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Nico R Mollet - One of the best experts on this subject based on the ideXlab platform.
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comprehensive assessment of Coronary artery stenoses computed tomography Coronary Angiography versus conventional Coronary Angiography and correlation with fractional flow reserve in patients with stable angina
Journal of the American College of Cardiology, 2008Co-Authors: Bob W Meijboom, Carlos Van Mieghem, Niels Van Pelt, Annick C Weustink, Francesca Pugliese, Nico R Mollet, Eric Boersma, E Regar, Robert Jan Van Geuns, Peter De JaegereAbstract:OBJECTIVES: We sought to determine the diagnostic accuracy of noninvasive visual (computed tomography Coronary Angiography [CTCA]) and quantitative computed tomography Coronary Angiography (QCT) to predict the hemodynamic significance of a Coronary stenosis, using intraCoronary fractional flow reserve (FFR) as the reference standard. BACKGROUND: It has been demonstrated that CTCA provides excellent diagnostic sensitivity for identifying Coronary stenoses, but may lack accurate delineation of the hemodynamic significance. METHODS: We investigated 79 patients with stable angina pectoris who underwent both 64-slice or dual-source CTCA and FFR measurement of discrete Coronary stenoses. CTCA and conventional Coronary Angiography (CCA), and QCT and quantitative Coronary Angiography (QCA), were performed to determine the severity of a stenosis that was compared with FFR measurements. A significant anatomical or functional stenosis was defined as >/=50% diameter stenosis or an FFR <0.75. Stented segments and bypass grafts were not included in the analysis. RESULTS: A total of 89 stenoses were evaluated of which 18% (16 of 89) had an FFR <0.75. The diagnostic accuracy of CTCA, QCT, CCA, and QCA to detect a hemodynamically significant Coronary lesion was 49%, 71%, 61%, and 67%, respectively. Correlation between QCT and QCA with FFR measurement was weak (R values of -0.32 and -0.30, respectively). Correlation between QCT and QCA was significant, but only moderate (R = 0.53; p < 0.0001). CONCLUSIONS: The anatomical assessment of the hemodynamic significance of Coronary stenoses determined by visual CTCA, CCA, or QCT or QCA does not correlate well with the functional assessment of FFR. Determining the hemodynamic significance of an angiographically intermediate stenosis remains relevant before referral for revascularization treatment.
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comprehensive assessment of Coronary artery stenoses computed tomography Coronary Angiography versus conventional Coronary Angiography and correlation with fractional flow reserve in patients with stable angina
Journal of the American College of Cardiology, 2008Co-Authors: Bob W Meijboom, Carlos Van Mieghem, Niels Van Pelt, Annick C Weustink, Francesca Pugliese, Nico R Mollet, Eric Boersma, E Regar, Robert Jan Van Geuns, Peter De JaegereAbstract:Objectives We sought to determine the diagnostic accuracy of noninvasive visual (computed tomography Coronary Angiography [CTCA]) and quantitative computed tomography Coronary Angiography (QCT) to predict the hemodynamic significance of a Coronary stenosis, using intraCoronary fractional flow reserve (FFR) as the reference standard. Background It has been demonstrated that CTCA provides excellent diagnostic sensitivity for identifying Coronary stenoses, but may lack accurate delineation of the hemodynamic significance. Methods We investigated 79 patients with stable angina pectoris who underwent both 64-slice or dual-source CTCA and FFR measurement of discrete Coronary stenoses. CTCA and conventional Coronary Angiography (CCA), and QCT and quantitative Coronary Angiography (QCA), were performed to determine the severity of a stenosis that was compared with FFR measurements. A significant anatomical or functional stenosis was defined as 50% diameter stenosis or an FFR 0.75. Stented segments and bypass grafts were not included in the analysis. Results A total of 89 stenoses were evaluated of which 18% (16 of 89) had an FFR 0.75. The diagnostic accuracy of CTCA, QCT, CCA, and QCA to detect a hemodynamically significant Coronary lesion was 49%, 71%, 61%, and 67%, respectively. Correlation between QCT and QCA with FFR measurement was weak (R values of 0.32 and 0.30, respectively). Correlation between QCT and QCA was significant, but only moderate (R 0.53; p 0.0001). Conclusions The anatomical assessment of the hemodynamic significance of Coronary stenoses determined by visual CTCA, CCA, or QCT or QCA does not correlate well with the functional assessment of FFR. Determining the hemodynamic significance of an angiographically intermediate stenosis remains relevant before referral for revascularization treatment. (J Am Coll Cardiol 2008;52:636‐43) © 2008 by the American College of Cardiology Foundation
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comprehensive assessment of Coronary artery stenoses computed tomography Coronary Angiography versus conventional Coronary Angiography and correlation with fractional flow reserve in patients with stable angina
Journal of the American College of Cardiology, 2008Co-Authors: Bob W Meijboom, Annick C Weustink, Francesca Pugliese, Nico R Mollet, Eric Boersma, E Regar, Carlos Van Mieghem, Niels Van Pelt, Robert Jan Van Geuns, Peter De JaegereAbstract:Objectives We sought to determine the diagnostic accuracy of noninvasive visual (computed tomography Coronary Angiography [CTCA]) and quantitative computed tomography Coronary Angiography (QCT) to predict the hemodynamic significance of a Coronary stenosis, using intraCoronary fractional flow reserve (FFR) as the reference standard. Background It has been demonstrated that CTCA provides excellent diagnostic sensitivity for identifying Coronary stenoses, but may lack accurate delineation of the hemodynamic significance. Methods We investigated 79 patients with stable angina pectoris who underwent both 64-slice or dual-source CTCA and FFR measurement of discrete Coronary stenoses. CTCA and conventional Coronary Angiography (CCA), and QCT and quantitative Coronary Angiography (QCA), were performed to determine the severity of a stenosis that was compared with FFR measurements. A significant anatomical or functional stenosis was defined as ≥50% diameter stenosis or an FFR Results A total of 89 stenoses were evaluated of which 18% (16 of 89) had an FFR Conclusions The anatomical assessment of the hemodynamic significance of Coronary stenoses determined by visual CTCA, CCA, or QCT or QCA does not correlate well with the functional assessment of FFR. Determining the hemodynamic significance of an angiographically intermediate stenosis remains relevant before referral for revascularization treatment.
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diagnostic accuracy of non invasive 64 slice ct Coronary Angiography in patients with stable angina pectoris
European Radiology, 2006Co-Authors: Francesca Pugliese, Nico R Mollet, Gabriel P Krestin, Carlos Van Mieghem, Giuseppe Runza, Timo Baks, Willem B Meijboom, Patrizia Malagutti, Pim J DefeyterAbstract:Multislice computed tomography (CT) is an emerging technique for the non-invasive detection of Coronary stenoses. While the diagnostic accuracy of 4-slice scanners was limited, 16-slice CT imagers showed promising results due to increased temporal and spatial resolution. These technical advances prompted us to evaluate the diagnostic performance of 64-slice CT Coronary Angiography in the detection of significant stenoses (defined as ≥ 50% luminal diameter reduction) versus invasive quantitative Coronary Angiography (QCA). Thirty-five patients with stable angina pectoris underwent CT Coronary Angiography performed with a 64-slice scanner (gantry rotation time 330 ms, individual detector width 0.6 mm) prior to conventional Coronary Angiography. Patients with heart rates >70 beats/min received 100 mg metoprolol orally. One hundred millilitres of contrast agent with an iodine concentration of 400 mgl/ml were injected at a rate of 5 ml/s into the antecubital vein. The CT scan was triggered with the bolus tracking technique. The sensitivity, specificity and the positive and negative predictive values of 64-slice CT were 99%, 96%, 78% and 99%, respectively, on a per-segment basis. The values obtained on a per-patient basis were 100%, 90%, 96% and 100%, respectively. When referral to catheterisation is questionable, CT Coronary Angiography may identify subjects with normal angiograms and consistently decrease the number of unnecessary invasive procedures.
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high resolution spiral computed tomography Coronary Angiography in patients referred for diagnostic conventional Coronary Angiography
Circulation, 2005Co-Authors: Nico R Mollet, Filippo Cademartiri, Patrick W. Serruys, Eugene P Mcfadden, Gabriel P Krestin, Carlos Van Mieghem, Giuseppe Runza, Timo Baks, Pim J. De FeyterAbstract:Background—The diagnostic performance of the latest 64-slice CT scanner, with increased temporal (165 ms) and spatial (0.4 mm 3 ) resolution, to detect significant stenoses in the clinically relevant Coronary tree is unknown. Methods and Results—We studied 52 patients (34 men; mean age, 59.612.1 years) with atypical chest pain, stable or unstable angina pectoris, or non–ST-segment elevation myocardial infarction scheduled for diagnostic conventional Coronary Angiography. All patients had stable sinus rhythm. Patients with initial heart rates 70 bpm received -blockers. Mean scan time was 13.30.9 seconds. The CT scans were analyzed by 2 observers unaware of the results of invasive Coronary Angiography, which was used as the standard of reference. All available Coronary segments, regardless of size, were included in the evaluation. Lesions with 50 luminal narrowing were considered significant stenoses. Invasive Coronary Angiography demonstrated the absence of significant disease in 25% (13 of 52), single-vessel disease in 31% (16 of 52), and multivessel disease in 45% (23 of 52) of patients. One unsuccessful CT scan was classified as inconclusive. Ninety-four significant stenoses were present in the remaining 51 patients. Sensitivity, specificity, and positive and negative predictive values of CT for detecting significant stenoses on a segment-by-segment analysis were 99% (93 of 94; 95% CI, 94 to 99), 95% (601 of 631; 95% CI, 93 to 96), 76% (93 of 123; 95% CI, 67 to 89), and 99% (601 of 602; 95% CI, 99 to 100), respectively. Conclusions—Noninvasive 64-slice CT Coronary Angiography accurately detects Coronary stenoses in patients in sinus rhythm and presenting with atypical chest pain, stable or unstable angina, or non–ST-segment elevation myocardial infarction. (Circulation. 2005;112:2318-2323.)
Pim J. De Feyter - One of the best experts on this subject based on the ideXlab platform.
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high resolution spiral computed tomography Coronary Angiography in patients referred for diagnostic conventional Coronary Angiography
Circulation, 2005Co-Authors: Nico R Mollet, Filippo Cademartiri, Patrick W. Serruys, Eugene P Mcfadden, Gabriel P Krestin, Carlos Van Mieghem, Giuseppe Runza, Timo Baks, Pim J. De FeyterAbstract:Background—The diagnostic performance of the latest 64-slice CT scanner, with increased temporal (165 ms) and spatial (0.4 mm 3 ) resolution, to detect significant stenoses in the clinically relevant Coronary tree is unknown. Methods and Results—We studied 52 patients (34 men; mean age, 59.612.1 years) with atypical chest pain, stable or unstable angina pectoris, or non–ST-segment elevation myocardial infarction scheduled for diagnostic conventional Coronary Angiography. All patients had stable sinus rhythm. Patients with initial heart rates 70 bpm received -blockers. Mean scan time was 13.30.9 seconds. The CT scans were analyzed by 2 observers unaware of the results of invasive Coronary Angiography, which was used as the standard of reference. All available Coronary segments, regardless of size, were included in the evaluation. Lesions with 50 luminal narrowing were considered significant stenoses. Invasive Coronary Angiography demonstrated the absence of significant disease in 25% (13 of 52), single-vessel disease in 31% (16 of 52), and multivessel disease in 45% (23 of 52) of patients. One unsuccessful CT scan was classified as inconclusive. Ninety-four significant stenoses were present in the remaining 51 patients. Sensitivity, specificity, and positive and negative predictive values of CT for detecting significant stenoses on a segment-by-segment analysis were 99% (93 of 94; 95% CI, 94 to 99), 95% (601 of 631; 95% CI, 93 to 96), 76% (93 of 123; 95% CI, 67 to 89), and 99% (601 of 602; 95% CI, 99 to 100), respectively. Conclusions—Noninvasive 64-slice CT Coronary Angiography accurately detects Coronary stenoses in patients in sinus rhythm and presenting with atypical chest pain, stable or unstable angina, or non–ST-segment elevation myocardial infarction. (Circulation. 2005;112:2318-2323.)
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value of preprocedure multislice computed tomographic Coronary Angiography to predict the outcome of percutaneous recanalization of chronic total occlusions
American Journal of Cardiology, 2005Co-Authors: Nico R Mollet, Filippo Cademartiri, Pedro A Lemos, Patrick W. Serruys, Eugene P Mcfadden, Gabriel P Krestin, Angela Hoye, Georgios Sianos, Pim J. De FeyterAbstract:We performed multislice computed tomographic Coronary Angiography in 45 patients who had chronic total occlusions and were scheduled for percutaneous recanalization. Multivariate analysis identified a blunt stump (by conventional Angiography), occlusion length >15 mm, and severe calcification (by multislice computed tomographic Coronary Angiography) as independent predictors of procedural failure.
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multislice spiral computed tomography Coronary Angiography in patients with stable angina pectoris
Journal of the American College of Cardiology, 2004Co-Authors: Nico R Mollet, Peter M. T. Pattynama, Koen Nieman, Filippo Cademartiri, Pedro A Lemos, Patrick W. Serruys, Eugene P Mcfadden, Francesco Saia, Gabriel P Krestin, Pim J. De FeyterAbstract:Abstract Objectives This study was designed to prospectively evaluate the diagnostic performance of multislice spiral computed tomography (MSCT) Coronary Angiography for the detection of significant lesions in all segments of the Coronary tree potentially suitable for revascularization. Background Noninvasive MSCT Coronary Angiography is a promising Coronary imaging technique. Methods Sixteen-row MSCT Coronary Angiography was performed in 128 patients (89% men, mean age 58.9 ± 11.7 years) in sinus rhythm with stable angina pectoris scheduled for conventional Coronary Angiography. Sixty percent (77 of 128) of patients received pre-scan oral beta-blockers, resulting in a mean heart rate of 57.7 ± 7.7 beats/min. The diagnostic performance of MSCT for detection of significant lesions (≥50% diameter reduction) was compared with that of quantitative Coronary Angiography (QCA). Results The sensitivity of MSCT for detection of significant lesions was 92% (216 of 234, 95% confidence interval [CI]: 88 to 95). Specificity was 95% (1,092 of 1,150, 95% CI: 93 to 96), positive predictive value 79% (216 of 274, 95% CI: 73 to 88), and negative predictive value 98% (1,092 of 1,110, 95% CI: 97 to 99). Two ≥50% lesions were missed because of motion artifacts and two because of severe Coronary calcifications. The rest (78%, 14 of 18) were detected but incorrectly classified as Conclusions Sixteen-row MSCT Coronary Angiography permits reliable detection of significant obstructive Coronary artery disease in patients with stable angina in sinus rhythm.
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multislice spiral computed tomography Coronary Angiography in patients with stable angina pectoris
Journal of the American College of Cardiology, 2004Co-Authors: Nico R Mollet, Peter M. T. Pattynama, Koen Nieman, Filippo Cademartiri, Pedro A Lemos, Patrick W. Serruys, Eugene P Mcfadden, Francesco Saia, Gabriel P Krestin, Pim J. De FeyterAbstract:Objectives This study was designed to prospectively evaluate the diagnostic performance of multislice spiral computed tomography (MSCT) Coronary Angiography for the detection of significant lesions in all segments of the Coronary tree potentially suitable for revascularization. Background Noninvasive MSCT Coronary Angiography is a promising Coronary imaging technique. Methods Sixteen-row MSCT Coronary Angiography was performed in 128 patients (89% men, mean age 58.9 ± 11.7 years) in sinus rhythm with stable angina pectoris scheduled for conventional Coronary Angiography. Sixty percent (77 of 128) of patients received pre-scan oral beta-blockers, resulting in a mean heart rate of 57.7 ± 7.7 beats/min. The diagnostic performance of MSCT for detection of significant lesions (≥50% diameter reduction) was compared with that of quantitative Coronary Angiography (QCA). Results The sensitivity of MSCT for detection of significant lesions was 92% (216 of 234, 95% confidence interval [CI]: 88 to 95). Specificity was 95% (1,092 of 1,150, 95% CI: 93 to 96), positive predictive value 79% (216 of 274, 95% CI: 73 to 88), and negative predictive value 98% (1,092 of 1,110, 95% CI: 97 to 99). Two ≥50% lesions were missed because of motion artifacts and two because of severe Coronary calcifications. The rest (78%, 14 of 18) were detected but incorrectly classified as <50% obstructions. All patients with and 86% (18 of 21) of patients without significant lesions on QCA were correctly classified by MSCT. All patients with significant left main disease or total occlusions were correctly identified on MSCT. Conclusions Sixteen-row MSCT Coronary Angiography permits reliable detection of significant obstructive Coronary artery disease in patients with stable angina in sinus rhythm.
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non invasive Coronary Angiography with multislice spiral computed tomography impact of heart rate
Heart, 2002Co-Authors: Koen Nieman, Peter M. T. Pattynama, Gabriel P Krestin, Benno J Rensing, Rj M Van Geuns, Jeroen Vos, P W Serruys, Pim J. De FeyterAbstract:Objective: To evaluate the impact of heart rate on the diagnostic accuracy of Coronary Angiography by multislice spiral computed tomography (MSCT). Design: Prospective observational study. Patients: 78 patients who underwent both conventional and MSCT Coronary Angiography for suspicion of de novo Coronary artery disease (n=53) or recurrent Coronary artery disease after percutaneous intervention (n=25). Setting: Tertiary referral centre. Methods: Intravenously contrast enhanced MSCT Coronary Angiography was done during a single breath hold, and ECG synchronised images were reconstructed retrospectively. All Coronary segments of ≥ 2.0 mm without stents were evaluated by two investigators and compared with quantitative Coronary Angiography. Patients were classified according to the average heart rate (mean (SD)) into three equally sized groups: group 1, 55.8 (4.1) beats/min; group 2, 66.6 (2.8) beats/min; group 3, 81.7 (8.8) beats/min. Results: Image quality was sufficient for analysis in 78% of the Coronary segments in patients in group 1, 73% in group 2, and 54% in group 3 (p Conclusions: MSCT allows reliable Coronary Angiography in patients with low heart rates.
Peter De Jaegere - One of the best experts on this subject based on the ideXlab platform.
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comprehensive assessment of Coronary artery stenoses computed tomography Coronary Angiography versus conventional Coronary Angiography and correlation with fractional flow reserve in patients with stable angina
Journal of the American College of Cardiology, 2008Co-Authors: Bob W Meijboom, Carlos Van Mieghem, Niels Van Pelt, Annick C Weustink, Francesca Pugliese, Nico R Mollet, Eric Boersma, E Regar, Robert Jan Van Geuns, Peter De JaegereAbstract:OBJECTIVES: We sought to determine the diagnostic accuracy of noninvasive visual (computed tomography Coronary Angiography [CTCA]) and quantitative computed tomography Coronary Angiography (QCT) to predict the hemodynamic significance of a Coronary stenosis, using intraCoronary fractional flow reserve (FFR) as the reference standard. BACKGROUND: It has been demonstrated that CTCA provides excellent diagnostic sensitivity for identifying Coronary stenoses, but may lack accurate delineation of the hemodynamic significance. METHODS: We investigated 79 patients with stable angina pectoris who underwent both 64-slice or dual-source CTCA and FFR measurement of discrete Coronary stenoses. CTCA and conventional Coronary Angiography (CCA), and QCT and quantitative Coronary Angiography (QCA), were performed to determine the severity of a stenosis that was compared with FFR measurements. A significant anatomical or functional stenosis was defined as >/=50% diameter stenosis or an FFR <0.75. Stented segments and bypass grafts were not included in the analysis. RESULTS: A total of 89 stenoses were evaluated of which 18% (16 of 89) had an FFR <0.75. The diagnostic accuracy of CTCA, QCT, CCA, and QCA to detect a hemodynamically significant Coronary lesion was 49%, 71%, 61%, and 67%, respectively. Correlation between QCT and QCA with FFR measurement was weak (R values of -0.32 and -0.30, respectively). Correlation between QCT and QCA was significant, but only moderate (R = 0.53; p < 0.0001). CONCLUSIONS: The anatomical assessment of the hemodynamic significance of Coronary stenoses determined by visual CTCA, CCA, or QCT or QCA does not correlate well with the functional assessment of FFR. Determining the hemodynamic significance of an angiographically intermediate stenosis remains relevant before referral for revascularization treatment.
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comprehensive assessment of Coronary artery stenoses computed tomography Coronary Angiography versus conventional Coronary Angiography and correlation with fractional flow reserve in patients with stable angina
Journal of the American College of Cardiology, 2008Co-Authors: Bob W Meijboom, Carlos Van Mieghem, Niels Van Pelt, Annick C Weustink, Francesca Pugliese, Nico R Mollet, Eric Boersma, E Regar, Robert Jan Van Geuns, Peter De JaegereAbstract:Objectives We sought to determine the diagnostic accuracy of noninvasive visual (computed tomography Coronary Angiography [CTCA]) and quantitative computed tomography Coronary Angiography (QCT) to predict the hemodynamic significance of a Coronary stenosis, using intraCoronary fractional flow reserve (FFR) as the reference standard. Background It has been demonstrated that CTCA provides excellent diagnostic sensitivity for identifying Coronary stenoses, but may lack accurate delineation of the hemodynamic significance. Methods We investigated 79 patients with stable angina pectoris who underwent both 64-slice or dual-source CTCA and FFR measurement of discrete Coronary stenoses. CTCA and conventional Coronary Angiography (CCA), and QCT and quantitative Coronary Angiography (QCA), were performed to determine the severity of a stenosis that was compared with FFR measurements. A significant anatomical or functional stenosis was defined as 50% diameter stenosis or an FFR 0.75. Stented segments and bypass grafts were not included in the analysis. Results A total of 89 stenoses were evaluated of which 18% (16 of 89) had an FFR 0.75. The diagnostic accuracy of CTCA, QCT, CCA, and QCA to detect a hemodynamically significant Coronary lesion was 49%, 71%, 61%, and 67%, respectively. Correlation between QCT and QCA with FFR measurement was weak (R values of 0.32 and 0.30, respectively). Correlation between QCT and QCA was significant, but only moderate (R 0.53; p 0.0001). Conclusions The anatomical assessment of the hemodynamic significance of Coronary stenoses determined by visual CTCA, CCA, or QCT or QCA does not correlate well with the functional assessment of FFR. Determining the hemodynamic significance of an angiographically intermediate stenosis remains relevant before referral for revascularization treatment. (J Am Coll Cardiol 2008;52:636‐43) © 2008 by the American College of Cardiology Foundation
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comprehensive assessment of Coronary artery stenoses computed tomography Coronary Angiography versus conventional Coronary Angiography and correlation with fractional flow reserve in patients with stable angina
Journal of the American College of Cardiology, 2008Co-Authors: Bob W Meijboom, Annick C Weustink, Francesca Pugliese, Nico R Mollet, Eric Boersma, E Regar, Carlos Van Mieghem, Niels Van Pelt, Robert Jan Van Geuns, Peter De JaegereAbstract:Objectives We sought to determine the diagnostic accuracy of noninvasive visual (computed tomography Coronary Angiography [CTCA]) and quantitative computed tomography Coronary Angiography (QCT) to predict the hemodynamic significance of a Coronary stenosis, using intraCoronary fractional flow reserve (FFR) as the reference standard. Background It has been demonstrated that CTCA provides excellent diagnostic sensitivity for identifying Coronary stenoses, but may lack accurate delineation of the hemodynamic significance. Methods We investigated 79 patients with stable angina pectoris who underwent both 64-slice or dual-source CTCA and FFR measurement of discrete Coronary stenoses. CTCA and conventional Coronary Angiography (CCA), and QCT and quantitative Coronary Angiography (QCA), were performed to determine the severity of a stenosis that was compared with FFR measurements. A significant anatomical or functional stenosis was defined as ≥50% diameter stenosis or an FFR Results A total of 89 stenoses were evaluated of which 18% (16 of 89) had an FFR Conclusions The anatomical assessment of the hemodynamic significance of Coronary stenoses determined by visual CTCA, CCA, or QCT or QCA does not correlate well with the functional assessment of FFR. Determining the hemodynamic significance of an angiographically intermediate stenosis remains relevant before referral for revascularization treatment.
Francesca Pugliese - One of the best experts on this subject based on the ideXlab platform.
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comprehensive assessment of Coronary artery stenoses computed tomography Coronary Angiography versus conventional Coronary Angiography and correlation with fractional flow reserve in patients with stable angina
Journal of the American College of Cardiology, 2008Co-Authors: Bob W Meijboom, Carlos Van Mieghem, Niels Van Pelt, Annick C Weustink, Francesca Pugliese, Nico R Mollet, Eric Boersma, E Regar, Robert Jan Van Geuns, Peter De JaegereAbstract:OBJECTIVES: We sought to determine the diagnostic accuracy of noninvasive visual (computed tomography Coronary Angiography [CTCA]) and quantitative computed tomography Coronary Angiography (QCT) to predict the hemodynamic significance of a Coronary stenosis, using intraCoronary fractional flow reserve (FFR) as the reference standard. BACKGROUND: It has been demonstrated that CTCA provides excellent diagnostic sensitivity for identifying Coronary stenoses, but may lack accurate delineation of the hemodynamic significance. METHODS: We investigated 79 patients with stable angina pectoris who underwent both 64-slice or dual-source CTCA and FFR measurement of discrete Coronary stenoses. CTCA and conventional Coronary Angiography (CCA), and QCT and quantitative Coronary Angiography (QCA), were performed to determine the severity of a stenosis that was compared with FFR measurements. A significant anatomical or functional stenosis was defined as >/=50% diameter stenosis or an FFR <0.75. Stented segments and bypass grafts were not included in the analysis. RESULTS: A total of 89 stenoses were evaluated of which 18% (16 of 89) had an FFR <0.75. The diagnostic accuracy of CTCA, QCT, CCA, and QCA to detect a hemodynamically significant Coronary lesion was 49%, 71%, 61%, and 67%, respectively. Correlation between QCT and QCA with FFR measurement was weak (R values of -0.32 and -0.30, respectively). Correlation between QCT and QCA was significant, but only moderate (R = 0.53; p < 0.0001). CONCLUSIONS: The anatomical assessment of the hemodynamic significance of Coronary stenoses determined by visual CTCA, CCA, or QCT or QCA does not correlate well with the functional assessment of FFR. Determining the hemodynamic significance of an angiographically intermediate stenosis remains relevant before referral for revascularization treatment.
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comprehensive assessment of Coronary artery stenoses computed tomography Coronary Angiography versus conventional Coronary Angiography and correlation with fractional flow reserve in patients with stable angina
Journal of the American College of Cardiology, 2008Co-Authors: Bob W Meijboom, Carlos Van Mieghem, Niels Van Pelt, Annick C Weustink, Francesca Pugliese, Nico R Mollet, Eric Boersma, E Regar, Robert Jan Van Geuns, Peter De JaegereAbstract:Objectives We sought to determine the diagnostic accuracy of noninvasive visual (computed tomography Coronary Angiography [CTCA]) and quantitative computed tomography Coronary Angiography (QCT) to predict the hemodynamic significance of a Coronary stenosis, using intraCoronary fractional flow reserve (FFR) as the reference standard. Background It has been demonstrated that CTCA provides excellent diagnostic sensitivity for identifying Coronary stenoses, but may lack accurate delineation of the hemodynamic significance. Methods We investigated 79 patients with stable angina pectoris who underwent both 64-slice or dual-source CTCA and FFR measurement of discrete Coronary stenoses. CTCA and conventional Coronary Angiography (CCA), and QCT and quantitative Coronary Angiography (QCA), were performed to determine the severity of a stenosis that was compared with FFR measurements. A significant anatomical or functional stenosis was defined as 50% diameter stenosis or an FFR 0.75. Stented segments and bypass grafts were not included in the analysis. Results A total of 89 stenoses were evaluated of which 18% (16 of 89) had an FFR 0.75. The diagnostic accuracy of CTCA, QCT, CCA, and QCA to detect a hemodynamically significant Coronary lesion was 49%, 71%, 61%, and 67%, respectively. Correlation between QCT and QCA with FFR measurement was weak (R values of 0.32 and 0.30, respectively). Correlation between QCT and QCA was significant, but only moderate (R 0.53; p 0.0001). Conclusions The anatomical assessment of the hemodynamic significance of Coronary stenoses determined by visual CTCA, CCA, or QCT or QCA does not correlate well with the functional assessment of FFR. Determining the hemodynamic significance of an angiographically intermediate stenosis remains relevant before referral for revascularization treatment. (J Am Coll Cardiol 2008;52:636‐43) © 2008 by the American College of Cardiology Foundation
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comprehensive assessment of Coronary artery stenoses computed tomography Coronary Angiography versus conventional Coronary Angiography and correlation with fractional flow reserve in patients with stable angina
Journal of the American College of Cardiology, 2008Co-Authors: Bob W Meijboom, Annick C Weustink, Francesca Pugliese, Nico R Mollet, Eric Boersma, E Regar, Carlos Van Mieghem, Niels Van Pelt, Robert Jan Van Geuns, Peter De JaegereAbstract:Objectives We sought to determine the diagnostic accuracy of noninvasive visual (computed tomography Coronary Angiography [CTCA]) and quantitative computed tomography Coronary Angiography (QCT) to predict the hemodynamic significance of a Coronary stenosis, using intraCoronary fractional flow reserve (FFR) as the reference standard. Background It has been demonstrated that CTCA provides excellent diagnostic sensitivity for identifying Coronary stenoses, but may lack accurate delineation of the hemodynamic significance. Methods We investigated 79 patients with stable angina pectoris who underwent both 64-slice or dual-source CTCA and FFR measurement of discrete Coronary stenoses. CTCA and conventional Coronary Angiography (CCA), and QCT and quantitative Coronary Angiography (QCA), were performed to determine the severity of a stenosis that was compared with FFR measurements. A significant anatomical or functional stenosis was defined as ≥50% diameter stenosis or an FFR Results A total of 89 stenoses were evaluated of which 18% (16 of 89) had an FFR Conclusions The anatomical assessment of the hemodynamic significance of Coronary stenoses determined by visual CTCA, CCA, or QCT or QCA does not correlate well with the functional assessment of FFR. Determining the hemodynamic significance of an angiographically intermediate stenosis remains relevant before referral for revascularization treatment.
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diagnostic accuracy of non invasive 64 slice ct Coronary Angiography in patients with stable angina pectoris
European Radiology, 2006Co-Authors: Francesca Pugliese, Nico R Mollet, Gabriel P Krestin, Carlos Van Mieghem, Giuseppe Runza, Timo Baks, Willem B Meijboom, Patrizia Malagutti, Pim J DefeyterAbstract:Multislice computed tomography (CT) is an emerging technique for the non-invasive detection of Coronary stenoses. While the diagnostic accuracy of 4-slice scanners was limited, 16-slice CT imagers showed promising results due to increased temporal and spatial resolution. These technical advances prompted us to evaluate the diagnostic performance of 64-slice CT Coronary Angiography in the detection of significant stenoses (defined as ≥ 50% luminal diameter reduction) versus invasive quantitative Coronary Angiography (QCA). Thirty-five patients with stable angina pectoris underwent CT Coronary Angiography performed with a 64-slice scanner (gantry rotation time 330 ms, individual detector width 0.6 mm) prior to conventional Coronary Angiography. Patients with heart rates >70 beats/min received 100 mg metoprolol orally. One hundred millilitres of contrast agent with an iodine concentration of 400 mgl/ml were injected at a rate of 5 ml/s into the antecubital vein. The CT scan was triggered with the bolus tracking technique. The sensitivity, specificity and the positive and negative predictive values of 64-slice CT were 99%, 96%, 78% and 99%, respectively, on a per-segment basis. The values obtained on a per-patient basis were 100%, 90%, 96% and 100%, respectively. When referral to catheterisation is questionable, CT Coronary Angiography may identify subjects with normal angiograms and consistently decrease the number of unnecessary invasive procedures.
Gabriel P Krestin - One of the best experts on this subject based on the ideXlab platform.
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diagnostic accuracy of non invasive 64 slice ct Coronary Angiography in patients with stable angina pectoris
European Radiology, 2006Co-Authors: Francesca Pugliese, Nico R Mollet, Gabriel P Krestin, Carlos Van Mieghem, Giuseppe Runza, Timo Baks, Willem B Meijboom, Patrizia Malagutti, Pim J DefeyterAbstract:Multislice computed tomography (CT) is an emerging technique for the non-invasive detection of Coronary stenoses. While the diagnostic accuracy of 4-slice scanners was limited, 16-slice CT imagers showed promising results due to increased temporal and spatial resolution. These technical advances prompted us to evaluate the diagnostic performance of 64-slice CT Coronary Angiography in the detection of significant stenoses (defined as ≥ 50% luminal diameter reduction) versus invasive quantitative Coronary Angiography (QCA). Thirty-five patients with stable angina pectoris underwent CT Coronary Angiography performed with a 64-slice scanner (gantry rotation time 330 ms, individual detector width 0.6 mm) prior to conventional Coronary Angiography. Patients with heart rates >70 beats/min received 100 mg metoprolol orally. One hundred millilitres of contrast agent with an iodine concentration of 400 mgl/ml were injected at a rate of 5 ml/s into the antecubital vein. The CT scan was triggered with the bolus tracking technique. The sensitivity, specificity and the positive and negative predictive values of 64-slice CT were 99%, 96%, 78% and 99%, respectively, on a per-segment basis. The values obtained on a per-patient basis were 100%, 90%, 96% and 100%, respectively. When referral to catheterisation is questionable, CT Coronary Angiography may identify subjects with normal angiograms and consistently decrease the number of unnecessary invasive procedures.
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high resolution spiral computed tomography Coronary Angiography in patients referred for diagnostic conventional Coronary Angiography
Circulation, 2005Co-Authors: Nico R Mollet, Filippo Cademartiri, Patrick W. Serruys, Eugene P Mcfadden, Gabriel P Krestin, Carlos Van Mieghem, Giuseppe Runza, Timo Baks, Pim J. De FeyterAbstract:Background—The diagnostic performance of the latest 64-slice CT scanner, with increased temporal (165 ms) and spatial (0.4 mm 3 ) resolution, to detect significant stenoses in the clinically relevant Coronary tree is unknown. Methods and Results—We studied 52 patients (34 men; mean age, 59.612.1 years) with atypical chest pain, stable or unstable angina pectoris, or non–ST-segment elevation myocardial infarction scheduled for diagnostic conventional Coronary Angiography. All patients had stable sinus rhythm. Patients with initial heart rates 70 bpm received -blockers. Mean scan time was 13.30.9 seconds. The CT scans were analyzed by 2 observers unaware of the results of invasive Coronary Angiography, which was used as the standard of reference. All available Coronary segments, regardless of size, were included in the evaluation. Lesions with 50 luminal narrowing were considered significant stenoses. Invasive Coronary Angiography demonstrated the absence of significant disease in 25% (13 of 52), single-vessel disease in 31% (16 of 52), and multivessel disease in 45% (23 of 52) of patients. One unsuccessful CT scan was classified as inconclusive. Ninety-four significant stenoses were present in the remaining 51 patients. Sensitivity, specificity, and positive and negative predictive values of CT for detecting significant stenoses on a segment-by-segment analysis were 99% (93 of 94; 95% CI, 94 to 99), 95% (601 of 631; 95% CI, 93 to 96), 76% (93 of 123; 95% CI, 67 to 89), and 99% (601 of 602; 95% CI, 99 to 100), respectively. Conclusions—Noninvasive 64-slice CT Coronary Angiography accurately detects Coronary stenoses in patients in sinus rhythm and presenting with atypical chest pain, stable or unstable angina, or non–ST-segment elevation myocardial infarction. (Circulation. 2005;112:2318-2323.)
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value of preprocedure multislice computed tomographic Coronary Angiography to predict the outcome of percutaneous recanalization of chronic total occlusions
American Journal of Cardiology, 2005Co-Authors: Nico R Mollet, Filippo Cademartiri, Pedro A Lemos, Patrick W. Serruys, Eugene P Mcfadden, Gabriel P Krestin, Angela Hoye, Georgios Sianos, Pim J. De FeyterAbstract:We performed multislice computed tomographic Coronary Angiography in 45 patients who had chronic total occlusions and were scheduled for percutaneous recanalization. Multivariate analysis identified a blunt stump (by conventional Angiography), occlusion length >15 mm, and severe calcification (by multislice computed tomographic Coronary Angiography) as independent predictors of procedural failure.
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multislice spiral computed tomography Coronary Angiography in patients with stable angina pectoris
Journal of the American College of Cardiology, 2004Co-Authors: Nico R Mollet, Peter M. T. Pattynama, Koen Nieman, Filippo Cademartiri, Pedro A Lemos, Patrick W. Serruys, Eugene P Mcfadden, Francesco Saia, Gabriel P Krestin, Pim J. De FeyterAbstract:Abstract Objectives This study was designed to prospectively evaluate the diagnostic performance of multislice spiral computed tomography (MSCT) Coronary Angiography for the detection of significant lesions in all segments of the Coronary tree potentially suitable for revascularization. Background Noninvasive MSCT Coronary Angiography is a promising Coronary imaging technique. Methods Sixteen-row MSCT Coronary Angiography was performed in 128 patients (89% men, mean age 58.9 ± 11.7 years) in sinus rhythm with stable angina pectoris scheduled for conventional Coronary Angiography. Sixty percent (77 of 128) of patients received pre-scan oral beta-blockers, resulting in a mean heart rate of 57.7 ± 7.7 beats/min. The diagnostic performance of MSCT for detection of significant lesions (≥50% diameter reduction) was compared with that of quantitative Coronary Angiography (QCA). Results The sensitivity of MSCT for detection of significant lesions was 92% (216 of 234, 95% confidence interval [CI]: 88 to 95). Specificity was 95% (1,092 of 1,150, 95% CI: 93 to 96), positive predictive value 79% (216 of 274, 95% CI: 73 to 88), and negative predictive value 98% (1,092 of 1,110, 95% CI: 97 to 99). Two ≥50% lesions were missed because of motion artifacts and two because of severe Coronary calcifications. The rest (78%, 14 of 18) were detected but incorrectly classified as Conclusions Sixteen-row MSCT Coronary Angiography permits reliable detection of significant obstructive Coronary artery disease in patients with stable angina in sinus rhythm.
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multislice spiral computed tomography Coronary Angiography in patients with stable angina pectoris
Journal of the American College of Cardiology, 2004Co-Authors: Nico R Mollet, Peter M. T. Pattynama, Koen Nieman, Filippo Cademartiri, Pedro A Lemos, Patrick W. Serruys, Eugene P Mcfadden, Francesco Saia, Gabriel P Krestin, Pim J. De FeyterAbstract:Objectives This study was designed to prospectively evaluate the diagnostic performance of multislice spiral computed tomography (MSCT) Coronary Angiography for the detection of significant lesions in all segments of the Coronary tree potentially suitable for revascularization. Background Noninvasive MSCT Coronary Angiography is a promising Coronary imaging technique. Methods Sixteen-row MSCT Coronary Angiography was performed in 128 patients (89% men, mean age 58.9 ± 11.7 years) in sinus rhythm with stable angina pectoris scheduled for conventional Coronary Angiography. Sixty percent (77 of 128) of patients received pre-scan oral beta-blockers, resulting in a mean heart rate of 57.7 ± 7.7 beats/min. The diagnostic performance of MSCT for detection of significant lesions (≥50% diameter reduction) was compared with that of quantitative Coronary Angiography (QCA). Results The sensitivity of MSCT for detection of significant lesions was 92% (216 of 234, 95% confidence interval [CI]: 88 to 95). Specificity was 95% (1,092 of 1,150, 95% CI: 93 to 96), positive predictive value 79% (216 of 274, 95% CI: 73 to 88), and negative predictive value 98% (1,092 of 1,110, 95% CI: 97 to 99). Two ≥50% lesions were missed because of motion artifacts and two because of severe Coronary calcifications. The rest (78%, 14 of 18) were detected but incorrectly classified as <50% obstructions. All patients with and 86% (18 of 21) of patients without significant lesions on QCA were correctly classified by MSCT. All patients with significant left main disease or total occlusions were correctly identified on MSCT. Conclusions Sixteen-row MSCT Coronary Angiography permits reliable detection of significant obstructive Coronary artery disease in patients with stable angina in sinus rhythm.