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Prognostic value of dual-source computed tomography (DSCT) angiography characteristics in anomalous coronary artery from the opposite sinus (ACAOS) patients: a large-scale retrospective study.

ABSTRACT: BACKGROUND:Most reported cases of right anomalous coronary artery from the opposite sinus (R-ACAOS) have benign clinical outcomes. However, patients with left ACAOS (L-ACAOS) and some of the patients with R-ACAOS are more at risk for arrhythmias and sudden cardiac death, which remains a major concern. Here we report the prevalence and anatomical features of ACAOS patients. Moreover, we explore the high-risk morphological signs and evaluate their mid-term prognostic value in R-ACAOS patients without surgical intervention. METHODS:Data from coronary computed tomography angiography (CTA) of 30,593 patients, pertaining to a single center over 5 consecutive years, were retrospectively analyzed. The image analysis included stenosis severity ranking and high-risk anatomy evaluation, based on the commercially available image post-processing software OsirX. Patients with R-ACAOS and without evidence of coronary atherosclerosis (CAD) were followed-up, with recording of the cardiovascular clinical events. Cox regression analysis was performed to identify the potential anatomical risk factors of cardiovascular clinical events for non-CAD R-ACAOS patients, using R project. RESULTS:The prevalence of ACAOS in the study population was 0.69% (211/30593). Significant differences were found between patients with mild (?50%) stenosis, in terms of height-to-weight ratio (HW ratio), take-off angle, and proximal stenosis length. A total of 54 cardiovascular clinical events were observed among 108 non-CAD R-ACAOS patients and an average follow-up of 27.8?±?18.7?months. Among those patients' anatomical features, stenosis severity was the main risk factor for cardiovascular clinical events during the mid-term follow-up, with a risk ratio of 4.14 (95% CI: 1.78 to 9.63, P?

SUBMITTER: Diao KY

PROVIDER: S-EPMC6966895 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Project description:The objective of the present study was to evaluate image quality and radiation dosage using a low-dose prospectively electrocardiogram (ECG)-gated computed tomography (CT) protocol for dual-source angiography in children with complex congenital heart disease. A total of 206 patients with complex congenital heart disease were equally assigned into two groups at random. The children in group A underwent low-dose retrospective ECG-gated CT scanning with an ECG-pulsing technique, and group B underwent prospective ECG-gated scanning with an ECG-pulsing technique. Radiation dose volume computed tomography dose index (CTDI vol), dose length product (DLP) and effective dose (ED) were recorded after scanning. Raw data were transferred to workstations for post-processing, diagnosis, grading, comparison with intra-operation findings or cardiac catheterisation, and the coincidence, false negative rate and misdiagnosis rates of groups A and B, respectively, were subsequently recorded. The results of the present study indicated that the height, age and weight of the children in the two groups exhibited no significant differences. The image quality of group A was graded as 3.94±0.08, whereas the grade for the image quality in group B was 4.05±0.08; no significant difference was detected. The coincidence rates of groups A and B were 89.37 and 88.48%, respectively; the false negative rates of groups A and B were 9.66 and 10.60%, respectively; the misdiagnosis rates of groups A and B were 0.97 and 0.92%. No significant differences between the two groups were detected. The CTDI value of group A was 3.24±1.62 mGy, the DLP value was 47.53±33.28 mGy·cm2, the ED value was 0.93±0.42 mSv. By contrast, the CTDI value of group B was 2.27±0.94 mGy, the DLP value was (27.03±17.64) mGy·cm2, and the ED value was 0.53±0.23 mSv. Significant differences were detected between the two groups (CTDI t=5.287, P<0.05; DLP t=5.523, P<0.05; ED t=8.497, P<0.05), and the radiation dose of group B was markedly decreased, compared with group A. In conclusion, the present study demonstrated that prospectively ECG-gated scanning of dual-source CT is an effective method of examination for dose reduction in children with congenital heart disease without impairment of image quality, which suggests that this protocol may be suitable for future application and dissemination.

Project description:AimsCoronary computed tomography angiography (CTA) has emerged as a non-invasive diagnostic method for patients with suspected coronary artery disease, but its usefulness in patients with complex coronary artery disease remains to be investigated. The present study sought to determine the agreement between separate heart teams on treatment decision-making based on either coronary CTA or conventional angiography.Methods and resultsSeparate heart teams composed of an interventional cardiologist, a cardiac surgeon, and a radiologist were randomized to assess the coronary artery disease with either coronary CTA or conventional angiography in patients with de novo left main or three-vessel coronary artery disease. Each heart team, blinded for the other imaging modality, quantified the anatomical complexity using the SYNTAX score and integrated clinical information using the SYNTAX Score II to provide a treatment recommendations based on mortality prediction at 4 years: coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or equipoise between CABG and PCI. The primary endpoint was the agreement between heart teams on the revascularization strategy. The secondary endpoint was the impact of fractional flow reserve derived from coronary CTA (FFRCT) on treatment decision and procedural planning. Overall, 223 patients were included. A treatment recommendation of CABG was made in 28% of the cases with coronary CTA and in 26% with conventional angiography. The agreement concerning treatment decision between coronary CTA and conventional angiography was high (Cohen's kappa 0.82, 95% confidence interval 0.74-0.91). The heart teams agreed on the coronary segments to be revascularized in 80% of the cases. FFRCT was available for 869/1108 lesions (196/223 patients). Fractional flow reserve derived from coronary CTA changed the treatment decision in 7% of the patients.ConclusionIn patients with left main or three-vessel coronary artery disease, a heart team treatment decision-making based on coronary CTA showed high agreement with the decision derived from conventional coronary angiography suggesting the potential feasibility of a treatment decision-making and planning based solely on this non-invasive imaging modality and clinical information.Trial registration numberNCT02813473.

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Prognostic value of dual-source computed tomography (DSCT) angiography characteristics in anomalous coronary artery from the opposite sinus (ACAOS) patients: a large-scale retrospective study.

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