Circulation. 2006;114:e251-e252
doi: 10.1161/CIRCULATIONAHA.105.610097
(Circulation. 2006;114:e251-e252.)
© 2006 American Heart Association, Inc.
Images in Cardiovascular Medicine |
Wall Motion Abnormalities Detection With Contrast-Enhanced Multislice Computed Tomography
Teck Wee Wong, MRCP;
Catherine De Larrazabal, MD, FPCR, FCTMRIS;
H. Khim Boey, DMRD, FRCR;
Michael C.L. Lim, MMed, FRCP
From Singapore Heart, Stroke, and Cancer Centre, and Singapore Reference Centre for Medical Imaging, Ngee Ann City, Singapore.
Correspondence to Dr Teck Wee Wong, Consultant Cardiologist, Singapore Heart, Stroke, and Cancer Centre, 391B Orchard Rd, 08-01 Tower B Ngee Ann City, 238874 Singapore. E-mail twwong68{at}yahoo.co.uk
A 63-year-old man with a previous history of myocardial infarction and primary angioplasty to the middle-left anterior descending artery presented with mild exertional angina. His risk factors were non–insulin-dependent diabetes mellitus, hypertension, and hyperlipidemia. Physical examination was unremarkable. A resting 12-lead ECG showed Q wave in the anterior leads. Multislice computed tomography angiography (MSCT) (Philips Medical System NV, Eindhoven, Holland) using 40 detectors demonstrated significant disease in left anterior descending and right coronary arteries. Contrast-enhanced images of the myocardium and left ventricle were compared with transthoracic echocardiography. MSCT images during the systolic phase were reconstructed retrospectively at 40% of the gated ECG. At 40% phase, the mitral valve was completely closed and the left ventricular contracted maximally. Mid-diastolic images were reconstructed at 75% of the gated ECG (Figures 1 through 4
). The images from MSCT correlated closely with those from echocardiography. In some segments, MSCT images were superior to those from echocardiography because of poor sonification windows in the latter. We recommend that patients be routinely screened for wall motion abnormalities during the systolic phase as part of MSCT coronary angiography analysis. It is easy and fast, does not require additional software, and presents no added risk.
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Figure 1. A and B, Standard vertical long-axis view (equivalent to echocardiographic apical 2-chamber view) at 75% (mid-diastole) and 40% (systole) phase, respectively. The middle and apical anterior (Ant) left ventricular (LV) wall was thin and akinetic. Apical inferior (Inf) LV wall was thin but slightly thickened during systole. Arrowheads indicate myocardial infarction scar. MV indicates mitral valve.
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Figure 2. A and B, Echocardiographic equivalent of parasternal long-axis view at 75% and 40% phase, respectively. The middle and apical anteroseptal (AS) LV wall was thin and akinetic. Apical posterolateral (PL) LV wall was thin but mildly thickened during systole. Arrowheads indicate myocardial infarction scar. RA indicates right atrium; LA, left atrium; AV, aortic valve; MV, mitral valve; RV, right ventricle; and LV, left ventricle.
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Figure 3. A and B, Standard horizontal long-axis view (equivalent to echocardiographic apical 4-chamber view) at 75% and 40% phase, respectively. The apical inferoseptal (IS) and anterolateral (AL) LV wall was thin and akinetic. Arrowheads indicate myocardial infarction scar. Abbreviations as in Figure 2.
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Figure 4. Echocardiographic equivalent of parasternal short-axis apical view at 40% phase. The anterior and anteroseptal LV wall was thin and akinetic. Arrowheads indicate myocardial infarction scar. Lat indicates lateral LV wall. Other abbreviations as in Figures 1 and 2.
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Acknowledgments
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Disclosures
None.
