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Neglia D.,CNR Institute of Neuroscience | Rovai D.,CNR Institute of Neuroscience | Caselli C.,CNR Institute of Neuroscience | Pietila M.,Heart Center | And 47 more authors.
Circulation: Cardiovascular Imaging | Year: 2015

Background-The choice of imaging techniques in patients with suspected coronary artery disease (CAD) varies between countries, regions, and hospitals. This prospective, multicenter, comparative effectiveness study was designed to assess the relative accuracy of commonly used imaging techniques for identifying patients with significant CAD. Methods and Results-A total of 475 patients with stable chest pain and intermediate likelihood of CAD underwent coronary computed tomographic angiography and stress myocardial perfusion imaging by single photon emission computed tomography or positron emission tomography, and ventricular wall motion imaging by stress echocardiography or cardiac magnetic resonance. If ≥1 test was abnormal, patients underwent invasive coronary angiography. Significant CAD was defined by invasive coronary angiography as >50% stenosis of the left main stem, >70% stenosis in a major coronary vessel, or 30% to 70% stenosis with fractional flow reserve ≤0.8. Significant CAD was present in 29% of patients. In a patient-based analysis, coronary computed tomographic angiography had the highest diagnostic accuracy, the area under the receiver operating characteristics curve being 0.91 (95% confidence interval, 0.88-0.94), sensitivity being 91%, and specificity being 92%. Myocardial perfusion imaging had good diagnostic accuracy (area under the curve, 0.74; confidence interval, 0.69-0.78), sensitivity 74%, and specificity 73%. Wall motion imaging had similar accuracy (area under the curve, 0.70; confidence interval, 0.65-0.75) but lower sensitivity (49%, P<0.001) and higher specificity (92%, P<0.001). The diagnostic accuracy of myocardial perfusion imaging and wall motion imaging were lower than that of coronary computed tomographic angiography (P<0.001). Conclusions-In a multicenter European population of patients with stable chest pain and low prevalence of CAD, coronary computed tomographic angiography is more accurate than noninvasive functional testing for detecting significant CAD defined invasively. © 2015 American Heart Association, Inc.

Kritharis E.P.,Center for Experimental Surgery | Kritharis E.P.,National Technical University of Athens | Giagini A.T.,Center for Experimental Surgery | Kakisis J.D.,National and Kapodistrian University of Athens | And 4 more authors.
Biorheology | Year: 2012

Numerous studies have provided evidence of diameter adaptation secondary to flow-overload, but with ambiguous findings vis à vis other morphological parameters and information on the biomechanical aspects of arterial adaptation is rather incomplete. We examined the time course of large-artery biomechanical adaptation elicited by long-term flow-overload in a porcine shunt model between the carotid artery and ipsilateral jugular vein. Post-shunting, the proximal artery flow was doubled and retained so until euthanasia (up to three months post-operatively), without pressure change. This hemodynamic stimulus induced lumen diameter enlargement, accommodated by elastin fragmentation and connective tissue accumulation, as witnessed by optical and confocal microscopy. Heterogeneous mass growth of the adventitia was observed at the expense of the media, associated with declining residual strains and opening angle at three months. The in vitro elastic properties of shunted arteries determined by inflation/extension testing were also modified, with the thickness-pressure curves shifted to larger thicknesses and the diameter-pressure curves shifted to larger diameters at physiologic pressures, resulting in normalization of intramural and shear stresses within fifteen and thirty days, respectively. We infer that the biomechanical adaptation in moderate flow-overload leads to normalization of intimal shear, without, however, restoring compliance and distensibility at mean in vivo pressure to control levels. © 2012 - IOS Press and the authors. All rights reserved.

Sokolis D.P.,Center for Experimental Surgery | Sassani S.,Center for Experimental Surgery | Sassani S.,National Technical University of Athens | Kritharis E.P.,Center for Experimental Surgery | And 2 more authors.
Medical and Biological Engineering and Computing | Year: 2011

The selection of a mathematical descriptor for the passive arterial mechanical behavior has been long debated in the literature and customarily constrained by lack of pertinent data on the underlying microstructure. Our objective was to analyze the response of carotid artery subjected to inflation/extension with phenomenological and microstructure-based candidate strain-energy functions (SEFs), according to species (rabbit vs. pig) and region (proximal vs. distal). Histological variations among segments were examined, aiming to explicitly relate them with the differential material response. The Fung-type model could not capture the biphasic response alone. Combining a neo-Hookean with a two-fiber family term alleviated this restraint, but force data were poorly captured, while consideration of low-stress anisotropy via a quadratic term allowed improved simulation of both pressure and force data. The best fitting was achieved with the quadratic and Fung-type or four-fiber family SEF. The latter simulated more closely than the two-fiber family the high-stress response, being structurally justified for all artery types, whereas the quadratic term was justified for transitional and muscular arteries exhibiting notable elastin anisotropy. Diagonally arranged fibers were associated with pericellular medial collagen, and circumferentially and longitudinally arranged fibers with medial and adventitial collagen bundles, evidenced by the significant correlations of SEF parameters with quantitative histology. © 2011 International Federation for Medical and Biological Engineering.

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