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Feasibility and accuracy of coronary imaging in elderly patients using the 64-row multi-detector computed tomography: a correlation study with conventional coronary angiography

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Journal of Geriatric Cardiology 2006年第1期3卷 9-14页

作者： Chee Khoon LIEW Sze Piaw CHIN Tiong Kiam ONG Seyfarth Tobias yean yip fong Choon Kiat ANG Houng Bang LIEW Rapaee ANNUAR Kui Hian SIM Deptartment of Cardiology Sarawak General Hospital SarawakMalaysia Siemens Cardiac Solutions Erlangen Germany Universitv Malaysia Sarawak Malaysia

Background Elderly patients generally have higher occurrence of coronary calcification, increased heart rate and difficulty with prolonged breath-holding. The aim of our study was to investigate the feasibility and accuracy of using 64-row multi-detector computed tomography (MDCT) in the assessment of coronary artery stenoses in elderly patients. Methods One hundred and fifty two patients with suspected or known coronary artery disease were divided into 4 groups according to their age (Group A: 40-49 years,n=34; Group B: 50-59 years, n=57; Group C: 60-69 years, n=48; Group D: 70 years and above; n=13). Coronary CT angiography (CTA) using a 64-row MDCT was performed and the findings were compared with that of conventional coronary angiography (CCA).Using axial images, multi-planar reconstructions (MPR) and maximum intensity projections (MIP), coronary segments of lumen diameter = 1.5mm were analyzed for the presence of significant stenosis (= 50% ). Results Percentages of poor image quality from coronary CTA preventing reliable correlations with CCA were 21%, 14%, 19% and 62% in Groups A to D respectively. Patients in Group D had significantly higher calcium scores compared with the other groups (P＜0.001). In patients where CTA images were of acceptable quality, percentages of accurate correlations with CCA were 89.8%, 93.4%, 86.6% and 78.0% for Groups A to D *** were no significant difference in serum creatinine, heart rate and contrast volume between the 4 groups. Conclusions The 64-row MDCT coronary angiography was less accurate and feasible for patients aged 70 years or above due to heavy coronary calcification and inability to perform a satisfactory breath-hold. However, a high diagnostic accuracy with the MDCT is possible in patients aged less than 70 years.

关键词： computed tomography angiography coronary artery disease elderly

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Assessment of left ventricular ejection fraction: comparison of two dimensional echocardiography, cardiac magnetic resonance imaging and 64-row multi-detector computed tomography

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Journal of Geriatric Cardiology 2006年第1期3卷 2-8页

作者： Chee Khoon LIEW Rapaee ANNUAR Tiong Kiam ONG Sze Piaw CHIN Tobias Seyfarth yean yip fong Choon Kiat ANG Houng Bang LIEW Kui Hian SIM Department of Cardiology Sarawak General Hospital Sarawak Malaysia University Malaysia Sarawak Siemens Cardiac Solutions Erlangen Germany Department of Cardiology Sarawak General Hospital SarawakMalaysia

Objectives To compare left ventricular ejection fraction (LVEF) determined from 64-row multi-detector computed tomography (64-row MDCT) with those determined from two dimensional echocardiography (2D echo) and cardiac magnetic resonance imaging (CMR). Methods Thirty-two patients with coronary artery disease underwent trans-thoracic 2D echo, CMR and contrast-enhanced 64-row MDCT for assessment of LVEF within 48 hours of each other. 64-row MDCT LVEF was derived using the Syngo Circulation software; CMR LVEF was by Area Length Ejection Fraction (ALEF) and Simpson method and 2D echo LVEF by Simpson *** The LVEF was 49.13 ± 15.91% by 2D echo, 50.72 ± 16.55% (ALEF method) and 47.65 ± 16.58%(Simpson method) by CMR and 50.00 ± 15.93% by 64-row MDCT. LVEF measurements by 64-row MDCT correlated well with LVEF measured with CMR using either the ALEF method (Pearson correlation r = 0.94, P ＜0.01) or Simpson method (r = 0.92, P＜0.01). It also correlated well with LVEF measured using 2D echo (r = 0.80, P ＜ 0.01). Conclusion LVEF measurements by 64-row MDCT correlated well with LVEF measured by CMR and 2D echo. The correlation between 64-row MDCT and CMR was better than the correlation between 2D echo with CMR. Standard data set from a 64-row MDCT coronary study can be reliably used to calculate the LVEF.

关键词： ejection fraction echocardiography magnetic resonance imaging computed tomography

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High-resolution computed tomography in patients with atypical 'cardiac' chest pain: a study investigating patients at 10-year cardiovascular risks defined by the Framingham and PROCAM scores

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Journal of Geriatric Cardiology 2006年第1期3卷 17-21页

作者： Choon Kiat ANG Alan yean yip fong Sze Piaw CHIN Tiong Kiam ONG Seyfarth M Tobias Chee Khoon LIEW Rapaee ANNUAR Houng Bang LIEW Kui Hian SIM Deptartment of Cardiology Sarawak General Hospital Sarawak Malaysia Siemens Medical Solutions Germany Deptartment of Cardiology Sarawak General Hospital SarawakMalaysia University Malaysia Sarawak Malaysia

Background and objective Atypical 'cardiac' chest pain (ACCP) is not usually caused by myocardial ischaemia. Current noninvasive investigations for these symptoms are not yet as accurate as invasive coronary angiography. The latest 64-row multi-detector computed tomography (MDCT) technology is non-invasive, has high specificity and negative predictive values for the detection of significant coronary disease. Our aim was to investigate if this modality can provide more information in the assessment of outpatients with ACCP in addition to established cardiovascular risk scores. Methods Seventy consecutive patients presenting to the outpatient clinic with ACCP underwent 64-row MDCT scan of the coronary arteries. They were categorized into low, medium or high risk groups based upon the Framingham and PROCAM scores. We defined a clinically abnormal MDCT scan as coronary stenosis =50% or calcium score ＞400 Agatston. Results Fifty-three (75.7%) patients did not have clinically abnormal scans. Framingham score classified 43 patients as low-risk while PROCAM classified 59 patients as low-risk. MDCT scans were abnormal for 18.6% and 22.0% of the respective low-risk group of patients. For patients with medium-to-high risk, 33.3% and 36.4% of Framingham and PROCAM patient groups respectively had abnormal MDCT scans. Conclusion MDCT adds valuable information in the assessment of patients with ACCP by identifying a significant proportion of patients categorized as low-risk to have underlying significant coronary stenosis and coronary calcification by established cardiovascular risk scores.

关键词： multi-detector computed tomography atypical 'cardiac' chest pain coronary artery disease risk stratification

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2021亚太心脏病学会P2Y12受体拮抗剂应用于亚太特殊人群的共识

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中华心血管病杂志 2023年第1期51卷 19-31页

作者： Jack Wei Chieh Tan Derek P Chew Kin Lam Tsui Doreen Tan Dmitry Duplyakov Ayman Hammoudeh 张波李毅徐凯 Paul J Ong DoniFirman Habib Gamra Wael Almahmeed Jamshed Dalal Lihua Tan Gabriel Steg Quang N Nguyen Junya Ako Jassim Al Suwaidi Mark Chan Mohamed Sobhy Abdulla Shehab Wacin Buddhari 王祖禄 Alan yean yip fong Bilgehan Karadag Byeong-Keuk Kim Usman Baber Chee Tang Chin 韩雅玲新加坡国立心脏中心新加坡盛港综合医院澳大利亚弗林德斯大学医学与公共卫生学院香港特别行政区东区尤德夫人那打素医院新加坡国立大学理学院药学系俄罗斯萨马拉地区心脏病医院约旦安曼Istishari医院心脏病科大连医科大学第一附属医院心内科大连116000 北部战区总医院心内科沈阳110840 新加坡伊丽莎白诺维娜医院新加坡陈笃生医院印度尼西亚Harapan Kita国家心血管中心、印度尼西亚大学医学院心脏病学和血管医学系突尼斯Fattouma Bourguiba大学医院/莫纳斯提尔大学心脏病科阿拉伯联合酋长国阿布扎比克利夫兰诊所印度孟买Kokilaben Dhirubhai Ambani医院心脏中心香港特别行政区广华医院法国巴黎比夏医院心脏病科越南河内医科大学心脏病科日本神奈川县相模原市北里大学医学院心血管内科卡塔尔多哈哈马德医疗公司成人心脏病科新加坡国立大学心脏中心埃及亚历山大大学医学院阿拉伯联合酋长国阿联酋大学医学与健康科学学院泰国曼谷朱拉隆功国王纪念医院马来西亚砂拉越哥打三马拉汉心脏中心土耳其伊斯坦布尔大学-Cerrahpasa医学院韩国首尔延世大学医学院Severance心血管医院心脏病科美国俄克拉荷马大学健康科学中心

高龄、糖尿病(DM)和慢性肾脏疾病(CKD)不仅会增加慢性冠状动脉综合征(CCS)患者缺血事件的风险,还会增加其接受抗血小板治疗期间的出血风险。此类特殊人群可能需要调整治疗方案,尤其是亚洲的特殊人群,往往表现出与西方人群不同的临床特... 详细信息

高龄、糖尿病(DM)和慢性肾脏疾病(CKD)不仅会增加慢性冠状动脉综合征(CCS)患者缺血事件的风险,还会增加其接受抗血小板治疗期间的出血风险。此类特殊人群可能需要调整治疗方案,尤其是亚洲的特殊人群,往往表现出与西方人群不同的临床特征。关于亚洲人群CCS高风险的分类和急性冠状动脉综合征(ACS)后使用新一代强效P2Y12受体抑制剂(如替格瑞洛和普拉格雷)的国际指南已相继发表。本共识总结了在特殊人群中使用强效P2Y12受体抑制剂的相关证据,提出了在冠状动脉疾病(CAD)特殊人群中应用标准疗程双联抗血小板治疗(DAPT)、短期DAPT和单一抗血小板治疗的推荐意见。本共识的特殊人群包括从ACS过渡至CCS,老年,或患有CKD、DM、多血管CAD和治疗期间发生出血并发症等特征的患者。

关键词：血小板聚集抑制剂亚洲心肌缺血共识双联抗血小板治疗

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64-row multi-dector computed tomography coronary image from a center with early experience: first illustration of learning curve

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Journal of Geriatric Cardiology 2006年第1期3卷 29-34页

作者： Sze Piaw CHIN Tiong Kiam ONG Chee Khoon LIEW M.Tobias Seyfarth fong yean yip ALAN Houng Bang LIEW Kui Hian SIM Dept of Cardiology Sarawak General Hospital Siemens Cardiac Solutions Erlangen Germany

Background and objectives The recent joint ACCF/AHA clinical competence statement on cardiac imaging with multi-detector computed tomography recommended a minimum of 6 months training and 300 contrast examinations, of which the candidate must be directly involved in at least 100 studies. Whether this is adequate to become proficient in interpretation of coronary computed tomogsignificant coronary stenosis in a center with 1 year's experience using a 64-row scanner. Methods A total of 778 patients underwent contrast-enhanced CTA between January and December 2005. Out of these patients, 301 patients also underwent contrast-enhanced conventional coronary angiography (CCA). These patients were divided into 4 groups according to the time the examination was underwent. Group Q1: first quarter of the year (n=20), Group Q2: second quarter (n=128), Group Q3: third quarter (n=134), and Group Results The sensitivity, specificity, positive, and negative predictive values were Q1 - 64%, 89%, 49% and 94%, respectively; Q2 -79%, 96%, 74% and 97%, respectively; Q3 - 78%, 96%, 74%, 97%, respectively, and Q4 - 100% for all. Conclusions In a center with formal training and high caseload, our accuracy in CTA analysis reached a plateau after 6 months experience. Test-bolus protocols produce better image quality and can improve accuracy. New centers embarking on CTA will need to overcome an initial 6-month learning curve depending upon the caseload during which time they should consider correlation with CCA.

关键词： computed tomography training angiography coronary artery disease

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Predictive Value of Resting Pd/Pa for Fractional Flow Reserve Assessed with Monorail Pressure Microcatheter in Real-World Practice

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Cardiovascular Innovations and Applications 2019年第B7期4卷 113-120页

作者： Keng Tat Koh Asri Said Khaw Chee Sin Oon Yen Yee Erwin Mulia Tan Chen Ting Francis Shu Eng Pbeng Ho Kian Hui Voon Chi Yen Cham Yee Ling Khiew Ning Zan Nor Hanim Mohd Amin Alan fong yean yip Ong Tiong Kiam Department of Cardiology Sarawak Heart Centre3rd RoundaboutSamarahan Expressway94300 Kota SamarahanSarawakMalaysia Faculty of Medicine and Health Sciences University Malaysia Sarawak94300 Kota SamarahanSarawakMalaysia Clinical Research Centre Sarawak General HospitalJalan Hospital 93586 KuchingSarawakMalaysia

Background and Objectives:The aims of this study were(1)to examine the diagnostic accuracy of resting timeaveraged distal coronary pressure(Pd)to mean aortic pressure(Pa)ratio to predict hyperemic fractional flow reserve(FFR)and(2)to identify a resting Pd/Pa value that can preclude the need for hyperemic FFR assessed with use of a monorail pressure ***:A total of 191 stenoses were *** exclusions,157 FFR data sets from 103 patients were ***:Resting Pd/Pa showed poor agreement with hyperemic FFR(r=0.619,P<0.001).The receiver operating characteristic curve for resting Pd/Pa with reference to hyperemic FFR of 0.80 or less showed an area under the curve of 0.800(95%confi dence interval 0.732– 0.868,P<0.001),with the greatest diagnostic accuracy of 74.5%for resting Pd/Pa of less than *** Pd/Pa of 0.96 or greater had a sensitivity of 100%and a negative predictive value of 100%,and resting Pd/Pa of 0.82 or less had a specifi city of 98.9%and a positive predictive value of 94.1%to predict abnormal FFR of 0.80 or *** results were consistent regardless of the vessels studied,the location of lesions,and the severity of ***:Resting Pd/Pa showed poor agreement with hyperemic FFR assessed with use of a monorail pressure ***,resting Pd/Pa of 0.96 or greater had excellent sensitivity and negative predictive value to predict normal hyperemic FFR,and resting Pd/Pa of 0.82 or less had excellent specifi city and positive predictive value to predict abnormal hyperemic FFR.

关键词： fractional fl ow reserve monorail pressure catheter resting time-averaged distal coronary pressure to mean aortic pressure ratio

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