‘Triple-rule-out’ CT angiography for clinical decision making and early triage of acute chest pain patients: use of 320-multislice CT angiography

Eltabbakh, Amira R.; Dawoud, Mahmoud A.; Langer, Mathias; Moharm, Mohammed A.; Hamdy, Ehab A.; Hamisa, Manal

doi:10.1186/s43055-019-0003-1

Cited by 9 publications

(10 citation statements)

References 34 publications

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“…Our study revealed that TRO CTA is an effective and non-invasive diagnostic method in COVID-19 patients who were admitted to the ED with acute chest pain. Acute chest pain might be due to pneumonia itself or accompanying vascular events which are related to an increased risk of thrombosis, endothelial dysfunction, and myocardial injury in COVID-19 cases[ 5 , 7 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

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Triple rule-out computed tomography angiography: Evaluation of acute chest pain in COVID-19 patients in the emergency department

Bahadir¹,

Aydın²,

Kantarcı³

et al. 2022

WJR

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BACKGROUND The aim of this study was to define clinical evidence supporting that triple rule-out computed tomography angiography (TRO CTA) is a comprehensive and feasible diagnostic tool in patients with novel coronavirus disease 2019 (COVID-19) who were admitted to the emergency department (ED) for acute chest pain. Optimizing diagnostic imaging strategies in COVID-19 related thromboembolic events, will help for rapid and noninvasive diagnoses and results will be effective for patients and healthcare systems in all aspects. AIM To define clinical evidence supporting that TRO CTA is a comprehensive and feasible diagnostic tool in COVID-19 patients who were admitted to the ED for acute chest pain, and to assess outcomes of optimizing diagnostic imaging strategies, particularly TRO CTA use, in COVID-19 related thromboembolic events. METHODS TRO CTA images were evaluated for the presence of coronary artery disease, pulmonary thromboembolism (PTE), or acute aortic syndromes. Statistical analyses were used for evaluation of significant association between the variables. A two tailed P -value < 0.05 was considered statistically significant. RESULTS Fifty-three patients were included into the study. In 31 patients (65.9%), there was not any pathology, while PTE was diagnosed in 11 patients. There was no significant relationship between the rates of pathology on CTA and history of hypertension. On the other hand, the diabetes mellitus rate was much higher in the acute coronary syndrome group, particularly in the PTE group (8/31 = 25.8% vs 6/16 = 37.5%, P = 0.001). The rate of dyslipidemia was significantly higher in the group with pathology on CTA while compared to those without pathology apart from imaging findings of the pneumonia group (62.5% vs 38.7%, P < 0.001). Smoking history rates were similar in the groups. Platelets, D-dimer, fibrinogen, C-reactive protein, and erythrocyte sedimentation rate values were higher in COVID-19 cases with additional pathologies. CONCLUSION TRO CTA is an effective imaging method in evaluation of all thoracic vascular systems at once and gives accurate results in COVID-19 patients.

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Section: Discussionmentioning

confidence: 99%

“…In our center, TRO CTA examination is performed according to the eligibility criteria in the article of Eltabbakh AR et al [ 8 ].…”

Section: Methodsmentioning

confidence: 99%

Triple rule-out computed tomography angiography: Evaluation of acute chest pain in COVID-19 patients in the emergency department

Bahadir¹,

Aydın²,

Kantarcı³

et al. 2022

WJR

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“…It is a useful method for the exclusion and the diagnosis of CAD, PTE, and AAS with high specificity; hence, it can play an important role in decision-making in the ED. TRO-CT can define CAD and PTE with a satisfying sensitivity and specificity in comparison with dedicated protocols [19,20]. We have used basically a similar protocol with TRO-CT, with the addition of DECT, to assess myocardial perfusion deficits.…”

Section: Discussionmentioning

confidence: 99%

Quadruple-Rule-Out Computed Tomography Angiography (QRO-CT): A Novel Dual-Energy Computed Tomography Technique for the Diagnostic Work-Up of Acute Chest Pain

Cetin,

Kantarci,

Irgul

et al. 2023

Diagnostics

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Background: Computerized tomography (CT) has been increasingly utilized in the differential diagnosis of acute chest pain. Combining the triple rule out CT angiography (TRO-CT) approach with dual-energy CT (DECT) can enhance the diagnostic capability by identifying myocardial perfusion deficiencies. This combination can yield a quadruple-rule-out computed tomography angiography (QRO-CT) technique. The aim of this study is to determine the efficacy of the QRO-CT. Methods: Intraluminal diseases and abnormalities in the main coronary arteries and branches were investigated. The myocardial dark spots on the color-coded iodine map were identified as perfusion deficiencies. Pulmonary arteries and aorta were also evaluated. Results: The study population consisted of 211 patients. The sensitivity, specificity, and positive and negative predictive values of QRO-CT for pulmonary embolism were 93.5%, 100%, 100%, and 95.3%, respectively. For obstructive coronary artery disease, the values were 96.1%, 93.4%, 89.2%, and 97.7%, respectively. For myocarditis, the values were 69.2%, 100%, 100%, and 93.6%, respectively. Conclusions: the QRO-CT method may successfully evaluate myocardial perfusion deficits, hence expanding the differential diagnosis capabilities of the standard TRO-CT method for myocarditis. It can provide useful information on myocardial perfusion, which may influence the choice to perform invasive catheterization in cases of coronary artery obstruction.

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“… 8 Triple rule-out CT has been a helpful and effective tool in the arsenal of emergency physicians in diagnosing cases of concern and determining the patient population which can be sent home without further cardiac testing. 9 – 13 The present study aims to quantify the diagnostic yield of TRO-CT in evaluating acute chest pain in patients presenting to the emergency department of a tertiary care hospital and revive and impart the knowledge on TRO-CT to our fellow emergency physicians and residents in India.…”

Section: Introductionmentioning

confidence: 99%

The Role of Triple Rule-out CT in an Indian Emergency Setting

Aggarwal¹,

Kumar²,

Jamshed³

et al. 2023

Indian Journal of Critical Care Medicine

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A bstract Background Emergency physicians are acutely aware of the consequences of missing fatal diagnoses for acute non-traumatic chest pain and subjecting patients to over-testing. In the large arsenal of tests that are available to us, a triple rule-out computed tomography (TRO-CT) Angiography is often less pursued, due to concerns about their efficacy and safety or because of nescience. We aim to find the yield of the test in an Indian emergency setting and impart some knowledge about it along the way. Materials and methods Twenty-six patients who presented to the emergency department of our institute with acute chest pain, with non-specific electrocardiogram (ECG) findings and negative serial troponin I, underwent TRO-CT. HEART scores of all patients, calculated at their presentation, were correlated with TRO-CT findings. Results Triple rule-out computed tomography angiography was positive in 5 patients (20%), of which 4 cases (16%) were diagnosed to have significant coronary artery disease and one had an acute pulmonary embolism. All 4 patients who had significant coronary artery disease (CAD) diagnosed by TRO-CT had a HEART score of intermediate risk. The mean effective radiation dose of the entire TRO study was 19.024 ± 3.319 mSv (range = 13.89–25.95 mSv). Conclusion Triple rule-out CT angiography is a useful tool in the evaluation of patients presenting with acute chest pain in the emergency and can be an important adjunct in ruling out significant CAD in intermediate-risk patients. Emergency physicians and young residents need to know about this tool in their armamentarium to tackle doubtful cases. How to cite this article Pattereth N, Chaliyadan S, Mathew R, Kumar S, Das CJ, Aggarwal P. et al. The Role of Triple Rule-out CT in an Indian Emergency Setting. Indian J Crit Care Med 2023;27(3):190–194.

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‘Triple-rule-out’ CT angiography for clinical decision making and early triage of acute chest pain patients: use of 320-multislice CT angiography

Cited by 9 publications

References 34 publications

Triple rule-out computed tomography angiography: Evaluation of acute chest pain in COVID-19 patients in the emergency department

Triple rule-out computed tomography angiography: Evaluation of acute chest pain in COVID-19 patients in the emergency department

Quadruple-Rule-Out Computed Tomography Angiography (QRO-CT): A Novel Dual-Energy Computed Tomography Technique for the Diagnostic Work-Up of Acute Chest Pain

The Role of Triple Rule-out CT in an Indian Emergency Setting

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