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An in-depth analysis of coronary computed tomography angiography segmental findings in acute spontaneous coronary artery dissection – a prospective multicenter study

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Title: An in-depth analysis of coronary computed tomography angiography segmental findings in acute spontaneous coronary artery dissection – a prospective multicenter study
Authors: Pagonis, Christos, Sandstedt, Mårten, Dworeck, Christian, Fagman, Erika, Erlinge, David, Adlam, David, Andersson, Jonas, Fredriksson, Mats, Glaser, Natalie, Henriksson, Lilian, Johnston, Nina, Henareh, Loghman, Markstad, Hanna, Ostenfeld, Ellen, Tornvall, Per, Venetsanos, Dimitrios, Welén-Schef, Kerstin, Yndigegn, Troels, Swahn, Eva, Sederholm Lawesson, Sofia
Contributors: Lund University, Faculty of Medicine, Department of Clinical Sciences, Lund, Section II, Cardiology, Lunds universitet, Medicinska fakulteten, Institutionen för kliniska vetenskaper, Lund, Sektion II, Kardiologi, Originator, Lund University, Faculty of Medicine, Department of Clinical Sciences, Lund, Section II, Cardiology, Molecular Cardiology, Lunds universitet, Medicinska fakulteten, Institutionen för kliniska vetenskaper, Lund, Sektion II, Kardiologi, Molekylär kardiologi, Originator, Lund University, Faculty of Medicine, Department of Clinical Sciences, Malmö, Cardiovascular Research - Translational Studies, Lunds universitet, Medicinska fakulteten, Institutionen för kliniska vetenskaper, Malmö, Kardiovaskulär forskning - translationella studier, Originator, Lund University, Profile areas and other strong research environments, Strategic research areas (SRA), EXODIAB: Excellence of Diabetes Research in Sweden, Lunds universitet, Profilområden och andra starka forskningsmiljöer, Strategiska forskningsområden (SFO), EXODIAB: Excellence of Diabetes Research in Sweden, Originator, Lund University, Faculty of Medicine, Department of Clinical Sciences, Lund, Section V, Clinical Physiology (Lund), Lunds universitet, Medicinska fakulteten, Institutionen för kliniska vetenskaper, Lund, Sektion V, Klinisk fysiologi, Lund, Originator, Lund University, Faculty of Medicine, Department of Clinical Sciences, Lund, Section V, Clinical Physiology (Lund), Lund Cardiac MR Group, Lunds universitet, Medicinska fakulteten, Institutionen för kliniska vetenskaper, Lund, Sektion V, Klinisk fysiologi, Lund, Hjärt-MR-gruppen i Lund, Originator
Source: Journal of Cardiovascular Computed Tomography. 19(5):559-567
Subject Terms: Engineering and Technology, Medical Engineering, Medical Imaging, Teknik, Medicinteknik, Medicinsk bildvetenskap, Medical and Health Sciences, Clinical Medicine, Cardiology and Cardiovascular Disease, Medicin och hälsovetenskap, Klinisk medicin, Kardiologi och kardiovaskulära sjukdomar
Description: Aims: Spontaneous coronary artery dissection (SCAD), causing acute coronary syndrome (ACS), primarily in middle-aged women, is diagnosed with invasive coronary angiography (ICA). Due to the risk of dissection propagation with ICA, a non-invasive diagnostic tool is needed. We investigated coronary computed tomography angiography (CCTA) findings in acute SCAD, as well as the inter-modality agreement between CCTA and ICA. Methods and results: Thirty-two (92 ​% women, mean age 52.4 years) SCAD patients at eight Swedish hospitals were investigated with ICA as well as dual source CCTA during the index hospitalisation between April 2021 and October 2022. ICA identified 46 dissected segments whereas CCTA detected 25, Cohen's kappa (κ) ​= ​0.595 (95 ​% confidence interval [CI] 0.46–0.73). CCTA primary and secondary features were identified in 24 dissected coronary artery segments in 21 patients, 8 (32 ​%) tapered luminal stenosis, 11 (44 ​%) abrupt luminal stenosis, 3 (12 ​%) visible dissection membrane, 4 (16 ​%) intramural-hematomas, 9 (36 ​%) epicardial fat stranding and 8 (25 ​%) with coronary artery tortuosity. ICA identified 3 dissected proximal segments whereas CCTA identified 5, (κ ​= ​0.74, 95 ​% CI 0.40–1.00). In distal segments, ICA identified 43 and CCTA 20 dissections, (κ ​= ​0.57, 95 ​% CI 0.43–0.72). Conclusions: In patients presenting with acute SCAD, CCTA should not be considered a substitute for ICA. While CCTA demonstrated good diagnostic performance in identifying proximal SCAD lesions, its sensitivity was notably reduced in distal coronary segments, where SCAD is more frequent. Among the 25 lesions detected, CCTA successfully detected specific features in 24 lesions.
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  Data: Lund University, Faculty of Medicine, Department of Clinical Sciences, Lund, Section II, Cardiology, Lunds universitet, Medicinska fakulteten, Institutionen för kliniska vetenskaper, Lund, Sektion II, Kardiologi, Originator<br />Lund University, Faculty of Medicine, Department of Clinical Sciences, Lund, Section II, Cardiology, Molecular Cardiology, Lunds universitet, Medicinska fakulteten, Institutionen för kliniska vetenskaper, Lund, Sektion II, Kardiologi, Molekylär kardiologi, Originator<br />Lund University, Faculty of Medicine, Department of Clinical Sciences, Malmö, Cardiovascular Research - Translational Studies, Lunds universitet, Medicinska fakulteten, Institutionen för kliniska vetenskaper, Malmö, Kardiovaskulär forskning - translationella studier, Originator<br />Lund University, Profile areas and other strong research environments, Strategic research areas (SRA), EXODIAB: Excellence of Diabetes Research in Sweden, Lunds universitet, Profilområden och andra starka forskningsmiljöer, Strategiska forskningsområden (SFO), EXODIAB: Excellence of Diabetes Research in Sweden, Originator<br />Lund University, Faculty of Medicine, Department of Clinical Sciences, Lund, Section V, Clinical Physiology (Lund), Lunds universitet, Medicinska fakulteten, Institutionen för kliniska vetenskaper, Lund, Sektion V, Klinisk fysiologi, Lund, Originator<br />Lund University, Faculty of Medicine, Department of Clinical Sciences, Lund, Section V, Clinical Physiology (Lund), Lund Cardiac MR Group, Lunds universitet, Medicinska fakulteten, Institutionen för kliniska vetenskaper, Lund, Sektion V, Klinisk fysiologi, Lund, Hjärt-MR-gruppen i Lund, Originator
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  Data: Aims: Spontaneous coronary artery dissection (SCAD), causing acute coronary syndrome (ACS), primarily in middle-aged women, is diagnosed with invasive coronary angiography (ICA). Due to the risk of dissection propagation with ICA, a non-invasive diagnostic tool is needed. We investigated coronary computed tomography angiography (CCTA) findings in acute SCAD, as well as the inter-modality agreement between CCTA and ICA. Methods and results: Thirty-two (92 ​% women, mean age 52.4 years) SCAD patients at eight Swedish hospitals were investigated with ICA as well as dual source CCTA during the index hospitalisation between April 2021 and October 2022. ICA identified 46 dissected segments whereas CCTA detected 25, Cohen's kappa (κ) ​= ​0.595 (95 ​% confidence interval [CI] 0.46–0.73). CCTA primary and secondary features were identified in 24 dissected coronary artery segments in 21 patients, 8 (32 ​%) tapered luminal stenosis, 11 (44 ​%) abrupt luminal stenosis, 3 (12 ​%) visible dissection membrane, 4 (16 ​%) intramural-hematomas, 9 (36 ​%) epicardial fat stranding and 8 (25 ​%) with coronary artery tortuosity. ICA identified 3 dissected proximal segments whereas CCTA identified 5, (κ ​= ​0.74, 95 ​% CI 0.40–1.00). In distal segments, ICA identified 43 and CCTA 20 dissections, (κ ​= ​0.57, 95 ​% CI 0.43–0.72). Conclusions: In patients presenting with acute SCAD, CCTA should not be considered a substitute for ICA. While CCTA demonstrated good diagnostic performance in identifying proximal SCAD lesions, its sensitivity was notably reduced in distal coronary segments, where SCAD is more frequent. Among the 25 lesions detected, CCTA successfully detected specific features in 24 lesions.
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