Multidetector computed tomography (MDCT) has been demonstrated as a feasible imaging modality for noninvasive assessment of coronary artery disease and left ventricular (LV) function. Recently, 320... Show moreMultidetector computed tomography (MDCT) has been demonstrated as a feasible imaging modality for noninvasive assessment of coronary artery disease and left ventricular (LV) function. Recently, 320-row systems have become available with 16 cm anatomical coverage allowing image acquisition of the entire heart within a single heartbeat. The purpose of this study was to evaluate the accuracy of 320-row MDCT in the assessment of global LV function compared to two-dimensional (2D) echocardiography as the standard of reference. A head-to-head comparison between 320-row MDCT and 2D-echocardiography was performed in 114 patients (68 men; mean age 62 +/- A 13 years) who were clinically referred for MDCT coronary angiography. The entire heart was imaged in a single heartbeat, using prospective dose modulation. LV end-diastolic volumes (LVEDV) and LV end-systolic volumes (LVESV) were determined and the LV ejection fraction (LVEF) was derived. Average LVEF was 60 +/- A 10% (range 26-78%) as determined on MDCT, compared with 59 +/- A 10% (range 25-77%) on 2D-echocardiography. Evaluation of LVEF by linear regression analysis showed a good correlation between MDCT and 2D-echocardiography (r (2) = .87; P < .001). Good correlations between MDCT and 2D-echocardiography were demonstrated for the assessment of LVEDV (r (2) = .91; P < .001) and LVESV (r (2) = .94; P < .001). At Bland-Altman analysis, mean differences (+/- SD) of 7.3 +/- A 12.1 mL (P < .05) and 1.8 +/- A 7.4 mL (P < .05) were observed between MDCT and 2D-echocardiography for LVEDV and LVESV, respectively. LVEF was slightly overestimated with MDCT (.9 +/- A 3.6%; P < .05). Accurate assessment of LV function and volumes is feasible with single heartbeat 320-row MDCT in patients referred for MDCT coronary angiography. Show less
In recent years, multi-slice computed tomography (MSCT) technology has developed rapidly, allowing high-resolution non-invasive imaging of the coronary arteries and surrounding structures. Since... Show moreIn recent years, multi-slice computed tomography (MSCT) technology has developed rapidly, allowing high-resolution non-invasive imaging of the coronary arteries and surrounding structures. Since the introduction of MSCT, acquisition time, detector number, spatial and temporal resolution have continuously improved with each new scanner generation, resulting in excellent image quality and diagnostic accuracy in the detection of coronary artery disease (CAD). At the same time, developments in MSCT technology have focused on reduction of the radiation dose. In particular, the availability of dose modulation and prospective ECG gating have drastically reduced patient radiation dose. Moreover, with the introduction of 320-slice MSCT, volumetric scanning of the entire heart has become possible in a single heart beat or gantry rotation, thereby eliminating oversampling and stair-step artifact. The present article provides an overview of state of the art clinical applications of cardiac MSCT, including the diagnosis of CAD, evaluation of plaque morphology and composition, prognostification, and the evaluation of left ventricular function and aortic and mitral valve anatomy. (Heart, Lung and Circulation 2010;19:107-116) (C) 2009 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand. Published by Elsevier Inc. All rights reserved. Show less
Multidetector computed tomographic coronary angiography (CTA) image quality is inversely related to the heart rate (HR). As a result beta-blocking medication is routinely administered before... Show moreMultidetector computed tomographic coronary angiography (CTA) image quality is inversely related to the heart rate (HR). As a result beta-blocking medication is routinely administered before investigation. In the present study, the use, contraindications, and efficacy of prescan beta blockade with regard to HR reduction and CTA image quality were assessed. In 537 patients referred for CTA, the baseline HR and blood pressure were measured on arrival, and contraindications for beta blockade were noted. Unless contraindicated, a single dose of metoprolol was administered orally 1 hour before data acquisition in patients with a HR of > or =65 beats/min according to a predefined medication protocol. After 1 hour, the HR was remeasured. A total of 283 patients (53%) had a HR of > or =65 beats/min. In this group, beta blockade was contraindicated in 46 patients (16%). Metoprolol was administered to the remaining 237 patients. However, 26 patients (11%) received suboptimal (lower dose than prescribed by protocol) beta blockade because of contraindications. Of the 211 patients receiving optimal beta blockade, 57 (27%) did not achieve the target HR. Of the patients with contraindications to beta blockade, 43 (60%) did not achieve the target HR. Compared to patients with optimal HR control, those receiving no or suboptimal beta blockade because of contraindications had significantly fewer examinations of good image quality (40% vs 74%, p <0.001), and significantly more examinations of poor image quality (20% vs 6%, p <0.001). In conclusion, most patients require HR reduction before CTA. Contraindications to beta blockade are present in a substantial proportion of patients. This results in suboptimal HR control and image quality, indicating the need for alternative approaches for HR reduction. Show less
Multidetector computed tomographic coronary angiography (CTA) image quality is inversely related to the heart rate (HR). As a result beta-blocking medication is routinely administered before... Show moreMultidetector computed tomographic coronary angiography (CTA) image quality is inversely related to the heart rate (HR). As a result beta-blocking medication is routinely administered before investigation. In the present study, the use, contraindications, and efficacy of prescan beta blockade with regard to HR reduction and CTA image quality were assessed. In 537 patients referred for CTA, the baseline HR and blood pressure were measured on arrival, and contraindications for beta blockade were noted. Unless contraindicated, a single dose of metoprolol was administered orally 1 hour before data acquisition in patients with a HR of >= 65 beats/min according to a predefined medication protocol. After 1 hour, the HR was remeasured. A total of 283 patients (53%) had a HR of >= 65 beats/min. In this group, beta blockade was contraindicated in 46 patients (16%). Metoprolol was administered to the remaining 237 patients. However, 26 patients (11%) received suboptimal (lower dose than prescribed by protocol) beta blockade because of contraindications. Of the 211 patients receiving optimal beta blockade, 57(27%) did not achieve the target HR. Of the patients with contraindications to beta blockade, 43 (60%) did not achieve the target FIR. Compared to patients with optimal FIR control, those receiving no or suboptimal beta blockade because of contraindications had significantly fewer examinations of good image quality (40% vs 74%, p <0.001), and significantly more examinations of poor image quality (20% vs 6%, p <0.001). In conclusion, most patients require FIR reduction before CTA. Contraindications to beta blockade are present in a substantial proportion of patients. This results in suboptimal HR control and image quality, indicating the need for alternative approaches for HR reduction. (C) 2010 Elsevier Inc. All rights reserved. (Am J Cardiol 2010;105:767-772) Show less
In recent years, multi-slice computed tomography (MSCT) technology has developed rapidly, allowing high-resolution non-invasive imaging of the coronary arteries and surrounding structures. Since... Show moreIn recent years, multi-slice computed tomography (MSCT) technology has developed rapidly, allowing high-resolution non-invasive imaging of the coronary arteries and surrounding structures. Since the introduction of MSCT, acquisition time, detector number, spatial and temporal resolution have continuously improved with each new scanner generation, resulting in excellent image quality and diagnostic accuracy in the detection of coronary artery disease (CAD). At the same time, developments in MSCT technology have focused on reduction of the radiation dose. In particular, the availability of dose modulation and prospective ECG gating have drastically reduced patient radiation dose. Moreover, with the introduction of 320-slice MSCT, volumetric scanning of the entire heart has become possible in a single heart beat or gantry rotation, thereby eliminating oversampling and stair-step artifact. The present article provides an overview of state of the art clinical applications of cardiac MSCT, including the diagnosis of CAD, evaluation of plaque morphology and composition, prognostification, and the evaluation of left ventricular function and aortic and mitral valve anatomy. Show less
Aims Multidetector computed tomography coronary angiography (CTA) has emerged as a feasible imaging modality for non-invasive assessment of coronary artery disease (CAD). Recently, 320-row CTA... Show moreAims Multidetector computed tomography coronary angiography (CTA) has emerged as a feasible imaging modality for non-invasive assessment of coronary artery disease (CAD). Recently, 320-row CTA systems were introduced, with 16 cm anatomical coverage, allowing image acquisition of the entire heart within a single heart beat. The aim of the present study was to assess the diagnostic accuracy of 320-row CTA in patients with known or suspected CAD. Methods and results A total of 64 patients (34 male, mean age 61 +/- 16 years) underwent CTA and invasive coronary angiography. All CTA scans were evaluated for the presence of obstructive coronary stenosis by a blinded expert, and results were compared with quantitative coronary angiography. Four patients were excluded from initial analysis due to non-diagnostic image quality. Sensitivity, specificity, and positive and negative predictive values to detect >/=50% luminal narrowing on a patient basis were 100, 88, 92, and 100%, respectively. Moreover, sensitivity, specificity, and positive and negative predictive values to detect >/=70% luminal narrowing on a patient basis were 94, 95, 88, and 98%, respectively. With inclusion of non-diagnostic imaging studies, sensitivity, specificity, and positive and negative predictive values to detect >/=50% luminal narrowing on a patient basis were 100, 81, 88, and 100%, respectively. Conclusion The current study shows that 320-row CTA allows accurate non-invasive assessment of significant CAD. Show less
