The international journal of cardiovascular imaging
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Int J Cardiovasc Imaging · Apr 2012
Comparative StudyPerformance and efficacy of 320-row computed tomography coronary angiography in patients presenting with acute chest pain: results from a clinical registry.
The purpose of this study was to evaluate the performance of 320-row computed tomography angiography (CTA) in the identification of significant coronary artery disease (CAD) in patients presenting with acute chest pain and to examine the relation to outcome during follow-up. A total of 106 patients with acute chest pain underwent CTA to evaluate presence of CAD. Each CTA was classified as: normal, non-significant CAD (<50% luminal narrowing) and significant CAD (≥50% luminal narrowing). ⋯ In patients with non-significant CAD on CTA, no cardiac death or myocardial infarctions occurred and only 1 patient underwent revascularization due to unstable angina. In patients presenting with acute chest pain, an excellent clinical performance for the non-invasive assessment of significant CAD was demonstrated using CTA. Importantly, normal or non-significant CAD on CTA predicted a low rate of adverse cardiovascular events and favorable outcome during follow-up.
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Int J Cardiovasc Imaging · Apr 2012
Comparative StudyEvaluation of right ventricular dysfunction and prediction of clinical outcomes in acute pulmonary embolism by chest computed tomography: comparisons with echocardiography.
To evaluate the ability to identify right ventricular (RV) dysfunction, and to predict adverse outcomes of chest computed tomography (CT), we compared CT and echocardiography in acute pulmonary embolism patients. We analyzed 56 patients diagnosed by CT with acute pulmonary embolism, who underwent echocardiography within 48 h of CT scan from January 2004 to December 2008. From the CT scan, the ratio of RV diameter to left ventricular diameter (RVd/LVd), the presence of septal bowing and embolus location were determined. ⋯ The three-parameter combination predicted adverse clinical outcomes with a PPV of 54.5%, and a NPV of 94.1%. CT parameters including RV dysfunction were significantly associated with poor outcomes. Rapid risk stratification of patients with acute pulmonary embolism based on chest CT appears to be comparable with echocardiography, is clinically reliable, and may be useful in guiding management strategy.
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Int J Cardiovasc Imaging · Apr 2012
Comparative StudyMajor determinants for the uncovered stent struts on optical coherence tomography after drug-eluting stent implantation.
There have been little data regarding major determinants for the uncovered stent struts after drug-eluting stent (DES) implantation on optical coherence tomography (OCT). We investigated the major determinants of incomplete neointimal coverage of DES struts on OCT after implantation in a large cohort of patients. A total of 261 patients with 279 lesions who were treated with various DESs were selected from the OCT registry database. ⋯ Of these variables, the most significant determinant of uncovered stent struts was DES type (odds ratio [OR] = 2.75, 95% confidence interval [CI] = 1.94-3.89, P < 0.001). The use of sirolimus-eluting stents (OR = 2.44, 95% CI, 1.15-5.47, P = 0.023) and zotarolimus-eluting stents (OR = 0.02, 95% CI = 0.01-0.25, P = 0.002) were the only significant risk and protective factors for uncovered stent struts, respectively. This study demonstrated that DES type might be associated with the most important determinants of uncovered struts compared to any other clinical or angiographic factor.
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Int J Cardiovasc Imaging · Apr 2012
Right ventricular function declines after cardiac surgery in adult patients with congenital heart disease.
Right ventricular function (RVF) is often selectively declined after coronary artery bypass graft surgery. In adult patients with congenital heart disease (CHD) the incidence and persistence of declined RVF after cardiac surgery is unknown. The current study aimed to describe RVF after cardiac surgery in these patients. ⋯ There was no association between decline in RVF and clinical outcome on the intensive care unit. 18 months post-operatively, most RVF parameters had recovered to pre-operative values, but TAPSE which remained still lower (P < 0.01). CHD patients have a decline in RVF directly after cardiac surgery, regardless the side of surgery. Although a gradual improvement was observed, complete recovery was not seen 18 months post-operatively.
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Int J Cardiovasc Imaging · Apr 2012
Multicenter Study Comparative StudyCardiac magnetic resonance imaging for the diagnosis of patients presenting with chest pain, raised troponin, and unobstructed coronary arteries.
To evaluate the incremental diagnostic and prognostic value of cardiac magnetic resonance (CMR) in patients with chest pain, raised troponin and unobstructed coronary arteries, and to compare subsequent event rates between diagnostic groups. 130 patients (mean age: 54 ± 17) presenting with troponin-positive acute chest pain and unobstructed coronary arteries were included. All patients were managed according to European Society of Cardiology guidelines, including echocardiography, and had CMR within 6.2 ± 5.3 days of presentation. During follow-up, major adverse cardiovascular events (MACE) were recorded. ⋯ MACE rate was not different between patients with a conclusive CMR and normal CMR. In patients with acute troponin-positive chest pain and unobstructed coronary arteries, early CMR has important diagnostic and therapeutic implications. However its association with occurrence of MACE during mid term follow-up was not obvious.