Journal of cardiovascular computed tomography

Publisher: Elsevier

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Current impact factor: 4.51

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2015 Impact Factor Available summer 2015
2013 / 2014 Impact Factor 4.506
2012 Impact Factor 2.552

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ISSN 1876-861X

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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Background Epicardial adipose tissue (EAT) is a metabolically active fat depot. Studies have investigated the impact of EAT thickness on outcomes of radiofrequency catheter ablation of atrial fibrillation (AF) However, data on the relationship between EAT thickness and outcome of cryoballoon- based pulmonary vein isolation (PVI) is lacking. Objective In this study, we investigate the association between EAT thickness and AF recurrence following cryoballoon- based PVI. Methods Patients with symptomatic paroxysmal or persistent AF despite ≥1 antiarrhythmic drug(s) were scheduled for cryoballoon- based PVI for AF per the recent recommendations. Periatrial, periventricular and total EAT thickness measurements were obtained from preprocedural multidetector computed tomography (MDCT) scans. Results 249 patients (55.6± 10.7 years, 48.2% male, 18.5% persistent AF) were involved in the study. Patients were followed- up for 29 (8- 48) months. When blanking period was considered, freedom from AF after the ablation procedure was 75.9% at a median follow- up of 29 months. Total periatrial EAT thickness (18.1± 6.2 vs. 14.7± 4.7 mm, p<0.001) was greater in patients with late AF recurrence when compared to those without. On the other hand, periventricular or total EAT thickness measurements did not differ between both groups (p>0.05). Multivariate Cox proportional hazard regression analysis showed that periatrial EAT thickness (HR: 1.086, p=0.001) and left atrial volume index (HR: 1.144, p<0.001) were independent predictors for late AF recurrence. Conclusion Quantification of EAT thickness from preprocedural MDCT scans may serve as a beneficial parameter for prediction of AF recurrence following cryoballoon- based PVI. Keywords atrial fibrillation; ablation; outcome; epicardial adipose tissue; cardiac computed tomography Conflict of Interest: None declared.
    Journal of cardiovascular computed tomography 04/2015; DOI:10.1016/j.jcct.2015.03.011
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    ABSTRACT: Both low tube voltage and sinogram-affirmed iterative reconstruction (IR) techniques hold promise to decrease radiation dose at coronary CT angiography (CCTA). The increased iodine contrast at low tube voltage allows for minimizing iodine load. To assess the effect of reduced x-ray tube voltage, low iodine concentration contrast medium and IR on image quality and radiation dose at CCTA. Two hundred thirty-one consecutive patients with suspected coronary artery disease were enrolled in this prospective, multicenter trial and randomized to 1 of 2 dual-source CCTA protocols: 120-kVp with 370 mgI/mL iopromide or iopamidol (n = 116; 44 women; 55.3 ± 9.8 years) or 100 kVp with 270 mgI/mL iodixanol (n = 115; 48 women; 54.2 ± 10.4 years). Reconstruction was performed with filtered back projection and IR. Attenuation, image noise, signal-to-noise ratio, and contrast-to-noise ratio were measured and image quality scored. Size-specific dose estimates and effective doses were calculated. There were no significant differences in mean arterial attenuation (406.6 ± 76.7 vs 409.7 ± 65.2 Hounsfield units; P = .739), image noise (18.7 ± 3.8 vs 17.9 ± 3.4 Hounsfield units; P = .138), signal-to-noise ratio (22.5 ± 5.4 vs 23.7 ± 6.1; P = .126), contrast-to-noise ratio (17.5 ± 5.5 vs 18.3 ± 6.1; P = .286), or image quality scores (4.1 ± 0.9 vs 4.0 ± 0.9; P > .05) between 120-kVp filtered back projection-reconstructed and 100-kVp IR-reconstructed series. Mean iodine dose was 26.5% lower (18.3 ± 0.5 vs 24.9 ± 0.9 g; P < .0001), mean size-specific dose estimate was 35.1% lower (17.9 ± 6.6 vs 27.5 ± 8.2 mGy; P < .0001), and effective dose was 34.9% lower (2.3 ± 1.0 vs 3.5 ± 1.1 mSv; P < .0001) with the 100 kVp compared with the 120-kVp protocol, respectively. Using low x-ray tube voltage and IR allows for decreasing the iodine load and effective radiation dose at CCTA while maintaining image quality. Copyright © 2015 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.
    Journal of cardiovascular computed tomography 01/2015; DOI:10.1016/j.jcct.2015.01.010
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    ABSTRACT: Fractional flow reserve (FFR) is the gold standard for determining lesion-specific ischemia. Computed FFRCT derived from coronary CT angiography (coronary CTA) correlates well with invasive FFR and accurately differentiates between ischemia-producing and nonischemic lesions. The diagnostic performance of FFRCT when applied in a clinically relevant way to all vessels ≥ 2 mm in diameter stratified by sex and age has not been previously examined. Two hundred fifty-two patients and 407 vessels underwent coronary CTA, FFRCT, invasive coronary angiography, and invasive FFR. FFRCT and FFR ≤0.80 were considered ischemic, whereas CT stenosis ≥50% was considered obstructive. The diagnostic performance of FFRCT was assessed following a prespecified clinical use rule which included all vessels ≥2 mm in diameter, not just those assessed by invasive FFR measurements. Stenoses <30% were assigned an FFR of 0.90, and stenoses >90% were assigned an FFR of 0.50. Diagnostic performance of FFRCT was stratified by vessel diameter, sex, and age. By FFR, ischemia was identified in 129 of 252 patients (51%) and in 151 of 407 vessels (31%). Mean age (±standard deviation) was 62.9 ± 9 years, and women were older (65.5 vs 61.9 years; P = .003). Per-patient diagnostic accuracy (83% vs 72%; P < .005) and specificity (54% vs 82%, P < .001) improved significantly after application of the clinical use tool. These were significantly improved over standard coronary CTA values before application of the clinical use rule. Discriminatory power of FFRCT also increased compared with baseline (area under the receiver operating characteristics curve [AUC]: 0.93 vs 0.81, P < .001). Diagnostic performance improved in both sexes with no significant differences between the sexes (AUC: 0.93 vs 0.90, P = .43). There were no differences in the discrimination of FFRCT after application of the clinical use rule when stratified by age ≥65 or <65 years (AUC: 0.95 vs 0.90, P = .10). The diagnostic accuracy and discriminatory power of FFRCT improve significantly after the application of a clinical use rule which includes all clinically relevant vessels >2 mm in diameter. FFRCT has similar diagnostic accuracy and discriminatory power for ischemia detection in men and women irrespective of age using a cut point of 65 years. Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.
    Journal of cardiovascular computed tomography 01/2015; 9(2). DOI:10.1016/j.jcct.2015.01.008
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    ABSTRACT: We present a case that demonstrates myocardial fibrosis detected on a cardiac computed tomography study performed for the evaluation of chest pain in a patient with hypertrophic cardiomyopathy. We describe the correlation between echocardiographic strain imaging, quantitative positron emission tomography, and computed tomographic evidence of fibrosis and its implications in hypertrophic cardiomyopathy.
    Journal of cardiovascular computed tomography 03/2014; 8(2):166-9. DOI:10.1016/j.jcct.2013.12.019
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    ABSTRACT: Most current iterative reconstruction algorithms for CT imaging are a mixture of iterative reconstruction and filtered back projection. The value of "fully" iterative reconstruction in coronary CT angiography remains poorly understood. We aimed to assess the value of the knowledge-based iterative model reconstruction (IMR) algorithm on the qualitative and quantitative image quality at 256-slice cardiac CT. We enrolled 21 patients (mean age: 69 ± 11 years) who underwent retrospectively ECG gated coronary CT anhgiography at 100 kVp tube voltage. Images were reconstructed with the filtered back projection (FBP), hybrid iterative reconstruction (IR), and IMR algorithms. CT attenuation and the contrast-to-noise ratio (CNR) of the coronary arteries were calculated. With the use of a 4-point scale, 2 reviewers visually evaluated the coronary arteries and cardiac structures. The mean CT attenuation of the proximal coronary arteries was 369.3 ± 73.6 HU, 363.9 ± 75.3 HU, and 363.3 ± 74.5 HU, respectively, for FBP, hybrid IR, and IMR and was not significantly different. The image noise of the proximal coronary arteries was significantly lower with IMR (11.3 ± 2.8 HU) than FBP (51.9 ± 12.9 HU) and hybrid IR (23.2 ± 5.2 HU). The mean CNR of the proximal coronary arteries was 9.4 ± 2.4, 20.2 ± 4.7, and 41.8 ± 9.5 with FBP, hybrid IR and IMR, respectively; it was significantly higher with IMR. The best subjective image quality for coronary vessels was obtained with IMR (proximal vessels: FBP, 2.6 ± 0.5; hybrid IR, 3.4 ± 0.5; IMR, 3.8 ± 0.4; distal vessels: FBP, 2.3 ± 0.5; hybrid IR. 3.1 ± 0.5; IMR, 3.7 ± 0.5). IMR also yielded the best visualization for cardiac systems, that is myocardium and heart valves. The novel knowledge-based IMR algorithm yields significantly improved CNR and better subjective image quality of coronary vessels and cardiac systems with reliable CT number measurements for cardiac CT imaging.
    Journal of cardiovascular computed tomography 03/2014; 8(2):115-23. DOI:10.1016/j.jcct.2013.12.010
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    ABSTRACT: Despite the improvement of cardiac CT, right heart visualization remains challenging. We herein describe a new method, called the time-adjusted gradual replacement injection protocol. The aim of this study was to compare this protocol with the split-bolus injection protocol. Fifty-two patients who had undergone dual-source cardiac CT were retrospectively recruited. Twenty-six patients were injected by using the split-bolus injection protocol, and 26 patients were injected by using the time-adjusted gradual replacement injection protocol. For this method, we injected contrast medium for 10 seconds at a flow rate of 0.07 × body weight mL/s, then gradually replaced the contrast material with saline until 2 seconds before finishing the scans. The CT attenuation was measured in 4 chambers, the aorta, and the coronary arteries. The visualization of the anatomic structures and the occurrence and severity of streak artifacts were scored for the cardiac structures in the heart. For the analyses, either Welch t-test or Student t-test was performed. In the right heart, the CT values and visualization scores were significantly higher in the time-adjusted replacement injection group than in the split-bolus injection group, whereas the artifact scores were comparable between the 2 groups. The CT values, visualization scores, and artifact scores of the left heart were not significantly different between the 2 groups. In this study, the time-adjusted gradual replacement injection protocol provided excellent attenuation for visualization of the right heart. This method may help to accurately evaluate the right cardiac anatomy and thereby identify any potential diseases.
    Journal of cardiovascular computed tomography 03/2014; 8(2):158-65. DOI:10.1016/j.jcct.2013.12.016
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    ABSTRACT: A 71-year-old woman underwent diagnostic workup for progressive shortness of breath. Transthoracic echocardiography showed a dilated main pulmonary artery (MPA) and an anomalous configuration of the pulmonary valve. CT revealed a bicuspid pulmonary valve (BPV) and confirmed MPA dilation. Further congenital abnormalities were excluded. An isolated finding of BPV is rather rare. To our knowledge we present the first 4-dimensional CT images of a BPV. As in this case, 4-dimensional cine cardiac CT may be helpful to reveal the underlying cause of MPA dilation.
    Journal of cardiovascular computed tomography 03/2014; 8(2):170-1. DOI:10.1016/j.jcct.2013.12.018
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    ABSTRACT: At least two-thirds of cases of acute coronary syndrome are caused by disruption of an atherosclerotic plaque. The natural history of individual plaques is unknown and needs to be established. The Plaque Registration and Evaluation Detected In Computed Tomography (PREDICT) registry is a prospective, multicenter, longitudinal, observational registry. This registry was designed to examine the relationships among coronary CT angiography (CTA) findings and clinical findings, mortality, and morbidity. The relationships among progression of coronary atherosclerosis, including changes in plaque characteristics on coronary CTA, and serum lipid levels and modification of coronary risk factors will also be evaluated. From October 2009 to December 2012, 3015 patients who underwent coronary CTA in 29 centers in Japan were enrolled. These patients were followed for 2 years. The primary end points were considered as all-cause mortality and major cardiac events, including cardiac death, nonfatal myocardial infarction, and unstable angina that required hospitalization. The secondary end points were heart failure that required administration of diuretics, target vessel revascularization, cerebral infarction, peripheral arterial disease, and invasive coronary angiography. Blood pressure, serum lipid, and C-reactive protein levels and all cardiovascular events were recorded at 1 and 2 years. If the initial coronary CTA showed any stenosis or plaques, follow-up coronary CTA was scheduled at 2 years to determine changes in coronary lesions, including changes in plaque characteristics. Analysis of the PREDICT registry data will clarify the relationships between coronary CTA findings and cardiovascular mortality and morbidity in a collaborative multicenter fashion. This trial is registered at as NCT 00991835.
    Journal of cardiovascular computed tomography 03/2014; 8(2):90-6. DOI:10.1016/j.jcct.2013.12.004
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    ABSTRACT: Background Treatment decisions for ascending aortic aneurysms are guided by measurements from CT angiograms. Objective To evaluate the reproducibility of these measurements using manual techniques and advanced imaging software. Methods Two radiologists measured maximal ascending aorta diameter on CT angiograms in 30 subjects at four separate reading sessions—two with manual techniques and two using semiautomated software analysis. Inter- and intraobserver variability was assessed using Bland-Altman plots and Spearman’s correlation coefficients. Results Interobserver variability was smaller for the software-assisted method. Limits of agreement for manual method were [-4.2 mm, 9.2 mm]; as compared to [-4.0 mm, 4.6 mm] for software-assisted; coefficients of repeatability were 6.8 mm and 4.3 mm. Intraobserver variability was inconsistent between readers. There was strong correlation between observers using both methods (R2 = 0.8078-0.9881, p<0.05 for all). Conclusion The use of an advanced imaging software for ascending aortic aneurysm measurement reduces interobserver variability.
    Journal of cardiovascular computed tomography 03/2014; DOI:10.1016/j.jcct.2013.12.009
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    ABSTRACT: The evaluation of native coronary arteries (NCAs) as well as coronary artery bypass graft (CABG) patency after surgery is essential. However, NCAs are often blurred in the craniocaudal scan direction because of long scan time with 64-slice CT. The purpose of the study was to determine the effect of scan direction on image quality and radiation exposure in assessment of NCAs and CABGs. Retrospective analysis of 191 consecutive individuals undergoing coronary CT angiography to evaluate CABG patency using 64-slice dual source CT. A retrospectively ECG gated spiral acquisition protocol with ECG based tube current modulation and automatic adjustment of tube current to a reference of 320 mAs ("CareDose 4D") was used. Tube current was 120 kVp. Scan direction was either cranio-caudal (CRC, n = 98) or caudo-cranial (CRC, n = 93) and the scan volume covered the entire course of all bypass grafts. Independent investigators determined quantitative image quality of the coronary arteries by evaluating contrast-to-noise ratio (CNR), radiation exposure by comparing the effective dose, and qualitative image quality through a 5 point rating scale. Quantitative image quality was not significantly different for the two groups except for the CNR of the right coronary artery which was significantly higher in patients with caudio-cranial scan direction (P = .0007). The qualitative image quality of the CaC group also was better for both NCAs and CABGs (P = .002 for NCAs and <.001 for CABGs), mostly because of the lower frequency of respiration artifacts on coronary arteries of the CaC group (P = .005). As an effect of automatic tube current adjustment, radiation dose was lower in patients with caudo-cranial scan direction (6.8 mSv vs. 9.6 mSv, p < 0.0001). In patients with coronary bypass grafts imaged by 64-slice dual source CT with spiral acquisition and automated tube current adjustment, a caudo-cranial scan direction results in improved image quality and reduced radiation exposure.
    Journal of cardiovascular computed tomography 03/2014; 8(2):124-30. DOI:10.1016/j.jcct.2013.12.011
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    ABSTRACT: We evaluated the accuracy of commonly used thresholds for vessel area evaluation on coronary CT angiography (CTA) and assessed ability of CTA to image the adventitial border. We evaluated 137 paired (coronary CTA and intravascular ultrasound [IVUS]) coronary artery cross-sections in 30 patients. CTA analysis included measurements of external vessel border area defined at Hounsfield unit (HU) thresholds of 0 (presumed adventitia), 50, and 70 (presumed external elastic membrane [EEM]). IVUS analysis included measurements of lumen, EEM, and outer border of the highly echogenic area adjacent to EEM (presumed adventitia area). High correlation was found between CTA and IVUS measurements for EEM areas (R(2) = 0.65, P < .001 and R(2) = 0.60, P < .001 for CTA thresholds of 50 and 70 HU, respectively). CTA and IVUS measurements of adventitia areas were significantly correlated (R(2) = 0.74; P < .001), with no significant difference between the 2 methods (20.2 ± 6.4 mm(2) vs 19.8 ± 6.4 mm(2), respectively; P = .278). Cross-sectional coronary lumen radiodensity on CTA images and plaque burden measured on IVUS significantly affected the accuracy of CTA in assessment of the EEM area but not the presumed adventitial area. We have demonstrated that use of a 50-HU threshold for vessel area determination by CTA led to its significant overestimation, whereas 70-HU threshold was close to that of EEM on IVUS. CTA may accurately delineate the coronary adventitial border by using a 0-HU threshold.
    Journal of cardiovascular computed tomography 03/2014; 8(2):141-8. DOI:10.1016/j.jcct.2013.12.014
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    ABSTRACT: The C-arm used for fluoroscopy during transcatheter aortic valve replacement (TAVR) may also be used to acquire 3-dimensional data sets similar to multidetector row CT (MDCT). The aim of this study was to evaluate the feasibility of C-arm CT (CACT) for aortic annulus and root (AoA/R) measurements in TAVR planning compared with MDCT. Twenty patients who were studied for TAVR underwent MDCT and CACT. Two independent observers measured predicted perpendicular projection to annular plane, diameters of the aortic annulus, sinus of Valsalva, sinotubular junction and ascending aorta, distance of coronary ostia to annular plane, sinus of Valsalva height, and leaflet length. Correlation between MDCT and CACT and interobserver variability were analyzed. MDCT and CACT showed strong correlation for all the measurements of the AoA/R (r ranging from 0.62 to 0.94; P between <.001 and .042) and also for the predicted perpendicular projection (left/right anterior oblique: r = 0.96, P = .002; cranial/caudal: r = 0.83, P = .043). Interobserver variability analysis showed disagreement for the measurements of the aortic annulus structures with CACT (intraclass correlation coefficient [ICC], <0.25) but not for the rest of the variables (ICC between 0.47 and 0.97). MDCT showed no interobserver variability for all the measurements (ICC between 0.45 and 0.93). CACT showed strong correlation with MDCT for the measurement of all AoA/R structures. However, CACT showed also important interobserver variability for the assessment of the aortic annulus. Therefore, valve sizing may not be reliably performed on the basis of CACT measurements alone.
    Journal of cardiovascular computed tomography 01/2014; 8(1):33-43. DOI:10.1016/j.jcct.2013.12.001
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    ABSTRACT: Reliability of coronary angiography by multidetector row CT (MDCT-CA) for stent evaluation is still a matter for debate, and it is unknown whether contrast medium characteristics may affect diagnostic performance of MDCT-CA. We compared iomeprol-400 with iodixanol-320 to evaluate coronary stents with MDCT-CA. We randomly assigned 254 patients undergoing coronary stent follow-up with the use of MDCT-CA to iomeprol-400 at 5.0 mL/sec flow rate (group 1; n = 83), iodixanol-320 at 6.2 mL/sec flow rate (group 2; n = 87), and iodixanol-320 at 5.0 mL/sec flow rate (group 3; n = 84). Heart rate (HR) immediately before and at the end of scanning, HR variation, premature heart beats, and heat sensation by visual analog scale during scanning were recorded. Mean attenuation was measured in the aortic root and coronary arteries. Image quality score and type of artifacts were assessed. Mean attenuation was significantly lower in group 3 than in the other groups. In group 3, stent evaluability was significantly higher and artifact rate was significantly lower than in group 2 (99% vs 91% and 4% vs 15%) and group 1 (99% vs 92% and 4% vs 17%), respectively, mainly because of a significant lower rate of beam-hardening artifacts (3 cases in group 3 vs 22 and 27 in groups 2 and 3, respectively). In group 3, visual analog scale, HR at the end of imaging, and number of patients with premature heart beats during the scan were significantly lower than in the other groups. Iodixanol-320 provides better image quality of coronary stents, allowing higher MDCT-CA evaluability, than iomeprol-400.
    Journal of cardiovascular computed tomography 01/2014; 8(1):44-51. DOI:10.1016/j.jcct.2013.12.003
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    ABSTRACT: Previous studies showed discrepancies between echocardiographic and multidector row CT (MDCT) measurements of aortic valve area (AVA). Our aim was to evaluate the effect of the ellipsoid shape of the left ventricular outflow tract (LVOT), as shown and measured by MDCT, on the assessment of AVA by transthoracic echocardiography (TTE) in patients with severe aortic stenosis. This retrospective single-center study involved 49 patients with severe aortic stenosis referred before transcatheter aortic valve implantation. The AVA was deduced from the continuity equation on TTE and from planimetry on cardiac MDCT. Area of the LVOT was calculated as follows: on TTE, from the measurement of LVOT diameter on parasternal long-axis view; on MDCT, from manual planimetry by using multiplanar reconstruction perpendicular to LVOT. At baseline, correlation of TTE vs MDCT AVA measurements was moderate (R = 0.622; P < .001). TTE underestimated AVA compared with MDCT (0.66 ± 0.15 cm(2) vs 0.87 ± 0.15 cm(2); P < .001). After correcting the continuity equation with the LVOT area as measured by MDCT, mean AVA drawn from TTE did not differ from MDCT (0.86 ± 0.2 cm(2)) and correlation between TTE and MDCT measurements increased (R = 0.704; P < .001). Assuming that LVOT area is circular with TTE results in constant underestimation of the AVA with the continuity equation compared with MDCT planimetry. The elliptical not circular shape of LVOT largely explains these discrepancies.
    Journal of cardiovascular computed tomography 01/2014; 8(1):52-7. DOI:10.1016/j.jcct.2013.12.006
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    ABSTRACT: The presence of calcified plaque in coronary arteries can be quantified by using 0.5-mm isotropic reconstructions from 320-row CT without increased radiation dose. Little is known about reclassification of patients with non-zero Agatston scores and quantitative measures of calcified plaque using 0.5-mm reconstructions. The aim was to compare proportions of zero vs non-zero Agatston scores (subclinical atherosclerosis) in 0.5-mm isotropic reconstructions vs standard 3.0-mm and CT angiography (CTA) scans on 320-row CT. Prospectively, we quantified calcified plaque in coronary arteries in 104 patients by using non-contrast-enhanced scans with 0.5 and 3.0 mm. Coronary calcium assessment was determined by 2 observers. Clinically indicated CTA was also performed; coronary calcium assessment findings were compared with CTA. Ranked Wilcoxon test and χ(2) test were performed for comparison. Reproducibility for proportion of zero vs non-zero was assessed by κ statistics. Median Agatston score (41.9 [interquartile range (IQR), 3.7-213.6] vs 5.2 [IQR, 0.0-128.5]), calcium volume (53.6 mm(3) [IQR, 8.1-202.3] vs 5.1 mm(3) [IQR, 0.0-96.8],), and lesion number (10.0 [IQR, 3.5-18.5] vs 1.0 [IQR, 0.0-6.0]) were significantly higher on 0.5-mm reconstruction (P < .0001) than on 3.0-mm reconstruction. More patients with subclinical atherosclerosis were detected on 0.5 mm than on 3.0 mm and CTA scans (76.9% vs 53.8% vs 54.8%; P < .0001). The κ values for inter-rater agreement were 0.94 and 0.52 on 3.0- and 0.5-mm data sets, respectively. However, when Agatston scores < 10 were excluded from analysis, the κ value rose to 0.83. Isotropic 0.5-mm reconstruction detected 23.1% and 22.1% more patients with subclinical atherosclerosis than standard 3.0-mm scans and CTA, which may be more sensitive for the detection of subclinical atherosclerosis; its potential clinical utility needs to be validated in large, prospective studies.
    Journal of cardiovascular computed tomography 01/2014; 8(1):58-66. DOI:10.1016/j.jcct.2013.12.007
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    ABSTRACT: Aneurysms of the branches of the coronary arteries are rare. We report a case of a right coronary artery aneurysm with aneurysmal dilation and thrombosis of the sinoatrial nodal branch presenting as a right atrial mass. The patient underwent multiple imaging evaluations before coronary CT angiography diagnosed aneurysm and thrombosis of the sinoatrial nodal branch.
    Journal of cardiovascular computed tomography 01/2014; 8(1):85-7. DOI:10.1016/j.jcct.2013.12.015
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    ABSTRACT: Arrhythmias can compromise image quality and increase radiation exposure during coronary CT angiography (CTA). However, premature ventricular contractions (PVCs) can occur in a predictable recurrent and regular pattern (ie, bigeminy, trigeminy, quadrigeminy) with post-PVC compensatory pauses. Electrocardiographic (ECG) electrode repositioning can achieve relative amplification of the R waves of PVCs compared with R waves of sinus beats. This technical note describes how simple ECG electrode repositioning, combined with an absolute-delay strategy, facilitated selective R waves of PVC ECG triggering of image acquisition in 6 patients with PVC bigeminy or quadrigeminy at the time of 320-row coronary CTA. All 6 studies were single heartbeat acquisition scans with excellent image quality and a median effective radiation dose of 2.9 mSv (interquartile range, 2.1-3.8 mSv). Standard ECG electrode positions used for 2 patients with PVC bigeminy undergoing coronary CTA were associated with an acquisition over 2 heartbeats and effective radiation doses of 6.8 and 10.3 mSv, respectively. In conclusion, ECG electrode repositioning combined with an absolute-delay strategy for regularly recurring PVCs, such as ventricular bigeminy, facilitates high image quality and lower radiation dose during coronary CTA. This simple and straightforward technique can be considered for all patients with regular and recurrent PVCs undergoing coronary CTA.
    Journal of cardiovascular computed tomography 01/2014; 8(1):13-8. DOI:10.1016/j.jcct.2013.12.008
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    ABSTRACT: Risk assessment in the extensive calcified plaque phenotype has been limited by small sample size. We studied all-cause mortality rates among asymptomatic patients with markedly elevated Agatston scores > 1000. We studied a clinical cohort of 44,052 asymptomatic patients referred for coronary calcium scans. Mean follow-up was 5.6 years (range, 1-13 years). All-cause mortality rates were calculated after stratifying by Agatston score (0, 1-1000, 1001-1500, 1500-2000, and >2000). A multivariable Cox regression model adjusting for self-reported traditional risk factors was created to assess the relative mortality hazard of Agatston scores 1001 to 1500, 1501 to 2000, and >2000. With the use of post-estimation modeling, we assessed for the presence of an upper threshold of risk with high Agatston scores. A total of 1593 patients (4% of total population) had Agatston score > 1000. There was a continuous graded decrease in estimated 10-year survival across increasing Agatston score, continuing when Agatston score > 1000 (Agatston score 1001-1500, 78%; Agatston score 1501-2000, 74%; Agatston score > 2000, 51%). After multivariable adjustment, Agatston scores 1001 to 1500, 1501 to 2000, and >2000 were associated with an 8.05-, 7.45-, and 13.26-fold greater mortality risk, respectively, than for Agatston score of 0. Compared with Agatston score 1001 to 1500, Agatston score 1501 to 2000 had a similar all-cause mortality risk, whereas Agatston score > 2000 had an increased relative risk (Agatston score 1501-2000: hazard ratio [HR], 1.01 [95% CI, 0.67-1.51]; Agatston score > 2000: HR, 1.79 [95% CI, 1.30-2.46]). Graphical assessment of the predicted survival model suggests no upper threshold for risk associated with calcified plaque in coronary arteries. Increasing calcified plaque in coronary arteries continues to predict a graded decrease in survival among patients with extensive Agatston score > 1000 with no apparent upper threshold.
    Journal of cardiovascular computed tomography 01/2014; 8(1):26-32. DOI:10.1016/j.jcct.2013.12.002