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Related Concept Videos

Imaging Studies for Cardiovascular System V: CT01:28

Imaging Studies for Cardiovascular System V: CT

Cardiac computed tomography (CT) scanning is an advanced cardiac imaging technique that utilizes CT technology, with or without intravenous (IV) contrast, to produce accurate cross-sectional virtual slices of specific areas of the heart, coronary circulation, and major blood vessels such as the aorta, pulmonary veins, and arteries. The computer processes these slices to generate three-dimensional images. Multidetector CT (MDCT) is a rapid form of CT scanning that captures multiple slices...
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Calcium-Scoring CT ScanA calcium-scoring CT scan, also known as coronary artery calcium (CAC) scan, detects calcium deposits in the coronary arteries. This test assesses the risk of coronary artery disease (CAD), which can lead to cardiovascular events such as angina, heart failure, and sudden cardiac arrest.A calcium-scoring CT scan is generally recommended for individuals at intermediate risk of CAD without symptoms. It includes:Men aged 40-75 and women aged 50-75: Especially those with a...
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Mitral Stenosis II: Clinical features and Diagnostic Tests

Mitral stenosis is a heart condition in which the mitral valve, which allows blood to flow from the left atrium to the left ventricle, becomes narrowed or stenotic. This narrowing hinders blood flow and leads to clinical symptoms requiring specific medical evaluations and management strategies. The following overview outlines the clinical symptoms, assessments, diagnostic findings, prevention methods, and treatments for mitral stenosis.Clinical ManifestationsDyspnea (shortness of breath): This...
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Acute Coronary Syndrome I: Introduction

Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
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Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...

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In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
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Coronary CT Angiography-based Morphologic Index for Predicting Hemodynamically Significant Coronary Stenosis.

Chenxi Wang1, Shuang Leng1, Ru-San Tan1

  • 1From the National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F., C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.); Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology, National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.) and Department of Biomedical Engineering (L.Z.), National University of Singapore, Singapore; and Department of Diagnostic Imaging, National University Hospital, Singapore (L.L.S.T., C.C.O.).

Radiology. Cardiothoracic Imaging
|January 2, 2024
PubMed
Summary

A new coronary CT angiography index, α×LL/MLD⁴, incorporating lesion entrance angle, accurately predicts significant coronary artery stenosis. This novel index demonstrates superior diagnostic performance compared to existing methods for identifying hemodynamically significant lesions.

Keywords:
CT AngiographyCardiacCoronary ArteriesInfarctionIschemiaTechnology Assessment

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Area of Science:

  • Cardiovascular Imaging
  • Interventional Cardiology
  • Radiology

Background:

  • Accurate assessment of coronary artery stenosis is crucial for guiding treatment decisions.
  • Current methods using coronary CT angiography (CCTA) have limitations in predicting hemodynamic significance.
  • Fractional flow reserve (FFR) derived from invasive coronary angiography (ICA) is the gold standard but is invasive.

Purpose of the Study:

  • To develop and validate a novel CCTA-based index, α×LL/MLD⁴, incorporating lesion entrance angle (α), lesion length (LL), and minimal lumen diameter (MLD).
  • To evaluate the efficacy of α×LL/MLD⁴ in predicting hemodynamically significant coronary stenosis compared to ICA-derived FFR.
  • To compare the diagnostic performance of α×LL/MLD⁴ against LL/MLD⁴ and diameter stenosis.

Main Methods:

  • Prospective study enrolling 133 participants undergoing both CCTA and ICA.
  • Semiautomatic CCTA image processing to measure LL, MLD, and α for calculating α×LL/MLD⁴.
  • Comparison of diagnostic performance (accuracy, sensitivity, specificity, PPV, NPV) of α×LL/MLD⁴ and LL/MLD⁴ against invasive FFR ≤ 0.80.

Main Results:

  • The α×LL/MLD⁴ index showed significantly higher median values in patients with FFR ≤ 0.80 compared to those with FFR > 0.80 (54.0 vs. 6.7 degree/mm³; P < .001).
  • α×LL/MLD⁴ achieved superior per-vessel diagnostic accuracy (86.2%) and sensitivity (83.1%) compared to LL/MLD⁴ (80.5% accuracy, 66.3% sensitivity).
  • The area under the ROC curve for α×LL/MLD⁴ (0.93) was significantly greater than for LL/MLD⁴ (0.84) and diameter stenosis (0.63) (P < .001).

Conclusions:

  • The novel CCTA-based index, α×LL/MLD⁴, incorporating lesion entrance angle, demonstrates enhanced diagnostic performance in identifying hemodynamically significant coronary stenosis.
  • α×LL/MLD⁴ offers improved accuracy and sensitivity over diameter stenosis and the LL/MLD⁴ index for predicting ischemia-causing lesions.
  • This index represents a promising non-invasive tool for better risk stratification and management of coronary artery disease.