1
|
Nurmohamed NS, van Rosendael AR, Danad I, Ngo-Metzger Q, Taub PR, Ray KK, Figtree G, Bonaca MP, Hsia J, Rodriguez F, Sandhu AT, Nieman K, Earls JP, Hoffmann U, Bax JJ, Min JK, Maron DJ, Bhatt DL. Atherosclerosis evaluation and cardiovascular risk estimation using coronary computed tomography angiography. Eur Heart J 2024; 45:1783-1800. [PMID: 38606889 PMCID: PMC11129796 DOI: 10.1093/eurheartj/ehae190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 02/13/2024] [Accepted: 03/13/2024] [Indexed: 04/13/2024] Open
Abstract
Clinical risk scores based on traditional risk factors of atherosclerosis correlate imprecisely to an individual's complex pathophysiological predisposition to atherosclerosis and provide limited accuracy for predicting major adverse cardiovascular events (MACE). Over the past two decades, computed tomography scanners and techniques for coronary computed tomography angiography (CCTA) analysis have substantially improved, enabling more precise atherosclerotic plaque quantification and characterization. The accuracy of CCTA for quantifying stenosis and atherosclerosis has been validated in numerous multicentre studies and has shown consistent incremental prognostic value for MACE over the clinical risk spectrum in different populations. Serial CCTA studies have advanced our understanding of vascular biology and atherosclerotic disease progression. The direct disease visualization of CCTA has the potential to be used synergistically with indirect markers of risk to significantly improve prevention of MACE, pending large-scale randomized evaluation.
Collapse
Affiliation(s)
- Nick S Nurmohamed
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Division of Cardiology, The George Washington University School of Medicine, Washington, DC, United States
| | | | - Ibrahim Danad
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Quyen Ngo-Metzger
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States
| | - Pam R Taub
- Section of Cardiology, Department of Medicine, University of California, San Diego, CA, United States
| | - Kausik K Ray
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Gemma Figtree
- Faculty of Medicine and Health, University of Sydney, Australia, St Leonards, Australia
| | - Marc P Bonaca
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Judith Hsia
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Fatima Rodriguez
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Alexander T Sandhu
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Koen Nieman
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - James P Earls
- Cleerly, Inc., Denver, CO, United States
- Department of Radiology, The George Washington University School of Medicine, Washington, DC, United States
| | | | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - David J Maron
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Deepak L Bhatt
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, Box 1030, New York, NY 10029, United States
| |
Collapse
|
2
|
Miller RJH, Killekar A, Shanbhag A, Bednarski B, Michalowska AM, Ruddy TD, Einstein AJ, Newby DE, Lemley M, Pieszko K, Van Kriekinge SD, Kavanagh PB, Liang JX, Huang C, Dey D, Berman DS, Slomka PJ. Predicting mortality from AI cardiac volumes mass and coronary calcium on chest computed tomography. Nat Commun 2024; 15:2747. [PMID: 38553462 PMCID: PMC10980695 DOI: 10.1038/s41467-024-46977-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 03/12/2024] [Indexed: 04/02/2024] Open
Abstract
Chest computed tomography is one of the most common diagnostic tests, with 15 million scans performed annually in the United States. Coronary calcium can be visualized on these scans, but other measures of cardiac risk such as atrial and ventricular volumes have classically required administration of contrast. Here we show that a fully automated pipeline, incorporating two artificial intelligence models, automatically quantifies coronary calcium, left atrial volume, left ventricular mass, and other cardiac chamber volumes in 29,687 patients from three cohorts. The model processes chamber volumes and coronary artery calcium with an end-to-end time of ~18 s, while failing to segment only 0.1% of cases. Coronary calcium, left atrial volume, and left ventricular mass index are independently associated with all-cause and cardiovascular mortality and significantly improve risk classification compared to identification of abnormalities by a radiologist. This automated approach can be integrated into clinical workflows to improve identification of abnormalities and risk stratification, allowing physicians to improve clinical decision-making.
Collapse
Affiliation(s)
- Robert J H Miller
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Aditya Killekar
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Aakash Shanbhag
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Bryan Bednarski
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Anna M Michalowska
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Terrence D Ruddy
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Andrew J Einstein
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, New York, NY, USA
- Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, New York, NY, USA
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Mark Lemley
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Konrad Pieszko
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Interventional Cardiology and Cardiac Surgery, University of Zielona Gora, Gora, Poland
| | - Serge D Van Kriekinge
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Paul B Kavanagh
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Joanna X Liang
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Cathleen Huang
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Damini Dey
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Berman
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Piotr J Slomka
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| |
Collapse
|
3
|
Sandfort V, Willemink MJ, Codari M, Mastrodicasa D, Fleischmann D. Denoising Multiphase Functional Cardiac CT Angiography Using Deep Learning and Synthetic Data. Radiol Artif Intell 2024; 6:e230153. [PMID: 38416035 PMCID: PMC10982910 DOI: 10.1148/ryai.230153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 02/06/2024] [Accepted: 02/13/2024] [Indexed: 02/29/2024]
Abstract
Coronary CT angiography is increasingly used for cardiac diagnosis. Dose modulation techniques can reduce radiation dose, but resulting functional images are noisy and challenging for functional analysis. This retrospective study describes and evaluates a deep learning method for denoising functional cardiac imaging, taking advantage of multiphase information in a three-dimensional convolutional neural network. Coronary CT angiograms (n = 566) were used to derive synthetic data for training. Deep learning-based image denoising was compared with unprocessed images and a standard noise reduction algorithm (block-matching and three-dimensional filtering [BM3D]). Noise and signal-to-noise ratio measurements, as well as expert evaluation of image quality, were performed. To validate the use of the denoised images for cardiac quantification, threshold-based segmentation was performed, and results were compared with manual measurements on unprocessed images. Deep learning-based denoised images showed significantly improved noise compared with standard denoising-based images (SD of left ventricular blood pool, 20.3 HU ± 42.5 [SD] vs 33.4 HU ± 39.8 for deep learning-based image denoising vs BM3D; P < .0001). Expert evaluations of image quality were significantly higher in deep learning-based denoised images compared with standard denoising. Semiautomatic left ventricular size measurements on deep learning-based denoised images showed excellent correlation with expert quantification on unprocessed images (intraclass correlation coefficient, 0.97). Deep learning-based denoising using a three-dimensional approach resulted in excellent denoising performance and facilitated valid automatic processing of cardiac functional imaging. Keywords: Cardiac CT Angiography, Deep Learning, Image Denoising Supplemental material is available for this article. © RSNA, 2024.
Collapse
Affiliation(s)
- Veit Sandfort
- From the Department of Radiology, Stanford University School of
Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105
| | - Martin J. Willemink
- From the Department of Radiology, Stanford University School of
Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105
| | - Marina Codari
- From the Department of Radiology, Stanford University School of
Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105
| | - Domenico Mastrodicasa
- From the Department of Radiology, Stanford University School of
Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105
| | - Dominik Fleischmann
- From the Department of Radiology, Stanford University School of
Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105
| |
Collapse
|
4
|
van Rosendael AR, Crabtree T, Bax JJ, Nakanishi R, Mushtaq S, Pontone G, Andreini D, Buechel RR, Gräni C, Feuchtner G, Patel TR, Choi AD, Al-Mallah M, Nabi F, Karlsberg RP, Rochitte CE, Alasnag M, Hamdan A, Cademartiri F, Marques H, Kalra D, German DM, Gupta H, Hadamitzky M, Deaño RC, Khalique O, Knaapen P, Hoffmann U, Earls J, Min JK, Danad I. Rationale and design of the CONFIRM2 (Quantitative COroNary CT Angiography Evaluation For Evaluation of Clinical Outcomes: An InteRnational, Multicenter Registry) study. J Cardiovasc Comput Tomogr 2024; 18:11-17. [PMID: 37951725 PMCID: PMC10923095 DOI: 10.1016/j.jcct.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 09/28/2023] [Accepted: 10/08/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND In the last 15 years, large registries and several randomized clinical trials have demonstrated the diagnostic and prognostic value of coronary computed tomography angiography (CCTA). Advances in CT scanner technology and developments of analytic tools now enable accurate quantification of coronary artery disease (CAD), including total coronary plaque volume and low attenuation plaque volume. The primary aim of CONFIRM2, (Quantitative COroNary CT Angiography Evaluation For Evaluation of Clinical Outcomes: An InteRnational, Multicenter Registry) is to perform comprehensive quantification of CCTA findings, including coronary, non-coronary cardiac, non-cardiac vascular, non-cardiac findings, and relate them to clinical variables and cardiovascular clinical outcomes. DESIGN CONFIRM2 is a multicenter, international observational cohort study designed to evaluate multidimensional associations between quantitative phenotype of cardiovascular disease and future adverse clinical outcomes in subjects undergoing clinically indicated CCTA. The targeted population is heterogenous and includes patients undergoing CCTA for atherosclerotic evaluation, valvular heart disease, congenital heart disease or pre-procedural evaluation. Automated software will be utilized for quantification of coronary plaque, stenosis, vascular morphology and cardiac structures for rapid and reproducible tissue characterization. Up to 30,000 patients will be included from up to 50 international multi-continental clinical CCTA sites and followed for 3-4 years. SUMMARY CONFIRM2 is one of the largest CCTA studies to establish the clinical value of a multiparametric approach to quantify the phenotype of cardiovascular disease by CCTA using automated imaging solutions.
Collapse
Affiliation(s)
| | | | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rine Nakanishi
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Saima Mushtaq
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Daniele Andreini
- Division of University Cardiology, IRCCS Galeazzi Sant'Ambrogio, Department of Biomedical and Clinical Sciences, University of Milan, Italy
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital and University of Zurich, Zurich, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Toral R Patel
- Cardiology at Stroobants Heart and Vascular Institute and UVA Cardiology, Lynchburg, VA, United States of America
| | - Andrew D Choi
- Cardiology and Radiology, George Washington University, Washington, DC, United States of America
| | - Mouaz Al-Mallah
- Department of Cardiology, Houston Methodist, Houston, TX, United States of America
| | - Faisal Nabi
- Department of Cardiology, Houston Methodist, Houston, TX, United States of America
| | - Ronald P Karlsberg
- Cardiovascular Research Foundation of Southern California, Cedars Sinai Heart Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Carlos E Rochitte
- Heart Institute, InCor, University of São Paulo Medical School, São Paulo, Brazil
| | - Mirvat Alasnag
- Cardiac Center, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Ashraf Hamdan
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
| | - Filippo Cademartiri
- Department of Imaging, Fondazione Monasterio/CNR, Pisa, Italy & SYNLAB IRCCS SDN, Naples, Italy
| | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa and Católica Medical School, Portugal
| | - Dinesh Kalra
- Division of Cardiology, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, United States of America
| | - David M German
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, United States of America
| | - Himanshu Gupta
- Cardiac Imaging, Heart and Vascular Institute, Valley Health System, Ridgewood, NJ, United States of America
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Roderick C Deaño
- Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Omar Khalique
- Division of Cardiovascular Imaging, St. Francis Hospital & Heart Center, Roslyn, NY, United States of America
| | - Paul Knaapen
- Department of Cardiology, Amsterdam University Medical Center, Location VUMC, Amsterdam, The Netherlands
| | - Udo Hoffmann
- Cleerly, Inc, Denver, CO, United States of America
| | - James Earls
- Cleerly, Inc, Denver, CO, United States of America
| | - James K Min
- Cleerly, Inc, Denver, CO, United States of America
| | - Ibrahim Danad
- Department of Cardiology, Amsterdam University Medical Center, Location VUMC, Amsterdam, The Netherlands; Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
| |
Collapse
|
5
|
Kadoya Y, Abtahi SS, Sritharan S, Omaygenc MO, Nehmeh A, Yam Y, Small GS, Chow BJW. The estimation of left ventricular function using prospective ECG-triggered coronary CT angiography. J Cardiovasc Comput Tomogr 2023; 17:429-435. [PMID: 37777389 DOI: 10.1016/j.jcct.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/23/2023] [Accepted: 09/20/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Coronary computed tomography angiography (CCTA) is vital for diagnosing coronary artery disease; however, prospective ECG-triggered acquisition, minimizing radiation exposure, limits left ventricular (LV) ejection fraction (EF) evaluation. We aimed to assess the feasibility and utility of LVEF100msec, a new index for estimating LV function using volumetric changes during 100 msec within systole. METHODS This retrospective study analyzed patients who underwent prospective ECG-triggered CCTA with systolic acquisition between January 2015 and June 2022. The LVEF100msec was calculated using the maximum and minimum LV volumes among the three phases (300, 350, and 400 msec post-QRS) and expressed as a percentage. Patients were classified into normal, mild-moderately reduced, or severely reduced LV function categories based on the reference test. The LVEF100msec was compared among groups, and the optimal cutoff value of LVEF100msec for predicting severe LV dysfunction was investigated. RESULTS The study included 271 patients (median age = 58 years, 52% male). LVEF was normal in 188 (69.4%), mild-moderately reduced in 57 (21.0%), and severely reduced in 26 (9.6%) patients. Median LVEF100msec value was 9.0 (6.7-12.6) for normal LV function, 4.7 (3.1-8.8) for mild-moderately reduced, and 2.9 (1.5-3.8) for severely reduced LV function. LVEF100msec values significantly differed among categories (p < 0.001). The optimal LVEF100msec cutoff for severe LV dysfunction was 4.3%, with an AUC of 0.924, sensitivity of 88%, and specificity of 89%. CONCLUSION The LVEF100msec may serve as a valuable indicator of severe LV dysfunction.
Collapse
Affiliation(s)
- Yoshito Kadoya
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, K1Y 4W7, Canada
| | - Shahin Sean Abtahi
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, K1Y 4W7, Canada
| | - Shankavi Sritharan
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, K1Y 4W7, Canada
| | - Mehmet Onur Omaygenc
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, K1Y 4W7, Canada
| | - Amal Nehmeh
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, K1Y 4W7, Canada
| | - Yeung Yam
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, K1Y 4W7, Canada
| | - Gary S Small
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, K1Y 4W7, Canada
| | - Benjamin J W Chow
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, K1Y 4W7, Canada.
| |
Collapse
|
6
|
Gebhard C, Maredziak M, Messerli M, Buechel RR, Lin F, Gransar H, Achenbach S, Al-Mallah MH, Andreini D, Bax JJ, Berman DS, Budoff MJ, Cademartiri F, Callister TQ, Chang HJ, Chinnaiyan K, Chow BJW, Cury RC, DeLago A, Feuchtner G, Hadamitzky M, Hausleiter J, Kim YJ, Leipsic J, Maffei E, Marques H, Gonçalves PDA, Pontone G, Raff GL, Rubinshtein R, Shaw LJ, Villines TC, Lu Y, Jones EC, Peña JM, Min JK, Kaufmann PA. Increased long-term mortality in women with high left ventricular ejection fraction: data from the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) long-term registry. Eur Heart J Cardiovasc Imaging 2021; 21:363-374. [PMID: 31985803 DOI: 10.1093/ehjci/jez321] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/15/2019] [Accepted: 12/23/2019] [Indexed: 12/19/2022] Open
Abstract
AIMS There are significant sex-specific differences in left ventricular ejection fraction (LVEF), with a higher LVEF being observed in women. We sought to assess the clinical relevance of an increased LVEF in women and men. METHODS AND RESULTS A total of 4632 patients from the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry (44.8% women; mean age 58.7 ± 13.2 years in men and 59.5 ± 13.3 years in women, P = 0.05), in whom LVEF was measured by cardiac computed tomography, were categorized according to LVEF (low <55%, normal 55-65%, and high >65%). The prevalence of high LVEF was similar in both sexes (33.5% in women and 32.5% in men, P = 0.46). After 6 years of follow-up, no difference in mortality was observed in patients with high LVEF in the overall cohort (P = 0.41). When data were stratified by sex, women with high LVEF died more often from any cause as compared to women with normal LVEF (8.6% vs. 7.1%, log rank P = 0.032), while an opposite trend was observed in men (5.8% vs. 6.8% in normal LVEF, log rank P = 0.89). Accordingly, a first order interaction term of male sex and high LVEF was significant (hazard ratios 0.63, 95% confidence intervals 0.41-0.98, P = 0.043) in a Cox regression model of all-cause mortality adjusted for age, cardiovascular risk factors, and severity of coronary artery disease (CAD). CONCLUSION Increased LVEF is highly prevalent in patients referred for evaluation of CAD and is associated with an increased risk of death in women, but not in men. Differentiating between normal and hyperdynamic left ventricles might improve risk stratification in women with CAD. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT01443637.
Collapse
Affiliation(s)
- Catherine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
| | - Monika Maredziak
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Fay Lin
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and New York Presbyterian Hospital, 1300 York Avenue, New York, NY 10065, USA
| | - Heidi Gransar
- Department of Imaging, Cedars-Sinai Medical Center, 8705 Gracie Allen Dr, Los Angeles, CA 90048, USA
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nuremberg, Maximiliansplatz 2, 91054 Erlangen, Germany
| | - Mouaz H Al-Mallah
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Cardiac Center, Ministry of National Guard, Health Affairs, Ar Rimayah, Riyadh 14611, Saudi Arabia
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS Milan, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 Leiden, The Netherlands
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars Sinai Medical Center, 8705 Gracie Allen Dr, Los Angeles, CA, USA
| | - Matthew J Budoff
- Department of Medicine, Los Angeles Biomedical Research Institute, 1124 W Carson St, Torrance, CA 90502, USA
| | - Filippo Cademartiri
- Cardiovascular Imaging Center, SDN IRCCS, via Gianturco 113, 80143 Naples, Italy
| | - Tracy Q Callister
- Tennessee Heart and Vascular Institute, 353 New Shackle Island Rd, Hendersonville, TN 37075, USA
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul 03722, South Korea
| | - Kavitha Chinnaiyan
- Department of Cardiology, William Beaumont Hospital, 3601 W 13 Mile Rd, Royal Oak, MI 48073, USA
| | - Benjamin J W Chow
- Department of Medicine and Radiology, University of Ottawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
| | - Ricardo C Cury
- Department of Radiology, Miami Cardiac and Vascular Institute, 8900 N Kendall Dr, Miami, FL 33176, USA
| | - Augustin DeLago
- Capitol Cardiology Associates, Corporate Woods 7 Southwoods Blvd., Albany, NY 12211, USA
| | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Christoph-Probst-Platz 1, Innrain 52, 6020 Innsbruck, Austria
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Lazarettstraße 36, 80636 Munich, Germany
| | - Joerg Hausleiter
- Medizinische Klinik I der Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany
| | - Yong-Jin Kim
- Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul, South Korea
| | - Jonathon Leipsic
- Department of Medicine and Radiology, University of British Columbia, 2775 Laurel St, Vancouver, BC V5Z 1M9, Canada
| | - Erica Maffei
- Department of Radiology, Area Vasta 1/ASUR Marche, Viale Federico Comandino, 70, 61029 Urbino, Italy
| | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Avenida Lusíada, 100, 1500-650 Lisboa, Portugal
| | - Pedro de Araújo Gonçalves
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Avenida Lusíada, 100, 1500-650 Lisboa, Portugal
| | - Gianluca Pontone
- Centro Cardiologico Monzino, IRCCS Milan, Via Carlo Parea, 4, 20138 Milan, Italy
| | - Gilbert L Raff
- Department of Cardiology, William Beaumont Hospital, 3601 W 13 Mile Rd, Royal Oak, MI 48073, USA
| | - Ronen Rubinshtein
- Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa 34362, Israel
| | - Leslee J Shaw
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and New York Presbyterian Hospital, 1300 York Avenue, New York, NY 10065, USA
| | - Todd C Villines
- Cardiology Service, Walter Reed National Military Center, 8901 Rockville Pike, Bethesda, MD 20889, USA
| | - Yao Lu
- Department of Healthcare Policy and Research, New York-Presbyterian Hospital and the Weill Cornell Medical College, 402 E. 67th Street, New York, NY 10065, USA
| | - Erica C Jones
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and New York Presbyterian Hospital, 1300 York Avenue, New York, NY 10065, USA
| | - Jessica M Peña
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and New York Presbyterian Hospital, 1300 York Avenue, New York, NY 10065, USA
| | - James K Min
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and New York Presbyterian Hospital, 1300 York Avenue, New York, NY 10065, USA
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| |
Collapse
|
7
|
Kerkhof PLM, Handly N. Insights from physiology applied to interpretation of supranormal ejection fraction in women. Eur Heart J Cardiovasc Imaging 2021; 21:375-377. [PMID: 32068778 PMCID: PMC7082723 DOI: 10.1093/ehjci/jeaa018] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Peter L M Kerkhof
- Department Radiology and Nuclear Medicine, Amsterdam University Medical Centers, VUmc, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Neal Handly
- Department Emergency Medicine, Drexel University College of Medicine, 2900 W Queen Ln, Philadelphia, PA 19119, USA
| |
Collapse
|
8
|
Accuracy of Diastolic Function by Cardiac Computed Tomography Relative to Echo-Doppler: Additive Clinical and Prognostic Value. J Comput Assist Tomogr 2021; 45:242-247. [PMID: 33661156 DOI: 10.1097/rct.0000000000001136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES We aimed to assess the agreement between cardiac computed tomography (CT) and echo for diagnosing advanced diastolic dysfunction (DD) and to assess the prognostic value of CT-based parameters. METHODS One hundred one consecutive patients who had both CT and echo-Doppler within 1 month were included. Diastolic function was assessed by CT using a previously validated method, based on left atrial volume changes, and compared with echocardiography grades 0 to 3. Patients were followed up for a combined outcome of cardiac death and hospitalization for heart failure. RESULTS By operating characteristic curve analysis, the best CT-based parameter for predicting advanced DD based on echo was left atrial total emptying fraction. Left atrial total emptying fraction <36% had sensitivity/specificity of 76%/86%. Agreement between echo and CT for detecting advanced (grades 2/3) DD was substantial (κ = 0.62, P < 0.0001). By Cox multivariate analysis, left atrial total emptying fraction was a powerful independent predictor of outcome at 3 years (hazard ratio, 8.0 [2.2-28.4]; P < 0.0001). CONCLUSIONS Computed tomography-based assessment of DD has a good agreement with echo-Doppler-based results. Left atrial total emptying fraction seems to have a strong prognostic value.
Collapse
|
9
|
van Rosendael AR, Bax AM, van den Hoogen IJ, Smit JM, Al'Aref SJ, Achenbach S, Al-Mallah MH, Andreini D, Berman DS, Budoff MJ, Cademartiri F, Callister TQ, Chang HJ, Chinnaiyan K, Chow BJW, Cury RC, DeLago A, Feuchtner G, Hadamitzky M, Hausleiter J, Kaufmann PA, Kim YJ, Leipsic JA, Maffei E, Marques H, de Araújo Gonçalves P, Pontone G, Raff GL, Rubinshtein R, Villines TC, Gransar H, Lu Y, Peña JM, Lin FY, Shaw LJ, Narula J, Min JK, Bax JJ. Associations between dyspnoea, coronary atherosclerosis, and cardiovascular outcomes: results from the long-term follow-up CONFIRM registry. Eur Heart J Cardiovasc Imaging 2020; 23:266-274. [PMID: 33538308 DOI: 10.1093/ehjci/jeaa323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 11/17/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS The relationship between dyspnoea, coronary artery disease (CAD), and major cardiovascular events (MACE) is poorly understood. This study evaluated (i) the association of dyspnoea with the severity of anatomical CAD by coronary computed tomography angiography (CCTA) and (ii) to which extent CAD explains MACE in patients with dyspnoea. METHODS AND RESULTS From the international COronary CT Angiography EvaluatioN for Clinical Outcomes: An InteRnational Multicenter (CONFIRM) registry, 4425 patients (750 with dyspnoea) with suspected but without known CAD were included and prospectively followed for ≥5 years. First, the association of dyspnoea with CAD severity was assessed using logistic regression analysis. Second, the prognostic value of dyspnoea for MACE (myocardial infarction and death), and specifically, the interaction between dyspnoea and CAD severity was investigated using Cox proportional-hazard analysis. Mean patient age was 60.3 ± 11.9 years, 63% of patients were male and 592 MACE events occurred during a median follow-up duration of 5.4 (IQR 5.1-6.0) years. On uni- and multivariable analysis (adjusting for age, sex, body mass index, chest pain typicality, and risk factors), dyspnoea was associated with two- and three-vessel/left main (LM) obstructive CAD. The presence of dyspnoea increased the risk for MACE [hazard ratio (HR) 1.57, 95% confidence interval (CI): 1.29-1.90], which was modified after adjusting for clinical predictors and CAD severity (HR 1.26, 95% CI: 1.02-1.55). Conversely, when stratified by CAD severity, dyspnoea did not provide incremental prognostic value in one-, two-, or three-vessel/LM obstructive CAD, but dyspnoea did provide incremental prognostic value in non-obstructive CAD. CONCLUSION In patients with suspected CAD, dyspnoea was independently associated with severe obstructive CAD on CCTA. The severity of obstructive CAD explained the elevated MACE rates in patients presenting with dyspnoea, but in patients with non-obstructive CAD, dyspnoea portended additional risk.
Collapse
Affiliation(s)
- Alexander R van Rosendael
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.,Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - A Maxim Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Inge J van den Hoogen
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Jeff M Smit
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Subhi J Al'Aref
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Mouaz H Al-Mallah
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Daniele Andreini
- Department of Cardiology, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Matthew J Budoff
- Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | - Filippo Cademartiri
- Department of Radiology, Cardiovascular Imaging Center, SDN IRCCS, Naples, Italy
| | - Tracy Q Callister
- Department of Cardiology, Tennessee Heart and Vascular Institute, Hendersonville, TN, USA
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | | | - Benjamin J W Chow
- Department of Medicine and Radiology, University of Ottawa, Ottawa, ON, Canada
| | - Ricardo C Cury
- Department of Radiology, Miami Cardiac and Vascular Institute, Miami, FL, USA
| | | | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Joerg Hausleiter
- Department of Radiology, Medizinische Klinik I der Ludwig-Maximilians-Universität München, Munich, Germany
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital, Zurich, Switzerland.,Department of Medicine, University of Zurich, Zurich, Switzerland
| | - Yong-Jin Kim
- Department of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Erica Maffei
- Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy
| | - Hugo Marques
- Department of Cardiology, UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal
| | | | - Gianluca Pontone
- Department of Cardiology, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy
| | - Gilbert L Raff
- Department of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA
| | - Ronen Rubinshtein
- Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Todd C Villines
- Department of Cardiology, Cardiology Service, Walter Reed National Military Center, Bethesda, MD, USA
| | - Heidi Gransar
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Yao Lu
- Department of Healthcare Policy and Research, New York-Presbyterian Hospital, The Weill Cornell Medical College, New York, NY, USA
| | - Jessica M Peña
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Fay Y Lin
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Leslee J Shaw
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Jagat Narula
- Department of Cardiology, Icahn School of Medicine, Mount Sinai Hospital, New York, NY, USA
| | - James K Min
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| |
Collapse
|
10
|
Toia P, La Grutta L, Sollami G, Clemente A, Gagliardo C, Galia M, Maffei E, Midiri M, Cademartiri F. Technical development in cardiac CT: current standards and future improvements-a narrative review. Cardiovasc Diagn Ther 2020; 10:2018-2035. [PMID: 33381441 DOI: 10.21037/cdt-20-527] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Non-invasive depiction of coronary arteries has been a great challenge for imaging specialists since the introduction of computed tomography (CT). Technological development together with improvements in spatial, temporal, and contrast resolution, progressively allowed implementation of the current clinical role of the CT assessment of coronary arteries. Several technological evolutions including hardware and software solutions of CT scanners have been developed to improve spatial and temporal resolution. The main challenges of cardiac computed tomography (CCT) are currently plaque characterization, functional assessment of stenosis and radiation dose reduction. In this review, we will discuss current standards and future improvements in CCT.
Collapse
Affiliation(s)
- Patrizia Toia
- Department of Biomedicine, Neurosciences and Advanced Diagnostic (BiND), University of Palermo, Palermo, Italy
| | - Ludovico La Grutta
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities (ProMISE), University of Palermo, Palermo, Italy
| | - Giulia Sollami
- Department of Biomedicine, Neurosciences and Advanced Diagnostic (BiND), University of Palermo, Palermo, Italy
| | - Alberto Clemente
- Fondazione Toscana G. Monasterio CNR - Regione Toscana, Pisa and Massa, Italy
| | - Cesare Gagliardo
- Department of Biomedicine, Neurosciences and Advanced Diagnostic (BiND), University of Palermo, Palermo, Italy
| | - Massimo Galia
- Department of Biomedicine, Neurosciences and Advanced Diagnostic (BiND), University of Palermo, Palermo, Italy
| | - Erica Maffei
- Department of Radiology, Area Vasta 1, ASUR Marche, Urbino (PU), Italy
| | - Massimo Midiri
- Department of Biomedicine, Neurosciences and Advanced Diagnostic (BiND), University of Palermo, Palermo, Italy
| | | |
Collapse
|
11
|
Andreini D, Conte E, Mushtaq S, Pontone G, Guglielmo M, Baggiano A, Annoni A, Mancini ME, Formenti A, Nicoli F, Tanzilli A, Muscogiuri G, Magini A, Agostoni P, Bartorelli AL, Fiorentini C, Pepi M. Rationale and design of the EPLURIBUS Study (Evidence for a comPrehensive evaLUation of left ventRicle dysfnctIon By a whole-heart coverage cardiac compUted tomography Scanner). J Cardiovasc Med (Hagerstown) 2020; 21:812-819. [DOI: 10.2459/jcm.0000000000001051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
12
|
Reference values for mid-diastolic right ventricular volume in population referred for cardiac computed tomography: An additional diagnostic value to cardiac computed tomography. J Cardiovasc Comput Tomogr 2020; 14:226-232. [DOI: 10.1016/j.jcct.2019.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/19/2019] [Accepted: 11/20/2019] [Indexed: 11/17/2022]
|
13
|
Lee JW, Nam KJ, Kim JY, Jeong YJ, Lee G, Park SM, Lim SJ, Choo KS. Simultaneous Assessment of Left Ventricular Function and Coronary Artery Anatomy by Third-generation Dual-source Computed Tomography Using a Low Radiation Dose. J Cardiovasc Imaging 2019; 28:21-32. [PMID: 31805621 PMCID: PMC6992922 DOI: 10.4250/jcvi.2019.0066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/16/2019] [Accepted: 10/20/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND To assess left ventricular function and coronary artery simultaneously by third-generation dual-source computed tomography (CT) using a low radiation dose. METHODS A total of 48 patients (36 men, 12 women; mean age 57.0 ± 9.5 years) who underwent both electrocardiography-gated cardiac CT angiography (CCTA) using 70–90 kVp and echocardiography were included in this retrospective study. The correlation between left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), and left ventricular ejection fraction (LVEF) measured using CCTA and echocardiography was determined. The quality of coronary artery images was analyzed using a 4-point scale (1, excellent; 4, poor). The effective radiation dose of CCTA was calculated. RESULTS Mean heart rate during the CT examination was 59.9 ± 9.9 bpm (range 38–79) and the body mass index of 48 patients was 24.5 ± 2.6 kg/m2 (range 17.0–29.4). LVEDV, LVESV, and LVEF measured using CCTA and echocardiography demonstrated a fair to moderate correlation (Pearson correlation coefficient: r = 0.395, p = 0.005 for LVEDV; r = 0.509. p < 0.001 for LVESV; r = 0.551, p < 0.001 for LVEF). Average image quality score of coronary arteries was 1.0 ± 0.1 (range 1–2). A total of 99.0% (783 of 791) of segments had an excellent image quality score, and 1.0% (8 of 791) of segments had a good score. Mean effective radiation dose was 2.2 ± 0.7 mSv. CONCLUSIONS Third-generation dual-source CT using a low tube voltage simultaneously provides information regarding LV function and coronary artery disease at a low radiation dose. It can serve as an alternative option for functional assessment, particularly when other imaging modalities are inadequate.
Collapse
Affiliation(s)
- Ji Won Lee
- Department of Radiology, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Kyung Jin Nam
- Department of Radiology, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jin You Kim
- Department of Radiology, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Yeon Joo Jeong
- Department of Radiology, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Geewon Lee
- Department of Radiology, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - So Min Park
- Department of Radiology, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Soo Jin Lim
- Department of Cardiology, Kim Hae Kangil Hospital, Gimhae, Korea
| | - Ki Seok Choo
- Department of Radiology, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Yangsan Hospital, Yangsan, Korea.
| |
Collapse
|
14
|
Computed Tomography in Heart Failure. CURRENT CARDIOVASCULAR IMAGING REPORTS 2019. [DOI: 10.1007/s12410-019-9512-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
15
|
Cardiac CT Assessment of Right and Left Ventricular and Valvular Function. CURRENT CARDIOVASCULAR IMAGING REPORTS 2019. [DOI: 10.1007/s12410-019-9495-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
16
|
Kobayashi K, Wakasa S, Sato K, Kanai S, Date H, Kimura S, Oyama-Manabe N, Matsui Y. Quantitative analysis of regional endocardial geometry dynamics from 4D cardiac CT images: endocardial tracking based on the iterative closest point with an integrated scale estimation. ACTA ACUST UNITED AC 2019; 64:055009. [DOI: 10.1088/1361-6560/ab009a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
17
|
Over-expression of a cardiac-specific human dopamine D5 receptor mutation in mice causes a dilated cardiomyopathy through ROS over-generation by NADPH oxidase activation and Nrf2 degradation. Redox Biol 2018; 19:134-146. [PMID: 30153650 PMCID: PMC6111036 DOI: 10.1016/j.redox.2018.07.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 07/10/2018] [Accepted: 07/12/2018] [Indexed: 12/26/2022] Open
Abstract
Dilated cardiomyopathy (DCM) is a severe disorder caused by medications or genetic mutations. D5 dopamine receptor (D5R) gene knockout (D5-/-) mice have cardiac hypertrophy and high blood pressure. To investigate the role and mechanism by which the D5R regulates cardiac function, we generated cardiac-specific human D5R F173L(hD5F173L-TG) and cardiac-specific human D5R wild-type (hD5WT-TG) transgenic mice, and H9c2 cells stably expressing hD5F173L and hD5WT. We found that cardiac-specific hD5F173L-TG mice, relative to hD5WT-TG mice, presented with DCM and increased cardiac expression of cardiac injury markers, NADPH oxidase activity, Nrf2 degradation, and activated ERK1/2/JNK pathway. H9c2-hD5F173L cells also had an increase in NADPH oxidase activity, Nrf2 degradation, and phospho-JNK (p-JNK) expression. A Nrf2 inhibitor also increased p-JNK expression in H9c2-hD5F173L cells but not in H9c2-hD5WT cells. We suggest that the D5R may play an important role in the preservation of normal heart function by inhibiting the production of reactive oxygen species, via inhibition of NADPH oxidase, Nrf2 degradation, and ERK1/2/JNK pathways.
Collapse
|
18
|
CT-derived left ventricular global strain in aortic valve stenosis patients: A comparative analysis pre and post transcatheter aortic valve implantation. J Cardiovasc Comput Tomogr 2018; 12:240-244. [DOI: 10.1016/j.jcct.2018.01.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 01/10/2018] [Accepted: 01/23/2018] [Indexed: 11/19/2022]
|
19
|
Andreini D, Conte E, Mushtaq S. Cardiac-CT in 2017: Over the coronary artery assessment. Int J Cardiol 2017; 249:497-499. [PMID: 28970038 DOI: 10.1016/j.ijcard.2017.09.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/14/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy.
| | | | | |
Collapse
|
20
|
Cardiac death in patients with left ventricular aneurysm, remodeling and myocardial viability by gated 99mTc-MIBI SPECT and gated 18F-FDG PET. Int J Cardiovasc Imaging 2017; 34:485-493. [DOI: 10.1007/s10554-017-1234-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 08/10/2017] [Indexed: 10/19/2022]
|
21
|
Radiation Dose Levels of Retrospectively ECG-Gated Coronary CT Angiography Using 70-kVp Tube Voltage in Patients with High or Irregular Heart Rates. Acad Radiol 2017; 24:30-37. [PMID: 28029558 DOI: 10.1016/j.acra.2016.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 08/02/2016] [Accepted: 08/04/2016] [Indexed: 01/08/2023]
Abstract
RATIONALE AND OBJECTIVES Despite ongoing technical refinements, coronary computed tomography angiography (cCTA) remains challenging in its diagnostic value by electrocardiographic (ECG) misregistration and motion artifacts, which commonly occur in patients with atrial fibrillation and high or irregular heart rates. The aim of this study was to evaluate the radiation dose and the number of inconclusive coronary segments at cCTA using retrospective ECG gating at 100 and 70 kV. MATERIALS AND METHODS With institutional review board approval, 154 patients (median age 54 years, 98 men) with high or irregular heart rate prospectively underwent retrospectively ECG-gated cCTA without tube current modulation on a third-generation dual-source computed tomography (DSCT) system at 70 kV (n = 103) or on a second-generation DSCT system at 100 kV (n = 51). Images were reconstructed in best diastolic phase (BDP), best systolic phase (BSP), and in all phases (APs) at 10% intervals across the R-R cycle. Objective and subjective image qualities were evaluated as well as the presence of motion artifacts with the three different reconstruction approaches. RESULTS The mean heart rate was 93 ± 16 bpm. The mean effective radiation dose was 4.5 mSv for 70 kV compared to 8.4 mSv for 100 kV (P < 0.05). At BDP reconstruction, 71% (n = 110) of the patients showed motion artifacts in one or more coronary segments. At BSP reconstruction, the number of patients with motion artifacts decreased to 37% (n = 57). In contrast, if images were reconstructed with the AP approach, all vessels and coronary segments were evaluable with both cCTA protocols. CONCLUSIONS Retrospectively ECG-gated cCTA at 70 kV results in 52% decreased radiation dose. Further using the AP algorithm allowed for diagnostic evaluation of all coronary segments for stenosis, in contrast to BDP or BSP phase alone.
Collapse
|
22
|
Tanabe Y, Kido T, Kurata A, Sawada S, Suekuni H, Kido T, Yokoi T, Uetani T, Inoue K, Miyagawa M, Mochizuki T. Three-dimensional maximum principal strain using cardiac computed tomography for identification of myocardial infarction. Eur Radiol 2016; 27:1667-1675. [PMID: 27541353 DOI: 10.1007/s00330-016-4550-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 08/04/2016] [Accepted: 08/09/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the feasibility of three-dimensional (3D) maximum principal strain (MP-strain) derived from cardiac computed tomography (CT) for detecting myocardial infarction (MI). METHODS Forty-three patients who underwent cardiac CT and magnetic resonance imaging (MRI) were retrospectively selected. Using the voxel tracking of motion coherence algorithm, the peak CT MP-strain was measured using the 16-segment model. With the trans-mural extent of late gadolinium enhancement (LGE) and the distance from MI, all segments were classified into four groups (infarcted, border, adjacent, and remote segments); infarcted and border segments were defined as MI with LGE positive. Diagnostic performance of MP-strain for detecting MI was compared with per cent systolic wall thickening (%SWT) assessed by MRI using receiver-operating characteristic curve analysis at a segment level. RESULTS Of 672 segments excluding16 segments influenced by artefacts, 193 were diagnosed as MI. Sensitivity and specificity of peak MP-strain to identify MI were 81 % [95 % confidence interval (95 % CI): 74-88 %] and 86 % (81-92 %) compared with %SWT: 76 % (60-95 %) and 68 % (48-84 %), respectively. The area under the curve of peak MP-strain was superior to %SWT [0.90 (0.87-0.93) vs. 0.80 (0.76-0.83), p < 0.05]. CONCLUSIONS CT MP-strain has a potential to provide incremental value to coronary CT angiography for detecting MI. KEY POINTS • CT MP-strain allows for three-dimensional assessment of regional cardiac function. • CT-MP strain has high diagnostic accuracy for detecting myocardial infarction. • CT-MP strain may assist in tissue characterisation of myocardium assessed by LGE-MRI. • CT-MP strain provides incremental values to coronary CTA for detecting myocardial infarction.
Collapse
Affiliation(s)
- Yuki Tanabe
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, 791-0295, Japan.
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, 791-0295, Japan
| | - Akira Kurata
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, 791-0295, Japan
| | - Shun Sawada
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, 791-0295, Japan
| | - Hiroshi Suekuni
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, 791-0295, Japan
| | - Tomoyuki Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, 791-0295, Japan
| | - Takahiro Yokoi
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, 791-0295, Japan
| | - Teruyoshi Uetani
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, 791-0295, Japan
| | - Katsuji Inoue
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, 791-0295, Japan
| | - Masao Miyagawa
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, 791-0295, Japan
| | - Teruhito Mochizuki
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, 791-0295, Japan
| |
Collapse
|
23
|
Gebhard C, Buechel RR, Stähli BE, Gransar H, Achenbach S, Berman DS, Budoff MJ, Callister TQ, Chow B, Dunning A, Al-Mallah MH, Cademartiri F, Chinnaiyan K, Rubinshtein R, Marques H, DeLago A, Villines TC, Hadamitzky M, Hausleiter J, Shaw LJ, Cury RC, Feuchtner G, Kim YJ, Maffei E, Raff G, Pontone G, Andreini D, Chang HJ, Leipsic J, Min JK, Kaufmann PA. Impact of age and sex on left ventricular function determined by coronary computed tomographic angiography: results from the prospective multicentre CONFIRM study. Eur Heart J Cardiovasc Imaging 2016; 18:990-1000. [DOI: 10.1093/ehjci/jew142] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 06/07/2016] [Indexed: 02/06/2023] Open
|
24
|
Hoebers LP, Elias J, van Dongen IM, Ouweneel DM, Claessen BE, Piek JJ, Henriques JP. The impact of the location of a chronic total occlusion in a non-infarct-related artery on long-term mortality in ST-elevation myocardial infarction patients. EUROINTERVENTION 2016; 12:423-30. [DOI: 10.4244/eijv12i4a75] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
25
|
Rizvi A, Deaño RC, Bachman DP, Xiong G, Min JK, Truong QA. Analysis of ventricular function by CT. J Cardiovasc Comput Tomogr 2015; 9:1-12. [PMID: 25576407 PMCID: PMC4329068 DOI: 10.1016/j.jcct.2014.11.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 11/14/2014] [Indexed: 11/22/2022]
Abstract
The assessment of ventricular function, cardiac chamber dimensions, and ventricular mass is fundamental for clinical diagnosis, risk assessment, therapeutic decisions, and prognosis in patients with cardiac disease. Although cardiac CT is a noninvasive imaging technique often used for the assessment of coronary artery disease, it can also be used to obtain important data about left and right ventricular function and morphology. In this review, we will discuss the clinical indications for the use of cardiac CT for ventricular analysis, review the evidence on the assessment of ventricular function compared with existing imaging modalities such cardiac magnetic resonance imaging and echocardiography, provide a typical cardiac CT protocol for image acquisition and postprocessing for ventricular analysis, and provide step-by-step instructions to acquire multiplanar cardiac views for ventricular assessment from the standard axial, coronal, and sagittal planes. Furthermore, both qualitative and quantitative assessments of ventricular function as well as sample reporting are detailed.
Collapse
Affiliation(s)
- Asim Rizvi
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, Suite 108, 413 East 69th Street, New York, NY 10021, USA
| | - Roderick C Deaño
- Division of Cardiovascular Disease, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA
| | - Daniel P Bachman
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, Suite 108, 413 East 69th Street, New York, NY 10021, USA
| | - Guanglei Xiong
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, Suite 108, 413 East 69th Street, New York, NY 10021, USA
| | - James K Min
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, Suite 108, 413 East 69th Street, New York, NY 10021, USA; Division of Cardiovascular Disease, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA
| | - Quynh A Truong
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, Suite 108, 413 East 69th Street, New York, NY 10021, USA; Division of Cardiovascular Disease, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA.
| |
Collapse
|