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The Efficacy of Non-invasive Diagnostic for CAD in PMK Hospital. Maj. Hutsaya Prasitdumrong , M.D. Cardiovascular Division, Department of Internal Medicine, Phramongkutklao Hospital. Endothelial Dysfunction. Coronary atherosclerosis Coronary artery disease (CAD)

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the efficacy of non invasive diagnostic for cad in pmk hospital

The Efficacy of Non-invasive Diagnostic for CAD in PMK Hospital

Maj. HutsayaPrasitdumrong, M.D.

Cardiovascular Division, Department of Internal Medicine,

Phramongkutklao Hospital

slide2

Endothelial Dysfunction

Coronary atherosclerosis

Coronary artery disease (CAD)

Ischemic heart disease (IHD)

Atheroma

Complicated

lesion/

rupture

Foam cells

Fatty streak

Fibrous

plaque

Intermediate

lesion

From First

Decade

From Third

Decade

From Fourth

Decade

investigations for cad
Investigations for CAD

Functional Tests

Exercise stress test

Stress ECHO

Stress CMR

MPI: SPECT PET

Anatomical Tests

CT angiography

MR angiography

Coronary angiography

coronary angiography
Coronary Angiography
  • GOLD standard for detection of CAD
  • Identify coronary arteries stenosis and its severity
diagnostic accuracy of non invasive modalities for detection of cad
Diagnostic Accuracy of Non-invasive Modalities for Detection of CAD

Applied Radiology 2011;40(5):13-22

coronary angiography vs coronary ct angiography
Coronary Angiography VS Coronary CT Angiography

Coronary Angiography

Coronary CT Angiography

Non-invasive

Out patient visit

Iodine contrast

Radiation

Cost

Resume normal activity right after scanning

Risk: safer

  • Invasive
  • Require day care admission
  • Iodine contrast
  • Radiation
  • Cost
  • Resume normal activity after 24 hours
  • Risk: death, stroke, CA dissection about 1:1000
coronary angiography vs coronary ct angiography1
Coronary Angiography VS Coronary CT Angiography

Coronary Angiography

Coronary CT Angiography

non invasive or invasive test
Non-invasive or Invasive Test

Circulation 2002;106:1883-92

coronary ct angiography
Coronary CT Angiography
  • Coronary artery calcified plaque is nearly 100% specific for atheromatous coronary plaque
  • Can develop early in the course of subclinical atherosclerosis
  • Present in the intima of both obstructive and non-obstructive lesion
coronary calcium score
Coronary Calcium Score

Developed by David King

Published by Agatston and coworker

coronary calcium vs atherosclerosis
Coronary Calcium VS Atherosclerosis

Coronary calcium by EBCT and atherosclerotic plaque by histopathology

Rumberger, j.a. et al. Circulation 1995;92:2157-62

coronary calcium coronary events
Coronary Calcium & Coronary Events

Detrano et al. NEJM 2008;358(13):1336-45

64 slice vs 640 slice ct angiography
64-Slice VS 640-Slice CT Angiography

64-Slice CTA

640-Slice CTA

160 mm wide area detector

Scanning in 1 rotation

Shorter exposure time

Radiation dose reduced by up to 50%

Less contrast (50 cc)

Less artifact

Available in AF patient

  • 32 mm area detector
  • Scanning is in helical mode
  • Longer exposure time
  • Higher dose of radiation
  • Higher dose of contrast (80-100 cc)
  • More artifact
pmk heart center protocol
PMK Heart Center Protocol

Take history of previous

contrast allergy and PDE5

drug use

0.4 mg Nitroglycerine oral spray 1 puff

Target HR 60 bpm prior to scan

Med: Metoprolol up to 100 mg

keep BP > 110/70

Alt: Ivabradine 5 mg bid for 3 days

CTA scan: Prospective scan

100-120 kVp

Contrast 40-45 cc

Effective dose 3.5-4.5 mSv

At observation room

effective dose for cardiovascular imaging tests
Effective Dose for Cardiovascular Imaging Tests

Catheterization and Cardiovascular Intervention 2011;77:546-56

appropriate criteria for calcium scan and coronary cta
Appropriate Criteria for Calcium Scan and Coronary CTA
  • Calcium scan
    • Intermediate risk for CAD
    • Low risk for CAD with family history of premature coronary heart disease
  • Coronary CTA
    • Symptomatic patient with low or intermediate risk
    • Reduced LVEF with low or intermediate risk
    • Pre-op evaluation for non-cardiac surgery
    • Post revascularization

JACC 2010;56(22):1864-1894