Nishtha Sareen

By Karthik Ananthasubramaniam, Nishtha Sareen and Gjeka Rudin

Coronary cardiac computed tomography (CCTA) has seen rapid improvements in technology including hardware and postprocessing techniques that have contributed to its rapid growth and enabled it to remain in the forefront on diagnostic imaging. Important technological advances include wider detectors for greater coverage with less gantry rotation times, dual-source computed tomography (CT) with improved temporal resolution, dual-energy CT where simultaneous imaging at different energies to increase the contrast difference between different tissues enhances diagnostic accuracy, and emergence of spectral CT to enhance atherosclerotic imaging through nanoparticle technology. Software advances include iterative reconstruction methodologies to reduce noise and radiation doses, plaque imaging and quantification tools to assess plaque morphology and stenosis severity. Processing advances using computational fluid dynamics now enables the determination of fractional flow reserve (FFR). Another important advancement in CCTA physiologic imaging is CCTA perfusion imaging to detect ischemia and compares favorably with myocardial perfusion imaging and coronary angiographic stenosis. Finally, large registry studies and single-center studies have now been published assessing the incremental value of coronary calcium score, CT plaque severity of disease and have demonstrated that the CCTA carries strong prognostic value over and above traditional risk assessment in predicting adverse outcomes.

Part of the book: Computed Tomography

By Yashwant Agrawal, Abhishek Ojha and Nishtha Sareen

Part of the book: Peripheral Arterial Disease

By Abhishek Ojha and Nishtha Sareen

Despite numerous studies focused on women’s cardiac health, deaths from cardiovascular disease continue to rise in women. Cardiovascular disease (CVD) continues to be the leading cause of death even in women in many areas of the world. It has been noted that despite higher frequency of chest pain/angina in women compared to men, the incidence of obstructive coronary artery disease (CAD) remains lower in the female population compared with men presenting with similar symptoms. It is critical to have a deep understanding of these topics to ensure a meaningful communication between public, patients, and healthcare professionals. One reason to which this discrepancy has been attributed to is that chest pain in women is less likely to be secondary to obstructive coronary stenosis in comparison to men presenting with similar symptoms. The other issue is that the gold standard for coronary atherosclerosis continues to coronary angiography. This is a key limitation in cardiovascular atherosclerosis management since endothelial dysfunction in addition to a higher risk of atherosclerosis is prevalent in women with hypertension, diabetes, and dyslipidemia. In this chapter, we will focus on the aspects of coronary atherosclerosis that deserve attention with respect to gender-specific considerations, particularly with respect to clinical practice.

Part of the book: Atherosclerosis, Arteriosclerosis and Arteriolosclerosis