Medicine › Radiology, Nuclear Medicine and Imaging

Cardiac Imaging and Diagnostics

Works Count: 138131

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Description

This cluster of papers focuses on advanced cardiac imaging techniques and diagnostics for the assessment of coronary artery disease, myocardial perfusion, and myocardial infarction using computed tomography angiography and magnetic resonance imaging. It also explores the association of coronary calcium, microvascular dysfunction, and cardiovascular risk assessment with cardiac imaging, while addressing concerns related to radiation exposure.

Keywords

Cardiac Imaging; Coronary Artery Disease; Myocardial Perfusion; Computed Tomography Angiography; Magnetic Resonance Imaging; Coronary Calcium; Microvascular Dysfunction; Cardiovascular Risk Assessment; Myocardial Infarction; Radiation Exposure

Diagnostic Performance of 64-Multidetector Row Coronary Computed Tomographic Angiography for Evaluation of Coronary Artery Stenosis in Individuals Without Known Coronary Artery Disease

2008-11-01

Matthew J. Budoff , David A. Dowe , James G. Jollis +7 more

1994 Consensus Conference on Acute GVHD Grading.

1995-06-01

Donna Przepiorka , Daniel Weisdorf , Peyton Martin +4 more

Myocardial infarction redefined—A consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the Redefinition of Myocardial Infarction

2000-09-15

Joseph S. Alpert , EM Antman , Fred S. Apple +7 more

This document was developed by a consensus conference initiated by Kristian Thygesen, MD, and Joseph S. Alpert, MD, after formal approval by Lars Rydén, MD, President of the European Society … This document was developed by a consensus conference initiated by Kristian Thygesen, MD, and Joseph S. Alpert, MD, after formal approval by Lars Rydén, MD, President of the European Society of Cardiology (ESC), and Arthur Garson, MD, President of the American College of Cardiology (ACC). All of the participants were selected for their expertise in the field they represented, with approximately one-half of the participants selected from each organization. Participants were instructed to review the scientific evidence in their area of expertise and to attend the consensus conference with prepared remarks. The first draft of the document was prepared during the consensus conference itself. Sources of funding appear in Appendix A. The recommendations made in this document represent the attitudes and opinions of the participants at the time of the conference, and these recommendations were revised subsequently. The conclusions reached will undoubtedly need to be revised as new scientific evidence becomes available. This document has been reviewed by members of the ESC Committee for Scientific and Clinical Initiatives and by members of the Board of the ESC who approved the document on April 15, 2000.*

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2013 ESC guidelines on the management of stable coronary artery disease

2013-08-30

Gilles Montalescot , Udo Sechtem , Stephan Achenbach +7 more

The ESC Guidelines represent the views of the ESC and were arrived at after careful consideration of the available evidence at the time they were written.Health professionals are encouraged to … The ESC Guidelines represent the views of the ESC and were arrived at after careful consideration of the available evidence at the time they were written.Health professionals are encouraged to take them fully into account when exercising their clinical judgement.The Guidelines do not, however, override the individual responsibility of health professionals to make appropriate decisions in the circumstances of the individual patients, in consultation with that patient and where appropriate and necessary the patient's guardian or carer.It is also the health professional's responsibility to verify the rules and regulations applicable to drugs and devices at the time of prescription.

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Nitric Oxide Is Responsible for Flow-Dependent Dilatation of Human Peripheral Conduit Arteries In Vivo

1995-03-01

Robinson Joannidès , Walter E. Haefeli , Lilly Linder +4 more

Background Experimental evidence suggests that flow-dependent dilatation of conduit arteries is mediated by nitric oxide (NO) and/or prostacyclin. The present study was designed to assess whether NO or prostacyclin also … Background Experimental evidence suggests that flow-dependent dilatation of conduit arteries is mediated by nitric oxide (NO) and/or prostacyclin. The present study was designed to assess whether NO or prostacyclin also contributes to flow-dependent dilatation of conduit arteries in humans. Methods and Results Radial artery internal diameter (ID) was measured continuously in 16 healthy volunteers (age, 24±1 years) with a transcutaneous A-mode echo-tracking system coupled to a Doppler device for the measurement of radial blood flow. In 8 subjects, a catheter was inserted into the brachial artery for measurement of arterial pressure and infusion of the NO synthase inhibitor N G -monomethyl- l -arginine (L-NMMA; 8 μmol/min for 7 minutes; infusion rate, 0.8 mL/min). Flow-dependent dilatation was evaluated before and after L-NMMA or aspirin as the response of the radial artery to an acute increase in flow (reactive hyperemia after a 3-minute cuff wrist occlusion). Under control conditions, release of the occlusion induced a marked increase in radial blood flow (from 24±3 to 73±11 mL/min; P <.01) followed by a delayed increase in radial diameter (flow-mediated dilatation; from 2.67±0.10 to 2.77±0.12 mm; P <.01) without any change in heart rate or arterial pressure. L-NMMA decreased basal forearm blood flow (from 24±3 to 13±3 mL/min; P <.05) without affecting basal radial artery diameter, heart rate, or arterial pressure, whereas aspirin (1 g PO) was without any hemodynamic effect. In the presence of L-NMMA, the peak flow response during hyperemia was not affected (76±12 mL/min), but the duration of the hyperemic response was markedly reduced, and the flow-dependent dilatation of the radial artery was abolished and converted to a vasoconstriction (from 2.62±0.11 to 2.55±0.11 mm; P <.01). In contrast, aspirin did not affect the hyperemic response nor the flow-dependent dilatation of the radial artery. Conclusions The present investigation demonstrates that NO, but not prostacyclin, is essential for flow-mediated dilatation of large human arteries. Hence, this response can be used as a test for the l -arginine/NO pathway in clinical studies.

Coronary Calcium as a Predictor of Coronary Events in Four Racial or Ethnic Groups

2008-03-26

Robert Detrano , Alan D. Guerci , J. Jeffrey Carr +7 more

In white populations, computed tomographic measurements of coronary-artery calcium predict coronary heart disease independently of traditional coronary risk factors. However, it is not known whether coronary-artery calcium predicts coronary heart … In white populations, computed tomographic measurements of coronary-artery calcium predict coronary heart disease independently of traditional coronary risk factors. However, it is not known whether coronary-artery calcium predicts coronary heart disease in other racial or ethnic groups.We collected data on risk factors and performed scanning for coronary calcium in a population-based sample of 6722 men and women, of whom 38.6% were white, 27.6% were black, 21.9% were Hispanic, and 11.9% were Chinese. The study subjects had no clinical cardiovascular disease at entry and were followed for a median of 3.8 years.There were 162 coronary events, of which 89 were major events (myocardial infarction or death from coronary heart disease). In comparison with participants with no coronary calcium, the adjusted risk of a coronary event was increased by a factor of 7.73 among participants with coronary calcium scores between 101 and 300 and by a factor of 9.67 among participants with scores above 300 (P<0.001 for both comparisons). Among the four racial and ethnic groups, a doubling of the calcium score increased the risk of a major coronary event by 15 to 35% and the risk of any coronary event by 18 to 39%. The areas under the receiver-operating-characteristic curves for the prediction of both major coronary events and any coronary event were higher when the calcium score was added to the standard risk factors.The coronary calcium score is a strong predictor of incident coronary heart disease and provides predictive information beyond that provided by standard risk factors in four major racial and ethnic groups in the United States. No major differences among racial and ethnic groups in the predictive value of calcium scores were detected.

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Myocardial infarction redefined—a consensus document of The Joint European Society of Cardiology/American College of Cardiology committee for the redefinition of myocardial infarction

2000-09-01

Elliott M. Antman , Jean‐Pierre Bassand , Werner Klein +5 more

The Use of Contrast-Enhanced Magnetic Resonance Imaging to Identify Reversible Myocardial Dysfunction

2000-11-16

Raymond J. Kim , Edwin Wu , Allen Rafael +6 more

Recent studies indicate that magnetic resonance imaging (MRI) after the administration of contrast material can be used to distinguish between reversible and irreversible myocardial ischemic injury regardless of the extent … Recent studies indicate that magnetic resonance imaging (MRI) after the administration of contrast material can be used to distinguish between reversible and irreversible myocardial ischemic injury regardless of the extent of wall motion or the age of the infarct. We hypothesized that the results of contrast-enhanced MRI can be used to predict whether regions of abnormal ventricular contraction will improve after revascularization in patients with coronary artery disease.

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Changes in collateral channel filling immediately after controlled coronary artery occlusion by an angioplasty balloon in human subjects

1985-03-01

K.Peter Rentrop , Marc Cohen , H. Blanke +1 more

Prognostic Value of Coronary Vascular Endothelial Dysfunction

2002-08-06

Julian Halcox , William H. Schenke , Gloria Zalos +5 more

Background — Whether patients at increased risk can be identified from a relatively low-risk population by coronary vascular function testing remains unknown. We investigated the relationship between coronary endothelial function … Background — Whether patients at increased risk can be identified from a relatively low-risk population by coronary vascular function testing remains unknown. We investigated the relationship between coronary endothelial function and the occurrence of acute unpredictable cardiovascular events (cardiovascular death, myocardial infarction, stroke, and unstable angina) in patients with and without coronary atherosclerosis (CAD). Methods and Results — We measured the change in coronary vascular resistance (ΔCVR) and epicardial diameter with intracoronary acetylcholine (ACh, 15 μg/min) to test endothelium-dependent function and sodium nitroprusside (20 μg/min) and adenosine (2.2 mg/min) to test endothelium-independent vascular function in 308 patients undergoing cardiac catheterization (132 with and 176 without CAD). Patients underwent clinical follow-up for a mean of 46±3 months. Acute vascular events occurred in 35 patients. After multivariate analysis that included CAD and conventional risk factors for atherosclerosis, ΔCVR with ACh ( P =0.02) and epicardial constriction with ACh ( P =0.003), together with increasing age, CAD, and body mass index, were independent predictors of adverse events. Thus, patients in the tertile with the best microvascular responses with ACh and those with epicardial dilation with ACh had improved survival by Kaplan-Meier analyses in the total population, as did those in the subset without CAD. Similar improvement in survival was also observed when all adverse events, including revascularization, were considered. Endothelium-independent responses were not predictive of outcome. Conclusions — Epicardial and microvascular coronary endothelial dysfunction independently predict acute cardiovascular events in patients with and without CAD, providing both functional and prognostic information that complements angiographic and risk factor assessment.

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Angina pectoris I. A variant form of angina pectoris

1959-09-01

Myron Prinzmetal , Rexford Kennamer , R. R. Merliss +2 more

Comparison of the Short-Term Survival Benefit Associated With Revascularization Compared With Medical Therapy in Patients With No Prior Coronary Artery Disease Undergoing Stress Myocardial Perfusion Single Photon Emission Computed Tomography

2003-06-04

Rory Hachamovitch , Sean W. Hayes , John D. Friedman +2 more

Background— The relationship between the amount of inducible ischemia present on stress myocardial perfusion single photon emission computed tomography (myocardial perfusion stress [MPS]) and the presence of a short-term survival … Background— The relationship between the amount of inducible ischemia present on stress myocardial perfusion single photon emission computed tomography (myocardial perfusion stress [MPS]) and the presence of a short-term survival benefit with early revascularization versus medical therapy is not clearly defined. Methods and Results— A total of 10 627 consecutive patients who underwent exercise or adenosine MPS and had no prior myocardial infarction or revascularization were followed up (90.6% complete; mean: 1.9±0.6 years). Cardiac death occurred in 146 patients (1.4%). Treatment received within 60 days after MPS defined subgroups undergoing revascularization (671 patients, 2.8% mortality) or medical therapy (MT) (9956 patients, 1.3% mortality; P =0.0004). To adjust for nonrandomization of treatment, a propensity score was developed using logistic regression to model the decision to refer to revascularization. This model (χ 2 =1822, c index=0.94, P <10 −7 ) identified inducible ischemia and anginal symptoms as the most powerful predictors (83%, 6% of overall χ 2 ) and was incorporated into survival models. On the basis of the Cox proportional hazards model predicting cardiac death (χ 2 =539, P <0.0001), patients undergoing MT demonstrated a survival advantage over patients undergoing revascularization in the setting of no or mild ischemia, whereas patients undergoing revascularization had an increasing survival benefit over patients undergoing MT when moderate to severe ischemia was present. Furthermore, increasing survival benefit for revascularization over MT was noted in higher risk patients (elderly, adenosine stress, and women, especially those with diabetes). Conclusions— Revascularization compared with MT had greater survival benefit (absolute and relative) in patients with moderate to large amounts of inducible ischemia. These findings have significant consequences for future approaches to post–single photon emission computed tomography patient management if confirmed by prospective evaluations.

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Interpretation of the Correlation Coefficient: A Basic Review

1990-01-01

Richard Taylor

A basic consideration in the evaluation of professional medical literature is being able to understand the statistical analysis presented. One of the more frequently reported statistical methods involves correlation analysis … A basic consideration in the evaluation of professional medical literature is being able to understand the statistical analysis presented. One of the more frequently reported statistical methods involves correlation analysis where a correlation coefficient is reported representing the degree of linear association between two variables. This article discusses the basic aspects of correlation analysis with examples given from professional journals and focuses on the interpretations and limitations of the correlation coefficient. No attention was given to the actual calculation of this statistical value.

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Myocardial viability testing and impact of revascularization on prognosis in patients with coronary artery disease and left ventricular dysfunction: a meta-analysis

2002-04-01

Kevin C. Allman , Leslee J. Shaw , Rory Hachamovitch +1 more

Unstable angina. A classification.

1989-08-01

Eugene Braunwald

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Assessment of Coronary Artery Disease by Cardiac Computed Tomography

2006-10-03

Matthew J. Budoff , Stephan Achenbach , Roger S. Blumenthal +7 more

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Evaluating the Yield of Medical Tests

1982-05-14

Frank E. Harrell

A method is presented for evaluating the amount of information a medical test provides about individual patients. Emphasis is placed on the role of a test in the evaluation of … A method is presented for evaluating the amount of information a medical test provides about individual patients. Emphasis is placed on the role of a test in the evaluation of patients with a chronic disease. In this context, the yield of a test is best interpreted by analyzing the prognostic information it furnishes. Information from the history, physical examination, and routine procedures should be used in assessing the yield of a new test. As an example, the method is applied to the use of the treadmill exercise test in evaluating the prognosis of patients with suspected coronary artery disease. The treadmill test is shown to provide surprisingly little prognostic information beyond that obtained from basic clinical measurements. (<i>JAMA</i>1982;247:2543-2546)

Diagnostic Accuracy of Noninvasive Coronary Angiography Using 64-Slice Spiral Computed Tomography

2005-06-27

Gilbert Raff , Michael J. Gallagher , William W. O’Neill +1 more

Coronary Artery Calcium Score Combined With Framingham Score for Risk Prediction in Asymptomatic Individuals

2004-01-13

Philip Greenland , Laurie LaBree , Stanley P. Azen +2 more

ContextGuidelines advise that all adults undergo coronary heart disease (CHD) risk assessment to guide preventive treatment intensity. Although the Framingham Risk Score (FRS) is often recommended for this, it has … ContextGuidelines advise that all adults undergo coronary heart disease (CHD) risk assessment to guide preventive treatment intensity. Although the Framingham Risk Score (FRS) is often recommended for this, it has been suggested that risk assessment may be improved by additional tests such as coronary artery calcium scoring (CACS).ObjectivesTo determine whether CACS assessment combined with FRS in asymptomatic adults provides prognostic information superior to either method alone and whether the combined approach can more accurately guide primary preventive strategies in patients with CHD risk factors.Design, Setting, and ParticipantsProspective observational population-based study, of 1461 asymptomatic adults with coronary risk factors. Participants with at least 1 coronary risk factor (>45 years) underwent computed tomography (CT) examination, were screened between 1990-1992, were contacted yearly for up to 8.5 years after CT scan, and were assessed for CHD. This analysis included 1312 participants with CACS results; excluded were 269 participants with diabetes and 14 participants with either missing data or had a coronary event before CACS was performed.Main Outcome MeasureNonfatal myocardial infarction (MI) or CHD death.ResultsDuring a median of 7.0 years of follow-up, 84 patients experienced MI or CHD death; 70 patients died of any cause. There were 291 (28%) participants with an FRS of more than 20% and 221 (21%) with a CACS of more than 300. Compared with an FRS of less than 10%, an FRS of more than 20% predicted the risk of MI or CHD death (hazard ratio [HR], 14.3; 95% confidence interval [CI]; 2.0-104; P = .009). Compared with a CACS of zero, a CACS of more than 300 was predictive (HR, 3.9; 95% CI, 2.1-7.3; P<.001). Across categories of FRS, CACS was predictive of risk among patients with an FRS higher than 10% (P<.001) but not with an FRS less than 10%.ConclusionThese data support the hypothesis that high CACS can modify predicted risk obtained from FRS alone, especially among patients in the intermediate-risk category in whom clinical decision making is most uncertain.

From Vulnerable Plaque to Vulnerable Patient

2003-10-13

Morteza Naghavi , Peter Libby , Erling Falk +7 more

Atherosclerotic cardiovascular disease results in >19 million deaths annually, and coronary heart disease accounts for the majority of this toll. Despite major advances in treatment of coronary heart disease patients, … Atherosclerotic cardiovascular disease results in >19 million deaths annually, and coronary heart disease accounts for the majority of this toll. Despite major advances in treatment of coronary heart disease patients, a large number of victims of the disease who are apparently healthy die suddenly without prior symptoms. Available screening and diagnostic methods are insufficient to identify the victims before the event occurs. The recognition of the role of the vulnerable plaque has opened new avenues of opportunity in the field of cardiovascular medicine. This consensus document concludes the following. (1) Rupture-prone plaques are not the only vulnerable plaques. All types of atherosclerotic plaques with high likelihood of thrombotic complications and rapid progression should be considered as vulnerable plaques. We propose a classification for clinical as well as pathological evaluation of vulnerable plaques. (2) Vulnerable plaques are not the only culprit factors for the development of acute coronary syndromes, myocardial infarction, and sudden cardiac death. Vulnerable blood (prone to thrombosis) and vulnerable myocardium (prone to fatal arrhythmia) play an important role in the outcome. Therefore, the term "vulnerable patient" may be more appropriate and is proposed now for the identification of subjects with high likelihood of developing cardiac events in the near future. (3) A quantitative method for cumulative risk assessment of vulnerable patients needs to be developed that may include variables based on plaque, blood, and myocardial vulnerability. In Part I of this consensus document, we cover the new definition of vulnerable plaque and its relationship with vulnerable patients. Part II of this consensus document will focus on vulnerable blood and vulnerable myocardium and provide an outline of overall risk assessment of vulnerable patients. Parts I and II are meant to provide a general consensus and overviews the new field of vulnerable patient. Recently developed assays (eg, C-reactive protein), imaging techniques (eg, CT and MRI), noninvasive electrophysiological tests (for vulnerable myocardium), and emerging catheters (to localize and characterize vulnerable plaque) in combination with future genomic and proteomic techniques will guide us in the search for vulnerable patients. It will also lead to the development and deployment of new therapies and ultimately to reduce the incidence of acute coronary syndromes and sudden cardiac death. We encourage healthcare policy makers to promote translational research for screening and treatment of vulnerable patients.

Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging

2015-01-01

Roberto M. Lang , Luigi P. Badano , Victor Mor‐Avi +7 more

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2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease: Executive Summary

2012-11-20

Stephan D. Fihn , Julius M. Gardin , Jonathan Abrams +7 more

Optimal Medical Therapy With or Without Percutaneous Coronary Intervention to Reduce Ischemic Burden

2008-02-12

Leslee J. Shaw , Daniel S. Berman , David J. Maron +7 more

Background— Extent and severity of myocardial ischemia are determinants of risk for patients with coronary artery disease, and ischemia reduction is an important therapeutic goal. The Clinical Outcomes Utilizing Revascularization … Background— Extent and severity of myocardial ischemia are determinants of risk for patients with coronary artery disease, and ischemia reduction is an important therapeutic goal. The Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) nuclear substudy compared the effectiveness of percutaneous coronary intervention (PCI) for ischemia reduction added to optimal medical therapy (OMT) with the use of myocardial perfusion single photon emission computed tomography (MPS). Methods and Results— Of the 2287 COURAGE patients, 314 were enrolled in this substudy of serial rest/stress MPS performed before treatment and 6 to 18 months (mean=374±50 days) after randomization using paired exercise (n=84) or vasodilator stress (n=230). A blinded core laboratory analyzed quantitative MPS measures of percent ischemic myocardium. Moderate to severe ischemia encumbered ≥10% myocardium. The primary end point was ≥5% reduction in ischemic myocardium at follow-up. Treatment groups had similar baseline characteristics. At follow-up, the reduction in ischemic myocardium was greater with PCI+OMT (−2.7%; 95% confidence interval, −1.7%, −3.8%) than with OMT (−0.5%; 95% confidence interval, −1.6%, 0.6%; P <0.0001). More PCI+OMT patients exhibited significant ischemia reduction (33% versus 19%; P =0.0004), especially patients with moderate to severe pretreatment ischemia (78% versus 52%; P =0.007). Patients with ischemia reduction had lower unadjusted risk for death or myocardial infarction ( P =0.037 [risk-adjusted P =0.26]), particularly if baseline ischemia was moderate to severe ( P =0.001 [risk-adjusted P =0.08]). Death or myocardial infarction rates ranged from 0% to 39% for patients with no residual ischemia to ≥10% residual ischemia on follow-up MPS ( P =0.002 [risk-adjusted P =0.09]). Conclusions— In COURAGE patients who underwent serial MPS, adding PCI to OMT resulted in greater reduction in ischemia compared with OMT alone. Our findings suggest a treatment target of ≥5% ischemia reduction with OMT with or without coronary revascularization.

Universal Definition of Myocardial Infarction

2007-10-19

Kristian Thygesen , Joseph S. Alpert , Harvey D. White

ACC/AHA Guidelines for the Management of Patients With Unstable Angina and Non–ST-Segment Elevation Myocardial Infarction: Executive Summary and Recommendations

2000-09-05

Eugene Braunwald , Elliott M. Antman , John W. Beasley +7 more

HomeCirculationVol. 102, No. 10ACC/AHA Guidelines for the Management of Patients With Unstable Angina and Non–ST-Segment Elevation Myocardial Infarction: Executive Summary and Recommendations HomeCirculationVol. 102, No. 10ACC/AHA Guidelines for the Management of Patients With Unstable Angina and Non–ST-Segment Elevation Myocardial Infarction: Executive Summary and Recommendations

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Diagnostic Performance of Coronary Angiography by 64-Row CT

2008-11-26

Julie M. Miller , Carlos Eduardo Rochitte , Marc Dewey +7 more

The accuracy of multidetector computed tomographic (CT) angiography involving 64 detectors has not been well established.We conducted a multicenter study to examine the accuracy of 64-row, 0.5-mm multidetector CT angiography … The accuracy of multidetector computed tomographic (CT) angiography involving 64 detectors has not been well established.We conducted a multicenter study to examine the accuracy of 64-row, 0.5-mm multidetector CT angiography as compared with conventional coronary angiography in patients with suspected coronary artery disease. Nine centers enrolled patients who underwent calcium scoring and multidetector CT angiography before conventional coronary angiography. In 291 patients with calcium scores of 600 or less, segments 1.5 mm or more in diameter were analyzed by means of CT and conventional angiography at independent core laboratories. Stenoses of 50% or more were considered obstructive. The area under the receiver-operating-characteristic curve (AUC) was used to evaluate diagnostic accuracy relative to that of conventional angiography and subsequent revascularization status, whereas disease severity was assessed with the use of the modified Duke Coronary Artery Disease Index.A total of 56% of patients had obstructive coronary artery disease. The patient-based diagnostic accuracy of quantitative CT angiography for detecting or ruling out stenoses of 50% or more according to conventional angiography revealed an AUC of 0.93 (95% confidence interval [CI], 0.90 to 0.96), with a sensitivity of 85% (95% CI, 79 to 90), a specificity of 90% (95% CI, 83 to 94), a positive predictive value of 91% (95% CI, 86 to 95), and a negative predictive value of 83% (95% CI, 75 to 89). CT angiography was similar to conventional angiography in its ability to identify patients who subsequently underwent revascularization: the AUC was 0.84 (95% CI, 0.79 to 0.88) for multidetector CT angiography and 0.82 (95% CI, 0.77 to 0.86) for conventional angiography. A per-vessel analysis of 866 vessels yielded an AUC of 0.91 (95% CI, 0.88 to 0.93). Disease severity ascertained by CT and conventional angiography was well correlated (r=0.81; 95% CI, 0.76 to 0.84). Two patients had important reactions to contrast medium after CT angiography.Multidetector CT angiography accurately identifies the presence and severity of obstructive coronary artery disease and subsequent revascularization in symptomatic patients. The negative and positive predictive values indicate that multidetector CT angiography cannot replace conventional coronary angiography at present. (ClinicalTrials.gov number, NCT00738218.)

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Standardized Myocardial Segmentation and Nomenclature for Tomographic Imaging of the Heart

2002-01-29

Manuel D. Cerqueira , Neil J. Weissman , Vasken Dilsizian +7 more

Nuclear cardiology, echocardiography, cardiovascular magnetic resonance (CMR), cardiac computed tomography (CT), positron emission computed tomography (PET), and coronary angiography are imaging modalities that have been used to measure myocardial perfusion, … Nuclear cardiology, echocardiography, cardiovascular magnetic resonance (CMR), cardiac computed tomography (CT), positron emission computed tomography (PET), and coronary angiography are imaging modalities that have been used to measure myocardial perfusion, left ventricular function, and coronary anatomy for clinical management and research. Although there are technical differences between these modalities, all of them image the myocardium and the adjacent cavity. However, the orientation of the heart, angle selection for cardiac planes, number of segments, slice display and thickness, nomenclature for segments, and assignment of segments to coronary arterial territories have evolved independently within each field. This evolution has been based on the inherent strengths and weaknesses of the technique and the practical clinical application of these modalities as they are used for patient management. This independent evolution has resulted in a lack of standardization and has made accurate intra- and cross-modality comparisons for clinical patient management and research very difficult, if not, at times, impossible. Attempts to standardize these options for all cardiac imaging modalities should be based on the sound principles that have evolved from cardiac anatomy and clinical needs.1–3⇓⇓ Selection of standardized methods must be based on the following criteria: An earlier special report from the American Heart Association, American College of Cardiology, and Society of Nuclear Medicine4 defined standards for plane selection and display orientation for serial …

Expert Consensus for Multimodality Imaging Evaluation of Adult Patients during and after Cancer Therapy: A Report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging

2014-08-27

Juan Carlos Plana , Maurizio Galderisi , Ana Barac +7 more

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Physiologic basis for assessing critical coronary stenosis

1974-01-01

K. Lance Gould , Kirk Lipscomb , Glen W. Hamilton

Effect of Very High-Intensity Statin Therapy on Regression of Coronary Atherosclerosis

2006-03-13

Steven E. Nissen , Stephen J. Nicholls , İlke Sipahi +7 more

ContextPrior intravascular ultrasound (IVUS) trials have demonstrated slowing or halting of atherosclerosis progression with statin therapy but have not shown convincing evidence of regression using percent atheroma volume (PAV), the … ContextPrior intravascular ultrasound (IVUS) trials have demonstrated slowing or halting of atherosclerosis progression with statin therapy but have not shown convincing evidence of regression using percent atheroma volume (PAV), the most rigorous IVUS measure of disease progression and regression.ObjectiveTo assess whether very intensive statin therapy could regress coronary atherosclerosis as determined by IVUS imaging.Design and SettingProspective, open-label blinded end-points trial (A Study to Evaluate the Effect of Rosuvastatin on Intravascular Ultrasound-Derived Coronary Atheroma Burden [ASTEROID]) was performed at 53 community and tertiary care centers in the United States, Canada, Europe, and Australia. A motorized IVUS pullback was used to assess coronary atheroma burden at baseline and after 24 months of treatment. Each pair of baseline and follow-up IVUS assessments was analyzed in a blinded fashion.PatientsBetween November 2002 and October 2003, 507 patients had a baseline IVUS examination and received at least 1 dose of study drug. After 24 months, 349 patients had evaluable serial IVUS examinations.InterventionAll patients received intensive statin therapy with rosuvastatin, 40 mg/d.Main Outcome MeasuresTwo primary efficacy parameters were prespecified: the change in PAV and the change in nominal atheroma volume in the 10-mm subsegment with the greatest disease severity at baseline. A secondary efficacy variable, change in normalized total atheroma volume for the entire artery, was also prespecified.ResultsThe mean (SD) baseline low-density lipoprotein cholesterol (LDL-C) level of 130.4 (34.3) mg/dL declined to 60.8 (20.0) mg/dL, a mean reduction of 53.2% (P<.001). Mean (SD) high-density lipoprotein cholesterol (HDL-C) level at baseline was 43.1 (11.1) mg/dL, increasing to 49.0 (12.6) mg/dL, an increase of 14.7% (P<.001). The mean (SD) change in PAV for the entire vessel was −0.98% (3.15%), with a median of −0.79% (97.5% CI, −1.21% to −0.53%) (P<.001 vs baseline). The mean (SD) change in atheroma volume in the most diseased 10-mm subsegment was −6.1 (10.1) mm3, with a median of −5.6 mm3 (97.5% CI, −6.8 to −4.0 mm3) (P<.001 vs baseline). Change in total atheroma volume showed a 6.8% median reduction; with a mean (SD) reduction of −14.7 (25.7) mm3, with a median of −12.5 mm3 (95% CI, −15.1 to −10.5 mm3) (P<.001 vs baseline). Adverse events were infrequent and similar to other statin trials.ConclusionsVery high-intensity statin therapy using rosuvastatin 40 mg/d achieved an average LDL-C of 60.8 mg/dL and increased HDL-C by 14.7%, resulting in significant regression of atherosclerosis for all 3 prespecified IVUS measures of disease burden. Treatment to LDL-C levels below currently accepted guidelines, when accompanied by significant HDL-C increases, can regress atherosclerosis in coronary disease patients. Further studies are needed to determine the effect of the observed changes on clinical outcome.Trial RegistrationClinicalTrials.gov Identifier: NCT00240318Published online March 13, 2006 (doi:10.1001/jama.295.13.jpc60002).

The stunned myocardium: prolonged, postischemic ventricular dysfunction.

1982-12-01

Eugene Braunwald , Robert A. Kloner

Myocardial ischemia has, for many decades, been viewed as an all-or-none process that causes myocardial necrosis when prolonged and severe, but whose effects are transient when it is brief or … Myocardial ischemia has, for many decades, been viewed as an all-or-none process that causes myocardial necrosis when prolonged and severe, but whose effects are transient when it is brief or mild. In view of the evidence that the ischemic process may "hit, run and stun," perhaps our thinking about the consequences of myocardial ischemia should be expanded. According to this formulation, an ischemic insult not of sufficient severity of duration to produce myocardial necrosis may acutely affect myocardial repolarization and cause angina (hit); but these changes wane rapidly (run), when the balance between myocardial oxygen supply and demand has been reestablished. However, the ischemia may interfere with normal myocardial function, biochemical processes and ultrastructure for prolonged periods (stun). The severity and duration of these postischemic changes depend on the length and intensity of the ischemia, as well as on the condition of the myocardium at the onset of the ischemic episode. Furthermore, it is likely that when the myocardium is repeatedly stunned, it may exhibit chronic postischemic left ventricular dysfunction, an ill-defined condition. If prolonged, chronic postischemic left ventricular dysfunction can progress to myocardial scarring and ischemic cardiomyopathy, it may be important to determine how often it can be ameliorated by permanent improvement of myocardial perfusion by surgical treatment.

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Low Diagnostic Yield of Elective Coronary Angiography

2010-03-10

Manesh R. Patel , Eric D. Peterson , David Dai +5 more

Guidelines for triaging patients for cardiac catheterization recommend a risk assessment and noninvasive testing. We determined patterns of noninvasive testing and the diagnostic yield of catheterization among patients with suspected … Guidelines for triaging patients for cardiac catheterization recommend a risk assessment and noninvasive testing. We determined patterns of noninvasive testing and the diagnostic yield of catheterization among patients with suspected coronary artery disease in a contemporary national sample.From January 2004 through April 2008, at 663 hospitals in the American College of Cardiology National Cardiovascular Data Registry, we identified patients without known coronary artery disease who were undergoing elective catheterization. The patients' demographic characteristics, risk factors, and symptoms and the results of noninvasive testing were correlated with the presence of obstructive coronary artery disease, which was defined as stenosis of 50% or more of the diameter of the left main coronary artery or stenosis of 70% or more of the diameter of a major epicardial vessel.A total of 398,978 patients were included in the study. The median age was 61 years; 52.7% of the patients were men, 26.0% had diabetes, and 69.6% had hypertension. Noninvasive testing was performed in 83.9% of the patients. At catheterization, 149,739 patients (37.6%) had obstructive coronary artery disease. No coronary artery disease (defined as <20% stenosis in all vessels) was reported in 39.2% of the patients. Independent predictors of obstructive coronary artery disease included male sex (odds ratio, 2.70; 95% confidence interval [CI], 2.64 to 2.76), older age (odds ratio per 5-year increment, 1.29; 95% CI, 1.28 to 1.30), presence of insulin-dependent diabetes (odds ratio, 2.14; 95% CI, 2.07 to 2.21), and presence of dyslipidemia (odds ratio, 1.62; 95% CI, 1.57 to 1.67). Patients with a positive result on a noninvasive test were moderately more likely to have obstructive coronary artery disease than those who did not undergo any testing (41.0% vs. 35.0%; P<0.001; adjusted odds ratio, 1.28; 95% CI, 1.19 to 1.37).In this study, slightly more than one third of patients without known disease who underwent elective cardiac catheterization had obstructive coronary artery disease. Better strategies for risk stratification are needed to inform decisions and to increase the diagnostic yield of cardiac catheterization in routine clinical practice.

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Quantification of coronary artery calcium using ultrafast computed tomography

1990-03-01

Arthur S. Agatston , Warren R. Janowitz , Frank J. Hildner +3 more

Coronary Artery Calcium Area by Electron-Beam Computed Tomography and Coronary Atherosclerotic Plaque Area

1995-10-15

John A. Rumberger , D.Brent Simons , Lorraine A. Fitzpatrick +2 more

Coronary calcium identified by electron-beam computed tomography (EBCT) correlates poorly with luminal atherosclerotic narrowing, but calcium, an intimate part of coronary plaque, may be more directly related to atheromatous plaque … Coronary calcium identified by electron-beam computed tomography (EBCT) correlates poorly with luminal atherosclerotic narrowing, but calcium, an intimate part of coronary plaque, may be more directly related to atheromatous plaque area.Thirty-eight coronary arteries from 13 autopsy hearts were dissected, straightened, and scanned with EBCT in 3-mm contiguous increments. Coronary calcium area was defined as one or more pixels with a density > 130 Hounsfield units (0.18 mm2/pixel). Each artery was divided into corresponding 3-mm segments, representative histological sections were stained, and atherosclerotic plaque area per segment (mm2) was quantified. Coronary artery calcium and coronary artery plaque areas were correlated for the hearts as a whole, for individual coronary arteries, and for individual coronary artery segments. The sums of histological plaque areas versus the sums of calcium areas were highly correlated for each heart and for each coronary artery. However, coronary plaque area was on the order of five times greater than calcium area. Furthermore, minimal diffuse segmental coronary plaque could be present despite the absence of coronary calcium detectable by EBCT.This histopathologic study confirms an intimate relation between whole heart, coronary artery, and segmental coronary atherosclerotic plaque area and EBCT coronary calcium area but suggests that there is a threshold value for plaque area below which coronary calcium is either absent or not detectable by this methodology.

AHA/ACC Guidelines for Secondary Prevention for Patients With Coronary and Other Atherosclerotic Vascular Disease: 2006 Update

2006-05-15

Sidney C. Smith , Jerilyn K. Allen , Steven N. Blair +7 more

HomeCirculationVol. 113, No. 19AHA/ACC Guidelines for Secondary Prevention for Patients With Coronary and Other Atherosclerotic Vascular Disease: 2006 Update HomeCirculationVol. 113, No. 19AHA/ACC Guidelines for Secondary Prevention for Patients With Coronary and Other Atherosclerotic Vascular Disease: 2006 Update

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Can coronary angiography predict the site of a subsequent myocardial infarction in patients with mild-to-moderate coronary artery disease?

1988-11-01

William C. Little , M Constantinescu , Robert J. Applegate +4 more

To help determine if coronary angiography can predict the site of a future coronary occlusion that will produce a myocardial infarction, the coronary angiograms of 42 consecutive patients who had … To help determine if coronary angiography can predict the site of a future coronary occlusion that will produce a myocardial infarction, the coronary angiograms of 42 consecutive patients who had undergone coronary angiography both before and up to a month after suffering an acute myocardial infarction were evaluated. Twenty-nine patients had a newly occluded coronary artery. Twenty-five of these 29 patients had at least one artery with a greater than 50% stenosis on the initial angiogram. However, in 19 of 29 (66%) patients, the artery that subsequently occluded had less than a 50% stenosis on the first angiogram, and in 28 of 29 (97%), the stenosis was less than 70%. In every patient, at least some irregularity of the coronary wall was present on the first angiogram at the site of the subsequent coronary obstruction. In only 10 of the 29 (34%) did the infarction occur due to occlusion of the artery that previously contained the most severe stenosis. Furthermore, no correlation existed between the severity of the initial coronary stenosis and the time from the first catheterization until the infarction (r2 = 0.0005, p = NS). These data suggest that assessment of the angiographic severity of coronary stenosis may be inadequate to accurately predict the time or location of a subsequent coronary occlusion that will produce a myocardial infarction.

Fourth Joint Task Force of the European Society of Cardiology and other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts)

2007-08-28

Ian Graham , Dan Atar , Knut Borch‐Johnsen +7 more

Other experts who contributed to parts of the guidelines: Edmond Walma, Tony Fitzgerald, Marie Therese Cooney, Alexandra Dudina European Society of Cardiology (ESC) Committee for Practice Guidelines (CPG): Alec Vahanian … Other experts who contributed to parts of the guidelines: Edmond Walma, Tony Fitzgerald, Marie Therese Cooney, Alexandra Dudina European Society of Cardiology (ESC) Committee for Practice Guidelines (CPG): Alec Vahanian (Chairperson), John Camm, Raffaele De Caterina, Veronica Dean, Kenneth Dickstein, Christian Funck-Brentano, Gerasimos Filippatos, Irene Hellemans, Steen Dalby Kristensen, Keith McGregor, Udo Sechtem, Sigmund Silber, Michal Tendera, Petr Widimsky, Jose Luis Zamorano Document reviewers: Irene Hellemans (CPG Review Co-ordinator), Attila Altiner, Enzo Bonora, Paul N. Durrington, Robert Fagard, Simona Giampaoli, Harry Hemingway, Jan Hakansson, Sverre Erik Kjeldsen, Mogens Lytken Larsen, Giuseppe Mancia, Athanasios J. Manolis, Kristina Orth-Gomer, Terje Pedersen, Mike Rayner, Lars Ryden, Mario Sammut, Neil Schneiderman, Anton F. Stalenhoef, Lale Tokgözoglu, Olov Wiklund, Antonis Zampelas

Measurement of Fractional Flow Reserve to Assess the Functional Severity of Coronary-Artery Stenoses

1996-06-27

Nico H.J. Pijls , Bernard De Bruyne , Kathinka Peels +4 more

The clinical significance of coronary-artery stenoses of moderate severity can be difficult to determine. Myocardial fractional flow reserve (FFR) is a new index of the functional severity of coronary stenoses … The clinical significance of coronary-artery stenoses of moderate severity can be difficult to determine. Myocardial fractional flow reserve (FFR) is a new index of the functional severity of coronary stenoses that is calculated from pressure measurements made during coronary arteriography. We compared this index with the results of noninvasive tests commonly used to detect myocardial ischemia, to determine the usefulness of the index.

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Analysis of Probability as an Aid in the Clinical Diagnosis of Coronary-Artery Disease

1979-06-14

George Diamond , James S. Forrester

The diagnosis of coronary-artery disease has become increasingly complex. Many different results, obtained from tests with substantial imperfections, must be integrated into a diagnostic conclusion about the probability of disease … The diagnosis of coronary-artery disease has become increasingly complex. Many different results, obtained from tests with substantial imperfections, must be integrated into a diagnostic conclusion about the probability of disease in a given patient. To approach this problem in a practical manner, we reviewed the literature to estimate the pretest likelihood of disease (defined by age, sex and symptoms) and the sensitivity and specificity of four diagnostic tests: stress electrocardiography, cardiokymography, thallium scintigraphy and cardiac fluoroscopy. With this information, test results can be analyzed by use of Bayes' theorem of conditional probability. This approach has several advantages. It pools the diagnostic experience of many physicians ans integrates fundamental pretest clinical descriptors with many varying test results to summarize reproducibly and meaningfully the probability of angiographic coronary-artery disease. This approach also aids, but does not replace, the physician's judgment and may assit in decisions on cost effectiveness of tests.

American College of Cardiology clinical expert consensus document on standards for acquisition, measurement and reporting of intravascular ultrasound studies (ivus)31When citing this document, the American College of Cardiology would appreciate the following citation format: Mintz GS, Nissen SE, Anderson WD, Bailey SR, Erbel R, Fitzgerald PJ, Pinto FJ, Rosenfield K, Siegel RJ, Tuzcu EM, Yock PG. ACC Clinical Expert Consensus Document on Standards for the acquisition, measurement and reporting …

2001-04-01

Gary S. Mintz , Steven E. Nissen , William Anderson +7 more

Deep Learning Techniques for Automatic MRI Cardiac Multi-Structures Segmentation and Diagnosis: Is the Problem Solved?

2018-05-17

Olivier Bernard , Alain Lalande , Clément Zotti +7 more

Delineation of the left ventricular cavity, myocardium, and right ventricle from cardiac magnetic resonance images (multi-slice 2-D cine MRI) is a common clinical task to establish diagnosis. The automation of … Delineation of the left ventricular cavity, myocardium, and right ventricle from cardiac magnetic resonance images (multi-slice 2-D cine MRI) is a common clinical task to establish diagnosis. The automation of the corresponding tasks has thus been the subject of intense research over the past decades. In this paper, we introduce the "Automatic Cardiac Diagnosis Challenge" dataset (ACDC), the largest publicly available and fully annotated dataset for the purpose of cardiac MRI (CMR) assessment. The dataset contains data from 150 multi-equipments CMRI recordings with reference measurements and classification from two medical experts. The overarching objective of this paper is to measure how far state-of-the-art deep learning methods can go at assessing CMRI, i.e., segmenting the myocardium and the two ventricles as well as classifying pathologies. In the wake of the 2017 MICCAI-ACDC challenge, we report results from deep learning methods provided by nine research groups for the segmentation task and four groups for the classification task. Results show that the best methods faithfully reproduce the expert analysis, leading to a mean value of 0.97 correlation score for the automatic extraction of clinical indices and an accuracy of 0.96 for automatic diagnosis. These results clearly open the door to highly accurate and fully automatic analysis of cardiac CMRI. We also identify scenarios for which deep learning methods are still failing. Both the dataset and detailed results are publicly available online, while the platform will remain open for new submissions.

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2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes

2019-08-31

Juhani Knuuti , William Wijns , Antti Saraste +7 more

Coronary artery disease (CAD) is a pathological process characterized by atherosclerotic plaque accumulation in the epicardial arteries, whether obstructive or non-obstructive. This process can be modified by lifestyle adjustments, pharmacological … Coronary artery disease (CAD) is a pathological process characterized by atherosclerotic plaque accumulation in the epicardial arteries, whether obstructive or non-obstructive. This process can be modified by lifestyle adjustments, pharmacological therapies, and invasive interventions designed to achieve disease stabilization or regression. The disease can have long, stable periods but can also become unstable at any time, typically due to an acute atherothrombotic event caused by plaque rupture or erosion. However, the disease is chronic, most often progressive, and hence serious, even in clinically apparently silent periods. The dynamic nature of the CAD process results in various clinical presentations, which can be conveniently categorized as either acute coronary syndromes (ACS) or chronic coronary syndromes (CCS). The Guidelines presented here refer to the management of patients with CCS. The natural history of CCS is illustrated in Figure 1.

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Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction. Universal definition of myocardial infarction

2007-01-01

Kristian Thygesen

Third Universal Definition of Myocardial Infarction

2012-09-05

Kristian Thygesen , Joseph S. Alpert , Allan S. Jaffe +7 more

Third universal definition of myocardial infarction

2012-08-25

Kristian Thygesen , Joseph S. Alpert , Allan S. Jaffe +3 more

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Universal Definition of Myocardial Infarction

2007-11-01

Kristian Thygesen , Joseph S. Alpert , Harvey D. White

Fourth Universal Definition of Myocardial Infarction (2018)

2018-08-25

Kristian Thygesen , Joseph S. Alpert , Allan S. Jaffe +4 more

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2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease

2012-11-19

Stephan D. Fihn , Julius M. Gardin , Jonathan Abrams +7 more

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Third Universal Definition of Myocardial Infarction

2012-08-26

Kristian Thygesen , Joseph S. Alpert , Allan S. Jaffe +7 more

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Third universal definition of myocardial infarction

2012-08-24

Kristian Thygesen , Joseph S. Alpert , Allan S. Jaffe +7 more

How to Report a Coronary CT Angiogram: Step-by-Step Guide for the Novice Reader

2025-06-26

| Radiographics

Expanding the coronary assessment in MINOCA: the diagnostic contribution of computed tomography angiography

2025-06-25

Ioannis Skalidis , Anthony Millin , Panayotis K. Vlachakis +2 more | The International Journal of Cardiovascular Imaging

Evaluating the Role of Computed Tomography Angiography in Assessing Return-to-Fly in Pilots with Coronary Artery Disease: An Evidence Based Virtual Case Report

2025-06-25

Rachmy Hamdiyati , Anugrah Dwi Riski , Monica Djaja Saputera +1 more | The Korean Journal of Aerospace and Environmental Medicine

Diagnostic Validity of Acetylcholine Provocation Protocols in the Evaluation of Coronary Artery Spasm in Patients With ANOCA

2025-06-25

Rajan Rehan , Chinmay Khandkar , Christopher Wong +6 more | Circulation Cardiovascular Interventions

BACKGROUND: Coronary artery spasm (CAS) is a common cause of angina with nonobstructive coronary arteries (ANOCA). While acetylcholine provocation testing is the diagnostic gold standard, protocol variations have led to … BACKGROUND: Coronary artery spasm (CAS) is a common cause of angina with nonobstructive coronary arteries (ANOCA). While acetylcholine provocation testing is the diagnostic gold standard, protocol variations have led to discrepancies in diagnostic accuracy. This study aimed to compare the diagnostic validity of conventional versus high-dose acetylcholine regimens in patients with ANOCA. METHODS: Multivessel acetylcholine provocation testing was systematically performed in patients with ANOCA and a control cohort undergoing invasive coronary angiography for noncoronary indications. Incremental acetylcholine doses in the left (20–200 μg) and right (20–80 μg) coronary arteries were manually injected over 20 seconds to induce CAS. RESULTS: The study included 62 ANOCA patients with typical CAS symptoms and 20 controls. Conventional-dose acetylcholine testing identified CAS in 67.1% (55/82) of patients, while high-dose testing detected CAS in 79.3% (65/82). Among patients with inducible spasm, 93.4% (61/65) had typical angina consistent with CAS. High-dose acetylcholine demonstrated significantly higher sensitivity (98% versus 87%, P =0.008), but a nonsignificant trend toward lower specificity (80% versus 95%, P =0.08). The high-dose regimen also showed a higher negative predictive value (94% versus 70%, P =0.01), while positive predictive values were comparable (93% versus 98%, P =0.12). CONCLUSIONS: High-dose acetylcholine provocation improves the detection of CAS in patients with ANOCA but may increase the risk of overdiagnosis. This approach should be reserved for patients with a high clinical suspicion of CAS, with the results interpreted within the broader clinical context.

Right Ventricular Strain Improves Cardiac MRI–based Prognostication (Radiology In A Minute)

2025-06-25

| Radiology

Combined prediction value of coronary plaque burden, serum creatinine, MLR and NLR in reinfarction risk after PCI in middle-aged and elderly patients with myocardial infarction

2025-06-24

Huanhua Du , Zheng Lü , Yun Liu +4 more | European journal of medical research

To analyze the predictive value of coronary plaque burden combined with serum creatinine (Scr), monocyte/lymphocyte ratio (MLR), and neutrophil/lymphocyte ratio (NLR) in the risk of reinfarction after percutaneous coronary intervention … To analyze the predictive value of coronary plaque burden combined with serum creatinine (Scr), monocyte/lymphocyte ratio (MLR), and neutrophil/lymphocyte ratio (NLR) in the risk of reinfarction after percutaneous coronary intervention (PCI) in middle-aged and elderly patients with acute myocardial infarction (AMI). A retrospective analysis was conducted on the clinical data of 1,582 patients with AMI who underwent PCI in our hospital from January 2021 to January 2024. Based on the occurrence of reinfarction within 6 months post-PCI, patients were divided into a reinfarction group (216 cases) and a non-reinfarction group (1,366 cases). To analyze the risk factors and related predictive values of reinfarction in middle-aged and elderly AMI patients after PCI. Multivariate Logistic regression analysis showed that age, Killip grade, LVEF, cTnI, non-calcified plaque burden, calcified plaque burden, total calcified plaque burden, Scr, MLR, and NLR were all risk factors for reinfarction in middle-aged and elderly AMI patients after PCI (P < 0.05). ROC analysis showed that the combined detection of coronary plaque burden, Scr, MLR and NLR predicted the risk of reinfarction in middle-aged and elderly AMI patients after PCI, and the AUC was 0.998, 95%CI was 0.997 ~ 1.000, the sensitivity was 99.10%, and the specificity was 97.20%, all of them were significantly higher than the individual detection of each index (P < 0.05). The combined detection of coronary plaque burden, Scr, MLR and NLR has a high predictive value for reinfarction after PCI in middle-aged and elderly AMI patients, and should be paid close attention to clinically.

Feasibility, Added Value, and Radiation Dose of Combined Coronary CT Angiography and Stress Dynamic CT Myocardial Perfusion Imaging in Moderate Coronary Artery Disease: A Real-World Study

2025-06-24

Marco Fogante , Emilio A Paolini , Fatjon Cela +4 more | Journal of Cardiovascular Development and Disease

Objective: We aimed to evaluate the feasibility, added value, and radiation dose of coronary computed tomography angiography (CCTA) and stress dynamic CT myocardial perfusion imaging (MPI) in patients with coronary … Objective: We aimed to evaluate the feasibility, added value, and radiation dose of coronary computed tomography angiography (CCTA) and stress dynamic CT myocardial perfusion imaging (MPI) in patients with coronary artery disease (CAD) in a real-world setting. Materials and Methods: This retrospective study included 65 patients (mean age: 51.2 ± 11.5 years; 21 female) with moderate CAD, selected from the Radiological Database of our hospital between May 2022 and December 2024. All patients underwent CCTA and stress dynamic CT-MPI using a third-generation dual-source CT scanner. The shuttle-mode acquisition technique was used for CT-MPI with 60 mL of contrast (iopamidol, 370 mg iodine/mL) administered at a flow rate of 6 mL/s. The mean myocardial blood flow (MBF) and other quantitative parameters were measured for both CAD and reference segments (RSs). A 17-segment-based analysis was employed (excluding the apex). The MBF ratio, defined as the mean MBF value of CAD segments divided by that of RS, was used with a cut-off value of 0.85 to distinguish hypoperfused from non-hypoperfused segments within CAD territories. Non-parametric statistical tests were applied. Results: A total of 1040 segments were evaluated. In 62 segments, the mean MBF of CAD territories was found to have decreased. The mean MBF and myocardial blood volume (MBV) in hypoperfused CAD segments were 65.1 ± 19.8 mL/100 mL/min and 14.5 ± 2.7 mL/100 mL, respectively, both significantly lower compared to non-hypoperfused CAD segments and RSs (p < 0.001). The mean effective dose of the protocol was 6.3 ± 1.4 mSv, corresponding to an estimated individual lifetime cancer risk of approximately 0.06% per test, based on BEIR VII Phase 2 modeling. This risk is cumulative, with repeat testing over a 10-year period potentially increasing lifetime cancer risk in proportion to total radiation exposure. The mean total examination time was 26 ± 4 min. Conclusion: The combined CCTA and dynamic CT-MPI protocol is feasible in real-world clinical practice and offers a comprehensive morphological and functional assessment of moderate CAD, with a manageable radiation dose and examination time.

Artificial Intelligence Powered Real-Time Coronary Stenosis Recognition and Quantification in Angiography

2025-06-24

Kuo-Ting Tang , Jhih‐Yuan Shih , Po-Chao Hsu +7 more | Deleted Journal

Effective and automated measurement of coronary lesions is essential for timely decision-making during interventions. However, a comprehensive, real-time strategy remains limited. This study aimed to develop a real-time deep learning … Effective and automated measurement of coronary lesions is essential for timely decision-making during interventions. However, a comprehensive, real-time strategy remains limited. This study aimed to develop a real-time deep learning system for automated detection and quantification of stenotic lesions in coronary angiography. The model was trained using 2651 diagnostic coronary angiographic images from 502 adult patients collected between February 2015 and January 2022 at two tertiary care hospitals. The system integrates five core components: vessel type classification, keyframe selection, lesion detection, vessel segmentation, and quantitative coronary angiography (QCA). In internal and external datasets, vessel type classification accuracies reached 96.33% and 94.19%, while keyframe selection accuracies were 98.29% and 93.27%, respectively. Lesion detection achieved recall/precision scores of 0.93/0.89 internally and 0.92/0.76 externally. Segmentation and QCA accuracies exceeded 0.92 in both cohorts. The complete system identifies stenotic lesions and their locations within 2 min. Clinical feedback indicated over 80% satisfaction. Our findings support the potential of this model to improve diagnostic accuracy and streamline clinical workflows in coronary angiography.

Optimized Preparation and Management of Calcified Coronary Artery Lesions

2025-06-24

Naotaka Okamoto , Yasuyuki Egami , Masami Nishino | Journal of Coronary Artery Disease

[Myocardial fibrosis: evidence-based validation and clinical application of cardiovascular magnetic resonance].

2025-06-24

Liyuan Zhu , Shui-Ping Zhao , Minjie Lu | PubMed

[The impact of myocardial infarct size dynamics on left ventricular remodeling in STEMI patients after primary percutaneous coronary intervention].

2025-06-24

Shengli Chen , Xin A , Yanping Zhao +7 more | PubMed

Objective: To explore the impact of changes of myocardial infarct size on left ventricular adverse remodeling in patients with acute ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention … Objective: To explore the impact of changes of myocardial infarct size on left ventricular adverse remodeling in patients with acute ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PCI). Methods: This was a prospective cohort study. The STEMI patients who underwent primary PCI in the First Medical Center of the Chinese People's Liberation Army General Hospital, Beijing Anzhen Hospital, Hainan Hospital of the Chinese People's Liberation Army General Hospital and Guangxi Yulin First People Hospital from January 1, 2017 to January 1, 2022 were enrolled. Cardiac magnetic resonance (CMR) was performed to dynamically assess the myocardial infarct size and calculate the rate of infarct size change between the acute phase (5 to 7 days post-primary PCI) and 6-month follow-up. The endpoint was left ventricular adverse remodeling which was defined as an increase of more than 20% in left ventricular end-diastolic volume (LVEDV) assessed by CMR at 6 months after primary PCI compared with LVEDV at 1 week after primary PCI. Based on serial CMR assessments, the patients were divided into left ventricular adverse remodeling group and non-remodeling group. The receiver operating characteristic (ROC) curve was used to evaluate the predictive performance of infarct size change for left ventricular adverse remodeling, and according to the optimal cutoff value, improved infarct size was defined as a decrease of >20% in the infarct size measured by CMR at 6 months after primary PCI compared with infarct size at 1 week after primary PCI. Multivariate logistic regression analysis was performed to identify the protective factors and risk factors for left ventricular adverse remodeling. Results: A total of 267 patients were enrolled, aged (58±11) years, with 234 males (87.6%). And 73 cases in the left ventricular remodeling group and 194 cases in the non-remodeling group. Infarct size assessed by CMR at 6 months after primary PCI decreased significantly compared with infarct size at 1 week after primary PCI in the left ventricular remodeling group ((23±13)% vs. (27±12)%, P=0.004), the same as in the non-remodeling group ((18±10)% vs. (23±10)%, P<0.001). The area under the ROC curve for the rate of infarct size change in predicting left ventricular remodeling was 0.735 (95%CI 0.670-0.799, P<0.001), a 20% reduction was the optimal cut-off value. Compared to the patients with non-improved infarct size, the incidence of left ventricular adverse remodeling was significantly lower in the patients with improved infarct size (18% (24/133) vs. 37% (49/134), P=0.001). Multivariate logistic regression analysis showed that improvement in IS was a protective factor for left ventricular adverse remodeling (OR=0.376, 95%CI 0.236-0.721, P=0.002). Conclusion: Patients with STEMI who experience obvious reduction in infarct size after primary PCI have a significantly reduced risk of left ventricular adverse remodeling.

A clinical study of coronary computed tomographic angiography in the diagnostic performance, risk assessment and guidance of treatment for coronary heart disease

2025-06-24

Haijun Li , Yanan Xie , Shujun Wang +1 more | Clinical and Experimental Hypertension

This study aimed to evaluate the diagnostic performance, risk assessment, and treatment-guiding value of coronary computed tomographic angiography (CCTA) in patients with coronary heart disease (CHD). The diagnostic value of … This study aimed to evaluate the diagnostic performance, risk assessment, and treatment-guiding value of coronary computed tomographic angiography (CCTA) in patients with coronary heart disease (CHD). The diagnostic value of CCTA for CHD was assessed by analyzing key parameters including sensitivity, specificity, accuracy, positive predictive value, and negative predictive value. Additionally, the diagnostic relevance of specific CCTA-derived metrics was explored. Patients with confirmed CHD underwent percutaneous coronary intervention (PCI), and the occurrence of major adverse cardiovascular events (MACE) within one year after PCI were recorded. Differences in CCTA parameters between patients with and without MACE were compared. Multivariate logistic regression was conducted to identify independent risk factors for post-PCI MACE. CCTA demonstrated high diagnostic value for CHD. Compared to the control group, patients with CHD exhibited significantly greater plaque length, total plaque volume, calcified plaque volume, lipid plaque volume, plaque burden, and coronary diameter stenosis, along with a smaller minimum lumen area. These imaging features were predictive of CHD. Relative to the non-MACE group (n = 69), the MACE group (n = 56) had higher plaque length, total plaque volume, plaque burden, and coronary diameter stenosis rate, and smaller minimum lumen area. Multivariate logistic regression analysis identified plaque burden, coronary diameter stenosis, and hypertension serve as independent predictors for adverse cardiovascular events following PCI in CHD patients. CCTA is a valuable noninvasive modality for the diagnosis of CHD, risk assessment, and optimization of treatment strategies, particularly in predicting adverse outcomes following PCI.

[Characteristics of left ventricular wall shear stress at each segment in patients with dilated cardiomyopathy based on vector flow imaging].

2025-06-24

Yan Yang , Xue Dong , Y X Zhang +3 more | PubMed

This study utilized vector flow mapping (VFM) technology to evaluate the characteristics of wall shear stress (WSS) in each segment of the left ventricle in patients with dilated cardiomyopathy (DCM). … This study utilized vector flow mapping (VFM) technology to evaluate the characteristics of wall shear stress (WSS) in each segment of the left ventricle in patients with dilated cardiomyopathy (DCM). A total of 39 DCM patients [DCM group, 17 males and 22 females, aged (56.4±12.3) years] treated at the Second Affiliated Hospital of Air Force Medical University from May 2020 to September 2022 were prospectively enrolled. Additionally, 46 age-and gender-matched healthy volunteers [control group, 20 males and 26 females, aged (55.2±11.8) years] were selected during the same period. VFM was applied to annlyze WSS in the apical four-chamber, three-chamber, and two-chamber views of the left ventricle, and differences in WSS between the two groups were compared. The results showed that WSS at each phase of cardiac cycle gradunlly decreased gradually from basal to apical segments of the left uenrtricle in the control group but not in the DCM group. The DCM group exhibited significantly lower WSS than the control group in the mid-inferolateral wall during rapid filling; the basal posterior septum, basal inferolateral wall, mid-inferolateral wall, basal anterior septum, basal inferior wall, mid-anterior wall, and basal anterior wall during isovolumic contraction; and the basal, mid, and apical inferolateral segments during rapid ejection (all P<0.05). In addition, the global WSS was significantly lower in the DCM group than in the control group only in the mid-systolic phase [0.23(0.16, 0.31) N/m2 vs 0.34(0.24, 0.38) N/m2, P<0.05]. This study suggests that abnormal WSS distribution in DCM patients may reflect differences in ventricular mechanics, and changes in this parameter could serve as a novel indicator of ventricular dysfunction.

USO DE DISPOSITIVOS PORTÁTEIS DE MONITORAMENTO CARDÍACO NA PREDIÇÃO DE FIBRILAÇÃO ATRIAL PAROXÍSTICA

2025-06-23

GIULIANA VIECILLI CASTILHOS , BEATRIZ CASSEL CORRÊA , ARTHUR VITÓRIO SCARTON SCHWERZ +6 more | Editora Pasteur eBooks

Enhanced risk stratification in chronic coronary syndrome using the left atrioventricular coupling index

2025-06-23

Ailís Ceara Haney , Janek Salatzki , Yahya Badran +7 more | Clinical Research in Cardiology

The study aimed to assess the prognostic value of left atrioventricular coupling index (LACI), measured by cardiovascular magnetic resonance (CMR), in predicting cardiovascular events in patients with chronic coronary syndrome … The study aimed to assess the prognostic value of left atrioventricular coupling index (LACI), measured by cardiovascular magnetic resonance (CMR), in predicting cardiovascular events in patients with chronic coronary syndrome (CCS). We retrospectively analyzed patients with CCS who underwent CMR stress testing between 2008 and 2018. LACI was defined as the ratio of left atrial end-diastolic volume to left ventricular end-diastolic volume. Additionally, global longitudinal strain was obtained. The primary endpoint was the occurrence of a major adverse cardiovascular event (MACE), including cardiac death and myocardial infarction. Secondary endpoints included hospitalization for heart failure (HFH) and all-cause death. In the cohort of 613 patients (81.2% male, median age 70 (63-76) years), 81 (13.2%) experienced MACE after a median follow-up of 5.6 (4.2-6.8) years. LACI was not significantly associated with MACE (HR per 1% increment 1.01; 95% CI 0.99-1.01, p = 0.07), but was significantly associated with HFH (HR per 1% increment 1.02, 95% CI 1.01-1.03, p < 0.0001) and all-cause death (HR per 1% increment 1.02, 95% CI 1.01-1.03, p < 0.0001). After adjusting for clinical as well as standard CMR parameters, the association of LACI remained significant for HFH and all-cause death. LACI showed incremental prognostic value for HFH in various multivariable models beyond traditional CMR parameters and global longitudinal strain. LACI is a significant predictor for all-cause death and HFH in a cohort with CCS and provides incremental prognostic value for HFH, beyond traditional cardiovascular risk factors and imaging parameters.

Prognostic Utility of Nodular Calcification Detected on Non-Contrast Computed Tomography in Severely Calcified Coronary Lesions

2025-06-23

Seigo Iwane , Takayoshi Toba , Hiroyuki Kawamori +7 more | Circulation Journal

Nodular calcification (NC) detected via intracoronary imaging is associated with adverse cardiovascular events after percutaneous coronary intervention (PCI). However, the impact of NC detected on pre-PCI non-contrast computed tomography (CT) … Nodular calcification (NC) detected via intracoronary imaging is associated with adverse cardiovascular events after percutaneous coronary intervention (PCI). However, the impact of NC detected on pre-PCI non-contrast computed tomography (CT) on clinical outcomes has not been fully investigated. We retrospectively included 267 consecutive patients with chronic coronary syndrome who underwent electrocardiography-gated non-contrast CT before PCI for severely calcified lesions. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE), a composite of all-cause death, stroke, non-fatal myocardial infarction, and target lesion revascularization (TLR). Fifty-eight patients had NC detected on non-contrast CT in target lesions. The MACCE-free survival rate was significantly lower in patients with than without NC (P<0.001). All-cause death, cardiac death, and TLR-free survival rates were significantly lower among patients with than without NC. Multivariate Cox regression analysis revealed that hemodialysis (hazard ratio [HR] 3.00; P=0.003), peripheral artery disease (HR 2.65; P=0.01), and the presence of NC (HR 5.25; P<0.001) were independently associated with MACCE. Adding NC to traditional cardiovascular risk factors, peripheral artery disease, and hemodialysis can provide discriminatory and reclassification abilities in predicting MACCE. NC detected on non-contrast CT was independently associated with MACCE. Therefore, evaluating NC using preprocedural non-contrast CT may be useful in predicting future clinical outcomes after PCI.

Is it Time to Redefine Criteria for Coronary Artery Calcification Significance for South-Asian Women?

2025-06-23

Soumya Patnaik | Indian Journal of Cardiovascular Disease in Women

Cost-Effectiveness of the CADScor System in Low-Risk Patients Presenting to the Emergency Department with Chest Pain

2025-06-23

Suzanne J. Baron , Serge Korjian , C. Michael Gibson +1 more | PharmacoEconomics - Open

Studies have shown that up to 13% of patients presenting to the emergency department (ED) with low-risk chest pain receive further cardiac testing beyond an electrocardiogram and serial cardiac enzymes. … Studies have shown that up to 13% of patients presenting to the emergency department (ED) with low-risk chest pain receive further cardiac testing beyond an electrocardiogram and serial cardiac enzymes. The CADScor System is a US Food and Drug Administration (FDA)-cleared device that uses ultra-sensitive phonocardiography to evaluate the risk of significant coronary artery disease (CAD). To evaluate the relative cost-effectiveness of the CADScor system compared with other diagnostic modalities for the evaluation of low-risk chest pain in patients presenting to the ED in the USA. A two-part economic model, consisting of a decision analytic tree followed by a short-term Markov model, was developed to compare 1-year costs and outcomes (e.g., quality-adjusted life year [QALY], false-negatives, and related cardiac events) associated with the CADScor System as the first-line test versus other noninvasive cardiac tests from the perspective of the US healthcare system (TreeAge Pro). Model inputs were derived from literature, and costs for treatment strategies were calculated from average US reimbursements associated with Current Procedural Terminology and Medicare Severity Diagnosis Related Group codes. Values were reported in 2023 US dollars (USD). Parameter uncertainty was assessed through a series of deterministic and one-way sensitivity analyses. Base case results demonstrated that a CADScor-First strategy was cost saving compared with other noninvasive cardiac tests without a substantial difference in adverse events. Economic results were consistent when coronary artery disease (CAD) prevalence rates were varied from 2 to 30% and across a variety of sensitivity analyses. The overall cost savings were estimated to be $7.3-15.3 million USD per 10,000 patients with low-risk chest pain. Use of a CADScor-First strategy in the evaluation of patients with low-risk chest pain presenting to the ED may result in substantial cost savings for the US healthcare system. More research is needed to understand the long-term costs and outcomes of this strategy.

SÍNDROMES CORONÁRIAS AGUDAS SEM SUPRADESNIVELAMENTO DO SEGMENTO ST: SELEÇÃO DE UMA ESTRATÉGIA DE TRATAMENTO

2025-06-23

Ludmila Franco Santos de Santana Vidal , Natália da Silva Freitas Marques | Revista fisio&terapia.

Intravascular physiology and imaging in determining the indications for revascularization in patients with intermediate coronary stenosis

2025-06-23

A.A. Arnt , A.Yu. Kolesnikov , N. А. Kochergin | Russian Journal of Cardiology and Cardiovascular Surgery

Objective. To compare functional and morphological indications for myocardial revascularization in patients with intermediate lesions of coronary arteries. Material and methods. Patients with coronary artery disease underwent functional (FFR/iFR) and … Objective. To compare functional and morphological indications for myocardial revascularization in patients with intermediate lesions of coronary arteries. Material and methods. Patients with coronary artery disease underwent functional (FFR/iFR) and morphological (OCT/IVUS) assessment of intermediate stenosis 40—70% (by diameter) to identify significance of lesions. Percutaneous coronary intervention was performed if indications for revascularization were identified according to one method. After 12 months, the following endpoints were assessed: recurrence of angina, myocardial infarction, all-cause mortality and target vessel revascularization. Results. The study included 49 patients with intermediate coronary artery stenosis. Coincidence of functional and morphological criteria was observed in 69% of cases. In 12% of patients, significant stenoses were detected by FFR in contrast to intravascular imaging. In 19% of patients, there were morphological criteria of significance, but hemodynamic effect of lesion was not confirmed by intravascular physiology. After 12 months, there was no significant difference in angina recurrence rate between groups of PCI and optimal therapy (8.3% and 4%, p=0.793). Conclusion. Thus, determining the strategy under control of intracoronary physiology and imaging allows us to identify functional and morphological criteria for revascularization. In turn, FFR/iFR was associated with lower frequency of detection of criteria for significance of intermediate lesions compared to IVUS/OCT. Percutaneous coronary intervention or avoiding revascularization in favor of optimal therapy did not demonstrate differences in the incidence of endpoints after a year.

Radial Wall Strain and μQFR as Complementary Predictors of Risk After Myocardial Infarction

2025-06-22

Ioannis Skalidis , Mauro Boiago , Gaetano Liccardo +1 more | Catheterization and Cardiovascular Interventions

Treatment options for patients with coronary microvascular dysfunction

2025-06-22

Ian Welch , Brian C. Case | Future Cardiology

Chronic cOronary Syndrome in Swedish PRImary care (COSPRI)—a study protocol for a 5-year cluster randomized controlled trial on a novel package versus standard investigation in patients with suspected chronic coronary syndrome referred from primary health care

2025-06-21

Staffan Nilsson , Fade Gabro , Erik Stertman +7 more | Trials

Abstract Background This trial aims to assess the effectiveness of a novel diagnostic package in the investigation of symptomatic chronic coronary artery disease (CAD), with a focus on reducing the … Abstract Background This trial aims to assess the effectiveness of a novel diagnostic package in the investigation of symptomatic chronic coronary artery disease (CAD), with a focus on reducing the time to diagnosis and improving risk assessment, compared to the current standard investigation approach. The package investigation is comprised of combined single photon emission computed tomography (SPECT), echocardiography, coronary artery calcification (CAC) scoring, not previously evaluated in Sweden for individual cardiovascular prevention, and CadScore, an acoustic risk score. The standard investigation is comprised of exercise bicycle stress testing and echocardiography. Methods The trial involves patients with a pre-test probability > 15% for significant CAD referred from primary healthcare centers (PHCs) in Region Östergötland (population 471,241 in March 2023) in south-east Sweden. All the 47 PHCs of the region will be invited to participate and will, after approval, be cluster randomized into two groups: package investigation versus standard investigation. The primary outcome is a composite measure comprised of waiting time to invasive coronary angiography or communication of non-invasive myocardial ischemia investigation results. Secondary outcomes include major adverse cardiovascular events (MACE), cost per patient, signs of reversible ischemia on any test, radiation exposure, and adherence to prescribed cardioprotective drugs. Discussion This trial addresses the urgent problem of chest pain and dyspnea assessment in primary care and aims to speed up diagnosis, reduce the need for specialist consultations, and potentially improve patient outcomes, with referral to SPECT directly from PHC in comparison with the widely used exercise test. The novel approach includes CAC scoring. Additionally, the utility of acoustic CadScore in reclassifying the risk of CAD is explored. Trial registration. The trial was registered on March 11, 2023, at ClinicalTrials.gov with the identifier: NCT05782582.

Towards accurate interpretation of hypothesis testing in cardiology randomised controlled clinical trials

2025-06-20

Amin Sharifan , Gregg C. Fonarow | Heart

Evaluation of [<sup>18</sup>F]FDG distribution and uptake via micro PET/CT in a murine model of myocardial infarction

2025-06-20

M Ayoub , César Ríos‐Navarro , Matilde Merino‐Sanjuán +4 more | Ars Pharmaceutica (Internet)

Introduction: To evaluate [18F]Fluodeoxyglucose ([18F]FDG) distribution in a murine model of myocardial infarction (MI), using Positron Emission Tomography and Computed Tomography (PET/CT) to validate this approach for use in evaluating … Introduction: To evaluate [18F]Fluodeoxyglucose ([18F]FDG) distribution in a murine model of myocardial infarction (MI), using Positron Emission Tomography and Computed Tomography (PET/CT) to validate this approach for use in evaluating new therapies for MI treatment. Method: MI was induced by permanent ligation of the left anterior descending coronary artery. The study included a sham group, a group with 7 days infarction (acute infarction) and another with 21 days infarction (chronic infarction). Prior to euthanasia, each group was imaged by PET/CT approximately 60 minutes after injection of [18F]FDG. Total and maximal Region of Interest and Standard Uptake Value values were obtained using CT, which enables more precise delineation of the anatomy to assess between-group differences in [18F]FDG uptake in the heart, brain and bladder. Results: Following distribution of [18F]FDG throughout the body, at 60 minutes after injection homogeneous cardiac distribution of the radiopharmaceutical was observed in the healthy group, while in the infarcted groups there was an absence of uptake in the infarct area. Using ANOVA analysis and the Kruskal-Wallis test, statistically significant differences were detected between the healthy and acute infarction groups and the acute and chronic infarction groups. There were no significant differences between the three groups in brain uptake or radiopharmaceutical clearance. Conclusions: The microPET/CT technique has the sensitivity to detect infarcted areas in the murine model. Moreover, it allows us to quantify [18F]FDG uptake and thus assess uptake by the organs in the different groups studied.

Reply: Restriction Spectrum Imaging as a Quantitative Biomarker for Prostate Cancer With Reliable Positive Predictive Value

2025-06-20

Mariluz Rojo Domingo , Tyler M. Seibert | The Journal of Urology

Serum Osmolality as a Predictor of Coronary Slow Flow Phenomenon

2025-06-20

Ramy Raymond Elias , Muhammad Alamsyah Aziz , Inas Eweda +1 more | International Journal of the Cardiovascular Academy

Artificial Intelligence and Coronary Artery Calcium Scoring: Enhancing Cardiovascular Risk Assessment

2025-06-20

Mehdi Zoghi | International Journal of the Cardiovascular Academy

Mycobacterium tuberculosis Infection and Acute or Subclinical Coronary Artery Disease: the Swiss HIV Cohort Study

2025-06-20

Andres Hilfiker , Isabella C Schoepf , Emma F Avery +7 more | JAIDS Journal of Acquired Immune Deficiency Syndromes

Background: In tuberculosis medium/high prevalence countries, Mycobacterium tuberculosis (MTB) infection has been associated with acute coronary artery disease (CAD) events and subclinical atherosclerosis. We aimed to examine whether MTB infection … Background: In tuberculosis medium/high prevalence countries, Mycobacterium tuberculosis (MTB) infection has been associated with acute coronary artery disease (CAD) events and subclinical atherosclerosis. We aimed to examine whether MTB infection contributes to clinical and subclinical CAD in people with HIV (PWH) in tuberculosis low incidence settings. Methods: Regarding CAD events, cases were Swiss HIV Cohort Study (SHCS) participants with a first CAD event (2000-2022). CAD-free SHCS controls were matched on sex, age and observation time. Regarding subclinical atherosclerosis, SHCS participants underwent (2013-2019) non-contrast CT for detection of coronary artery calcification (CAC) and coronary CT angiography (CCTA) for the detection of coronary soft, mixed, or high-risk plaque (SMHRP). We obtained univariable/multivariable odds ratios (OR) for CAD events, CAC, and SMRHP, in participants with negative TB status, MTB infection, and active TB, analyzed in the context of traditional and HIV-related CAD risk factors. Results: We included 465 patients with acute CAD events and 1123 controls (median age 56 years, 14% women, 86% with suppressed HIV RNA). MTB infection was not associated with CAD events in multivariable analysis (odds ratio [95% confidence interval], 0.92 [0.55-1.52]) vs. participants with negative TB status. In 402 participants undergoing CAC/CCTA (median age 53 years, 14% women, 96% with suppressed HIV RNA), MTB infection was not associated with SMHRP (OR=0.55 [0.19-1.55]) or with CAC (OR=0.38 [0.1-1.41]) in multivariable analysis. Conclusions: In PWH in Switzerland, a tuberculosis low prevalence country, we found no evidence of any association between MTB infection and acute CAD events or subclinical coronary atherosclerosis.

Correction: Machine learning for cardio-oncology: predicting global longitudinal strain from conventional echocardiographic measurements in cancer patients

2025-06-20

Tagayasu Anzai , Kenji Hirata , Ken Kato +1 more | Cardio-Oncology

Introduction to the Topical Collection on Pediatric Cardiovascular Imaging

2025-06-20

Cara E. Morin , Nazia Husain , Mónica Epelman | Pediatric Radiology

Multi-section myocardial status evaluation algorithm based on electrocardiogram and ultrasound image fusion

2025-06-19

Mingjun Tian , Minjuan Zheng , Shi Qiu +1 more | Information Fusion

Valor pronóstico de los nomogramas de carga global de placa coronaria estimada por tomografía computarizada convencional

2025-06-19

Gastón A. Rodríguez-Granillo , Exequiel Reynoso , Carlos Capuñay +2 more | Revista Argentina de Cardiología

Introducción: La calcificación coronaria, de valor pronóstico establecido, puede valorarse por tomografía computarizada (TC) de tórax convencional.Objetivo: Explorar el valor pronóstico de los nomogramas de carga global de placa ateroesclerótica … Introducción: La calcificación coronaria, de valor pronóstico establecido, puede valorarse por tomografía computarizada (TC) de tórax convencional.Objetivo: Explorar el valor pronóstico de los nomogramas de carga global de placa ateroesclerótica aplicados a datos obtenidos de la (TC) de tórax convencional.Material y métodos: Incluimos pacientes consecutivos de 40 a 74 años que se sometieron a una (TC) de tórax en nuestra institución entre agosto y diciembre de 2012 por diversas indicaciones. Se evaluó la presencia y extensión de calcificaciones coronarias y los pacientes fueron clasificados según el percentil de la puntuación de afectación de segmento por edad y sexo (CACSIS).Resultados: Se incluyeron 1194 pacientes. Tras un seguimiento medio de 3,7 ± 0,5 años, 53 (4,4%) pacientes fallecieron. Se identificó una relación significativa entre las tasas de sobrevida ajustadas según sexo y edad y el percentil de la puntuación de afectación de segmento por [RR 1,27 (95% IC 1,01-1,60), p = 0,040].Conclusiones: Los nomogramas de carga de placa ateroesclerótica global ajustados por edad aplicados a la TC de tórax convencional fueron predictores de mortalidad.

Nuevos desafíos anatómicos, fisiológicos y clínicos de la ecocardiografía tridimensional

2025-06-19

Marcelo Luiz Campos Vieira | Revista Argentina de Cardiología

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Computed Tomography Derived Extracellular Volume (CT-ECV): Assessment, Protocols and Utility

2025-06-19

Sarang Paleri , Clare Rayner , Timothy Abrahams +5 more | Current Cardiovascular Imaging Reports

Abstract Purpose of Review This review examines recent developments in computed tomography-derived extracellular volume (CT-ECV) assessment, focusing on acquisition protocols, clinical applications, and emerging technologies. Recent Findings CT-derived extracellular volume … Abstract Purpose of Review This review examines recent developments in computed tomography-derived extracellular volume (CT-ECV) assessment, focusing on acquisition protocols, clinical applications, and emerging technologies. Recent Findings CT-derived extracellular volume fraction (CT-ECV) has emerged as a robust tool for myocardial characterisation across various cardiac conditions. Recent advancements in technology, including photon-counting detector CT and artificial intelligence integration, have enhanced image quality and workflow efficiency while reducing radiation exposure. CT-ECV demonstrates particular utility in cardiac amyloidosis detection, cancer therapy-related cardiac dysfunction monitoring, and risk stratification in aortic stenosis. The technique boosts the utility of CCTA by adding myocardial tissue characterisation to coronary evaluation. Synthetic ECV calculation and automated post-processing further streamline clinical implementation. While protocol standardisation remains an important goal, CT-ECV’s ability to provide valuable prognostic information positions it as an increasingly important tool in cardiovascular imaging. As evidence accumulates supporting its clinical value, CT-ECV is likely to play a growing role in patient care and research. Summary CT-ECV has matured into a versatile and powerful tool for myocardial characterisation across a spectrum of cardiac conditions. The integration of cutting-edge technologies, such as photon-counting detector CT and artificial intelligence, has significantly enhanced image quality and streamlined workflow efficiency while simultaneously reducing radiation exposure. This evolution addresses previous limitations and expands the clinical applicability of CT-ECV.

SAM-MyoNet: A fine-grained perception myocardial ultrasound segmentation network based on segment anything model with prior knowledge driven

2025-06-19

Yuhan Ying , Xingyu Fang , Yiwen Zhao +7 more | Biomedical Signal Processing and Control

Prognostic value of CMR-derived extracellular volume in myocardial infarction with non-obstructive coronary arteries

2025-06-18

Lei Chen , Liqi Ge , Fuad A. Abdu +5 more | International Journal of Cardiology

Development of a multiparametric nomogram model for coronary lesion-specific ischemia prediction based on coronary CTA technology

2025-06-18

Tianyang Gao , Libo Zhang , Wei Zhou +2 more | Technology and Health Care

Background Coronary artery disease (CAD) is a leading cause of ischemic heart disease, and accurate identification of coronary lesion-specific ischemia (CLSI) is crucial for treatment. Coronary computed tomography angiography (CCTA) … Background Coronary artery disease (CAD) is a leading cause of ischemic heart disease, and accurate identification of coronary lesion-specific ischemia (CLSI) is crucial for treatment. Coronary computed tomography angiography (CCTA) provides detailed visualization of coronary lesions, but its multiparameter analysis for predicting ischemia remains underexplored. Objective To develop a nomogram prediction model for CLSI based on multiparameters derived from CCTA. Methods A total of 160 patients with CAD were divided into non-ischemic and ischemic groups according to the target-vessel CT-fractional flow reserve (CT-FFR). The baseline data of the two groups were collected, and the quantitative parameters of CCTA were compared. The predictive value of these parameters for CLSI was analyzed by the receiver operator characteristic (ROC) curve, and independent risk factors were analyzed by logistic regression. Results The ischemic group showed significant differences in maximum diameter stenosis (MDS), maximum area stenosis (MAS), minimum lumen area (MLA), plaque burden (PB), pericoronary fat attenuation index (FAI), and low-attenuation plaque compared to the non-ischemic group (P < 0.05). Logistic regression revealed that MAS, MLA, FAI, and PB were independent risk factors for CLSI. The area under the curve (AUC) for MAS, MLA, FAI, and PB were 0.783, 0.947, 0.804, and 0.935, respectively. The calibration curve of the nomogram showed a good fit to the actual values [0.995 (95%CI: 0.988–1.000)]. Conclusions This study constructed a nomogram risk prediction model for CLSI based on MAS, MLA, FAI, and PB, which holds significant clinical value.

Coronary Artery Disease Evaluation on Pre-TAVR Computed Tomography Angiography: The New Standard of Care

2025-06-18

Dhaval Kolte , Sandeep Hedgire , Arminder S. Jassar | Circulation Cardiovascular Interventions

Analysis and Characterization of Factors Affecting the Consistency of Tl-201 Myocardial Perfusion Single-Photon Emission Computed Tomography and Coronary Angiography Results in Patients with Suspected Coronary Artery Disease

2025-06-18

Fu-Ren Tsai , Hung-Pin Chan , Chun-Hao Yin +3 more | Diagnostics

Background/Objectives: Tl-201 myocardial perfusion single-photon emission computed tomography (MPS) is a minimally invasive test for patients with suspected coronary artery disease (CAD). While its predictive and prognostic values are well … Background/Objectives: Tl-201 myocardial perfusion single-photon emission computed tomography (MPS) is a minimally invasive test for patients with suspected coronary artery disease (CAD). While its predictive and prognostic values are well established, diagnostic performance varies. A recent meta-analysis reported that the sensitivity and specificity of MPS range from 48.8 to 100% and 46.7 to 94.7%, respectively, reflecting discordance between CAG. Little is known, however, about the influence of patients' characteristics and CAD risk factors on the diagnostic performance of MPS. This study aims to evaluate these factors in relation to MPS performance. Methods: We screened 4817 consecutive patients referred to our Nuclear Medicine Department in 2015 for Tl-201 MPS. Patients with clinically suspected ischemic heart disease who underwent CAG within 60 days post-MPS were included in the present analysis. The percentage of agreement/disagreement between the MPS-abnormal/normal and CAG-positive/negative groups was evaluated. Additionally, patient characteristics, CAD risk factors, co-morbidities, and single-photon emission computed tomography (SPECT) image-derived parameters were compared among the patients. Results: Among 635 patients with abnormal MPS, 583 had coronary stenosis. For the 52 without stenosis, causes included non-obstructive CAD (34.6%), prior infarction with scarring (32.7%), and imaging artifacts (32.7%). Significant stenosis was associated with older age, male sex, diabetes, dyslipidemia, CKD, and prior PCI, while hypertension and higher BMI were more common in insignificant CAD. Among 104 patients with normal MPS, 79 had stenosis, mainly in the LAD. Clinical risk factors were more prevalent in patients with any degree of stenosis. Conclusions: In patients with an abnormal MPS, the incorporation of visual interpretation, parameters, and CAD risk factors increases specificity and helps differentiate obstructive from non-obstructive CAD.

Coronary Vasospasm Masquerading as Coronary Artery Disease

2025-06-18

Muhammad U Rana , Anuj Garg , Krishna Prasad Kurpad +3 more | Cureus

The Last Mile in Prevention—Can Coronary CT Angiography Help?

2025-06-18

Pamela S. Douglas , Neha J. Pagidipati | JAMA Cardiology

CT Angiography, Healthy Lifestyle Behaviors, and Preventive Therapy

2025-06-18

Michael McDermott , Phue Khaing , Mohammed N. Meah +7 more | JAMA Cardiology

Importance Healthy lifestyles and uptake of primary preventive therapies for cardiovascular disease remain poor. Objective To determine the impact of coronary computed tomography (CT) angiography on healthy lifestyle behaviors, acceptance … Importance Healthy lifestyles and uptake of primary preventive therapies for cardiovascular disease remain poor. Objective To determine the impact of coronary computed tomography (CT) angiography on healthy lifestyle behaviors, acceptance of recommended treatments, and modification of risk factors as compared with guideline-directed cardiovascular risk scoring. Design, Setting, and Participants This was a nested substudy conducted from September 2020 to August 2024 of a randomized clinical trial where participants underwent cardiovascular risk scoring or coronary CT angiography. Primary care–based screening took place in Scotland. Included in the analysis were asymptomatic individuals aged 40 to 70 years without known cardiovascular disease and with at least 1 cardiovascular risk factor. Study data were analyzed from August to September 2024. Interventions All participants received lifestyle advice with additional recommendations for moderate-intensity statin therapy if the 10-year cardiovascular risk was greater than or equal to 10% or combined antiplatelet and at least moderate-intensity statin therapies if coronary atherosclerosis was identified on CT angiography. Main Outcomes and Measures The composite primary outcome was compliance with the National Institute for Health and Care Excellence recommendations for diet, body mass index, smoking, and physical exercise at 6 months. Results Between September 2020 and January 2024, 400 participants were enrolled (median [IQR] age, 62 [56-65] years; 198 female [49.5%]; median [IQR] 10-year cardiovascular risk, 14% [9%-19%]) with 195 randomized to cardiovascular risk scoring and 205 to coronary CT angiography. At 6 months, those who underwent CT angiography were more likely to meet the primary composite end point (17% [33 of 194 participants] vs 6% [10 of 177 participants]; odds ratio, 3.42; 95% CI, 1.63-6.94; P &amp;lt; .001). Compared with cardiovascular risk scoring, fewer participants were recommended preventive therapy after CT angiography (51% [105 of 205 participants] vs 75% [147 of 195 participants]; P &amp;lt; .001), but acceptance of recommendations was higher (77% [81 of 105 participants] vs 46% [68 of 147 participants]; P &amp;lt; .001). This resulted in similar use of lipid-lowering therapy (44% [90 of 205 participants] vs 35% [69 of 195 participants]; OR, 1.43; 95% CI, 0.96-2.15; P = .08) and greater use of antiplatelet therapy in those randomized to CT angiography (40% [83 of 205 participants] vs 0.5% [1 of 195 participants]; P &amp;lt; .001). Participants randomized to coronary CT angiography had small incremental improvements in risk factors and 10-year cardiovascular risk, largely driven by those with CT-defined coronary atheroma. Conclusions and Relevance Results of this cohort study reveal that compared with cardiovascular risk scoring, coronary CT angiography was associated with modest improvements in healthier lifestyle behaviors, acceptance of recommended preventive therapy, and risk factor modification. Whether this strategy reduces coronary events remains to be established.

Differential Association of PET-Derived Rest and Stress Myocardial Blood Flow with Cardiovascular Outcomes

2025-06-18

Ahmed Sayed , Mahmoud Al Rifai , Mouaz H. Al‐Mallah | Journal of Nuclear Medicine

Although there is strong evidence for the prognostic value of myocardial flow reserve (MFR), there are fewer data on the prognostic implications of its constituents: myocardial blood flow at rest … Although there is strong evidence for the prognostic value of myocardial flow reserve (MFR), there are fewer data on the prognostic implications of its constituents: myocardial blood flow at rest (MBFrest) and stress (MBFstress). Methods: Consecutive patients undergoing 82Rb PET imaging with regadenoson stress testing at a tertiary care center between August 2019 and August 2024 were included in this study. The 2 coprimary outcomes were a composite of death or heart failure (HF) hospitalization and a composite of myocardial infarction (MI) or late revascularization. Multivariable Andersen-Gill Cox models with robust variance estimators were used to incorporate recurrent events. Outcomes were modeled as a smooth function of MBFstress and MBFrest, with restricted cubic splines to allow nonlinearity. Results: The analysis included 8,131 consecutive patients (median age of 68 y; 46.1% were women; median follow-up of 520 d (interquartile range, 186-921 d), among whom 471 deaths, 828 HF hospitalizations, 164 MIs, and 429 late revascularizations occurred. After adjusting for the relevant covariates, an MFR of 2 achieved through a lower MBFrest was associated with a significantly lower incidence of death and HF hospitalization, whereas an MFR of 2 achieved through a greater MBFstress was associated with a significantly lower incidence of MI and late revascularization. Assessments of the partial χ2 statistic, which measures the importance of predictors, similarly confirmed that MBFrest was more important for predicting death or HF hospitalization whereas MBFstress was more important for predicting MI or late revascularization. Conclusion: Measurements of absolute myocardial blood flow offer complementary prognostic value to MFR. A diminished MBFstress may signal a greater risk of future ischemic outcomes, whereas an elevated MBFrest may signal a greater risk of future death or HF hospitalization.