This study demonstrates that, in the case of diagnostic image quality, contrast-enhanced MDCT permits an accurate identification of coronary plaques and that computed tomography density values measured within plaques reflect echogenity and plaque composition.

We conclude that 64-slice CT reveals encouraging results to noninvasively detect different types of coronary plaques located in the proximal coronary system. The ability to determine plaque burden currently is hampered by mainly an insufficient reproducibility.

The authors introduce a method for cardiac investigations by using electrocardiographically gated spiral scanning with a four-section computed tomographic system. Three-dimensional images were reconstructed by means of a 250-msec temporal resolution and continuous volume coverage by using a dedicated multisection cardiac volume reconstruction algorithm. Motion-free thin-section volume images were acquired with thin sections and overlapping image increments within a single breath hold. Data segment shifts in time allowed for multiphase imaging.

Viewing a stressful soccer match more than doubles the risk of an acute cardiovascular event. In view of this excess risk, particularly in men with known coronary heart disease, preventive measures are urgently needed.

Calcium screening with EBCT is a highly sensitive and moderately specific test to predict stenotic disease. Exclusion of coronary calcium defines a substantial subgroup of patients, albeit symptomatic, with a very low probability of significant stenoses.

Objectives-Pericardial fat as a visceral fat depot may be involved in the pathogenesis of coronary atherosclerosis. To gain evidence for that concept we sought to investigate the relation of pericardial fat volumes to risk factors, serum adiponectin levels, inflammatory biomarkers, and the quantity and morphology of coronary atherosclerosis. PϾ0.001). No association was found between BMI and coronary atherosclerosis. PAT volumes Ͼ300 cm 3 were the strongest independent risk factor for coronary atherosclerosis (odds ratio 4.1; CI 3.63 to 4.33) also significantly stronger compared to the Framingham score. We furthermore demonstrated that elevated PAT volumes are significantly associated with low adiponectin levels, low HDL levels, elevated TNF-␣ levels, and hsCRP. Conclusion-In the present study we demonstrated that elevated PAT volumes are associated with coronary atherosclerosis, hypoadiponectinemia, and inflammation and represent the strongest risk factor for the presence of atherosclerosis and may be important for risk stratification and monitoring. Key Words: cardiac CT Ⅲ pericardial fat Ⅲ obesity Ⅲ adiponectin Ⅲ plaque imaging T here is growing evidence that regional visceral fat distribution may contribute to an unfavorable metabolic and cardiovascular risk profile. 1,2 In patients with obesity, insulin resistance, diabetes, and hyperlipidemia visceral fat hypertrophies and transforms into a multifunctional organ that produces and secretes multiple endocrine and paracrine factors promoting inflammation, neovascularization, and oxidative stress, features that also characterize atherosclerosis. 3 Pericardial fat as a local visceral fat depot with close proximity to coronary arteries may serve as a source of inflammatory cytokines and cells that may locally enhance systemic proatherogenic effects via outside to inside signaling. 4,5 Thus it may be a specific parameter indicating an unfavorable cardio-metabolic state and may be used for risk stratification. To date, however, only little attention has focused on this regional fat depot located around the heart and its relation to cardiovascular risk factors, and the quantity and composition of coronary atherosclerosis is not well studied yet. Methods and Results-UsingMulti-slice CT is a noninvasive tool that allows to reliably assess both obstructive and nonobstructive subclinical coronary artery disease in an earlier stage than invasive angiography. 6 -9 Based on density measurements, plaques can be further characterized in noncalcified, mixed, and calcified plaques. 7 By using the same scan data this tool furthermore allows to quantify the exact pericardial fat volume. 9 We thus sought to assess the relation of pericardial fat volume to cardiovascular risk factors, levels of inflammatory cytokines, adiponectin, and to the extent and the phenotype of coronary atherosclerosis.

The relation of heart rate and image quality in the depiction of coronary arteries, heart valves and myocardium was assessed on a dual-source computed tomography system (DSCT). Coronary CT angiography was performed on a DSCT (Somatom Definition, Siemens) with high concentration contrast media (Iopromide, Ultravist 370, Schering) in 24 patients with heart rates between 44 and 92 beats per minute. Images were reconstructed over the whole cardiac cycle in 10% steps. Two readers independently assessed the image quality with regard to the diagnostic evaluation of right and left coronary artery, heart valves and left ventricular myocardium for the assessment of vessel wall changes, coronary stenoses, valve morphology and function and ventricular function on a three point grading scale. The image quality ratings at the optimal reconstruction interval were 1.24+/-0.42 for the right and 1.09+/-0.27 for the left coronary artery. A reconstruction of diagnostic systolic and diastolic images is possible for a wide range of heart rates, allowing also a functional evaluation of valves and myocardium. Dual-source CT offers very robust diagnostic image quality in a wide range of heart rates. The high temporal resolution now also makes a functional evaluation of the heart valves and myocardium possible.

Background-Coronary calcification measured by fast computed tomography techniques is a surrogate marker of coronary atherosclerotic plaque burden. In a cohort study, we prospectively investigated whether lipid-lowering therapy with a cholesterol synthesis enzyme inhibitor reduces the progression of coronary calcification. Methods and Results-In 66 patients with coronary calcifications in electron beam tomography (EBT), LDL cholesterol Ͼ130 mg/dL, and no lipid-lowering treatment, the EBT scan was repeated after a mean interval of 14 months and treatment with cerivastatin was initiated (0.3 mg/d). After 12 months of treatment, a third EBT scan was performed. Coronary calcifications were quantified using a volumetric score. Cerivastatin therapy lowered the mean LDL cholesterol level from 164Ϯ30 to 107Ϯ21 mg/dL. The median calcified volume was 155 mm 3 (range, 15 to 1849) at baseline, 201 mm 3 (19 to 2486) after 14 months without treatment, and 203 mm 3 (15 to 2569) after 12 months of cerivastatin treatment. The median annualized absolute increase in coronary calcium was 25 mm 3 during the untreated versus 11 mm 3 during the treatment period (Pϭ0.01). The median annual relative increase in coronary calcium was 25% during the untreated versus 8.8% during the treatment period (PϽ0.0001). In 32 patients with an LDL cholesterol level Ͻ100 mg/dL under treatment, the median relative change was 27% during the untreated versus Ϫ3.4% during the treatment period (Pϭ0.0001). Conclusions-Treatment with the cholesterol synthesis enzyme inhibitor cerivastatin significantly reduces coronary calcium progression in patients with LDL cholesterol Ͼ130 mg/dL.