The Role Of Noninvasive 320-Row Multidetector Computer Tomography

This pilot study consisting of a prospective non-randomized observational trial where a team of surgeon, anesthesiologist, and evaluator are blinded to CTCA results. We hypothesize that the preoperative use of noninvasive computer tomography, with the 320-row MDCT, to visualize the degree of coronary artery stenosis can lead to improved clinical prediction of perioperative cardiac complications.

The 320-row MDCT is based on the 64-row technology with the significant addition of a larger detector capable of scanning the heart within 1 sec or a cardiac cycle, thereby, eliminating patient-related artifacts and may produce higher image quality.13, 14 The scanning time of 5 seconds with the 320-row MDCT is significantly reduced compared to 8-10 seconds for the 64-row MDCT

Inclusion criteria

• Male or female, 18 years and older
• Able to understand and willing to sign the Informed Consent Form
• Undergoing vascular surgery or intermediate risk surgery (these include intraperitoneal, intrathoracic, carotid endarterectomy , head and neck, orthopedics or prostate) AND
• One or more of the following clinical predictors according to the Revised Cardiac Risk Index:

• history of ischemic heart disease (CABG, MI, Stent, positive stress test, Q-waves on ECG)
• Diabetes (requiring insulin)
• history of congestive heart failure (NYHA I- II)
• history of cerebrovascular disease, any of :

• history of carotid stenosis
• history of ischemic cerebrovascular disease (stroke or TIA)
• Aortic or peripheral vascular disease OR
• Risk of CAD with 3 or more of the following

• Age ≥ 70 years
• Hypertension (medicated)
• Cholesterol (medicated)
• Diabetes (medicated-oral hypoglycemic)
• Family history of coronary artery disease

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Exclusion criteria

• Lack of consent for participation
• Pregnancy
• History of an allergic response to iodinated contrast medium
• History of an allergic response, or other contraindication to beta blockers
• eGFR < 45 mL/min
• Hemodynamically unstable/compromised
• Urgent surgery
• Atrial fibrillation > 80 bpm
• Uncontrolled tachyarrhythmia
• Atrioventricular block (second and third degree)
• Moderate to severe aortic stenosis
• Not able to hold breath for 5 - 10 seconds
• History of multiple myeloma or organ transplant
• Severe pulmonary disease including COPD, PAH, asthma
• Congestive heart failure presented as NYHA functional class III - IV
• Severe anemia
• Increased intracranial pressure
• Closed angle glaucoma
• Absolute contraindication to Nitroglycerin
• Presence of medical condition or history that investigator feels would be problematic
• Acute myocardial infarction (within 4-6 weeks) -