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IntroductionCoronary artery calcification (CAC) is indicative of atherosclerosis and is readily apparent on non-gated CT images with the chest in the field of view. Semi-quantitative reporting of this CAC on non-gated CT is national guidance. CAC can negatively impact computed tomography coronary angiography (CTCA) quality, sometimes precluding luminal assessment. We sought to determine what proportion of referrals for CTCA had previous CAC on non-gated CT and how this impacted CTCA diagnostic yield and the need for layered testing.MethodsRetrospective review of CTCAs carried out between 01/05/2018 and 31/05/2020 was cross referenced for previous non-gated CT at our institution, the Royal United Hospitals Bath. CAC of the major epicardial vessels of non-gated CT was evaluated by published semi-quantitative methods (0=none, 1=mild, 2=moderate, 3=severe), in addition to a cumulative CAC score (mild=1-3, moderate=4-6, severe>6). Subsequent complete diagnostic yield of the CTCA and any further testing was examined.Results2150 CTCAs were identified, 250 with a preceding non-gated CT. 56% female, age 62±12 years. Of the 250 cases, 132 had no CAC, 78 mild, 25 moderate and 15 severe. In the 132 cases with no CAC on previous non-gated CTs the complete diagnostic rate at CTCA was 95% with 0% layered testing. For mild it was 81% and 25%, moderate 48% and 50% and for severe 40% and 29% respectively (p<0.001). Such testing was in the absence of obstructive CAD elsewhere.ConclusionsPrevious non-gated CT imaging may be useful to determine the likelihood of achieving a complete CTCA evaluation. It may offer a serendipitous opportunity to redirect diagnostic pathways to avoid costly layered testing, multiple appointments and delay to diagnosis.Conflict of InterestNone

BackgroundCoronary Artery Disease-Reporting and Data System (CAD-RADS) standardises Computed Tomography Coronary Angiography (CTCA) reporting. Coronary calcification can overestimate stenosis. We hypothesized where CAD-RADS category is assigned due to predominantly calcified maximal stenosis (Ca+), the CTCA-derived Fractional Flow Reserve (FFRCT) would be lower compared to predominantly non-calcified maximal stenoses (Ca-) of the same CAD-RADS category.MethodsConsecutive patients undergoing routine clinical CTCA (September 2018 to May 2020) with ≥1 stenosis ≥25% with FFRCT correlation were included. CTCAs were subdivided into Ca+ and Ca-. FFRCT was measured in the left anterior descending (LAD), left circumflex (LCx) and right coronary artery (RCA). Potentially flow-limiting classified as FFRCT≤0.8. A subset had Invasive Coronary Angiography (ICA).Results561 patients screened, 320 included (60% men, 69±10 years). Ca+ in 51%, 69% and 50% of CAD-RADS 2, 3 and 4 respectively. There was no difference in the prevalence of FFRCT≤0.8 between Ca+ and Ca- stenoses for each CAD-RADS categories. No difference was demonstrated in the median maximal stenoses FFRCT or end-vessel FFRCT within CAD-RADS 2 and 4. CAD-RADS 3 Ca+ had a lower FFRCT (maximal stenosis p= .02, end-vessel p= .005) vs Ca-. No difference in the prevalence of obstructive disease at ICA between predominantly Ca+ and Ca- for any CAD-RADS category.ConclusionThere was no difference in median FFRCT values or rate of obstructive disease at ICA between Ca+ and Ca- stenosis in both CAD-RADS 2 and 4. Ca+ CAD-RADS 3 was suggestive of an underestimation based on FFRCT but not corroborated at ICA.Conflict of InterestNone

IntroductionComputed Tomography Cardiac Angiography (CTCA) is now the first-line recommended investigation as per the NICE in new-onset stable chest pain patients. European and International guidance however still recommends risk stratification and functional testing in high and intermediate risk individuals.MethodsWe performed a retrospective review of stable chest pain patients who had a CTCA on an outpatient basis between January – March 2023. Data was collected using a pre-designed proforma, demographic data, risk factor profile including QRISK, indication for scan, CTCA result and outcome following scan were collected. Statistical analysis was performed using Microsoft Excel software; unpaired t-testing was used to evaluate statistical significance. Results99 patients were included in this retrospective review 49/99 (49%) patients were male, median age was 57 years. Most common co-morbidities included hypertension (28%), hyperlipidaemia (34%). Median QRISK3 score was 7.8% (table 1) The most common reason for referral for CTCA was atypical chest pain in 75/99 (76%) patients. Mean Calcium score was 41. All patients with severe coronary stenosis (>70%) identified on CTCA proceeded to have LHC+/-PCI. CTCA changed patient management in most cases, in 34/99 cases it led to a change in medication regime namely primary prevention initiation. 10 patients had functional assessment following the CTCA result. 13 patients underwent invasive coronary angiography (ICA) following CTCA. 5/13 had percutaneous coronary intervention and 1/13 patients was referred for CABG. Higher QRISK score was associated with increased number of vessel stenosis (p<0.01) and a higher degree of coronary artery stenosis on CTCA (p<0.01) (figure 1). ConclusionsOutpatient CTCA imaging in the stable chest pain cohort can lead to significant changes in patient management. In 34/99 cases primary prevention was optimised and in 44 patients the CTCA demonstrated no coronary disease/plaque leading to discharge from the Cardiology services hence demonstrating its utility as a rule-out test for epicardial obstructive coronary artery disease in a low-risk population.Abstract 201 Table 1Baseline patient characteristics n % Male 49 49% Age (years) <40 3 3% 40–60 62 62% >60 34 34% Risk Factors Hypertension 28 28% Hypercholesterolaemia 34 34% Ex-smoker/Smoker 35 35% Abstract 201 Figure 1Diagram showing, from left to right, patient progression through QRISK3 score calculation and CTCA resultsConflict of InterestNone

ObjectivesAs stipulated by the 2016 NICE Chest Pain of recent onset guidelines, Computed Tomography Coronary Angiography (CTCA) is the recommended first line investigation when stable angina cannot be excluded by clinical assessment alone (1). Non-invasive Computed Fractional Flow Reserve (CT-FFR; Heartflow) is a method which utilises CT data as a diagnostic tool in identification of patients that may benefit from coronary revascularisation (2). We aimed to evaluate the diagnostic utility of CT-FFR in a district general setting in predicting significant coronary disease, defined as a positive functional test or the need for revascularisation (percutaneous or coronary artery bypass grafting).Method:This was a single centre, retrospective study of patients who had CTCA with subsequent FFR analysis from July 2019 to February 2021 (n=106). Electronic records were used to determine subsequent downstream testing and revascularisation. Lesions were documented as concordant or discordant; the former indicating an FFR result that was in keeping with the reported anatomical severity and the latter indicated discrepant results. Due to the intermediate nature of CAD-RADS 3 results, CT-FFR findings could not be defined as either concordant or discordant. Positive and negative predictive values of both CTCA and CT-FFR in identifying significant coronary pathology were calculated.Results:106 patients underwent CTCA with FFR analysis. 15 were excluded from this study due to suboptimal image quality preventing reliable FFR results. The Positive Predictive Value (PPV) and Negative Predictive Value (NPV) for CTCA alone in predicting functionally significant coronary disease was 41.3% and 86.9%, respectively. When the CAD-RADS 3 cohort was eliminated, PPV increased to 71.4% and the NPV remained unchanged (86.9%). The combination of CTCA with FFR gives a Positive and Negative Predictive Value of 48.4% and 83.3%, respectively. With elimination of the CAD-RADS 3 group, PPV was 85.7% and NPV of 80%.Abstract 152 Figure 1Revascularisation in the discordant and concordant CT-FFR groupsAbstract 152 Figure 2Outcomes of FFR analysis in the CAD-RADS 3 cohortConclusionAs supported by previously published literature, the negative predictive value of both CTCA in isolation, and when combined with FFR remains consistently reliable. Our study demonstrated that the positive predictive value is less reliable for both tests and supports the notion that these tests tend to over-estimate the severity of coronary lesions. However, at the extremes of the CAD-RADS spectrum, PPV is a much more robust variable, as highlighted by the increase in this value when CAD-RADS 3 results are removed from the cohort. This reiterates the importance of not letting test results detract from robust clinical assessment and symptom correlation, particularly in the context of discordant or intermediate results.References1. National Institute for health and care excellence (NICE) guidance for the assessment and diagnosis of recent-onset chest pain of suspected cardiac origin (clinical guideline 95 (CG95)).2. Pijls NH, van Schaardenburgh P, Manoharan G, et al. Percutaneous coronary intervention of functionally non-significant stenosis: 5-year follow-up of the defer study. J Am Coll Cardiol. 2007;49:2105–2111.Conflict of Interestnone

Anatomical variations in cardiac venous anatomy can occur. This case highlights an extremely rare anomaly of the great cardiac vein draining into the superior vena cava (SVC) depicted by computed tomography coronary angiography.

Thin-film catalysts are recently recognized as promising catalysts due to their reduced amount of materials and good catalytic activity, leading to low-cost and high-efficiency catalysts. A series of CuFeO x thin-film catalysts were prepared with different Fe contents using a one-step method as well as tested for the catalytic reduction of nitrous oxide (N 2 O) in the presence of CH 4 at a high GHSV of 185 000 mL/(g·h). The increase of iron strongly affects the dispersion and leads to the creation of a less-active segregated Fe2O3 phase, which was confirmed by XRD, EDX, and XPS outcomes. The results show that the synergistic properties between Cu and Fe, which affect the CuFeO x film catalysts in many aspects, such as the hollow-like texture, specific surface area, nano-crystallite size, the surface contents of Cu + , Fe 3+ , and oxygen species, the reductive strength and the strong active sites on the surface. Using DFT calculations, the adsorption and decomposition energy profiles of N 2 O on the CuFeO 2 (012) surface model were explored. The surface Fe-site and hollow-site are active for N 2 O decomposition, and the decomposition energy barriers on the Fe-site and the hollow-site are 1.02 eV and 1.25 eV respectively at 0 K. The strategy adopted here to tailor the activity through low-doping Fe-oxide catalysts could establish a promising way to improve the catalytic reduction of N 2 O with CH 4 .

BackgroundCoronary artery anomalies (CAAs) are a rare congenital condition and represent additional challenges in interventional treatment of coronary artery disease.Case summaryA 76-year-old male, was admitted for elective coronary angiography due to symptoms of typical angina. CT coronary angiography (CTCA) revealed all three coronary arteries arising from the right sinus of Valsalva, where right coronary artery (RCA) and left anterior descending artery (LAD) had common ostium with significant stenosis of ostio-proximal RCA and circumflex artery (CX) coming from a separate one. Percutaneous coronary intervention (PCI) of ostial RCA was planned and intravascular ultrasound (IVUS) in both RCA and LAD was done. Due to extensive calcification, prior to intended PCI, intravascular lithotripsy (IVL) was done. Following IVL and extensive predilatation drug eluting stent (DES) was implanted. Final IVUS was used to confirm optimal stent deployment in proximal RCA and to verify that LAD ostium was not compromised with RCA stent. Six months later, due to angina and positive stress test, repeated coronary angiography revealed a restenosis of the ostial RCA so the lesion was again treated with drug-coated balloon with optimal procedural results.ConclusionAlthough rare, CAAs could be associated with coronary artery disease and usually present additional challenge for interventional treatment. Advanced imaging modalities, including CTCA and IVUS, provide good procedural guidance during complex PCI procedures in patients with CAAs.

PurposeThe study investigates the comparative efficacy of the culturo-techno-contextual approach (CTCA) and the lecture method in students’ understanding of the human resource management (HRM) curriculum in Ghana.Design/methodology/approachA quasi-experimental design is employed to gather data from 245 4th-year undergraduate students studying HRM at a Ghanaian public university. The experimental group with a population of 115 students was taught with CTCA, whilst the control group with a population of 130 students was taught using the lecture method. The data was collected using the HRM achievement test (HRMAT). The data were analysed using the descriptive analysis of covariance technique with pre-test scores added as a covariate.FindingsThe findings reveal that the experimental group significantly outperformed the control group in the study of HRM, affirming the effectiveness of the CTCA over the lecture method.Originality/valueThis study is novel because it is the first paper to apply the CTCA to the study of HRM in the Ghanaian higher education space. It will, therefore, benefit HRM education in the country when educational stakeholders adopt a sequential and methodical approach to teaching and learning HRM using the CTCA.

Background 8–28% of patients infected with COVID-19 have evidence of cardiac injury, and this is associated with an adverse prognosis. The cardiovascular mechanisms of injury are poorly understood and speculative. We aim to use multimodality cardiac imaging including cardiac magnetic resonance (CMR) imaging, computed tomography coronary angiography (CTCA) and positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro- d -glucose integrated with computed tomography (18F-FDG-PET/CT) to identify the cardiac pathophysiological mechanisms related to COVID-19 infections. Methods This is a single-centre exploratory observational study aiming to recruit 50 patients with COVID-19 infection who will undergo cardiac biomarker sampling. Of these, 30 patients will undergo combined CTCA and 18F-FDG-PET/CT, followed by CMR. Prevalence of obstructive and non-obstructive atherosclerotic coronary disease will be assessed using CTCA. CMR will be used to identify and characterise myocardial disease including presence of cardiac dysfunction, myocardial fibrosis, myocardial oedema and myocardial infarction. 18F-FDG-PET/CT will identify vascular and cardiac inflammation. Primary endpoint will be the presence of cardiovascular pathology and the association with troponin levels. Discussion The results of the study will identify the presence and modality of cardiac injury associated COVID-19 infection, and the utility of multi-modality imaging in diagnosing such injury. This will further inform clinical decision making during the pandemic. Trial Registration : This study has been retrospectively registered at the ISRCTN registry (ID ISRCTN12154994) on 14th August 2020. Accessible at https://www.isrctn.com/ISRCTN12154994