Clinical Outcomes of Dynamic Computed Tomography Myocardial Perfusion Imaging Combined With Coronary Computed Tomography Angiography Versus Coronary Computed Tomography Angiography-Guided Strategy.
- 作者列表："Yu M","Shen C","Dai X","Lu Z","Wang Y","Lu B","Zhang J
BACKGROUND:Dynamic computed tomography (CT) myocardial perfusion imaging (MPI) provides quantitative myocardial blood flow for the precise assessment of myocardial ischemia. However, compared with coronary CT angiography (CCTA), whether this functional imaging modality can reduce invasive coronary angiography without revascularization remains unknown. We aimed to determine the clinical outcomes of a dynamic CT-MPI+CCTA-guided versus CCTA-guided strategy in patients with suspected coronary artery disease. METHODS:Consecutive patients with intermediate pretest probability of coronary artery disease were prospectively enrolled and randomized to dynamic CT-MPI+CCTA-guided or CCTA-guided workup. The primary end point was the rate of invasive coronary angiography without revascularization within 3 months. The secondary end point was a composite of major adverse cardiac event at the 3-month, 6-month, and 1-year follow-up. RESULTS:A total of 240 patients (mean age, 69.01±11.2 years; 173 men) were included. The total radiation dose and contrast media usage within 90 days were higher in the CT-MPI+CCTA group than in the CCTA group (10.3 versus 7.1 mSv, P=0.031; 134.5±40.6 versus 108.1±48.2 mL, P<0.0001). Compared with the CCTA-guided group, the CT-MPI+CCTA-guided group had significantly lower rates of invasive coronary angiography within 90 days (48.3% [58/120] versus 30.8% [37/120], P=0.006) and invasive coronary angiography without revascularization (50.0% [29/58] versus 10.8% [4/37], P<0.0001). There were no significant differences regarding the frequency of major adverse cardiac event between the 2 groups at the 3-month, 6-month, and 1-year follow-up. CONCLUSIONS:In patients with intermediate pretest probability of coronary artery disease, CT-MPI+CCTA-guided patient management may be preferred over the CCTA-guided strategy as an approach to reduce unnecessary invasive procedures.
背景: 动态计算机断层扫描 (CT) 心肌灌注成像 (MPI) 为精确评估心肌缺血提供了定量的心肌血流。然而，与冠状动脉CT血管造影术 (CCTA) 相比，这种功能成像模式是否可以减少侵入性冠状动脉造影而不进行血运重建仍然是未知的。我们的目的是确定动态CT-MPI + CCTA引导与CCTA引导策略在疑似冠心病患者中的临床结局。 方法: 前瞻性纳入具有中等预试验概率的冠状动脉疾病的连续患者，并随机分为动态CT-MPI + CCTA引导或CCTA引导检查。主要终点是3个月内无血运重建的有创冠状动脉造影率。次要终点是3个月、6个月和1年随访时的主要心脏不良事件的复合终点。 结果: 共纳入240例患者 (平均年龄，69.01 ± 11.2岁; 173例男性)。Ct-mpi + CCTA组90天内的总辐射剂量和造影剂使用量高于CCTA组 (10.3 vs 7.1 mSv，P = 0.031; 134.5 ± 40.6 vs 108.1 ± 48.2 mL，P<0.0001)。与CCTA引导组相比，ct-mpi + CCTA引导组在90天内有创冠状动脉造影率显著降低 (48.3% [58/120] 比30.8% [37/120]，P = 0.006)，无血运重建的有创冠状动脉造影率显著降低 (50.0% [29/58] 比10.8% [4/37]，P<0.0001)。在3个月、6个月和1年随访时，两组之间主要心脏不良事件的频率没有显著差异。 结论: 在具有中等冠状动脉疾病预检查概率的患者中，CT-MPI + CCTA指导的患者管理可能优于CCTA指导的策略，作为减少不必要的侵入性操作的方法。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.