State of the art review: Multislice CTA, myocardial perfusion, functional measurement

A study from Germany looks at the accuracy of CT angiography in detecting stenoses following CABG surgery. A head-to-head comparison from the Netherlands pits MSCTA against myocardial perfusion. A study from France determines if CTA can reliably calculate right ventricular function.

Coronary artery disease diagnosis

Diagnostic accuracy of noninvasive coronary angiography in patients after bypass surgery using 64-slice spiral computed tomography with 330-ms gantry rotation

Circulation 2006;114:2334-2341

Dr. Stephan Achenbach's group at the University of Erlangen in Germany determined from 50 patients that 64-slice CTA accurately detects stenoses in coronary artery bypass grafts. Multislice CT evaluated all 138 grafts, correctly identifying 100% of the stenoses with a specificity of 94%. Imaging was performed an average of 106 months after revascularizing surgery. For the per-segment evaluation of native coronary arteries and distal runoff vessels, the sensitivity and specificity of evaluable segments were 91% and 76%, respectively. A sensitivity of 86% and specificity of 90% were achieved when the evaluation was limited to nongrafted arteries and distal runoff vessels.

Myocardial perfusion

Relationship between noninvasive coronary angiography with multi-slice computed tomography and myocardial perfusion imaging

J Am Coll Cardiol 2006;48:2508-2514

A head-to-head comparison between multislice CT angiography and myocardial perfusion imaging (MPI) found that the two modalities provide complementary information about coronary artery disease. Multislice CT detects atherosclerosis, and perfusion imaging detects and evaluates ischemia. Collaborating radiologists and cardiologists at Leiden University Medical Center in the Netherlands examined 114 patients with an intermediate likelihood of coronary artery disease. Only 45% of patients with abnormal MSCTA had abnormal MPI. Half of the patients with obstructive CAD had normal MPI.

Functional measurement

MDCT of right ventricular function: comparison of right ventricular ejection fraction estimation and equilibrium radionuclide ventriculography (Parts 1 and 2)

AJR 2006;187(6):1597-1609

Dr. Damien Delhaye and colleagues at Hospital Calmette in Lille, France, found from a study of 49 consecutive patients that right ventricular function can be reliably calculated with contrast-enhanced 16-slice CT angiography.

Arrhythomogenic right ventricular dysplasia

Magnetic resonance imaging of arrhythmogenic right ventricular dysplasia (ARVD)

J Am Coll Cardiol 2006;48:2277-2284

Dr. David A. Bluemke and colleagues in the radiology and cardiology divisions of Johns Hopkins University established that qualitative assessments of right ventricular structure and function with cardiac MR are highly reproducible among experienced physicians. Based on the group's criteria, 40 patients were diagnosed with arrhythmogenic right ventricular dysplasia (ARVD). Fat infiltration was less reproducible and less specific than RV kinetic abnormalities. The correlation coefficients between observers for RV end-diastolic volume, end-systolic volume, and ejection fraction were 0.93, 0.94, and 0.95, respectively. The sensitivity for fat infiltration, RV enlargement, and regional RV dysfunction for diagnosing ARVD was 84%, 68%, and 78%, respectively. The specificity for these three indicators was 79%, 96%, and 94%, respectively.

Surgical ventricular restoration

Effects of surgical ventricular restoration on left ventricular function: dynamic MRI

Radiology 2006;241:710-717

Under the direction of Dr. Richard D. White, Dr. Brett B. Carmichael and colleagues at the Cleveland Clinic evaluated 105 patients with cardiac MR before and twice after surgical ventricular restoration surgery. The procedure involved the excision of the scarred antero-apical post-MI zones of the left ventricle followed by approximation of the free edges with circumferential endocardial and epicardial sutures and a patch, if necessary, to restore the configuration of the left ventricle. Procedures were performed on patients with chronic ischemic heart disease, including large nonaneurysmal or aneurysmal postmyocardial infarction zones. Baseline cardiac MRI confirmed presence of LV dilation and diminished global and regional LV function. Imaging performed about a week after restorative surgery found that global left ventricular function improved significantly, but regional LV function did not improve, and LV remodeling had continued.