A 60-year-old woman with a past medical history of hyperlipidemia and elevated diastolic blood pressure, presented with a two-month history of worsening intermittent palpitations, chest tightness, and diaphoresis. Electrocardiography revealed non-specific ST-T changes in the anterior leads; high-sensitivity troponin was normal. Based on intermediate pre-test probability per 2021 AHA/ACC Chest Pain Guidelines,1 coronary CT angiography (CTA) was performed for suspected coronary artery disease.
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Importance of coronary artery lumen size in the relationship between coronary artery plaque and vessel-specific ischemia: A post hoc analysis of CREDENCE and PACIFIC-1
While coronary artery plaque burden and stenosis are important for development of ischemia, the role of lumen size remains underexplored. This study evaluated the relationship between average lumen area (ALA) and vessel-specific ischemia beyond diameter stenosis (DS) and percent atheroma volume (PAV).
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Normal-resolution vs. super-resolution deep learning reconstruction for diagnosis of functionally significant coronary stenosis using cardiac CT
Super-resolution deep learning reconstruction (SR-DLR) has been developed to reduce image noise and enhance spatial resolution beyond that of normal-resolution deep learning reconstruction (NR-DLR).
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Doubly obstructed mixed total anomalous pulmonary venous connection with a unique “vascular vise”
An 11-month-old cyanotic infant presented to pediatric cardiology outpatient clinic with respiratory distress and oxygen saturation of 70 % on room air. Chest radiograph revealed dextrocardia and with a tortuous tubular opacity (Fig. 1A) seen in left lower lung field. Subsequently transthoracic echocardiography was performed which revealed dextrocardia with complete atrioventricular septal defect and total anomalous pulmonary venous connection (TAPVC).
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CCTA and CTO-PCI – ‘see’ beyond the blind end
We congratulate Sharma et al. for providing important insights into the anatomical relevance of calcification characteristics in chronic total occlusions (CTOs).1 Moving beyond the traditional binary assessment of calcification, their study demonstrates that the location, density, and circumferential burden of calcification, particularly at the proximal cap, are strongly associated with CTO percutaneous coronary intervention (PCI) failure and are relevant to procedural planning.1
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Coronary plaque volume quantification using coronary computed tomography angiography is associated with periprocedural myocardial injury in patients with chronic coronary syndrome
TOC Summary This study investigated the relationship between periprocedural myocardial injury (PMI) and plaque volume assessed by coronary computed tomography angiography (CCTA). PMI is a common complication following percutaneous coronary intervention (PCI) and is associated with worse outcomes. We found that both total plaque volume and low-attenuation plaque volume, measured at target lesions and across all lesions per patient, were significantly higher in patients with myocardial injury afte…
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Disease progression and plaque composition in patients with non-obstructive coronary artery disease (THRONE): A coronary computed tomography angiography follow-up study
Fractional flow reserve (FFR)-negative coronary lesions are usually managed medically. Lesion-specific plaque characterization and FFR changes over time remain elusive.
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Calcium-phosphate dynamics in vascular calcification: Pathways and implications
The implications of calcium-phosphate metabolism in vascular calcification and related cardiovascular risk are complex and remains poorly understood. A deranged calcium-phosphate metabolism is often described as a non-traditional cardiovascular risk factor in chronic kidney disease (CKD), and more recently in patients without advanced CKD.1 Notably, Mendelian randomization studies have described a causal relationship between serum phosphate and coronary artery calcification without hyperphosphat…
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When imaging phase shapes physiology: A commentary on CFD fidelity in multiphase CCTA
We read with interest the article by Zheng et al. who evaluated the influence of cardiac phase selection on coronary geometry and Coronary Computed Tomography Angiography based computational fluid dynamics (CFD) outputs in normal and anomalous anatomies.1 Their findings highlight substantial phase-dependent variability in luminal area, wall shear stress derived metrics, and CT-FFR, underscoring an important but often overlooked source of analytic heterogeneity. While the study contributes valuab…
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Coronary computed tomography angiography guidance for selective invasive coronary angiography; a prospective registry study
Coronary computed tomography angiography (CCTA) offers excellent negative predictive value for coronary artery disease (CAD). In suspected single-vessel disease, invasive coronary angiography (ICA) could be simplified by deferring visualization of the normal coronary artery as identified on CCTA. This ultraselective ICA strategy might reduce procedure time, contrast use, and radiation exposure. This prospective study evaluated the potential benefits of this strategy.