Post on 06-Aug-2020
Anatomical and Functional Imaging of CAD in CKD
Paolo Raggi, MD Professor of Medicine and
Cardiology Mazankowski Alberta Heart Institute University of Alberta,
Edmonton, AB
KDIGO
Anatomical Imaging
KDIGO
Invasive Angiography
KDIGO
KDIGO
Hypertension 2003;42:263-68
MPI
Risk Stratification
Stress Echo
Invasive Angio KDIGO
Intravascular Ultrasound
Gruberg Am J Cardiol 2005;96:892-96
KDIGO
Composition and plaque patterns of coronary culprit lesions and clinical characteristics of patients with chronic kidney
disease
Keiji Kono, Hideki Fujii, Kentaro Nakai, Shunsuke Goto, Junya Shite, Ken-ichi Hirata, Masafumi Fukagawa, Shinichi Nishi
Kidney International Volume 82, Issue 3, Pages 344-351 (August 2012)
DOI: 10.1038/ki.2012.118 KDIGO
Kidney International 2012 82, 344-351DOI: (10.1038/ki.2012.118)
KDIGO
Optical Coherence Tomography
KDIGO
Computerized Tomography
KDIGO
KDIGO
KDIGO
Kramer H. JASN 2005
KDIGO
KDIGO
Kidney Int 2013;83:1159
KDIGO
KDIGO
KDIGO
Coron Art Dis 2013, 24:135-41
KDIGO
Coronarycalcifica,onsandplaquecharacteris,csinpa,entswithend-stagerenaldisease:aCTstudy
JugBetal.CoronArtDis2013,24:501–508
Comparisonof:ESRDpts,age-sex-CACscorematchedandage-sexmatchednon-ESRDptsGreaterprevalenceofcalcifiedplaquesinESRD(56%vs38%vs27%,p=0.005)PlaquecomposiNon(%) ESRD Age-sex-CACAge-Sex-match-noCKD
Noncalcific 12.6 13.914.7 p=0.233Mixed 43.7 51.6 51.4 p=0.002Calcific 43.7 34.5 33.9 p=0.003
AUCofCACscoretodetect>50%luminalstenosis
0.77 0.75 0.69
KDIGO
International registry 5572 patients Median f/u: 19 months
Am J Cardiol 2013;111:1563-69
KDIGO
KDIGO
Epicardial Adipose Tissue An Overlooked Marker of Risk?!
KDIGO
InflammaNoninEAT
Mazurek T. Circulation 2003;108:2460-66
KDIGO
KDIGO
!
D’Marco L et al. NDT 2013
KDIGO
Cardiac MR
Anatomy, Function, Cardiomyopathies Viability, Perfusion and Angiography
KDIGO
CMR: Volume and Mass Analysis
LVendocardialcontourcontour
LVepicardialcontour
RVepicardialcontour
RVendocardialcontour
Papavassiliu,T.etal.Radiology2005;236:57-64
KDIGO
KimRetal.NEJM2000;343:1443-53
KDIGO
Salerno M. JACC Img 2013;6:806-22
T1 Mapping for better Tissue Characterization
KDIGO
KDIGO
Functional Imaging
KDIGO
* *
KDIGO
Am J Cardiol 2008;102:1451-56
KDIGO
KDIGO
Single independent predictor of MACE = CKD!
KDIGO
KDIGO
KDIGO
Alexopoulos N. and Raggi P. Seminars in Dial 2017
KDIGO
Increased arterial wall inflammation in patients with CKD. 18F-FDG uptake in the aortic arch (top) and the carotid arteries (bottom) was quantified as the TBR in controls (n=14, represented in A)
and patients with CKD (n=14, represented in B).
Sophie J. Bernelot Moens et al. JASN 2017;28:1278-1285
©2017 by American Society of Nephrology
KDIGO
Ridker P et al JACC 2018;71:2405-14
KDIGO
Active and indolent molecular vascular calcification. (A) Patient without structural vascular calcification. A positive Na18F PET signal, representing molecular vascular calcification, was observed in the ascending aorta (interrupted arrow). (B) Patient with active (arrow) and indolent vascular calcification in the descending aorta. Note the intense uptake of Na18F in the sternum, vertebra, and ribs
18F-Sodium Fluoride
KDIGO
Radiation
Exposure Milli-Sieverts
Chest x-ray 0.1
Mammogram 0.4
FLASH coronary calcium 0.5*
Lumbar x-ray 1.5
1 year on planet Earth 3-3.5
*Meanandmediandoseoflast15casesdoneatUAH(range0.2-0.8mSv)
AmericanCollegeofRadiology+RSNA
KDIGO
Yearly Natural Background Radiation
l ~ 3.5mSv (350 mRem)/yr in the USA
– ~2.0 mSv from radon gas from U decay – ~0.50 mSv from cosmic and terrestrial radiation – ~1.0 mSv other sources (including foods, water
etc)
KDIGO
ALARA
l As l Low l As l Reasonably l Achievable
• Public exposure
Dose equivalent 1 mSv
• Occupational exposure
Dose equivalent 50 mSv
• Embryo/fetus
Dose equivalent 0.5 mSv
KDIGO
American Cancer Society 42 Expected Cancers per 100 US Adults
1 Due to Exposure to 100mSv of Radiation
Case per 10 mSv
KDIGO
KDIGO
Summary
v Many techniques are available
q Most require advanced expertise for interpretation § The radiation exposure for some of the techniques is not negligible and the best ALARA principles should be applied. Patient involvement in decision making is necessary.
KDIGO