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doi: 10.1007/s10554-013-0184-zpmid: 23344910
In the past 12 years, during the process of imaging congenital heart disease (CHD), Asian doctors have not only made every effort to adhere to established magnetic resonance imaging (MRI) protocols as in Western countries, but also have developed Computed tomography (CT) as an alternative problem-solving technique. Databases have shown that Asian doctors were more inclined to utilize CT than MRI in evaluating CHD. Articles in the literature focusing on CT have been cited more frequently than articles on MRI. Additionally, several repeatedly cited CT articles have become seminal papers in this field. The database reflects a trend suggesting that Asian doctors actively adapt to new techniques and flexibly develop unique strategies to overcome limitations caused by the relatively limited resources often available to them.
Jinzaki, Masahiro; Hirano, Masaharu; Hara, Kazuhiro; Suzuki, Takahiko; Yamashina, Akira; Ikari, Yuji; Iino, Misako; Yamaguchi, Takuhiro; Kuribayashi, Sachio
doi: 10.1007/s10554-013-0253-3pmid:
Kim, Jeong; Chun, Eun; Lee, Min; Kim, Kil; Choi, Sang
doi: 10.1007/s10554-013-0224-8pmid: 23624929
Current smoking is a powerful independent predictor of coronary atherosclerosis in asymptomatic individuals. Many researchers have suggested a cigarette dose–response relationship between smoking and subclinical coronary atherosclerosis. Our study purposes were (a) to investigate the prevalence and plaque characteristics of coronary atherosclerosis in asymptomatic smokers and (b) to assess the cigarette dose–response relationship between smoking and subclinical coronary atherosclerosis using coronary CT angiography (CTA). We consecutively enrolled 7,104 self-referred asymptomatic subjects who underwent coronary CTA as part of a general health evaluation. Current smokers (n = 1,784) were categorized according to total pack years (TPY) with four grades (A, 0.1–10; B, 10–20; C, 20–30; D, >30), smoking duration (SD, years) with four grades (A, 0.1–10; B, 10–20; C, 20–30; D, >30), and number of cigarettes per day (CPD) with four grades (A, 1–20; B, 10–20; C, 20–40; D, >40). After adjusting for other cardiovascular risk factors, adjusted odds ratios for current smokers versus never-smokers as a control group were estimated for the presence of plaques, significant stenosis, and non-calcified plaques (NCP). Current smokers had a statistically significant higher prevalence of any plaque, significant stenosis, NCP, and coronary artery calcium score >100 than never-smokers. According to each categorization of TPY, SD, and CPD, the subclinical coronary atherosclerosis risk increased as grades increased in asymptomatic current smokers relative to never-smokers after adjusting for variable clinical and chemical risk factors. Our study suggests a cigarette dose–response relationship between current smoking and coronary atherosclerosis in asymptomatic individuals.
Lee, Min; Chun, Eun; Kim, Kil; Kim, Jeong; Yoo, Jin; Choi, Sang
doi: 10.1007/s10554-013-0257-zpmid: 23754773
The aims of this study were: (a) to assess clinical predictors and coronary computed tomography angiography (CCTA) characteristics of noncalcified coronary plaques (NCP) in subjects who had cardiac events despite a zero coronary artery calcium score (CACS), and (b) to describe computed tomography (CT) plaque characteristics in subjects with cardiac events. A total of 7,961 subjects with zero CACS were evaluated; 6,531 subjects underwent CCTA as part of a health check-up. Those who had zero CACS were included in our mid-term follow-up study. Cardiac events included cardiac death, acute coronary syndrome or revascularization with stable angina. More than one NCP was identified in 441 subjects with zero CACS, including 48 subjects with obstructive coronary artery disease (CAD) caused by NCPs. Age, male gender, hypertension, diabetes and low density lipoprotein were independent predictors of obstructive CAD. Among subjects with obstructive CAD, young adults were classified into low (79.2 %) or moderate (72.9 %) risk groups by the National Centers for Environmental Prediction III guidelines. Approximately 0.2 % of subjects had cardiac events during our follow-up period. All patients with cardiac events had NCPs with significantly lower mean CT numbers, higher remodeling indexes and worse degree of stenosis. In asymptomatic subjects with zero CACS, NCP was associated with cardiac events. CCTA might be useful for risk stratification among select populations with CAD and zero CACS who have certain plaque characteristics associated with cardiac events.
Park, Eun-Ah; Lee, Whal; Na, Sang-Hoon; Chung, Jin; Park, Jae
doi: 10.1007/s10554-013-0243-5pmid: 23797295
To analyze computed tomography (CT) characteristics of left ventricle (LV) fat deposition in patients without proven myocardial disease and to correlate these CT findings with electrocardiogram (ECG) and echocardiography data. We retrospectively searched our database of 14,470 consecutive coronary CT scans performed in the past 4 years for LV fat deposition in patients without proven myocardial disease. In total, we identified 25 patients (0.2 %; 10 males, 15 females; mean age 63 years) involving 91 cardiac segments. Pattern and location of LV fat deposition on CT were analyzed and compared to ECG and echocardiographic data. LV fat deposition can be categorized into 3 patterns: fat deposits in an apical cap (pattern I, n = 14), localized fat accumulation (pattern II, n = 12), and diffuse linear accumulation (pattern III, n = 6). Both patterns I and II were seen in 7 patients. The most common locations were apical segments (40 %) and the mid-myocardial layer (70 %). No patients had ECG findings positive for left-dominant arrhythmogenic dysplasia. Regional wall-motion abnormalities and decreased LV function (ejection fraction < 50 %) were only observed in 33 % of pattern III cases. LV fat deposition on CT can be seen in patients without proven myocardial disease. LV fat depositions were most commonly seen in the mid-myocardial location and apical segments. Diffuse linear fat deposition in the LV may correlates with decreased regional and global function.
Park, Chan; Choo, Ki; Jeon, Ung; Baik, Seung; Kim, Yong; Kim, Tae; Kim, Chang; Jeong, Yeon; Jeong, Dong; Lim, Soo
doi: 10.1007/s10554-013-0252-4pmid: 23748369
Kim, Soo-Yeon; Hong, Yoo; Lee, Hye-Jeong; Hur, Jin; Choi, Byoung; Kim, Young
doi: 10.1007/s10554-013-0195-9pmid: 23443338
In contrast to the coronary arterial system, little attention has been paid to the coronary venous system in previous literature. We report a rare case of a combined anomaly of the coronary artery and the great cardiac vein (GCV). In this patient, the right coronary artery (RCA) arose from the left coronary artery, and the GCV drained directly into the right atrium. The anomalous RCA and GCV ran parallel courses along the anterior side of the right ventricular outflow tract. We briefly review the clinical significance and the role of cardiac computed tomography in this anomaly.
Kim, Eun; Chang, Sung-A; Jang, Shin; Kim, Yiseul; Kim, Sung; Oh, Jae; Choe, Yeon; Kim, Duk-Kyung
doi: 10.1007/s10554-013-0206-xpmid: 23504214
The aim of this study was to determine the normal values for aortic pulse wave velocity (PWV) and distensibility using cine and phase contrast cardiac magnetic resonance imaging (CMRI) in patients without cardiovascular risk factors. PWV and distensibility are indispensible predictors of global and regional cardiovascular risk. Regional heterogeneity in aortic stiffness plays an important role in the pathogenesis of cardiovascular disease. Contrary to global estimates of aortic PWV that are commonly measured with tonometry, CMRI has emerged as an important method for estimating regional PWV and distensibility. A total of 124 Korean patients, aged 20–79 years and free of cardiovascular risk factors, were categorized by age decade. Using cine and phase contrast sequences, the cross-sectional area for distensibility and average blood flow were measured at four aortic levels: the ascending, upper descending thoracic, lower thoracic and abdominal aorta. Regional PWV was determined in four aortic segments: proximal, descending thoracic, abdominal aorta and across the entire aorta. Distensibility at the four levels of the aorta from the ascending to distal (4.4 ± 2.5, 4.0 ± 1.6, 5.2 ± 1.9, and 3.3 ± 1.7 × 10−3 mm/Hg, respectively) was higher in women (P < 0.001) and decreased with age. The regional PWV was highest in the descending thoracic aorta and increased with age. The present study is the first to show the heterogeneity in aortic PWV and distensibility, as well to provide normal values for these parameters using CMRI in an Asian sample.
Park, Chul; Choi, Eui-Young; Kwon, Hyuck; Hong, Bum; Lee, Byoung; Yoon, Young; Min, Pil-Ki; Greiser, Andreas; Paek, Mun; Yu, Wei; Sung, Yon; Hwang, Sung; Hong, Yoo; Kim, Tae
Showing 1 to 10 of 11 Articles
The purpose of this study was to compare the safety and efficacy of the short-acting β1-receptor blocker, landiolol hydrochloride (0.06 and 0.125-mg/kg), to placebo during coronary computed tomography angiography (CTA) in a phase 2 dose-finding study. A total of 183 patients suspected of having ischemic cardiac disease and scheduled to undergo an invasive coronary angiography were randomized to groups treated with landiolol hydrochloride (0.06 or 0.125-mg/kg) or placebo. The heart rate, safety, and the performance of coronary diagnosis using landiolol hydrochloride were evaluated in a multicenter, double-blind, randomized, parallel study. The patients’ heart rates during the coronary CTA were 67.6 ± 8.7 and 62.6 ± 7.8 beats/min in the 0.06 and 0.125-mg/kg landiolol hydrochloride groups, respectively, both of which were significantly lower than the heat rate of 73.7 ± 11.8 beats/min in the placebo group (P = 0.003 and P < 0.001, respectively). No adverse events or reactions occurred at an incidence of 5 % or greater, confirming the safety of landiolol hydrochloride. The proportion of correctly classified patients was significantly higher in the 0.125-mg/kg landiolol hydrochloride group than in the placebo group (73.6 vs. 50.0 %). Landiolol hydrochloride at doses of 0.06 and 0.125-mg/kg significantly decreased the heart rate compared with a placebo. The present findings suggest that landiolol hydrochloride is safe and useful at a dose of 0.125-mg/kg to improve coronary diagnostic performance during coronary CTA.
To compare vascular enhancement, image quality, and radiation dose of 128-slice dual-source CT venography (CTV) between an imaging setting of 120 kVp with low pitch, and a setting of 100 kVp combined with high pitch and automatic tube current modulation. A total of 100 patients with suspected deep vein thrombosis and varicose veins were divided into two groups: Group 1 [50 patients, 120 kVp, low pitch (0.6), and fixed 120 mA) and Group 2 (50 patients, 100 kVp, high pitch (3.0), and automatic tube current modulation]. Two radiologists, who were blinded to the image protocol, assessed vascular enhancement and image noise in the inferior vena cava (IVC), femoral vein, and popliteal vein. They also assigned an image quality score independently using a 5-point visual scale. Effective dose was estimated using the dose-length product (DLP). Group demographics, radiation dose, vascular enhancement, image noise, and image quality in the two groups were analyzed. Mean vascular enhancement of the IVC, femoral vein, and popliteal vein was significantly higher in group 2 than in group 1, and images in group 2 had significantly higher image noise. However, there were no significant differences in subjective image quality score of the IVC, femoral vein, and popliteal vein. The mean DLP in group 2 (402.10 ± 94.29 mGy cm) was significantly lower than that in group 1 (973.36 ± 63.20 mGy cm) (P < 0.001). Lower extremity CTV using 100 kVp, high pitch (3.0), and automatic tube current modulation improved vascular enhancement with acceptable image quality and low radiation dose.
doi: 10.1007/s10554-013-0256-0pmid: 23765068
This study evaluates the clinical usefulness of T2 mapping for the detection of myocardial edema in the re-perfused acute myocardial infarction (MI). Cardiac MRIs were reviewed in 20 patients who had acute MI after reperfusion therapy. The regional T2 values and T2-weighted image (T2WI) signal intensities (SI) were measured in the infarcted and remote zones of the myocardium. Patients were divided into three groups according to the signal patterns of the infarcted myocardium on the T2WIs. The T2 values of the infarcted zones were compared on the T2 maps among the three groups. Validation of the T2 values was performed in the normal myocardium of seven healthy volunteers. There were no significant differences in mean T2WI-SI or T2 values in the normal myocardium of healthy volunteers compared to the remote myocardium of acute MI patients (p > 0.05). Mean SI on the T2WIs was significantly higher in the infarcted myocardium (81.3 ± 37.6) than in the remote myocardium (63.8 ± 18.1) (p < 0.05). The T2WIs showed high SI in ten patients (group 1), iso-SI in seven (group 2), and low SI in three (group 3) in the infarcted myocardium, compared to the remote myocardium. The T2 maps showed that T2 values in the infarcted myocardium had mostly increased, regardless of group, with values of 71 ± 9 ms in group 1, 64.9 ± 7.4 ms in group 2, and 61.4 ± 8.5 ms in group 3. T2 mapping is superior to T2WI for detecting areas of high SI in the infarcted myocardium. Therefore, quantitative T2 mapping sequences may be more useful and reliable in identifying myocardial edema in the infarcted myocardium than T2WI.