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      Diagnostic Value of Multislice Spiral CT Cardiothoracic Combined with Angiography in Acute Chest Pain

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      Author(s): 1 , 2 , , 3
      Publication date (Electronic):
      Journal: Journal of Healthcare Engineering
      Publisher: Hindawi

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          Abstract

          Acute chest pain is a common clinical emergency condition with a variety of causes, including acute coronary syndrome, pulmonary embolism, aortic coarctation, and pneumothorax. It is essential for emergency physicians to quickly and accurately understand the cause of acute chest pain. 64-slice spiral CT combined cardiothoracic angiography is an accurate and rapid way to diagnose and differentiate the cause of acute chest pain. 64-slice combined cardiothoracic angiography can accurately and rapidly display the thoracic aorta, both pulmonary arteries, the main trunk of the coronary artery and its major branches, and also provide a comprehensive view of both lungs and mediastinum, which is an effective test for the diagnosis and differential diagnosis of acute chest pain. Based on this, this study further investigated the value of 64-slice spiral CT triplex examination in the diagnosis of acute chest pain. The results showed that 64-slice spiral CT has the advantages of fast scanning speed, high resolution, and advanced postprocessing technology, and combined cardiothoracic angiography can quickly and accurately help emergency physicians analyze the cause of acute chest pain, which plays a very important role in formulating the correct treatment plan in a timely manner. At the same time, with the continuous development of CT technology, the temporal and spatial resolution has improved the quality of CT images, giving us more options to reduce the effective radiation dose and reduce the total amount of contrast, making the 64-row spiral CT cardiothoracic imaging more perfect.

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          Coronary Computed Tomography Angiography From Clinical Uses to Emerging Technologies

          Khaled M. Abdelrahman, Marcus Y Chen, Amit K. Dey … (2020)
          Evaluation of coronary artery disease (CAD) using coronary computed tomography angiography (CCTA) has seen a paradigm shift in the last decade. Evidence increasingly supports the clinical utility of CCTA across various stages of CAD, from the detection of early subclinical disease to the assessment of acute chest pain. Additionally, CCTA can be used to noninvasively quantify plaque burden and identify high-risk plaque, aiding in diagnosis, prognosis, and treatment. This is especially important in the evaluation of CAD in immune-driven conditions with increased cardiovascular disease prevalence. Emerging applications of CCTA based on hemodynamic indices and plaque characterization may provide personalized risk assessment, affect disease detection, and further guide therapy. This review provides an update on the evidence, clinical applications, and emerging technologies surrounding CCTA as highlighted at the 2019 National Heart, Lung and Blood Institute CCTA Summit.
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            Diagnostic value of exome and whole genome sequencing in craniosynostosis

            Kerry A Miller, Stephen R F Twigg, Simon J McGowan … (2016)
            Background Craniosynostosis, the premature fusion of one or more cranial sutures, occurs in ∼1 in 2250 births, either in isolation or as part of a syndrome. Mutations in at least 57 genes have been associated with craniosynostosis, but only a minority of these are included in routine laboratory genetic testing. Methods We used exome or whole genome sequencing to seek a genetic cause in a cohort of 40 subjects with craniosynostosis, selected by clinical or molecular geneticists as being high-priority cases, and in whom prior clinically driven genetic testing had been negative. Results We identified likely associated mutations in 15 patients (37.5%), involving 14 different genes. All genes were mutated in single families, except for IL11RA (two families). We classified the other positive diagnoses as follows: commonly mutated craniosynostosis genes with atypical presentation (EFNB1, TWIST1); other core craniosynostosis genes (CDC45, MSX2, ZIC1); genes for which mutations are only rarely associated with craniosynostosis (FBN1, HUWE1, KRAS, STAT3); and known disease genes for which a causal relationship with craniosynostosis is currently unknown (AHDC1, NTRK2). In two further families, likely novel disease genes are currently undergoing functional validation. In 5 of the 15 positive cases, the (previously unanticipated) molecular diagnosis had immediate, actionable consequences for either genetic or medical management (mutations in EFNB1, FBN1, KRAS, NTRK2, STAT3). Conclusions This substantial genetic heterogeneity, and the multiple actionable mutations identified, emphasises the benefits of exome/whole genome sequencing to identify causal mutations in craniosynostosis cases for which routine clinical testing has yielded negative results.
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              Safely Identifying Emergency Department Patients With Acute Chest Pain for Early Discharge

              Simon Mahler, Kristin M Lenoir, Brian Wells … (2018)
              Background: The HEART Pathway is an accelerated diagnostic protocol (ADP) designed to identify low-risk Emergency Department (ED) patients with chest pain for early discharge without stress testing or angiography. The objective of this study was to determine whether implementation of the HEART Pathway is safe (30 day death and myocardial infarction rate <1% in low-risk patients) and effective (reduces 30 day hospitalizations) in ED patients with possible acute coronary syndrome (ACS). Methods: A prospective pre/post study was conducted at three US sites among 8,474 adult ED patients with possible ACS. Patients included were ≥21 years old, investigated for possible ACS, and had no evidence of ST-segment elevation myocardial infarction on electrocardiography. Accrual occurred for 12 months before and after HEART Pathway implementation from November 2013- January 2016. The HEART Pathway ADP was integrated into each site’s electronic health record as an interactive clinical decision support tool. Following ADP integration, ED providers prospectively utilized the HEART Pathway to identify patients with possible ACS as low-risk (appropriate for early discharge without stress testing or angiography) or non-low-risk (appropriate for further in-hospital evaluation). The primary safety and effectiveness outcomes, death and myocardial infarction (MI) and hospitalization rates at 30 days, were determined from health records, insurance claims, and death index data. Results: Pre- and post-implementation cohorts included 3713 and 4761 patients, respectively. The HEART Pathway identified 30.7% as low-risk; 0.4% of these patients experienced death or MI within 30 days. Hospitalization at 30 days was reduced by 6% in the post- vs pre-implementation cohort (55.6% vs 61.6%; aOR: 0.79, 95%CI: 0.71–0.87). During the index visit more MIs were detected in the post-implementation cohort (6.6% vs 5.7%; aOR: 1.36, 95%CI: 1.12–1.65). Rates of death or MI during follow-up were similar (1.1% vs 1.3%; aOR: 0.88, 95% CI: 0.58–1.33). Conclusions: HEART Pathway implementation was associated with decreased hospitalizations, increased identification of index visit MIs, and a very low death and MI rate among low-risk patients. These findings support use of the HEART Pathway to identify low-risk patients that can be safely discharged without stress testing or angiography. Clinical Trial Registration: clinicaltrials.gov Identifier: NCT02056964
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                Author and article information

                Contributors
                Yinggan Du:
                ORCID: https://orcid.org/0000-0001-9032-7258
                Journal
                Journal ID (nlm-ta): J Healthc Eng
                Journal ID (iso-abbrev): J Healthc Eng
                Journal ID (publisher-id): JHE
                Title: Journal of Healthcare Engineering
                Publisher: Hindawi
                ISSN (Print): 2040-2295
                ISSN (Electronic): 2040-2309
                Publication date Collection: 2021
                Publication date (Electronic): 20 February 2021
                Volume: 2021
                Electronic Location Identifier: 5549971
                Affiliations
                1Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Jinhua, Zhejiang 321000, China
                2Wuhan University, Wuhan, Hubei 430072, China
                3Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China
                Author notes

                Academic Editor: Zhihan Lv

                Author information
                https://orcid.org/0000-0001-9032-7258
                Article
                DOI: 10.1155/2021/5549971
                PMC ID: 7914098
                PubMed ID: 33688419
                SO-VID: b890deef-c1ef-4ef2-82f6-73c1f4b967b4
                Copyright © Copyright © 2021 Yinggan Du and Zetian Yang.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 17 January 2021
                Date revision received : 7 February 2021
                Date accepted : 13 February 2021
                Categories
                Subject: Research Article

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