RESUMEN
OBJECTIVE: We examined the prevalence and clinical predictors of atherosclerotic coronary artery disease in asymptomatic patients undergoing multidetector computed tomography BACKGROUND: In recent years multidetector computed tomography imaging has taken a leading role in the detection of subclinical atherosclerosis, even before its clinical manifestation. We examined the prevalence and clinical predictors of atherosclerotic coronary artery disease in asymptomatic patients undergoing multidetector computed tomography of the coronary arteries. METHODS: A total of 244 consecutive asymptomatic patients (190 men and 54 women aged 53.8+/-7.9 years) with at least one atherogenic risk factor underwent multidetector computed tomography angiography of the coronary arteries. The severity and extent of coronary atherosclerosis were graded and evaluated against clinical and laboratory parameters. RESULTS: Multidetector computed tomography identified significant obstructive coronary artery disease (>50% luminal stenosis) in 13 patients (4.9%), mild or moderate nonobstructive disease (<50% stenosis) in 124 patients (50.8%), and no atherosclerosis in 108 patients (44.3%). On multivariate logistic regression analysis, significant independent clinical predictors of coronary artery disease were male sex (odds ratio, 1.6, P<0.0047), family history of coronary artery disease (odds ratio, 1.4, P<0.0099), low-density lipoprotein cholesterol >130 mg/dl (OR 1.3, P<0.027), hypertension (odds ratio, 1.27, P<0.05), and noninsulin-dependent diabetes mellitus (odds ratio, 1.6, P<0.006). On the basis of the multidetector computed tomography results, pharmacological treatment was initiated or intensified in 40% of patients (statins in 31% and aspirin in 9%). Twenty-two patients (9%) were referred for complementary exercise testing and five (2%) for catheterization. CONCLUSIONS: (i) Occult atherosclerosis is not uncommon in asymptomatic patients with a risk profile for coronary artery disease. (ii) Conventional risk factors independently correlate with imaging findings of coronary atherosclerosis. (iii) Risk management could be intensified in a significant proportion (approximately 40%) of patients based on the multidetector computed tomography findings. (iv) In approximately 5% of patients at clinical risk, multidetector computed tomography might detect obstructive atherosclerosis that mandates further investigation.
Asunto(s)
Enfermedad de la Arteria Coronaria/epidemiología , Tomografía Computarizada por Rayos X/métodos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Humanos , Israel/epidemiología , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Valor Predictivo de las Pruebas , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Factores SexualesRESUMEN
OBJECTIVE: Myocardial bridging is a congenital condition in which a segment of an epicardial artery has an intramural course within the myocardium. The aim of the present study was to evaluate the prevalence of myocardial bridging and the ability of 64-slice coronary computed tomography angiography to identify myocardial bridging in asymptomatic adults. METHODS: One hundred sixty-nine consecutive asymptomatic subjects underwent 64-row multidetector computed tomography (MDCT) of the coronary arteries. Two experienced CT radiologists identified myocardial bridging >1 mm in thickness, by consensus. We examined the frequency of myocardial bridging and evaluated the length, thickness, and coronary wall lesions. RESULTS: Myocardial bridges were found in 28 (17%) of 165 subjects. Twenty-one subjects (75%) had 1 bridge and 7 subjects (25%) had 2, for a total of 35 myocardial bridges. Twenty-one bridges (60%) were located in the left anterior descending, 8.5% in the diagonal branch, and 2.8% in the circumflex arteries. The segment beneath the myocardial bridge was always free of coronary wall plaques, but the arterial segment proximal to it had significant coronary wall plaques in 24 cases (68.6%). CONCLUSION: We found that the incidence of myocardial bridging in asymptomatic adults is 7%, which is in agreement with some pathologic studies in the literature. Our study shows that MDCT of the coronary arteries is a reliable and noninvasive technique, which can accurately locate the site of myocardial bridging, and measure its thickness, course, and length.