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Journal ArticleDOI

Evaluation of coronary allograft vasculopathy using multi-detector row computed tomography: a systematic review.

01 Feb 2012-European Journal of Cardio-Thoracic Surgery (Oxford University Press)-Vol. 41, Iss: 2, pp 415-422
TL;DR: The high sensitivity and NPV of MDCT suggest that it may be a useful, noninvasive screening tool to rule out CAV.
Abstract: Summary Coronary allograft vasculopathy (CAV) is a significant cause of morbidity and mortality after cardiac transplantation and requires frequent surveillance with catheter-based coronary angiography (CCA). Multi-detector row computed tomography (MDCT) has been shown to be effective in assessing atherosclerosis in native coronary arteries. This article systematically reviews the literature to determine the accuracy of MDCT in CAVassessment. An English-language literature search was performed using EMBASE, OVID, PubMed, and Cochrane Library databases. Studies that directly compared MDCTwith CCA and/or IVUS for the detection of coronary artery stenosis or significant intimal thickening in cardiac transplant patients were analyzed. Data were pooled to obtain weighted sensitivities, specificities, and diagnostic accuracies. Negative and positive predictive values (NPV/PPV) were calculated. A total of seven studies with a sum of 272 patients were included in this review. There were three studies examining 16-slice MDCTand four studies looking at 64-slice MDCT in CAV. Using per-segment analysis, MDCTassessed between 91% and 96% of all coronary segments when evaluating for stenosis. Pooled estimates for sensitivity and specificity for MDCTranged from 82% to 89% and 89% to 99%, respectively, while NPV was 99%. Per-patient analysis revealed a sensitivity of 87—100% and NPV of 96—100%. PPV was less than 50% for 64slice MDCT in both per-segment and per-patient analysis. When compared with IVUS, MDCT had a sensitivity of 74—96% and specificity of 88—92% in assessment of intimal thickening. NPVand PPV were 80—81% and 84—98%, respectively. The high sensitivity and NPV of MDCTsuggest that it may be a useful, noninvasive screening tool to rule out CAV. # 2011 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

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Citations
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Journal ArticleDOI
TL;DR: CCTA using currently available technology is a reliable noninvasive imaging alternative to coronary angiography with an excellent sensitivity, specificity, and NPV for the detection of CAV.

112 citations

Journal ArticleDOI
TL;DR: The purpose of this guideline is to assist clinicians and other health professionals in the use of cardiac CT for diagnosis and treatment of heart diseases, especially in patients at high risk or suspected of heart disease.
Abstract: The development of cardiac CT has provided a non-invasive alternative to echocardiography, exercise electrocardiogram, and invasive angiography and cardiac CT continues to develop at an exponential speed even now. The appropriate use of cardiac CT may lead to improvements in the medical performances of physicians and can reduce medical costs which eventually contribute to better public health. However, until now, there has been no guideline regarding the appropriate use of cardiac CT in Korea. We intend to provide guidelines for the appropriate use of cardiac CT in heart diseases based on scientific data. The purpose of this guideline is to assist clinicians and other health professionals in the use of cardiac CT for diagnosis and treatment of heart diseases, especially in patients at high risk or suspected of heart disease.

61 citations

Journal ArticleDOI
TL;DR: It is therefore of utmost importance that interventional cardiologists become familiar with image interpretation and up-to-date regarding several CCTA features, taking advantage of this information in planning the procedure, ultimately leading to improvement in patient outcomes.
Abstract: In recent years, coronary CT angiography (CCTA) has become a widely adopted technique, not only due to its high diagnostic accuracy, but also to the fact that CCTA provides a comprehensive evaluation of the total (obstructive and non-obstructive) coronary atherosclerotic burden. More recently, this technique has become mature, with a large body of evidence addressing its prognostic validation. In addition, CT angiography has moved from the field of ‘imagers’ and clinicians and entered the interventional cardiology arena, aiding in the planning of both coronary and structural heart interventions, being transcatheter aortic valve implantation one of its most successful examples. It is therefore of utmost importance that interventional cardiologists become familiar with image interpretation and up-to-date regarding several CTA features, taking advantage of this information in planning the procedure, ultimately leading to improvement in patient outcomes. On the other hand, the increasing use of CCTA as a gatekeeper for invasive coronary angiography is expected to lead to an increase in the ratio of interventional to diagnostic procedures and significant changes in the daily cath-lab routine. In a foreseeable future, cath-labs will probably offer an invasive procedure only to patients expected to undergo an intervention, perhaps becoming in this change true interventional-labs.

15 citations

Journal ArticleDOI
TL;DR: MCP-1, RANTES, and fractalkine probably promote instability of coronary atherosclerotic plaque.
Abstract: Our aim was to investigate the role of chemokines in promoting instability of coronary atherosclerotic plaques and the underlying molecular mechanism. Coronary angiography and intravascular ultrasound (IVUS) were performed in 60 stable angina pectoris (SAP) patients and 60 unstable angina pectoris (UAP) patients. The chemotactic activity of monocytes in the 2 groups of patients was examined in Transwell chambers. High-sensitivity C-reactive protein (hs-CRP), monocyte chemoattractant protein-1 (MCP-1), regulated on activation in normal T-cell expressed and secreted (RANTES), and fractalkine in serum were examined with ELISA kits, and expression of MCP-1, RANTES, and fractalkine mRNA was examined with real-time PCR. In the SAP group, 92 plaques were detected with IVUS. In the UAP group, 96 plaques were detected with IVUS. The plaques in the UAP group were mainly lipid 51.04% (49/96) and the plaques in the SAP group were mainly fibrous 52.17% (48/92). Compared with the SAP group, the plaque burden and vascular remodeling index in the UAP group were significantly greater than in the SAP group (P<0.01). Chemotactic activity and the number of mobile monocytes in the UAP group were significantly greater than in the SAP group (P<0.01). Concentrations of hs-CRP, MCP-1, RANTES, and fractalkine in the serum of the UAP group were significantly higher than in the serum of the SAP group (P<0.05 or P<0.01), and expression of MCP-1, RANTES, and fractalkine mRNA was significantly higher than in the SAP group (P<0.05). MCP-1, RANTES, and fractalkine probably promote instability of coronary atherosclerotic plaque.

10 citations


Additional excerpts

  • ...Complications include occlusion, rupture, and hemorrhage (2,3)....

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Journal ArticleDOI
TL;DR: This work intends to provide guidelines for the appropriate use of cardiac CT in heart diseases based on scientific data to assist the clinicians and other health professionals when using cardiac CT for diagnosis and treatments of heart diseases in Korea.
Abstract: This work is supported by a Grant from National Strategic Coordiating Center for Clinical Research, Republic of Korea (A102065). Heart disease is one of the leading causes of deaths in Korea, along with malignant neoplasms and cerebrovascular diseases. The proper diagnosis and management for patients with suspected heart diseases should be warranted for the public health care. Advances in CT technology have allowed detailed images of the heart to be obtained, which enable evaluations not only of the coronary arteries but also of other cardiac structures. Currently, the latest multi-detector CT machines are widespread around Korea. The appropriate use of cardiac CT may lead to improvements of the physicians’ medical performances and to reduce medical costs which eventually contribute to promotions of public health. However, until now, there has been no guidelines regarding the appropriate use of cardiac CT in Korea. We intend to provide guidelines for the appropriate use of cardiac CT in heart diseases based on scientific data. The purpose of this guideline is to assist the clinicians and other health professionals when using cardiac CT for diagnosis and treatments of heart diseases.

7 citations

References
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Journal ArticleDOI
TL;DR: This document has been developed as a Clinical Expert Consensus Document (CECD), combining the resources of the American College of Cardiology and the Society for Cardiac Angiography and Interventions (SCA&I).

342 citations


"Evaluation of coronary allograft va..." refers background in this paper

  • ...[21] These risks may increase in the setting of repeated testing as is the standard for transplant patients [18]....

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Journal ArticleDOI
TL;DR: The mean effective dose for MSCT coronary angiography was significantly higher than that for conventionalAngiography, and operators must be aware of the radiation dose and the factors that affect it.

277 citations

Journal ArticleDOI
TL;DR: Using CTA, CAD severity, LVEF, and total plaque score seems to have prognostic and incremental value over routine clinical predictors and Cardiac CTA seems to be a promising noninvasive modality with prognostic value.

257 citations


"Evaluation of coronary allograft va..." refers background in this paper

  • ...However, in native CAD, total plaque score and CAD severity as assessed by MDCT have been shown to be predictors of major adverse cardiovascular events [33]....

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Journal ArticleDOI
TL;DR: Histologic and angiographic comparisons of the degree of luminal narrowing showed generally good correlation for high grade stenoses, and Lesions graded as having less than 25% diameter narrowing were often underestimated angiographically as compared with histologic determinations.

256 citations


"Evaluation of coronary allograft va..." refers background in this paper

  • ...and intravascular ultrasound (IVUS) [4,5] due to the absence of...

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Journal ArticleDOI
TL;DR: Rapidly progressive vasculopathy by IVUS, defined as an increase of >/=0.5 mm in intimal thickness within the first year after transplantation, is a powerful predictor of all-cause mortality, MI, and angiographic abnormalities.

255 citations


"Evaluation of coronary allograft va..." refers background in this paper

  • ...In addition to diagnosis, the presence of intimal thickening detected by IVUS also provides prognostic information regarding patient mortality and future cardiac events [31,32]....

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