CORONARY ANGIOGRAPHY – ADVANCES IN NONINVASIVE IMAGING APPROACH FOR EVALUATION OF CORONARY ARTERY DISEASE Edited by Branislav Baškot Coronary Angiography – Advances in Noninvasive Imaging Approach for Evaluation of Coronary Artery Disease Edited by Branislav Baškot Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2011 InTech All chapters are Open Access articles distributed under the Creative Commons Non Commercial Share Alike Attribution 3.0 license, which permits to copy, distribute, transmit, and adapt the work in any medium, so long as the original work is properly cited. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published articles. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Iva Simcic Technical Editor Teodora Smiljanic Cover Designer Jan Hyrat Image Copyright Jeffrey Collingwood, 2010. Used under license from Shutterstock.com First published August, 2011 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Coronary Angiography – Advances in Noninvasive Imaging Approach for Evaluation of Coronary Artery Disease, Edited by Branislav Baškot p. cm. ISBN 978-953-307-675-1 free online editions of InTech Books and Journals can be found at www.intechopen.com Contents Preface IX Chapter 1 Utilization of Functional Tests Prior to and Adherence to Guidelines on Coronary Angiography 1 James T Leung and Dominic Y Leung Chapter 2 Transthoracic Echocardiography in the Assessment of Coronary Arteries 21 Alla Boshchenko, Alexander Vrublevsky and Rostislav Karpov Chapter 3 Contrast Echocardiography in Coronary Artery Disease 61 Mai Tone Lønnebakken and Eva Gerdts Chapter 4 Non-Invasive Imaging in Approaching Ischemic Coronary Artery Disease 81 Lucia Agoston-Coldea, Teodora Mocan and Silvia Lupu Chapter 5 Non-Invasive Coronary Angiography 99 Mohanaluxmi Sriharan, Paula McParland, Stephen Harden and Edward Nicol Chapter 6 Coronary CT Angiography as an Alternative to Invasive Coronary Angiography 123 Seshu C. Rao and Randall C. Thompson Chapter 7 New Noninvasive Modalities in Coronary Angiography: Cardiac Computed Tomography Angiography 141 Ryotaro Wake and Minoru Yoshiyama Chapter 8 Simultaneous Assessment Beyond Coronary Stenosis by Multislice Computed Tomography 151 Shoichi Ehara and Kenei Shimada VI Contents Chapter 9 Assessment of Coronary Artery Bypass Graft (CABG) Patency and Graft Disease Using Multidetector Computed Tomography (MDCT) 161 Bong Gun Song, Hyun Suk Yang, Joon Hyung Doh, Hong Jang, Gu Hyun Kang, Yong Hwan Park, Woo Jung Chun, Ju Hyeon Oh, Sung Min Ko and Hweung Kon Hwang Chapter 10 Detection Myocardial Bridging Using Non-Invasive Technique 183 Junbo Ge and Jianying Ma Chapter 11 When Cardiac Computed Tomography Becomes the Gold Standard Technique to Evaluate Coronary Artery Disease Patients 199 Mohamed Bamoshmoosh Chapter 12 Physiologic Risk Assessment in Stable Ischemic Heart Disease – Functional Evaluation Versus Coronary Anatomy 215 Alessia Gimelli and Paolo Marzullo Chapter 13 Clinical Significance of Tetrofosm in Extracardiac Uptake During Myocardial Perfusion Imaging 225 Panagiotis Georgoulias, Varvara Valotassiou, Ioannis Tsougos, George Angelidis and Nikolaos Demakopoulos Chapter 14 Myocardial Perfusion Imaging in Diagnosis of Culprit Lesion in Patients Undergoing Elective Percutaneous Coronary Intervention 249 Branislav Baskot, Slobodan Obradovic, Saso Rafajlovski, Branko Gligic, Robert Jung, Vladimir Ivanovic, Miroslav Bikicki and Miodrag Pavlovic Chapter 15 New Noninvasive Modalities in Coronary Angiography - Diagnostic Values of New Biomarkers for Cardiovascular Disease 267 Yilmaz. N, Yegin A and Aykal G. Chapter 16 The Role of Inflammatory Biomarkers in the Assessment of Coronary Artery Disease 281 Patrícia Napoleão, Mafalda Selas, Cláudia Freixo, Catarina Ramos, Valeska Andreozzi, Antónia Turkman, Miguel Mota Carmo, Ana Maria Viegas-Crespo, Rui Cruz Ferreira and Teresa Pinheiro Chapter 17 Platelet, Fatty Acids, Membrane Viscosity, Depression and Ischemic Heart Disease - Biological-Molecular Path, with Medical-Anthropology Insights 315 Massimo Cocchi, Lucio Tonello and Fabio Gabrielli Contents VII Chapter 18 Acceleration of New Biomarkers Development and Discovery in Synergistic Diagnostics of Coronary Artery Disease 353 Ewa Stępień Chapter 19 Biomarkers and Coronary Atherosclerotic Burden and Activity as Assessed by Coronary Angiography and Intra-Coronary Imaging Modalities 375 Valentina Loria, Nicola Cosentino, Rocco A Montone and Giampaolo Niccoli Preface This book brings together contributions from around the world, investigators who are clinical versus imaging science in their orientation, and representatives from academic medical centers and the imaging industry. Each article is written to be accessible to those with a basic knowledge of coronary imaging but also to be stimulating and educational to those who are experts and investigators in medical imaging. This book covers where advances have been dramatic in the past two decades and shows the major contributions of the imaging scientists and engineers from both academia and industry. Patients with know or suspected coronary artery disease who are asymptomatic or who have stable symptoms are often evaluated noninvasive. Functional test, such as stress electrocardiography, stress echocardiography, and stress nuclear perfusion imaging, detect and quantity the presence of ischemia based on electrical, mechanical, or perfusion abnormalities, indirectly, but nuclear perfusion imaging directly, establishing the burden of coronary artery disease. Multidetector CT (MDCT) has emerged as a tool to evaluate noninvasive the coronary anatomy. MDCT has overcome many of its original limitations and now provides ECG-gated acquisition with short acquisition time, sub millimeter spatial resolution, allowing excellent visualization of the coronary arteries. Over the last 15 years, the rate of technologic advancements leading to improved coronary angiography with MDCT has rapidly exceeded those of other cardiac imaging modalities. Image quality is undergoing constant refinement, and the number of uninterpretable coronary studies has gradually decreased from 20%-40% using for detector, to 15% - 25% with 16- detector, and is now as low as 3% to 10% with 64-detector systems. But this section is also devoted to the current state of myocardial perfusion imaging (MPI). MPI is well establishment imaging techniques and is already integral part of the management of coronary artery disease (CAD), and is included in a number of professional guidelines. Coronary angiography, considered the “gold standard” for the diagnosis of CAD, often does not provide information about the functional significance of coronary stenosis, especially in borderline lesions. Andres Gruentzig said; when coronary angiography founded coronary narrowing, I would like to have some kind of diagnostic procedure who gives me functional significance that lesion. MPI is very important diagnostic tool for the diagnosis culprit lesions, and indicating who patients have for cardiovascular intervention (PCI or ACBP). The predominant theme is that X Preface MPI finding can serve as the gatekeeper for more costly and more risky invasive strategies in the evaluation and treatment of patients with coronary artery disease. The book Coronary Angiography – Advances in Noninvasive Imaging Approach for Evaluation of Coronary Artery Disease includes a series of articles that provide a state‐ of‐the‐art summary of the current clinical applications of cardiac CT, reviews data that support the accuracy and the prognostic use of CT coronary angiography and reports of the newest technological advances and promising future applications of these imaging modalities. Its also provide other diagnostic approach like functional test, which finding helps to make decision about invasive strategies with best benefit for patients. Finally, the next decades should see even greater advances in the field, and such breakthroughs will be instrumental in further enhancing the information that can be derived from functional testing for the assessment of myocardial blood flow, cardiac function, and myocardial viability. Readers of Coronary Angiography will enjoy in this book and will find the information and expert opinions very useful to their clinical practice. Branislav Baškot MD PhD Ass Prof Department of Nuclear Medicine Imaging “Dr Baskot” Belgrade, Serbia [...]... functional testing and other imaging modalities like CT coronary angiography in patients with suspected coronary artery disease In particular, the incremental value of non-invasive testing in risk stratification and the prediction of adverse events in these patients will be of interest in guiding practice and, more importantly, health care policy 2 Utilisation of functional tests prior to coronary angiography. .. despite their well-documented clinical usefulness, there is little information on the pattern of use of functional tests in patients prior to undergoing invasive coronary angiography In particular, for patients who are subsequently found to have no significant coronary artery disease on coronary angiography, it will be interesting to examine how and why they ended up having invasive coronary angiography. .. perfusion imaging are well-described sources of false positive findings The recent advent of CT coronary angiography may help in ruling out coronary artery disease and its use in equivocal or un-interpretable functional tests is considered appropriate The increased use of coronary angiography, regardless of whether it is indicated or not, may have more than just an economic impact In addition to the increased... complications, increased diagnostic testing has been shown to result in an increased therapeutic intervention rate downstream (VerrilliWelch, 1996; Wennberg et al., 1996) While the concern of increased downstream therapeutic intervention is minimal in patients 8 Coronary Angiography – Advances in Noninvasive Imaging Approach for Evaluation of Coronary Artery Disease with angiographically normal coronary. .. no 4 Coronary Angiography – Advances in Noninvasive Imaging Approach for Evaluation of Coronary Artery Disease significant differences in gender distribution, number of coronary risk factors and pre-test probability of coronary artery disease between patients who underwent coronary angiography as inpatients and those who underwent the procedure as day-only patients However, patients who underwent coronary. .. initially published in 1987 and were revised in May of 1999 These guidelines provide recommendations for coronary 2 Coronary Angiography – Advances in Noninvasive Imaging Approach for Evaluation of Coronary Artery Disease angiography in clinical scenarios such as patients with known or suspected coronary artery disease, stable or unstable angina pectoris, acute coronary syndromes, recurrence of symptoms... considerable interest in evaluating compliance with guidelines in clinical practice This is particularly pertinent as improved compliance with treatment guidelines is associated with better clinical outcomes in patients with acute coronary syndromes (Schiele et al., 2005) Despite the widespread dissemination of the guidelines on coronary angiography, the compliance rate with these guidelines in clinical... appropriateness of coronary angiography (Bernstein et al., 1999; Chassin et al., 1987b) A significant proportion of coronary angiography was found to be "inappropriate" (Gray et al., 1990), with "inappropriate" use of coronary angiography higher in high-use sites (Chassin et al., 1987a) In the study by Chassin et al (Chassin et al., 1987b), patients without angina or with atypical angina and who had not... chest pain as indications for coronary angiography in each category) (Reproduced with permission from: Leung DY, Hallani H, Lo ST, Hopkins AP, Juergens CP How compliant are we with guidelines for coronary angiography in clinical practice? Internal Medicine Journal 2007, Oct;37(10):69 9-7 04 John Wiley and Sons) 3.2.4 Coronary angiography results The coronary arteries were angiographically normal in 152... syndrome without ST elevation: findings from nationwide FINACS studies Journal of Internal Medicine, 256, 4, pp 31 6-3 23 20 Coronary Angiography – Advances in Noninvasive Imaging Approach for Evaluation of Coronary Artery Disease Wennberg, D E.;Kellett, M A.;Dickens, J D.;Malenka, D J.;Keilson, L M &Keller, R B (1996) The association between local diagnostic testing intensity and invasive cardiac procedures . can be obtained from orders@intechweb.org Coronary Angiography – Advances in Noninvasive Imaging Approach for Evaluation of Coronary Artery Disease, Edited by Branislav Baškot p. cm. ISBN. screening tests is highest in patients with intermediate pre-test probability. Proceeding to coronary angiography without functional tests may be justifiable in patients with high pre- test probability. CORONARY ANGIOGRAPHY – ADVANCES IN NONINVASIVE IMAGING APPROACH FOR EVALUATION OF CORONARY ARTERY DISEASE Edited by Branislav Baškot Coronary Angiography