Pub Date : 2020-09-01DOI: 10.1136/heartjnl-2020-bsci.20
S. Hill, S. Thiru, A. Farag
{"title":"P07 David vs. Goliath: CTCA versus invasive angiography in previous bypass patients presenting with NSTEACS","authors":"S. Hill, S. Thiru, A. Farag","doi":"10.1136/heartjnl-2020-bsci.20","DOIUrl":"https://doi.org/10.1136/heartjnl-2020-bsci.20","url":null,"abstract":"","PeriodicalId":383700,"journal":{"name":"Scientific poster abstracts","volume":"115 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132730596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-01DOI: 10.1136/HEARTJNL-2020-BSCI.19
C. Józsa, E. Cheasty
Introduction CT coronary angiography (CTCA) is the preferred test in patients with low to intermediate likelihood of coronary artery disease. This retrospective study was conducted to determine a new cut for calcium score without adversely affecting the diagnostic accuracy of CTCA. Methods CTCA was performed on a third generation dual-source CT scanner (Siemens Force 512 slice). Agatston method was used for the quantification of the coronary artery calcium. The degree of luminal narrowing was classified using the CAD-RAD scoring system. The coronary plaques were classified into calcified, non-calcified and mixed subtypes. We reviewed the results of any subsequent non-invasive (stress echocardiography, cardiac magnetic resonance perfusion imaging) and invasive (coronary angiography) tests to assess the correlation with CTCA. Results 296 patients were included in the analysis. 22% (64/296) did not go on to further investigations. 78% (232/296) underwent non-invasive or invasive tests. The correlation of CTCA with further investigations did not depend on total calcium score. 76% of CTCAs correlated with further investigations, 5% did not correlate and 19% had inconclusive results. (Multiple artefacts preventing complete CTCA interpretation). Conclusion The correlation or non-correlation of the CTCA results with further investigations was not affected by the total calcium score. Therefore we deem it is reasonable to proceed with a CTCA even when the calcium score exceeds 1000.
CT冠状动脉造影(CTCA)是低到中等可能性冠状动脉疾病患者的首选检查。本回顾性研究旨在确定一种不影响CTCA诊断准确性的钙评分新方法。方法在第三代双源CT扫描仪(Siemens Force 512层)上进行CTCA。冠状动脉钙定量采用Agatston法。采用CAD-RAD评分系统对管腔狭窄程度进行分类。冠状动脉斑块分为钙化型、非钙化型和混合型。我们回顾了所有随后的非侵入性(应激超声心动图、心脏磁共振灌注成像)和侵入性(冠状动脉造影)试验的结果，以评估与CTCA的相关性。结果296例患者纳入分析。22%(64/296)未进行进一步调查。78%(232/296)接受了非侵入性或侵入性检查。CTCA与进一步检查的相关性不依赖于总钙评分。76%的ctca与进一步调查相关，5%不相关，19%结果不确定。(多重伪影妨碍完整的CTCA解释)。结论CTCA结果与进一步检查的相关或不相关不受总钙评分的影响。因此，我们认为即使钙评分超过1000，也可以进行CTCA检查。
{"title":"P06 Establishing a new cut off of calcium score","authors":"C. Józsa, E. Cheasty","doi":"10.1136/HEARTJNL-2020-BSCI.19","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BSCI.19","url":null,"abstract":"Introduction CT coronary angiography (CTCA) is the preferred test in patients with low to intermediate likelihood of coronary artery disease. This retrospective study was conducted to determine a new cut for calcium score without adversely affecting the diagnostic accuracy of CTCA. Methods CTCA was performed on a third generation dual-source CT scanner (Siemens Force 512 slice). Agatston method was used for the quantification of the coronary artery calcium. The degree of luminal narrowing was classified using the CAD-RAD scoring system. The coronary plaques were classified into calcified, non-calcified and mixed subtypes. We reviewed the results of any subsequent non-invasive (stress echocardiography, cardiac magnetic resonance perfusion imaging) and invasive (coronary angiography) tests to assess the correlation with CTCA. Results 296 patients were included in the analysis. 22% (64/296) did not go on to further investigations. 78% (232/296) underwent non-invasive or invasive tests. The correlation of CTCA with further investigations did not depend on total calcium score. 76% of CTCAs correlated with further investigations, 5% did not correlate and 19% had inconclusive results. (Multiple artefacts preventing complete CTCA interpretation). Conclusion The correlation or non-correlation of the CTCA results with further investigations was not affected by the total calcium score. Therefore we deem it is reasonable to proceed with a CTCA even when the calcium score exceeds 1000.","PeriodicalId":383700,"journal":{"name":"Scientific poster abstracts","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130015819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-01DOI: 10.1136/HEARTJNL-2020-BSCI.18
Z. Khan, S. Elfawal, A. Deshpande
Introduction The acute cardiac CT pathway was set up at University hospitals of Leicester in 2017 to provide early outpatient Cardiac CT slots for patients presenting to hospital with Troponin negative chest pain to exclude coronary artery disease (CAD). A slot was created in each Cardiac CT list. Prior to this, patients would remain inpatients for up to 48 hours waiting for a scan or would have an outpatient scan after 10–20 weeks in 50% of cases. Methods Data was collected retrospectively from the radiology information system for the time period between September 2017 and August 2019 and analysed with regards to the time from request received to scan performed, degree of stenosis and management. Results Data for 116 patients was collected of which 9 were excluded due to patient cancellation or equipment failure. Of the remaining 107, the average time from request received to scan performed was 9.9 days. CT coronary angiogram (CTCA) was reported as normal in 50 cases and mild stenosis in 30 cases. There were 3 patent stents and grafts. Three patients had zero calcium but no CTCA performed. Two patients had high calcium score and no CTCA. One of these went onto have CABG. Stenosis was reported ranging from moderate to severe in 19 patients; 6 of these had stent insertions. Conclusion The acute Cardiac CT pathway demonstrated a substantial reduction in average waiting times to 9.9 days and allows earlier management of obstructive CAD in those patients presenting with Troponin negative chest pain.
{"title":"P05 Acute cardiac CT pathway for troponin negative chest pain","authors":"Z. Khan, S. Elfawal, A. Deshpande","doi":"10.1136/HEARTJNL-2020-BSCI.18","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BSCI.18","url":null,"abstract":"Introduction The acute cardiac CT pathway was set up at University hospitals of Leicester in 2017 to provide early outpatient Cardiac CT slots for patients presenting to hospital with Troponin negative chest pain to exclude coronary artery disease (CAD). A slot was created in each Cardiac CT list. Prior to this, patients would remain inpatients for up to 48 hours waiting for a scan or would have an outpatient scan after 10–20 weeks in 50% of cases. Methods Data was collected retrospectively from the radiology information system for the time period between September 2017 and August 2019 and analysed with regards to the time from request received to scan performed, degree of stenosis and management. Results Data for 116 patients was collected of which 9 were excluded due to patient cancellation or equipment failure. Of the remaining 107, the average time from request received to scan performed was 9.9 days. CT coronary angiogram (CTCA) was reported as normal in 50 cases and mild stenosis in 30 cases. There were 3 patent stents and grafts. Three patients had zero calcium but no CTCA performed. Two patients had high calcium score and no CTCA. One of these went onto have CABG. Stenosis was reported ranging from moderate to severe in 19 patients; 6 of these had stent insertions. Conclusion The acute Cardiac CT pathway demonstrated a substantial reduction in average waiting times to 9.9 days and allows earlier management of obstructive CAD in those patients presenting with Troponin negative chest pain.","PeriodicalId":383700,"journal":{"name":"Scientific poster abstracts","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126421133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-01DOI: 10.1136/HEARTJNL-2020-BSCI.17
S. Elfawal, Z. Khan, A. Bajaj, I. Das, P. Rao, R. Machin, A. Deshpande
Introduction FFRCT is a novel software for analysis of CT coronary angiographic images and aims to identify flow limiting disease non-invasively. FFRCT was introduced in our regular practice at ‘UHL’ in April 2018. This audit sought to assess the utility of FFRCT in evaluating the functional significance of all potentially flow limiting stenosis as seen on conventional CT. Methods We reviewed all cases which were sent for FFRCT analyses from April 2018 to December 2019. Patients with FFRCT values of >0.80 and Results A total of 222 cases were sent for FFRCT analysis to Heartflow. FFRCT was 0.80 in 100 patients in at least one coronary vessel. Invasive angiogram was performed in 59 of these patients, of which 50 had CTFFR 0.80. Of these, 35 patients had stents or were referred to surgery. Five of the patients that had revascularisation, had a CT FFR of >0.8. Conclusion We found that FFRCT has a valuable role in assessing the significance of moderate to severe stenosis on CTCA. Interpretation of FFRCT results needs to be made with caution and in conjunction with the CT angiographic images, as the quality of CT images may impact the accuracy of CT FFR values.
{"title":"P04 FFRCT: Benefits and limitations. a tertiary centre experience at glenfield hospital/university of hospitals leicester","authors":"S. Elfawal, Z. Khan, A. Bajaj, I. Das, P. Rao, R. Machin, A. Deshpande","doi":"10.1136/HEARTJNL-2020-BSCI.17","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BSCI.17","url":null,"abstract":"Introduction FFRCT is a novel software for analysis of CT coronary angiographic images and aims to identify flow limiting disease non-invasively. FFRCT was introduced in our regular practice at ‘UHL’ in April 2018. This audit sought to assess the utility of FFRCT in evaluating the functional significance of all potentially flow limiting stenosis as seen on conventional CT. Methods We reviewed all cases which were sent for FFRCT analyses from April 2018 to December 2019. Patients with FFRCT values of >0.80 and Results A total of 222 cases were sent for FFRCT analysis to Heartflow. FFRCT was 0.80 in 100 patients in at least one coronary vessel. Invasive angiogram was performed in 59 of these patients, of which 50 had CTFFR 0.80. Of these, 35 patients had stents or were referred to surgery. Five of the patients that had revascularisation, had a CT FFR of >0.8. Conclusion We found that FFRCT has a valuable role in assessing the significance of moderate to severe stenosis on CTCA. Interpretation of FFRCT results needs to be made with caution and in conjunction with the CT angiographic images, as the quality of CT images may impact the accuracy of CT FFR values.","PeriodicalId":383700,"journal":{"name":"Scientific poster abstracts","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114553001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-01DOI: 10.1136/HEARTJNL-2020-BSCI.14
S. Qayyum, Abubakar Habib, Svyatoslav Kechyn, D. Auger, N. Damani, A. Griguer, N. Hadjiloizou, P. Jain, N. Keenan, Masood Khan, Anish Prabhakar, Kevin Rosenfeld, J. Sehmi
Introduction HeartFlow is a non-invasive technique for estimating fractional flow reserve (FFRCT) from computer tomography coronary angiography (CTCA). HeartFlow has been made available via an NHS England funded program since September 2018 and is now fully embedded within our stable chest pain pathway. The aim of this work was to evaluate the impact of HeartFlow, which replaced previous practice of stress testing for patients with moderate coronary lesions, and invasive angiography for those with severe stenoses on CTCA. Methods We reviewed 360 consecutive patients who underwent CTCA and FFRCT between September 2018 and June 2019. CT coronary angiograms and HeartFlow models were read by a cardiologist and radiologist. Clinical records of all patients were reviewed. Results All patients referred for FFRCT had coronary stenoses greater than 50%. 72% had FFRCT≥0.8 and were discharged. 26% had FFRCT Conclusion Our study demonstrates the impact of HeartFlow in a high-volume CTCA service. Two thirds of patients referred for HeartFlow, who would previously have undergone downstream testing, had negative results and the pathway stopped at that point. Of the patients referred for invasive assessment, significant disease was found in two thirds, and in one third significant stenoses were not identified.
{"title":"P01 Heartflow: experience of a high-volume district general hospital","authors":"S. Qayyum, Abubakar Habib, Svyatoslav Kechyn, D. Auger, N. Damani, A. Griguer, N. Hadjiloizou, P. Jain, N. Keenan, Masood Khan, Anish Prabhakar, Kevin Rosenfeld, J. Sehmi","doi":"10.1136/HEARTJNL-2020-BSCI.14","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BSCI.14","url":null,"abstract":"Introduction HeartFlow is a non-invasive technique for estimating fractional flow reserve (FFRCT) from computer tomography coronary angiography (CTCA). HeartFlow has been made available via an NHS England funded program since September 2018 and is now fully embedded within our stable chest pain pathway. The aim of this work was to evaluate the impact of HeartFlow, which replaced previous practice of stress testing for patients with moderate coronary lesions, and invasive angiography for those with severe stenoses on CTCA. Methods We reviewed 360 consecutive patients who underwent CTCA and FFRCT between September 2018 and June 2019. CT coronary angiograms and HeartFlow models were read by a cardiologist and radiologist. Clinical records of all patients were reviewed. Results All patients referred for FFRCT had coronary stenoses greater than 50%. 72% had FFRCT≥0.8 and were discharged. 26% had FFRCT Conclusion Our study demonstrates the impact of HeartFlow in a high-volume CTCA service. Two thirds of patients referred for HeartFlow, who would previously have undergone downstream testing, had negative results and the pathway stopped at that point. Of the patients referred for invasive assessment, significant disease was found in two thirds, and in one third significant stenoses were not identified.","PeriodicalId":383700,"journal":{"name":"Scientific poster abstracts","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124266416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-20DOI: 10.1136/HEARTJNL-2020-BSCI.27
A. Amlani, G. Benedetti, S. Mak, R. Preston
Introduction In the UK, national guidance on the assessment of cardiac sounding chest pain (NICE CG95 2016), advises that CT coronary angiography (CTCA) is the first line imaging modality. If this reveals coronary artery disease of uncertain functional significance or is non-diagnostic, non-invasive functional testing is advised as second line. Invasive coronary angiography is only advocated as third-line when functional imaging is inconclusive or if intervention is planned and should not be performed merely to ‘check’ CTCA. We present an audit to assess the adherence to this national guidance in our centre. Methods Retrospective analysis of 281 consecutive CTCA performed between July 2017 to June 2018 and October 2018 to January 2019. Data collected include demographics, CAD-RADS score, and the presence/absence of any subsequent functional imaging, invasive angiography, PCI, or CABG up until the data collection time-point (September 2019). Results 276 scans were suitable for analysis and, out of these, 231 (84%) were discharged without further investigation. A total of 24 patients underwent subsequent functional imaging and 25 underwent invasive coronary angiography; in 16 of these patients (64%) no revascularisation was performed. Conclusion Overall adherence to the guidelines at our institution is good with the majority of patients (84%) discharged without further investigation. Importantly, in 64% of patients undergoing invasive angiography no intervention was performed, suggesting that some of these may be unnecessary.
{"title":"P14 Downstream investigation following CT coronary angiography: an audit of practice in a UK centre","authors":"A. Amlani, G. Benedetti, S. Mak, R. Preston","doi":"10.1136/HEARTJNL-2020-BSCI.27","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BSCI.27","url":null,"abstract":"Introduction In the UK, national guidance on the assessment of cardiac sounding chest pain (NICE CG95 2016), advises that CT coronary angiography (CTCA) is the first line imaging modality. If this reveals coronary artery disease of uncertain functional significance or is non-diagnostic, non-invasive functional testing is advised as second line. Invasive coronary angiography is only advocated as third-line when functional imaging is inconclusive or if intervention is planned and should not be performed merely to ‘check’ CTCA. We present an audit to assess the adherence to this national guidance in our centre. Methods Retrospective analysis of 281 consecutive CTCA performed between July 2017 to June 2018 and October 2018 to January 2019. Data collected include demographics, CAD-RADS score, and the presence/absence of any subsequent functional imaging, invasive angiography, PCI, or CABG up until the data collection time-point (September 2019). Results 276 scans were suitable for analysis and, out of these, 231 (84%) were discharged without further investigation. A total of 24 patients underwent subsequent functional imaging and 25 underwent invasive coronary angiography; in 16 of these patients (64%) no revascularisation was performed. Conclusion Overall adherence to the guidelines at our institution is good with the majority of patients (84%) discharged without further investigation. Importantly, in 64% of patients undergoing invasive angiography no intervention was performed, suggesting that some of these may be unnecessary.","PeriodicalId":383700,"journal":{"name":"Scientific poster abstracts","volume":"83 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129080572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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