How to perform a cardiac computed tomography (CT) and a coronary CT angiography?

Université de Paris Descartes, CHU Necker et HEGP, Paris, France, The IVth Congress of Radiology and Medical Imaging of the Republic of Moldova with international participation, Chisinau, May 31 – June 2, 2018Introduction: Grâce à la performance diagnostique élevée du scanner cardiaque et coronarien (SCC), il est devenu une des méthodes couramment utilisées, dans la pathologie cardiaque. En effet le SCC est le seul examen complet, qui permet de manière non invasive, d’évaluer d’une part l’anatomie cardiaque et son environnement, et d’autre part, appréhender l’étendue de la maladie coronarienne. Contenu: La présentation passe en revue plusieurs techniques qui s’offrent à nous. Dans un premier temps, une acquisition sans injection de produit de contraste va permettre le calcul du score calcique qui s’est imposé comme prédicteur le plus puissant d’évènements coronariens chez les patients asymptomatiques. Dans un second temps, l’injection de produit de contraste va nous permettre d’étudier de manière précise, le luminogramme des artères coronaires à l’aide de différents moyens de reconstruction, et ceci avec une valeur prédictive négative > 90% permettant ainsi d’éviter la réalisation d’une coronarographie à visée diagnostique. Cependant, malgré les progrès très rapides de ces dernières années, le SCC connait de nombreuses limites. La plupart d’entre elles sont liées au patient (poids, fréquence cardiaque, arythmie, coopération…), ce qui va nous conduire à une première sélection pour espérer tirer bénéfice de l’exploration. Puis secondairement, nous allons être amenés à avoir une «bonne mise en condition du patient» pour la réussite de l’examen. Plusieurs paramètres vont alors intervenir, ceux liés à la physiologie du patient, et ceux liés à la technique découlant d’un choix judicieux et adapté de protocole d’acquisition puis de reconstruction. Conclusions: Cet exposé a pour but d’apporter des solutions aux problèmes auxquels nous pouvons être confrontés lors de la réalisation d’un SCC.Introduction: Thanks to its high diagnostic performance, cardiac computed tomography with coronary CT angiography, also known as coronary computed tomography angiography (CCTA), has become one of the commonly used methods of investigation in cardiac pathology. In fact, it represents the only complete, non-invasive examination that assesses both the cardiac anatomy and the extent of coronary artery disease. Content: The presentation reviews several techniques available to us. Initially, an acquisition without injection of contrast medium will allow the calculation of the calcium score which has emerged as the most powerful predictor of coronary events in asymptomatic patients. At a second step, the injection of contrast medium will allow us to study in a precise way, the luminogram of the coronary arteries using different means of reconstruction. The technique has a negative predictive value over 90%, allowing to avoid performing coronary angiography for diagnostic purposes. However, despite its very rapid progress in recent years, the technique has many limitations. Most of these limitations are related to the patient’s status (weight, heart rate, arrhythmia, cooperation, etc), and can be minimized by patient selection in order to increase the benefit from the investigation. Secondly, we will have to have a «good condition of the patient» for the success of the examination. This involves adjusting the parameters related to the physiology of the patient, and those related to the employed technique and adapted protocols for image acquisition and reconstruction. Conclusions: The presentation provides a variety of explanations and solutions to the potential problems we may face when performing the investigation

Intracoronary autologous mononucleated bone marrow cell infusion for acute myocardial infarction: results of the randomized multicenter BONAMI trial.

International audienceAIMS: Intracoronary administration of autologous bone marrow cells (BMCs) leads to a modest improvement in cardiac function, but the effect on myocardial viability is unknown. The aim of this randomized multicentre study was to evaluate the effect of BMC therapy on myocardial viability in patients with decreased left ventricular ejection fraction (LVEF) after acute myocardial infarction (AMI) and to identify predictive factors for improvement of myocardial viability. METHODS AND RESULTS: One hundred and one patients with AMI and successful reperfusion, LVEF ≤45%, and decreased myocardial viability (resting Tl201-SPECT) were randomized to either a control group (n = 49) or a BMC group (n = 52). Primary endpoint was improvement of myocardial viability 3 months after AMI. Baseline mean LVEF measured by radionuclide angiography was 36.3 ± 6.9%. Bone marrow cell infusion was performed 9.3 ± 1.7 days after AMI. Myocardial viability improved in 16/47 (34%) patients in the BMC group compared with 7/43 (16%) in the control group (P = 0.06). The number of non-viable segments becoming viable was 0.8 ± 1.1 in the control group and 1.2 ± 1.5 in the BMC group (P = 0.13). Multivariate analysis including major post-AMI prognostic factors showed a significant improvement of myocardial viability in BMC vs. control group (P = 0.03). Moreover, a significant adverse role for active smoking (P = 0.04) and a positive trend for microvascular obstruction (P = 0.07) were observed. CONCLUSION: Intracoronary autologous BMC administration to patients with decreased LVEF after AMI was associated with improvement of myocardial viability in multivariate-but not in univariate-analysis. A large multicentre international trial is warranted to further document the efficacy of cardiac cell therapy and better define a group of patients that will benefit from this therapy. Clinical Trial Registration Information: URL: http://www.clinicaltrials.gov. Unique identifier NCT00200707