Images in cardiovascular medicine. Left main coronary artery compression syndrome: evaluation with 64-slice cardiac multidetector computed tomography.
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
Suhny Abbara
Publications and source records attributed to Suhny Abbara.
Common pulmonary venous ostium of the right and left inferior pulmonary veins: an unusual pulmonary vein anomaly depicted with 64-slice cardiac computed tomography.
Explore the source record for details and available documents.
Coronary Angiography↗
Coronary multidetector computed tomography in the assessment of patients with acute chest pain.
BACKGROUND: Noninvasive assessment of coronary atherosclerotic plaque and significant stenosis by coronary multidetector computed tomography (MDCT) may improve early and accurate triage of patients presenting with acute chest pain to the emergency department. METHODS AND RESULTS: We conducted a blinded, prospective study in patients presenting with acute chest pain to the emergency department between May and July 2005 who were admitted to the hospital to rule out acute coronary syndrome (ACS) with no ischemic ECG changes and negative initial biomarkers. Contrast-enhanced 64-slice MDCT coronary angiography was performed immediately before admission, and data sets were evaluated for the presence of coronary atherosclerotic plaque and significant coronary artery stenosis. All providers were blinded to MDCT results. An expert panel, blinded to the MDCT data, determined the presence or absence of ACS on the basis of all data accrued during the index hospitalization and 5-month follow-up. Among 103 consecutive patients (40% female; mean age, 54+/-12 years), 14 patients had ACS. Both the absence of significant coronary artery stenosis (73 of 103 patients) and nonsignificant coronary atherosclerotic plaque (41 of 103 patients) accurately predicted the absence of ACS (negative predictive values, 100%). Multivariate logistic regression analyses demonstrated that adding the extent of plaque significantly improved the initial models containing only traditional risk factors or clinical estimates of the probability of ACS (c statistic, 0.73 to 0.89 and 0.61 to 0.86, respectively). CONCLUSIONS: Noninvasive assessment of coronary artery disease by MDCT has good performance characteristics for ruling out ACS in subjects presenting with possible myocardial ischemia to the emergency department and may be useful for improving early triage.
Acute Disease↗
Usefulness of coronary computed tomographic angiography to assess suitability for revascularization in patients with significant coronary artery disease and angina pectoris.
Coronary computed tomographic angiography (CTA) accurately excludes the presence of coronary stenoses in selected patient populations. However, it remains unclear whether coronary CTA has the potential to replace invasive coronary angiography as a tool to assess a patient's suitability for revascularization as determined by the characterization of lesion morphology in patients with significant coronary artery disease. Coronary CTA (64-slice computed tomography) was performed before invasive coronary angiography in 29 patients. We evaluated the accuracy of CTA for the detection of complex lesion morphology, including the presence of severe calcium, total occlusions, and ostial or bifurcation location, and compared the results with those of invasive angiography. On CTA, 10 of 69 lesions (15%) were not evaluable for any feature of complex lesion morphology. Of the evaluable lesions, CTA detected >or=1 feature of complexity in 58% of lesions, corresponding to a sensitivity of 88% (23 of 26) and a specificity of 83% (24 of 29). For those single features, the sensitivity of CTA was 100% for the presence of severe calcium, 93% for total occlusions, and 60% and 80% for the detection of ostial and bifurcation lesions, respectively. The specificity was high for total occlusions (97%), ostial lesions (97%), and bifurcations (100%). It was moderate (85%) for severe calcium. Severe calcium precluded the evaluation of other features of complex lesion morphology in 6 lesions (11%). In conclusion, invasive selective coronary angiography remains the cornerstone to assess a patient's suitability for revascularization given the high proportion of unevaluable segments and segments with severe calcium that precluded adequate revascularization planning on CTA.
Angina Pectoris↗
Arterial wall imaging: evaluation with 16-section multidetector CT in blood vessel phantoms and ex vivo coronary arteries.
PURPOSE: To evaluate the diagnostic performance of 16-section multidetector computed tomography (CT) for assessment of plaques in phantoms and ex vivo coronary arteries, with intravascular ultrasonography (US) and optical coherence tomography (OCT) as reference standards. MATERIALS AND METHODS: Research protocol was HIPAA compliant and approved by institutional review board, without informed consent required. Blood vessel and lesion composition phantoms and ex vivo coronary arteries were imaged with 16-section CT. Wall areas of phantoms and ex vivo coronary arteries were measured with multidetector CT and intravascular US. Sensitivity and specificity for lipid detection were determined in lesion composition phantoms. CT numbers of blood vessel wall were determined in ex vivo coronary arteries and compared with lesion classification results from OCT. Agreement in dimensional measurements was compared (paired t tests). CT numbers within blood vessel wall of CT cross sections classified as lipid rich, fibrous, and calcified at OCT were compared (Kruskal-Wallis tests). RESULTS: Mean blood vessel wall areas measured with CT and US in phantoms were 9.2 mm(2) +/- 1.8 (standard deviation) and 10.4 mm(2) +/- 3.4 (bias, -1.3 mm(2) +/- 3.1; P < .05), respectively. Mean blood vessel wall areas measured in ex vivo coronary arteries with CT and US were 10.9 mm(2) +/- 4.1 and 9.1 mm(2) +/- 3.1 (bias, 1.8 mm(2) +/- 3.0; P < .001), respectively. Sensitivity and specificity of 93% and 92%, respectively, for identification of lipid-rich lesions were observed in lesion composition phantoms. Mean CT numbers in blood vessel wall of ex vivo coronary arteries identified at OCT as predominantly lipid rich, fibrous, and calcified were 29 HU +/- 43, 101 HU +/- 21, and 135 HU +/- 199, respectively (P < .001). CONCLUSION: Determination of composition of individual plaques from attenuation values can be more challenging because of overlapping values for different tissue types.
Coronary Angiography↗
Differentiation of recent and chronic myocardial infarction by cardiac computed tomography.
Clinical use of cardiac computed tomography is rapidly expanding, and its purpose may reach beyond noninvasive coronary angiography. We investigated the ability of 64-slice multidetector computed tomography to differentiate between recent and long-standing myocardial infarction (MI). Contrast-enhanced coronary computed tomographic (CT) scans (Siemens Sensation 64) of patients with a recent MI (< 7 days, n = 16), long-standing MI (> 12 months, n = 13), and no MI (n = 13) were retrospectively evaluated. To anticipate transmural variation of myocardial perfusion and to neutralize image noise, a series of thin, overlapping slices was created in parallel alignment to the myocardial wall. Within each of these slices, a small region of interest was placed at a constant in-plane position to measure the CT attenuation (Hounsfield units [HU]) at consecutive transmural locations of injured and normal remote myocardium. In addition, wall thickness and the myocardial cavity were measured. Significantly lower CT attenuation values were found in patients with long-standing MI (-13 +/- 37 HU) than in those with acute MI (26 +/- 26 HU) and normal controls (73 +/- 14 HU, p < 0.001). The attenuation difference between infarcted and remote myocardia was larger in patients with long-standing MI than in patients with recent MI (89 +/- 41 and 55 +/- 33 HU, respectively, p < 0.001). In addition, long-standing MI was associated with wall thinning (p < 0.01), and ventricular dilation (p < 0.05), whereas recent MI was not (p > 0.05). In conclusion, recent and long-standing MIs may be differentiated by computed tomography based on myocardial CT attenuation values and ventricular dimensions.
Coronary Angiography↗
Noninvasive assessment of plaque morphology and composition in culprit and stable lesions in acute coronary syndrome and stable lesions in stable angina by multidetector computed tomography.
OBJECTIVES: The purpose of this study was to assess morphology and composition of culprit and stable coronary lesions by multidetector computed tomography (MDCT). BACKGROUND: Noninvasive identification of culprit lesions has the potential to improve noninvasive risk stratification in patients with acute chest pain. METHODS: Thirty-seven patients with acute coronary syndrome (ACS) or stable angina underwent coronary 16-slice MDCT and invasive selective angiography. In all significant coronary lesions two observers measured the degree of stenosis, plaque area at stenosis, and remodeling index and assessed plaque composition. Differences between culprit lesions in patients with ACS and stable lesions in patients with ACS or stable angina were determined. RESULTS: We analyzed 40 lesions with excellent image quality in 14 patients with ACS and 9 patients with stable angina. Culprit lesions in patients with ACS (n = 14) had significantly greater plaque area and a higher remodeling index than both stable lesions in patients with ACS (n = 13) and in patients with stable angina (n = 13) (17.5 +/- 5.9 mm2 vs. 9.1 +/- 4.8 mm2 vs. 13.5 +/- 10.7 mm2, p = 0.02; and 1.4 +/- 0.3 vs. 1.0 +/- 0.4 vs. 1.2 +/- 0.3, p = 0.04, respectively). The prevalence of non-calcified plaque was 100%, 62%, and 77%, respectively, and the prevalence of calcified plaque was 71%, 92%, and 85%, respectively, in culprit lesions in patients with ACS and in stable lesions in patients with ACS or stable angina. CONCLUSIONS: We introduce the concept of noninvasive detection and characterization of coronary atherosclerotic lesions in patients with ACS by MDCT. We identified differences in lesion morphology and plaque composition between culprit lesions in ACS and stable lesions in ACS or stable angina, consistent with previous intravascular ultrasound studies.
Acute Disease↗
Accuracy of 16-slice multi-detector CT to quantify the degree of coronary artery stenosis: assessment of cross-sectional and longitudinal vessel reconstructions.
BACKGROUND: Sixteen-slice multi-detector computed tomography (MDCT) permits reliable noninvasive detection of significant coronary stenosis based on qualitative visual assessment. The purpose of this study was to determine the accuracy of MDCT to quantify the degree of coronary stenosis as compared to quantitative coronary angiography (QCA) using two different reconstruction methods. METHODS: We studied 69 coronary artery lesions from 38 consecutive patients that underwent 16-slice MDCT as a part of research study, which enrolled consecutive subjects scheduled for clinically indicated invasive coronary angiography. Nine coronary artery lesions with motion artifacts, heavily calcified plaques or stents were excluded from the analysis. The degree of stenosis was calculated by two independent readers non-blinded to the location of the stenosis, but blinded to the results of the QCA. MDCT luminal diameters were measured in cross-sectional multi-planar reformatted (CS-MPR) images created perpendicular to the centerline of the vessel and in 5 mm thin-slab maximum intensity projections (MIP) parallel to the long axis of the vessel. Both MDCT methods were compared against QCA. RESULTS: The mean degree of stenosis as measured by MDCT was closely correlated to QCA for both methods (CS-MPR versus QCA: 61 +/- 23% versus 64 +/- 29%; r2 = 0.83, p < 0.001 and MIP versus QCA: 64 +/- 22% versus 64 +/- 29%; r2 = 0.84, p < 0.001 for MIP. Bland-Altman analysis demonstrated a negative bias of the degree of stenosis of -2.8 +/- 12% using CS-MPR and a minimally positive bias of 0.6 +/- 12% for MIP. In stratified analysis for lesion severity (mild, 0-40%; moderate, 41-70% or severe, > 70%) the agreement between both CS-MPR and MIP was high when compared to QCA (kappa = 0.74 and 0.71, respectively). CONCLUSION: Multi-detector spiral CT permits accurate quantitative assessment of the degree of coronary stenosis in selected data sets of sufficient quality using both cross-sectional and longitudinal vessel reconstructions.
Aged↗
Improved vessel morphology measurements in contrast-enhanced multi-detector computed tomography coronary angiography with non-linear post-processing.
Multi-detector computed tomography (MDCT) permits detection of coronary plaque. However, noise and blurring impair accuracy and precision of plaque measurements. The aim of the study was to evaluate MDCT post-processing based on non-linear image deblurring and edge-preserving noise suppression for measurements of plaque size. Contrast-enhanced MDCT coronary angiography was performed in four subjects (mean age 55 +/- 5 years, mean heart rate 54 +/- 5 bpm) using a 16-slice scanner (Siemens Sensation 16, collimation 16 x 0.75 mm, gantry rotation 420 ms, tube voltage 120 kV, tube current 550 mAs, 80 mL of contrast). Intravascular ultrasound (IVUS; 40 MHz probe) was performed in one vessel in each patient and served as a reference standard. MDCT vessel cross-sectional images (1 mm thickness) were created perpendicular to centerline and aligned with corresponding IVUS images. MDCT images were processed using a deblurring and edge-preserving noise suppression algorithm. Then, three independent blinded observers segmented lumen and outer vessel boundaries in each modality to obtain vessel cross-sectional area and wall area in the unprocessed MDCT cross-sections, post-processed MDCT cross-sections and corresponding IVUS. The wall area measurement difference for unprocessed and post-processed MDCT images relative to IVUS was 0.4 +/- 3.8 mm2 and -0.2 +/- 2.2 mm2 (p < 0.05), respectively. Similarly, Bland-Altman analysis of vessel cross-sectional area from unprocessed and post-processed MDCT images relative to IVUS showed a measurement difference of 1.0 +/- 4.4 and 0.6 +/- 4.8 mm2, respectively. In conclusion, MDCT permitted accurate in vivo measurement of wall area and vessel cross-sectional area as compared to IVUS. Post-processing to reduce blurring and noise reduced variability of wall area measurements and reduced measurement bias for both wall area and vessel cross-sectional area.
Algorithms↗
Quantitative parameters of image quality in 64-slice computed tomography angiography of the coronary arteries.
We explored quantitative parameters of image quality in consecutive patients undergoing 64-slice multi-detector computed tomography (MDCT) coronary angiography for clinical reasons. Forty-two patients (36 men, mean age 61 +/- 11 years, mean heart rate 63 +/- 10 bpm) underwent contrast-enhanced MDCT coronary angiography with a 64-slice scanner (Siemens Sensation 64, 64 mm x 0.6 mm collimation, 330 ms tube rotation, 850 mAs, 120 kV). Two independent observers measured the overall visualized vessel length and the length of the coronary arteries visualized without motion artifacts in curved multiplanar reformatted images. Contrast-to-noise ratio was measured in the proximal and distal segments of the coronary arteries. The mean length of visualized coronary arteries was: left main 12 +/- 6 mm, left anterior descending 149 +/- 25 mm, left circumflex 89 +/- 30 mm, and right coronary artery 161 +/- 38 mm. On average, 97 +/- 5% of the total visualized vessel length was depicted without motion artifacts (left main 100 +/- 0%, left anterior descending 97 +/- 6%, left circumflex 98 +/- 5%, and right coronary artery 95 +/- 6%). In 27 patients with a heart rate < or = 65 bpm, 98 +/- 4% of the overall visualized vessel length was imaged without motion artifacts, whereas 96+/-6% of the overall visualized vessel length was imaged without motion artifacts in 15 patients with a heart rate > 65 bpm (p < 0.001). The mean contrast-to-noise ratio in all measured coronary arteries was 14.6 +/- 4.7 (proximal coronary segments: range 15.1 +/- 4.4 to 16.1 +/- 5.0, distal coronary segments: range 11.4 +/- 4.2 to 15.9 +/- 4.9). In conclusion, 64-slice MDCT permits reliable visualization of the coronary arteries with minimal motion artifacts and high CNR in consecutive patients referred for non-invasive MDCT coronary angiography. Low heart rate is an important prerequisite for excellent image quality.
Adult↗
Threshold-dependent variability of coronary artery calcification measurements -- implications for contrast-enhanced multi-detector row-computed tomography.
INTRODUCTION: The present study investigated the threshold-dependent variability of coronary artery calcification (CAC) measurements and the potential to quantify CAC in contrast-enhanced multi-detector row-computed tomography (MDCT). METHODS: We compared the mean CT attenuation of CAC to luminal contrast enhancement of the coronary arteries in 30 patients (n = 30) undergoing standard coronary contrast-enhanced spiral MDCT. The modified Agatston score [AS], calcified plaque volume [CV], and mineral mass [MM]) at four different thresholds (130, 200, 300, and 400 HU) were measured in 50 patients who underwent non-contrast-enhanced MDCT. RESULTS: Mean CT attenuation of CAC was similar to the attenuation of the contrast-enhanced coronary lumen (CAC 297.1 +/- 68.7 HU versus 295 +/- 65 HU (p < 0.0001), respectively). Above a threshold of 300 HU CAC measurements significantly varied to standard measurements obtained at a threshold of 130 HU (p < 0.0001). The threshold-dependent variation of MM measurements was significantly smaller than for AS and CV (130 HU versus 400 HU: 63, 75, and 81, respectively; p < 0.001). These differences resulted in a change of age and gender based percentile category for AS in 78% of subjects. DISCUSSION: We demonstrated that CAC measurements are threshold dependent with MM measurements having significantly less variation than AS or CV. Due to the similarity of mean CT attenuation of CAC and the contrast-enhanced coronary lumen accurate quantification of CAC may be difficult in standard coronary contrast-enhanced spiral MDCT.
Calcinosis↗
Mapping epicardial fat with multi-detector computed tomography to facilitate percutaneous transepicardial arrhythmia ablation.
A sizable portion of ventricular tachycardia circuits are epicardial, especially in patients with non-ischemic cardiomyopathy, e.g. Chagas disease. Thus there is a growing interest among the electrophysiologists in transepicardial mapping and myocardial ablation for treatment of arrhythmias. However, increased epicardial fat can be a significant hindrance in procedural success as it can mimic infarct during mapping and can also decrease the effectiveness of ablation. Quantitative knowledge of epicardial fat pre-procedure can potentially significantly facilitate the conduct and outcomes of these procedures. In this study we assessed the epicardial fat distribution and thickness in vivo in 59 patients who underwent multi-detector computed tomography (MDCT) for coronary artery assessment using a 16-slice scanner. Multiplanar reconstructions were obtained in the ventricular short axis at the basal, mid ventricular, and near the apex level, and in a four-chamber view. In the short axis slices, we measured epicardial fat diameter in nine segments, and in the four-chamber view, it was measured in five segments. In grooved segments the maximum fat thickness was recorded, while in non-grooved segments thickness at three equally spaced points were averaged. The results were as follows starting clockwise: superior inter-ventricular (IV) groove (all measurements are in mm, in basal, mid ventricular, and apical levels, respectively) (11.2, 8.6, 7.3), left ventricular (LV) superior lateral wall (1.0, 1.5, 1.7), LV inferior lateral wall (1.3, 2.2, 3.5), inferior IV groove (9.2, 6.5, 6.1), right ventricular (RV) diaphragmatic wall (1.4, 0.2, 1.0), acute margin (9.2, 7.3, 7.8), RV anterior free wall inferior (6.8, 4.0, 4.7), RV anterior free wall superior (6.5, 3.2, 3.1), RV superior wall (5.6, 2.7, 4.0), We measured the following four-chamber segments: LV apex (2.8 mm), left atrio-ventricular (AV) groove (12.7), right AV groove (14.8), RV apex (4.8), and anterior IV groove (7.7). The mean epicardial fat thickness for all cases was 5.3 mm (S.D. 1.6). The mean total epicardial fat for patients over 65 was 22% greater than younger patients, with a 36% increase along the RV anterior free wall, 57% along the RV diaphragmatic wall and 38% along the LV lateral wall. Women averaged 17% more total epicardial fat. In conclusion, this study was designed to provide an epicardial fat map for physicians performing percutaneous epicardial mapping and interventions. While the acute margin and RV anterior free wall tend to have high epicardial fat, and the LV lateral wall and RV diaphragmatic wall tend to have little to no fat, there is significant variation between patients. MDCT is a reliable modality for visualizing epicardial fat, and should be considered prior to undergoing procedures that are affected by epicardial fat content, especially in elderly and female populations.
Adipose Tissue↗
MDCT in early triage of patients with acute chest pain.
OBJECTIVE: Current risk stratification of patients with acute chest pain but normal initial cardiac enzymes and nondiagnostic ECG is inefficient. We sought to determine whether contrast-enhanced MDCT-based detection of stenosis is feasible and improves early and accurate triage of patients with acute chest pain. SUBJECTS AND METHODS: We studied 40 patients (53% men; mean age, 57 +/- 13 years) with chest pain who were awaiting hospital admission to rule out an acute coronary syndrome (ACS) despite the absence of diagnostic ECG changes and normal cardiac enzymes on emergency department presentation. Patients underwent contrast-enhanced MDCT before hospital admission. Afterward, patients received standard clinical care. All physicians involved in the patients' care were blinded to the results of MDCT. An expert panel established the presence or absence of ACS based on American Heart Association (AHA) guidelines. The MDCT images were evaluated for the presence of significant coronary artery stenosis (diameter reduction > 50%) and were used to make a triage decision. RESULTS: All five patients (12.5%) with ACS (one with non-ST elevation myocardial infarction, four with unstable angina pectoris) had at least one significant coronary stenosis on MDCT (sensitivity, 100% [95% CI, 49-100%)]. ACS was ruled out in 35 patients (87.5%). Significant coronary stenosis was excluded in 26 of the 35 patients without ACS by MDCT (specificity, 74% [CI, 75-88%]), potentially saving 70% of unnecessary hospital admissions. CONCLUSION: MDCT-based detection of significant coronary stenoses has tremendous potential to decrease the number of unnecessary hospital admissions, without reducing appropriate admission rates, in patients with chest pain who have nondiagnostic ECG results and normal cardiac enzymes. These results are likely to further improve with advances in MDCT technology.
Acute Disease↗
Comparison of the degree of coronary stenoses by multidetector computed tomography versus by quantitative coronary angiography.
Sixteen-slice multidetector computed tomography (MDCT) and quantitative coronary angiography (QCA) were performed in 29 patients. Quantification of the degree of luminal narrowing and lesion length measurements were performed independently on MDCT and QCA at 42 sites with sufficient computed tomographic image quality. The correlation between MDCT and QCA for quantifying the degree of stenosis was excellent (r2 = 0.93), although a systematic overestimation was observed by MDCT (bias 4% +/- 8%). The correlation between MDCT and QCA was moderate with respect to lesion length (r2 = 0.54). In the absence of severe calcifications or motion artifacts, MDCT permits noninvasive quantification of coronary stenosis.
Aged↗
Calcium concentration of individual coronary calcified plaques as measured by multidetector row computed tomography.
BACKGROUND: Characteristics of individual calcified plaques, especially calcium concentration (CC), may provide incremental value to global calcium scores in the assessment of plaque burden and risk of coronary events and evaluation of therapeutic intervention. In this study, therefore, we assessed the characteristics of individual calcified plaques and their relationship to other parameters derived from CT analysis of coronary calcium in a community-based cross-sectional cohort. METHODS AND RESULTS: Coronary artery calcium (CAC) was analyzed in 612 participants of the Framingham Heart Study (third-generation and offspring cohorts) using prospectively ECG-triggered multidetector CT. We determined the CC, Agatston score, calcified volume, and mineral mass of individual calcified plaques in each subject. Heterogeneity of CC was defined as the standard deviation of CC of all individual calcified plaques in a subject. CAC was detected in 274 of 605 subjects. After excluding 57 subjects (21%) because of motion artifacts, we identified a total of 956 calcified coronary plaques in 217 subjects (74 women, 143 men; mean age, 57.1+/-10.8 years) with detectable CAC and no image artifacts. CC of individual calcified plaques was independent of subject age (P=0.76) and sex (197.8+/-74.8 versus 183.6+/-52.8 mg/cm3 for men versus women; P=0.21). Among a subgroup of 125 subjects with multiple (> or =3) individual calcified plaques, CC was heterogeneous within individual subjects (mean SD of CC, 43.6+/-23.1 mg/cm3). The degree of heterogeneity of CC in these subjects was independent of age (P=0.60), sex (P=0.99), and number of plaques (P=0.06). CONCLUSIONS: The CC of individual calcified plaques is independent of age and sex but heterogeneous within a subject, which may reflect that the pathological process of calcified plaque formation and progression is the same in men and women regardless of age. CC may have incremental value to global calcium scores in the assessment of plaque burden and risk of coronary events and the evaluation of therapeutic intervention. Further studies are warranted to confirm that individual plaque analysis is preferable to global CAC scores to evaluate progression of atherosclerosis and to assess whether individual plaque analysis may be complementary to global CAC measures to assess coronary event risk.
Age Factors↗
Images in cardiovascular medicine. Visualization of endomyocardial fibrosis by delayed-enhancement magnetic resonance imaging.
Explore the source record for details and available documents.
Adolescent↗
Relationship of the esophagus and aorta to the left atrium and pulmonary veins: implications for catheter ablation of atrial fibrillation.
BACKGROUND: A potential complication during ablation of atrial fibrillation (AF) is damage to adjacent structures such as the esophagus and aorta. Fatal atrio-esophageal fistulas have developed after surgery- or catheter-based AF ablation procedures. OBJECTIVES: The purpose of this study was to analyze multidetector computed tomography (MDCT) angiographic images to determine the anatomic relationship of the aorta and esophagus to the left atrium (LA). METHODS: Sixty-five subjects underwent CT imaging using a 16-slice MDCT scanner: 24 with paroxysmal AF, 21 with chronic AF, and 20 "control" subjects without a history of AF. Measurements assessed included LA diameters, width of the esophagus and aorta in contact with the posterior LA wall, and distance from the esophagus to the four pulmonary veins (PVs), spine, and LA endocardium. RESULTS: Mean LA diameters were significantly larger in patients with AF vs the control group (P = .003 for anteroposterior diameter; P = .009 for transverse diameter). The anterior aspect of the esophagus was directly apposed to the LA in all cases (contact width 18.9 +/- 4.4 mm). The position of the esophagus varied in the posterior mediastinum but on average was closer to the ostia of the left PVs (P = .0001). The descending aorta was in contact with the LA and/or left PVs in 50 of 65 subjects. The esophagus was closer to the spine in the chronic AF vs control group (P = .007), likely due to increased LA dimension. CONCLUSION: In addition to its ability to assess PV anatomy, preprocedural MDCT imaging can investigate the variable relationship of adjacent structures, such as the esophagus and aorta to the LA and PVs.
Aorta↗
Noninvasive evaluation of cardiac veins with 16-MDCT angiography.
OBJECTIVE: Anatomic mapping of the cardiac veins is important to guide transvenous therapeutic procedures such as biventricular pacing. As an alternative to invasive venography, we studied the feasibility of MDCT of the cardiac venous anatomy. CONCLUSION: Cardiac venous anatomy is variable. MDCT is a noninvasive method that allows detailed imaging of the cardiac venous anatomy, including small cardiac veins and thebesian valves. Therefore, cardiac MDCT may be a valuable tool for guiding procedures that involve the cardiac venous system.
Coronary Angiography↗