Computed Tomography Coronary Angiography Is Feasible and Reliable for Proximal Coronary Segment Interpretation in Patients with Elevated Body Mass Index
Computed tomography coronary angiography (CTCA) is under-utilised in detecting coronary artery disease (CAD) in obese patients due to concerns about non-evaluable testing. We hypothesise that these concerns are predominantly related to smaller and branch coronary vessels, and CTCA remains adequate f...
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MDPI AG
2024-12-01
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| Series: | Journal of Cardiovascular Development and Disease |
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| Online Access: | https://www.mdpi.com/2308-3425/11/12/400 |
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| author | Anthony Salib Michael Hay Rahul Muthalaly Timothy Abrahams Nushrat Sultana Raj Kanna Ravi Rao Akira Abe John Bastwrous Emma Aldous Huong Tu Sarang Paleri Sheran Vasanthakumar Alisha Patel Rhea Nandurkar Adam Brown Andrew Lin Nitesh Nerlekar |
| author_facet | Anthony Salib Michael Hay Rahul Muthalaly Timothy Abrahams Nushrat Sultana Raj Kanna Ravi Rao Akira Abe John Bastwrous Emma Aldous Huong Tu Sarang Paleri Sheran Vasanthakumar Alisha Patel Rhea Nandurkar Adam Brown Andrew Lin Nitesh Nerlekar |
| author_sort | Anthony Salib |
| collection | DOAJ |
| description | Computed tomography coronary angiography (CTCA) is under-utilised in detecting coronary artery disease (CAD) in obese patients due to concerns about non-evaluable testing. We hypothesise that these concerns are predominantly related to smaller and branch coronary vessels, and CTCA remains adequate for proximal segment stenosis interpretation, which has significant clinical implications. This retrospective cohort study, on consecutive patients referred for CTCA for suspected CAD, grouped patients by body mass index. A 4-point Likert scale assessed image quality, with any poorly visualised segment at the per-patient level resulting in the CTCA being subsequently analysed for proximal coronary artery segment evaluability. Of the 703 patients, 93.5% of the studies were fully evaluable. Patients with a BMI ≥ 40, diabetic patients, and patients with an elevated acquisition heart rate were associated with suboptimal studies. Of the 46 suboptimal studies, 163/182 (90%) of proximal segments were fully evaluable. Non-evaluable segments were derived from seven patients (one with a BMI ≥ 40). Reasons for proximal segment non-evaluability were predominantly due to calcific blooming (12/19 segments). While CTCA may be less reliable for distal and side-branch artery evaluation in obese patients, it remains highly evaluable for stenosis severity of the proximal main coronary segments, which carries prognostic significance. It may therefore be considered a suitable non-invasive anatomic test for patients, regardless of BMI. |
| format | Article |
| id | doaj-art-20ddf8a28ca444d38571c08d7df61a39 |
| institution | DOAJ |
| issn | 2308-3425 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Cardiovascular Development and Disease |
| spelling | doaj-art-20ddf8a28ca444d38571c08d7df61a392025-08-20T02:55:57ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252024-12-01111240010.3390/jcdd11120400Computed Tomography Coronary Angiography Is Feasible and Reliable for Proximal Coronary Segment Interpretation in Patients with Elevated Body Mass IndexAnthony Salib0Michael Hay1Rahul Muthalaly2Timothy Abrahams3Nushrat Sultana4Raj Kanna5Ravi Rao6Akira Abe7John Bastwrous8Emma Aldous9Huong Tu10Sarang Paleri11Sheran Vasanthakumar12Alisha Patel13Rhea Nandurkar14Adam Brown15Andrew Lin16Nitesh Nerlekar17Faculty of Medicine, Monash University, Wellington Rd, Melbourne 3800, AustraliaMonash Cardiovascular Research Centre, Victorian Heart Hospital, Blackburn Rd, Melbourne 3800, AustraliaFaculty of Medicine, Monash University, Wellington Rd, Melbourne 3800, AustraliaMonash Cardiovascular Research Centre, Victorian Heart Hospital, Blackburn Rd, Melbourne 3800, AustraliaMonash Cardiovascular Research Centre, Victorian Heart Hospital, Blackburn Rd, Melbourne 3800, AustraliaIndependent Researcher, Perth 6000, AustraliaIndependent Researcher, Perth 6000, AustraliaIndependent Researcher, Melbourne 3800, AustraliaIndependent Researcher, Melbourne 3800, AustraliaFaculty of Medicine, Monash University, Wellington Rd, Melbourne 3800, AustraliaFaculty of Medicine, Monash University, Wellington Rd, Melbourne 3800, AustraliaMonash Cardiovascular Research Centre, Victorian Heart Hospital, Blackburn Rd, Melbourne 3800, AustraliaMonash Cardiovascular Research Centre, Victorian Heart Hospital, Blackburn Rd, Melbourne 3800, AustraliaMonash Cardiovascular Research Centre, Victorian Heart Hospital, Blackburn Rd, Melbourne 3800, AustraliaFaculty of Medicine, Monash University, Wellington Rd, Melbourne 3800, AustraliaFaculty of Medicine, Monash University, Wellington Rd, Melbourne 3800, AustraliaFaculty of Medicine, Monash University, Wellington Rd, Melbourne 3800, AustraliaFaculty of Medicine, Monash University, Wellington Rd, Melbourne 3800, AustraliaComputed tomography coronary angiography (CTCA) is under-utilised in detecting coronary artery disease (CAD) in obese patients due to concerns about non-evaluable testing. We hypothesise that these concerns are predominantly related to smaller and branch coronary vessels, and CTCA remains adequate for proximal segment stenosis interpretation, which has significant clinical implications. This retrospective cohort study, on consecutive patients referred for CTCA for suspected CAD, grouped patients by body mass index. A 4-point Likert scale assessed image quality, with any poorly visualised segment at the per-patient level resulting in the CTCA being subsequently analysed for proximal coronary artery segment evaluability. Of the 703 patients, 93.5% of the studies were fully evaluable. Patients with a BMI ≥ 40, diabetic patients, and patients with an elevated acquisition heart rate were associated with suboptimal studies. Of the 46 suboptimal studies, 163/182 (90%) of proximal segments were fully evaluable. Non-evaluable segments were derived from seven patients (one with a BMI ≥ 40). Reasons for proximal segment non-evaluability were predominantly due to calcific blooming (12/19 segments). While CTCA may be less reliable for distal and side-branch artery evaluation in obese patients, it remains highly evaluable for stenosis severity of the proximal main coronary segments, which carries prognostic significance. It may therefore be considered a suitable non-invasive anatomic test for patients, regardless of BMI.https://www.mdpi.com/2308-3425/11/12/400obesityCTCACADproximal coronary segment |
| spellingShingle | Anthony Salib Michael Hay Rahul Muthalaly Timothy Abrahams Nushrat Sultana Raj Kanna Ravi Rao Akira Abe John Bastwrous Emma Aldous Huong Tu Sarang Paleri Sheran Vasanthakumar Alisha Patel Rhea Nandurkar Adam Brown Andrew Lin Nitesh Nerlekar Computed Tomography Coronary Angiography Is Feasible and Reliable for Proximal Coronary Segment Interpretation in Patients with Elevated Body Mass Index Journal of Cardiovascular Development and Disease obesity CTCA CAD proximal coronary segment |
| title | Computed Tomography Coronary Angiography Is Feasible and Reliable for Proximal Coronary Segment Interpretation in Patients with Elevated Body Mass Index |
| title_full | Computed Tomography Coronary Angiography Is Feasible and Reliable for Proximal Coronary Segment Interpretation in Patients with Elevated Body Mass Index |
| title_fullStr | Computed Tomography Coronary Angiography Is Feasible and Reliable for Proximal Coronary Segment Interpretation in Patients with Elevated Body Mass Index |
| title_full_unstemmed | Computed Tomography Coronary Angiography Is Feasible and Reliable for Proximal Coronary Segment Interpretation in Patients with Elevated Body Mass Index |
| title_short | Computed Tomography Coronary Angiography Is Feasible and Reliable for Proximal Coronary Segment Interpretation in Patients with Elevated Body Mass Index |
| title_sort | computed tomography coronary angiography is feasible and reliable for proximal coronary segment interpretation in patients with elevated body mass index |
| topic | obesity CTCA CAD proximal coronary segment |
| url | https://www.mdpi.com/2308-3425/11/12/400 |
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