To evaluate the diagnostic accuracy of 256-slice Multidetector Computerized Tomography (256-MDCT) in detection of coronary graft patency by comparison with the gold standard invasive coronary angiography (ICA). MATERIALS AND METHODS.From January 2009 to April 2011, a total of 29 consecutive patients who had previously had CABG surgery were referred to us for assessment of graft patency. A total of 84 coronary bypass graft conduits (38 arterial graft conduits, 46 venous graft conduits) were studied, using 256-MDCT and ICA with iodine contrast intravenous injection. All patients underwent coronary angiography to either confirm result or PCI of graft disease. The diagnostic accuracy of the 256-MDCT for coronary bypass graft evaluation was assessed by comparing it to the ICA in terms of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).
To study the accuracy of the 256 Multi-detector Computerized Tomography (MDCT) in detecting coronary artery stenosis. MATERIALS AND METHODS.We retrospectively analyzed angiographic findings of patients who underwent both 256 MDCT and invasive coronary angiography (ICA). All epicardial arteries, regardless of calcium burden, were segmented into proximal, mid and distal part for comparative analysis. Significant coronary artery stenosis was defined as the reduction of luminal diameter being equal to or more than 50%. The diagnostic accuracy of 256 MDCT in coronary artery stenosis evaluation was assessed by comparing its' sensitivity, specificity, positive and negative predictive values to the gold standard ICA. RESULTS.From January to December 2009, a total of 147 consecutive patients (124 male, 23 female, mean age of 60 ±12 years) underwent both MDCT and ICA were enrolled. Of total 1470 coronary segments (147 segments of LMA, 441 segments of the LAD, 441 segments of the LCx, 441 segments of the RCA), 98.9% were eligible to be assessed and only 1.1% (15/1470) were ineligible due to very high calcium clumps and severe motion artifacts. Compared to the ICA, the overall sensitivity of the 256 MDCT in detecting coronary stenosis was 88.3 %, specificity was 96.1%, positive predictive value was 88.1 % and the negative predictive value was 96.2% with an overall accuracy of 94.2% (p=0.20). In massive calcium scoring cases (calcium scoring ≥400 U), the sensitivity of 256 MDCT in detecting coronary artery stenosis was 90.3%, specificity was 96.1%, positive predictive value was 87.5% and the negative predictive value was 95.5%; the overall accuracy was 92.9%. In nonmassive calcium scoring cases (calcium scoring <400 U), sensitivity for classifying coronary stenoses was 89.2 %, specificity was 97.2%, positive predictive value was 88.7 % and the negative predictive value was 97.4 %; the overall accuracy was 94.9%.CONCLUSION. The 256 MDCT, regardless of calcium burden, offers a reliable diagnostic accuracy in assessing coronary artery stenosis.N owadays, the 64 slice MDCT has become a reliable, standard tool for diagnosing coronary stenosis in mild to moderate risk patients. The overall reported sensitivity and specificity were reasonably accepted. 4,5 However, several limitations of the 64 MDCT existed, which included a long acquisition time, and the often required administration of beta-blockades to lower the motion artifacts from patients with high heart rates. With the new 256 MDCT, more data was collected within a shorter time, patients received reduced doses of radiation and the image quality was also much improved.
To study the accuracy of the 256 Multi-detector Computerized Tomography (MDCT) in detecting coronary artery stenosis. MATERIALS AND METHODS. We retrospectively analyzed angiographic findings of patients who underwent both 256 MDCT and invasive coronary angiography (ICA). All epicardial arteries, regardless of calcium burden, were segmented into proximal, mid and distal part for comparative analysis. Significant coronary artery stenosis was defined as the reduction of luminal diameter being equal to or more than 50%. The diagnostic accuracy of 256 MDCT in coronary artery stenosis evaluation was assessed by comparing its' sensitivity, specificity, positive and negative predictive values to the gold standard ICA. RESULTS. From January to December 2009, a total of 147 consecutive patients (124 male, 23 female, mean age of 60 ±12 years) underwent both MDCT and ICA were enrolled. Of total 1470 coronary segments (147 segments of LMA, 441 segments of the LAD, 441 segments of the LCx, 441 segments of the RCA), 98.9% were eligible to be assessed and only 1.1% (15/1470) were ineligible due to very high calcium clumps and severe motion artifacts. Compared to the ICA, the overall sensitivity of the 256 MDCT in detecting coronary stenosis was 88.3 %, specificity was 96.1%, positive predictive value was 88.1 % and the negative predictive value was 96.2% with an overall accuracy of 94.2% (p=0.20). In massive calcium scoring cases (calcium scoring ≥400 U), the sensitivity of 256 MDCT in detecting coronary artery stenosis was 90.3%, specificity was 96.1%, positive predictive value was 87.5% and the negative predictive value was 95.5%; the overall accuracy was 92.9%. In nonmassive calcium scoring cases (calcium scoring <400 U), sensitivity for classifying coronary stenoses was 89.2 %, specificity was 97.2%, positive predictive value was 88.7 % and the negative predictive value was 97.4 %; the overall accuracy was 94.9%. CONCLUSION. The 256 MDCT, regardless of calcium burden, offers a reliable diagnostic accuracy in assessing coronary artery stenosis.
OBJECTIVE.To determine the safety and efficacy of intramyocardial autologous blood stem cell injection for cardiomyopathy. MATERIALS AND METHODS.Between May 2005 and February 2010, 126 consecutive patients underwent intramyocardial cell injection. Fifty two were dilated cardiomyopathy (DCM) and 74 were ischemic cardiomyopathy (ICM). Mean age was 59.2 ± 12.4 years. The stem cells are isolated from the patient's own blood and cultured. The final product is called angiogenic cell precursors (ACPs). The number of cells prior to injection was 46.1 ± 36.5 million cells. ACPs were injected into all areas of the left ventricle in DCM patients, and into the non-viable myocardium and hypokinetic segments in ICM patients. Combined coronary artery surgery and cell injection were performed in 33.8% of ICM cases. RESULTS.There was no new ventricular arrhythmia. The 30-day mortality rate was 3.8% (2/52) and 4.1% (3/74) in DCM and ICM, respectively. New York Heart Association (NYHA) class improved from 3.0 ± 0.6 to 2.0 ± 0.9 at 485.8 ± 370.3 days (p < 0.001) in DCM and improved from 2.7 ± 0.6 to 1.9 ± 0.8 at 419.6 ± 345.5 days (p < 0.001) in ICM. Left ventricular ejection fraction (LVEF) increased from 23.3 ± 7.0% to 27.7 ± 11.3% at 409.7 ± 352.4 days (p = 0.03) in DCM and increased from 23.6 ± 7.7% to 31.5 ± 10.0% at 400.6 ± 350.1 days (p < 0.001) in ICM. Quality of life evaluated at 3 months has significantly improved for physical function, rolephysical, general health and vitality domains in DCM. For ICM, physical function, role-physical, general health and social function domains were also improved. CONCLUSION.Intramyocardial ACPs injection is feasible and safe in both DCM and ICM. NYHA, quality of life and LVEF had significantly improved in both DCM and ICM.
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