Noninvasive Cardiac Imaging with Computed Tomography

Wilson, Gregory T.; Gopalakrishnan, Prabhakaran; Tak, Tahir

doi:10.3121/cmr.2007.747

Cited by 16 publications

(15 citation statements)

References 57 publications

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“…More recently, other diagnostic tools, including intravascular ultrasound (IVUS) and 64-slice computed tomography (CT), have shown to have equal or greater accuracy in the assessment of coronary lesions. 36,37 Our results strongly support the notion that alterations in plasma lipoprotein levels other than LDL, which is the current target of the NCEP recommendations, 9 play an important role in the development of CHD in women. Our findings indicate that the degree of coronary atherosclerosis in postmenopausal women is linked to a dysregulation of the TG-HDL metabolism: increases in remnant lipoprotein levels may be associated with increased lipid deposition in the arterial wall, plaque formation, and the generation of HDL subpopulations that are less efficient in the reverse cholesterol removal from the arterial wall.…”

Section: Discussionsupporting

confidence: 77%

Plasma Levels of HDL Subpopulations and Remnant Lipoproteins Predict the Extent of Angiographically-Defined Coronary Artery Disease in Postmenopausal Women

Lamon‐Fava

Herrington

Reboussin

et al. 2008

ATVB

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Objective-The association of coronary heart disease (CHD) with subpopulations of triglyceride (TG)-rich lipoproteins and high-density lipoproteins (HDL) is established in men, but has not been well characterized in women. Methods and Results-Plasma HDL subpopulation concentrations, quantified by 2-dimensional gel electrophoresis, and plasma remnant-like particle cholesterol (RLP-C) concentrations were measured in 256 postmenopausal women with established CHD and in 126 CHD-free postmenopausal women. Coronary artery disease was assessed in women with CHD by quantitative coronary angiography. Plasma RLP-C and pre␤1 HDL concentrations were higher and ␣1 and ␣2 HDL concentrations were lower in CHD than in CHD-free women. After adjustment for conventional CHD-risk factors, plasma levels of RLP-C were positively associated with the degree of coronary artery disease. In similar analyses, plasma pre␤1 HDL particle concentrations were positively associated and ␣2 HDL particle concentrations were inversely associated with the extent of coronary atherosclerosis. Plasma TG, low density lipoprotein cholesterol, and HDL cholesterol levels were not associated with the degree of coronary atherosclerosis. Key Words: women Ⅲ angiography Ⅲ lipoproteins Ⅲ coronary heart disease P opulation-based prospective studies have established an association between plasma triglyceride (TG) levels and risk of coronary heart disease (CHD). 1 This association is stronger in women than in men. 1 Fasting plasma TG concentrations reflect the concentration of both TG-rich very lowdensity lipoproteins (VLDL) and remnants of VLDL and chylomicrons. Remnant lipoproteins are generated by lipolysis of TG-rich lipoproteins and play a greater role in CHD risk than their precursors. The first evidence that remnant lipoproteins are related to the development of CHD came from studies conducted more than 50 years ago in which remnant lipoproteins with Svedberg flotation rate of 12 to 60 were isolated by ultracentrifugation. 2 More recently, case-control studies conducted predominantly in male patients have supported the concept that remnant lipoproteins play an important role in the development of CHD. [3][4][5] Remnant lipoprotein levels have also been shown to be significantly higher in women with CHD as compared with healthy women in the Framingham Offspring Study. 6 The association between low levels of high-density lipoprotein (HDL) cholesterol (C) and increased risk of CHD is well documented. 7,8 The National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) has defined an HDL-C Ͻ40 mg/dL as an independent risk factor for CHD. 9 HDL comprise a number of subpopulations differing in apolipoprotein and lipid composition and representing different stages of the continuous HDL remodeling occurring in plasma. These HDL subpopulations exhibit a different ability to protect from CHD. 10 Separation of HDL particles by 2-dimensional gel electrophoresis allows the identification of eight major subpopulations: pre␤1 to 2, ␣1 to 3, and pre␣1 to 3....

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Section: Discussionsupporting

confidence: 77%

Plasma Levels of HDL Subpopulations and Remnant Lipoproteins Predict the Extent of Angiographically-Defined Coronary Artery Disease in Postmenopausal Women

Lamon‐Fava

Herrington

Reboussin

et al. 2008

ATVB

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“…Recently, coronary MDCT has become a widelyused technique that has proven useful to evaluate the cardiovascular anatomy and anomalies [11,12]. There are several case reports of CPAF diagnosed by MDCT [1,[4][5][6]9].…”

Section: Discussionmentioning

confidence: 98%

Coronary to pulmonary artery fistula: morphologic features at multidetector CT

Kim

Jung

Chun

2010

Int J Cardiovasc Imaging

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The objective of this study is to evaluate the incidence and morphologic features of coronary-pulmonary artery fistulas (CPAF) by multidetector computed tomography (MDCT). From 2006 to 2008, 5,372 patients underwent ECG-gated cardiac CT scans using 64-slice MDCT at our institute. Among them, 17 cases of CPAF were detected (M:F = 14:3, mean age = 63 years). Chief complaints of patients were chest pain (n = 12), abnormal cardiac test (n = 3), known coronary artery disease (n = 1), and known CPAF (n = 1). We retrospectively analyzed the morphologic features of CPAF, such as origin vessels, draining site, fistula size, and aneurysmal sac. Five cases underwent coronary angiography (CAG) and correlated with MDCT findings. Incidence of CPAF was 0.32% by MDCT. The origin of CPAF was the left coronary artery in five (29.4%), the right coronary artery in two (11.8%) and both coronary arteries in ten cases (58.8%). In regard to the diameter of the detected fistula, the diameter of the largest vessel excluding aneurysm was variable from less than 2 to 5.7 mm. Five patients (29.4%) had a fistula that was shown as one vessel that could be traced, one patient (5.9%) was shown as two vessels, and eleven patients (64.7%) were shown as innumerable multiple vessel networks. Five cases were associated with aneurysm (29.4%). Fistulas were located primarily in the left anterolateral aspect of the pulmonary trunk (82.3%) and mostly the drainage site was the left lateral side of the pulmonary trunk (82.3%). CAG was performed in five cases and revealed identical findings to MDCT. In conclusion, coronary-pulmonary artery fistula is more frequently found than anticipated on MDCT. CPAF is supplied by either single or both coronary arteries and drains to the left side of the pulmonary trunk. It is typically located in the anterolateral aspect of the pulmonary trunk. Sometimes CPAF is associated with aneurysms.

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“…1 Atrial fibrillation is still considered to be a relative contraindication to CCT despite constant improvements in scanner technology. [4][5][6][7] Inappropriate data sampling occurs due to high beat-beat variations with severe motion artifacts.…”

Section: Discussionmentioning

confidence: 99%

Controlling Rate and Rhythm Increases Feasiblity of CT Angiography in Atrial Fibrillation

Fagih¹,

Ghamdi²,

Dagriri³

et al. 2010

Clinical Medicine & Research

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A woman, aged 48 years, with severe rheumatic mitral stenosis and uncontrolled permanent atrial fibrillation (AF) underwent preoperative assessment of coronary arteries. Invasive coronary angiography was not possible because of occluded common iliac artery and bilateral radial spasm. Transesophageal echocardiogram showed a very large mobile left atrial appendage clot, precluding cardioversion. The severe motion artifacts during cardiac CT angiography (64 slices) due to atrial fibrillation were overcome by controlling rhythm and rate through insertion of a temporary pacemaker via right femoral vein, and slowing heart rate below 65 beats per minute by intravenous metoprolol (25 mg) and verapamil (5 mg). Clear pictures of all coronary arteries as well as the left atrial appendage clot were obtained. The temporary pacemaker was removed after eight hours. Uneventful mechanical mitral valve replacement and maze procedure were performed and the patient was discharged in a stable condition.

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Noninvasive Cardiac Imaging with Computed Tomography

Cited by 16 publications

References 57 publications

Plasma Levels of HDL Subpopulations and Remnant Lipoproteins Predict the Extent of Angiographically-Defined Coronary Artery Disease in Postmenopausal Women

Plasma Levels of HDL Subpopulations and Remnant Lipoproteins Predict the Extent of Angiographically-Defined Coronary Artery Disease in Postmenopausal Women

Coronary to pulmonary artery fistula: morphologic features at multidetector CT

Controlling Rate and Rhythm Increases Feasiblity of CT Angiography in Atrial Fibrillation

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