Background-Multislice spiral computed tomography (MSCT) is a promising technique for noninvasive coronary angiography, although clinical application has remained limited because of frequently incomplete interpretability, caused by motion artifacts and calcifications. Methods and Results-In 59 patients (53 male, aged 58Ϯ12 years) with suspected obstructive coronary artery disease, ECG-gated MSCT angiography was performed with a 16-slice MSCT scanner (0.42-s rotation time, 12ϫ0.75-mm detector collimation). Thirty-four patients were given additional ␤-blockers (average heart rate: 56Ϯ6 min

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We introduce the concept of noninvasive detection and characterization of coronary atherosclerotic lesions in patients with ACS by MDCT. We identified differences in lesion morphology and plaque composition between culprit lesions in ACS and stable lesions in ACS or stable angina, consistent with previous intravascular ultrasound studies.

SCD in the family Echocardiography Cardiomyopathies Clinical and genetic family screening in selected cases Known cardiomyopathy in the family CMR Mitral valve prolapse Palpitations Echocardiography Cardiomyopathies Consider 24-h and/or long-term ambulatory ECG monitoring and/or electrophysiological study in selected cases Syncope CMR Coronary artery disease/ anomalies CT according to clinical suspicion Consider stress echo to rule out LV outflow obstruction Chest pain Echocardiography Coronary artery disease/ anomalies Consider the risk profile, age and radiation exposure CMR Consider exercise stress imaging CT Nuclear imaging Physical examination Imaging tests of choice Heart disease Additional testing Cardiac murmurs Echocardiography Valvular heart disease Additional tests on the basis of echocardiographic findings and clinical suspicion (e.g. CMR) Abnormal cardiac sound Congenital heart defects Marfanoid habitus Echocardiography Marfan disease Clinical and genetic family screening CT Accurate evaluation of thoracic aorta CMR 12-leads electrocardiogram Imaging tests of choice Heart disease Additional testing T-wave inversion Echocardiogram Cardiomyopathies Clinical and genetic family screening CMR Myocarditis Annual follow-up with imaging tests in athletes with normal findings at initial evaluation ST-segment depression Echocardiogram Cardiomyopathies Consider exercise stress imaging CMR Myocarditis Coronary CT or nuclear imaging in athletes with clinical suspicion of coronary artery disease Coronary artery disease Valve disease Pathologic Q-waves Echocardiogram Cardiomyopathies Consider exercise stress imaging CMR Myocarditis Coronary CT or nuclear imaging in athletes with clinical suspicion of coronary artery disease Coronary artery disease Complete LBBB Echocardiogram Cardiomyopathies Comprehensive cardiac evaluation for exclusion CMR Myocarditis of heart disease CT Cardiac sarcoidosis Consider exercise stress imaging Nuclear imaging Valve disease Coronary artery disease/ anomalies Bifascicular block (RBBB and left anterior hemiblock) Echocardiogram Cardiomyopathies Additional tests on the basis of echocardiographic findings and clinical suspicion Myocarditis Cardiac sarcoidosis Coronary artery disease Non-specific intraventricular conduction delay Echocardiogram Cardiomyopathies Additional tests on the basis of echocardiographic findings and clinical suspicion Coronary artery disease/ anomalies Minor non-voltage criteria for LV or RV hypertrophy (atrial enlargement and QRS axis deviation) Echocardiogram Cardiomyopathies Additional tests on the basis of echocardiographic findings and clinical suspicion Valve disease Congenital heart disease Pulmonary hypertension Abnormal exercise testing (repolarization abnormalities/ symptoms/arrhythmias) Echocardiography Coronary artery disease/ anomalies Consider the cardiovascular risk profile and age CMR Consider also exercise stress imaging CT Cardiomyopathies Low-radiation examinations advised in young individuals Nuclear imaging Myocarditis CMR, cardiac magnetic re...

The cohort of long-term survivors of heart transplant is expanding, and the assessment of these patients requires specific knowledge of the surgical techniques employed to implant the donor heart, the physiology of the transplanted heart, complications of invasive tests routinely performed to detect graft rejection (GR), and the specific pathologies that may affect the transplanted heart. A joint EACVI/Brazilian cardiovascular imaging writing group committee has prepared these recommendations to provide a practical guide to echocardiographers involved in the follow-up of heart transplant patients and a framework for standardized and efficient use of cardiovascular imaging after heart transplant. Since the transplanted heart is smaller than the recipient's dilated heart, the former is usually located more medially in the mediastinum and tends to be rotated clockwise. Therefore, standard views with conventional two-dimensional (2D) echocardiography are often difficult to obtain generating a large variability from patient to patient. Therefore, in echocardiography laboratories equipped with three-dimensional echocardiography (3DE) scanners and specific expertise with the technique, 3DE may be a suitable alternative to conventional 2D echocardiography to assess the size and the function of cardiac chambers. 3DE measurement of left (LV) and right ventricular (RV) size and function are more accurate and reproducible than conventional 2D calculations. However, clinicians should be aware that cardiac chamber volumes obtained with 3DE cannot be compared with those obtained with 2D echocardiography. To assess cardiac chamber morphology and function during follow-up studies, it is recommended to obtain a comprehensive echocardiographic study at 6 months from the cardiac transplantation as a baseline and make a careful quantitation of cardiac chamber size, RV systolic function, both systolic and diastolic parameters of LV function, and pulmonary artery pressure. Subsequent echocardiographic studies should be interpreted in comparison with the data obtained from the 6-month study. An echocardiographic study, which shows no change from the baseline study, has a high negative predictive value for GR. There is no single systolic or diastolic parameter that can be reliably used to diagnose GR. However, in case several parameters are abnormal, the likelihood of GR increases. When an abnormality is detected, careful revision of images of the present and baseline study (side-by-side) is highly recommended. Global longitudinal strain (GLS) is a suitable parameter to diagnose subclinical allograft dysfunction, regardless of aetiology, by comparing the changes occurring during serial evaluations. Evaluation of GLS could be used in association with endomyocardial biopsy (EMB) to characterize and monitor an acute GR or global dysfunction episode. RV size and function at baseline should be assessed using several parameters, which do not exclusively evaluate longitudinal function. At follow-up echocardiogram, all these parameters should be...

Computed tomography coronary angiography is useful in symptomatic patients with a low or intermediate estimated pretest probability of having significant CAD, and a negative CT scan reliably rules out the presence of significant CAD. Computed tomography coronary angiography does not provide additional relevant diagnostic information in symptomatic patients with a high estimated pretest probability of CAD.

Though conventional coronary angiography (CCA) has been the standard of reference for diagnosing coronary artery disease in the past decades, computed tomography angiography (CTA) has rapidly emerged, and is nowadays widely used in clinical practice. Here, we introduce a standardized evaluation framework to reliably evaluate and compare the performance of the algorithms devised to detect and quantify the coronary artery stenoses, and to segment the coronary artery lumen in CTA data. The objective of this evaluation framework is to demonstrate the feasibility of dedicated algorithms to: (1) (semi-)automatically detect and quantify stenosis on CTA, in comparison with quantitative coronary angiography (QCA) and CTA consensus reading, and (2) (semi-)automatically segment the coronary lumen on CTA, in comparison with expert's manual annotation. A database consisting of 48 multicenter multivendor cardiac CTA datasets with corresponding reference standards are described and made available. The algorithms from 11 research groups were quantitatively evaluated and compared. The results show that (1) some of the current stenosis detection/quantification algorithms may be used for triage or as a second-reader in clinical practice, and that (2) automatic lumen segmentation is possible with a precision similar to that obtained by experts. The framework is open for new submissions through the website, at http://coronary.bigr.nl/stenoses/.

OBJECTIVESThis study was designed to prospectively evaluate the diagnostic performance of multislice spiral computed tomography (MSCT) coronary angiography for the detection of significant lesions in all segments of the coronary tree potentially suitable for revascularization. BACKGROUND Noninvasive MSCT coronary angiography is a promising coronary imaging technique. METHODSSixteen-row MSCT coronary angiography was performed in 128 patients (89% men, mean age 58.9 Ϯ 11.7 years) in sinus rhythm with stable angina pectoris scheduled for conventional coronary angiography. Sixty percent (77 of 128) of patients received pre-scan oral betablockers, resulting in a mean heart rate of 57.7 Ϯ 7.7 beats/min. The diagnostic performance of MSCT for detection of significant lesions (Ն50% diameter reduction) was compared with that of quantitative coronary angiography (QCA). RESULTSThe sensitivity of MSCT for detection of significant lesions was 92% (216 of 234, 95% confidence interval [CI]: 88 to 95). Specificity was 95% (1,092 of 1,150, 95% CI: 93 to 96), positive predictive value 79% (216 of 274, 95% CI: 73 to 88), and negative predictive value 98% (1,092 of 1,110, 95% CI: 97 to 99). Two Ն50% lesions were missed because of motion artifacts and two because of severe coronary calcifications. The rest (78%, 14 of 18) were detected but incorrectly classified as Ͻ50% obstructions. All patients with and 86% (18 of 21) of patients without significant lesions on QCA were correctly classified by MSCT. All patients with significant left main disease or total occlusions were correctly identified on MSCT. CONCLUSIONS Sixteen-row MSCT coronary angiography permits reliable detection of significant obstructive coronary artery disease in patients with stable angina in sinus rhythm. (J Am Coll Cardiol 2004;43:2265-70) © 2004 by the American College of Cardiology FoundationMultislice spiral computed tomography (MSCT) coronary angiography is a promising noninvasive technique for the detection of obstructive epicardial coronary artery disease (CAD), and 16-row MSCT scanners have the potential to further improve its diagnostic performance (1). Complete visualization of all clinically important coronary segments is a prerequisite for MSCT coronary angiography to become an accepted clinical tool for the assessment of patients with suspected CAD. Previous studies performed in relatively small numbers of patients showed high sensitivity and specificity for the detection of significant obstructive lesions (2,3). However, in one study, a significant number of coronary segments were excluded because of poor image quality, and neither report presented a comprehensive lesion-by-lesion comparative analysis. We prospectively evaluated the diagnostic accuracy of MSCT coronary angiography for the detection of significant lesions in coronary segments potentially amenable to revascularization (Ն2 mm in diameter). METHODS Study population.During a period of six months, we studied 128 patients (113 men, 15 women, mean age 58.9 Ϯ 11.7 years) with stable angina pec...