Kentaro Kakuta

Detection of Coronary Artery Disease Using Coronary Flow Velocity Reserve by Transthoracic Doppler Echocardiography versus Multidetector Computed Tomography Coronary Angiography: Influence of Calcium Score

BACKGROUND There have been no clinical data specifying the degree of calcium deposition at which coronary flow velocity reserve (CFVR) measurement using transthoracic Doppler echocardiography surpasses 320-row multidetector computed tomographic coronary angiography (CTCA) in detecting obstructive coronary artery disease. METHODS One hundred seventy patients who underwent invasive coronary angiography, transthoracic Doppler echocardiography, and CTCA were prospectively enrolled. Coronary artery stenosis was defined as percentage diameter stenosis ≥ 50% on invasive coronary angiography. CFVR < 2.0 and narrowing ≥ 50% measured with CTCA were the thresholds indicating the presence of coronary artery stenosis. The degree of coronary artery calcification was also assessed using the Agatston calcium score method by computed tomography. RESULTS The majority of patients (89%) were classified as having either high or intermediate pretest probability of coronary artery disease. Significant coronary artery stenoses by invasive coronary angiography were found in 71 patients and 104 vessels. Although the overall diagnostic performance of CTCA was comparable with that of CFVR measurement for detecting coronary artery stenosis, only the diagnostic performance of CTCA was negatively affected by the extent of a patients coronary artery calcification. Receiver operating characteristic curve analysis indicated that only CFVR measurement is diagnostically accurate when calcium scores are >319 in the patient-based assessment, 189 for the left anterior descending coronary artery, 98 for the left circumflex coronary artery and 282 for the right coronary artery. CONCLUSIONS Transthoracic Doppler echocardiography and 320-row multidetector CTCA successfully diagnosed significant coronary artery stenosis with high feasibility and accuracy. However, only the diagnostic performance of CTCA was negatively affected by the extent of a patients coronary artery calcification, and therefore the diagnostic performance of CFVR measurement for detecting coronary artery stenosis surpassed that of CTCA when the calcium score exceeded specified cutoff values.

Comparison of coronary flow velocity reserve measurement by transthoracic Doppler echocardiography with 320-row multidetector computed tomographic coronary angiography in the detection of in-stent restenosis in the three major coronary arteries.

We sought to compare the diagnostic accuracy and feasibility of coronary flow velocity reserve (CFVR) measurement using transthoracic Doppler echocardiography (TTDE) and 320-row multidetector computed tomographic coronary angiography (CTCA) for predicting in-stent restenosis (ISR). We enrolled 126 consecutive patients with 309 implanted coronary stents in the 3 major coronary arteries. TTDE and CTCA were performed within the 2-week period before follow-up invasive coronary angiography. Binary ISR was defined as percent diameter stenosis ≥50% on invasive coronary angiogram. A CFVR <2.0 using TTDE and a narrowing of ≥50% measured with CTCA were the thresholds indicating the presence of binary ISR. Presence of ISR using invasive coronary angiography was observed in 26 (8%) stents and 26 (14%) vessels. Feasibilities of CFVR measurement and CTCA for predicting ISR in the 3 major vessels were 94% and 91%, respectively. A CFVR <2.0 revealed a 95% diagnostic accuracy with sensitivity of 87%, specificity of 96%, positive predictive value of 77%, and negative predictive value of 98%. Diagnostic accuracy of CTCA was comparable to that of CFVR measurement; however, CTC angiographic results were confounded by metal artifacts in the assessment of small-diameter stents. In conclusion, noninvasive CFVR measurement has high feasibility and accuracy for predicting ISR and is comparable to 320-row CTCA.

CORONARY MICROVASCULAR DYSFUNCTION AND CORONARY ARTERY CALCIFICATION IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS, SYSTEMIC SCLEROSIS, AND RHEUMATOID ARTHRITIS

We aimed to detect the disease-related differences in the prevalence and severity of coronary microvascular dysfunction (CMD) and coronary artery calcification among patients with different types of chronic inflammatory disease including systemic lupus erythematosus (SLE), systemic sclerosis (SSc)

Assessment of coronary artery disease based on coronary flow velocity reserve by transthoracic Doppler echocardiography and coronary computed tomography angiography in a patient with dextrocardia: a case report

A 71-year-old female patient with dextrocardia was referred to our hospital for close examination of atypical chest pain. On chest X-ray radiography, dextrocardia with an increased cardiothoracic ratio were observed (Fig. 1a). On right 12-lead electrocardiography, borderline ST elevation was detected on II, III, and aVF. On coronary computed tomography angiography (CCTA), no stenosis was detected in the left anterior descending coronary artery or left circumflex coronary artery despite the presence of eccentric calcified lesions, but the degree of lumen stenosis could not be assessed in the right coronary artery (RCA) because of artifacts generated by severely calcified lesions (Fig. 1b). The posterior descending artery of the RCA was visualized using transthoracic Doppler echocardiography (TTDE), and then the coronary flow velocity reserve (CFVR) was 2.49, suggesting less than 50% stenosis (Fig. 1c–e). Finally, invasive coronary angiography (ICA) was performed, and the degree of stenosis of the RCA was less than 50% (Fig. 1f). Discussion

Echocardiographic Assessment of Cardiac Structural and Functional Abnormalities in Patients With End-Stage Renal Disease Receiving Chronic Hemodialysis

BACKGROUND The aim of this study was to assess the echocardiographic characteristics of chronic hemodialysis (HD) patients with end-stage renal disease (ESRD) in a multicenter prospective cohort study.Methods and Results:Three hundred and fifteen patients with ESRD (67.9±10.6 years, 47.6% male) on chronic HD for ≥1 year were examined on transthoracic echocardiography, including Doppler-derived aortic valve area (AVA) measurement. Only 11.5% and 3.4% of all patients had normal left ventricular (LV) geometry and normal LV filling pattern, respectively. The majority of patients had aortic and mitral valvular calcification, and approximately 50% of all 315 patients had aortic valve narrowing with AVA <2.0 cm2. Patients were divided into 3 groups according to AVA index tertile: group 1, highest tertile; group 2, middle tertile; and group 3, lowest tertile. Group 3 was older, had a greater cardiothoracic ratio on chest X-ray, higher plasma brain natriuretic peptide and total LV afterload, and lower stroke volume index than the other 2 groups. Age and intact parathyroid hormone (PTH) level were independently associated with low AVA index. CONCLUSIONS Patients with ESRD on chronic HD have a high prevalence of cardiac structural and functional abnormalities including calcified aortic sclerosis. High age and PTH were associated with aortic valve narrowing in these patients.