Coronary CT Angiography in Challenging Patients: High Heart Rate and Atrial Fibrillation. A Review

Mushtaq, Saima; Conte, Edoardo; Melotti, Eleonora; Andreini, Daniele

doi:10.1016/j.acra.2019.01.022

Cited by 19 publications

(18 citation statements)

References 42 publications

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“…Risk model for deciding to perform CCTA is more intuitive and important to quickly and accurately identify high risk patients to optimally allocate ED resources. Moreover, CCTA is limited in various situations including patients with tachycardia or irregular heartbeat; not round-clock-availability for 24 h; contrast and radiation issues [27].…”

Section: Discussionmentioning

confidence: 99%

Use of Coronary CT Angiography to Predict Obstructive Lesions in Patients with Chest Pain without Enzyme and ST-Segment Elevation

Kim

Shin

et al. 2021

JCM

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It is challenging to rule out acute coronary syndrome among chest pain patients without both ST-segment elevation in electrocardiography and troponin elevation at emergency departments (ED). The purpose of this study was to develop a prediction model for rapidly determining the occurrence of significant stenosis in coronary computed tomography angiography (CCTA). Retrospective observational cohort study was conducted with 904 patients who had presented with chest pain without troponin elevation and ST-segment changes and underwent CCTA between January 2017 and December 2018. The primary endpoint was the presence of significant stenosis on CCTA, defined as narrowing above 70% diameter. The logistic regression model was used for development a new predictive model. One hundred and thirty-four patients (14.8%) were shown severe stenosis. The independent associated factors for significant stenosis were age ≥65 years, male, diabetes, history of acute coronary syndrome, and typical chest pain. Based these results, we developed a new prediction model. The area under the curve was 0.782 (95% confidence interval 0.742–0.822). Moreover, score of ≥5 was chosen as cut-off values with 86.6% sensitivity and 56.4% specificity. In conclusion, among chest pain patients without ST changes and troponin elevation, the new score will be helpful to identify potential candidate for CCTA such as patients with significant stenosis.

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Section: Discussionmentioning

confidence: 99%

Use of Coronary CT Angiography to Predict Obstructive Lesions in Patients with Chest Pain without Enzyme and ST-Segment Elevation

Kim

Shin

et al. 2021

JCM

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“…e acceleration of HR is not only the performance of CHD and myocardial infarction but also an important cause of cardiovascular disease [48]. Lower HR values are beneficial for infarction and surrounding area angiogenesis and establishment of collateral circulation, restoring cardiac function and improving prognosis.…”

Section: Discussionmentioning

confidence: 99%

Tai Chi Improves Coronary Heart Disease Risk by Inactivating MAPK/ERK Pathway through Serum miR‐126

Zhang

Wang

et al. 2020

Evidence-Based Complementary and Alternative Medicine

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Background. Tai Chi is effective in preventing heart disease (CHD) risk, but the molecular mechanism remains unclear. Mitogen-activated protein kinase (MAPK) signaling plays a critical role in the pathogenesis of CHD and can be activated by miR-126. Tai Chi may exert its protective function through the miR-126-modulated MAPK pathway. Methods. The CHD patients after PCI were randomized into the CG group (CG) (n = 19, normal care) and Tai Chi group (TG) (Tai Chi intervention, n = 17). Epicardial adipose tissue volume (EATV) (one main adverse cardiovascular event of CHD), HR (heart rate), QoL (quality of life) scores, and balance performance were measured in the two groups. The body fat content, abdominal subcutaneous fat, and visceral fat were measured to reflect the improvement of adipose tissue dysfunction. The levels of miR-126 and MAPK-associated molecules were measured in peripheral blood leukocytes. Meanwhile, the effects of miR-126 silence and mimic on MAPK-associated molecules were also explored in cardiac cell H9C2. Results. After the 3-month intervention, Tai Chi reduced EATV and HR and increased QoL scores and balance performance, respectively (P<0.05). The fat percentage, body fat mass, and BMI were also significantly reduced after Tai Chi intervention (P<0.05). The levels of miR-126, MAPK, JNK, and ERK in the TG group were lower than those in the CG group (P<0.05). The miR-126 levels had a strong relationship with the values of EATV, HR, and QoL scores (P<0.05). miR-126 silence or mimic inactivated or activated MAPK-associated molecules in the cardiac cell lines. Conclusions. Tai Chi improved CHD risk by inactivating the MAPK/ERK pathway via serum miR-126.

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“…Some sources thus advise not to examine patients with AF on 16or 64-slice CT scanners, reporting that diagnostic image quality is frequently not achieved in these patients 9,17 . As a result, patients with severe CA such as tachyarrhythmias including AF and/or HR variability/HR higher than 65 bpm have often been excluded from research trials of cardiac CT imaging 10 . Therefore, we investigated the performance of a high-pitch non-ECG-gated protocol for preprocedural TAVR imaging in patients in whom ECG-gating was precluded based on the presence of severe CA at the time of CT planning compared to a group of patients with sinus rhythm imaged with prospective ECGgating.…”

Section: Discussionmentioning

confidence: 99%

“…However, more than 9% of patients suffering from AS have concomitant atrial brillation (AF) 7 , which is characterized by a high heart rate (HR) and HR variability 8 . This and other cardiac arrhythmias (CA) may result in signi cant artifacts 9,10 and impair diagnostic performance of CT imaging 11 . Beta-blockers to regulate heartbeat are, however, not recommended in AS because there is concern that antihypertensive treatment may result in hypotension and hemodynamic collapse 9,12 .…”

Section: Introductionmentioning

confidence: 99%

Feasibility of a High-Pitch Protocol for Transcatheter Aortic Valve Replacement Evaluation in Patients not Suitable for ECG-Gated CT

Shnayien

Bressem

Beetz

et al. 2020

Preprint

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High-Pitch CT for TAVR Evaluation in Patients not Suitable for ECG-GatingThe use of transcatheter aortic valve replacement (TAVR) has been established to be non-inferior to surgical aortic valve replacement (SAVR). As a result, in the United States, more patients now undergo TAVR than SAVR. It is recommended that preprocedural CT imaging for aortic valve evaluation and optimal sizing should include an ECG-gated scan of, at least, the aortic root. However, many patients suffer from concomitant tachyarrhythmias such as atrial fibrillation, which may seriously degrade the diagnostic accuracy of ECG-gated scans. The aim of the present study is to explore whether a high-pitch non-ECG-gated computed tomography angiography (CTA) of the entire aorta can render similar diagnostic preprocedural images as a standard ECG-gated scan. 108 patients were included. Objective image quality parameters such as image noise, CNR and SNR as well as subjective image quality analysis by two different readers were compared. The results showed a significant increase in image noise at the level of the aortic root with use of the high-pitch protocol (p = 0.001). Otherwise, our study revealed no significant differences in subjective and objective image quality. Diagnostic image quality was achieved in all patients without a record of inaccurate sizing in the surgical reports or subsequent patient histories.

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Coronary CT Angiography in Challenging Patients: High Heart Rate and Atrial Fibrillation. A Review

Cited by 19 publications

References 42 publications

Use of Coronary CT Angiography to Predict Obstructive Lesions in Patients with Chest Pain without Enzyme and ST-Segment Elevation

Use of Coronary CT Angiography to Predict Obstructive Lesions in Patients with Chest Pain without Enzyme and ST-Segment Elevation

Tai Chi Improves Coronary Heart Disease Risk by Inactivating MAPK/ERK Pathway through Serum miR‐126

Feasibility of a High-Pitch Protocol for Transcatheter Aortic Valve Replacement Evaluation in Patients not Suitable for ECG-Gated CT

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