Anomalous left main coronary artery detected by CT angiography

Congenital absence of the right coronary artery: A case report

BACKGROUND

As a rare anomaly, congenital absence of the right coronary artery (RCA) occurs during the development of coronary artery. Patients with congenital absence of the RCA often show no clinical symptoms, and this disease is considered benign. The left coronary artery gives blood supply to the whole myocardium. The prevalence of congenital absence of the RCA is approximately 0.024%-0.066%. There are few cases reported as for this disease. In this work, a patient, with congenital absence of the RCA diagnosed by coronary angiography (CAG), was described.

CASE SUMMARY

A 41-year-old man arrived at our hospital for treatment, due to the repeated palpitations for a duration of one year. Considering the possibility of coronary heart disease, the patient underwent CAG that indicated the congenital absence of the RCA. Unfortunately, the patient refused to accept computed tomography coronary angiography (CTCA), to further confirm the congenital absence of the RCA.

CONCLUSION

Single coronary artery is a rare type of coronary artery abnormality, which usually has no obvious clinical manifestations and is considered as a benign disease. CAG is the main means by which congenital absence of the RCA can be diagnosed, and the disease can also be further confirmed by CTCA.

Imaging and Biomarkers in Acute Aortic Syndromes: Diagnostic and Prognostic Implications

Acute aortic syndrome (AAS) is an emergency and life-threatening condition including aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer and iatrogenic-traumatic aortic injury. An integrated multiparametric approach (clinical history and examination, electrocardiogram, biomarkers and imaging techniques) is recommended in order to make timely and accurate diagnosis, delineate the prognosis, choose the most appropriate therapeutic interventions tailored for the individual patient. Nowadays the best imaging strategy for diagnosing AAS and its complications is a combination of transthoracic echocardiography and computed tomography angiography (CTA). Transesophageal echocardiography tends to be carried out in complicated cases prior to surgical or endovascular therapy, often in the operating room and under general anesthesia. In this regard, intravascular ultrasound and intraluminal phase array imaging may be implemented during the endovascular procedures depending on operator expertise and cost issues. On the other hand, owing to its intrinsic characteristics, magnetic resonance imaging is an ideal imaging technique for serial measurements in patients at risk of AAS or with chronic dissection. Among biomarkers, D-dimer is the closest to "golden status" (high sensitivity and low negative likelihood ratio). Interestingly, 18fluorodeoxyglucose positron emission tomography/CT is increasingly being used along with specific serologic biomarkers (white blood cells, C-reactive protein, fibrinogen and D-dimer) to detect and monitor vascular inflammation affecting the aorta and systemic arteries. It is expected, in the near future, the development of serologic and imaging biomarkers able to early detect clinically-silent pathologic changes in the aorta wall before (primary prevention) and after (secondary prevention) the acute index event.

A case report of right coronary artery agenesis diagnosed by computed tomography coronary angiography

INTRODUCTION

Single coronary artery is a rare condition characterized by the origin of a coronary that supplies the entire heart from a single coronary ostium.

PATIENT CONCERNS

A 45-year-old woman with an altered exercise testing was addressed to a computed tomography coronary angiography (CTCA) to rule out coronary artery disease (CAD).

DIAGNOSIS

CTCA examination showed the absence of the right coronary artery (RCA). The left anterior descending artery and the left circumflex artery (LCX) presented regular origin and course and LCX provided the posterior interventricular artery and the posterolateral artery.

INTERVENTIONS

As CTCA highlighted the absence of potentially life-threatening features related to coronary anomaly, no surgical treatment was advised.

OUTCOMES

The patient was dismissed, kept under pharmacological control and monitored over time.

CONCLUSION

CTCA is the first-choice imaging modality in patients with ECG abnormalities properly allowing the differential diagnosis between CAD and congenital heart disease.

Case report of coronary artery fistula: Added value of multimodal advanced imaging with cardiac computed tomography and cardiac magnetic resonance

RATIONALE

Unlike invasive coronary angiography and echocardiography, cardiac computed tomography (CCT) and cardiac magnetic resonance (CMR) imaging allow a coronary artery fistula (CAF) comprehensive evaluation focusing on both coronary and myocardial findings.

PATIENT CONCERNS

We present the case of an asymptomatic patient suspected for CAF and referred to our structure for cardiovascular evaluation.

DIAGNOSIS

The patient was diagnosed a CAF without coronary artery disease on the basis of CMR and CCT.

INTERVENTIONS

The patient underwent an invasive coronary angiography after which the medical staff decided not to surgically treat the CAF. Therefore, a conservative treatment was chosen with strict temporal monitoring.

OUTCOMES

After less than 1 year follow-up, the patient presented stable conditions without complaints.

LESSONS

Multimodal non-invasive imaging has a key role in patient assessment for disease diagnosis providing better understanding for prognosis and treatment.

Evidence of association of circulating epigenetic-sensitive biomarkers with suspected coronary heart disease evaluated by Cardiac Computed Tomography

Circulating biomarkers available in clinical practice do not allow to stratify patients with coronary heart disease (CHD) prior the onset of a clinically relevant event. We evaluated the methylation status of specific genomic segments and gene expression in peripheral blood of patients undergoing Cardiac Computed Tomography (CCT) for CHD (n = 95).

We choose to investigate cholesterol metabolism. Methylation and gene expression of low density lipoprotein receptor (LDLR), sterol regulatory element-binding factor 2 (SREBF2) and ATP-binding cassette transporter 1 (ABCA1) were evaluated by qRT-PCR. Calcium score (CACS), stenosis degree, total plaque volume (TPV), calcified plaque volume (CPV), non-calcified plaque volume (NCPV) and plaque burden (PB) were assessed in all CHD patients (n = 65). The percentage of methylation at the specific analyzed segment of LDLR promoter was higher in CHD patients vs healthy subjects (HS) (n = 30) (p = 0.001). LDLR, SREBF2 and ABCA1 mRNAs were up-regulated in CHD patients vs HS (p = 0.02; p = 0.019; p = 0.008). SREBF2 was overexpressed in patients with coronary stenosis ≥50% vs subjects with stenosis <50% (p = 0.036). After adjustment for risk factors and clinical features, ABCA1 (p = 0.005) and SREBF2 (p = 0.010) gene expression were identified as independent predictors of CHD and severity. ROC curve analysis revealed a good performance of ABCA1 on predicting CHD (AUC = 0.768; p<0.001) and of SREBF2 for the prediction of disease severity (AUC = 0.815; p<0.001). Moreover, adjusted multivariate analysis demonstrated SREBF2 as independent predictor of CPV, NCPV and TPV (p = 0.022; p = 0.002 and p = 0.006) and ABCA1 as independent predictor of NCPV and TPV (p = 0.002 and p = 0.013).

CHD presence and characteristics are related to selected circulating transcriptional and epigenetic-sensitive biomarkers linked to cholesterol pathway. More extensive analysis of CHD phenotypes and circulating biomarkers might improve and personalize cardiovascular risk stratification in the clinical settings.

Image Quality and Dose Reduction by Dual Source Computed Tomography Coronary Angiography: Protocol Comparison

Purpose:

To compare image quality and radiation dose among different protocols in patients who underwent a 128-slice dual source computed tomography coronary angiography (DSCT-CTCA).

Methods:

Ninety patients were retrospectively grouped according to heart rate (HR): 26 patients (group A) with stable HR ≤60 bpm were acquired using high pitch spiral mode (FLASH); 48 patients (group B) with irregular HR ≤60 bpm or stable HR between 60 and 70 bpm using step and shoot mode; and 16 patients (group C) with irregular HR >60 bpm or stable HR ≥70 bpm by retrospective electrocardiogram pulsing acquisition. Signal to noise ratio (SNR) and contrast to noise ratio (CNR) were measured for the main vascular structures. Moreover, the dose-length product and the effective dose were assessed.

Results:

Both SNR and CNR were higher in group A compared to group C (18.27 ± 0.32 vs 11.22 ± 0.50 and 16.75 ± 0.32 vs 10.17 ± 0.50; P = .001). The effective dose was lower in groups A and B (2.09 ± 1.27 mSv and 4.60 ± 2.78 mSv, respectively) compared to group C (9.61 ± 5.95 mSv) P < .0001.

Conclusion:

The correct selection of a low-dose, HR-matched CTCA scan protocol with a DSCT scanner provides substantial reduction of radiation exposure and better SNR and CNR.

Coronary artery aneurysms detected by computed tomography coronary angiography

Aims

Coronary artery aneurysms (CAAs) are incidentally revealed by coronary angiography and consist in a localized dilation of a coronary artery. Although invasive coronary angiography (ICA) is the gold standard imaging technique, it can lead to the underestimation of CAAs diameter in presence of parietal thrombi. Computed tomography coronary angiography (CTCA) is a very sensitive tool in CAAs detection and provides a clear visualization of coronary lumen highlighting intraluminal thrombi.

Methods and results

We retrospectively reviewed 390 CTCA performed at our institution, 9 patients (6 men, 3 women) resulted affected by CAAs and represented the aneurysmal group (A group). Matched controls were identified among the non-aneurysmal patients with healthy coronaries to CTCA (NAH group). Clinical variables and imaging findings were compared and correlated. CAAs prevalence in our population was 2.31%. 15 CAAs were detected, mainly on the right coronary artery (RCA) (9 aneurysms) followed by the left anterior descending coronary artery (LAD) (three aneurysms) and the left circumflex coronary artery (CX) (three aneurysms). In six patients (66.7%) CTCA displayed an aneurysmal thrombosis and in 5 patients (55.5%) CAAs were associated to coronary artery stenoses. A statistically significant difference was found between the diameters of coronary vessels measured in healthy segments in A and NAH group.

Conclusions

CTCA has led to a non-invasive estimation of CAAs prevalence and characterization of aneurysmal features and coronary anatomy. Overcoming ICA limitations, CTCA has provided a fine analysis of the aneurysms, also in presence of intraluminal thrombi.

In Vivo and In Vitro Analysis in Coronary Artery Disease Related to Type 2 Diabetes

AIM

The leading cause of morbidity and mortality in patients with type 2 diabetes mellitus (DM) is coronary artery disease (CAD), a condition often asymptomatic but severe in these patients. Although glucose metabolism impairment and oxidative stress are known actors in the endothelial dysfunction/remodeling that occurs in diabetic patients, the relationship between cardiovascular disorders and DM is not fully understood. We have performed both an in vivo imaging and in vitro molecular analysis to investigate diabetic-specific CAD alterations.

METHODS

Computed tomography coronary angiography (CTCA) was performed in a group of 20 diabetic patients with CAD (DM⁺CAD⁺), 20 non-diabetic with CAD (DM^-CAD⁺), 10 diabetic non-CAD patients (DM⁺CAD^-), and 20 non-diabetic healthy subjects (HS). Imaging quantitative parameters such as calcium score (Cascore), calcified plaque volume (CPV), non-calcified plaque volume (NCPV), total plaque volume (TPV), remodeling index (RI), and plaque burden were extracted for each CAD subject. Moreover, the expression levels of superoxide dismutase 2 (SOD2) and liver X receptor alpha (LXRα) genes were analyzed in the peripheral blood mononuclear cells, whereas hyaluronan (HA) concentrations were evaluated in the plasma of each subject.

RESULTS

Imaging parameters, such as Cascore, CPV, RI, and plaque burden, were significantly higher in DM⁺CAD⁺ group, compared to DM^-CAD⁺ (P = 0.019; P = 0.014; P < 0.001, P < 0.001, respectively). SOD2 mRNA was downregulated, while LXRα gene expression was upregulated in DM⁺CAD^-, DM⁺CAD⁺, and DM^-CAD⁺ groups compared to HS (P = 0.001, P = 0.03, and P = 0.001 for SOD2 and P = 0.006, P = 0.008, and P < 0.001 for LXRα, respectively). Plasmatic levels of HA were higher in DM^-CAD⁺, DM⁺CAD^-, and DM⁺CAD⁺ groups, compared to HS (P = 0.001 for the three groups). When compared to DM^-CAD⁺, HA concentration was higher in DM⁺CAD^- (P = 0.008) and DM⁺CAD⁺ (P < 0.001) with a significant difference between the two diabetic groups (P = 0.003). Moreover, HA showed a significant association with diabetes (P = 0.01) in the study population, and the correlation between HA levels and glycemia was statistically significant (ρ = 0.73, P < 0.001).

CONCLUSION

In our population, imaging parameters highlight a greater severity of CAD in diabetic patients. Among molecular parameters, HA is modulated by diabetic CAD-related alterations while SOD2 and LXRα are found to be more associated with CAD but do not discriminate between diabetic and non-diabetic subgroups.