Coronary Artery Disease: Halliburton SS

Oudkerk M, Stillman AE, Halliburton SS, Kalender WA, Möhlenkamp S, McCollough CH, Vliegenthart R, Shaw LJ, Stanford W, Taylor AJ, van Ooijen PM, Wexler L, Raggi P, Anonymous00008, Anonymous00009. · Department of Radiology, Groningen University Hospital, Hanzeplein 1, 9700 RB, Groningen, The Netherlands. · Eur Radiol. · Pubmed #18651153 No free full text.

Abstract: Current guidelines and literature on screening for coronary artery calcium for cardiac risk assessment are reviewed for both general and special populations. It is shown that for both general and special populations a zero score excludes most clinically relevant coronary artery disease. The importance of standardization of coronary artery calcium measurements by multidetector CT is discussed.

Halliburton SS. · No affiliation provided · J Cardiovasc Comput Tomogr. · Pubmed #19083969 No free full text.

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Halliburton SS. · No affiliation provided · J Cardiovasc Comput Tomogr. · Pubmed #19083955 No free full text.

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Schoenhagen P, Barreto M, Halliburton SS. · No affiliation provided · Int J Cardiovasc Imaging. · Pubmed #18043892 No free full text.

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Schoenhagen P, Stillman AE, Garcia MJ, Halliburton SS, Tuzcu EM, Nissen SE, Modic MT, Lytle BW, Topol EJ, White RD. · No affiliation provided · Am Heart J. · Pubmed #16644309 No free full text.

Abstract: Modern multidetector computed tomography systems are capable of a comprehensive assessment of the cardiovascular system, including noninvasive assessment of coronary anatomy. Multidetector computed tomography is expected to advance the role of noninvasive imaging for coronary artery disease, but clinical experience is still limited. Clinical guidelines are necessary to standardize scanner technology and appropriate clinical applications for coronary computed tomographic angiography. Further evaluation of this evolving technology will benefit from cooperation between different medical specialties, imaging scientists, and manufacturers of multidetector computed tomography systems, supporting multidisciplinary teams focused on the diagnosis and treatment of early and advanced stages of coronary artery disease. This cooperation will provide the necessary education, training, and guidelines for physicians and technologists assuring standard of care for their patients.

Oudkerk M, Stillman AE, Halliburton SS, Kalender WA, Möhlenkamp S, McCollough CH, Vliegenthart R, Shaw LJ, Stanford W, Taylor AJ, van Ooijen PM, Wexler L, Raggi P. · Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. · Int J Cardiovasc Imaging. · Pubmed #18504647 links to  free full text

Abstract: Current guidelines and literature on screening for coronary artery calcium for cardiac risk assessment are reviewed for both general and special populations. It is shown that for both general and special populations a zero score excludes most clinically relevant coronary artery disease. The importance of standardization of coronary artery calcium measurements by multi-detector CT is discussed.

Schoenhagen P, Stillman AE, Halliburton SS, Kuzmiak SA, Painter T, White RD. · Department of Radiology, Center for Integrated Non-Invasive Cardiovascular Imaging, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA. · Int J Cardiovasc Imaging. · Pubmed #15915941 No free full text.

Abstract: Selective coronary angiography introduced clinical coronary imaging in the late 1950s. The angiographic identification of high-grade coronary lesions in patients with acute and chronic symptomatic coronary artery disease (CAD) led to the development of surgical and percutaneous coronary revascularization. However, the fact that CAD remains the major cause of death in North America and Europe demonstrates the need for novel, complementary diagnostic strategies. These are driven by the need to characterize both increasingly advanced disease stages but also early, asymptomatic disease development. Complex revascularization techniques for patients with advanced disease stages will initiate a growing demand for 3-dimensional coronary imaging and integration of imaging modalities with new mechanical therapeutic devices. An emerging focus is atherosclerosis imaging with the goal to identify subclinical disease stages as the basis for pharmacological intervention aimed at disease stabilization or reversal. Non-invasive coronary imaging with coronary multidetector computed tomographic angiography (MDCTA) allows both assessment of luminal stenosis and subclinical disease of the arterial wall. Its complementary role in the assessment of early and advanced stages of CAD is increasingly recognized.

Schoenhagen P, Stillman AE, Halliburton SS, White RD. · Center for Integrated Non-Invasive Cardiovascular Imaging, Department of Diagnostic Radiology, The Cleveland Clinic Foundation, OH 44195, USA. · Cleve Clin J Med. · Pubmed #15757168 links to  free full text

Abstract: Computed tomography (CT) has become a standard test for many cardiovascular conditions (eg, aortic dissection and pulmonary embolism), and it has great potential in assessing other common diseases, including coronary artery disease. We review the principles of CT and its uses in cardiovascular medicine.

Schoenhagen P, Halliburton SS, Stillman AE, Kuzmiak SA, Nissen SE, Tuzcu EM, White RD. · Department of Radiology, Cleveland Clinic Foundation, Desk Hb 6, 9500 Euclid Ave, Cleveland, OH 44195, USA. · Radiology. · Pubmed #15220490 links to  free full text

Abstract: While invasive imaging techniques, especially selective conventional coronary angiography, will remain vital to planning and guiding catheter-based and surgical treatment of significantly stenotic coronary lesions, the comprehensive and serial assessment of asymptomatic or minimally symptomatic stages of coronary artery disease (CAD) for preventive purposes will eventually need to rely on noninvasive imaging techniques. Cardiovascular imaging with tomographic modalities, including computed tomography (CT) and magnetic resonance imaging, has great potential for providing valuable information. This review article will describe the current and future role of cardiac CT, and in particular that of multi-detector row CT, for imaging of atherosclerotic and other pathologic changes of the coronary arteries. It will describe how tomographic coronary imaging may eventually supplement traditional angiographic techniques in understanding the patterns of atherosclerotic CAD development.

Klingensmith JD, Schoenhagen P, Tajaddini A, Halliburton SS, Tuzcu EM, Nissen SE, Vince DG. · Department of Biomedical Engineering, Lerner Research Institute, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. · Am Heart J. · Pubmed #12766735 No free full text.

Abstract: BACKGROUND: Angiography allows the definition of advanced, severe stages of coronary artery disease, but early atherosclerotic lesions, which do not lead to luminal stenosis, are not identified reliably. In contrast, intravascular ultrasound scanning allows the precise characterization and quantification of a wide range of atherosclerotic lesions, independent of the severity of luminal stenosis. METHODS: Three-dimensional (3-D) reconstruction of entire coronary segments is possible with the integration of sequential 2-dimensional tomographic images and allows volumetric analysis of coronary arteries. RESULTS: Automated systems able to recognize lumen and vessel borders and to display 3-D images are becoming available. CONCLUSION: These systems have the potential for on-line 3-D image reconstruction for clinical decision-making and fast routine volumetric analysis in research studies. This review describes 3-D intravascular ultrasound scanning acquisition, analysis, and processing, and the associated technical challenges.

Halliburton SS, Stillman AE, White RD. · Department of Diagnostic Radiology, The Cleveland Clinic Foundation, OH 44195, USA. · Cleve Clin J Med. · Pubmed #12086233 links to  free full text

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Halliburton SS, Sola S, Kuzmiak SA, Obuchowski NA, Desai M, Flamm SD, Schoenhagen P. · Cardiovascular Imaging Laboratory, Imaging Institute, Cleveland Clinic, Cleveland, OH 44195, USA. · J Cardiovasc Comput Tomogr. · Pubmed #19083984 No free full text.

Abstract: BACKGROUND: Dual-source computed tomography (DSCT) was introduced with significant hardware and software changes compared with single-source CT (SSCT), resulting in improved temporal resolution (83 ms) and the potential for improved image quality. The effect of these changes on radiation dose requirements for coronary CT angiography in clinical practice has not been investigated. OBJECTIVE: We evaluated patient radiation dose and image quality of electrocardiogram (ECG)-gated helical techniques, using DSCT compared with SSCT for clinical imaging of the coronary arteries. METHODS: DSCT data from 160 patients were evaluated; 82 patients (DSCT group 1) were imaged with early software, and 78 patients (DSCT group 2) were imaged with a later software version. Patients imaged with SSCT (n = 124) were the control group. Effective radiation dose values were estimated for all patients. Image noise was measured, and image quality was evaluated on a 5-point scale. RESULTS: Effective dose values for DSCT group 2 (11.7 +/- 4.0 mSv) were not different from those for SSCT group (10.9 +/- 2.9 mSv); the highest doses, 13.2 +/- 3.2 mSv, were recorded for DSCT group 1 (P < 0.001). A decrease in image noise was observed for DSCT compared with SSCT (P <or= 0.001) as was an increase in image quality (P < 0.01). With optimized DSCT imaging, lower dose values were associated with (1) shorter scan range, (2) lower maximum tube current, and (3) lower fraction of R-R interval receiving maximum tube current. CONCLUSION: ECG-gated helical DSCT can provide images of the coronary arteries with improved image quality and decreased noise without an increase in radiation dose compared with SSCT in clinical patient groups.

Barreto M, Schoenhagen P, Nair A, Amatangelo S, Milite M, Obuchowski NA, Lieber ML, Halliburton SS. · Imaging Institute, Cardiovascular Imaging Lab, Cleveland Clinic, Cleveland, OH 44195, USA. · J Cardiovasc Comput Tomogr. · Pubmed #19083956 No free full text.

Abstract: BACKGROUND: Noninvasive characterization of coronary atherosclerotic plaque is limited with current computed tomography (CT) techniques. Dual-energy CT (DECT) has the potential to provide additional attenuation data for better differentiation of plaque components. OBJECTIVE: We attempted to characterize coronary atherosclerotic plaque with DECT. METHODS: Seven human coronary arteries acquired at autopsy were scanned consecutively at 80 and 140 kVp with CT. Vessels were perfused with saline, and data were acquired before and after contrast agent injection. Lesions were identified, and attenuation measurements were made from CT image quadrants. CT quadrants were classified as densely calcified, fibrocalcific, fibrous, lipid-rich, or normal vessel wall, corresponding to matched histology images. Attenuation values at each peak tube voltage were compared within plaque types for both noncontrast and contrast scans. Further, dual-energy index (DEI) values computed from attenuation were analyzed for classification of plaque. RESULTS: In 14 lesions, a total of 56 quadrants were identified. Histology results classified 8 (14%) as densely calcified, 8 (14%) as fibrocalcific, 9 (16%) as fibrous, 5 (9%) as lipid-rich, and 25 (45%) as normal vessel wall. Calcified lesions attenuated significantly more at 80 kVp in both contrast and noncontrast scans, whereas fibrous plaque attenuated more at 80 kVp only for contrast-enhanced scans. No differences were found for lipid-rich plaques. Using DEI values, only densely calcified plaques could be distinguished from other plaque types except fibrocalcific plaques in contrast images. CONCLUSIONS: Only densely calcified and fibrocalcific plaques showed a true change in attenuation at 80 versus 140 kVp. Therefore, calcified plaques could be distinguished from noncalcified plaques with DECT, but further classification of plaque types was not possible.

Halliburton SS, Abbara S. · Division of Radiology, Cardiovascular Imaging Laboratory, Cleveland Clinic, Cleveland, OH 44195, USA. · J Cardiovasc Comput Tomogr. · Pubmed #19083880 No free full text.

Abstract: The acquisition of diagnostic cardiovascular computed tomography (CT) images requires careful preparation of the patient before scanning. Guidelines for patient preparation are largely dictated by scanner capabilities and the technical limits they impose on patient-specific characteristics. The objective of this paper is to highlight procedures for patient screening, premedication, instruction, positioning, and electrocardiographic (ECG) lead placement. Awareness of scanner limitations and adherence to patient preparation guidelines can significantly improve CT image quality and diagnostic yield.

McCollough CH, Ulzheimer S, Halliburton SS, Shanneik K, White RD, Kalender WA. · Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA. · Radiology. · Pubmed #17456875 links to  free full text

Abstract: PURPOSE: To develop a consensus standard for quantification of coronary artery calcium (CAC). MATERIALS AND METHODS: A standard for CAC quantification was developed by a multi-institutional, multimanufacturer international consortium of cardiac radiologists, medical physicists, and industry representatives. This report specifically describes the standardization of scan acquisition and reconstruction parameters, the use of patient size-specific tube current values to achieve a prescribed image noise, and the use of the calcium mass score to eliminate scanner- and patient size-based variations. An anthropomorphic phantom containing calibration inserts and additional phantom rings were used to simulate small, medium-size, and large patients. The three phantoms were scanned by using the recommended protocols for various computed tomography (CT) systems to determine the calibration factors that relate measured CT numbers to calcium hydroxyapatite density and to determine the tube current values that yield comparable noise values. Calculation of the calcium mass score was standardized, and the variance in Agatston, volume, and mass scores was compared among CT systems. RESULTS: Use of the recommended scanning parameters resulted in similar noise for small, medium-size, and large phantoms with all multi-detector row CT scanners. Volume scores had greater interscanner variance than did Agatston and calcium mass scores. Use of a fixed calcium hydroxyapatite density threshold (100 mg/cm(3)), as compared with use of a fixed CT number threshold (130 HU), reduced interscanner variability in Agatston and calcium mass scores. With use of a density segmentation threshold, the calcium mass score had the smallest variance as a function of patient size. CONCLUSION: Standardized quantification of CAC yielded comparable image noise, spatial resolution, and mass scores among different patient sizes and different CT systems and facilitated reduced radiation dose for small and medium-size patients.

Halliburton SS, Schoenhagen P, Nair A, Stillman A, Lieber M, Murat Tuzcu E, Geoffrey Vince D, White RD. · Section of Cardiovascular Imaging, Division of Radiology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. · Coron Artery Dis. · Pubmed #16905968 No free full text.

Abstract: OBJECTIVES: The objective of this study was to investigate the effect of contrast injection on atherosclerotic coronary plaque attenuation measured using multidetector-row computed tomography. BACKGROUND: Recent multidetector-row computed tomography studies have described the characterization of coronary atherosclerotic plaque on the basis of Hounsfield unit values. The influence of contrast injection on the attenuation of individual plaque components, however, is unknown. METHODS: Using a pressurized perfusion system, 10 human coronary arteries were examined postmortem with multidetector-row computed tomography and histology. Pre-enhanced, peak-enhanced, and delayed enhanced multidetector-row computed tomography images were acquired during continuous perfusion of the vessel. A total of 37 focal atherosclerotic plaques were identified. Vessel wall attenuation was measured from multidetector-row computed tomography images during all three enhancement phases. On the basis of the histology, plaques were categorized as noncalcified (predominantly fibrous or predominantly fibrofatty), mixed calcified (calcified fibrous or calcified necrotic core), or densely calcified. The mean Hounsfield unit was compared among contrast phases for all plaques and in plaque subgroups. RESULTS: We observed contrast enhancement of atherosclerotic plaques within the vessel wall. For noncalcified plaques including both fibrous and fibrofatty plaques, the mean Hounsfield unit of the vessel wall during and after contrast injection exceeded the mean value before injection (t-test, P<0.002). CONCLUSION: The present study demonstrates that intra-arterial injection of iodinated contrast agent results not only in luminal enhancement but also in atherosclerotic plaque enhancement in pressure-perfused coronary arteries imaged ex vivo. Plaque enhancement should be considered when characterizing plaque components on the basis of Hounsfield unit with multidetector-row computed tomography.

Setser RM, O'Donnell TP, Smedira NG, Sabik JF, Halliburton SS, Stillman AE, White RD. · Department of Radiology, Section of Cardiovascular Imaging, the Cleveland Clinic Foundation, Cleveland, OH 44195, USA. · Radiology. · Pubmed #16244254 links to  free full text

Abstract: PURPOSE: To evaluate assignment of left ventricular (LV) myocardial segments to coronary arterial territories by using coregistered magnetic resonance (MR) imaging and multi-detector row computed tomography (CT) displays; to assess the accuracy of coregistered displays in determining the distribution of clinically important coronary artery disease (CAD) and regional effect of CAD on LV myocardium in patients with chronic ischemic heart disease (CIHD); and to determine the utility of coregistered displays in optimizing surgical revascularization planning. MATERIALS AND METHODS: This study was HIPAA compliant and was approved by the local Institutional Review Board, with waiver of informed consent. Twenty-six patients (19 men, seven women; age, 56 years +/- 12 [+/- standard deviation]) with CIHD underwent MR imaging assessment of myocardial viability and multi-detector row CT assessment of CAD on the same day. For coregistration, a population-based LV model was fit to each data set separately; models were then registered spatially. For data analysis, correspondence between coregistered displays and the 17-segment LV model for assessment of CIHD was evaluated, accuracy of using coregistered displays to evaluate the extent of CAD and myocardial disease was assessed, and utility of coregistered displays in optimizing surgical revascularization planning was determined. RESULTS: Coronary assignment for coregistered displays and the 17-segment LV model differed in 17% of myocardial segments. For the majority of patients, three segments (midanterolateral [62%], apical lateral [73%], and apical inferior [58%]) were discordant. Segments were supplied by the left anterior descending artery, a diagonal branch, or a ramus intermedius with diagonal distribution in all but one case. Coregistered displays were deemed concordant with selective coronary angiography and alternate myocardial imaging in all cases. Overall, surgical planning was potentially enhanced in 83% of cases because, compared with alternate imaging modalities, coregistered displays were believed to demonstrate the relationship between coronary arteries and underlying myocardial tissue more definitively and efficiently (for patients in whom surgery was performed) or more correctly and comprehensively (for a presumably better-tailored surgery). CONCLUSION: Assessment of CIHD can be improved by using coregistered displays that directly relate the condition of LV myocardium to the anatomy of the coronary arteries in individual patients.

Halliburton SS, Stillman AE, Lieber M, Kasper JM, Kuzmiak SA, White RD. · Section of Cardiovascular Imaging, Division of Radiology/Hb6, The Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44195, USA. · AJR Am J Roentgenol. · Pubmed #15671391 links to  free full text

Abstract: OBJECTIVE: The potential clinical impact of variability in the measurement of coronary artery calcification with sequential MDCT was evaluated using Agatston, volume, and mass scoring algorithms. SUBJECTS AND METHODS: Fifty-six patients were imaged twice using an identical prospectively ECG-triggered sequential scanning protocol. The Agatston, volume, and mass scores were computed by two observers independently. In addition, a patient's total Agatston score was referenced to an age- and sex-stratified database to determine a percentile ranking. Interscan, interobserver, and intraobserver variability and the resultant impact on patients' risk stratifications were assessed. RESULTS: Significant interscan differences were found for all mean coronary calcium scores (Wilcoxson's signed rank test, p <0.0001). Although the median percentage of interscan variability was low for all scoring methods, the interquartile range was wide, indicating significant variability in the data. Median scores (lower quartile-upper quartile) for observers 1 and 2, respectively, were as follows: Agatston, 5% (0-79%) and 6% (0-83%); volume, 12% (0-51%) and 12% (0-57%); and mass, 14% (0-57%) and 14% (0-58%). Interobserver and intraobserver differences between mean calcium scores were not significant, and consequently, lower interobserver and intraobserver variabilities (narrow interquartile ranges of 0-5%) were observed for all scores. Despite significant interscan differences in calcium scores, the percentile ranking assigned to the two scans differed in only 13% of patients. Interobserver differences resulted in a change in the percentile ranking in 7-9% of patients, whereas intraobserver differences caused a change in only 5% of patients. CONCLUSION: The accuracy of sequential MDCT for coronary calcium quantification is sufficient in most cases for stratification of patient risk.

Schoenhagen P, Tuzcu EM, Stillman AE, Moliterno DJ, Halliburton SS, Kuzmiak SA, Kasper JM, Magyar WA, Lieber ML, Nissen SE, White RD. · Department of Radiology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA. · Coron Artery Dis. · Pubmed #12966267 No free full text.

Abstract: BACKGROUND: Non-invasive identification and characterization of mildly stenotic atherosclerotic lesions is an increasingly important focus of coronary imaging. DESIGN: We examined the accuracy of multi (16)-slice computed tomography (MSCT) for imaging of these lesions in comparison with intravascular ultrasound (IVUS). MATERIALS: Mildly stenotic segments of the left coronary artery were identified by coronary angiography and analyzed using IVUS and contrast-enhanced MSCT. Independent reviewers evaluated the accuracy of MSCT for presence, composition and distribution of atherosclerotic plaque and remodeling response in comparison to IVUS using receiver operating characteristic (ROC) data analysis. RESULTS: Of 46 segments in 14 patients, diagnostic characterization by MSCT was possible in 37 (80.4%) segments. In these segments the accuracy of MSCT for identifying plaque presence, calcification, distribution and positive remodeling was consistently greater than 0.90 (reader 1) and 0.87 (reader 2). CONCLUSION: State-of-the-art MSCT can accurately identify mildly stenotic coronary atherosclerosis and provide an assessment of morphology and remodeling response.

Flohr T, Küttner A, Bruder H, Stierstorfer K, Halliburton SS, Schaller S, Ohnesorge BM. · Siemens Medical Solutions, Computed Tomography, Forchheim, Germany. · Herz. · Pubmed #12616316 No free full text.

Abstract: BACKGROUND: 4-slice CT scanners have shown limitations in clinical application for noninvasive coronary CT angiography (CTA). We evaluate advances in ECG-gated scanning of the heart and the coronary arteries with recently introduced 16-slice CT equipment (SOMATOM Sensation 16, Siemens, Forchheim, Germany). MATERIALS AND METHODS: The technical principles of ECG-gated cardiac scanning, scan parameters, and detector design of the new scanner are presented. ECG-gated scan and image reconstruction techniques and ECG-controlled dose modulation ("ECG pulsing") for a reduction of the patient dose are described, key parameters for image quality and simulation results presented, and phantom studies and initial patient experience discussed. The impact of reduced gantry rotation time (0.42 s) on temporal resolution and initial estimations of the patient dose are presented. RESULTS: Extensions of ECG-gated reconstruction algorithms used for 4-slice CT provide adequate image quality for up to 16 slices. For each detector collimation different slice widths are available for retrospective reconstruction with well-defined slice sensitivity profiles (SSPs). For coronary CTA the heart can be covered with 0.75 mm collimation within a 20-s breathhold. The best possible spatial resolution is 0.5 x 0.5 x 0.6 mm. For 0.42 s gantry rotation time, temporal resolution reaches its optimum (105 ms) at a heart rate of 81 bpm. Effective patient dose for coronary CTA is 4-5 mSv using ECG-pulsed acquisition. CONCLUSION: The clinical performance of coronary CTA by means of spatial resolution, temporal resolution and scan time is substantially improved with the evaluated 16-slice CT scanner. Also, display of smaller coronary segments and instent visualization are substantially improved.

Halliburton SS, Petersilka M, Schvartzman PR, Obuchowski N, White RD. · Section of Cardiovascular Imaging, Division of Radiology Cleveland Clinic Foundation, Cleveland, OH 44195, USA. · Int J Cardiovasc Imaging. · Pubmed #12602485 No free full text.

Abstract: PURPOSE: Multi-slice computed tomography (MSCT) is an emerging technique for the angiographic assessment of coronary artery disease (CAD). The purpose of this work was to determine if multiphasic reconstructions of the same data used for the assessment of CAD could also be used for global functional evaluation of the left ventricle (LV). MATERIALS AND METHODS: Fifteen patients with chronic ischemic heart disease (CIHD) were imaged for CAD using a contrast-enhanced retrospective electrocardiographic-gated spiral technique on a MSCT scanner. The same data were reconstructed at both end-diastole and end-systole in order to measure left ventricular end-diastolic volume (LVEDV), end-systolic volume (LVESV), and ejection fraction (LVEF). The results were compared to values obtained using a cine true-fast imaging with steady-state precession technique on a magnetic resonance imaging (MRI) scanner. Interobserver variability in the measurement from MSCT images was also evaluated. RESULTS: For LVEF, there was substantial agreement between MSCT and MRI (intraclass correlation coefficient of 0.825); the intermodality reproducibility for LVEF (5%) was within an acceptable clinical range. However, mean values of LVEDV and LVESV with MSCT compared to cine MRI (LVEDV: 262.0 +/- 85.6 ml and 297.2 +/- 98.8 ml, LVESV: 196.2 +/- 75.6 ml and 218.6 +/- 90.99 ml, respectively) were significantly less for both volumes (p < 0.015). Intermodality variabilities for these measurements were high (15 and 13% for LVEDV and LVESV, respectively). Readers' mean measurements of LVESV from MSCT images were significantly different (p = 0.003) resulting in differences in calculation of LVEF (p < 0.024). Still, interobserver variabilities for all values were acceptable (6, 8, and 5% for LVEDV, LVESV, and LVEF, respectively). CONCLUSION: Although values for LVEDV and LVESV were less with MSCT than with MRI, LVEF values were in agreement. This suggests that combined imaging of CAD and the evaluation of global LV dysfunction due to CIHD is feasible with the same MSCT acquisition.

Acevedo M, Sprecher DL, Calabrese L, Pearce GL, Coyner DL, Halliburton SS, White RD, Sykora E, Kondos GT, Hoff JA. · Section of Preventive Cardiology and Rehabilitation, Department of Cardiology, The Cleveland Clinic Foundation, OH 44195, USA. · Atherosclerosis. · Pubmed #12052482 No free full text.

Abstract: BACKGROUND: Highly active antiretroviral therapy (HAART) has dramatically improved the life expectancy of patients with human immunodeficiency virus (HIV) prompting increasing concerns related to chronic management. Suggestions of greater cardiovascular risk, partially related to recently proposed HAART-induced dyslipidemia and glucose intolerance, amplify these concerns. At this time, further corroboration of the emerging evidence for increased coronary risk, as well as complimentary estimates of coronary artery atherosclerotic burden, would be valuable to practicing physicians. METHODS: Seventeen HIV patients on HAART (all from the same HIV clinic population) without coronary artery disease (CAD) were referred to Preventive Cardiology for treatment of dyslipidemia ('referred group'). Upon entry, they underwent computed tomography (CT) of the coronary arteries. Subsequently, the referred group was matched (1:4) for age, gender and traditional risk to non-HIV non-CAD subjects (matched group, n=68) from the University of Illinois CT database. A serial review of 90 subjects from the original HIV population was sampled to determine general cardiovascular risk. RESULTS: Thirteen (76%) of the 17 referred patients revealed the presence of coronary calcium compared with 63% in the matched HIV seronegative controls (P=0.18). Log-transformed median calcium score was 2.93+/-2.3 in the referred group versus 1.97+/-2.5 in the matched group (P=0.09). Fifty one percent of the overall population smoked cigarettes, 11% were diabetic (30% diagnosed pre-HAART and 70% post-HAART) and 30% were hypertensive (33% diagnosed pre-HAART and 67% post-HAART). CONCLUSIONS: In a particularly dyslipidemic subgroup of HIV subjects without known CAD we found evidence for atherosclerosis in three-quarters based on coronary calcium. Further, in this population of HIV patients on HAART, we found an enhanced prevalence of traditional cardiovascular risk. This pilot study encourages the development of preventive strategies in this population.