Comprehensive Assessment of Coronary Artery Stenoses

Meijboom, Willem B.; Mieghem, Carlos A.G. van; Pelt, Niels van; Weustink, Annick C.; Pugliese, Francesca; Mollet, Nico R.; Boersma, Eric; Regar, Eveline; Geuns, Robert Jan van; Jaegere, Peter J. de; Serruys, Patrick W.; Krestin, Gabriël P.; Feyter, Pim J. de

doi:10.1016/j.jacc.2008.05.024

Cited by 568 publications

(117 citation statements)

References 49 publications

Supporting

Mentioning

111

Contrasting

Unclassified

Order By: Relevance

“…This is particularly relevant in clinical practice for patients with borderline degrees of stenosis [35], where CT and CT angiography are unable to detect myocardial ischemia and necrosis. As shown in the Meijboom study, CT can help rule out coronary stenosis and myocardial ischemia, but even pronounced atherosclerotic changes and stenosis seen on CT do not reliably predict the presence of ischemia that can be visualised by perfusion imaging [35,36]. In our postmortem series, pathological enhancement of the myocardium was observed in five cases and is thought to be an indirect sign of a myocardial lesion.…”

Section: Discussionmentioning

confidence: 61%

Evaluation of postmortem MDCT and MDCT-angiography for the investigation of sudden cardiac death related to atherosclerotic coronary artery disease

Michaud

Grabherr

Doenz

et al. 2012

Int J Cardiovasc Imaging

100

View full text Add to dashboard Cite

The goal of this study was to evaluate the diagnostic value of postmortem multi-computed tomography (MDCT) and MDCT-angiography for sudden cardiac deaths related to ischemic heart disease. Twenty three cases were selected based on clinical history and the results of native MDCT, multiphase post-mortem CT-angiography and conventional autopsy were compared. Radiological examination showed calcification of coronary arteries in 78% of the cases, most of which were not detailed at autopsy. MDCT-angiography allowed better visualization of the coronary arteries than MDCT and permitted the evaluation of stenoses and occlusions. Of the 14 cases of coronary thrombosis detected at conventional autopsy, 11 were visible as stop of perfusion with CT-angiography and three were found to be partly perfused. One case had an old thrombosis with collateral circulation. One case had a coronary artery postmortem clot found with MDCT-angiography. Coronary artery calcifications are more easily detected and documented with radiological examination than with conventional autopsy. MDCT is of limited diagnostic value for ischemic heart disease. MDCT-angiography, when correctly interpreted, is a reasonable tool to view the morphology of coronary arteries, rule out significant coronary artery stenoses, identify occlusions and direct sampling for histological examination.

show abstract

Section: Discussionmentioning

confidence: 61%

Evaluation of postmortem MDCT and MDCT-angiography for the investigation of sudden cardiac death related to atherosclerotic coronary artery disease

Michaud

Grabherr

Doenz

et al. 2012

Int J Cardiovasc Imaging

100

View full text Add to dashboard Cite

show abstract

“…In the recent PROMISE and SCOT‐HEART trials, frontline coronary CTA compared with noninvasive functional assessment in patients with stable CAD enhanced diagnostic certainty and favorably influenced the diagnostic workflow and therapeutic plans 18, 19. Coronary CTA, however, overestimates the severity of lesions and cannot reliably determine their functional significance 1. This gap in noninvasive diagnostic testing may be addressed by combining anatomic and physiologic data 20…”

Section: Discussionmentioning

confidence: 99%

“…Coronary CTA, however, tends to overestimate stenosis severity, and the correlation to downstream myocardial ischemia is poor 1. Consequently, guidelines recommend that ischemia testing should be performed before referral to invasive coronary angiography (ICA) when coronary CTA shows significant CAD 2…”

Section: Introductionmentioning

confidence: 99%

Myocardial Perfusion Imaging Versus Computed Tomography Angiography–Derived Fractional Flow Reserve Testing in Stable Patients With Intermediate‐Range Coronary Lesions: Influence on Downstream Diagnostic Workflows and Invasive Angiography Findings

Nørgaard

Gormsen

Bøtker

et al. 2017

JAHA

View full text Add to dashboard Cite

BackgroundData on the clinical utility of coronary computed tomography angiography–derived fractional flow reserve (FFRCT) are sparse. In patients with intermediate (40–70%) coronary stenosis determined by coronary computed tomography angiography, we investigated the association of replacing standard myocardial perfusion imaging with FFRCT testing with downstream utilization of invasive coronary angiography (ICA) and the diagnostic yield of ICA (rate of no obstructive disease, and rate of revascularization).Methods and ResultsThis was a single‐center observational study of symptomatic patients with suspected coronary artery disease referred to coronary computed tomography angiography between 2013 and 2015. Patients were divided into 3 historical groups based on the adjunctive functional testing approach: myocardial perfusion imaging (n=1332) or FFRCT “implementation” (n=800) or “clinical use” (n=1391). Propensity score matching was used to estimate the average period effect on outcomes. Patients in the FFRCT clinical use group versus the myocardial perfusion imaging group were older and had higher pretest probability of obstructive disease. After adjusting for baseline risk characteristics, there was a reduction in downstream ICA utilization (absolute risk difference: −4.2; 95% CI, −6.9 to −1.6; P=0.002). In patients referred to ICA, findings of no obstructive coronary artery disease decreased (−12.8%; 95% CI, −22.2 to −3.4; P=0.008) and rate of coronary revascularization increased (14.1%; 95% CI, 3.3–24.9; P=0.01), as did availability of functional information for guidance of revascularization (27.8%; 95% CI, 11.3–44.4; P<0.001) after clinical adoption of FFRCT.ConclusionsReplacing adjunctive myocardial perfusion imaging with FFRCT testing for functional assessment of intermediate stenosis determined by coronary computed tomography angiography in stable coronary artery disease was associated with less ICA utilization, and a higher ICA diagnostic yield. The findings in this observational study needs confirmation in prospective, randomized trials.

show abstract

“…Changes in the coronary artery blood flow can be interpreted as signs of CAD [56]. Therefore, features based on fluid dynamic algorithms carry diagnostically important information which can be used in future computer aided diagnosis systems.…”

Section: Coronary Artery Diseasementioning

confidence: 99%

Computer aided diagnosis of Coronary Artery Disease, Myocardial Infarction and carotid atherosclerosis using ultrasound images: A review

et al. 2017

View full text Add to dashboard Cite

Comprehensive Assessment of Coronary Artery Stenoses

Cited by 568 publications

References 49 publications

Evaluation of postmortem MDCT and MDCT-angiography for the investigation of sudden cardiac death related to atherosclerotic coronary artery disease

Evaluation of postmortem MDCT and MDCT-angiography for the investigation of sudden cardiac death related to atherosclerotic coronary artery disease

Myocardial Perfusion Imaging Versus Computed Tomography Angiography–Derived Fractional Flow Reserve Testing in Stable Patients With Intermediate‐Range Coronary Lesions: Influence on Downstream Diagnostic Workflows and Invasive Angiography Findings

Computer aided diagnosis of Coronary Artery Disease, Myocardial Infarction and carotid atherosclerosis using ultrasound images: A review

Contact Info

Product

Resources

About