AIM To determine the radiation dose and image quality in coronary computed tomography angiography(CCTA)using state-of-the-art dose reduction methods in unselected"real world"patients.METHODS In this single-c...AIM To determine the radiation dose and image quality in coronary computed tomography angiography(CCTA)using state-of-the-art dose reduction methods in unselected"real world"patients.METHODS In this single-centre study,consecutive patients in sinus rhythm underwent CCTA for suspected coronary artery disease(CAD)using a 320-row detector CT scanner.All patients underwent the standard CT acquisition protocol at our institute(Morriston Hospital)a combination of dose saving advances including prospective electrocardiogram-gating,automated tube current modulation,tube voltage reduction,heart rate reduction,and the most recent novel adaptive iterative dose reconstruction 3D(AIDR3D)algorithm.The cohort comprised real-world patients for routine CCTA who were not selected on age,body mass index,or heart rate.Subjective image quality was graded on a 4-point scale(4=excellent,1=non-diagnostic).RESULTS A total of 543 patients were included in the study with a mean body weight of 81±18 kg and a pre-scan mean heart rate of 70±11 beats per minute(bpm).When indicated,patients received rate-limiting medication with an oral beta-blocker followed by additional intravenous beta-blocker to achieve a heart rate below 65 bpm.The median effective radiation dose was 0.88 mSv(IQR,0.6-1.4 mSv)derived from a Dose Length Product of61.45 mGy.cm(IQR,42.86-100.00 mGy.cm).This also includes what we believe to be the lowest ever-reported radiation dose for a routine clinical CCTA(0.18 mSv).The mean image quality(SD)was 3.65±0.61,with a subjective image quality score of 3("good")or above for 93%of patient CCTAs.CONCLUSION Combining a low-dose scan protocol and AIDR3D with a 320-detector row CT scanner can provide high quality images at exceptionally low radiation dose in unselected patients being investigated for CAD.展开更多
Background and objective To assess the predictive value of C-reactive protein(CRP) for major adverse cardiac events and the association between CRP level and the coronary lesion morphology and extent in patients with ...Background and objective To assess the predictive value of C-reactive protein(CRP) for major adverse cardiac events and the association between CRP level and the coronary lesion morphology and extent in patients with coronary heart disease (CHD).Methods CRP was measured on admission in 177 consecutive elderly (age≥60 years) patients with CHD who underwent coronary angiography. Patients were divided into high CRP group (CRP≥3mg/L) and normal CRP group (CRP ＜3mg/L). The association between CRP levels and the coronary lesion features, including severity of stenosis (mild, moderate, severe), extent of lesion (diffused or nondiffused), eccentricity of the plaque (eccentric or non-eccentric) were analyzed. Patients were followed up for a mean of 8 months for the occurrences of major adverse cardiac events (MACE). Results Compared with patients in normal CRP group, patients in high CRP group were more frequently to have unstable angina, multi-vessel, diffuse, eccentric lesions, positive remodeling, and non-smooth plaques (P＜0.01). Kaplan-Meier analysis showed patients in high CRP group had a significantly lower MACE-free survival rate than patients in normal CRP group (Log-rank = 12.0, P＜0.01); Cox regression analysis indicated CRP level as an independent predictor for the occurrence of MACE (OR=3.16, P＜0.05) Conclusions High CRP level is associated with more extend, severe and eccentric coronary lesions and is an independent predictor for MACE in elderly patients with CHD.展开更多
Background:Myxomas are the most common primary cardiac tumors.Angiographically detectable neovascularity(ADN)of myxoma is increasingly being reported as a result of the use of coronary angiography(CAG)to detect corona...Background:Myxomas are the most common primary cardiac tumors.Angiographically detectable neovascularity(ADN)of myxoma is increasingly being reported as a result of the use of coronary angiography(CAG)to detect coronary artery disease.However,the clinical signifi cance of these fi ndings is not fully understood.Methods:We enrolled 59 patients with cardiac myxoma who also underwent CAG between January 2013 and October 2018.Patients were followed up for a mean of 28.9 months(range 1-69 months).The clinical features,echocardiography measurements,pathological examination fi ndings,CAG results,and outcomes during follow-up were compared between patients with ADN and patients without ADN.Results:ADN was found in 25 patients(42.4%).The arteries feeding the ADN included the right coronary artery(n=15),the left circumfl ex coronary artery(n=7),and both arteries(n=3).The patients with ADN had a higher proportion of eosinophils(3.2%vs.2.2%,P=0.03)and higher low-density lipoprotein cholesterol level(2.7 mmol/L vs.2.2 mmol/L,P=0.02).Myxoma pedicles were more likely to be located in the interatrial septum in patients with ADN(96%vs.73.5%,P=0.02).No signifi cant correlation was observed between the groups in clinical manifestations,atrial arrhythmia,myxoma size,cardiac chamber size,left ventricular ejection fraction,and the prevalence of complication with coronary artery disease[16%in the ADN group(n=4)vs.20.6%in the non-ADN group(n=7),P=0.66].However,patients with ADN tended to have a lower incidence of major adverse cardiac and cerebrovascular events on long-term follow-up(0%vs.14.7%,P=0.07).Conclusion:CAG-detected ADN in patients with cardiac myxoma is associated with a borderline lower rate of major adverse cardiac and cerebrovascular events.展开更多
文摘AIM To determine the radiation dose and image quality in coronary computed tomography angiography(CCTA)using state-of-the-art dose reduction methods in unselected"real world"patients.METHODS In this single-centre study,consecutive patients in sinus rhythm underwent CCTA for suspected coronary artery disease(CAD)using a 320-row detector CT scanner.All patients underwent the standard CT acquisition protocol at our institute(Morriston Hospital)a combination of dose saving advances including prospective electrocardiogram-gating,automated tube current modulation,tube voltage reduction,heart rate reduction,and the most recent novel adaptive iterative dose reconstruction 3D(AIDR3D)algorithm.The cohort comprised real-world patients for routine CCTA who were not selected on age,body mass index,or heart rate.Subjective image quality was graded on a 4-point scale(4=excellent,1=non-diagnostic).RESULTS A total of 543 patients were included in the study with a mean body weight of 81±18 kg and a pre-scan mean heart rate of 70±11 beats per minute(bpm).When indicated,patients received rate-limiting medication with an oral beta-blocker followed by additional intravenous beta-blocker to achieve a heart rate below 65 bpm.The median effective radiation dose was 0.88 mSv(IQR,0.6-1.4 mSv)derived from a Dose Length Product of61.45 mGy.cm(IQR,42.86-100.00 mGy.cm).This also includes what we believe to be the lowest ever-reported radiation dose for a routine clinical CCTA(0.18 mSv).The mean image quality(SD)was 3.65±0.61,with a subjective image quality score of 3("good")or above for 93%of patient CCTAs.CONCLUSION Combining a low-dose scan protocol and AIDR3D with a 320-detector row CT scanner can provide high quality images at exceptionally low radiation dose in unselected patients being investigated for CAD.
文摘Background and objective To assess the predictive value of C-reactive protein(CRP) for major adverse cardiac events and the association between CRP level and the coronary lesion morphology and extent in patients with coronary heart disease (CHD).Methods CRP was measured on admission in 177 consecutive elderly (age≥60 years) patients with CHD who underwent coronary angiography. Patients were divided into high CRP group (CRP≥3mg/L) and normal CRP group (CRP ＜3mg/L). The association between CRP levels and the coronary lesion features, including severity of stenosis (mild, moderate, severe), extent of lesion (diffused or nondiffused), eccentricity of the plaque (eccentric or non-eccentric) were analyzed. Patients were followed up for a mean of 8 months for the occurrences of major adverse cardiac events (MACE). Results Compared with patients in normal CRP group, patients in high CRP group were more frequently to have unstable angina, multi-vessel, diffuse, eccentric lesions, positive remodeling, and non-smooth plaques (P＜0.01). Kaplan-Meier analysis showed patients in high CRP group had a significantly lower MACE-free survival rate than patients in normal CRP group (Log-rank = 12.0, P＜0.01); Cox regression analysis indicated CRP level as an independent predictor for the occurrence of MACE (OR=3.16, P＜0.05) Conclusions High CRP level is associated with more extend, severe and eccentric coronary lesions and is an independent predictor for MACE in elderly patients with CHD.
文摘Background:Myxomas are the most common primary cardiac tumors.Angiographically detectable neovascularity(ADN)of myxoma is increasingly being reported as a result of the use of coronary angiography(CAG)to detect coronary artery disease.However,the clinical signifi cance of these fi ndings is not fully understood.Methods:We enrolled 59 patients with cardiac myxoma who also underwent CAG between January 2013 and October 2018.Patients were followed up for a mean of 28.9 months(range 1-69 months).The clinical features,echocardiography measurements,pathological examination fi ndings,CAG results,and outcomes during follow-up were compared between patients with ADN and patients without ADN.Results:ADN was found in 25 patients(42.4%).The arteries feeding the ADN included the right coronary artery(n=15),the left circumfl ex coronary artery(n=7),and both arteries(n=3).The patients with ADN had a higher proportion of eosinophils(3.2%vs.2.2%,P=0.03)and higher low-density lipoprotein cholesterol level(2.7 mmol/L vs.2.2 mmol/L,P=0.02).Myxoma pedicles were more likely to be located in the interatrial septum in patients with ADN(96%vs.73.5%,P=0.02).No signifi cant correlation was observed between the groups in clinical manifestations,atrial arrhythmia,myxoma size,cardiac chamber size,left ventricular ejection fraction,and the prevalence of complication with coronary artery disease[16%in the ADN group(n=4)vs.20.6%in the non-ADN group(n=7),P=0.66].However,patients with ADN tended to have a lower incidence of major adverse cardiac and cerebrovascular events on long-term follow-up(0%vs.14.7%,P=0.07).Conclusion:CAG-detected ADN in patients with cardiac myxoma is associated with a borderline lower rate of major adverse cardiac and cerebrovascular events.
