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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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…
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Diagnostic accuracy of energy-integrating and standard-resolution photon counting detector CT for coronary artery stenosis grading in CCTA: A comparative study
Table of Contents Summary: This prospective study compared standard-resolution photon-counting detector CT (SR-PCD-CT) with energy-integrating detector CT (EID-CT) for coronary stenosis assessment, using quantitative coronary angiography (QCA) as reference. Twenty-one patients underwent both CT modalities and invasive angiography. Stenosis grades (%DS) showed good agreement across modalities, with comparable diagnostic accuracy. PCD-CT provided significantly higher image quality than EID-CT, tho…
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Feasibility and utility of anatomical and physiological evaluation of coronary artery disease with cardiac CT in severe aortic stenosis (FUTURE-AS registry)
Coronary artery disease (CAD) is common in patients with severe aortic stenosis (AS) and may impact transcatheter aortic valve replacement (TAVR) procedural and long-term outcomes. CT coronary angiography (CTA) and CT-derived fractional flow reserve (FFRCT) are tools used to assess CAD. However, adoption in the TAVR population is hindered by safety concerns with nitroglycerin and beta-blockers. The safety, accuracy, and utility of CTA and FFRCT optimised with these medications for TAVR have not …
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The impact of heart rate on motion-related artefacts and diagnostic image quality in coronary CT angiography
Coronary CT angiography (CCTA) has benefited from major technological advancements over the past two decades, resulting in improved image acquisition and reconstruction techniques with better spatial and temporal resolution. However, image quality remains susceptible to motion-related artefacts when coronary artery movement exceeds the scanner’s temporal resolution. Imaging during mid-diastole at heart rates (HRs) <60 beats per minute (bpm) generally provides the most stable, motion-free pha…
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A novel pendulum-based impulse method to measure CT temporal resolution
High temporal resolution (TR) in CT is essential for reducing motion artifacts from rapidly moving structures like the heart. Although the conventional impulse method can measure TR, it requires specialized equipment to accelerate a sphere, which limits its practicality.
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Optimization of coronary plaque assessment on coronary computed tomography angiography
The detection, quantification of severity, and characterization of plaque features in coronary atherosclerosis forms the cornerstone of contemporary management. Invasive coronary angiography remains the gold standard for defining the degree of luminal stenosis, while invasive intravascular imaging modalities, particularly intravascular ultrasound (IVUS) and optical coherence tomography (OCT), provide high-resolution insights that enable more detailed assessment of complex coronary lesions.1 Coro…
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Novel deep learning CCTA-FFR for detecting functionally significant coronary stenosis: Comparison with iFR
Deep learning–based fractional flow reserve derived from coronary CT angiography (CT-FFR) enables noninvasive assessment of lesion-specific ischemia. Onsite CT-FFR systems provide near–real-time physiologic evaluation at the workstation, potentially reducing unnecessary invasive testing. This study evaluated the diagnostic performance of a novel onsite deep learning CT-FFR algorithm compared with invasive instantaneous wave-free ratio (iFR).
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Carotid perivascular adipose tissue attenuation predicts stroke and TIA in symptomatic carotid artery disease patients
The aim of this study was to investigate the predictive value of carotid PVAT attenuation for the prediction of stroke and TIA recurrence in symptomatic patients with <70% carotid stenosis. We demonstrated that increased carotid PVAT attenuation is strongly associated with recurrent events. Importantly, our analysis demonstrated that adding PVAT attenuation to the ECST clinical prediction model, which is the most commonly used model in clinical practice, or to the presence of IPH, provides ad…