In 100 patients studied without beta-blocker pre-medication, DSCT demonstrated slightly lower per-segment evaluability for high heart rates but no decrease in diagnostic accuracy for the detection of coronary artery stenoses.

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SRAP are commonly scattered, and their dimensions were smaller than previously recognized. (Detecting Ruptured Aortic Plaques by Nonobstructive Angioscopy; UMIN000029772).

Circ J 2009; 73: 718 -725 here have been many reports that intensive lowering of low-density lipoprotein-cholesterol (LDL-C) with 3-hydroxy-3-methylglutaryl-coenzyme A (HMGCoA) reductase inhibitors (statins) is effective in preventing cardiovascular events. [1][2][3] Although the mechanism by which statins confer cardiovascular benefit is not precisely understood, regression of coronary plaque volume and reduction of plaque vulnerability are presumed to play important roles. Angioscopic observations have shown that the presence of yellow plaque is associated with unstable symptoms, which suggests that as plaques become more yellow in appearance, they also become more prone to rupture. [4][5][6] Editorial p 628Angioscopy is used to assess plaque vulnerability on the basis of its color and the presence of thrombi. 7,8 Angioscopy gives a full-color, 3-dimensional perspective of the intracoronary surface morphology, and reasonably accurate information regarding a specific lesion, if performed by trained technicians. Intravascular ultrasound (IVUS) is an alternative imaging modality that provides real-time tomographic images of blood vessels on a monitor. It generates information on vessel wall structure, atheroma volume, and the echogenicity of plaque, which is amenable to qualitative and quantitative analysis and can be used to evaluate plaque regression. 9 The effects of statins on coronary plaque have been evaluated by angioscopy, as well as IVUS, in patients with hypercholesterolemia. Using angioscopy, Takano et al demonstrated that the grade of yellow color decreased during statin therapy, 10 and Nissen et al 11 and Okazaki et al 12 used IVUS to investigate the effects of statins on atheroma volume. However, because no study has serially monitored the coronary plaques of patients receiving statin therapy using both angioscopy and IVUS, the relationship between changes in plaque color and changes in atheroma volume has not been elucidated. Therefore, we used both imaging modalities concurrently to investigate the qualitative and quantitative changes over time in coronary plaques in patients receiving atorvastatin therapy to reduce LDL-C levels to ≤100 mg/dl. Methods Study PopulationPatients with coronary artery disease (CAD) complicated by hypercholesterolemia, with a fasting LDL-C level (Received August 10, 2008; accepted December 2, 2008; released online February 18, 2009

Systematic heart rate control significantly improves image quality for coronary visualization by 64-slice single-source CT, whereas image quality and diagnostic accuracy remain unaffected in dual-source CT angiography. Improved temporal resolution obviates the need for heart rate control.

ultislice computed tomography (MSCT) enables visualization of not only coronary artery stenoses and occlusions, 1-4 but also coronary artery plaque of various textures. [5][6][7][8][9][10][11][12] Previous studies have repeatedly shown that non-calcified, CT low-dense plaques (CTLDP) on MSCT correspond well to rupture-prone soft plaques on intracoronary ultrasound 5,6,9,10,12 and on coronary angioscopy. 9 We have shown that patients with acute coronary syndrome (ACS) are likely to have CTLDP and that the CT density of the culprit coronary artery lesion is significantly lower in patients with ACS as compared with that in patients with stable angina. 8 Furthermore, we have also shown that patients with evolving ACS consistently have CTLDP in their culprit coronary artery lesions. 7,13 Because ACS is a consequence of coronary artery plaque rupture and subsequent thrombosis, 14,15 it would be reasonable to speculate that patients who have CTLDP are more likely to have coronary events, including ACS and sudden cardiac death, than patients without plaque. In this study of a large population, we evaluated the prognostic value of non-obstructive CTLDP in mild to moderate coronary artery stenosis for future cardiac events. Methods Study PopulationWe identified 1,179 consecutive patients who underwent MSCT between August 2002 and July 2006, at Nihon University Hospital. The reasons for MSCT were evaluation of typical and atypical chest pain in 715 patients, evaluation of the post-coronary intervention status in 112 patients, and evaluation of coronary artery disease (CAD) in 182 asymptomatic patients with multiple coronary risk factors. A structured interview and clinical history were obtained, and the following cardiac risk factors were assessed prior to the MSCT study: (1) hypertension (defined as blood pressure ≥140/90 mmHg or the use of antihypertensive agents), (2) hyperlipidemia as defined by low-density lipoprotein-cholesterol >140 mg/dl, (3) diabetes mellitus (defined as fasting glucose level >120 mg/dl or the need for insulin or oral antidiabetic medicines), (4) smoking (defined as current or previous smoking), and (5) previous history of acute myocardial infarction (AMI) and unstable angina (UA), and (4). Exclusion criteria for MSCT scans were known allergy to iodine, arrhythmias, impaired renal function (serum creatinine ≥1.3 mg/dl), bronchial asthma and left ventricular failure (left ventricular ejection fraction <30%). MSCT ProtocolMSCT was performed using either a SOMATOM Volume Background The prognostic value of non-obstructive, CT low-dense plaques (CTLDP) on multislice computed tomography (MSCT) for the prediction of nonfatal acute myocardial infarction (AMI), unstable angina (UA) and cardiac death has not yet been defined. Methods and ResultsIn the present study 810 patients who underwent MSCT and had non-obstructive coronary artery disease were followed up for the occurrence of AMI, UA and cardiac death. Non-obstructive CTLDP were defined as plaques with a CT density <68 Hounsfield units, accompanied by...

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp owering of low-density lipoprotein-cholesterol (LDL-C) with 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) has been shown to reduce cardiovascular mortality and morbidity. 1-4 Many multicenter trials found that statin therapy produced plaque regression and stabilization as seen on intravascular ultrasound (IVUS). 5-8Coronary angioscopy gives a full-color, 3-D perspective of the intracoronary surface morphology, and reasonably accurate information regarding a specific lesion. 9-20 Coronary angioscopy can detect some features of vulnerable plaque effectively. 12 Among these, the yellow color intensity of plaques on coronary angioscopy, determined by the thickness of the fibrous cap, is known to be associated with plaque vulnerability. Particularly, a high grade of yellow plaque may indicate a large lipid core and thin fibrous cap, suggesting a high risk of rupture. 12 This study group previously had prospectively investigated the qualitative and quantitative changes in coronary plaques in hypercholesterolemic patients with coronary artery disease receiving atorvastatin titrated to achieve LDL-C levels of ≤100 mg/dl (TWINS study). 13 In that study, angioscopic Background: Few studies have serially monitored the change of coronary plaque after statin therapy using multiple plaque imaging modalities.