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Erica Maffei,
Chiara Martini,
Teresa Arcadi,
Alberto Clemente, Sara Seitun,
Alessandra Zuccarelli,
Tito Torri,
Nico R Mollet,
Alexia Rossi,
Onofrio Catalano,
Giancarlo Messalli,
Filippo Cademartiri
[show abstract]
[hide abstract]
ABSTRACT: To assess the attenuation of non-calcified atherosclerotic coronary artery plaques with computed tomography coronary angiography (CTCA).
Four hundred consecutive patients underwent CTCA (Group 1: 200 patients, Sensation 64 Cardiac, Siemens; Group 2: 200 patients, VCT GE Healthcare, with either Iomeprol 400 or Iodixanol 320, respectively) for suspected coronary artery disease (CAD). CTCA was performed using standard protocols. Image quality (score 0-3), plaque (within the accessible non-calcified component of each non-calcified/mixed plaque) and coronary lumen attenuation were measured. Data were compared on a per-segment/per-plaque basis. Plaques were classified as fibrous vs lipid rich based on different attenuation thresholds. A P < 0.05 was considered significant.
In 468 atherosclerotic plaques in Group 1 and 644 in Group 2, average image quality was 2.96 ± 0.19 in Group 1 and 2.93 ± 0.25 in Group 2 (P ≥ 0.05). Coronary lumen attenuation was 367 ± 85 Hounsfield units (HU) in Group 1 and 327 ± 73 HU in Group 2 (P < 0.05); non-calcified plaque attenuation was 48 ± 23 HU in Group 1 and 39 ± 21 HU in Group 2 (P < 0.05). Overall signal to noise ratio was 15.6 ± 4.7 in Group 1 and 21.2 ± 7.7 in Group 2 (P < 0.01).
Higher intra-vascular attenuation modifies significantly the attenuation of non-calcified coronary plaques. This results in a more difficult characterization between lipid rich vs fibrous type.
World journal of radiology. 06/2012; 4(6):265-72.
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Erica Maffei,
Giancarlo Messalli,
Chiara Martini,
Koen Nieman,
Onofrio Catalano,
Alexia Rossi, Sara Seitun,
Andrea I Guaricci,
Carlo Tedeschi,
Nico R Mollet,
Filippo Cademartiri
[show abstract]
[hide abstract]
ABSTRACT: To compare Magnetic Resonance (MR) and Computed Tomography (CT) for the assessment of left (LV) and right (RV) ventricular functional parameters.
Seventy nine patients underwent both Cardiac CT and Cardiac MR. Images were acquired using short axis (SAX) reconstructions for CT and 2D cine b-SSFP (balanced-steady state free precession) SAX sequence for MR, and evaluated using dedicated software.
CT and MR images showed good agreement: LV EF (Ejection Fraction) (52 ± 14% for CT vs. 52 ± 14% for MR; r = 0.73; p > 0.05); RV EF (47 ± 12% for CT vs. 47 ± 12% for MR; r = 0.74; p > 0.05); LV EDV (End Diastolic Volume) (74 ± 21 ml/m² for CT vs. 76 ± 25 ml/m² for MR; r = 0.59; p > 0.05); RV EDV (84 ± 25 ml/m² for CT vs. 80 ± 23 ml/m² for MR; r = 0.58; p > 0.05); LV ESV (End Systolic Volume)(37 ± 19 ml/m² for CT vs. 38 ± 23 ml/m² for MR; r = 0.76; p > 0.05); RV ESV (46 ± 21 ml/m² for CT vs. 43 ± 18 ml/m² for MR; r = 0.70; p > 0.05). Intra- and inter-observer variability were good, and the performance of CT was maintained for different EF subgroups.
Cardiac CT provides accurate and reproducible LV and RV volume parameters compared with MR, and can be considered as a reliable alternative for patients who are not suitable to undergo MR. KEY POINTS : • Cardiac-CT is able to provide Left and Right Ventricular function. • Cardiac-CT is accurate as MR for LV and RV volume assessment. • Cardiac-CT can provide accurate evaluation of coronary arteries and LV and RV function.
European Radiology 01/2012; 22(5):1041-9. · 3.22 Impact Factor
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Erica Maffei, Sara Seitun,
Chiara Martini,
Andrea Igoren Guaricci,
Giuseppe Tarantini,
Niels van Pelt,
Annick C Weustink,
Nico R Mollet,
Elena Berti,
Roberto Grilli,
Giancarlo Messalli,
Annachiara Aldrovandi,
Filippo Cademartiri
[show abstract]
[hide abstract]
ABSTRACT: To assess the prognostic relevance of 64-slice computed tomography coronary angiography (CT-CA) and symptoms in diabetics and non-diabetics referred for cardiac evaluation.
We followed 210 patients with diabetes type 2 (DM) and 203 non-diabetic patients referred for CT-CA for ruling out coronary artery disease (CAD). Patients were without known history of CAD and were divided into four categories on the basis of symptoms at presentation (none, atypical angina, typical angina and dyspnoea). Clinical end points were major cardiac events (MACE): cardiac-related death, non-fatal myocardial infarction, unstable angina and cardiac revascularizations. Cox proportional hazard models, with and without adjustment for risk factors and multiplicative interaction term (obstructive CAD × DM), were developed to predict outcome.
DM patients with dyspnoea or who were asymptomatic showed a higher prevalence of obstructive CAD than non-diabetics (p ≤ 0.01). At mean follow-up of 20.4 months, DM patients had worse cardiac event-free survival in comparison with non-DM patients (90% vs. 81%, p = 0.02). In multivariate analysis, CT-CA evidence of obstructive CAD (in DM patients: HR: 6.4; 95% CI: 2.3-17.5; p < 0.001; in non-DM patients: HR: 7.4; 95% CI: 2.1-26.7; p = 0.002) and the presence of typical angina (in DM patients: HR: 2.9; 95% CI: 1.3-6.3; p = 0.007; in non-DM patients: HR: 2.7; 95% CI: 1.1-7.1; p = 0.03) were independent predictors of MACE in both groups. Furthermore, other independent outcome predictors included dyspnoea (HR: 3.8; 95% CI: 1.7-8.5; p = 0.001), the number of segments with any CAD (HR: 1.1; 95% CI: 1.001-1.2; p = 0.04) in DM patients and coronary calcium score >100 in non-DM patients (HR: 5.6; 95% CI: 1.4-21.5; p = 0.01). In Cox regression analysis of the overall population, interaction term obstructive CAD × DM resulted in non-significance.
Among DM patients, dyspnoea carried a high event risk with a MACE rate four times higher. CT-CA findings were strongly predictive of outcome and proved valuable for further risk stratification.
Insights into imaging. 02/2011; 2(1):25-38.
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Erica Maffei, Sara Seitun,
Chiara Martini,
Alessandro Palumbo,
Giuseppe Tarantini,
Elena Berti,
Roberto Grilli,
Carlo Tedeschi,
Giancarlo Messalli,
Andrea Guaricci,
Annick C Weustink,
Nico Ra Mollet,
Filippo Cademartiri
[show abstract]
[hide abstract]
ABSTRACT: To evaluate diagnostic accuracy of exercise ECG (ex-ECG) versus 64-slice CT coronary angiography (CT-CA) for the detection of significant coronary artery stenosis in a population with low-to-intermediate pre-test likelihood of coronary artery disease (CAD).
Retrospective single centre.
Tertiary academic hospital.
177 consecutive patients (88 men, 89 women, mean age 53.5±7.6 years) with chest pain and low-to-intermediate pre-test likelihood of CAD were retrospectively enrolled.
All patients underwent ex-ECG, CT-CA and invasive coronary angiography (ICA).
A lumen diameter reduction of ≥50% was considered as significant stenosis for CT-CA. Ex-ECG was classified as positive, negative or non-diagnostic.
were compared with ICA. Diagnostic accuracy of CT-CA and ex-ECG was calculated using ICA as the reference standard. A parallel comparative analysis using a cut-off value of 70% for significant lumen reduction was also performed too. Results ICA disclosed an absence of significant stenosis (≥50% luminal narrowing) in 85.3% (151/177) patients, single-vessel disease in 9.0% (16/177) patients and multivessel disease in 5.6% (10/177) patients. Prevalence of obstructive disease at ICA was 14.7% (26/177). Sensitivity, specificity, positive and negative predictive values at the patient level were 100.0%, 98.7%, 92.9%, 100%, respectively, for CT-CA and 46.2%, 16.6%, 8.7%, 64.1%, respectively, for ex-ECG. Agreement between CT-CA and ex-ECG was 20.9%. CT-CA performed equally well in men and women, while ex-ECG had a better performance in men. After considering the cut-off value of 70% for significant stenosis, the difference between CT-CA and ex-ECG remained significant (p<0.01), with a low agreement (21.5%).
CT-CA provides optimal diagnostic performance in patients with atypical chest pain and low-to-intermediate risk of CAD. Ex-ECG has poor diagnostic accuracy in this population. Concerns are related to risk of radiation dose versus the benefits of correct disease stratification.
Heart (British Cardiac Society) 11/2010; 96(24):1973-9. · 4.22 Impact Factor
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Annachiara Aldrovandi,
Erica Maffei, Sara Seitun,
Chiara Martini,
Elena Berti,
Roberto Grilli,
Giancarlo Messalli,
Annick C Weustink,
Nico R Mollet,
Koen Nieman,
Diego Ardissino,
Pim J de Feyter,
Gabriel P Krestin,
Filippo Cademartiri
[show abstract]
[hide abstract]
ABSTRACT: To investigate the predictive value of 64-slice computed tomography coronary angiography (CTCA) for major adverse cardiac events (MACEs) in patients with suspected or known coronary artery disease (CAD).
Seven hundred and sixty-seven consecutive patients (496 men, age 62±11 y) with suspected or known heart disease referred to an outpatient clinic underwent 64-slice CTCA. The patients were followed for the occurrence of MACE (ie, cardiac death, nonfatal myocardial infarction, unstable angina).
Eleven thousand five hundred and sixty-four coronary segments were assessed. Of these, 178 (1.5%) were not assessable because of insufficient image quality. Overall, CTCA revealed the absence of CAD in 219 (28.5%) patients, nonobstructive CAD (coronary plaque ≤50%) in 282 (36.8%) patients, and obstructive CAD in 266 (34.7%) patients. A total of 21 major cardiac events (4 cardiac deaths, 12 myocardial infarctions, and 5 unstable angina) occurred during a mean follow-up of 20 months. One noncardiac death occurred. Seventeen events occurred in the group of patients with obstructive CAD, and 4 events occurred in the group with nonobstructive CAD. The event rate was 0% among patients with normal coronary arteries at CTCA. In multivariate analysis, the presence of obstructive CAD and diabetes were the only independent predictors of MACE.
Coronary plaque evaluation by CTCA provides an independent prognostic value for the prediction of MACE. Patients with normal CTCA findings have an excellent prognosis at follow-up.
Journal of thoracic imaging 11/2010; 27(1):23-8. · 1.42 Impact Factor
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Erica Maffei, Sara Seitun,
Koen Nieman,
Chiara Martini,
Andrea Igoren Guaricci,
Carlo Tedeschi,
Annick C Weustink,
Nico R Mollet,
Elena Berti,
Roberto Grilli,
Giancarlo Messalli,
Filippo Cademartiri
[show abstract]
[hide abstract]
ABSTRACT: To compare the coronary atherosclerotic burden in patients with and without type-2 diabetes using CT Coronary Angiography (CTCA).
147 diabetic (mean age: 65 ± 10 years; male: 89) and 979 nondiabetic patients (mean age: 61 ± 13 years; male: 567) without a history of coronary artery disease (CAD) underwent CTCA. The per-patient number of diseased coronary segments was determined and each diseased segment was classified as showing obstructive lesion (luminal narrowing >50%) or not. Coronary calcium scoring (CCS) was assessed too.
Diabetics showed a higher number of diseased segments (4.1 ± 4.2 vs. 2.1 ± 3.0; p < 0.0001); a higher rate of CCS > 400 (p < 0.001), obstructive CAD (37% vs. 18% of patients; p < 0.0001), and fewer normal coronary arteries (20% vs. 42%; p < 0.0001), as compared to nondiabetics. The percentage of patients with obstructive CAD paralleled increasing CCS in both groups. Diabetics with CCS ≤ 10 had a higher prevalence of coronary plaque (39.6% vs. 24.5%, p = 0.003) and obstructive CAD (12.5% vs. 3.8%, p = 0.01). Among patients with CCS ≤ 10 all diabetics with obstructive CAD had a zero CCS and one patient was asymptomatic.
Diabetes was associated with higher coronary plaque burden. The present study demonstrates that the absence of coronary calcification does not exclude obstructive CAD especially in diabetics.
European Radiology 11/2010; 21(5):944-53. · 3.22 Impact Factor
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Jacob M Van Werkhoven,
Filippo Cademartiri, Sara Seitun,
Erica Maffei,
Alessandro Palumbo,
Chiara Martini,
Giuseppe Tarantini,
Lucia J Kroft,
Albert de Roos,
Annick C Weustink,
J Wouter Jukema,
Diego Ardissino,
Nico R Mollet,
Joanne D Schuijf,
Jeroen J Bax
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the prognostic value of multidetector computed tomographic (CT) coronary angiography in a diabetic population known to have or suspected of having coronary artery disease (CAD) compared with that in nondiabetic individuals.
Institutional review board approval and patient informed consent were obtained. Three hundred thirteen patients with type 2 diabetes mellitus (DM) and 303 patients without DM underwent unenhanced 64-detector row CT, at which a calcium score was obtained, followed by CT angiography. Multidetector CT coronary angiograms were retrospectively classified as normal, showing nonobstructive CAD (<or=50% luminal narrowing), or showing obstructive CAD (>50% luminal narrowing). During follow-up after CT angiography, major events (cardiac death, nonfatal myocardial infarction, and unstable angina requiring hospitalization) and total events (major events plus coronary revascularizations) were recorded for each patient. Cox proportional hazards analysis and Kaplan-Meier analysis were used to compare survival rates.
In the group of 313 patients with DM, there were 213 men, and the mean age was 62 years +/- 11 (standard deviation). In the group of 303 patients without DM, there were 203 men, and the mean age was 63 years +/- 11. The mean number of diseased segments (5.6 vs 4.4, P = .001) and the rate of obstructive CAD (51% vs 37%, P < .001) were higher in patients with DM. Patients were followed up for a mean of 20 months +/- 5.4 (range, 6-44 months). At multivariate analysis, DM (P < .001) and evidence of obstructive CAD (P < .001) were independent predictors of outcome. Obstructive CAD remained a significant multivariate predictor for both patients with DM and patients without DM. In both patients with DM and patients without DM with absence of disease, the event rate was 0%. The event rate increased to 36% in patients without DM but with obstructive CAD and was highest (47%) in patients with DM and obstructive CAD.
In both patients with DM and patients without DM, multidetector CT coronary angiography provides incremental prognostic information over baseline clinical variables, and the absence of atherosclerosis at CT coronary angiography is associated with an excellent prognosis. Multidetector CT coronary angiography might be a clinically useful tool for improving risk stratification in both patients with DM and patients without DM.
Radiology 07/2010; 256(1):83-92. · 5.73 Impact Factor
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Filippo Cademartiri,
Erica Maffei,
Alessandro Palumbo, Sara Seitun,
Chiara Martini,
Carlo Tedeschi,
Ludovico La Grutta,
Massimo Midiri,
Annick C Weustink,
Nico R Mollet,
Gabriel P Krestin
[show abstract]
[hide abstract]
ABSTRACT: The aim of the study was to compare the coronary artery calcium score (CACS) and computed tomography coronary angiography (CTCA) for the assessment of non-obstructive/obstructive coronary artery disease (CAD) in high-risk asymptomatic subjects.
Two hundred and thirteen consecutive asymptomatic subjects (113 male; mean age 53.6 +/- 12.4 years) with more than one risk factor and an inconclusive or unfeasible non-invasive stress test result underwent CACS and CTCA in an outpatient setting. All patients underwent conventional coronary angiography (CAG). Data from CACS (threshold for positive image: Agatston score 1/100/1,000) and CTCA were compared with CAG regarding the degree of CAD (non-obstructive/obstructive; </>or=50% lumen reduction).
The mean calcium score was 151 +/- 403 and the prevalence of obstructive CAD was 17% (8% one-vessel and 10% two-vessel disease). Per-patient sensitivity, specificity, positive and negative predictive values of CACS were: 97%, 75%, 45%, and 100%, respectively (Agatston >or=1); 73%, 90%, 60%, and 94%, respectively (Agatston >or=100); 30%, 98%, 79%, and 87%, respectively (Agatston >or=1,000). Per-patient values for CTCA were 100%, 98%, 97%, and 100%, respectively (p < 0.05). CTCA detected 65% prevalence of all CAD (48% non-obstructive), while CACS detected 37% prevalence of all CAD (21% non-obstructive) (p < 0.05).
CACS proved inadequate for the detection of obstructive and non-obstructive CAD compared with CTCA. CTCA has a high diagnostic accuracy for the detection of non-obstructive and obstructive CAD in high-risk asymptomatic patients with inconclusive or unfeasible stress test results.
European Radiology 09/2009; 20(4):846-54. · 3.22 Impact Factor
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Filippo Cademartiri,
Erica Maffei,
Alessandro Palumbo,
Chiara Martini, Sara Seitun,
Carlo Tedeschi,
Roberto De Rosa,
Teresa Arcadi,
Ignazio Salamone,
Alfredo Blandino,
Annick C Weustink,
Nico R Mollet,
Pim J De Feyter,
Gabriel P Krestin
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the diagnostic accuracy of 64-slice CT coronary angiography (CT-CA) for the detection of significant coronary artery stenosis in patients with zero on the Agatston Calcium Score (CACS). We enrolled 279 consecutive patients (96 male, mean age 48 +/- 12 years) with suspected coronary artery disease. Patients were symptomatic (n = 208) or asymptomatic (n = 71), and underwent conventional coronary angiography (CAG). For CT-CA we administered an IV bolus of 100 ml of iodinated contrast material. CT-CA was compared to CAG using a threshold for significant stenosis of >or=50%. The prevalence of disease demonstrated at CAG was 15% (1.4% in asymptomatic). The population at CAG showed no or non-significant disease in 85% (238/279), single vessel disease in 9% (25/279), and multi-vessel disease in 6% (16/279). Sensitivity, specificity, and positive and negative predictive values of CT-CA vs. CAG on the patient level were 100%, 95%, 76%, and 100% in the overall population and 100%, 100%, 100%, and 100% in asymptomatic patients, respectively. CT-CA proves high diagnostic performance in patients with or without symptoms and with zero CACS. The prevalence of significant disease detected by CT-CA was not negligible in asymptomatic patients. The role of CT-CA in asymptomatic patients remains uncertain.
European Radiology 08/2009; 20(1):81-7. · 3.22 Impact Factor
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Erica Maffei,
Alessandro A Palumbo,
Chiara Martini,
Carlo Tedeschi,
Giuseppe Tarantini, Sara Seitun,
Livia Ruffini,
Annachiara Aldrovandi,
Annick C Weustink,
Willem B Meijboom,
Nico R Mollet,
Gabriel P Krestin,
Pim J de Feyter,
Filippo Cademartiri
[show abstract]
[hide abstract]
ABSTRACT: We retrospectively evaluated the effect, timing and safety of different pharmacological strategies during 64-slice CT coronary angiography (CT-CA). From the institutional database of CT-CAwe enrolled 560 consecutive patients with suspected coronary artery disease. The type of drug preparation (group 1 = no treatment; group 2 = oral metoprolol; group 3 = other; group 4 = intravenous (IV) atenolol; group 5 = IV atenolol + nitrates; NR = non-responders), timing, and adverse effects were recorded. Heart rate (HR) during different preparation phases was recorded. Four adverse effects were recorded, none of which was attributable to pharmacological treatment. In all groups, except group 1, the HR on arrival was significantly reduced by the pharmacological treatment (p<0.01). Group 4 showed the best (-16±8 bpm) HR reduction. There was no significant effect on HR due to nitrates (p = 0.49), while a slight increase due to contrast material was noted (p<0.05). Average time required for preparation was 44±25min. Groups 4 and 5 showed the most effective timing (8±9 min and 8±8 min, respectively; p<0.01). Pharmacological preparation in patients undergoing CT-CA is safe and effective. Best results in terms of HR reduction and fast preparation are obtained with IV administration of beta-blockers.
European Radiology 07/2009; 19(12):2931-40. · 3.22 Impact Factor
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Erica Maffei, Sara Seitun,
Matteo Romano,
Alessandro A Palumbo,
Chiara Martini,
Giuseppe Tarantini,
Carlo Tedeschi,
Annick C Weustink,
Nico R Mollet,
Teresa Arcadi,
Ignazio Salamone,
Alfredo Blandino,
Ludovico La Grutta,
Massimo Midiri,
Filippo Cademartiri
[show abstract]
[hide abstract]
ABSTRACT: To determine the relationship between established cardiovascular risk factors, clinical presentation and the extent of coronary artery disease (CAD), as described with computed tomography coronary angiography.
In this cross-sectional study, we included 567 symptomatic individuals without a history of CAD who consecutively underwent 64-slice computed tomography coronary angiography for evaluation of suspected CAD. We analyzed the prevalence of CAD depending on sex, age, symptoms and risk factors.
A total of 8542 segments were analyzed. No evidence of CAD was observed in 225 patients (40%), nonsignificant CAD in 221 patients (39%) and significant CAD (luminal narrowing >50%) in the remaining 121 patients (21%). CAD increased with advancing age, significantly above 50 years (P < 0.05). Female patients had a higher prevalence of normal coronary arteries and males of significant CAD (P < 0.01). With the increase of risk factors, there was a significant increase of the significant disease (P < 0.01). Typical pain with respect to atypical pain had the strongest association with significant CAD (16 vs. 38%; P < 0.05). In multivariate analysis, the number of risk factors, age, male sex and typical pain remained strong predictors of significant CAD (P < 0.0001).
Computed tomography coronary angiography may play an important role in risk stratification of patients with suspected CAD.
Journal of Cardiovascular Medicine 06/2009; 10(12):913-20. · 1.51 Impact Factor
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Annachiara Aldrovandi,
Erica Maffei,
Alessandro Palumbo, Sara Seitun,
Chiara Martini,
Valerio Brambilla,
Alessandra Zuccarelli,
Giuseppe Tarantini,
Annick C Weustink,
Nico R Mollet,
Livia Ruffini,
Girolamo Crisi,
Diego Ardissino,
Pim J de Feyter,
Gabriel P Krestin,
Filippo Cademartiri
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to determine the predictive value of 64-slice computed tomography coronary angiography (CTCA) for major cardiac events in patients with suspected coronary artery disease (CAD). A total of 187 consecutive patients (119 men, age 62.5 +/- 10.5 years) without known heart disease underwent single-source 64-slice CTCA (Somatom Sensation 64, Siemens) for clinical suspicion of CAD. Patients underwent follow-up for the occurrence of cardiac death, nonfatal myocardial infarction, unstable angina and cardiac revascularization. In total, 2,822 coronary segments were assessed. Forty-two segments (1.5%) were not assessable because of insufficient image quality. Overall, CTCA revealed absence of CAD in 65 (34.7%) patients, nonobstructive CAD (coronary plaque < or =50%) in 87 (46.5%) patients and obstructive CAD (>50%) in 35 (18.8%) patients. A total of 20 major cardiac events (3 myocardial infarctions, 16 cardiac revascularizations, 1 unstable angina) occurred during a mean follow-up of 24 months. One noncardiac death occurred. Seventeen events occurred in the group of patients with obstructive CAD and three events occurred in the group of nonobstructive CAD. The event rate was 0% among patients with normal coronary arteries at CTCA. CTCA has a 100% negative predictive value for major cardiac events at 24-month follow-up in patients with normal coronary arteries.
European Radiology 02/2009; 19(7):1653-60. · 3.22 Impact Factor
