Journal of Cardiovascular Computed Tomography最新文献

英文中文

Left main coronary artery disease—cardiac CT's ticket to fame 左冠状动脉主干疾病--心脏 CT 的成名之路。

IF 5.5 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Computed Tomography

Pub Date : 2024-11-01 DOI: 10.1016/j.jcct.2024.10.009

Armin Arbab-Zadeh

引用次数: 0

Down by the Bayes’ (theorem): Exploring the use of Bayes’ theorem to establish the diagnosis of obstructive coronary artery disease with coronary CT angiography 被贝叶斯（定理）击倒：探索利用贝叶斯定理确定冠状动脉 CT 血管造影对阻塞性冠状动脉疾病的诊断。

IF 5.5 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Computed Tomography

Pub Date : 2024-11-01 DOI: 10.1016/j.jcct.2024.09.013

Ramtin Hakimjavadi, Kevin E. Boczar

引用次数: 0

Bridging the distance between non-invasive coronary angiography and in vivo plaque assessment 弥合无创冠状动脉造影与活体斑块评估之间的距离。

IF 5.5 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Computed Tomography

Pub Date : 2024-11-01 DOI: 10.1016/j.jcct.2024.10.008

Edoardo Conte, Davide Marchetti, Daniele Andreini

引用次数: 0

Automated coronary atherosclerotic plaque quantification and differentiation—much more work to do 冠状动脉粥样硬化斑块的自动量化和分化--还有很多工作要做

IF 5.5 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Computed Tomography

Pub Date : 2024-09-01 DOI: 10.1016/j.jcct.2024.08.004

Armin Arbab-Zadeh

引用次数: 0

Quantitative coronary computed tomography assessment for differentiating between total occlusions and severe stenoses 用于区分全闭塞和严重狭窄的冠状动脉计算机断层扫描定量评估。

IF 5.5 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Computed Tomography

Pub Date : 2024-09-01 DOI: 10.1016/j.jcct.2024.04.013

Backgrounds

The impact of quantitative assessment to differentiate total occlusions (TOs) from severe stenoses on coronary computed tomography angiography (CCTA) remains unknown.

Objective

This study investigated whether quantitative characteristics assessed on CCTA could help differentiate a TO from a severe stenosis on invasive coronary angiography (ICA).

Methods

This study is a sub-analysis of the FASTTRACK CABG (NCT04142021) in which both CCTA and ICA were routinely performed. Quantitative analysis was performed with semi-automated CCTA plaque-analysis software. Blinded analysts compared TOs on CCTA, defined as a complete lack of contrast opaciﬁcation within the coronary occlusion, with corresponding ICA.

Results

Eighty-four TOs were seen on CCTA in 59 of the 114 patients enrolled in the trial. The concordance in diagnosing a TO between ICA and CCTA was 56.0% (n = 47). Compared to severe stenoses, TOs had a significantly longer lesion length (25.1 ± 23.0 mm vs 9.4 ± 11.2 mm, P < 0.001). The best cut-off value to differentiate a TO from severe stenosis was a lesion length of 5.5 mm (area under the curve 0.77, 95% CI: 0.66–0.87), with a 91.1% sensitivity and 61.1% specificity. Dense calcium percentage atheroma volume (PAV) was significantly higher in TOs compared to severe stenoses (18.7 ± 19.6% vs. 6.6 ± 13.0%, P < 0.001), whilst the opposite was seen for fibro-fatty PAV (31.3 ± 14.2% vs. 19.5 ± 10.5%, P < 0.001). On a multivariable logistic regression analysis, lesion length (>5.5 mm) was the only parameter associated with differentiating a TO from a severe stenosis.

Conclusion

In quantitative CCTA analysis, a lesion length >5.5 mm was the only independent predictor differentiating a TO from a severe stenosis.

NCT registration number

NCT04142021.

背景：定量评估对区分冠状动脉计算机断层扫描血管造影（CCTA）上的全闭塞（TO）和严重狭窄的影响仍然未知：本研究调查了在 CCTA 上评估的定量特征是否有助于区分全闭塞和有创冠状动脉造影（ICA）上的严重狭窄：本研究是对 FASTTRACK CABG（NCT04142021）的子分析，在该研究中，CCTA 和 ICA 均为常规检查。定量分析采用半自动 CCTA 斑块分析软件进行。双盲分析师将 CCTA 上的 TO（定义为冠状动脉闭塞处完全没有造影剂形成）与相应的 ICA 进行比较：结果：在 114 名参与试验的患者中，有 59 名患者的 CCTA 检查发现了 84 个 TO。ICA和CCTA诊断TO的一致性为56.0%（n = 47）。与严重狭窄相比，TO的病变长度明显更长（25.1 ± 23.0 mm vs 9.4 ± 11.2 mm，P 5.5 mm），这是唯一与区分TO和严重狭窄相关的参数：结论：在CCTA定量分析中，病变长度大于5.5毫米是区分TO和严重狭窄的唯一独立预测指标：NCT04142021。

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引用次数: 0

Infracardiac total anomalous pulmonary venous connection with dual drainage into the hepatic and portal venous system 心下全异常肺静脉连接，双重引流至肝静脉和门静脉系统。

IF 5.5 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Computed Tomography

Pub Date : 2024-09-01 DOI: 10.1016/j.jcct.2024.06.004

引用次数: 0

Biomarkers for identification of high-risk coronary artery plaques in patients with suspected coronary artery disease 用于识别疑似冠心病患者高危冠状动脉斑块的生物标记物。

IF 5.5 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Computed Tomography

Pub Date : 2024-09-01 DOI: 10.1016/j.jcct.2024.06.009

Background

Patients with atherosclerotic plaques containing high-risk features have an increased likelihood of events and a worse prognosis. Whether increased levels of Troponin I (TnI) and C-reactive protein (CRP) are associated with the presence of high-risk coronary atherosclerotic plaques (HRP) is not well described. We assessed the association between 1) TnI and 2) CRP with quantified coronary plaque burden, luminal diameter stenosis, and HRP in patients with low/intermediate pre-test probability of obstructive coronary artery disease (CAD) referred for coronary computed tomography angiography (CCTA).

Methods

The CCTA from 1615 patients were analyzed using a semiautomatic software for coronary artery plaque characterization. Patients with high TnI (>6 ng/L) and high CRP (>2 mg/L) were identified. Associations of TnI and CRP with plaque burden, stenosis (≥50% luminal diameter stenosis on CCTA), and HRP were investigated.

Results

TnI and CRP were both positively correlated with total plaque burden (TnI rs = 0.14, p < 0.001; CRP rs = 0.08, p < 0.001). In multivariate logistic regression analyses, high TnI was associated with stenosis (OR 1.43, 95% confidence interval (CI) 1.03–1.99, p = 0.034), the presence of HRP (OR 1.79, 95% CI: 1.17–2.74, p = 0.008), and the subtypes of HRP; low attenuation plaque (OR 1.93, 95% CI: 1.24–3.00, p = 0.003), and positive remodeling (OR 1.51, 95% CI: 1.07–2.13, p = 0.018). For CRP, only stenosis and napkin ring sign correlated significantly.

Conclusion

In patients with suspected CAD, TnI and CRP are associated with HRP features. These findings may suggest that inflammatory and particularly ischemic biomarkers might improve early risk stratification and affect patient management.

ClinicalTrials.gov identifier

NCT02264717

背景：冠状动脉粥样硬化斑块具有高危特征的患者发生心血管事件的可能性增加，预后较差。肌钙蛋白 I (TnI) 和 C 反应蛋白 (CRP) 水平的升高是否与高危冠状动脉粥样硬化斑块 (HRP) 的存在有关，目前还没有很好的描述。我们评估了 1) TnI 和 2) CRP 与冠状动脉计算机断层扫描（CCTA）转诊的阻塞性冠状动脉疾病（CAD）低/中等预检概率患者的量化冠状动脉斑块负荷、管腔直径狭窄和 HRP 之间的关系：使用半自动冠状动脉斑块特征描述软件对 1615 名患者的 CCTA 进行分析。确定了高 TnI（>6 ng/L）和高 CRP（>2 mg/L）的患者。研究了TnI和CRP与斑块负荷、狭窄（CCTA显示管腔直径狭窄≥50%）和HRP的关系：结果：TnI 和 CRP 与斑块总负荷均呈正相关（TnI rs = 0.14，p 结论：TnI 和 CRP 与斑块总负荷呈正相关：在疑似 CAD 患者中，TnI 和 CRP 与 HRP 特征相关。这些发现可能表明，炎症尤其是缺血性生物标志物可改善早期风险分层并影响患者管理：Gov 标识符：NCT02264717。

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引用次数: 0

Computed coronary tomography angiography for left main diameter assessment 用于评估左主干直径的计算机冠状动脉断层血管造影。

IF 5.5 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Computed Tomography

Pub Date : 2024-09-01 DOI: 10.1016/j.jcct.2024.04.004

引用次数: 0

Ultra-high-resolution CT vs. invasive angiography for detecting hemodynamically significant coronary artery disease: Rationale and methods of the CORE-PRECISION multicenter study 超高分辨率 CT 与侵入性血管造影在检测血流动力学显著性冠状动脉疾病方面的对比：CORE-PRECISION 多中心研究的原理和方法

IF 5.5 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Computed Tomography

Pub Date : 2024-09-01 DOI: 10.1016/j.jcct.2024.04.012

Background

Direct coronary arterial evaluation via computed tomography (CT) angiography is the most accurate noninvasive test for the diagnosis of coronary artery disease (CAD). However, diagnostic accuracy is limited in the setting of severe coronary calcification or stents. Ultra-high-resolution CT (UHR-CT) may overcome this limitation, but no rigorous study has tested this hypothesis.

Methods

The CORE-PRECISION is an international, multicenter, prospective diagnostic accuracy study testing the non-inferiority of UHR-CT compared to invasive coronary angiography (ICA) for identifying patients with hemodynamically significant CAD. The study will enroll 150 patients with history of CAD, defined as prior documentation of lumen obstruction, stenting, or a calcium score ≥400, who will undergo UHR-CT before clinically prompted ICA. Assessment of hemodynamically significant CAD by UHR-CT and ICA will follow clinical standards. The reference standard will be the quantitative flow ratio (QFR) with <0.8 defined as abnormal. All data will be analyzed in independent core laboratories.

Results

The primary outcome will be the comparative diagnostic accuracy of UHR-CT vs. ICA for detecting hemodynamically significant CAD on a patient level. Secondary analyses will focus on vessel level diagnostic accuracy, quantitative stenosis analysis, automated contour detection, in-depth plaque analysis, and others.

Conclusion

CORE-PRECISION aims to investigate if UHR-CT is non-inferior to ICA for detecting hemodynamically significant CAD in high-risk patients, including those with severe coronary calcification or stents. We anticipate this study to provide valuable insights into the utility of UHR-CT in this challenging population and for its potential to establish a new standard for CAD assessment.

背景通过计算机断层扫描（CT）血管造影直接评估冠状动脉是诊断冠状动脉疾病（CAD）最准确的无创检查。然而，在冠状动脉严重钙化或有支架的情况下，诊断的准确性就会受到限制。方法CORE-PRECISION 是一项国际性、多中心、前瞻性诊断准确性研究，目的是测试超高分辨率 CT（UHR-CT）与有创冠状动脉造影术（ICA）相比，在识别有血流动力学意义的 CAD 患者方面的非劣效性。该研究将招募 150 名有 CAD 病史的患者，定义为之前有管腔阻塞、支架植入或钙化评分≥400 分的患者，他们将在临床提示的 ICA 之前接受 UHR-CT 检查。通过 UHR-CT 和 ICA 评估有血流动力学意义的 CAD 将遵循临床标准。参考标准是定量血流比（QFR），0.8 为异常。所有数据都将在独立的核心实验室中进行分析。结果主要结果是 UHR-CT 与 ICA 在检测患者血流动力学显著性 CAD 方面的诊断准确性比较。次要分析将侧重于血管水平的诊断准确性、定量狭窄分析、自动轮廓检测、深入斑块分析等。结论CORE-PRECISION 的目的是研究 UHR-CT 在检测高危患者（包括有严重冠状动脉钙化或支架的患者）的血流动力学显著性 CAD 方面是否不逊于 ICA。我们期待这项研究能为 UHR-CT 在这一具有挑战性的人群中的应用提供有价值的见解，并为其建立 CAD 评估新标准的潜力提供依据。

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引用次数: 0

Cardiac computed tomography-derived coronary artery volume to myocardial mass in patients with severe coronary artery disease 严重冠状动脉疾病患者心脏计算机断层扫描得出的冠状动脉容量与心肌质量之比。

IF 5.5 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Computed Tomography

Pub Date : 2024-09-01 DOI: 10.1016/j.jcct.2024.06.010

Background

Coronary artery lumen volume (V) to myocardial mass (M) ratio (V/M) can show the mismatch between epicardial coronary arteries and the underlying myocardium.

Methods

The V, M and V/M were obtained from the coronary computed tomography angiography (CCTA) of patients in the FAST-TRACK CABG study, the first-in-human trial of coronary artery bypass grafting (CABG) guided solely by CCTA and fractional flow reserve derived from CCTA (FFR_CT) in patients with complex coronary artery disease (CAD). The correlations between V/M ratios and baseline characteristics were determined and compared with those from the ADVANCE registry, an unselected cohort of historical controls with chronic CAD.

Results

The V/M ratio was obtained in 106 of the 114 pre-CABG CCTAs. Mean age was 65.6 years and 87% of them were male. The anatomical SYNTAX score from CCTA was significantly higher than the functional SYNTAX score derived using FFR_CT [43.1 (15.2) vs 41.1 (16.5), p < 0.001]. Mean V, M, and V/M were 2204 mm³, 137 g, and 16.5 mm³/g, respectively. There were weak negative correlations between V and anatomical and functional SYNTAX scores (Pearson's r = −0.26 and −0.34). V and V/M had a strong correlation (r = 0.82). The V/M ratio in the current study was significantly lower than that in the ADVANCE registry (median 16.1 vs. 24.8 [1st quartile 20.1]).

Conclusion

Systematically smaller V/M ratios were found in this population with severe CAD requiring CABG compared to an unselected cohort with chronic CAD. The V/M ratio could provide additional non-invasive assessment of CAD especially when combined with FFR_CT.

背景：冠状动脉管腔容积（V）与心肌质量（M）之比（V/M）可显示心外膜冠状动脉与下层心肌之间的不匹配：方法：V、M 和 V/M 均来自 FAST-TRACK CABG 研究中患者的冠状动脉计算机断层扫描（CCTA），该研究是在复杂冠状动脉疾病（CAD）患者中进行的首次完全由 CCTA 和来自 CCTA 的分数血流储备（FFRCT）引导的冠状动脉旁路移植术（CABG）人体试验。研究确定了 V/M 比值与基线特征之间的相关性，并将其与 ADVANCE 登记的相关性进行了比较：114例CABG前CCTAs中有106例获得了V/M比值。平均年龄为 65.6 岁，87% 为男性。CCTA得出的解剖SYNTAX评分明显高于FFRCT得出的功能SYNTAX评分[分别为43.1 (15.2) vs 41.1 (16.5)，P 3，137 g和16.5 mm3/g]。V值与SYNTAX解剖和功能评分呈弱负相关（Pearson's r = -0.26和-0.34）。V和V/M具有很强的相关性（r = 0.82）。本研究中的V/M比值明显低于ADVANCE登记中的比值（中位数16.1 vs. 24.8 [第一四分位数20.1]）：结论：与未入选的慢性 CAD 患者队列相比，在需要进行 CABG 的严重 CAD 患者中发现了系统性较小的 V/M 比值。V/M比值可为CAD提供额外的非侵入性评估，尤其是与FFRCT结合使用时。

{"title":"Cardiac computed tomography-derived coronary artery volume to myocardial mass in patients with severe coronary artery disease","authors":"","doi":"10.1016/j.jcct.2024.06.010","DOIUrl":"10.1016/j.jcct.2024.06.010","url":null,"abstract":"<div><h3>Background</h3><p>Coronary artery lumen volume (V) to myocardial mass (M) ratio (V/M) can show the mismatch between epicardial coronary arteries and the underlying myocardium.</p></div><div><h3>Methods</h3><p>The V, M and V/M were obtained from the coronary computed tomography angiography (CCTA) of patients in the FAST-TRACK CABG study, the first-in-human trial of coronary artery bypass grafting (CABG) guided solely by CCTA and fractional flow reserve derived from CCTA (FFR<sub>CT</sub>) in patients with complex coronary artery disease (CAD). The correlations between V/M ratios and baseline characteristics were determined and compared with those from the ADVANCE registry, an unselected cohort of historical controls with chronic CAD.</p></div><div><h3>Results</h3><p>The V/M ratio was obtained in 106 of the 114 pre-CABG CCTAs. Mean age was 65.6 years and 87% of them were male. The anatomical SYNTAX score from CCTA was significantly higher than the functional SYNTAX score derived using FFR<sub>CT</sub> [43.1 (15.2) vs 41.1 (16.5), p < 0.001]. Mean V, M, and V/M were 2204 mm<sup>3</sup>, 137 g, and 16.5 mm<sup>3</sup>/g, respectively. There were weak negative correlations between V and anatomical and functional SYNTAX scores (Pearson's r = −0.26 and −0.34). V and V/M had a strong correlation (r = 0.82). The V/M ratio in the current study was significantly lower than that in the ADVANCE registry (median 16.1 vs. 24.8 [1st quartile 20.1]).</p></div><div><h3>Conclusion</h3><p>Systematically smaller V/M ratios were found in this population with severe CAD requiring CABG compared to an unselected cohort with chronic CAD. The V/M ratio could provide additional non-invasive assessment of CAD especially when combined with FFR<sub>CT</sub>.</p></div>","PeriodicalId":49039,"journal":{"name":"Journal of Cardiovascular Computed Tomography","volume":"18 5","pages":"Pages 478-488"},"PeriodicalIF":5.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1934592524003794/pdfft?md5=8611e89f9c021447528045267916df06&pid=1-s2.0-S1934592524003794-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141473936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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