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Assessment of coronary spasms with transluminal attenuation gradient in coronary computed tomography angiography
Jae Yang Park1, Eun-Ju Kang1, Moo Hyun Kim2
1Department of Radiology, College of Medicine, Dong-A University, Busan, Republic of Korea.
Insights
Transluminal attenuation gradient (TAG) on coronary computed tomography angiography (CCTA) can help identify coronary vasospasm (VA). Diffuse coronary spasms show steeper TAG than focal spasms, aiding in diagnosis.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Diagnostic Medicine
Background:
- Vasospastic angina (VA) is a clinical syndrome characterized by reversible coronary artery narrowing.
- Accurate diagnosis of VA is crucial for effective management and prevention of adverse cardiac events.
- Coronary computed tomography angiography (CCTA) offers detailed visualization of coronary arteries, but its role in evaluating coronary spasm requires further investigation.
Purpose of the Study:
- To evaluate the imaging features of coronary spasm using transluminal attenuation gradient (TAG) on CCTA.
- To assess the utility of TAG in differentiating between focal and diffuse types of coronary spasm.
- To investigate the changes in TAG and contrast enhancement in patients with suspected vasospastic angina.
Main Methods:
- A cohort of 43 patients with high clinical suspicion for VA underwent dual CCTA acquisition: baseline and during intravenous nitrate infusion.
- Coronary spasm was confirmed using a catheterized ergonovine provocation test.
- Transluminal attenuation gradient (TAG) and proximal ostium contrast enhancement (ProxHU) were measured for major coronary arteries.
Main Results:
- Twenty-four patients (55.8%) were diagnosed with VA.
- Diffuse-type spasms were more prevalent (76%) than focal-type spasms (24%).
- Baseline CCTA showed significantly steeper TAG in spasm-positive vessels (LCX) and lower ProxHU in spasm-positive vessels (LAD). Diffuse spasms exhibited steeper TAG than focal spasms.
Conclusions:
- Transluminal attenuation gradient (TAG) on CCTA is a valuable imaging biomarker for detecting coronary spasm.
- TAG values differ significantly based on the morphological type of coronary spasm, with diffuse spasms showing steeper gradients.
- CCTA-derived TAG holds promise for non-invasively characterizing coronary spasm in patients with suspected vasospastic angina.
Purpose:
To evaluate the imaging features of coronary spasm, including transluminal attenuation gradient (TAG) on coronary computed tomography angiography (CCTA), in patients with vasospastic angina (VA).
Methods:
A total of 43 patients with a high clinical likelihood of VA were included in the study. All the subjects underwent double CCTA acquisition: CCTA without a vasodilator ('baseline CT') and CCTA during continuous intravenous nitrate infusion ('IV nitrate CT'). A catheterized ergonovine provocation test was used to determine true VA patients. Coronary spasm is classified into focal- and diffuse-types according to morphological differences. We measured TAG and contrast enhancement of the proximal ostium (ProxHU) of each coronary artery for both the baseline and IV nitrate CT.
Results:
Twenty-four patients (55.8%) showed positive results of coronary vasospasm on the provocation test. Thirty-eight vessels showed coronary spasms (29.5%): Focal-type in nine vessels (24%), and diffuse-type in 29 (76%). In the baseline CT, LCX showed significantly lower (steeper) TAG in spasm(+) vessels than in spasm(-) vessels, while LAD and RCA showed no significant differences in TAG. The ProxHU of LAD showed significantly lower values in spasm(+) vessels than in spasm(-) vessels, while the other vessels did not show significant differences in ProxHU. For IV nitrate CT, there were no significant differences in either the TAG and ProxHU between spasm(+) and (-) vessels for all the three vessel types. In subgroup analysis for spasm(+) vessels, diffuse spasms showed significantly lower TAG than focal spasms, while the ProxHU did not differ between the two types of spasm.
Conclusions:
A relatively large percentage of coronary spasms present as diffuse type, and the TAG values significantly differed according to the morphological type of the coronary spasm.
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