Prevalence and characteristics of coronary artery disease in a population with suspected ischaemic heart disease using CT coronary angiography: Correlations with cardiovascular risk factors and clinical presentation

Dipartimento di Radiologia e Cardiologia, Erasmus Medical Center, Rotterdam, The Netherlands.
La radiologia medica (Impact Factor: 1.34). 05/2008; 113(3):363-72. DOI: 10.1007/s11547-008-0257-6
Source: PubMed


This study was undertaken to describe the correlation between the distribution of coronary artery disease (CAD) in a symptomatic population with suspected ischaemic heart disease, cardiovascular risk factors (RF) and clinical presentation.
we studied 163 patients (mean age 65.5 years; 101 men and 62 women) referred for multidetector computed tomography coronary angiography (MDCT-CA) to rule out CAD. The patients had no prior history of revascularisation or myocardial infarction. We analysed how the characteristics of CAD (severity and type of plaque) can change with the increase in RF and how they are related to different clinical presentations.
patients were divided into three groups according to the number of RF: zero or one, two or three, and four or more. The percentage of coronary arteries with no plaque, nonsignificant disease and significant disease was 55%, 41% and 4%, respectively, in patients with zero or one RF; 27%, 51% and 22%, respectively, in patients with two or three RF; and 19%, 38% and 44%, respectively, in patients with four or more RF. Plaque in patients with nonsignificant disease was mixed in 65%, soft in 18% and calcified in 17%. The percentage of coronaries with no plaque in the three RF groups was 50%, 20% and 0% in patients with typical chest pain and 46%, 24% and 12% in those with atypical pain. The percentage of significant disease in patients with typical pain was 0%, 47% and 86% and in those with atypical pain 4%, 20% and 29%.
MDCT plays an important role in the identification of CAD in patients with suspected ischaemic heart disease. Severity and type of disease is highly correlated with RF number and assumes different characteristics according to clinical presentation.

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    • "For bi-ventricular volume assessment, patients were also scheduled for an MR within one week after CT. We adhered to the exclusion criteria reported in literature [33–35]: for CT, we excluded patients with a) an heart rate >65 bpm (beats per minute) not responding to beta-blockers; b) atrial fibrillation and concomitant high ventricular response; c) known reactions to contrast medium; d) renal insufficiency (creatinine > 1.5 mg/dL); e) impaired pulmonary function (unable to perform a 12-s breath-hold); for MR, we excluded patients with a) claustrophobia; b) pacemaker/other non MR compatible devices [34]. Twenty-one patients were excluded because of unsuitability to undergo MR (11 for claustrophobia; 3 for increasing dyspnoea during acquisition; 4 for ICD; 2 for pacemaker; 1 for a Starr-Edwards mitral valve); within our cohort no patient needed exclusion from CT. Complete CT and MR datasets could be acquired in 79 patients (mean age: 58; 46 male) (Table 1). "
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    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.
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