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TCT-181: How to Use Dose Modulation Protocols to Reduce Radiation Doses of Cardiac CT Scan ?
http://www.aievolution.com/tct0901/
TUESDAY, SEPTEMBER 22, 2009, 8:00AM - 10:00AM
Conclusions: CAD patients with high calcium score had more vulnerable plaque components compared with those with low calcium score. TCT-180 Relationship Between Coronary Atherosclerotic Plaques and Traditional Risk Factors in People with No History of Cardiovascular Disease Undergoing Multi-Detector Computed Coronary Angiography Ilaria D’Angeli1, Francesco Fulvio Faletra1, Catherine Klersy2, Maria Penco3, Vincenza Procaccini3, Elena Pasotti1, Giovanni Pedrazzini1, Stefano De Castro4, Tiziano Moccetti1, Angelo Auricchio1 1 Cardiocentro Ticino, Lugano, Switzerland2Biometry & Clinical Epidemiology, Research Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy3Division of Cardiology, Department of Internal Medicine and Public Health, University of L’Aquila, L’Aquila, Italy4Department of Cardiovascular, Respiratory and Morphological Sciences, “La Sapienza” University, Rome, Italy
P O S T E R A B S T R AC T S
Background: To prospectively investigate the prevalence of coronary artery plaques (CAP) as detected by CT-based angiography in a large number of consecutive individuals with no history of coronary artery disease (CAD) RUDFXWHFRURQDU\V\QGURPH WRHYDOXDWHZKHWKHUWUDGLWLRQDOULVNIDFWRUVDUH UHODWHGWRSUHYDOHQFHRI&$3DQGWRWKHH[SHFWHG\HDUULVNRI¿UVWPDMRURU fatal cardiovascular event (CVE). Methods: It is a prospective, single center, cross-sectional study. We prospectively included 920 consecutive individuals with no history of CAD who underwent FRPSXWHGWRPRJUDSK\FRURQDU\DQJLRJUDSK\ &7&$ 5LVNHVWLPDWLRQRIIDWDODQG QRQIDWDO&9(ZDVDVVHVVHGXVLQJ*OREDO$VVHVVPHQW5LVN *$5 DQG6\VWHPDWLF &RURQDU\5LVN(YDOXDWLRQ 6&25( UHVSHFWLYHO\/RJLVWLFUHJUHVVLRQZDVXVHGWR DVVHVVWKHDVVRFLDWLRQRIULVNIDFWRUV 5)V ZLWKWKHSUHYDOHQFHRI&$3 Results: CAP were found in 459 (49.9%) individuals. Older age, higher BMI, PDOHJHQGHUGLDEHWHVK\SHUWHQVLRQDQGG\VOLSLGHPLDDOOLQFUHDVHGWKHOLNHOLKRRG of CAP burden at univariable analysis (p<0.001). At the multivariable analysis older age, male gender, hypertension, and diabetes independently increased WKHOLNHOLKRRGRI&$3EXUGHQ S $QLQFUHDVHLQOLNHOLKRRGRI&$3ZDV observed in presence of 1,2 and 3 or more RFs and with an increasing value of GAR and SCORE. Notably, about 18% of subjects with CAP did not report any traditional RFs and among individuals without CAPs, 12% had 3 or more RFs. Conclusions: A direct relationship between the prevalence of CAP, number RI5)VDQGWKHUHODWHG\HDUULVNRI&9(ZDVIRXQG(LJKWHHQSHUFHQWRI subjects without RFs had CAP. In these individuals CTCA may help in further RSWLPL]LQJWKHULVNUHGXFWLRQVWUDWHJLHVRQDQLQGLYLGXDOEDVLV TCT-181 How to Use Dose Modulation Protocols to Reduce Radiation Doses of Cardiac CT Scan ? Diaa El Din A Abd El hakim, II, Jean marc Pernes, Sr., Valari Huar, III, jean calude Gaux, Sr., patrick Dupouy, Sr. Antony Hospital, Paris, France Background: Multislices Cardiac CT scan (MSCT) is a current non- invasive coronary artery imaging modality which is increasingly used. Radiation dose to which the patient is exposed remains a major problematic issue. 3URVSHFWLYH'RVHPRGXODWLRQSURWRFRO '03 DOORZVPDUNHGGRVHUHGXFWLRQ when correctly applied. Aim and Methods:LQRUGHUWR¿JXUHRXWKRZ'03LPSDFWVGRVHUDGLDWLRQWR patient in daily life practice. We prospectively studied 187 consecutive patients referred to our centre for a 64 slices MSCT over a 2 months period. DMP was variably used according to the operator’s discretion whether to modulate (1 to 3 EKG phases) or not based on patient’s heart rate. Dose length product (DLP), percent of modulation induced dose reduction; qualitative quality of the image (assessed by two blinded expert cardiologists) and signal on noise ratio (S/N) were compared for each patient according to DMP status.
70D
Results: patients were divided into 4 groups according to the dose modulation protocol used: no DMP (n=24), DMP 1 phase (n=97), DMP 2 phases (n=51), DMP 3 (n=15) phases. All groups were comparable considering age, sex ratio and body mass index. Kilovolt and intensity were comparable between JURXSV'/3ZDVVLJQL¿FDQWO\ORZHULQWKHPRGXODWHGJURXSFRPSDUHGWRQRQ modulated (734±311 vs 1100±371, p<0.0001). Percent of dose reduction was RQO\VLJQL¿FDQWO\KLJKHUIRU'03SKDVHFRPSDUHGWRRWKHUJURXSV DMP 1 vs 15±6% DMP 2, 10±3% DMP 3, 0 DMP 0; p<0.0001). Global image TXDOLW\ ZDV VLJQL¿FDQWO\ EHWWHU LQ WKH PRGXODWHG YV QRQ PRGXODWHG JURXS (p=0.0016) and there was no quality difference between DMP 1 vs others. Conclusion: Dose modulation protocol has a positive impact in MSCT dose reduction with no deterioration of image quality. When using DMP the best dose reduction is obtained when modulation has been conducted over 1 phase. TCT-182 Endovascular Salvage of the “Failing Bypass Graft”: An Endovascular Surgeon Experience in 48 Cases Facilitated By Multichannel Computed Tomography Angiography David E Allie1, Chris J Hebert2, Raghotham R Patlola2, Agostino Ingraldi2, Craig M Walker3 1 Louisiana Cardiovascular and Limb Salvage Center, Lafayette, LA;2Cardiovascular Institute of the South, Lafayette, LA;3Cardiovascular Institute of the South, Houma, LA Background: Traditional infrainguinal bypass grafts (IBG) require a 10-20% reintervention or revision rate at 24-months. Contemporary IBG for limb VDOYDJHRIWHQUHTXLUHVFUHDWLYHLQÀRZDQGRXWÀRZE\SDVVVWUDWHJLHVWRSRRU targets including the use of prosthetic conduits with vein patch anastamosis, donor veins and alternative conduits (arm veins - lesser saphenous - composite JUDIWV HWF ZKLFK LQFUHDVH WKH OLNHOLKRRG IRU JUDIW IDLOXUH &RQWHPSRUDU\ IBGs require creative surveillance and management strategies. 64-channel CTA provides an excellent noninvasive tool for detailed 3-D imaging of contemporary IBG for early and late failure surveillance. Methods: Between May 1, 2006 and May 1, 2009, 48 contemporary IBG ZHUHLGHQWL¿HGDV³IDLOLQJE\SDVVJUDIWV´E\FKDQQHO&7$ FDVHVGHPRQVWUDWHG³NLQNLQJ´RIWKH,%*ERG\SUHYLRXVO\WKRXJKWWREHD rare phenomenon. 30/48 (62.5%) had anastomotic strictures [proximal = GLVWDO DQGERWK @$YDULHW\RI PLGJUDIW OHVLRQV ZHUH LGHQWL¿HG YDOYH VWULFWXUHV FRPSRVLWH DQDVWDPRVLV lesions, etc.). Progression of proximal or distal disease was common, 21/48 (43.7). IBG follow-up included baseline, 1-month and 6-month ABI and duplex ultrasound (DU). 64-channel CTA was performed at 1-month if symptomatic, 6-months and 12-months as surveillance. Results: 30/48 (62.5%) of “failing IBG” were asymptomatic and 30/30 DV\PSWRPDWLF³IDLOLQJJUDIWV´ZHUHLGHQWL¿HGE\&7$2QO\ (41.6%) cases had DU > 50% stenosis. 40/48 (83.3%) required endovascular interventions [PTA = 20/40 (50%), PTA/stent = 30/40 (75%), laser = 18/40 (45%), plaque excision = 2/40 (5%), specialty balloon = 17/40 (42.5%), FU\RSODVW\ DQGFRPELQDWLRQ @6XUJLFDOUHYLVLRQ was required as initial therapy in 6/48 (12.5%) but overall 15/40 (37.5%) required surgical revision for ultimate long-term IBG salvage. Conclusion: Contemporary IBG require close surveillance for short and long-term patency. 64-channel CTA provides optimal surveillance imaging. A combined endovascular and surgical treatment strategy is required to insure longer-term patency. TCT-183 Impact of Coronary Artery Lesion Calcium Score Measured by 64-Slice Multi-detector Computed Tomography on Optimal Stent Expansion After Drug-Eluting Stents Implantation Hyoung-Mo Yang, Myeong-Ho Yoon, Hong-Seok Lim, Byoung-Joo Choi, So-Yeon Choi, Gyo-Seung Hwang, Joon-Han Shin, Seung-Jea Tahk Ajou University Hospital, Suwon, Republic of Korea
The American Journal of Cardiology® |
September 21-25, 2009
|
TCT Abstracts/POSTER
TUESDAY, SEPTEMBER 22, 2009, 8:00AM - 10:00AM
Conclusions: CAD patients with high calcium score had more vulnerable plaque components compared with those with low calcium score. TCT-180 Relationship Between Coronary Atherosclerotic Plaques and Traditional Risk Factors in People with No History of Cardiovascular Disease Undergoing Multi-Detector Computed Coronary Angiography Ilaria D’Angeli1, Francesco Fulvio Faletra1, Catherine Klersy2, Maria Penco3, Vincenza Procaccini3, Elena Pasotti1, Giovanni Pedrazzini1, Stefano De Castro4, Tiziano Moccetti1, Angelo Auricchio1 1 Cardiocentro Ticino, Lugano, Switzerland2Biometry & Clinical Epidemiology, Research Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy3Division of Cardiology, Department of Internal Medicine and Public Health, University of L’Aquila, L’Aquila, Italy4Department of Cardiovascular, Respiratory and Morphological Sciences, “La Sapienza” University, Rome, Italy
P O S T E R A B S T R AC T S
Background: To prospectively investigate the prevalence of coronary artery plaques (CAP) as detected by CT-based angiography in a large number of consecutive individuals with no history of coronary artery disease (CAD) RUDFXWHFRURQDU\V\QGURPH WRHYDOXDWHZKHWKHUWUDGLWLRQDOULVNIDFWRUVDUH UHODWHGWRSUHYDOHQFHRI&$3DQGWRWKHH[SHFWHG\HDUULVNRI¿UVWPDMRURU fatal cardiovascular event (CVE). Methods: It is a prospective, single center, cross-sectional study. We prospectively included 920 consecutive individuals with no history of CAD who underwent FRPSXWHGWRPRJUDSK\FRURQDU\DQJLRJUDSK\ &7&$ 5LVNHVWLPDWLRQRIIDWDODQG QRQIDWDO&9(ZDVDVVHVVHGXVLQJ*OREDO$VVHVVPHQW5LVN *$5 DQG6\VWHPDWLF &RURQDU\5LVN(YDOXDWLRQ 6&25( UHVSHFWLYHO\/RJLVWLFUHJUHVVLRQZDVXVHGWR DVVHVVWKHDVVRFLDWLRQRIULVNIDFWRUV 5)V ZLWKWKHSUHYDOHQFHRI&$3 Results: CAP were found in 459 (49.9%) individuals. Older age, higher BMI, PDOHJHQGHUGLDEHWHVK\SHUWHQVLRQDQGG\VOLSLGHPLDDOOLQFUHDVHGWKHOLNHOLKRRG of CAP burden at univariable analysis (p<0.001). At the multivariable analysis older age, male gender, hypertension, and diabetes independently increased WKHOLNHOLKRRGRI&$3EXUGHQ S $QLQFUHDVHLQOLNHOLKRRGRI&$3ZDV observed in presence of 1,2 and 3 or more RFs and with an increasing value of GAR and SCORE. Notably, about 18% of subjects with CAP did not report any traditional RFs and among individuals without CAPs, 12% had 3 or more RFs. Conclusions: A direct relationship between the prevalence of CAP, number RI5)VDQGWKHUHODWHG\HDUULVNRI&9(ZDVIRXQG(LJKWHHQSHUFHQWRI subjects without RFs had CAP. In these individuals CTCA may help in further RSWLPL]LQJWKHULVNUHGXFWLRQVWUDWHJLHVRQDQLQGLYLGXDOEDVLV TCT-181 How to Use Dose Modulation Protocols to Reduce Radiation Doses of Cardiac CT Scan ? Diaa El Din A Abd El hakim, II, Jean marc Pernes, Sr., Valari Huar, III, jean calude Gaux, Sr., patrick Dupouy, Sr. Antony Hospital, Paris, France Background: Multislices Cardiac CT scan (MSCT) is a current non- invasive coronary artery imaging modality which is increasingly used. Radiation dose to which the patient is exposed remains a major problematic issue. 3URVSHFWLYH'RVHPRGXODWLRQSURWRFRO '03 DOORZVPDUNHGGRVHUHGXFWLRQ when correctly applied. Aim and Methods:LQRUGHUWR¿JXUHRXWKRZ'03LPSDFWVGRVHUDGLDWLRQWR patient in daily life practice. We prospectively studied 187 consecutive patients referred to our centre for a 64 slices MSCT over a 2 months period. DMP was variably used according to the operator’s discretion whether to modulate (1 to 3 EKG phases) or not based on patient’s heart rate. Dose length product (DLP), percent of modulation induced dose reduction; qualitative quality of the image (assessed by two blinded expert cardiologists) and signal on noise ratio (S/N) were compared for each patient according to DMP status.
70D
Results: patients were divided into 4 groups according to the dose modulation protocol used: no DMP (n=24), DMP 1 phase (n=97), DMP 2 phases (n=51), DMP 3 (n=15) phases. All groups were comparable considering age, sex ratio and body mass index. Kilovolt and intensity were comparable between JURXSV'/3ZDVVLJQL¿FDQWO\ORZHULQWKHPRGXODWHGJURXSFRPSDUHGWRQRQ modulated (734±311 vs 1100±371, p<0.0001). Percent of dose reduction was RQO\VLJQL¿FDQWO\KLJKHUIRU'03SKDVHFRPSDUHGWRRWKHUJURXSV DMP 1 vs 15±6% DMP 2, 10±3% DMP 3, 0 DMP 0; p<0.0001). Global image TXDOLW\ ZDV VLJQL¿FDQWO\ EHWWHU LQ WKH PRGXODWHG YV QRQ PRGXODWHG JURXS (p=0.0016) and there was no quality difference between DMP 1 vs others. Conclusion: Dose modulation protocol has a positive impact in MSCT dose reduction with no deterioration of image quality. When using DMP the best dose reduction is obtained when modulation has been conducted over 1 phase. TCT-182 Endovascular Salvage of the “Failing Bypass Graft”: An Endovascular Surgeon Experience in 48 Cases Facilitated By Multichannel Computed Tomography Angiography David E Allie1, Chris J Hebert2, Raghotham R Patlola2, Agostino Ingraldi2, Craig M Walker3 1 Louisiana Cardiovascular and Limb Salvage Center, Lafayette, LA;2Cardiovascular Institute of the South, Lafayette, LA;3Cardiovascular Institute of the South, Houma, LA Background: Traditional infrainguinal bypass grafts (IBG) require a 10-20% reintervention or revision rate at 24-months. Contemporary IBG for limb VDOYDJHRIWHQUHTXLUHVFUHDWLYHLQÀRZDQGRXWÀRZE\SDVVVWUDWHJLHVWRSRRU targets including the use of prosthetic conduits with vein patch anastamosis, donor veins and alternative conduits (arm veins - lesser saphenous - composite JUDIWV HWF ZKLFK LQFUHDVH WKH OLNHOLKRRG IRU JUDIW IDLOXUH &RQWHPSRUDU\ IBGs require creative surveillance and management strategies. 64-channel CTA provides an excellent noninvasive tool for detailed 3-D imaging of contemporary IBG for early and late failure surveillance. Methods: Between May 1, 2006 and May 1, 2009, 48 contemporary IBG ZHUHLGHQWL¿HGDV³IDLOLQJE\SDVVJUDIWV´E\FKDQQHO&7$ FDVHVGHPRQVWUDWHG³NLQNLQJ´RIWKH,%*ERG\SUHYLRXVO\WKRXJKWWREHD rare phenomenon. 30/48 (62.5%) had anastomotic strictures [proximal = GLVWDO DQGERWK @$YDULHW\RI PLGJUDIW OHVLRQV ZHUH LGHQWL¿HG YDOYH VWULFWXUHV FRPSRVLWH DQDVWDPRVLV lesions, etc.). Progression of proximal or distal disease was common, 21/48 (43.7). IBG follow-up included baseline, 1-month and 6-month ABI and duplex ultrasound (DU). 64-channel CTA was performed at 1-month if symptomatic, 6-months and 12-months as surveillance. Results: 30/48 (62.5%) of “failing IBG” were asymptomatic and 30/30 DV\PSWRPDWLF³IDLOLQJJUDIWV´ZHUHLGHQWL¿HGE\&7$2QO\ (41.6%) cases had DU > 50% stenosis. 40/48 (83.3%) required endovascular interventions [PTA = 20/40 (50%), PTA/stent = 30/40 (75%), laser = 18/40 (45%), plaque excision = 2/40 (5%), specialty balloon = 17/40 (42.5%), FU\RSODVW\ DQGFRPELQDWLRQ @6XUJLFDOUHYLVLRQ was required as initial therapy in 6/48 (12.5%) but overall 15/40 (37.5%) required surgical revision for ultimate long-term IBG salvage. Conclusion: Contemporary IBG require close surveillance for short and long-term patency. 64-channel CTA provides optimal surveillance imaging. A combined endovascular and surgical treatment strategy is required to insure longer-term patency. TCT-183 Impact of Coronary Artery Lesion Calcium Score Measured by 64-Slice Multi-detector Computed Tomography on Optimal Stent Expansion After Drug-Eluting Stents Implantation Hyoung-Mo Yang, Myeong-Ho Yoon, Hong-Seok Lim, Byoung-Joo Choi, So-Yeon Choi, Gyo-Seung Hwang, Joon-Han Shin, Seung-Jea Tahk Ajou University Hospital, Suwon, Republic of Korea
The American Journal of Cardiology® |
September 21-25, 2009
|
TCT Abstracts/POSTER