Dual-energy computed tomography coronary angiography in patients with chronic ischemic heart disease

Authors: Boldyreva K.M., Aslanidis I.P., Dorofeev A.V., Rychina I.E., Dariy O.Yu., Golukhova E.Z.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

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Type:  Clinical Cases


DOI: https://doi.org/10.24022/1997-3187-2022-16-3-413-420

For citation: Boldyreva K.M., Aslanidi I.P., Dorofeev A.V., Rychina I.E., Dariy O.Yu., Golukhova E.Z. Dual-energy computed tomography coronary angiography in patients with chronic ischemic heart disease. Creative Cardiology. 2022; 16 (3): 413–20 (in Russ.). DOI: 10.24022/1997-3187-2022-16-3-413-420

Received / Accepted:  05.07.2022 / 26.08.2022

Keywords: dual-energy computed tomography CT perfusion myocardial infarction coronary heart disease iodine cards

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Abstract

Description of opportunity of computed tomography (CT) coronary angiography with static dual-energy CT perfusion in rest status of myocardium for assessment of coronary arteries and postischemic (scars) changes in patients with coronary arteries disease. The aim of our study was to show the assessment patency of revascularization segments of coronary arteries and dynamic observation in 2 clinical cases of men ages up to 60 years old who had a history of myocardial infarction and symptoms of chronic coronary arteries disease. Both patients underwent myocardium revascularization after acute myocardial infarction (Q-myocardial infarction). CT examinations were performed using dual-tube CT Siemens SOMATOM Force in double energy scan mode with results postprocessing on Syngo.via workstation. Оmnipaque 350 was used for contrast enhancement. The violation of perfusion in modelling myocardium iodine maps in peak of passage of contrast agent was detected. The area of hypoperfusion corresponded area of damage arteries. Indications of iodine concentration in area of hypoperfusion was 0,0–0,1 mg/ml for patient А, and 3,2 mg/ml for non-damaged arteria area, while for patient B, the concentration of iodine in hypoperfusion was 0,5–0,6 mg/ml and 4,2 mg/ml for non-damaged arteria area. Dualenergy myocardial CT perfusion in combination with the standard CT coronary angiography protocol in patients with chronic CAD is a promising method capable of detecting the presence of perfusion defects in the myocardium, which reliably indicates myocardial fibrous replacement.

References

  1. Bockeria L.A., Milievskaya E.B., Pryanishnikov V.V., Yurlov I.A. Cardiovascular surgery – 2020. Moscow; 2021 (in Russ.).
  2. Ardashev A.V., Shlyakhto E.V., Arutyunov G.P., Belenkov Yu.N., Boytsov S.A. at al. National guidelines for the definition of risk and prevention of sudden cardiac death – 2018. Cardiology: News. Opinion. Education. 2019; 1 (20): 64–88 (in Russ.).
  3. Boytsov S.A., Nikulina N.N., Yakushin S.S., Akinina S.A., Furmenko G.I. Sudden cardiac death in patients with coronary heart disease: results of the russian multi-centre epidemiological study of mortality, morbidity, and diagnostics and treatment quality in acute chd (resonance). Russian Journal of Cardiology. 2011; (2): 59–64 (in Russ.).
  4. Kuck K.H., Cappato R., Siebels J., Ruppel R. Randomized comparison of antiarrhythmic drug therapy with implantable defibrillators in patients resuscitated from cardiac arrest. Circulation. 2000; 102 (7): 748–54. DOI: 10.1161/01.cir.102.7.748
  5. Cairns J.A., Connolly S.J., Roberts R., Gent M. Canadian Amiodarone Myocardial Infarction Arrhythmia Trial (CAMIAT): rationale and protocol. CAMIAT Investigators. Am. J. Cardiol. 1993; 72 (16): 87–94. DOI: 10.1016/0002-9149(93)90969-j
  6. Porcari A., De Luca A., Grigoratos C., Biondi F., Faganello G., Vitrella G. Arrhythmic risk stratification by cardiac magnetic resonance tissue characterization: disclosing the arrhythmic substrate within the heart muscle. Heart Fail. Rev. 2022; 27 (1): 49–69. DOI: 10.1007/s10741-020-09986-0
  7. Delgado V., Bucciarelli-Ducci C., Bax J.J. Diagnostic and prognostic roles of echocardiography and cardiac magnetic resonance. J. Nucl. Cardiol. 2016; 23 (6): 1399–410. DOI: 10.1007/s12350- 016-0595-z
  8. Kang D.K., Schoepf U.J., Bastarrika G., Nance J.W. Jr, Abro J.A., Ruzsics B. Dual-energy computed tomography for integrative imaging of coronary artery disease: principles and clinical applications. Semin. Ultrasound CT MR. 2010; 31 (4): 276–91. DOI: 10.1053/j.sult.2010.05.004
  9. Ruzsics B., Schwarz F., Schoepf U.J., Lee Y.S., Bastarrika G., Chiaramida S.A., Costello P. at al. Comparison of dual-energy computed tomography of the heart with single photon emission computed tomography for assessment of coronary artery stenosis and of the myocardial blood supply. Am. J. Cardiol. 2009; 104 (3): 318–26. DOI: 10.1016/j.amjcard.2009.03.051
  10. Pershina E.S., Sinitsin V.E., Mershina E. A., Komarova M.A., Chaban A.S. Static myocardial dualenergy (de) perfusion and delayed enhancement in detection of chronic myocardial scar tissue. Comparison with late gadolinium ebhancement mri. Medical Imaging. 2017; 21 (4): 10–8 (in Russ.). DOI: 10.24835/1607-0763-2017-4-10-18
  11. Niemeijer M.N., van den Berg M.E., Leening M.J., Hofman A., Franco O.H., Deckers J.W. at al. Declining incidence of sudden cardiac death from 1990–2010 in a general middle-aged and elderly population: the Rotterdam Study. Heart Rhythm. 2015; 12 (1): 123–9. DOI: 10.1016/j.hrthm.2014.09.054
  12. Bauer R.W., Kerl J.M., Fischer N., Burkhard T., Larson M.C., Ackermann H. at al. Dual-energy CT for the assessment of chronic myocardial infarction in patients with chronic coronary artery disease: comparison with 3-T MRI. Am. J. Roentgenol. 2010; 195(3): 639–46. DOI: 10.2214/AJR.09.3849.
  13. Ruzsics B., Lee H., Zwerner P.L., Gebregziabher M., Costello P., Schoepf U.J. Dual-energy CT of the heart for diagnosing coronary artery stenosis and myocardial ischemia-initial experience. Eur. Radiol. 2008; 18 (11): 2414–24. DOI: 10.1007/s00330-008-1022-x
  14. Abadia A.F., van Assen M., Martin S.S., Vingiani V., Griffith L.P., Giovagnoli D.A. at al. Myocardial extracellular volume fraction to differentiate healthy from cardiomyopathic myocardium using dual-source dual-energy CT. J. Cardiovasc. Comput. Tomogr. 2020; 14 (2): 162–7. DOI: 10.1016/j.jcct.2019.09.008
  15. van Assen M., De Cecco C.N., Sahbaee P., Eid M.H., Griffith L.P., Bauer M.J. at al. Feasibility of extracellular volume quantification using dualenergy CT. J. Cardiovasc. Comput. Tomogr. 2019; 13 (1): 81–4. DOI: 10.1016/j.jcct.2018.10.011

About Authors

  • Kiriena M. Boldyreva, Postgraduate, Junior Researcher; ORCID
  • Irakliy P. Aslanidis, Dr. Med. Sci., Professor, Head of Department, Deputy Director; ORCID
  • Aleksey V. Dorofeev, Cand. Med. Sci., Head of Department; ORCID
  • Inna E. Rychina, Cand. Med. Sci., Senior Research Associate, Head of Department; ORCID
  • Ol’ga Yu. Dariy, Cand. Med. Sci., Radiologist, ORCID
  • Elena Z. Golukhova, Dr. Med. Sci., Professor, Academician of Russian Academy of Sciences, Head of Department, Director; ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery