between atherosclerotic burden with invasive coronary angiography and virtual monochromatic imaging derived from dual-energy computed tomography coronary angiography.
Methods
Eighty consecutive patients referred for invasive coronary angiography underwent dual-energy computed tomography coronary angiography and were categorized according to the atherosclerotic burden extent using the modified Duke prognostic coronary artery disease index, coronary artery disease extension score, segment involvement score, and the segment stenosis score.
Results
The mean segment involvement score (8.2 ± 3.9 vs 6.0 ± 3.7; P < .0001), modified Duke index (4.33 ± 1.6 vs 4.0 ± 1.7; P = .003), coronary artery disease extension score (4.84 ± 1.8 vs 4.43 ± 2.1; P = .005), and the median segment stenosis score (13.5 [9.0-18.0] vs 9.5 [5.0-15.0]; P < .0001) were significantly higher on dual-energy computed tomography compared with invasive angiography. Dual-energy computed tomography showed a significantly higher number of patients with any left main coronary artery lesion (46 [58%] vs 18 [23%]; P < .0001) and with severe proximal lesions (0.28 ± 0.03 vs 0.26 ± 0.03; P < .0001) than invasive angiography. Levels of coronary artery calcification below and above the median showed a sensitivity, specificity, positive predictive value, and negative predictive value of 100% and 97%; 86% and 50%; 93% and 95%; 100% and 67% for the identification of ≥ 50% stenosis.
Conclusions
Dual-energy computed tomography coronary angiography identified a significantly larger atherosclerotic burden compared with invasive coronary angiography, particularly involving the proximal segments.Introducción y objetivos
Se analizaron las diferencias de carga ateroesclerótica observadas entre la coronariografÃa invasiva y las imágenes monocromáticas virtuales obtenidas con la tomografÃa computarizada de doble energÃa.
Métodos
Se examinó con tomografÃa computarizada de doble energÃa y se clasificó a 80 pacientes consecutivos remitidos a una coronariografÃa invasiva según el grado de carga ateroesclerótica utilizando el Ãndice pronóstico de enfermedad coronaria de Duke modificado, la puntuación de extensión de la enfermedad coronaria, la puntuación de afección de segmentos y la puntuación de estenosis de segmentos.
Resultados
La media de la puntuación de afección de segmento (8,2 ± 3,9 frente a 6,0 ± 3,7; p < 0,0001), el Ãndice de Duke modificado (4,33 ± 1,6 frente a 4,0 ± 1,7; p = 0,003), la puntuación de extensión de la enfermedad coronaria (4,84 ± 1,8 frente a 4,43 ± 2,1; p = 0,005) y la mediana de la puntuación de estenosis de segmento (13,5 [9,0-18,0] frente a 9,5 [5,0-15,0]; p < 0,0001) fueron significativamente superiores con la tomografÃa computarizada de doble energÃa que con la coronariografÃa invasiva. La tomografÃa computarizada de doble energÃa mostró un número de pacientes con alguna lesión del tronco coronario izquierdo significativamente mayor (46 [58%] frente a 18 [23%]; p < 0,0001) y con lesiones proximales graves (0,28 ± 0,03 frente a 0,26 ± 0,03; p < 0,0001) en comparación con lo observado en la coronariografÃa invasiva. Los grados de calcificación arterial coronaria por debajo y por encima de la mediana mostraron sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo del 100 y el 97%; el 86 y el 50%; el 93 y el 95% y el 100 y el 67% para la identificación de estenosis ≥ 50%.
Conclusiones
La angiografÃa coronaria con tomografÃa computarizada de energÃa dual identificó una carga ateroesclerótica significativamente mayor que la observada con la coronariografÃa invasiva, en especial por lo que respecta a la afección de los segmentos proximales.Fil: Rodriguez Granillo, Gaston Alfredo. Diagnostico Maipú; Argentina. Consejo Nacional de Investigaciones CientÃficas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Cardiológicas. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Cardiológicas; ArgentinaFil: Carrascosa, Patricia. Diagnostico Maipú; ArgentinaFil: Deviggiano, Alejandro. Diagnostico Maipú; ArgentinaFil: Capunay, Carlos. Diagnostico Maipú; ArgentinaFil: De Zan, Macarena C.. Diagnostico Maipú; ArgentinaFil: Goldsmit, Alejandro. Sanatorio Güemes; Argentin
Pericardial fat volume is related to atherosclerotic plaque burden rather than to lesion severity
Aims: We sought to explore the relationship between pericardial fat volume (PFV) and both coronary atherosclerosis (CA) extent and severity using coronary artery calcium score (CAC), computed tomography coronary angiography (CTCA), and invasive coronary angiography in patients at high to intermediate likelihood of coronary artery disease (CAD). Methods and results: Patients clinically referred to invasive angiography who underwent CTCA and CAC within 1 month before the procedure comprised the study population. PFV, CAC, atherosclerotic burden indexes [segment involvement score (SIS); segment stenosis score; three-vessel plaque; and any left main plaque], and the invasive angiography-derived CAD index were evaluated independently. A total of 75 patients were included in the study. PFV did not differ between patients with or without obstructive (stenosis .70%) CAD defined by invasive angiography (86.4±31.7 vs. 77.1±42.8 cm3, P = 0.34), although patients with obstructive CAD had significantly higher CAC scores [636.0 (IQR 229.5-1101.0) vs. 206.0 (IQR 0.0-675), P<0.0001] than patients without obstructive CAD. Patients with extensive CA (SIS . 5) had significantly larger PFV (89.9±33.9 vs. 58.7±33.2 cm3, P = 0.003) than patients with non-extensive CA. Significant correlations were found between PFV and CAC (r = 0.49, P<0.0001), and SIS (r = 0.46, P<0.0001), whereas very weak correlations were observed between PFV and the CAD index (r = 0.27, P = 0.02), and between PFV and the body mass index (r = 0.33, P = 0.004). Conclusion: The main finding of the present study was the identification of PFV as more closely related to atherosclerotic plaque burden rather than to lesion severity in patients referred to invasive coronary angiography.Fil: Rodriguez Granillo, Gaston Alfredo. Consejo Nacional de Investigaciones CientÃficas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Cardiológicas. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Cardiológicas; Argentina. Diagnóstico Maipú; ArgentinaFil: Carrascosa, Patricia. Diagnóstico Maipú; ArgentinaFil: Deviggiano, Alejandro. Diagnóstico Maipú; ArgentinaFil: Capunay, Carlos. Diagnóstico Maipú; ArgentinaFil: De Zan, Macarena C.. Diagnóstico Maipú; ArgentinaFil: Goldsmit, Alejandro. Sanatorio Güemes; ArgentinaFil: Campisi, Roxana. Diagnóstico Maipú; Argentin
Virtual Monochromatic Imaging in Patients with Intermediate to High Likelihood of Coronary Artery Disease: Impact of Coronary Calcification
Rationale and Objectives
We sought to explore the image quality and diagnostic performance of virtual monochromatic imaging derived from dual-energy computed tomography coronary angiography (DE-CTCA) in patients with intermediate to high likelihood of coronary artery disease (CAD) and the influence of calcification.
Materials and Methods
Consecutive symptomatic patients with suspected CAD referred for invasive coronary angiography who underwent DE-CTCA and a coronary artery calcium scoring before the invasive procedure comprised the study population.
Results
Sixty-seven patients were included. Image quality was significantly lower at 45 keV reconstructions (mean Likert score 45 keV 3.57 ± 0.6, 65 keV 4.07 ± 0.5, and 85 keV 4.09 ± 0.6; P < .0001). Patients with moderate calcification showed a trend toward a significant improvement in the diagnostic performance with 65 keV vs 45 keV reconstructions (45 keV, area under the curve 0.92 [95% confidence interval 0.89–0.95] vs 65 keV, area under the curve 0.96 [95% confidence interval 0.93–0.98], P = .06). The diagnostic performance of DE-CTCA was significantly lower in segments with higher coronary artery calcium scoring compared to segments with none or mild calcification, independent of the energy level applied.
Conclusions
In patients with intermediate to high likelihood of CAD, DE-CTCA had a good diagnostic performance, although significantly lower in segments with severe calcification.Fil: Carrascosa, Patricia. Diagnóstico Maipú; ArgentinaFil: Leipsic, Jonathon A.. St. Paul's Hospital; CanadáFil: Deviggiano, Alejandro. Diagnóstico Maipú; ArgentinaFil: Capunay, Carlos. Diagnóstico Maipú; ArgentinaFil: Vallejos, Javier. Diagnóstico Maipú; ArgentinaFil: Goldsmit, Alejandro. Sanatorio Güemes; ArgentinaFil: De Zan, Macarena. Diagnóstico Maipú; ArgentinaFil: Rodriguez Granillo, Gaston Alfredo. Diagnóstico Maipú; Argentina. Consejo Nacional de Investigaciones CientÃficas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Cardiológicas. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Cardiológicas; Argentin
Curva de aprendizaje en el tratamiento percutáneo de las lesiones carotÃdeas
Background
Percutaneous transluminal angioplasty (PTA) of the carotid artery with stent implantation is an effective procedure for the prevention of ischemic stroke but its periprocedural morbimortality is still subject to debate.
Objective
The aim of this study is to report the results of a prospective series of patients treated with PTA.
Methods
This is a descriptive, observational, prospective study using the database of three Hemodynamic centers in Buenos Aires, which included all patients submitted to PTA from January 1998 to December 2010. The results of PTA performed by the same operator were analyzed.
Results
Mean age was 69 years, 58% of the patients were men, 58.8% were smokers, 52% had dyslipidemia, 79.1% were hypertensive, and 28% had diabetes. Prior history of acute myocardial infarction and coronary surgery was present in 19.4 and 11.6% of the patients, respectively. From 1998 to 2004 (initial stage, n=54) 72% of symptomatic patients had indication of revascularization, which was performed without cerebral protection in all cases. During the most recent stage (2004-2010, n=171), only 17.5% of the patients were symptomatic and revascularization was performed systematically with cerebral protection. Similar angiographic success was obtained in both stages (initial 96% vs. recent 97%), whereas clinical success rate was greater in the recent phase (96.1% vs. 87%, p=0.016). There were no cardiac complications. The rate of death or intrahospital stroke was 4%, 4.3% (3/70) in symptomatic and 3.2% (5/155) in asymptomatic patients; moreover, this rate was higher in the initial than in the recent phase (11.1% [6/54] vs. 1.7% [2/171], p=0.0028).
Conclusions
PTA represents an acceptably safe therapeutic alternative to surgical revascularization, providing the procedure is performed by experienced operators.Introducción
La angioplastia transluminal percutánea (ATP) carotÃdea con implante de stent es un procedimiento
eficaz en la prevención del accidente cerebrovascular (ACV) de tipo isquémico, pero
su morbimortalidad periprocedimiento aún es discutida.
Objetivo
Comunicar los resultados de una serie prospectiva de pacientes tratados con ATP.
Material y métodos
Estudio descriptivo, observacional y prospectivo de la base de datos de tres centros de Hemodinamia
de la Ciudad de Buenos Aires, en el que se incluyeron todos los pacientes sometidos
a ATP carotÃdea desde enero de 1998 a noviembre de 2010. Se analizaron los resultados de
las ATP realizadas por un mismo operador.
Resultados
La edad media fue de 69 años, el 58% de los pacientes eran hombres, el 58,8% tabaquistas,
el 52% dislipidémicos, el 79,1% hipertensos y el 28% diabéticos. El 19,4% y el 11,6% tenÃan
historia previa de infarto y cirugÃa coronaria, respectivamente. Desde 1998 hasta 2004 (etapa
inicial, n = 54) hubo un 72% de pacientes sintomáticos con indicación de revascularización;
en esta etapa no se utilizó sistema de protección cerebral. En la etapa más contemporánea
(2004-2010, n = 171), sólo el 17,5% fueron sintomáticos y el uso de sistema de protección
cerebral fue sistemático. Se observó una tasa similar de éxito angiográfico en las dos etapas
(inicial 96% vs. contemporánea 97%), en tanto que la tasa de éxito clÃnico de la etapa contemporánea
fue superior a la obtenida en la etapa inicial (96,1% vs. 87%; p = 0,016). No se
observaron complicaciones cardiológicas. La tasa de muerte o ACV intrahospitalario fue del
4%, del 4,3% (3/70) en los sintomáticos y del 3,2% (5/155) en los asintomáticos; esta tasa fue
mayor en la etapa inicial que en la contemporánea [11,1% (6/54) vs. 1,7% (2/171); p = 0,0028].
Conclusión
La ATP representa una alternativa terapéutica de aceptable seguridad, siempre que sea
realizada por operadores experimentados
Problemas y soluciones en la implementación de un Programa de Implante Valvular Aórtico Percutáneo
Introducción
La sobrevida de la estenosis aórtica grave sintomática inoperable es baja. El implante percutáneo
de válvula aórtica (IVAP) representa una alternativa para estos pacientes. Es nuestra
práctica que los candidatos a IVAP ingresen en un programa de evaluación (Programa de
IVAP) para determinar su elegibilidad clÃnica para, luego, solicitar la aprobación a la cobertura
de salud.
Objetivos
Evaluar las causas de la exclusión de pacientes del procedimiento y su impacto clÃnico.
Material y métodos
Desde abril de 2009 hasta agosto de 2011, 37 pacientes ingresaron en el Programa de IVAP.
Resultados
De los 37 pacientes, 29 recibieron el tratamiento o fueron descartados: 14 fueron sometidos a
IVAP (grupo IVAP, 48,3%) y 15 fueron descartados (grupo no IVAP 52,7%). Del grupo no IVAP,
seis pacientes (40%) fueron descartados por el Programa y cuatro por la cobertura médica,
mientras que otros cinco pacientes fallecieron aguardando la autorización. La mediana de
EuroSCORE de la población fue del 22% (rango 10-56%) y el promedio de edad fue de 79 ± 8
años. En un seguimiento de 12 meses, la mortalidad del grupo IVAP y no IVAP fue del 7,1%
y del 33,3%, respectivamente (p = 0,082). La mortalidad cardiovascular total fue del 17,2%,
en todos los casos del grupo no IVAP.
Conclusión
En nuestro medio, más de la mitad de los pacientes evaluados en un Programa de IVAP no
son intervenidos. Razones médicas y socioeconómicas inciden en la toma de decisiones y en la
realización o no del IVAP, observándose una mortalidad importante en los pacientes no tratados