Evaluation of Diagnostic Performance of MDCT Coronary Angiography in Comparison with Conventional Coronary Angiography

Background: Coronary artery disease is now becoming increasingly prevalent than before especially in younger age groups. We in the current study tried to evaluate the potential of 128 slice MDCT coronary angiography for the detection of stenotic coronary lesions by comparing the results of computed tomographic coronary angiography to a gold standard set by Conventional coronary angiography. Methods: A total of n=30 patients with clinically suspected Coronary artery disease. They were evaluated with 128 Slice CT Scanner (PHILIPS INGENUITY) and conventional coronary angiography. All patients were examined with a 128 slice MDCT scanner (Philips Ingenuity 128 slice Netherlands) using standard cardiac CT protocol. Gantry rotation time was 400 ms with a half sector acquisition protocol and multisector reconstruction permitting an effective temporal resolution between 50 and 200 ms depending on patient heart rate. Results: In the n=30 Patients included in the study with CCA, the n=450 coronary segments included in the study were found to contain a total number of n=138 stenoses among them non-significant stenoses. The accuracy of MDCT detection of coronary stenoses greater than 50% diameter of vessel lumen is about 94.78. When raising the threshold for stenosis from 50% to 70% of the vessel lumen, so that only hemodynamic relevant stenoses enter the evaluation, the sensitivity decreases from 88%. The MDCT detection in the patient group with heart rates below 60 beats per minute higher values for sensitivity 93% and specificity 97% were observed, compared to sensitivity 87% and specificity 93% of the patient group with heart rates above 60 beats per minute. Conclusion:The present study revealed that a high negative predictive value (98.08%)suggests that 128- Slice MDCT coronary angiography is a good screening modality for evaluation of patients with mild to intermediate-risk factors who might otherwise require invasive angiography.

Is myocardial bridge more frequently detected on radial access coronary angiography?

Background Although the incidence of myocardial bridge (MB) has been defined in different femoral access conventional coronary angiography (FACCA) studies, the frequency of MB on radial access coronary angiography (RACA) is unknown. The aim of this study was to determine the difference in the incidence of MB between patients undergoing RACA and FACCA. Method A total of 2500 consecutive patients who underwent RACA and a total of 1455 consecutive patients who underwent FACCA were retrospectively investigated to detect the presence of MB. The incidences of the groups were calculated separately and compared. The clinical and angiographic features of the patients with MB were analyzed. Results MB was detected at an incidence of 10.2%, in 255/2500 patients who underwent RACA, and 1.8% in 27/1455 patients who underwent FACCA (p < 0.001). In both RACA and FACCA patients, the most involved coronary artery was the left anterior descending artery (LAD) (86.9% and 93.1%) and the mid-segment (84.9% and 88.9%) was the most affected section. Co-involvement of multiple coronary arteries by MB was 7.8% in patients who underwent RACA and 7.4% in patients who underwent FACCA. Coronary artery disease (CAD) was determined in 111 (35.7%) of the coronary arteries with MB, of which 81.9% were proximal to the MB. No significant CAD was detected in any of the vessels of 69.8% (178/255) of the patients who underwent RACA for different clinical indications. Conclusion These data demonstrated that the incidence of myocardial bridge able to be detected on RACA was much higher than FACCA.

Radiation Dose Assessment of the Fog Lead Acrylic Shields during Coronary Angiography: A Phantom Study

This study aimed to evaluate the effects of fogging on the effectiveness of a lead glass shield in protecting an operator from radiation exposure during conventional coronary angiography (CAG). Optically stimulated luminescence dosimeters (OSLDs) were used to measure the effects of fogged lead glass shields (FLSs) and clear lead glass shields (CLSs) on the radiation doses of a cardiac catheterization surgeon. We simulated the scatter radiation incident on the operator with five angiographic projections with 10-s exposures. Experiments were conducted with a field of view of 25 cm, maximum of 100 cm between the X-ray tube and image intensifier, and 80 cm between the image intensifier and operator. Lead glass fogging had no significant effect at any angiographic projection. The average dose at the lens of the eye, thyroid glands, and gonads did not differ significantly between FLS and CLS. Although most surgeons view ceiling-suspended shields as hindrances during surgical procedures, the radiation dose at the operator’s eyes and thyroid glands increased by 13 and 10 times without the shield. The fogging of the shield is probably caused by post-surgery UV decontamination or detergents. An operator has no cause for concern regarding the radiation protection afforded by an FLS during CAG procedures.

Case Report: Intraoperative Open-Heart Coronary Angiography in Acute Type A Aortic Dissection

For patients with acute type A aortic dissection, strongly suspected of having concomitant severe coronary artery disease (CAD), preoperative or intraoperative coronary angiography has been recommended. However, conventional selective coronary angiography in this setting may extend the dissection or aortic rupture. We present the use of intraoperative open-heart coronary angiography in a patient with acute type A aortic dissection. A 50-year-old man presented with chest pain and dyspnea and was admitted to our department with acute type A aortic dissection. The patient underwent coronary artery stent implantation in the left anterior descending coronary artery (LAD) 3 years previously due to an acute myocardial infarction. This time we failed to evaluate the patency of the LAD using multidetector computed tomography. An aortic rupture occurred due to conventional coronary angiography, and open-heart coronary angiography was performed. The examination revealed no significant stenosis. A Bentall procedure and total aortic arch replacement were performed, with an intraoperative stent inserted into the descending aorta, and the patient had an uneventful postoperative course. From this case, we learn that intraoperative open-heart coronary angiography is safe and effective in patients with acute type A aortic dissection.

Anomalous Origin of Left Main Coronary Artery from Right Coronary Artery in A Patient Presenting with Inferior Wall Myocardial Infarction: A Case Report

Anomalous origin of the coronary arteries is a very rare phenomenon and is seen only in less than 1% of the general population. Single coronary artery (SCA) is a congenital anatomic abnormality identified by a single coronary ostium giving rise to one coronary artery. Our case presented at 40 years with intermittent chest discomfort, effort intolerance and a history of getting Streptokinase one month back due to AMI (Inferior). Diagnosis was confirmed with elective conventional coronary angiography and coronary CT angiography as an extremely rare variant of the left main coronary artery (LMCA) branching off from the right coronary artery (RCA) and then following a pre-pulmonic course. We did Off Pump CABG surgery with four grafts and discharged the patient uneventfully with guidelinedirected medical therapy with a beta-blocker, statin, and dual antiplatelet agents and the patient is on follow up. Bangladesh Heart Journal 2021; 36(1) : 61-66

The recent advances, drawbacks, and the future directions of CMRI in the diagnosis of IHD

Ischemic heart disease (IHD), also known as coronary artery disease (CAD), is a leading cause of morbidity and mortality in adults. The aims of this research were to study the recent advances on the prognostic and diagnostic value, drawbacks, and the future directions of cardiac magnetic resonance imaging (CMRI) in the diagnosis of IHD. One hundred patients with IHD who had been clinically diagnosed were enrolled in this study prospectively. CMRI; Siemens Magnetom Sola 1.5 T MRI scanner was used to examine the patients. To confirm the diagnosis, conventional coronary angiography was used. CMRI revealed that the left ventricular (LV) volumes and systolic function of male and female patients differed by age decile were 28.9 ± 3.5%; 32 ± 1.7%, 53.3 ± 11.2; 58 ± 6.6 ml, 100.6 ± 7.1; 98.3 ± 14.7 bpm, 5.4 ± 1.4; 5.8 ± 1.5 L/min, 189 ± 14.3; 180 ± 10.9 ml, and 136 ± 3.1; 123 ± 4.4 ml for the left ventricle ejection fraction (LVEF), stroke volume (SV), heart rate, cardiac output, end diastolic volume (EDV), and end systolic volume (ESV), respectively. CMRI has sensitivity, specificity, and accuracy of 97%, 33.33%, and 95.15%, respectively. Finally, CMRI provides a comprehensive assessment of LV function, myocardial perfusion, and viability, as well as coronary anatomy.

Does Myocardial Bridge Appear More Frequently and Diffusely on Radial Access Coronary Angiography?

Background: Although the incidence of myocardial bridge (MB) has been defined in different conventional coronary angiography (CCA) studies,the frequency of MB in radial access coronary angiography (RACA) is unknown.The aim of this study was to determine the incidence of MB in patients undergoing RACA.Method: A total of 2600 consecutive patients who underwent RACA were retrospectively investigated to detect the presence of MB.The clinical,laboratory, and angiographic features of the patients with MB were analyzed. Results: MB was detected at an incidence of 10.2%, in 255/2600 patients who underwent RACA.The most involved coronary artery was the left anterior descending artery (LAD) (86.9%) and the mid segment (84.9%) was the most affected section.Co-involvement of multiple coronary arteries by MB was 7.8%. Coronary artery disease (CAD) was determined in 102 (36.2%) of the coronary arteries with MB, 82.4% which were proximal to the MB.Conclusion: These data demonstrated that the incidence of MB able to be detected on RACA was much higher than reported in previous CCA studies.

Midterm follow up of transcatheter closure of coronary artery fistula with Nit-Occlud® patent ductus arteriosus coil

Background Coronary artery fistula (CAF) is a rare congenital anomaly with a challenging scenario in children. This study reports our experience in transcatheter closure of CAF with Nit-Occlude PDA coil and midterm clinical and imaging follow-up. Methods Twelve children with congenital CAF between 2009 and 2019, mean age 2.05 ± 2.05 years (4 days to 7.2 years), mean weight 8.8 ± 4.83 (2.8–17 kg), who underwent transcatheter closure with PFM coil at the Namazi hospital, Shiraz, Iran, were reported. Echocardiography and electrocardiogram were done before and after the procedure (early, 3, and 6 months after), and Multi-slice computerized tomography or conventional coronary angiography was performed at least one year after closure. Results In a median follow-up of 5.5 years (range 13 months to 8 years), retrogradely closed fistula had no residual, and the fistula tract was wholly occluded, but in most anterogradely closed fistula, had a small residual, which made the fistula tract open and need additional coil closure. Conclusions Transcatheter closure of CAF with PFM coil is feasible and effective with low mortality and morbidity, although antegrade closure with this device may be accompanied by residual shunt and need for multiple coil insertion.

Anemia increases long-term mortality in patients undergoing conventional coronary angiography – the ECAT registry

Background Anemia is a frequent comorbidity in patients with coronary artery disease (CAD). Besides a complemental effect on myocardial oxygen undersupply of CAD and anemia, available data suggests that it may independently impact the prognosis in CAD patients. We aimed to determine the association of anemia with long-term survival in a longitudinal registry of patients undergoing conventional coronary angiography. Methods The present analysis is based on the ECAD registry of patients undergoing conventional coronary angiography at the Department of Cardiology and Vascular Medicine at the University Clinic Essen between 2004 and 2019. For this analysis, we excluded all patients with missing hemoglobin levels at baseline admission or missing follow-up information. Anemia was defined as a hemoglobin level of &lt;13.0g/dl for male and &lt;12.0g/dl for female patients according to the world health organization's definition. Cox regression analysis was used to determine the association of anemia with morality, stratifying by clinical presentation of patients. Hazard ratio and 95% confidence interval are depicted for presence vs. absence of anemia. Results Overall, data from 28,917 patient admissions (mean age: 65.3±13.2 years, 69% male) were included in our analysis (22,570 patients without and 6,347 patients with anemia). Prevalence of anemia increased by age group (age &lt;50 years: 16.0%, age ≥80 years: 27.7%). During a mean follow-up of 3.2±3.4 years, 4,792 deaths of any cause occurred (16.6%). In patients with anemia, mortality was relevantly higher as compared to patients without anemia (13.4% vs. 28.0% for patients without and with anemia, respectively, p&lt;0.0001, figure 1). In univariate regression analysis, anemia was associated with 2.4-fold increased mortality risk (2.27–2.55, p&lt;0.0001). Effect sizes remained stable upon adjustment for traditional risk factors (2.38 [2.18–2.61], p&lt;0.0001). Mortality risk accountable to anemia was significantly higher for patients receiving coronary interventions (2.62 [2.35–2.92], p&lt;0.0001) as compared to purely diagnostic coronary angiography examinations (2.31 [2.15–2.47], p&lt;0.0001). Likewise, survival probability was slightly worse for patients with anemia in acute coronary syndrome (2.70 [2.29–3.12], p&lt;0.0001) compared to chronic coronary syndrome (2.60 [2.17–3.12], p&lt;0.0001). Interestingly, within the ACS entity, association of anemia with mortality was relevantly lower in STEMI patients (1.64 [1.10–2.44], p=0.014) as compared to NSTEMI and IAP (NSTEMI: 2.68 [2.09–3.44], p&lt;0.0001; IAP: 2.67 [2.06–3.47], p&lt;0.0001). Conclusion In this large registry of patients undergoing conventional coronary angiography, anemia was a frequent comorbidity. Anemia relevantly influences log-term survival, especially in patients receiving percutaneous coronary interventions. Our results confirm the important role of anemia for prognosis in patients with coronary artery disease, demonstrating the need for specific treatment options. Figure 1. Kaplan Meier analysis Funding Acknowledgement Type of funding source: None

Graft Patency Rate and Risk Factors for Graft Failure among Symptomatic Post Coronary Artery Bypass Graft Surgery Patients

BACKGROUND Malaysia, a multiracial country, has been burdened by ischemic heart disease, the leading cause of death for the past 10 years. The success of coronary artery bypass grafting surgery (CABG) particularly depends on the continued patency of aortocoronary grafts. The study aims to identify the graft patency rate and risk factors of graft failure among symptomatic post CABG patients. METHODS Data were collected from 80 patients with a history of CABG, who underwent conventional coronary angiography for refractory angina in Hospital Sultanah Aminah Johor, Malaysia from January 2014 till December 2018. The graft patency was evaluated with conventional coronary angiography. Graft patency was assessed with the Kaplan-Meier method. Differences between graft patency were tested with log-rank test at a 5% significance level and result with p-value <0.05 was considered statistically significant. RESULTS Among the 80 post CABG patients with cardiac symptoms, there were 2 patients with acute myocardial infarction (2.5%) and 24 patients with NSTEMI (30%). 22 patients (27.5%) were found to have all grafts patent despite being persistently symptomatic. Left internal mammary arterial (LIMA) graft remained as the best conduit with a significantly better short, medium, and long term patency (up to 20 years) compared to SVG graft (Log-rank test, p-value < 0.05). Indian race and age less than 70 years had higher risk of SVG graft stenosis. CONCLUSION Type of conduits remains the most important factor in determining the coronary artery bypass graft patency, with LIMA produces the best patency rate in both short and long term.