The supplemental data for the paper: "Methodology of generation of CFD meshes and 4D shape reconstruction of coronary arteries from patient-specific dynamic CT" A video file (minimum play resolution is HD to see the mesh) showing the movement of the LCA throughout the heart cycle and .STL files for 10--100% (increment of 10\%) of the heart cycle phase.
Inflammatory activity is one of the potential mechanisms of spontaneous coronary artery dissection (SCAD). Recently, the pericoronary adipose tissue attenuation (PCAT) derived from CT angiography (CTA) has been established as a method for measuring vascular inflammation. We aimed to characterise the pancoronary and vessel-specific PCAT in patients with and without recent SCAD.The study comprised patients with SCAD referred to a tertiary centre between 2017 and 2022 who underwent CTA and were compared with individuals with no prior SCAD. PCAT was analysed on end-diastolic CTA reconstructions along proximal 40 mm of all major coronary vessels as well as the SCAD-related vessel. We analysed 48 patients with recent SCAD (median 6.1 (IQR 3.5-14.9) months since SCAD, 95.8% female) and 48 patients in the group without SCAD.Pancoronary PCAT was higher in patients with SCAD compared with those without SCAD (-80.6±7.9 vs -85.3 HU±6.1, p=0.002). Vessel-specific PCAT in patients with SCAD compared with patients without SCAD was higher for both the RCA (-80.9±9.5 vs -87.1±6.9 HU, p=0.001) and the LCA (-80.3±7.8 vs -83.4±7.2 HU, p=0.04). In patients with SCAD, PCAT of the SCAD-related vessel was not significantly different from averaged PCAT of unaffected vessels (-81.2±9.2 vs -80.6±7.6, p=0.74). There was no association between PCAT and the interval from SCAD to CTA.Patients with recent SCAD have higher PCAT compared with patients without SCAD, suggesting an increased perivascular inflammatory activity. This association is not restricted to the dissected vessel.
Background: The use of regadenoson in dynamic computed tomography perfusion (CTP) and magnetic resonance myocardial perfusion imaging (MR MPI) is off‑label. Aims: The study aimed to assess the safety of regadenoson with theophylline reversal during CTP and MR MPI in patients with coronary artery disease (CAD). Methods: In this prospective study, patients with 1 or more intermediate coronary artery stenoses on computed tomography angiography underwent CTP and MR MPI with 0.4 mg of regadenoson. After examinations, 200 mg of theophylline was given intravenously in 100 ml of saline. Changes in blood pressure (BP) and heart rate (HR) were repeatedly assessed. All side effects and adverse events were recorded. Results: Out of 106 examinations in 53 patients (25 females, 63.5 [8.5] years), all were diagnostic. There were no deaths, myocardial infarctions, severe arrhythmias, high‑grade atrioventricular blocks, or bronchospasms. The most common symptoms were palpitations (17%), hot flushing (8%), chest discomfort (4%), and mild dyspnea (3%). There were no differences between baseline and peak BP. There was an increase in median (interquartile range) peak HR after regadenoson as compared with baseline (MR MPI, 63 [59–75] bpm vs 93 [86–102] bpm; P < 0.001; and CTP, 65 [60–70] bpm vs 95 [86–107] bpm; P < 0.001). The hemodynamic response to regadenoson and its side effects were completely reversible by theophylline. Conclusions: Regadenoson may be a safe vasodilator for CTP and MR MPI in patients with CAD. The administration of theophylline after perfusion is safe and reverses side effects of regadenoson.
Current risk assessment concepts in ST-elevation myocardial infarction (STEMI) are suboptimal for guiding clinical management.To elaborate a composite risk management concept for STEMI, enhancing clinical decision making.1995 unselected, registry patients with STEMI treated with primary percutaneous coronary intervention (pPCI) (mean age 60.1 years, 72.1% men) were included in the study. The independent risk markers were grouped by means of factor analysis, and the appropriate hazards were identified.In-hospital death was the primary outcome, observed in 95 (4.7%) patients. Independent predictors of mortality included age, leukocytosis, hyperglycemia, tachycardia, low blood pressure, impaired renal function, Killip > 1, anemia, and history of coronary disease. The factor analysis identified two significant clusters of risk markers: 1. age-anemia- impaired renal function, interpreted as the patient-related hazard; and 2. tachycardia-Killip > 1-hyperglycemia-leukocytosis, interpreted as the event-related (hemodynamic) hazard. The hazard levels (from low to high) were defined based on the number of respective risk markers. Patient-related hazard determined outcomes most significantly within the low hemodynamic hazard group.The dissection of the global risk into the combination of patient- and event-related (hemodynamic) hazards allows comprehensive assessment and management of several, often contradictory sources of risk in STEMI. The cohort of high-risk STEMI patients despite hemodynamically trivial infarction face the most suboptimal outcomes under the current invasive management strategy.
Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): National Institute of Cardiology grant. Objectives To evaluate, whether a pre-CABG coronary computed tomography based FFR (FFR-CT) result at the site of a future anastomosis would predict the graft failure in patients undergoing CABG. Background Functional guidance of surgical coronary revascularization remains debatable. Recently FFR-CT is recognized as suitable for the diagnosis of vessel-specific ischemia. Methods In 43 patients (mean age 65.14y (± 9.91), 15 women) who had CCTA performed less than 6 months prior to the isolated CABG, follow-up CCTA were acquired >12 months post CABG procedure (at median of 903[IQR:468–1669] days). Based on the pre-CABG CCTA, FFR-CT values were simulated. On the basis of follow-up CCTA the anastomosis sites and the graft patency were determined. The graft failure was defined as either its stenosis >50% or occlusion. Results 98 (44 saphenous, 54 LIMA/RIMA) grafts were assessed. 18 graft from 16 patients were dysfunctional on follow-up CCTA. FFR-CT values measured at the location of the future anastomosis were significantly higher in the dysfunctional than normal grafts (0.77[0.71–0.81] vs 0.60[0.56–0.66] respectively, p = 0.0007). According to multivariable Cox regression model pre-CABG FFR-CT (HR=1.1;95%CI:1.0–1.1, p = 0.0230), and bypass graft to RCA (HR=3.7; 95%CI:1.4–9.3 vs. LAD) were independent predictors of graft dysfunction during follow-up. The optimal threshold of FFR-CT to predict graft failure was >0.68 (sensitivity 88.9% (95%CI:65.3–98.6), specificity 63.7% (95%CI:52.2–74.2), PPV 35.6% (95%CI:28.3%-43.5%), NPV 96.2% (95%CI:87.2%-99.0%). Conclusions Pre-CABG functional FFR-CT predicts future coronary bypass graft failure. This shows utility of FFR-CT for guiding coronary revascularization and also suggests significance of physiological assessment prior to CABG.
