Eur Heart J Cardiovasc Imaging Abstracts Supplement, December 2013 doi:10.1093/ehjci/jet210 MODERATED POSTERS SESSION Cardiovascular computed tomography, magnetic resonance and nuclear imaging Location: Moderated Poster area P834 P835 CT-derived atrial and ventricular septal signs for risk stratification of patients with acute pulmonary embolism: clinical associations of CT-derived signs for prediction of mortality Three-dimensional reconstruction of the left atrium and pulmonary veins in patients with atrial fibrillation: analysis using multi-slice tomography HO. Jung; MJ. Kim; HJ. Youn Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea, Republic of Purpose: A left-bulging atrial septum (AS) in diastole is an abnormal sign indicating hemodynamic overloading of the right heart. Main hypothesis is computed tomography (CT)derived AS bulging and ventricular septum (VS) bowing signs would be used to identify patients with acute pulmonary embolism (PE) and significant hemodynamic derangements. Methods: In the prospective registry, 221 consecutive patients with a first episode of acute PE diagnosed by chest CTwere grouped by clinical hemodynamic assessment: massive or submassive PE (Group 1), and small PE (Group 2). The curvatures of the AS and VS, right ventricle (RV) and left ventricle (LV) diameters were measured on chest CT. Results: Group 1 showed higher degrees of RV dilatation, and abnormal VS and AS curvatures versus Group2. The sensitivity and specificity of a CT-derived RVD/LVD ratio .0.9 for predicting PE with clinically significant RV dysfunction were 60.8% and 69.7%, respectively. An abnormal VS bowing sign was observed in 33 (32.4%) and 7 (5.9%) patients in Groups 1 and 2, respectively (p,0.001). An abnormal AS bulging sign was observed in 62 (60.8%) and 35 (29.4%) patients in Groups 1 and 2, respectively (p,0.001). On the basis of the CT-derived RVD/LVD ratio, VS bowing, and AS bulging status, patients with acute PE were classified into three risk groups: higher risk, lower risk, and intermediate risk. An algorithm was designed to predict clinically significant hemodynamic abnormality based on these signs (Figure); patients deemed "higher risk" exhibited higher 90-day allcause mortality than patients in the lower-risk group (p=0.028). Conclusions: Conventional chest CT-derived hemodynamic findings, including abnormal AS and VS signs, can be used to identify high-risk patients with acute PE and to predict early mortality. I. Wozniak-Skowerska1; M. Skowerski2; M. Skowerski2; A. Hoffmann1; A. Hoffmann1; J. Kolasa1; J. Kolasa1; T. Skowerski3; T. Skowerski3; M. Sosnowski2; M. Sosnowski2; AM. Wnuk-Wojnar1; AM. Wnuk-Wojnar1; Z. Gasior4; Z. Gasior4; K. Mizia-Stec1; K. Mizia-Stec1 1 Medical University of Silesia, 1st Department of Cardiology, Katowice, Poland; 2Medical University of Silesia, Unit of Noninvasive Cardiovascular Diagnostics, Katowice, Poland; 3 Medical University of Silesia, Katowice, Poland; 4Medical University of Silesia, 2nd Department of Cardiology, Katowice, Poland Summary: Detailed imaging modalities of the left atrium and pulmonary veins increase the safety and effectiveness of circumferential pulmonary vein isolation (CPVI). The aim of the study was to compare the anatomy of the left atrium and pulmonary veins (PV) in patients with atrial fibrillation (AF) and healthy subjects. Methods: 204 consecutive pts with symptomatic paroxysmal AF (group AF, 127 males (mean age 57 + 9 yrs) referred to CPVI and 31 healthy subjects (group C, 16 males, mean age 45 + 6 yrs) were enrolled into the study. Multi-slice computed tomography (MSCT) was performed using a 64-slice Toshiba Multislice Aquillon System. Standard dimensions of left atrium (LA) as well as any anomaly of the pulmonary veins (PV), common ostia (CO) and additional PV (APV) were analysed. Diameters of PV ostia were measured automatically in two directions – anterior-posterior (AP) and superior-inferior (SI) using Vitrea 4.0. Venous ostium index (VOI) was also calculated. Results: PV anatomy variants were observed more frequently in the AF group 56 (27.5%; 7% left CO, 1% right CO, 14% APV right, 1.5% APV left) as compared to group C – 5 (16%) pts (13% left CO, 3% right APV). Both the mean value of the LA diameters (39.5+.. mm vs 35+ mm, p,0.0001) and the diameters of the PV ostia were significantly larger in the AF group than in the group C – see Table 1. Conclusions: The anatomy of pulmonary veins is highly variable in pts with AF. A higher prevalence of common ostia, and additionally veins as well as larger diameters of the LA and PV ostia were detected. P836 The impact of coronary calcium on improvement over a year of diagnostic accuracy for coronary artery stenosis with low dose cardiac CT in 402 patients without previous coronary revascularisation H. Schirmer1; SH. Forsdahl2; T. Sildnes2; T. Trovik3; A. Iqbal3 University of Tromso, Faculty of Health Sciences, Cardiovascular Research Group, Tromso, Norway; 2University Hospital of Northern Norway, Department of Radiology, Tromso, Norway; 3University Hospital of Northern Norway, Department of Cardiology, Tromso, Norway 1 Purpose: Increase in coronary calcium is significantly correlated to coronary stenosis but also an obstacle to accurate detection of stenosis. This study explores the impact of coronary calcium on improvement of diagnostic accuracy over a year in a tertiary cardiac centre establishing cardiac CT service. Abstract P834 Figure. Abstract P835 Table. AP and SI diameters and VOI of PV ostia PV FA group SI (mm) C group p FA group AP (mm) C group p FA group VOI C group p RS RI LS LI 18.4 17.0 18.1 16.0 14.8 13.9 15.1 13.7 ,0.0001 ,0.0001 ,0.0001 ,0.0001 16.5 15.3 14.5 12.3 13.7 13.6 12.0 10.3 ,0.001 ,0.01 ,0.0001 ,0.0005 0.92 0.91 0.83 0.79 0.94 1.02 0.81 0.75 NS ,0.05 NS NS RS right superior, RI right inferior, LS left superior, LI left inferio Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2013. For permissions please email: journals.permissions@oup.com Downloaded from https://academic.oup.com/ehjcimaging/article-abstract/14/suppl_2/ii142/2403240 by guest on 29 May 2020 13/12/2013, 08:30–12:30 Abstracts P837 Magnetic resonance feature tracking for the determination of right ventricular longitudinal strain M. Astrom Aneq1; JE. Engvall2 Linkoping University Hospital, Department of Clinical Physiology, Linkoping, Sweden; 2 Linkoping University, Department of Medical and Health Sciences, Linkoping, Sweden 1 Background: Cardiovascular magnetic resonance imaging (CMR) is the gold standard for visualization and volume quantification of the RV, but in the assessment of wall motion, qualitative "eye-balling" is still used. For diagnostic accuracy and follow-up of diseases, there is a substantial need for quantification of segmental as well as of global changes. Feature tracking (CMR-FT) is a novel technique for tracking and measuring myocardial strain in the left heart that may be applicable also to the right heart. Our purpose in this study was to test the feasibility of using CMR-FT to assess RV strain of healthy volunteers. Methods: Twenty healthy subjects underwent cardiac MRI at 1,5 Tesla (Philips Achieva). To visualize all segments of the RV, steady state free precision cine of six long axis planes was acquired by rotating the cut planes around the long axis of the RV in 30 degree increments (RLA, rotated longaxis). The 3-, 4- and 2-chamber views of the RV were identified and feature tracking analysis was performed off-line using TomTec 2D Cardiac Performance software. Segmental longitudinal strain for the base, mid and apical levels of the RV as well as global strain were measured. RV volumes and EF were calculated. Results: Based on RLA, RV volume was on average 177 ml and ejection fraction 56 %. Segments that tracked poorly were excluded (10%). Longitudinal strain decreased from base to apex (-30%, -24%, -20%). In the regional analysis, anterior and septal walls displayed lower absolute strain values (-18%) than the inferior and lateral walls (-32% and -28%). Time-to-peak was similar in all segments. Conclusion: RV longitudinal strain is higher at the base compared to the apex and regional strain is higher in walls that are free from effects of left ventricular ejection. Abstract P837 Figure. P838 123 I-MIBG heart-mediastinum rate and washout: predictive factors of systolic and diastolic left ventricular function modification after CRT? A. Abreu1; L. Oliveira2; G. Portugal1; M. Goncalves3; M. Mota Carmo4; H. Santa Clara3; T. Pereiro1; M. Oliveira1; L. Branco1; R. Ferreira1 1 Hospital Santa Marta, CHLC, Lisbon, Portugal; 2Clinica Quadrantes-Medicina Nuclear, Lisbon, Portugal; 3Technical University of Lisbon, Human Motricity Faculty, Lisbon, Portugal; 4University Nova, Faculty of Medica Sciences, Dep. Physiology, lisbon, Portugal Background: Autonomic nervous system, which is disfunctional in cardiac heart failure, has been noninvasively evaluated by 123-MIBG cardiac imaging. Several cardiac scintigraphic parameters have been correlated to prognosis in the last years. Also, left ventricular function is an important prognostic factor and may be increased, in some heart failure patients, after cardiac resynchronization. Aim: To correlate, in patients (P) with chronic heart failure (CHF) disease, baseline 123 I-MIBG cardiac scintigraphic parameters with the change of systolic and diastolic left ventricular function echocardiographic measurements, after cardiac resynchronization (CRT). Methods: We prospectively assessed 50 consecutive CHF referred to CRT. Sample characteristics: patients mean age 67+14 (34-82 years old), 32 male, LVEF,35%; 30% ischemic cardiomyopathy P and 70% nonischemic cardiomyopathy P; 34% diabetic P; 42% P class III and 58%≤ class II (NYHA), under optimal pharmacological therapy. All patients underwent: - 123 I-MIBG cardiac scintigraphy, performed pre CRT implant (48 hours) for determination of early heart-mediastinum rate (HMRe), late HMR (HMRl) and washout (WO); - Echocardiogram, performed, before CRT (48 hours) and after 3-6 months, for left ventricular ejection fraction (LVEF), %, left ventricular volumes, diastolic (LVEDV), ml, and systolic (LVESV), ml, left ventricular inflow E wave (E), cm/seg, A wave (A),cm/seg, ratio E/A, TDI e’, E/e’. All echocardiographic function parameters changes after CRT were calculated. Patients were divided according to scintigraphic HMRe and HMRl (cut-off 1.6) and WO (cut-off 30). Results: Our preliminary results showed: - HMRe (cut-off 1.6): % LVEF variation 43.6+/ 39.9 (HMRe,1.6) vs 78.2+69.3(HMRe≥1.6), p=0.063 - HMRl (cut-off 1.6): % LVEDV variation 3.4+25.9 (HMRl,1.6) vs 32.5+16.7 (HMRl≥1.6), p,0.05 - WO (cut-off 30): %LVEF variation 8.26+ 19.3 (WO,30) vs 61.5+ 53.9 (WO≥30), p,0.001; absolute variation 3+4.7 (WO,30) vs 12.5+ 9.8 (WO≥30), p,0.01 There were no significant differences in the other echocardiographic parameters, regarding the 123 I-MIBG scintigraphic determined groups (HMRe, HMRl, WO). Conclusion: In this group of heart failure patients, baseline 123 I-MIBG early and late heartmediastinum rate and, especially washout, predicted the magnitude of changes in systolic left ventricular function after CRT implant. None of the scintigraphic parameters did predict diastolic function changes. Larger numbers will be needed to confirm these results. P839 Real-world relative utility of stress testing and coronary calcium score for the detection of coronary artery disease in prospective renal transplant recipients WE. Moody; L. Sze Lin; N. Bloxham; H. Fraser; RJ. Taylor; B. Holloway; NC. Edwards; CJ. Ferro; JN. Townend; RP. Steeds University of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom Introduction: Exercise capacity is integral to pre-operative risk assessment although its role in end-stage renal disease (ESRD) remains undecided. Arterial calcification is highly prevalent in ESRD yet coronary calcium score (CCS) is unable to differentiate intimal (atherosclerosis) from medial (arteriosclerosis) involvement. Whilst CCS is strongly associated with cardiovascular (CV) morbidity in the general population, whether it predicts obstructive coronary events in ESRD is unclear. Aim: To determine the relative ability of exercise capacity and CCS to discriminate the likelihood of prognostically significant CAD in ESRD. Methods: 125 consecutive patients with ESRD (n=125; male 56%) were referred to a University hospital for CV risk stratification before transplant listing. Each subject fulfilled at least one of the following: age ≥50yr (71%), diabetes (37%), previous MI (35%) or current angina (28%). Patients performed maximal treadmill exercise and those unable to achieve .85% maximum predicted heart rate underwent standard adenosine stress. Abstract P839 Figure. Poor ET associated with perfusion defect Eur Heart J Cardiovasc Imaging Abstracts Supplement, December 2013 Downloaded from https://academic.oup.com/ehjcimaging/article-abstract/14/suppl_2/ii142/2403240 by guest on 29 May 2020 Method: We examined 402 consecutively referred patients both with invasive and CTangiography and CT calcium score with observers blinded for each other’s evaluation of images. Exclusion criteria were GFR , 30%, iodine allergy, pregnancy, acute coronary syndrome, heart rate .110 despite adequate medication. 65% of eligible population consented to the trial which were approved by the regional board of ethics (Clinicaltrials.gov: NCT01476579) A Siemens, Somatotom Definition Flash 256 slice dual source was used. After blinded readings were entered in the database, the radiologists were given access to the angiography report. The inclusion period were divided in two and specificity, sensitivity, positive and negative predictive value were calculated for invasively determined significant stenosis .50% or revascularisation on a per patient level. Calcium score was graded in 5 with 0, 10, 100, 400 and 800 as cut off levels. Results: The prevalence of significant stenosis was 38% and 29% were treated with revascularisation. Decision to revascularise was supported by measurement of fractional flow reserve in 7.4% of patients. Calcium score did not influence sensitivity for stenosis (93% 87-96) or revascularisation (98% 93-99), which was high throughout the study period. Specificity for stenosis and revascularisation increased significantly during the study period significantly more for higher than lower calcium score (p 0.04). This reduced overall mismatch between CT and invasive angiography significantly (from 45-30%, p 0.001) mainly by reducing false positives among those with high calcium score in the latter half of the study period. With increasing calcium score, age increased from 56 to 72 years and there were an increasing proportion of men (43-73%). Conclusion: Improvement in diagnostic accuracy for coronary CT angiography was highest where coronary calcium was highest. Although the reduction in false positives was lowest for low calcium score, this has the highest clinical impact as all those with calcium score above 400 had a prevalence of coronary stenosis justifying invasive angiography. ii143 ii144 Abstracts All subjects had a Tc-99m SPECT scan and of those, 48 underwent MDCT imaging (Siemens SOMATOM Sensation 16). Results: Inability to perform treadmill exercise was common (45%) and strongly associated with abnormal perfusion on stress radionuclide imaging (p,0.001). Patients achieving .7 METS (Bruce stage 3) were unlikely to have abnormal perfusion (NPV 93%). A graded inverse association between exercise capacity and CCS was evident. In univariate ROC analysis, exercise capacity was at least as good a predictor of abnormal perfusion as CCS (AUC, 0.76(0.60-0.88) vs. 0.65(0.48-0.79); p=0.29). Conclusion: This study supports recent consensus statements that place strong emphasis on using functional status to stratify CV risk before renal transplantation. 146 (16.7%) as MP, and 114 (13.1%) as CP. Elderly patients showed a significantly higher ratio of mixed CAP and calcified CAP compared with younger patients (15.3% versus 10.3%, and 20.2% versus 12.6%, respectively; p , .001). Conclusion: Although age has an impact on MDCT image quality, per-segment analysis revealed a slight deterioration in the sensitivity and PPV but a negligible decrease in the specificity and NPV. Therefore, the overall image quality of dual-source MDCT is sufficient for diagnosis and exclusion of coronary artery disease, not only for younger patients, but also for elderly patients. P842 Risk stratification and optimal therapeutic approach in asymptomatic patients with high cardiovascular risk: the value of myocardial gated SPECT imaging P840 GO. Perea; M. Corneli; AH. Meretta; ME. Aguirre; D. Rosa; R. Henquin; R. Ronderos; N. Perez Balino Instituto Cardiovascular de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina Purpose: The aim of our study is to relate the different levels of coronary calcium score (CS) with the presence of carotid atherosclerotic disease assessed by Doppler ultrasound color. Materials and Methods: Between January 2012 and April 2013, we studied 460 patients with Framingham score intermediate grade. CS was determined by computed tomography, classifying them according to Agatston score in 4 groups: 1)CS: 0, 2)SC: 1-99, 3)CS: 100-399 and 4)CS: .400. Doppler ultrasound evaluated Myointimal thickness (IMT) and the presence of atheromatous plaques.To analyze the findings 3 groups were built (G): GA: patients without carotid lesions, GB: preclinical injury patients (diffuse increase of IMT. 1mm without plaques) and GC: patients with atheroesclerotic plaques. Overall analysis was performed for GA, GB and GC and then analyzed: 1) GA vs. GB to compare findings in preclinical disease and 2) GA vs GC to compare patients with atherosclerosis. For comparison between CS and carotid Doppler was used Chi2 test trend. Results: The mean age was 57 + 11 years, 285 male patients. SeeTable. Conclusions: This study shows that the higher CS severity, there is a greater degree of atheroesclerotic disease manifested by increased carotid IMTand atherosclerotic plaques. Abstract P840 Table. Results General analysis n CS GA GB GC Chi2 p 100 238 56 66 Preclinical injury n 82 174 24 22 Atherosclerosis n 88 179 47 54 0 1-99 100-399 .400 70 (70%) 115 (48%) 15 (27%) 10 (15%) 12 (12%) 59 (25%) 9 (16%) 12 (18%) 18 (18%) 64 (27%) 32 (57%) 44 (67%) ,0,0001 ,0,0001 ,0,0001 0 1-99 100-399 .400 70 (85%) 115 (66%) 15 (62%) 10 (45%) 12 (15%) 59 (34%) 9 (38%) 12 (55%) 0 1-99 100-399 .400 70 (80%) 115 (64%) 15 (32%) 10 (19%) ,0,001 ,0,01 ,0,0001 18 (20%) 64 (36%) 32 (68%) 44 (81%) 0,0109 ,0,0001 ,0,001 Results P841 Comparison of multidetector computed tomography coronary angiography with conventional angiography in elderly and younger patients H. Sunman1; H. Yorgun2; L. Sahiner2; B. Kaya2; T. Hazirolan3; N. Ozer2; K. Aytemir2; L. Tokgozoglu2; G. Kabakci2; A. Oto2 1 Ministry of Health Diskapi Yildirim Beyazit Research and Educational Hospital, Ankara, Turkey; 2Hacettepe University, Faculty of Medicine, Department of Cardiology, Ankara, Turkey; 3Hacettepe University, Faculty of Medicine, Department of Radiology, Ankara, Turkey Objectives: To investigate the diagnostic accuracy of multidetector computed tomography (MDCT) in elderly patients in comparison to younger patients and to determine the influence of coronary plaque morphology. Methods: The patients were examined by using dual-source MDCTand conventional coronary angiography (CAG). MDCT results were compared with the results of CAG with regard to the severity (.50% stenosis) and morphology (non-calcified, mixed, or calcified) of coronary atherosclerotic plaques evaluated in a 16-segment model. The study patients were examined by dual-source MDCT (Somatom Definition; Siemens, Erlangen, Germany) and CAG. Results: In total, 181 patients (94 men and 87 women) with 2687 coronary artery segments were examined with MDCT. 93 patients were older than 65 years of age (group A; 42 men) and 88 were younger (group B; 52 men). A total of 209 (7.2%) coronary artery segments were excluded because of intensive calcification, stenting, irregular heart rate, and/ or non-diagnostic imaging. Of the 2687 evaluated segments, 157 (5.8%) were significantly diseased, and 144 of them were correctly detected by MDCT. Diagnostic evaluation showed that the sensitivity, positive predictive value (PPV), specificity, and negative predictive value (NPV) were 89.5%, 62.5%, 96.0%, and 99.2%, respectively in group A, and 95.2%, 64.8%, 97.5%, and 99.8% in group B, respectively. 873 (32.5%) segments had CAPs and of those, 613(70.2% of 873) segments were classified as non-calcified CAP, Eur Heart J Cardiovasc Imaging Abstracts Supplement, December 2013 I. Peovska1; E. Srbinovska2; E. Hristova2; M. Otljanska2; M. Bosevski2; F. Arnaudova2; V. Andova2 1 University Cardiology Clinic, Institute for Pathophysiology and Nuclear Medicine, Skopje, Macedonia, The Former Yugoslav Republic of; 2University Cardiology Clinic, Skopje, Macedonia, The Former Yugoslav Republic of Background: The dilemma of the best diagnostic approach to asymptomatic patients with high cardiovascular (CV) risk in relation to the optimal therapeutic approach is still ongoing. We wanted to evaluate the prevalence of myocardial ischemia in these group of patients in relation to the stress induced ECG changes and risk factors as well as their influence on the final management decision. Methods: We evaluated 60 asymptomatic patients (pts) with high CV risk according to SCORE stratification, who underwent SPECT myocardial perfusion imaging (MPI) for detection of suspected CAD. ECG changes during pharmacological stress were compared with MPI results. We use 17 segment model for MPI quantitative analysis.. Myocardial perfusion scores and functional parameters were evaluated. We assess the influence of MPI results on final patient’s management. Logistic regression analysis was used to assess the impact of diabetes on myocardial ischemia prevalence. Results: Stress inducible ischemia was found in 19 pts (33%), from which 8 pts (40%) were diabetic Fixed defects were found in 13% and mixed defects in 9% of cases. The average percent of ischemia was 10%. Mildly abnormal scans were found in 7 patients (36%) - summed stress score (SSS) ,8, moderate abnormality in 4 patients (22%) – SSS ,13 and severely abnormal scans in 8 patients (42%) – SSS .13. Severe ischemia was only related to the duration of diabetes. Six pts with severe ischemia (75%), had ST segment depression .2mm on pharmaceutical stress, and higher wall motion index (p,0.01). Pts with severe ischemia had fall of LVEF during stress .5% comparing to rest LVEF. Transit ischemic dilatation (TID) was observed in 5 pts with severe ischemia. Stepwise logistic regression analysis of stress induced ischemia showed OR 3.9 (95% CI 2.3–6.6) for stress induced ECG changes and OR 2.4 for presence of DM over 10y (95% CI 1.7–3.6). All pts with ischemia .10%, were referred for coronary angiography. Pts with mild ischemia (SSS ,8) and normal MPI findings were put on intensive medical therapy and advices for life style modification Conclusions: SPECT MPI is valuable method for preclinical assessment myocardial ischemia in patients with high CV risk. MPI can improve cardiac risk stratification and guide management decision in this group of patients P843 The influence of the arc and length of calcification to image quality of coronary MRA T. Iwaki Yokohama Sakae Kyosai Hospital, Department of Internal Medicine, Yokohama, Japan Objective: It is said that MRI is less affected by calcification, but we sometime experience tho poor MRI image of calcified coronary artery. The objective of our study was to evaluate the influence of calcification to image quality of coronary MRA. Subjects and methods: Twenty seven patients who had at least one calcified plaque detected by coronary CT underwent coronary MRA. MRA quality score was assessed on a 4-point scale (1= not visible, 2= poor, 3= good, 4= excellent) using a 10-segment model from the modified American Heart Association classification. The MRA quality score(QS) of the segment was compared by the cross sectional arc calcium (no calcification, mild to moderate =A1808, severe= .1808calcification) and calcified length in the curved MPR image(none = no calcification, spot = A10mm, diffuse= .10mm ) on coronary CT. In this study, all patients were performed CAG and if the coronary segment had more than 50% stenosis or the vessel diameter of that was less than 2.0mm by QCA, the segments were excluded from the objects of this analysis. Results: Two hundred forty lesions of 27 patients were analyzed. The image QS of coronary segment with severe calcification (n=31) was significantly lower than that of the segment with no calcification (n=129) (2.87+0.72 vs 3.50+0.80,; P,0.0001) The image QS of coronary segment with severe calcification was also significantly lower than that of the segment with mild to moderte calcification (n=75) (2.87+0.72 vs 3.52+;0.73, ; P,0.0001). There was no difference of QS between no calcification and mild to moderate calcification segment. The image QS of coronary segment with diffuse calcification (n=22) was significantly lower than that of the segment with no calcification (n=126) (2.77+0.87 vs 3.48+0.80,; P,0.0002) The image QS of coronary segment with diffuse calcification was also significantly lower than that of the segment with spot calcification (n=92) (2.77+0.87 vs 3.49+0.73, ; P,0.0001). There was no difference of QS between no calcification and spot calcification segment. Conclusions: We considered that severe arc calcification and calcified length affected the image quality of coronary MRA. Downloaded from https://academic.oup.com/ehjcimaging/article-abstract/14/suppl_2/ii142/2403240 by guest on 29 May 2020 Relationship between carotid atherosclerotic disease and degree of coronary calcification, myth or reality?