Current concepts in coronary physiology for the interventionalist

Herrmann, Steven C.; El-Shafei, Amr; Kern, Morton J.

doi:10.1080/14628840310017357

Cited by 2 publications

(1 citation statement)

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“…17 At times the angiogram can be misleading when judging the impact that a lesion imparts on the coronary circulation. 18 It can be hard to estimate the amount of myocardium at risk for a specific vessel lesion 4 and critical to know the viability of that zone. Finally, we know the impact of inflammation and other molecular mechanisms in the development of ischemic syndromes.…”

Section: Discussionmentioning

confidence: 99%

Anatomy of an Emerging Diagnostic Test

Christian

2005

Circulation

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He that will divide a minute into a thousand parts and break but a part of the thousandth part of a minute in the affairs of love, it may be said of him that Cupid hath clapped him o' the shoulder, but I'll warrant him heart-whole.- The 64-multislice technology for acquiring tomographic x-rays of the coronary vessels during the arterial phase of a bolus of iodinated contrast introduces several technical advances: improved spatial resolution (thinner slices), improved temporal resolution (less time needed to acquire an image means less time for the vessel to move), and improved spatial coverage of the heart (reduction of registration errors). Unlike previous studies, the authors attempted to analyze the entire length of all of the major arteries, not just those in which image quality was optimal. All patients had the definitive end point comparison to invasive angiography, which was not prompted by the results of the CT examination. The authors report sensitivity for the detection of significant obstructive disease of 99% and a specificity of 95%, confirming a slight propensity of CT to generate false-positive lesions in the presence of vessel wall calcification. Although the results were excellent, it is clear that this study and others have struggled with the question as to how to best evaluate CT angiography. Article p 2318New tests face validation challenges that are both common to all emerging technologies and unique to the specific test. CT coronary angiography is a purely anatomical (at least at present) result of a structure that is variable between individuals. It is also noninvasive, therefore, it cannot be compared with a direct pathological analysis clinically. These conditions give rise to 4 issues that have a direct impact on the evaluation and use of this technology: division of a complex structure into inflexible units, evaluation of what cannot be seen, referral bias, and efficacy and the effectiveness of a test.

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Section: Discussionmentioning

confidence: 99%