Ahmed Alsaileek

Cardiac computed tomography in current cardiology guidelines.

Practice guidelines issued by professional societies significantly impact cardiology practice throughout the world. They increasingly incorporate cardiac CT imaging. This review systematically analyzes clinical practice guidelines issued by the American College of Cardiology Foundation (ACCF)/American Heart Association (AHA) and the European Society of Cardiology (ESC) as well as the multi-societal appropriateness criteria in their latest versions as of September 1st, 2015, in order to identify the extent to which they include recommendations to use cardiac CT in specific clinical situations.

Intracoronary Reopro during Percutaneous Coronary Intervention in Acute and Stable Patient can Influence Stent Thrombosis Formation (IRPASST) Study.

Background: In patients with acute myocardial infarction or unstable angina undergoing coronary angioplasty, abciximab reduces major adverse cardiac events (MACE). Most clinical trials have studied mainly intravenous administration. Intracoronary (IC) bolus application of abciximab causes very high local drug concentrations and may be more effective in reducing acute and sub-acute stent thrombosis (ST). We studied whether IC bolus administration of abciximab is associated with a reduced ST and target vessels revascularization (TVR); therefore, less MACE rate compared with the standard intravenous IV bolus and infusion application. Materials and Methods: This was a single-center observational study conducted between June 2007 and 2009. We studied a total of 447 patients admitted with either acute coronary intervention (PCI) and stenting. Patients with bleeding disorder, recent major surgery and high blood pressure were excluded. Patients were divided into two groups: Group I (n = 199) patient received IC bolus of abciximab (reopro) 0.25 μg/kg during the PCI in cath lab. Group II (n = 248) received the standard dose of reopro-a bolus intravenous 0.25 μg/kg and maintenance dose of 0.125 μg/kg over 12 h. Results: There were no differences between the groups with regard to diabetes mellitus, group I (56%) vs. group II (58%), P = 0.613; ACS, group I (38%) vs. group II (44%), P = 0.175; Dietthylstilbestrol Drug eluted stent (DES) in group I (66.5%) vs. (57.6%) group II, P = 0.056; Bare Metal Stent (BMS) in group I (33%) vs. (40.7%) group II, P=0.093; target vessel revascularization (TRV) was seen in 9 patients (4%) in group I vs. 16 patients (6%) in group II. ST elevation was seen in 4 patients (2%) in group I vs. 7 patients (2.8%) in group II, all presented with STEMI. Conclusion: In this study, there was a trend toward less ST and TVR in patients who received IC reopro vs. intravenous route both in ACS and stable CAD. The percentage of DM was high in both groups (56%), especially in Saudi patients. In-stent restenosis (ISR) was less in group I than in group II, this was mainly associated with BMS usage. The percentage of BMS was more than 30% in both groups, either due to STEMI cases or large vessel size. Randomized controlled trials are warranted to further assess IC application of abciximab in reducing ST.

INCREMENTAL PROGNOSTIC VALUE OF CORONARY CALCIUM SCORING IN PATIENTS UNDERGOING 82-RUBIDIUM MYOCARDIAL PERFUSION IMAGING

Introduction: Coronary artery calcium (CAC) score and hyperaemic myocardial blood flow (HMBF) have been associated with clinical outcomes. The aim of this analysis is to determine the incremental prognostic value of CAC over HMBF in the prediction of cardiac events. Methods: A total of 2,060

Temporal trends in the referral pattern to and yield of cardiac MRI: an analysis from Saudia Arabia

Results A total of 1,581 patients (38% females) were included. In first few years of the initiation of the service, most patients were referred for assessment of viability (54%) followed by assessment of etiology of cardiomyopathy (19%). However, in the subsequent years, viability referrals decreased and there was a steady increase in other indications (assessment of LV function, arrhythmias, cardiac masses, congenital heart disease,..etc.) (figure). Referral to stress MRI continued to be very low (less than 1%). 46% of the reoffered patients had an ejection fraction less than 50% and 42% of the patients had evidence of myocardial delayed enhancement.

The reproducibility of coronary artery calcium scoring on different software platforms

Coronary Artery Calcium Score (CACS) is commonly used to risk-stratify asymptomatic patients with intermediate risk for coronary ar-tery disease (CAD) [1] and in patients in whom treatment decisionsare still uncertain. Coronary artery calcium is usually assessed via anon-contrast electrocardiographic (ECG) gated study and quantifiedusing a score developed by Agatston et al. [2] The score is based onthe volume and density of calcium deposits and the X-ray attenuationcoefficient. The CACS has been shown in many studies to predict out-comes [3–5]. However, there is scarce data documenting the reproduc-ibility of CACS using different software platforms. Thus, the aim of thisanalysis is to evaluate the reproducibility of CACS using two differentcommercial softwares.A total of 159 clinically indicated patients who underwent CACSusing a 64-slice multi-detector computed tomography (CT) system(General Electric VCT Milwaukee, WI) with non-enhanced prospectiveECG gating were included. The CT scan parameters were as follows:tube voltage of 120 kV, tube current of 200 mAs, rotation time of400 ms, and collimation of 0.4 mm. The examination was performedin a cranio-caudal direction during deep inspiratory breath holding.All images were reconstructed in 3 mm slice thickness. The data setswere evaluated using two different commercially available softwares:software A (4DM Calcium score, INVIA, Ann Arbor, MI) and software B(Smart score, General Electric, Milwaukee, WI). Two, blinded indepen-dent and experienced readers evaluated each dataset. Each softwaredetected coronary arterial calcifications based on a threshold of 130Hounsfield units. The resultant calcium scores were divided into differ-ent groups (i.e. 0, 1–9, 10–99, 100–399, ≥400), as previously described[4]. The correlation between the different CACS was performed usingSpearman rank correlation. In addition, Bland–Altman plots were usedto evaluate the reproducibility CACS score.Almost half of the included patients were females (51%). The meanage was 62 ± 12 years old. Diabetes mellitus, hypertension and dyslip-idemia were highly prevalent in the study population (52%, 91% and88%, respectively). The mean heart rate at the scan time was 68 ± 9beats per minute, while the mean body mass index was 29 ± 6 kg/m