1.A Case of Extrinsic Compression of the Left Main Coronary Artery Secondary to Pulmonary Artery Dilatation.
Yoon Jung CHOI ; Ung KIM ; Jin Sung LEE ; Won Jong PARK ; Sang Hee LEE ; Jong Seon PARK ; Dong Gu SHIN ; Young Jo KIM
Journal of Korean Medical Science 2013;28(10):1543-1548
Extrinsic compression of the left main coronary artery (LMCA) secondary to pulmonary artery dilatation is a rare syndrome. Most cases of pulmonary artery hypertension but no atherosclerotic risk factors rarely undergo coronary angiography, and hence, diagnoses are seldom made and proper management is often delayed in these patients. We describe a patient that presented with pulmonary hypertension, clinical angina, and extrinsic compression of the LMCA by the pulmonary artery, who was treated successfully by percutaneous coronary intervention. Follow-up coronary angiography showed patent stent in the LMCA in the proximity of the dilated main pulmonary artery. This case reminds us that coronary angiography and percutaneous coronary intervention should be considered in pulmonary hypertension patients presenting with angina or left ventricular dysfunction.
Angina Pectoris/etiology
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Angioplasty, Balloon, Coronary
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Coronary Angiography
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Coronary Stenosis/radiography/therapy
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Coronary Vessels/radiography/*ultrasonography
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Dilatation, Pathologic
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Female
;
Humans
;
Hypertension, Pulmonary/etiology/radiography
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Middle Aged
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Pulmonary Artery/radiography/*ultrasonography
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Stents
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Tomography, X-Ray Computed
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Ventricular Dysfunction, Left
2.Prediction of Coronary Atherosclerotic Ostial Lesion with a Damping of the Pressure Tracing during Diagnostic Coronary Angiography.
Ae Young HER ; Soe Hee ANN ; Gillian Balbir SINGH ; Yong Hoon KIM ; Bon Kwon KOO ; Eun Seok SHIN
Yonsei Medical Journal 2016;57(1):58-63
PURPOSE: When performing coronary angiography (CAG), diagnostic catheter intubation to the ostium can cause damping of the pressure tracing. The aim of this study was to determine the predictors of atherosclerotic ostial stenosis in patients showing pressure damping during CAG. MATERIALS AND METHODS: In total, 2926 patients who underwent diagnostic CAG were screened in this study. Pressure damping was defined as an abrupt decline of the coronary blood pressure with a blunted pulse pressure after engagement of the diagnostic catheter. According to CAG and intravascular ultrasound (IVUS), we divided damped ostia into two groups: atherosclerotic ostial lesion group (true lesion group) and non-atherosclerotic ostium group (false lesion group). Clinical and angiographic characteristics were compared between the two groups. RESULTS: The overall incidence of pressure damping was 2.3% (68 patients and 76 ostia). Among the pressure damped ostia, 40.8% (31 of 76 ostia) were true atherosclerotic ostial lesions (true lesion group). The true lesion group had more frequent left main ostial damping and more percutaneous coronary interventions (PCIs) performed on non-ostial lesions, compared to the false lesion group. On multivariate logistic regression analysis, left main ostial damping [hazard ratio (HR) 4.11, 95% confidence interval (CI) 1.24-13.67, p=0.021] and PCI on non-ostial lesion (HR 5.34, 95% CI 1.34-21.27, p=0.018) emerged as independent predictors for true atherosclerotic ostial lesions in patients with pressure damping. CONCLUSION: Left main ostial damping and the presence of a non-ostial atherosclerotic lesion may suggest a significant true atherosclerotic lesion in the coronary ostium.
Aged
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*Coronary Angiography
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Coronary Artery Disease/etiology/*radiography
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Coronary Occlusion/diagnosis/*therapy
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Coronary Stenosis/etiology/*radiography
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Coronary Vessel Anomalies/radiography
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Coronary Vessels/*pathology
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Female
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Humans
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Incidence
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Male
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Middle Aged
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Percutaneous Coronary Intervention/adverse effects/methods
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Predictive Value of Tests
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Proportional Hazards Models
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Radiography, Interventional
3.The Utility of Multi-detector Row Spiral CT for Detection of Coronary Artery Stenoses.
Jae Youn MOON ; Namsik CHUNG ; Byoung Wook CHOI ; Kyu Ok CHOE ; Hye Sun SEO ; Young Guk KO ; Seok Min KANG ; Jong Won HA ; Se Joong RIM ; Yangsoo JANG ; Won Heum SHIM ; Seung Yun CHO
Yonsei Medical Journal 2005;46(1):86-94
Contrast-enhanced multi-detector row spiral computed tomography (MDCT) was introduced as a promising noninvasive method for vascular imaging. This study examined the accuracy of this technique for detecting significant coronary artery stenoses. Both MDCT (Sensation 16, Siemens, Germany, 12 x 0.75 mm collimation and 0.42 sec rotation speed, 120 kV, 500 effective mA, and 2.7 mm/rotation table-feed) and invasive coronary angiography (CAG) were performed on 61 patients (mean age 59.2 +/- 10, 44 men) who were suspected of having coronary artery disease. All patients were treated with atenolol (25 - 50 mg) prior to imaging and the heart rate was maintained below 65 beats per minutes during image acquisition. The images were reconstructed in the diastole around TI - 400 ms with a 0.5 mm increment and a 1.0 mm thickness. All coronary arteries with a diameter of 2.0 mm or more were assessed for the presence of a stenosis (> 50% luminal narrowing). Two independent radiologists who were unaware of the results of the invasive CAG evaluated the MDCT data, and the results were compared with those from the invasive CAG (interval 1- 27, mean 11 days). An evaluation of the CT coronary angiogram (CTCA) was possible in 58 of the 61 patients (95%). Image acquisition of the major coronary arteries including the left main trunk was available in 229 out of 244 arteries. Invasive CAG showed that 35 out of 58 patients had significant coronary artery stenoses by. patient analysis of those who could be evaluated showed that CT coronary angiography correctly classified 30 out of 35 patients as having at least 1 coronary stenosis (sensitivity 85.7%, specificity 91.3%, positive predictive value 93.8%, negative predictive value 80.8%). By analyzing each coronary artery, CAG found 62 stenotic coronary arteries in the 229 coronary arteries that could be evaluated. MDCT correctly detected 50 out of 62 stenotic coronary arteries and an absence of stenosis was correctly identified in 156 out of 167 normal coronary arteries (sensitivity 80.6%, specificity 93.4%, positive predictive value 81.9%, negative predictive value 92.8%). The non-invasive technique of MDCT for examining the coronary artery appears to be a useful method for detecting coronary artery stenoses with a high accuracy particularly with the proximal portion and large arteries.
Aged
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Coronary Stenosis/*radiography
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Female
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Humans
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Male
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Middle Aged
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Predictive Value of Tests
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Reproducibility of Results
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Sensitivity and Specificity
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*Tomography, Spiral Computed/standards
4.Comparison of Transaxial Source Images and 3-Plane, Thin-Slab Maximal Intensity Projection Images for the Diagnosis of Coronary Artery Stenosis with Using ECG-Gated Cardiac CT.
Jin Woo CHOI ; Joon Beom SEO ; Kyung Hyun DO ; Sang Il CHOI ; Whal LEE ; Sung Min KO ; Soo Hyun LEE ; Jin Seong LEE ; Jae Woo SONG ; Koun Sik SONG ; Tae Hwan LIM
Korean Journal of Radiology 2006;7(1):20-27
OBJECTIVE: We wanted to compare the transaxial source images with the optimized three plane, thin-slab maximum intensity projection (MIP) images from electrocardiographic (ECG)-gated cardiac CT for their ability to detect hemodynamically significant stenosis (HSS), and we did this by means of performing a receiver operating characteristic (ROC) analysis. MATERIALS AND METHODS: Twenty-eight patients with a heart rate less than 66 beats per minute and who were undergoing both retrospective ECG-gated cardiac CT and conventional coronary angiography were included in this study. The contrast-enhanced CT scans were obtained with a collimation of 16x0.75-mm and a rotation time of 420 msec. The transaxial images were reconstructed at the mid-diastolic phase with a 1-mm slice thickness and a 0.5-mm increment. Using the transaxial images, the slab MIP images were created with a 4-mm thickness and a 2-mm increment, and they covered the entire heart in the horizontal long axis (4 chamber view), in the vertical long axis (2 chamber view) and in the short axis. The transaxial images and MIP images were independently evaluated for their ability to detect HSS. Conventional coronary angiograms of the same study group served as the standard of reference. Four radiologists were requested to rank each image with using a five-point scale (1 = definitely negative, 2 = probably negative, 3 = indeterminate, 4 = probably positive, and 5 = definitely positive) for the presence of HSS; the data were then interpreted using ROC analysis. RESULTS: There was no statistical difference in the area under the ROC curve between transaxial images and MIP images for the detection of HSS (0.8375 and 0.8708, respectively; p > 0.05). The mean reading time for the transaxial source images and the MIP images was 116 and 126.5 minutes, respectively. CONCLUSION: The diagnostic performance of the MIP images for detecting HSS of the coronary arteries is acceptable and this technique's ability to detect HSS is comparable to that of the transaxial source images.
Tomography, X-Ray Computed/*methods
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Retrospective Studies
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ROC Curve
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Middle Aged
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Male
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*Image Interpretation, Computer-Assisted
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Humans
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Heart Rate
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Female
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Electrocardiography
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Coronary Stenosis/*radiography
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Coronary Angiography
;
Aged
;
Adult
5.Association of Apolipoprotein B/Apolipoprotein A1 Ratio and Coronary Artery Stenosis and Plaques Detected by Multi-Detector Computed Tomography in Healthy Population.
Chang Hee JUNG ; Jenie Yoonoo HWANG ; Mi Seon SHIN ; Ji Hee YU ; Eun Hee KIM ; Sung Jin BAE ; Dong Hyun YANG ; Joon Won KANG ; Joong Yeol PARK ; Hong Kyu KIM ; Woo Je LEE
Journal of Korean Medical Science 2013;28(5):709-716
Despite the noninvasiveness and accuracy of multidetector computed tomography (MDCT), its use as a routine screening tool for occult coronary atherosclerosis is unclear. We investigated whether the ratio of apolipoprotein B (apoB) to apolipoprotein A1 (apoA1), an indicator of the balance between atherogenic and atheroprotective cholesterol transport could predict occult coronary atherosclerosis detected by MDCT. We collected the data of 1,401 subjects (877 men and 524 women) who participated in a routine health screening examination of Asan Medical Center. Significant coronary artery stenosis defined as > 50% stenosis was detected in 114 subjects (8.1%). An increase in apoB/A1 quartiles was associated with increased percentages of subjects with significant coronary stenosis and noncalcified plaques (NCAP). After adjustment for confounding variables, each 0.1 increase in serum apoB/A1 was significantly associated with increased odds ratios (ORs) for coronary stenosis and NCAP of 1.23 and 1.18, respectively. The optimal apoB/A1 ratio cut off value for MDCT detection of significant coronary stenosis was 0.58, which had a sensitivity of 70.2% and a specificity of 48.2% (area under the curve, 0.61; 95% CI, 0.58-0.63, P < 0.001). Our results indicate that apoB/A1 ratio is a good indicator of occult coronary atherosclerosis detected by coronary MDCT.
Adult
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Aged
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Apolipoprotein A-I/*blood
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Apolipoproteins B/*blood
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Area Under Curve
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Carotid Stenosis/*radiography
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Coronary Stenosis/*radiography
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Female
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Humans
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Male
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Middle Aged
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Odds Ratio
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ROC Curve
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Tomography, X-Ray Computed
6.Efficacy and Safety of the Computed Tomography Coronary Angiography Based Approach for Patients with Acute Chest Pain at an Emergency Department: One Month Clinical Follow-up Study.
Joonghee KIM ; Hwijae LEE ; Sungwook SONG ; Jinsik PARK ; Hwanjun JAE ; Whal LEE ; Sangdo SHIN ; Sungkoo JUNG ; Youngho KWAK ; Giljoon SUH ; Jaehyung PARK
Journal of Korean Medical Science 2010;25(3):466-471
To evaluate the safety and efficacy of the computed tomography coronary angiography (CTCA) for evaluation of acute chest pain in real world population, we prospectively enrolled 296 patients with acute chest pain at emergency department (ED) from November 2005 to February 2007. The patients were grouped based on the clinical information and CTCA result. The patients with a low risk profile and no significant coronary stenosis (>50%) in CTCA were discharged immediately (Group 1, n=103). On the other hand, the patients with an intermediate risk profile without significant stenosis were observed in ED for 24 hr (Group 2, n=104). The patients with significant stenosis underwent further coronary evaluation and management accordingly (Group 3, n=89). While no false negative case was found in Group 1, seven cases (6.73%) were found in Group 2, mostly during the observation period. In Group 3, there were 54 (60.67%) cases of acute coronary syndrome including 10 myocardial infarctions. The overall accuracy of CTCA for acute coronary syndrome was 88.5% (sensitivity), 85.1% (specificity), 60.7% (positive predictive value) and 96.6% (negative predictive value). In conclusion, clinical decision based on CTCA is safe and effective for low risk patients. Further validation is needed in patients with intermediate risk profile.
Adult
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Aged
;
*Chest Pain/diagnosis/etiology/radiography
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Coronary Angiography/*methods
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Coronary Stenosis/radiography
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Decision Making
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Emergency Service, Hospital
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Female
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Follow-Up Studies
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Humans
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Male
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Middle Aged
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Prospective Studies
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Risk Factors
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Sensitivity and Specificity
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Tomography, X-Ray Computed/*methods
7.Significance of Microalbuminuria in Relation to Subclinical Coronary Atherosclerosis in Asymptomatic Nonhypertensive, Nondiabetic Subjects.
Hyo Eun PARK ; Nam Ju HEO ; Minkyung KIM ; Su Yeon CHOI
Journal of Korean Medical Science 2013;28(3):409-414
We aimed to investigate the significance of microalbuminuria and its relationship with subclinical atherosclerosis in nonhypertensive and nondiabetic patients, by using coronary artery computed tomography (CT). A total of 1,318 nonhypertensive and nondiabetic subjects who had taken coronary artery CT and measured spot urine albumin to creatinine ratio (UACR) were evaluated. The atherosclerotic changes of coronary arteries were greater in subjects with microalbuminuria, reflected by coronary artery calcium score (CACS) and significant coronary artery stenosis (CACS > or = 100 in 15.3% vs 7.6% and stenosis > or = 50% in 11.5% vs 4.9% of patients with vs without microalbuminuria, P = 0.008 and P = 0.011, respectively). Among various parameters that are known as a risk factor or possible biomarkers of coronary artery disease, presence of microalbuminuria, age and Framingham risk score were significantly related to coronary artery stenosis. Among them the presence of microalbuminuria showed stronger correlation than others to the coronary artery stenosis detected by CT, even after adjusting confounding factors (OR 3.397, 95% confidence interval 1.138 to 10.140, P = 0.028). The presence of microalbuminuria by UACR was significantly associated with presence of coronary artery stenosis > or = 50% in asymptomatic, nonhypertensive and nondiabetic general population. Our study suggests that the presence of microalbuminuria may imply subclinical coronary artery disease, even in asymptomatic population.
Adult
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Age Factors
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Aged
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Albuminuria/*complications
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Blood Pressure
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Calcium/analysis
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Coronary Artery Disease/complications/*radiography
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Coronary Stenosis/complications
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Coronary Vessels/chemistry
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Creatinine/urine
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Female
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Humans
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Male
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Middle Aged
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Odds Ratio
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Retrospective Studies
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Risk Factors
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Sex Factors
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Tomography, X-Ray Computed
8.Diabetes mellitus and heart disease.
Anand AMBHORE ; Swee Guan TEO ; Kian Keong POH
Singapore medical journal 2013;54(7):370-quiz 376
Diabetes mellitus is responsible for diverse cardiovascular complications such as accelerated atherosclerosis, increased plaque burden and diffuse coronary lesions. It is also a major risk factor for myocardial infarction, stroke and peripheral vascular disease. Here, we present two cases. The first patient had subtle changes in the ECGs, with severe coronary artery disease requiring coronary artery bypass grafting, while the second had deep T wave inversion in the ECG and was found to have normal coronary arteries and nonischaemic cardiomyopathy. Although ECG failed to show the severity of the disease, it is invaluable as a simple, noninvasive test to aid in diagnosis. Our two cases stress the importance of a high index of suspicion and the low threshold for investigations in the diabetic population.
Aged
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Biomarkers
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analysis
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Combined Modality Therapy
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Coronary Angiography
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Coronary Artery Bypass
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Coronary Stenosis
;
diagnosis
;
therapy
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Diabetes Complications
;
diagnosis
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drug therapy
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surgery
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Diagnosis, Differential
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Electrocardiography
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Humans
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Male
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Middle Aged
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Pulmonary Edema
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diagnosis
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therapy
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Radiography, Thoracic
9.Trans-Radial versus Trans-Femoral Intervention for the Treatment of Coronary Bifurcations: Results from Coronary Bifurcation Stenting Registry.
Seungmin CHUNG ; Sung Ho HER ; Pil Sang SONG ; Young Bin SONG ; Joo Yong HAHN ; Jin Ho CHOI ; Sang Hoon LEE ; Yangsoo JANG ; Jung Han YOON ; Seung Jea TAHK ; Seung Jung PARK ; Seung Hyuk CHOI ; Ki Bae SEUNG ; Hyeon Cheol GWON
Journal of Korean Medical Science 2013;28(3):388-395
Trans-radial (TR) approach is increasingly recognized as an alternative to the routine use of trans-femoral (TF) approach. However, there are limited data comparing the outcomes of these two approaches for the treatment of coronary bifurcation lesions. We evaluated outcomes of TR and TF percutaneous coronary interventions (PCI) in this complex lesion. Procedural outcomes and clinical events were compared in 1,668 patients who underwent PCI for non-left main bifurcation lesions, according to the vascular approach, either TR (n = 503) or TF (n = 1,165). The primary outcome was major adverse cardiac events (MACE), including cardiac death, myocardial infarction (MI), and target lesion revascularization (TLR) in all patients and in 424 propensity-score matched pairs of patients. There were no significant differences between TR and TF approaches for procedural success in the main vessel (99.6% vs 98.6%, P = 0.08) and side branches (62.6% vs 66.7%, P = 0.11). Over a mean follow-up of 22 months, cardiac death or MI (1.8% vs 2.2%, P = 0.45), TLR (4.0% vs 5.2%, P = 0.22), and MACE (5.2% vs 7.0%, P = 0.11) did not significantly differ between TR and TF groups, respectively. These results were consistent after propensity score-matched analysis. In conclusion, TR PCI is a feasible alternative approach to conventional TF approaches for bifurcation PCI (clinicaltrials.gov number: NCT00851526).
Aged
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Angioplasty, Balloon, Coronary/adverse effects/*methods
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Coronary Angiography
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Coronary Stenosis/mortality/radiography/*therapy
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Coronary Vessels/radiography/surgery
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*Drug-Eluting Stents
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Female
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Follow-Up Studies
;
Hemorrhage/etiology
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Humans
;
Kaplan-Meier Estimate
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Male
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Middle Aged
;
Myocardial Infarction/etiology
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Myocardial Revascularization
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Proportional Hazards Models
;
Registries
10.Fusion of 3D Cardiac SPECT and 64-Channel-CT Angiography Using Personal Computer in Functionally Relevant Coronary Artery Stenosis.
Nuclear Medicine and Molecular Imaging 2007;41(3):252-254
Image fusion is fast catching attention as Wagner pointed out in his 2006 version of the recent progress and development presented at the annual meeting of Society of Nuclear Medicine. Prototypical fusion of bone scan and radiograph was already attempted at in 1961 when Fleming et al. published an article on strontium-85 bone scan. They simply superimposed dot scan on radiograph enabling simultaneous assessment of altered bone metabolism and local bone anatomy. Indeed the parallel reading of images of bone scan and radiography, CT, MRI or ultrasonography has been practiced in nuclear medicine long since. It is fortunate that recent development of computer science and technology along with the availability of refined CT and SPECT machines has permitted us to open a new avenue to digitally produce precise fusion image so that they can readily be read, exchanged and disseminated using internet. Ten years ago fusion was performed using Bresstrahlung SPECT/CT and it is now achievable by PET/CT and SPECT/CT software and SPECT/CT hardware. The merit of image fusion is its feasibility of reliable assessment of morphological and metabolic change. It is now applicable not only to stationary organs such as brain and skeleton but also to moving organs such as the heart, lung and stomach. Recently, we could create useful fusion image of cardiac SPECT and 64-channel CT angiograph. The former provided myocardial metabolic profile and the latter vascular narrowing in two patients with coronary artery stenosis and myocardial ischemia. Arterial stenosis was severe in Case 1 and mild in Case 2.
Angiography*
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Brain
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Constriction, Pathologic
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Coronary Stenosis*
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Coronary Vessels*
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Heart
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Humans
;
Internet
;
Lung
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Magnetic Resonance Imaging
;
Metabolism
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Metabolome
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Microcomputers*
;
Myocardial Ischemia
;
Nuclear Medicine
;
Positron-Emission Tomography and Computed Tomography
;
Radiography
;
Skeleton
;
Stomach
;
Tomography, Emission-Computed, Single-Photon*
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Ultrasonography