Journal of cardiovascular computed tomography最新文献

Introduction: Remnant cholesterol (RC) is an independent predictor of cardiovascular risk (CVR) beyond low-density lipoprotein cholesterol (LDL-C) and has been associated with major adverse cardiovascular events (MACE). However, its prognostic interaction with coronary atherosclerotic burden as assessed by coronary CT angiography (CCTA) remains poorly defined. The aim of this study was to evaluate whether RC acts as an independent factor or as a modulator of the effect of atherosclerotic burden on the risk of death, myocardial infarction, or revascularization in patients without prior coronary events.

Methods: This was a retrospective cohort study including 296 consecutive patients undergoing CCTA for chest pain with no history of coronary events. RC was calculated indirectly and stratified into quartiles. Coronary atherosclerotic burden was assessed using coronary artery calcium (CAC) score, CAD-RADS, segment involvement score (SIS), visual plaque burden, and the presence of high-risk plaques. Adjusted Cox regression models and four-way mediation analyses were employed to evaluate the interaction between RC, plaque burden, and MACE during follow-up.

Results: After a mean follow-up of 6.3 years, 44 MACE occurred in 41 patients (13.3 ​%). Elevated RC (>30 ​mg/dL) was associated with an increased risk of MACE (HR 4.16; 95 ​% CI: 1.2-14.9). No direct association was found between RC and atherosclerotic burden; however, a significant interaction was observed, whereby the likelihood of MACE in patients with higher plaque burden increased more markedly in the presence of elevated RC. These findings were robust and consistent across various models and sensitivity analyses.

Conclusions: RC amplifies the effect of coronary atherosclerosis on the risk of MACE. Its integration with atherosclerotic burden assessment via CCTA may help optimize cardiovascular risk stratification.

Background: Calcification in a chronic total occlusion (CTO) is better visualised on Computed Tomography Coronary Angiography (CTCA) than invasive angiography.

Objectives: The authors sought to assess the characteristics of calcification of a CTO on CTCA and correlate with CTO percutaneous coronary intervention (PCI) outcome.

Methods: Retrospective analysis of the PCI database was performed (April 2017-April 2024) (clinical trials registration: NCT06414551). Patients who underwent both CTO PCI and CTCA were grouped into successful CTO PCI and any failed attempt of CTO PCI and compared for characteristics of calcification on CTCA: site of calcification, density of calcification in Hounsfield Units (HU) and quantity of calcification in % of cross section of the vessel.

Results: Out of 499 CTO PCIs performed, 82 patients had undergone CTCA. 51/82 (62.2 ​%) patients had analysable CTCAs. Mean age was 68.5 (±10.9) years and 19.6 ​% were female. Patients in the failed group were more likely to have calcification in the proximal cap (failed 65.4 ​% vs. success 24 ​%, p ​= ​0.003), more dense calcification in the proximal cap (failed: 611.8 (±517) HU vs. success: 177.6 (±356) HU; p ​= ​0.001) and proximal cap calcification quantity ≥50 ​% (failed: 75 ​% vs. success 16.7 ​%, p ​= ​0.03). Proximal cap calcification ≥50 ​% was an independent predictor of CTO PCI failure (OR, 3.21, 95 ​% CI 1.29 to 7.98, p ​= ​0.012).

Conclusions: Proximal cap calcification density and quantity on CTCA was associated with CTO PCI failure. Assessment of the proximal cap calcification may help with procedure planning in CTO PCI. Larger, prospective multicentre studies are required to corroborate these findings.

Lifetime management of aortic stenosis represents a growing procedural and clinical challenge. With recent clinical trials indicating that transcatheter aortic valve replacement (TAVR) is at least on par with surgical aortic valve replacement (SAVR) in treating lower risk patients, there has been a rise in TAVR uptake in younger, lower risk patients, leading to an increased likelihood of bioprosthetic valve degradation within a patient's lifetime. This shift in treatment has changed the landscape of interventional cardiology, incentivising the Heart Team to now plan for the initial procedure with subsequent interventions in mind. While traditional multi-slice computed tomography image-based risk assessments are sufficient for initial valve placement, they fall short in their ability to accurately predict post-procedural outcomes and future interventions. Therefore, the need to balance competing risks to optimise patient outcomes over multiple interventions requires innovation. CT-derived computational techniques are being developed to incorporate biomechanics and fluid dynamics into the risk assessment process to allow more comprehensive analysis of the risks associated with different procedures. The goal of this review is to provide an overview of computational techniques that are being developed for the purposes of optimising outcomes in both the index and valve-in-valve interventions and to give cardiologists an understanding of how they may use computational modelling as an additional tool in the lifetime management of aortic stenosis.

Background: To evaluate and compare the diagnostic performance of non-contrast, early-phase, delayed-phase images, and CT-derived extracellular volume (ECV) maps in detecting left ventricular (LV) thrombus (LVT) using cardiac computed tomography (CT).

Methods: We retrospectively analyzed 30 patients (mean age 64.3 ​± ​13.6 years) with clinically diagnosed LVT who underwent multiphase cardiac CT. Imaging protocols included non-contrast CT, coronary CT angiography (early-phase), delayed-phase CT acquired 7 ​min post-contrast, and CT-derived ECV mapping. Quantitative analysis involved measuring CT attenuation values of LVT, myocardium, and LV cavity. Two cardiovascular radiologists independently performed qualitative visual conspicuity scoring. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis.

Results: Early-phase, delayed-phase, and ECV maps demonstrated significant differentiation among LVT, myocardium, and LV cavity, with ECV maps showing the highest classification accuracy. Visual conspicuity scores were also highest for ECV maps. ROC curve analysis revealed superior diagnostic performance for delayed-phase images (AUC 0.95) and ECV maps (AUC 0.98), compared with early-phase (AUC 0.78) and non-contrast images (AUC 0.55).

Conclusion: Delayed-phase imaging and CT-derived ECV mapping significantly improve the detection and characterization of LVT compared with non-contrast and early-phase CT. Incorporating these imaging techniques into cardiac CT protocols may improve diagnostic confidence and facilitate timely clinical decision-making in patients at risk of thromboembolic events.