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.
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Coronary CTA for SCAD: Promise, pitfalls, and perspective
We thank Çelik and colleagues for their thoughtful comments and engagement with our study evaluating coronary computed tomography angiography (CCTA) utilization during hospitalizations for spontaneous coronary artery dissection (SCAD). We agree that this is an evolving clinical area in which additional evidence is needed to inform best practices. Our original analysis leveraged a nationally representative inpatient database to evaluate contemporary patterns in CCTA utilization during SCAD hospit…
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Disproportionate atherosclerotic burden in the left anterior descending coronary artery in participants without standard modifiable cardiovascular risk factors: The multi-ethnic study of atherosclerosis (MESA)
Standard modifiable cardiovascular risk factors (SMuRF) have been identified for coronary artery disease (CAD) and targeted in primary prevention efforts, resulting in significantly improved outcomes. However, an increasing proportion of individuals present with ST elevation myocardial infarction (STEMI) in the absence of conventionally elevated levels of modifiable risk factors (“SMuRFless”), with significantly worse short-term outcomes. Culprit lesions of the left anterior descending artery (L…
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Impact of sex-specific aortic valve calcification thresholds on reclassification of normal-flow, low-gradient aortic stenosis
Severe aortic stenosis (AS) is a leading cause of morbimortality in the elderly, and accurate identification of patients who benefit from valve replacement (AVR) is essential. Although guideline-directed diagnostic pathways are well established for high-gradient AS and low-flow, low-gradient (LFLG) AS, management of patients with normal-flow, low-gradient (NFLG) AS, defined by an aortic valve area (AVA) ≤1.0 cm2, stroke volume index (SVi) > 35 mL/m2 and mean gradient (MG) < 40 mmHg, r…