Search

Introduction Smoking and obesity are recognized as important modifiable risk factors for coronary artery disease (CAD). However, the general perception that smoking protects against obesity is a common reason for starting, and/or not quitting smoking. Purpose To detect the quantity, quality and relative distribution of subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) estimated by abdominal computed tomography in smokers versus non- smokers. Methods The abdominal muscular wall was traced manually to calculate SAT and VAT areas (cm2) (outside and inside abdominal muscular wall respectively) as well as SAT density [Hounsfield units (HU)] at L4-L5 in 409 consecutive patients referred for evaluation of chest pain by multi-slice computed tomography coronary angiography (MSCT-CA). Results 26% of the studied patients (n=107) were current smokers, while the remaining 74% (n=302) never smoked. Coronary artery atherosclerosis was more prevalent in smokers compared to non-smokers (64.5% vs 55.0%; p=0.09). Smokers had statistically significantly lower body mass index (BMI) (31.2±4.3 vs. 32.5±4.7 kg/m2; p=0.015), hip circumference (HC) (98.6±22.5 vs. 103.9±20.9 cm; p=0.031), total fat area (441.62±166.34 vs. 517.95±169.51cm2; p Conclusion Smoking contributes to CAD and to the pathogenic redistribution of body fat towards VAT, through limiting SAT potential to expand. Funding Acknowledgement Type of funding source: None

Background Echocardiographic assessment of prosthetic mechanical valves is limited by shadows, artefacts and the need for cumbersome Doppler calculations. CT scan has the potential to overcome some of the limitations of echocardiography in assessment of prosthetic valves. Objectives Determine the incremental diagnostic value of cardiac computed tomographic angiography (CTA) over transesophageal echocardiography (TEE) in patients with suspected prosthetic valve dysfunction (PVD) and its impact on treatment decisions. Methods 50 consecutive patients with suspected PVD underwent both 64-slice ECG-gated CT and TEE and the results were compared. Imaging was compared against surgical findings (Reference standard). Echocardiographic evaluation focused on the detection of signs of PVD: vegetations, new or increased paravalvular leakage (PVL), aortic root pseudoaneurysms or abscesses and occluder malfunction. The CT interpreter was blinded to the findings of TEE. Results ECG-gated CT showed findings that were not detected by TEE in fifteen patients (30%). Additional aortic root abscess in four patients (8%), additional aortic root pseudoaneurysm in four patients (8%), and sclero-degenerative change across one of occluder of aortic prosthesis as cause of PVL in another patient (2%) not detected by TEE. CT negated the presence of aortic root abscess in one patient (2%), negated the presence of PVL in another patient (2%) both were detected by TEE. CT diagnosed occluder malfunction in one patient (2%) and underlying cause in two patients (4%) both were not detected by TEE. CT diagnosed presence of aortic arch dissection in one patient (2%) with large aortic root pseudoaneurysm. CT showed minor diagnostic change in six patients (12%). CT showed better delineation of site and periannular extension of aortic root abscess in four patients (8%). CT showed better assessment severity of PVL in one patient (2%) and cause of PVL across mechanical aortic prosthesis in another patient (2%). CT resulted in change of treatment strategy in 14 patients (28%). This included surgical excision of additional aortic root abscess or aortic root pseudoaneurysm in four patients (8%), surgical removal of prosthesis for underlying pathology (vegetation, malfunction due to underlying thrombus or PVL) in four patients (8%), aortic arch replacement with tubular graft and reimplantation of coronaries in one patient (2%) and conservative treatment with antibiotic therapy for small aortic root abscess not detected by TEE in 2 patients (4%), proper anticoagulation therapy and close monitor of INR in one patient (2%). Conclusion ECG-gated CT and TEE are complementary in patients with prosthetic valve dysfunction. Therefore, CT imaging has to be considered after clinical routine workup and TEE in patients with a high suspicion on prosthetic valve dysfunction.

Aims: To compare between computed tomography coronary angiography (CTCA) and conventional coronary angiography (CCA) in assessment of coronary chronic total occlusions (CTOs). To better define the added value of CTCA in prediction of outcome of percutaneous coronary intervention for chronic total occlusions (CTO PCI). Methods and results: Thirty one coronary CTO lesions were studied. The median estimated CTO duration was 12 months (range 3-108). CTCA was performed in all patients using 320-channel scanner. The median estimated CTO length by CTCA was 22.2 mm (range 7.7-89.4) and by CCA was 20.9 mm (range 6.1-80.7); p= 0.49. Calcification within the CTO segment was detected by CTCA in 24 (77.4%) CTO lesions and by CCA in only 14 (45.2%) CTO lesions; p=0.019. Severe calcification; >50% of cross sectional area (CSA) was detected by CTCA in 12 (38.7%) of the CTO lesions. Proximal vessel tortuosity, shape of the stump and presence of side branch at the CTO entry were similarly detected by both modalities; p=1. Thirty four attempts at CTO PCI were performed in the 31 patients. Eighteen (52.9%) of the attempts utilized the antegrade approach, 3 (8.8%) utilized the retrograde approach alone and 13 (38.2%) of the attempts utilized a bidirectional approach. The overall success rate per attempt was 85.3%. Calcium occupying >50% of CSA by CTCA was the only predictor of failure of the antegrade approach for CTO PCI; p=0.036. There were trends of longer estimated CTO duration and longer estimated CTO length in the failed antegrade approaches for CTO PCI (p=0.073, p=0.063 respectively). None of the CTCA or the CCA factors was found to predict the outcome of the retrograde approach for CTO PCI. A trend of successful outcome of the retrograde approach for CTO PCI was noted with higher Werner collateral channel grades (p=0.057). Conclusions: CTCA provides better means of detection and assessment of calcification within the coronary CTO lesions than CCA. Severe calcification (>50% of CSA by CTCA) was the only statistically significant predictor of failure of the antegrade approach for CTO PCI.