This scientific statement reviews the scientific data for cardiac computed tomography (CT) related to imaging of coronary artery disease (CAD) and atherosclerosis. Cardiac CT is a CT imaging technique that accounts for cardiac motion, typically through the use of ECG gating. The utility and limitations of generations of cardiac CT systems are reviewed in this statement with emphasis on CT measurement of CAD and coronary artery calcified plaque (CACP) and noncalcified plaque. Successive generations of CT technology have been applied to cardiac imaging beginning in the early 1980s with conventional CT, electron beam CT (EBCT) in 1987, and multidetector CT (MDCT) in 1999. Compared with other imaging modalities, cardiac CT has undergone an accelerated …

/pdf/assessment-of-coronary-artery-disease-by-cardiac-computed-2wtsac0gh8.pdf

Assessment of coronary artery disease by cardiac computed tomography : A scientific statement from the american heart association committee on cardiovascular imaging and intervention, council on cardiovascular radiology and intervention, and committee on cardiac imaging, council on clinical cardiology

background Calcific aortic stenosis has many characteristics in common with atherosclerosis, including hypercholesterolemia. We hypothesized that intensive lipid-lowering therapy would halt the progression of calcific aortic stenosis or induce its regression. methods In this double-blind, placebo-controlled trial, patients with calcific aortic stenosis were randomly assigned to receive either 80 mg of atorvastatin daily or a matched placebo. Aortic-valve stenosis and calcification were assessed with the use of Doppler echocardiography and helical computed tomography, respectively. The primary end points were change in aortic-jet velocity and aortic-valve calcium score. results Seventy-seven patients were assigned to atorvastatin and 78 to placebo, with a median follow-up of 25 months (range, 7 to 36). Serum low-density lipoprotein cholesterol concentrations remained at 130±30 mg per deciliter in the placebo group and fell to 63±23 mg per deciliter in the atorvastatin group (P<0.001). Increases in aortic-jet velocity were 0.199±0.210 m per second per year in the atorvastatin group and 0.203±0.208 m per second per year in the placebo group (P=0.95; adjusted mean difference, 0.002; 95 percent confidence interval, i0.066 to 0.070 m per second per year). Progression in valvular calcification was 22.3±21.0 percent per year in the atorvastatin group, and 21.7±19.8 percent per year in the placebo group (P=0.93; ratio of posttreatment aortic-valve calcium score, 0.998; 95 percent confidence interval, 0.947 to 1.050). conclusions Intensive lipid-lowering therapy does not halt the progression of calcific aortic stenosis or induce its regression. This study cannot exclude a small reduction in the rate of disease progression or a significant reduction in major clinical end points. Long-term, large-scale, randomized, controlled trials are needed to establish the role of statin therapy in patients with calcific aortic stenosis.

https://www.nejm.org/doi/pdf/10.1056/NEJMoa043876

A randomized trial of intensive lipid-lowering therapy in calcific aortic stenosis.

Accuracy of 64-slice computed tomography to classify and quantify plaque volumes in the proximal coronary system: a comparative study using intravascular ultrasound.

Accuracy of multidetector spiral computed tomography in identifying and differentiating the composition of coronary atherosclerotic plaques. A comparative study with intracoronary ultrasound

As a consequence of improved technology, there is growing clinical interest in the use of multi-detector row computed tomography (MDCT) for non-invasive coronary angiography. Indeed, the accuracy of MDCT to detect or exclude coronary artery stenoses has been high in many published studies. This report of a Writing Group deployed by the Working Group Nuclear Cardiology and Cardiac CT (WG 5) of the European Society of Cardiology and the European Council of Nuclear Cardiology summarizes the present state of cardiac CT technology, as well as the currently available data concerning its accuracy and applicability in certain clinical situations. Besides coronary CT angiography, the use of CT for the assessment of cardiac morphology and function, evaluation of perfusion and viability, and analysis of heart valves is discussed. In addition, recommendations for clinical applications of cardiac CT imaging are given and limitations of the technique are described.

https://www.zora.uzh.ch/id/eprint/14228/4/Schroeder_EuropHeartJourn_2008V.pdf

Cardiac computed tomography: Indications, applications, limitations, and training requirements - Report of a Writing Group deployed by the Working Group Nuclear Cardiology and Cardiac CT of the European Society of Cardiology and the European Council of Nuclear Cardiology

Background— Coronary calcification measured by fast computed tomography techniques is a surrogate marker of coronary atherosclerotic plaque burden In a cohort study, we prospectively investigated whether lipid-lowering therapy with a cholesterol synthesis enzyme inhibitor reduces the progression of coronary calcification Methods and Results— In 66 patients with coronary calcifications in electron beam tomography (EBT), LDL cholesterol >130 mg/dL, and no lipid-lowering treatment, the EBT scan was repeated after a mean interval of 14 months and treatment with cerivastatin was initiated (03 mg/d) After 12 months of treatment, a third EBT scan was performed Coronary calcifications were quantified using a volumetric score Cerivastatin therapy lowered the mean LDL cholesterol level from 164±30 to 107±21 mg/dL The median calcified volume was 155 mm3 (range, 15 to 1849) at baseline, 201 mm3 (19 to 2486) after 14 months without treatment, and 203 mm3 (15 to 2569) after 12 months of cerivastatin treatment T

Influence of Lipid-Lowering Therapy on the Progression of Coronary Artery Calcification: A Prospective Evaluation

An aberrant origin of the left main coronary artery (LM) or left anterior descending coronary artery (LAD) from the right sinus of Valsalva is a rare anomaly that has been associated with myocardial ischemia and sudden cardiac death. Depending on the anatomic relationship of the anomalous vessel to the aorta and the pulmonary trunk, the anomaly can be classified into 4 common courses: posterior, interarterial, anterior, and septal course. Contrast-enhanced electron beam tomography (EBT) has been shown to permit classification of anomalous coronary arteries. We present 4 cases that illustrate the common variations of this anomaly. In all cases, EBT was performed using a C-150 XP EBT scanner (Imatron Inc). During inspiratory breathhold, 40 to 50 axial cross-sections of the heart were acquired triggered to the ECG at 40% of the R-R interval (100 ms acquisition time, slice thickness 3 mm, table feed 2 mm, intravenous injection of 160 mL contrast agent …

Anomalous Course of the Left Main or Left Anterior Descending Coronary Artery Originating From the Right Sinus of Valsalva

Hintergrund: Die kathetervermittelte Therapie degenerierter aortokoronarer Venenbypasse ist haufig mit einer periinterventionellen Embolisation von Thromben, Plaqueartikeln und atherosklerotischem Debris verbunden. Fallbeschreibung: Ein 66-jahriger mannlicher Patient mit operativer Myokardrevaskularisation 1995 wurde aufgrund eines akuten koronaren Ischamiesyndroms in unsere Abteilung stationar eingewiesen. Unter einer antiischamischen Kombinationstherapie konnte eine klinische Stabilisierung erzielt werden. In einer elektiven Koronarangiographie stellten sich zwei kritische Stenosen im Venengraft zum Ramus interventricularis anterior (RIVA) als klinisch fuhrende Lasionen heraus. Nach einer 24-stundigen Vorbehandlung mit einem Glykoprotein-IIb/IIIa-Inhibitor wurden im Bereich der distalen Stenose ein Stentgraft (Jostent™, Jomed) und im Bereich der proximalen Stenose ein Magic Wallstent™ (Boston Scientific) implantiert. Nach einer Hochdruckdilatation im Magic Wallstent™ verblieb keinerlei residuelle Stenose. Im weiteren Verlauf klagte der Patient uber heftige Stenokardien, die mit ausgepragten ST-Hebungen uber den linksprakordialen Ableitungen einhergingen. Angiographisch war der RIVA nach der koronaren Bypassanastomose okkludiert. Nach Einfuhren eines X-Sizer™-Absaugsystems (EndiCOR Medical, Inc.) in den Venengraft und das proximale Drittel der Vorderwandarterie konnte nach mehrfacher Aspiration eine komplette Reperfusion des RIVA wiederhergestellt werden. Die maximale CK-Aktivitat betrug postinterventionell 127 U/l. In einer Kontrollkoronarangiographie nach 7 Tagen war der RIVA weiterhin perfundiert. Schlussfolgerung: Das X-Sizer™-Absaugsystem erscheint als eine erfolgversprechende Therapieoption zur perkutanen transluminalen Thrombektomie bei stattgehabter Makroembolisation mit No-Reflow-Phanomen bei Katheterinterventionen in degenerierten Venenbypassen.

Rescue-Thrombektomie nach Stentimplantation in einem degenerierten aortokoronaren Venenbypass

Electron beam tomography permits to noninvasively rule out coronary artery stenoses in patients scheduled for noncoronary cardiac surgery

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Influence of Lipid-Lowering Therapy on the Progression of Coronary Artery Calcification: A Prospective Evaluation

Anomalous Course of the Left Main or Left Anterior Descending Coronary Artery Originating From the Right Sinus of Valsalva

Rescue-Thrombektomie nach Stentimplantation in einem degenerierten aortokoronaren Venenbypass

Electron beam tomography permits to noninvasively rule out coronary artery stenoses in patients scheduled for noncoronary cardiac surgery