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1.  A low-dose comprehensive cardiac CT protocol assessing anatomy, function, perfusion, and viability 
Radiation exposure in cardiac imaging is a major healthcare concern and low-dose cardiac imaging has important implications for patients. We describe the application of a low-dose comprehensive cardiac computed tomography protocol that assesses anatomy, function, perfusion and viability with correlations to invasive coronary angiography and magnetic resonance imaging.
doi:10.1016/j.jcct.2012.11.005
PMCID: PMC3605584  PMID: 23333187
Myocardial perfusion; Computed tomography coronary angiography; Coronary heart disease; Radiation dose
2.  Role of multidetector computed tomography in the diagnosis and management of patients attending the rapid access chest pain clinic, The Scottish computed tomography of the heart (SCOT-HEART) trial: study protocol for randomized controlled trial 
Newby, David E | Williams, Michelle C | Flapan, Andrew D | Forbes, John F | Hargreaves, Allister D | Leslie, Stephen J | Lewis, Steff C | McKillop, Graham | McLean, Scott | Reid, John H | Sprat, James C | Uren, Neal G | van Beek, Edwin J | Boon, Nicholas A | Clark, Liz | Craig, Peter | Flather, Marcus D | McCormack, Chiara | Roditi, Giles | Timmis, Adam D | Krishan, Ashma | Donaldson, Gillian | Fotheringham, Marlene | Hall, Fiona J | Neary, Paul | Cram, Louisa | Perkins, Sarah | Taylor, Fiona | Eteiba, Hany | Rae, Alan P | Robb, Kate | Barrie, Dawn | Bissett, Kim | Dawson, Adelle | Dundas, Scot | Fogarty, Yvonne | Ramkumar, Prasad Guntur | Houston, Graeme J | Letham, Deborah | O’Neill, Linda | Pringle, Stuart D | Ritchie, Valerie | Sudarshan, Thiru | Weir-McCall, Jonathan | Cormack, Alistair | Findlay, Iain N | Hood, Stuart | Murphy, Clare | Peat, Eileen | Allen, Barbara | Baird, Andrew | Bertram, Danielle | Brian, David | Cowan, Amy | Cruden, Nicholas L | Dweck, Marc R | Flint, Laura | Fyfe, Samantha | Keanie, Collette | MacGillivray, Tom J | Maclachlan, David S | MacLeod, Margaret | Mirsadraee, Saeed | Morrison, Avril | Mills, Nicholas L | Minns, Fiona C | Phillips, Alyson | Queripel, Laura J | Weir, Nicholas W | Bett, Fiona | Divers, Frances | Fairley, Katie | Jacob, Ashok J | Keegan, Edith | White, Tricia | Gemmill, John | Henry, Margo | McGowan, James | Dinnel, Lorraine | Francis, C Mark | Sandeman, Dennis | Yerramasu, Ajay | Berry, Colin | Boylan, Heather | Brown, Ammani | Duffy, Karen | Frood, Alison | Johnstone, Janet | Lanaghan, Kirsten | MacDuff, Ross | MacLeod, Martin | McGlynn, Deborah | McMillan, Nigel | Murdoch, Laura | Noble, Colin | Paterson, Victoria | Steedman, Tracey | Tzemos, Nikolaos
Trials  2012;13:184.
Background
Rapid access chest pain clinics have facilitated the early diagnosis and treatment of patients with coronary heart disease and angina. Despite this important service provision, coronary heart disease continues to be under-diagnosed and many patients are left untreated and at risk. Recent advances in imaging technology have now led to the widespread use of noninvasive computed tomography, which can be used to measure coronary artery calcium scores and perform coronary angiography in one examination. However, this technology has not been robustly evaluated in its application to the clinic.
Methods/design
The SCOT-HEART study is an open parallel group prospective multicentre randomized controlled trial of 4,138 patients attending the rapid access chest pain clinic for evaluation of suspected cardiac chest pain. Following clinical consultation, participants will be approached and randomized 1:1 to receive standard care or standard care plus ≥64-multidetector computed tomography coronary angiography and coronary calcium score. Randomization will be conducted using a web-based system to ensure allocation concealment and will incorporate minimization. The primary endpoint of the study will be the proportion of patients diagnosed with angina pectoris secondary to coronary heart disease at 6 weeks. Secondary endpoints will include the assessment of subsequent symptoms, diagnosis, investigation and treatment. In addition, long-term health outcomes, safety endpoints, such as radiation dose, and health economic endpoints will be assessed. Assuming a clinic rate of 27.0% for the diagnosis of angina pectoris due to coronary heart disease, we will need to recruit 2,069 patients per group to detect an absolute increase of 4.0% in the rate of diagnosis at 80% power and a two-sided P value of 0.05. The SCOT-HEART study is currently recruiting participants and expects to report in 2014.
Discussion
This is the first study to look at the implementation of computed tomography in the patient care pathway that is outcome focused. This study will have major implications for the management of patients with cardiovascular disease.
Trial registration
ClinicalTrials.gov Identifier: NCT01149590
doi:10.1186/1745-6215-13-184
PMCID: PMC3667058  PMID: 23036114
Computed tomography; Coronary heart disease; Rapid access chest pain clinic
3.  Mechanisms for an effect of acetylcysteine on renal function after exposure to radio-graphic contrast material: study protocol 
Background
Contrast-induced nephropathy is a common complication of contrast administration in patients with chronic kidney disease and diabetes. Its pathophysiology is not well understood; similarly the role of intravenous or oral acetylcysteine is unclear. Randomized controlled trials to date have been conducted without detailed knowledge of the effect of acetylcysteine on renal function. We are conducting a detailed mechanistic study of acetylcysteine on normal and impaired kidneys, both with and without contrast. This information would guide the choice of dose, route, and appropriate outcome measure for future clinical trials in patients with chronic kidney disease.
Methods/Design
We designed a 4-part study. We have set up randomised controlled cross-over studies to assess the effect of intravenous (50 mg/kg/hr for 2 hrs before contrast exposure, then 20 mg/kg/hr for 5 hrs) or oral acetylcysteine (1200 mg twice daily for 2 days, starting the day before contrast exposure) on renal function in normal and diseased kidneys, and normal kidneys exposed to contrast. We have also set up a parallel-group randomized controlled trial to assess the effect of intravenous or oral acetylcysteine on patients with chronic kidney disease stage III undergoing elective coronary angiography. The primary outcome is change in renal blood flow; secondary outcomes include change in glomerular filtration rate, tubular function, urinary proteins, and oxidative balance.
Discussion
Contrast-induced nephropathy represents a significant source of hospital morbidity and mortality. Over the last ten years, acetylcysteine has been administered prior to contrast to reduce the risk of contrast-induced nephropathy. Randomized controlled trials, however, have not reliably demonstrated renoprotection; a recent large randomized controlled trial assessing a dose of oral acetylcysteine selected without mechanistic insight did not reduce the incidence of contrast-induced nephropathy. Our study should reveal the mechanism of effect of acetylcysteine on renal function and identify an appropriate route for future dose response studies and in time randomized controlled trials.
Trial registration
Clinical Trials.gov: NCT00558142; EudraCT: 2006-003509-18.
doi:10.1186/1472-6904-12-3
PMCID: PMC3293780  PMID: 22305183
Contrast-induced nephropathy; acetylcysteine; prevention; kidney; contrast media
4.  The effect of intensive lipid lowering on coronary atheroma and clinical outcome 
Heart  2006;93(2):149-151.
The association between raised plasma cholesterol and cardiovascular risk is well established, with consistent evidence associating LDL‐cholesterol reduction with a reduction in primary and secondary cardiovascular events. It is believed that intensive lipid lowering may improve clinical outcomes further by acting to stabilise plaque and preventing plaque progression, ultimately reducing plaque vulnerability. However, it remains uncertain whether a continued clinical benefit occurs with intensive lipid lowering or if there is a threshold level below which no further benefit occurs.
doi:10.1136/hrt.2006.105676
PMCID: PMC1861387  PMID: 17035507
atherosclerosis; cholesterol; hydroxymethylglutaryl‐CoA reductase inhibitors; inflammation
5.  Non-invasive assessment of coronary artery bypass graft patency using 16-slice computed tomography angiography 
Background
Invasive coronary angiography is the gold standard means of imaging bypass vessels and carries a small but potentially serious risk of local vascular complications, including myocardial infarction, stroke and death. We evaluated computed tomography as a non-invasive means of assessing graft patency.
Methods
Fifty patients with previous coronary artery bypass surgery who were listed for diagnostic coronary angiography underwent contrast enhanced computed tomography angiography using a 16-slice computed tomography scanner. Images were retrospectively gated to the electrocardiogram and two dimensional axial, multiplanar and three dimensional reconstructions acquired. Sensitivity, specificity, positive and negative predictive value, accuracy and level of agreement for detection of graft patency by multidetector computed tomography.
Results
A total of 116 grafts were suitable for analysis. The specificity of CT for the detection of graft patency was 100%, with a sensitivity of 92.8%, positive predictive value 100%, negative predictive value 85.8% and an accuracy of 94.8%. The kappa value of agreement between the two means of measuring graft patency was 0.9. Mean radiation dose was 9.0 ± 7.2 mSv for coronary angiography and 18.5 ± 4 mSv for computed tomography. Pooled analysis of eight studies, incorporating 932 grafts, confirmed a 97% accuracy for the detection of graft patency by multidetector computed tomography.
Conclusion
Computed tomography is an accurate, rapid and non-invasive method of assessing coronary artery bypass graft patency. However, this was achieved at the expense of an increase in radiation dose.
doi:10.1186/1749-8090-2-27
PMCID: PMC1894797  PMID: 17550615
6.  Myopericarditis in Churg-Strauss Syndrome 
Texas Heart Institute Journal  1991;18(2):127-131.
Churg-Strauss syndrome is a disseminated vasculitis with multisystem involvement, characterized by necrotizing arteritis, eosinophilic infiltration, and extravascular granuloma formation. In as many as 60% of all cases, the heart may be affected. We describe a 30-year-old man in whom pericarditis was followed by the development of a large pericardial effusion, with evidence of impaired right and left ventricular function. The patient had a 5-year history of asthma. Early therapy with high-dose prednisolone and azathioprine led to resolution of the pericardial effusion and prevented a further reduction in biventricular function. (Texas Heart Institute Journal 1991;18:127-31)
Images
PMCID: PMC324980  PMID: 15227496
Churg-Strauss syndrome; echocardiography; eosinophilia; eosinophilic granuloma; myocarditis; pericarditis; vasculitis

Results 1-6 (6)