Multidetector computed tomography angiography for assessment of in-stent restenosis: meta-analysis of diagnostic performance

<p>Abstract</p> <p>Background</p> <p>Multi-detector computed tomography angiography (MDCTA)of the coronary arteries after stenting has been evaluated in multiple studies.</p> <p>The purpose of this study was to perform a structured review and meta-analysis of the diagnostic performance of MDCTA for the detection of in-stent restenosis in the coronary arteries.</p> <p>Methods</p> <p>A Pubmed and manual search of the literature on in-stent restenosis (ISR) detected on MDCTA compared with conventional coronary angiography (CA) was performed. Bivariate summary receiver operating curve (SROC) analysis, with calculation of summary estimates was done on a stent and patient basis. In addition, the influence of study characteristics on diagnostic performance and number of non-assessable segments (NAP) was investigated with logistic meta-regression.</p> <p>Results</p> <p>Fourteen studies were included. On a stent basis, Pooled sensitivity and specificity were 0.82(0.72–0.89) and 0.91 (0.83–0.96). Pooled negative likelihood ratio and positive likelihood ratio were 0.20 (0.13–0.32) and 9.34 (4.68–18.62) respectively. The exclusion of non-assessable stents and the strut thickness of the stents had an influence on the diagnostic performance. The proportion of non-assessable stents was influenced by the number of detectors, stent diameter, strut thickness and the use of an edge-enhancing kernel.</p> <p>Conclusion</p> <p>The sensitivity of MDTCA for the detection of in-stent stenosis is insufficient to use this test to select patients for further invasive testing as with this strategy around 20% of the patients with in-stent stenosis would be missed. Further improvement of scanner technology is needed before it can be recommended as a triage instrument in practice. In addition, the number of non-assessable stents is also high.</p

CMS physics technical design report : Addendum on high density QCD with heavy ions

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Influence of microvascular obstruction on regional myocardial deformation in the acute phase of myocardial infarction: a speckle-tracking echocardiography study

International audienceBACKGROUND: In the acute phase of myocardial infarction (MI), infarct size and microvascular obstruction (MVO) are important prognostic factors for cardiovascular outcome. MI size is a major determinant of myocardial function, but the specific effect of MVO is less documented. The aim of this study was to evaluate the impact of MVO on longitudinal myocardial strain assessed by speckle-tracking echocardiography. METHOD: Speckle-tracking echocardiography and contrast-enhanced cardiac magnetic resonance studies were performed in 69 patients 72 hours after first acute MI. Segmental and global longitudinal systolic strain (epsilonL) was measured using speckle-tracking echocardiography. Transmural extent of MI, MI size, and the presence or absence of MVO were assessed using contrast-enhanced cardiac magnetic resonance. Left ventricular (LV) ejection fraction was assessed at 6 months using echocardiography. RESULTS: The mean infarct size was 23 +/- 13% of LV mass. MVO was present in 64% of patients. MVO was significantly associated with epsilonL impairment (-7.8 +/- 4.9% vs -16.3 +/- 6.4%, P \textless .001), and epsilonL remained significantly worse in MVO-positive segments after adjustment for transmural extent of MI. A epsilonL value \textgreater -12.5% predicted the presence of MVO with 83% sensitivity and 75% specificity. On multivariate analysis, global epsilonL and MI size, but not MVO, were identified as independent predictors of LV ejection fraction at follow-up (beta = -0.9, P = .023, and beta = -0.2, P = .034, respectively). CONCLUSION: In the acute phase of MI, segmental and global epsilonL is significantly altered by the presence of MVO, in addition to MI size. However, MI size but not MVO independently predicts LV ejection fraction at follow-up

Mission Caucase. Arménie : La Préhistoire du Petit Caucase

International audienc

Mission Caucase. Arménie : La Préhistoire du Petit Caucase

International audienc