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Frederiks P, Castaldi G, McCutcheon K, Bennett J. Platinum chromium everolimus-eluting stents for the treatment of (complex) coronary artery disease; from SYNERGY™ to the MEGATRON™. Expert Rev Med Devices 2024:1-11. [PMID: 38720513 DOI: 10.1080/17434440.2024.2353722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 05/07/2024] [Indexed: 05/14/2024]
Abstract
INTRODUCTION The introduction of drug-eluting coronary stents (DES) into clinical practice in 2002 represented a major milestone in the treatment of obstructive coronary artery disease. Over the years, significant advances in polymer coating and in antiproliferative agent technology have further improved the safety and clinical performance of newer-generation DES. AREAS COVERED Development of platinum chromium (PtCr) alloys with high radial strength and high radiopacity have enabled the design of new, thin-strut, flexible, and highly trackable stent platforms, while simultaneously improving stent visibility. These advances have facilitated complex percutaneous treatment of a diverse population of patients in clinical practice. This review will provide an overview of the evolution in PtCr everolimus-eluting stents from PROMUS Element™ to SYNERGY™ to the recently introduced SYNERGY MEGATRON™. The clinical data will be summarized and put into perspective, especially focusing on the role of the SYNERGY™ and MEGATRON™ platforms in the treatment of complex coronary artery disease and high-risk patients. EXPERT OPINION The SYNERGY™ stent demonstrates favorable clinical efficacy and safety outcome data, and whilst the clinical data on MEGATRON™ are sparse, early experience is promising. The specific overexpansion capabilities, visibility, and radial strength of the MEGATRON™ are attractive features for complex coronary interventions.
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Affiliation(s)
- Pascal Frederiks
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Gianluca Castaldi
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Keir McCutcheon
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
- Department of Cardiology, Lady Pohamba Private Hospital, Windhoek, Namibia
| | - Johan Bennett
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
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Wu B, Kheiwa A, Swamy P, Mamas MA, Tedford RJ, Alasnag M, Parwani P, Abramov D. Clinical Significance of Coronary Arterial Dominance: A Review of the Literature. J Am Heart Assoc 2024; 13:e032851. [PMID: 38639360 DOI: 10.1161/jaha.123.032851] [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] [Indexed: 04/20/2024]
Abstract
Coronary dominance describes the anatomic variation of coronary arterial supply, notably as it relates to perfusion of the inferior cardiac territories. Differences in the development and outcome in select disease states between coronary dominance patterns are increasingly recognized. In particular, observational studies have identified higher prevalence of poor outcomes in left coronary dominance in the setting of ischemic, conduction, and valvular disease. In this qualitative literature review, we summarize anatomic, physiologic, and clinical implications of differences in coronary dominance to highlight current understanding and gaps in the literature that should warrant further studies.
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Affiliation(s)
- Bovey Wu
- Department of Medicine Loma Linda University Medical Center Loma Linda CA USA
| | - Ahmed Kheiwa
- Department of Cardiology Loma Linda University Medical Center Loma Linda CA USA
| | - Pooja Swamy
- Department of Cardiology Loma Linda University Medical Center Loma Linda CA USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research Keele University Stoke-on-Trent United Kingdom
| | - Ryan J Tedford
- Department of Medicine, Division of Cardiology Medical University of South Carolina Charleston SC USA
| | - Mirvat Alasnag
- Cardiac Center King Fahd Armed Forces Hospital Jeddah Saudi Arabia
| | - Purvi Parwani
- Department of Cardiology Loma Linda University Medical Center Loma Linda CA USA
| | - Dmitry Abramov
- Department of Cardiology Loma Linda University Medical Center Loma Linda CA USA
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Rubens FD, Fremes SE, Grubic N, Fergusson D, Taljaard M, van Walraven C. Outcomes following coronary artery bypass grafting with multiple arterial grafting by pump status in men and women. J Thorac Cardiovasc Surg 2024; 167:1796-1807.e15. [PMID: 36935299 DOI: 10.1016/j.jtcvs.2023.02.008] [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: 10/23/2022] [Revised: 01/17/2023] [Accepted: 02/04/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Multiple arterial grafting (MAG) and off-pump surgery are strategies proposed to improve outcomes with coronary artery bypass grafting (CABG). This study was conducted to determine the impact of off-pump surgery on outcomes after CABG with MAG in men and women. METHODS This cohort study used population-based data to identify all Ontarians undergoing isolated CABG with MAG between October 2008 and September 2019. The primary outcome was all-cause mortality. Secondary outcomes included major adverse cardiac and cerebrovascular events (MACCE; hospitalization for stroke, myocardial infarction hospitalization or heart failure, or repeat revascularization). Analysis used propensity-score overlap-weighted cause-specific Cox proportional hazard regression. RESULTS A total of 2989 women (1188 off-pump, 1801 on-pump) and 16,209 men (6065 off-pump, 10,144 on-pump) underwent MAG with a median follow-up of 5.0 years (interquartile range, 2.7-8.0) years. Compared to the on-pump approach, all-cause mortality was not changed with off-pump status (hazard ratio [HR] in women: 1.25 [95% CI, 0.83-1.88]; in men: 1.08 [95% CI, 0.85-1.37]). In women, the risk of MACCE was significantly higher off-pump (HR, 1.45; 95% CI, 1.04-2.03), with nonsignificantly increased risk observed for all component outcomes. CONCLUSIONS In patients undergoing CABG with MAG, this population-based analysis found no association between pump status and survival in either men or women. However, it did suggest that off-pump MAG in women may be associated with an increased risk of MACCE.
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Affiliation(s)
- Fraser D Rubens
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
| | - Stephen E Fremes
- Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Nicholas Grubic
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Dean Fergusson
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Monica Taljaard
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Carl van Walraven
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Bouisset F, Ohashi H, Seiki R, Mizukami T, Norgaard BL, Stottrup NB, Zivelonghi C, Ko B, Otake H, Sonck J, Koo BK, Amano T, Wilgenhof A, Agostoni P, Collet C. Computed coronary tomography angiography for left main diameter assessment. J Cardiovasc Comput Tomogr 2024:S1934-5925(24)00078-9. [PMID: 38697882 DOI: 10.1016/j.jcct.2024.04.004] [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: 03/14/2024] [Revised: 04/04/2024] [Accepted: 04/11/2024] [Indexed: 05/05/2024]
Affiliation(s)
- Frederic Bouisset
- Cardiovascular Center OLV, Aalst, Belgium; Department of Cardiology, Toulouse University Hospital, Toulouse, France
| | - Hirofumi Ohashi
- Cardiovascular Center OLV, Aalst, Belgium; Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | | | - Takuya Mizukami
- Cardiovascular Center OLV, Aalst, Belgium; Department of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | | | | | - Carlo Zivelonghi
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Brian Ko
- Monash Cardiovascular Research Centre, Monash University and Monash Heart, Monash Health, Clayton, Victoria, Australia
| | - Hiromasa Otake
- Division of Cardiovascular Medicine, Department of Internal Medicine Kobe University Graduate School of Medicine Kobe Japan, Japan
| | | | - Bon-Kwon Koo
- Department of Internal Medicine, Cardiology Centre, Seoul National University Hospital, Seoul, South Korea
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | - Adriaan Wilgenhof
- Cardiovascular Center OLV, Aalst, Belgium; Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
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Herten VRLM, Hampe N, Takx RAP, Franssen KJ, Wang Y, Sucha D, Henriques JP, Leiner T, Planken RN, Isgum I. Automatic Coronary Artery Plaque Quantification and CAD-RADS Prediction Using Mesh Priors. IEEE TRANSACTIONS ON MEDICAL IMAGING 2024; 43:1272-1283. [PMID: 37862273 DOI: 10.1109/tmi.2023.3326243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
Coronary artery disease (CAD) remains the leading cause of death worldwide. Patients with suspected CAD undergo coronary CT angiography (CCTA) to evaluate the risk of cardiovascular events and determine the treatment. Clinical analysis of coronary arteries in CCTA comprises the identification of atherosclerotic plaque, as well as the grading of any coronary artery stenosis typically obtained through the CAD-Reporting and Data System (CAD-RADS). This requires analysis of the coronary lumen and plaque. While voxel-wise segmentation is a commonly used approach in various segmentation tasks, it does not guarantee topologically plausible shapes. To address this, in this work, we propose to directly infer surface meshes for coronary artery lumen and plaque based on a centerline prior and use it in the downstream task of CAD-RADS scoring. The method is developed and evaluated using a total of 2407 CCTA scans. Our method achieved lesion-wise volume intraclass correlation coefficients of 0.98, 0.79, and 0.85 for calcified, non-calcified, and total plaque volume respectively. Patient-level CAD-RADS categorization was evaluated on a representative hold-out test set of 300 scans, for which the achieved linearly weighted kappa ( κ ) was 0.75. CAD-RADS categorization on the set of 658 scans from another hospital and scanner led to a κ of 0.71. The results demonstrate that direct inference of coronary artery meshes for lumen and plaque is feasible, and allows for the automated prediction of routinely performed CAD-RADS categorization.
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van Driest FY, Broersen A, van der Geest RJ, Wouter Jukema J, Scholte AJHA, Dijkstra J. Automatic Quantification of Local Plaque Thickness Differences as Assessed by Serial Coronary Computed Tomography Angiography Using Scan-Quality-Based Vessel-Specific Thresholds. Cardiol Ther 2024; 13:103-116. [PMID: 38062285 PMCID: PMC10899547 DOI: 10.1007/s40119-023-00341-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/03/2023] [Indexed: 02/29/2024] Open
Abstract
INTRODUCTION The use of serial coronary computed tomography angiography (CCTA) allows for the early assessment of coronary plaque progression, a crucial factor in averting major adverse cardiac events (MACEs). Traditionally, serial CCTA is assessed using anatomical landmarks to match baseline and follow-up scans. Recently, a tool has been developed that allows for the automatic quantification of local plaque thickness differences in serial CCTA utilizing plaque contour delineation. The aim of this study was to determine thresholds of plaque thickness differences that define whether there is plaque progression and/or regression. These thresholds depend on the contrast-to-noise ratio (CNR). METHODS Plaque thickness differences between two scans acquired at the same moment in time should always be zero. The negative and positive differences in plaque contour delineation in these scans were used along with the CNR in order to create calibration graphs on which a linear regression analysis was performed. This analysis was conducted on a cohort of 50 patients referred for a CCTA due to chest complaints. A total of 300 coronary vessels were analyzed. First, plaque contours were semi-automatically determined for all major epicardial coronary vessels. Second, manual drawings of seven regions of interest (ROIs) per scan were used to quantify the scan quality based on the CNR for each vessel. RESULTS A linear regression analysis was performed on the CNR and negative and positive plaque contour delineation differences. Accounting for the standard error of the estimate, the linear regression analysis revealed that above 1.009 - 0.002 × CNR there is an increase in plaque thickness (progression), and below - 1.638 + 0.012 × CNR there is a decrease in plaque thickness (regression). CONCLUSION This study demonstrates the feasibility of developing vessel-specific, quality-based thresholds for visualizing local plaque thickness differences evaluated by serial CCTA. These thresholds have the potential to facilitate the early detection of atherosclerosis progression.
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Affiliation(s)
- Finn Y van Driest
- Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Alexander Broersen
- Department of Radiology, Division of Image Processing, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Rob J van der Geest
- Department of Radiology, Division of Image Processing, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Arthur J H A Scholte
- Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Jouke Dijkstra
- Department of Radiology, Division of Image Processing, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
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Tsugu T, Tanaka K, Belsack D, Nagatomo Y, Tsugu M, Argacha JF, Cosyns B, Buls N, De Maeseneer M, De Mey J. Impact of vessel morphology on CT-derived fractional-flow-reserve in non-obstructive coronary artery disease in right coronary artery. Eur Radiol 2024; 34:1836-1845. [PMID: 37658136 PMCID: PMC10873436 DOI: 10.1007/s00330-023-09972-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/16/2023] [Accepted: 05/28/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVES Computed tomography (CT)-derived fractional flow reserve (FFRCT) decreases continuously from proximal to distal segments of the vessel due to the influence of various factors even in non-obstructive coronary artery disease (NOCAD). It is known that FFRCT is dependent on vessel-length, but the relationship with other vessel morphologies remains to be explained. PURPOSE To investigate morphological aspects of the vessels that influence FFRCT in NOCAD in the right coronary artery (RCA). METHODS A total of 443 patients who underwent both FFRCT and invasive coronary angiography, with < 50% RCA stenosis, were evaluated. Enrolled RCA vessels were classified into two groups according to distal FFRCT: FFRCT ≤ 0.80 (n = 60) and FFRCT > 0.80 (n = 383). Vessel morphology (vessel length, lumen diameter, lumen volume, and plaque volume) and left-ventricular mass were assessed. The ratio of lumen volume and vessel length was defined as V/L ratio. RESULTS Whereas vessel-length was almost the same between FFRCT ≤ 0.80 and > 0.80, lumen volume and V/L ratio were significantly lower in FFRCT ≤ 0.80. Distal FFRCT correlated with plaque-related parameters (low-attenuation plaque, intermediate-attenuation plaque, and calcified plaque) and vessel-related parameters (proximal and distal vessel diameter, vessel length, lumen volume, and V/L ratio). Among all vessel-related parameters, V/L ratio showed the highest correlation with distal FFRCT (r = 0.61, p < 0.0001). Multivariable analysis showed that calcified plaque volume was the strongest predictor of distal FFRCT, followed by V/L ratio (β-coefficient = 0.48, p = 0.03). V/L ratio was the strongest predictor of a distal FFRCT ≤ 0.80 (cut-off 8.1 mm3/mm, AUC 0.88, sensitivity 90.0%, specificity 76.7%, 95% CI 0.84-0.93, p < 0.0001). CONCLUSIONS Our study suggests that V/L ratio can be a measure to predict subclinical coronary perfusion disturbance. CLINICAL RELEVANCE STATEMENT A novel marker of the ratio of lumen volume to vessel length (V/L ratio) is the strongest predictor of a distal CT-derived fractional flow reserve (FFRCT) and may have the potential to improve the diagnostic accuracy of FFRCT. KEY POINTS • Physiological FFRCT decline depends not only on vessel length but also on the lumen volume in non-obstructive coronary artery disease in the right coronary artery. • FFRCT correlates with plaque-related parameters (low-attenuation plaque, intermediate-attenuation plaque, and calcified plaque) and vessel-related parameters (proximal and distal vessel diameter, vessel length, lumen volume, and V/L ratio). • Of vessel-related parameters, V/L ratio is the strongest predictor of a distal FFRCT and an optimal cut-off value of 8.1 mm3/mm.
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Affiliation(s)
- Toshimitsu Tsugu
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Jette, Brussels, Belgium.
| | - Kaoru Tanaka
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Jette, Brussels, Belgium
| | - Dries Belsack
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Jette, Brussels, Belgium
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College Hospital, Tokorozawa, Japan
| | - Mayuko Tsugu
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Jette, Brussels, Belgium
| | - Jean-François Argacha
- Cardiology, Centrum Voor Hart- en Vaatziekten, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Bernard Cosyns
- Cardiology, Centrum Voor Hart- en Vaatziekten, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Nico Buls
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Jette, Brussels, Belgium
| | - Michel De Maeseneer
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Jette, Brussels, Belgium
| | - Johan De Mey
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Jette, Brussels, Belgium
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Yang CC, Hou KY. A CNN-based denoising method trained with images acquired with electron density phantoms for thin-sliced coronary artery calcium scans. J Appl Clin Med Phys 2024; 25:e14287. [PMID: 38346094 DOI: 10.1002/acm2.14287] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/13/2023] [Accepted: 01/16/2024] [Indexed: 03/13/2024] Open
Abstract
PURPOSE This work proposed a convolutional neural network (CNN)-based method trained with images acquired with electron density phantoms to reduce quantum noise for coronary artery calcium (CAC) scans reconstructed with slice thickness less than 3 mm. METHODS A DenseNet model was used to estimate quantum noise for CAC scans reconstructed with slice thickness of 0.5, 1.0 and 1.5 mm. Training data was acquired using electron density phantoms in three different sizes. The label images of the CNN model were real noise maps, while the input images of the CNN model were pseudo noise maps. Image denoising was conducted by subtracting the CNN output images from thin-sliced CAC scans. The efficacy of the proposed method was verified through both phantom study and patient study. RESULTS By means of phantom study, the proposed method was proven effective in reducing quantum noise in CAC scans reconstructed with 1.5-mm slice thickness without causing significant texture change or variation in HU values. With regard to patient study, calcifications were more clear on the denoised CAC scans reconstructed with slice thickness of 0.5, 1.0 and 1.5 mm than on 3-mm slice images, while over-smooth changes were not observed in the denoised CAC scans reconstructed with 1.5-mm slice thickness. CONCLUSION Our results demonstrated that the electron density phantoms can be used to generate training data for the proposed CNN-based denoising method to reduce quantum noise for CAC scans reconstructed with 1.5-mm slice thickness. Because anthropomorphic phantom is not a necessity, our method could make image denoising more practical in routine clinical practice.
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Affiliation(s)
- Ching-Ching Yang
- Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Kuei-Yuan Hou
- Department of Radiology, Cathay General Hospital, Taipei, Taiwan
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Sim DS, Hyun DY, Hong YJ, Kim JH, Ahn Y, Jeong MH, Lee SR, Chae JK, Park KH, Koh YY, Yun KH, Oh SK, Joo SJ, Hwang SH, Park JP, Rhew JY, Kim SH, Cho JH, Lee SU, Kang DG. Clinical Outcome after Everolimus-Eluting Stent Implantation for Small Vessel Coronary Artery Disease: XIENCE Asia Small Vessel Study. Chonnam Med J 2024; 60:78-86. [PMID: 38304131 PMCID: PMC10828083 DOI: 10.4068/cmj.2024.60.1.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/11/2023] [Accepted: 10/17/2023] [Indexed: 02/03/2024] Open
Abstract
There are limited data on outcomes after implantation of everolimus-eluting stents (EES) in East Asian patients with small vessel coronary lesions. A total of 1,600 patients treated with XIENCE EES (Abbott Vascular, CA, USA) were divided into the small vessel group treated with one ≤2.5 mm stent (n=119) and the non-small vessel group treated with one ≥2.75 mm stent (n=933). The primary end point was a patient-oriented composite outcome (POCO), a composite of all-cause death, myocardial infarction (MI), and any repeat revascularization at 12 months. The key secondary end point was a device-oriented composite outcome (DOCO), a composite of cardiovascular death, target-vessel MI, and target lesion revascularization at 12 months. The small vessel group was more often female, hypertensive, less likely to present with ST-elevation MI, and more often treated for the left circumflex artery, whereas the non-small vessel group more often had type B2/C lesions, underwent intravascular ultrasound, and received unfractionated heparin. In the propensity matched cohort, the mean stent diameter was 2.5±0.0 mm and 3.1±0.4 mm in the small and non-small vessel groups, respectively. Propensity-adjusted POCO at 12 months was 6.0% in the small vessel group and 4.3% in the non-small vessel group (p=0.558). There was no significant difference in DOCO at 12 months (small vessel group: 4.3% and non-small vessel group: 1.7%, p=0.270). Outcomes of XIENCE EES for small vessel disease were comparable to those for non-small vessel disease at 12-month clinical follow-up in real-world Korean patients.
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Affiliation(s)
- Doo Sun Sim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Dae Young Hyun
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Young Joon Hong
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Ju Han Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Youngkeun Ahn
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Sang Rok Lee
- Department of Cardiology, Jeonbuk National University Hospital, Jeonju, Korea
| | - Jei Keon Chae
- Department of Cardiology, Jeonbuk National University Hospital, Jeonju, Korea
| | - Keun Ho Park
- Department of Cardiology, Chosun University Hospital, Gwangju, Korea
| | - Young Youp Koh
- Department of Cardiology, Chosun University Hospital, Gwangju, Korea
| | - Kyeong Ho Yun
- Department of Cardiology, Wonkwang University Hospital, Iksan, Korea
| | - Seok Kyu Oh
- Department of Cardiology, Wonkwang University Hospital, Iksan, Korea
| | - Seung Jae Joo
- Department of Cardiology, Jeju National University Hospital, Jeju, Korea
| | - Sun Ho Hwang
- Department of Cardiology, KS Hospital, Gwangju, Korea
| | - Jong Pil Park
- Department of Cardiology, Presbyterian Medical Center, Jeonju, Korea
| | - Jay Young Rhew
- Department of Cardiology, Presbyterian Medical Center, Jeonju, Korea
| | - Su Hyun Kim
- Department of Cardiology, St. Carollo General Hospital, Suncheon, Korea
| | - Jang Hyun Cho
- Department of Cardiology, St. Carollo General Hospital, Suncheon, Korea
| | - Seung Uk Lee
- Department of Cardiology, Kwangju Christian Hospital, Gwangju, Korea
| | - Dong Goo Kang
- Department of Cardiology, Cheomdan Medical Center, Gwangju, Korea
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Keramati H, de Vecchi A, Rajani R, Niederer SA. Using Gaussian process for velocity reconstruction after coronary stenosis applicable in positron emission particle tracking: An in-silico study. PLoS One 2023; 18:e0295789. [PMID: 38096169 PMCID: PMC10721050 DOI: 10.1371/journal.pone.0295789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/28/2023] [Indexed: 12/17/2023] Open
Abstract
Accurate velocity reconstruction is essential for assessing coronary artery disease. We propose a Gaussian process method to reconstruct the velocity profile using the sparse data of the positron emission particle tracking (PEPT) in a biological environment, which allows the measurement of tracer particle velocity to infer fluid velocity fields. We investigated the influence of tracer particle quantity and detection time interval on flow reconstruction accuracy. Three models were used to represent different levels of stenosis and anatomical complexity: a narrowed straight tube, an idealized coronary bifurcation with stenosis, and patient-specific coronary arteries with a stenotic left circumflex artery. Computational fluid dynamics (CFD), particle tracking, and the Gaussian process of kriging were employed to simulate and reconstruct the pulsatile flow field. The study examined the error and uncertainty in velocity profile reconstruction after stenosis by comparing particle-derived flow velocity with the CFD solution. Using 600 particles (15 batches of 40 particles) released in the main coronary artery, the time-averaged error in velocity reconstruction ranged from 13.4% (no occlusion) to 161% (70% occlusion) in patient-specific anatomy. The error in maximum cross-sectional velocity at peak flow was consistently below 10% in all cases. PEPT and kriging tended to overestimate area-averaged velocity in higher occlusion cases but accurately predicted maximum cross-sectional velocity, particularly at peak flow. Kriging was shown to be useful to estimate the maximum velocity after the stenosis in the absence of negative near-wall velocity.
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Affiliation(s)
- Hamed Keramati
- School of Bioengineering and Imaging Sciences, King’s College London, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Adelaide de Vecchi
- School of Bioengineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Ronak Rajani
- School of Bioengineering and Imaging Sciences, King’s College London, London, United Kingdom
- Cardiology Department, Guy’s and St, Thomas’s Hospital, London, United Kingdom
| | - Steven A. Niederer
- School of Bioengineering and Imaging Sciences, King’s College London, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Turing Research and Innovation Cluster in Digital Twins (TRIC: DT), The Alan Turing Institute, London, United Kingdom
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Mohan A, Gopalakrishnan A, Chandran R, Joseph S, Mathew AJ, S Nair A, Sudhakaran R. Examining the Influence of Gender, Age, and Dominance on the Caliber of Normal Coronary Arteries in the South Indian Population. Cureus 2023; 15:e51146. [PMID: 38283514 PMCID: PMC10811496 DOI: 10.7759/cureus.51146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 01/30/2024] Open
Abstract
Background The diameter of coronary arteries serves as a potential predictor of coronary artery diseases (CADs) that can lead to sudden death. Factors such as gender, age, and coronary artery dominance play a role in influencing the size of normal coronary arteries. The outcome of coronary interventions, to a certain extent, depends on luminal size. Given the considerable variability in luminal size within the normal population, establishing the baseline size of normal coronary arteries in a specific population can aid in estimating the severity of coronary disease and predicting the outcome of interventional procedures. The current study focuses on estimating the luminal diameter of normal coronary arteries within the context of age, gender, and cardiac dominance in the South Indian population. Methods A retrospective study was conducted utilizing coronary angiograms with normal findings from 453 patients, comprising 257 males and 196 females, with a mean age of 54.66±10.66 years. These patients attended the outpatient service of the Cardiology Department at Amrita Institute of Medical Sciences, Kochi, a quaternary care center, between 2015 and 2017. The luminal diameter of coronary arteries is represented as mean±SD in millimeters. Results In the present study, we noted that the largest coronary artery was the left main coronary artery (LMCA, 3.59±0.58 mm), followed by the left anterior descending artery (LAD, 3.50±0.52 mm), the left circumflex artery (LCX, 3.31±0.57 mm), and the right coronary artery (RCA, 3.18±0.57 mm). We further broke down the statistics to evolve a gender pattern. In the raw comparison of data, the luminal size of coronary arteries in males was greater than in females, and statistical significance was noted in all except LAD. In males, the largest coronary artery was LMCA (3.70±0.60 mm), followed by LAD (3.54±0.48 mm), LCX (3.36±0.58 mm), and RCA (3.25±0.62 mm). In females, no significant size difference was observed between LMCA (3.45±0.53 mm) and LAD (3.46±0.55 mm). Females exhibited an increase in the size of LMCA with advancing age. Regardless of right or left cardiac dominance, LMCA was consistently larger than RCA in both genders. However, in cases of co-dominance, only males demonstrated significantly larger LMCA. Conclusion Precise knowledge of the size of normal coronary arteries and their influence by gender, age, and dominance can be crucial for the comprehensive evaluation of CADs and the success of interventional procedures.
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Affiliation(s)
- Anu Mohan
- Anatomy, Government Medical College, Thrissur, IND
| | - Asha Gopalakrishnan
- Anatomy, Amrita School of Medicine, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, IND
| | | | - Susan Joseph
- Anatomy, Amrita School of Medicine, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, IND
| | - Asha Joselet Mathew
- Anatomy, Amrita School of Medicine, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, IND
| | - Anjaly S Nair
- Biostatistics, Amrita School of Medicine, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, IND
| | - Rathi Sudhakaran
- Anatomy, Amrita School of Medicine, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, IND
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Frolov A, Lobov A, Kabilov M, Zainullina B, Tupikin A, Shishkova D, Markova V, Sinitskaya A, Grigoriev E, Markova Y, Kutikhin A. Multi-Omics Profiling of Human Endothelial Cells from the Coronary Artery and Internal Thoracic Artery Reveals Molecular but Not Functional Heterogeneity. Int J Mol Sci 2023; 24:15032. [PMID: 37834480 PMCID: PMC10573276 DOI: 10.3390/ijms241915032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/02/2023] [Accepted: 10/08/2023] [Indexed: 10/15/2023] Open
Abstract
Major adverse cardiovascular events occurring upon coronary artery bypass graft surgery are typically accompanied by endothelial dysfunction. Total arterial revascularisation, which employs both left and right internal thoracic arteries instead of the saphenous vein to create a bypass, is associated with better mid- and long-term outcomes. We suggested that molecular profiles of human coronary artery endothelial cells (HCAECs) and human internal mammary artery endothelial cells (HITAECs) are coherent in terms of transcriptomic and proteomic signatures, which were then investigated by RNA sequencing and ultra-high performance liquid chromatography-mass spectrometry, respectively. Both HCAECs and HITAECs overexpressed molecules responsible for the synthesis of extracellular matrix (ECM) components, basement membrane assembly, cell-ECM adhesion, organisation of intercellular junctions, and secretion of extracellular vesicles. HCAECs were characterised by higher enrichment with molecular signatures of basement membrane construction, collagen biosynthesis and folding, and formation of intercellular junctions, whilst HITAECs were notable for augmented pro-inflammatory signaling, intensive synthesis of proteins and nitrogen compounds, and enhanced ribosome biogenesis. Despite HCAECs and HITAECs showing a certain degree of molecular heterogeneity, no specific markers at the protein level have been identified. Coherence of differentially expressed molecular categories in HCAECs and HITAECs suggests synergistic interactions between these ECs in a bypass surgery scenario.
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Affiliation(s)
- Alexey Frolov
- Department of Experimental Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, Kemerovo 650002, Russia; (A.F.); (D.S.); (V.M.); (A.S.); (E.G.); (Y.M.)
| | - Arseniy Lobov
- Laboratory for Regenerative Biomedicine, Research Institute of Cytology of the Russian Academy of Sciences, 4 Tikhoretskiy Prospekt, St. Petersburg 194064, Russia;
| | - Marsel Kabilov
- SB RAS Genomics Core Facility, Institute of Chemical Biology and Fundamental Medicine of the Siberian Branch of the Russian Academy of Sciences, 8 Prospekt Akademika Lavrentieva, Novosibirsk 630090, Russia; (M.K.); (A.T.)
| | - Bozhana Zainullina
- Centre for Molecular and Cell Technologies, Research Park, Saint Petersburg State University, 7/9 Universitetskaya Embankment, St. Petersburg 199034, Russia;
| | - Alexey Tupikin
- SB RAS Genomics Core Facility, Institute of Chemical Biology and Fundamental Medicine of the Siberian Branch of the Russian Academy of Sciences, 8 Prospekt Akademika Lavrentieva, Novosibirsk 630090, Russia; (M.K.); (A.T.)
| | - Daria Shishkova
- Department of Experimental Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, Kemerovo 650002, Russia; (A.F.); (D.S.); (V.M.); (A.S.); (E.G.); (Y.M.)
| | - Victoria Markova
- Department of Experimental Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, Kemerovo 650002, Russia; (A.F.); (D.S.); (V.M.); (A.S.); (E.G.); (Y.M.)
| | - Anna Sinitskaya
- Department of Experimental Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, Kemerovo 650002, Russia; (A.F.); (D.S.); (V.M.); (A.S.); (E.G.); (Y.M.)
| | - Evgeny Grigoriev
- Department of Experimental Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, Kemerovo 650002, Russia; (A.F.); (D.S.); (V.M.); (A.S.); (E.G.); (Y.M.)
| | - Yulia Markova
- Department of Experimental Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, Kemerovo 650002, Russia; (A.F.); (D.S.); (V.M.); (A.S.); (E.G.); (Y.M.)
| | - Anton Kutikhin
- Department of Experimental Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, Kemerovo 650002, Russia; (A.F.); (D.S.); (V.M.); (A.S.); (E.G.); (Y.M.)
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13
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Munneke AG, Lumens J, Arts T, Prinzen FW, Delhaas T. Myocardial perfusion and flow reserve in the asynchronous heart: mechanistic insight from a computational model. J Appl Physiol (1985) 2023; 135:489-499. [PMID: 37439238 PMCID: PMC10538979 DOI: 10.1152/japplphysiol.00181.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/08/2023] [Accepted: 06/27/2023] [Indexed: 07/14/2023] Open
Abstract
The tight coupling between myocardial oxygen demand and supply has been recognized for decades, but it remains controversial whether this coupling persists under asynchronous activation, such as during left bundle branch block (LBBB). Furthermore, it is unclear whether the amount of local cardiac wall growth, following longer-lasting asynchronous activation, can explain differences in myocardial perfusion distribution between subjects. For a better understanding of these matters, we built upon our existing modeling framework for cardiac mechanics-to-perfusion coupling by incorporating coronary autoregulation. Regional coronary flow was regulated with a vasodilator signal based on regional demand, as estimated from regional fiber stress-strain area. Volume of left ventricular wall segments was adapted with chronic asynchronous activation toward a homogeneous distribution of myocardial oxygen demand per tissue weight. Modeling results show that 1) both myocardial oxygen demand and supply are decreased in early activated regions and increased in late-activated regions; 2) but that regional hyperemic flow remains unaffected; while 3) regional myocardial flow reserve (the ratio of hyperemic to resting myocardial flow) decreases with increases in absolute regional myocardial oxygen demand as well as with decreases in wall thickness. These findings suggest that septal hypoperfusion in LBBB represents an autoregulatory response to reduced myocardial oxygen demand. Furthermore, oxygen demand-driven remodeling of wall mass can explain asymmetric hypertrophy and the related homogenization of myocardial perfusion and flow reserve. Finally, the inconsistent observations of myocardial perfusion distribution can primarily be explained by the degree of dyssynchrony, the degree of asymmetric hypertrophy, and the imaging modality used.NEW & NOTEWORTHY This versatile modeling framework couples myocardial oxygen demand to oxygen supply and myocardial growth, enabling simulation of resting and hyperemic myocardial flow during acute and chronic asynchronous ventricular activation. Model-based findings suggest that reported inconsistencies in myocardial perfusion and flow reserve responses with asynchronous ventricular activation between patients can primarily be explained by the degree of dyssynchrony and wall mass remodeling, which together determine the heterogeneity in regional oxygen demand and, hence, supply with autoregulation.
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Affiliation(s)
- Anneloes G Munneke
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Joost Lumens
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Theo Arts
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Frits W Prinzen
- Department of Physiology, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Tammo Delhaas
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
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14
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Shyu TC, Wu CJ, Fu YC, Peng YC, Chuang TY, Kuo HC, Hsieh KS, Tai IH. Prevalence of antecedent Kawasaki disease in young adults with suspected acute coronary syndrome in high incidence cohort. Front Cardiovasc Med 2023; 10:1167771. [PMID: 37600029 PMCID: PMC10436480 DOI: 10.3389/fcvm.2023.1167771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
Background Acute coronary syndrome (ACS) in early adulthood (<40 years old) may be associated with unrevealed diagnoses of Kawasaki disease (KD) in childhood. Daniels et al. showed that 5% of young adults with acute coronary syndrome might have antecedent Kawasaki disease in a cohort with Kawasaki disease incidence rates ranging from about 9 to 20 per 100,000 children under 5 years of age. However, there is no relevant research from the cohort with higher incidence rates (>80-100 per 100,000 children under 5 years of age) of Kawasaki disease. Methods We conducted a multicenter, retrospective study by reviewing medical records and angiographic data from two institutions (middle and southern Taiwan, respectively) of adults <40 years of age who underwent coronary angiography for clinically suspected acute coronary syndrome (2009-2019). Angiographic images were independently analyzed by three cardiologists who were blinded to the medical records. Demographic and laboratory data and risk factors of coronary artery disease were integrated to assess the likelihood of antecedent KD. Results All 323 young adults underwent coronary angiography, and 27 had coronary aneurysms. The patients' clinical and angiographic characteristics were evaluated, and 7.4% had aneurysms likely to be associated with KD. Most subjects were male (23/24), and their low-density lipoprotein (LDL) levels were significantly higher (p = 0.028) than those of subjects unlikely to have KD. Conclusion This study proposed that the cohort with higher Kawasaki disease incidence rates may have a higher prevalence of young adult ACS associated with antecedent KD. The importance of determining the clinical therapeutic significance of antecedent Kawasaki disease in young adult ACS warrants advanced research. Higher LDL levels may have a long-term cardiovascular impact in KD patients with persistent coronary aneurysms.
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Affiliation(s)
- Tsung-Cheng Shyu
- Department of Pediatric Cardiology, Structural/Congenital Heart Disease and Echocardiography Center, China Medical University Children’s Hospital, Taichung, Taiwan
- Department of Pediatrics, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chiung-Jen Wu
- Division of Cardiology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Yun-Ching Fu
- Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yi-Chin Peng
- Department of Pediatric Cardiology, Structural/Congenital Heart Disease and Echocardiography Center, China Medical University Children’s Hospital, Taichung, Taiwan
- Department of Pediatrics, College of Medicine, China Medical University, Taichung, Taiwan
| | - Tzu-Yao Chuang
- Department of Pediatric Cardiology, Structural/Congenital Heart Disease and Echocardiography Center, China Medical University Children’s Hospital, Taichung, Taiwan
- Department of Pediatrics, College of Medicine, China Medical University, Taichung, Taiwan
| | - Ho-Chang Kuo
- Kawasaki Disease Center and Pediatrics, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Kai-Sheng Hsieh
- Department of Pediatric Cardiology, Structural/Congenital Heart Disease and Echocardiography Center, China Medical University Children’s Hospital, Taichung, Taiwan
- Department of Pediatrics, College of Medicine, China Medical University, Taichung, Taiwan
| | - I-Hsin Tai
- Department of Pediatric Cardiology, Structural/Congenital Heart Disease and Echocardiography Center, China Medical University Children’s Hospital, Taichung, Taiwan
- Department of Pediatrics, College of Medicine, China Medical University, Taichung, Taiwan
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15
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Crielaard H, Hoogewerf M, van Putte BP, van de Vosse FN, Vlachojannis GJ, Stecher D, Stijnen M, Doevendans PA. Evaluating the Arteriotomy Size of a New Sutureless Coronary Anastomosis Using a Finite Volume Approach. J Cardiovasc Transl Res 2023; 16:916-926. [PMID: 36943615 PMCID: PMC10480236 DOI: 10.1007/s12265-023-10367-9] [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: 05/05/2022] [Accepted: 02/27/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVES The ELANA® Heart Bypass creates a standardized sutureless anastomosis. Hereby, we investigate the influence of arteriotomy and graft size on coronary hemodynamics. METHODS A computational fluid dynamics (CFD) model was developed. Arteriotomy size (standard 1.43 mm2; varied 0.94 - 3.6 mm2) and graft diameter (standard 2.5 mm; varied 1.5 - 5.0 mm) were independent parameters. Outcome parameters were coronary pressure and flow, and fractional flow reserve (FFR). RESULTS The current size ELANA (arteriotomy 1.43 mm2) presented an estimated FFR 0.65 (39 mL/min). Enlarging arteriotomy increased FFR, coronary pressure, and flow. All reached a maximum once the arteriotomy (2.80 mm2) surpassed the coronary cross-sectional area (2.69 mm2, i.e. 1.85 mm diameter), presenting an estimated FFR 0.75 (46 mL/min). Increasing graft diameter was positively related to FFR, coronary pressure, and flow. CONCLUSION The ratio between the required minimal coronary diameter for application and the ELANA arteriotomy size effectuates a pressure drop that could be clinically relevant. Additional research and eventual lengthening of the anastomosis is advised.
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Affiliation(s)
- Hanneke Crielaard
- LifeTec Group, Eindhoven, The Netherlands
- Department of Cardiovascular Biomechanics, University of Eindhoven, Eindhoven, The Netherlands
- Department of Biomedical Engineering, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marieke Hoogewerf
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands.
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
| | - Bart P van Putte
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Frans N van de Vosse
- Department of Cardiovascular Biomechanics, University of Eindhoven, Eindhoven, The Netherlands
| | - Georgios J Vlachojannis
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands
| | - David Stecher
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Pieter A Doevendans
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
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16
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Kusk MW, Bromark CS, Hestbek-Møller M, Davidsen LØ, Precht H, Brage K. Pill or pump? Nitroglycerin 0.5 mg tablet vs 0.8 mg spray: Effect on proximal vessel diameters at Coronary CT Angiography (CCTA). Radiography (Lond) 2023; 29:918-925. [PMID: 37478639 DOI: 10.1016/j.radi.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/22/2023] [Accepted: 07/07/2023] [Indexed: 07/23/2023]
Abstract
INTRODUCTION The administration of sublingual Nitroglycerin (NTG) prior to CT coronary angiography (CCTA) can be perfomed using pump spray or tablets. Choice of method seems to be based on local preference, rather than published guidelines. This retrospective analysis tested whether proximal coronary diameters differed dependent on the sublingual administration of 0.5 mg Nitroglycerin (NTG) tablets or 0.8 mg NTG spray. METHODS 287 ECG-gated CCTA studies with optimal image quality and Agatston scores<400 were included in this retrospective analysis. 143 of the patients were dosed with NTG tablets at a dose of 0.5 mg prior to CCTA. 144 patients received 2 puffs of 0.4 mg NTG spray for a total dose of 8 mg. All were scanned on a second-generation Dual Source CT. Diameters of proximal segments of Left Main (LM), Right (RCA), Left Anterior (LAD) and circumflex (CX) coronary arteries were measured using semi-automatic electronic callipers by two blinded readers. Results were summarised as the mean of maximum and minimum diameters. Sex-specific analysis of diameters was carried out using repeated-measures ANOVA for each vessel. Agreement between readers was examined with Bland-Altman analysis and intra-class-correlation coefficient (ICC). RESULTS No significant differences in coronary diameters were found except in the RCA for women and LM for men. In both cases, diameters were smaller in the spray group (11 and 9%, respectively). Reader agreement was excellent, with ICC>0.96 for all vessels, and no significant bias, except in CX (0.03 mm). CONCLUSIONS We found no evidence for the systematic superiority of either administration method in proximal coronary vessels. IMPLICATIONS FOR PRACTICE Choosing between tablet or spray NTG prior to CCTA can be guided by practical, economical and hygienic considerations alone.
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Affiliation(s)
- M W Kusk
- Imaging Research Initiative SouthWest (IRIS), Esbjerg, Denmark; Department of Radiology and Nuclear Medicine, Esbjerg Hospital - University Hospital of Southern Denmark, Denmark; University College Dublin, School of Medicine, Dublin, Ireland; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - C S Bromark
- Department of Radiology, Lillebaelt Hospital, University Hospitals of Southern Denmark, Kolding, Denmark
| | - M Hestbek-Møller
- Department of Radiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - L Ø Davidsen
- Department of Radiology, Odense University Hospital, Svendborg, Denmark
| | - H Precht
- Department of Radiology, Lillebaelt Hospital, University Hospitals of Southern Denmark, Kolding, Denmark; Health Sciences Research Centre, UCL University College, Odense, Denmark; Education of Radiography, UCL University College, Odense, Denmark; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - K Brage
- Education of Radiography, UCL University College, Odense, Denmark; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Bienstock S, Lin F, Blankstein R, Leipsic J, Cardoso R, Ahmadi A, Gelijns A, Patel K, Baldassarre LA, Hadley M, LaRocca G, Sanz J, Narula J, Chandrashekhar YS, Shaw LJ, Fuster V. Advances in Coronary Computed Tomographic Angiographic Imaging of Atherosclerosis for Risk Stratification and Preventive Care. JACC Cardiovasc Imaging 2023; 16:1099-1115. [PMID: 37178070 DOI: 10.1016/j.jcmg.2023.02.002] [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: 08/11/2022] [Revised: 01/04/2023] [Accepted: 02/01/2023] [Indexed: 05/15/2023]
Abstract
The diagnostic evaluation of coronary artery disease is undergoing a dramatic transformation with a new focus on atherosclerotic plaque. This review details the evidence needed for effective risk stratification and targeted preventive care based on recent advances in automated measurement of atherosclerosis from coronary computed tomography angiography (CTA). To date, research findings support that automated stenosis measurement is reasonably accurate, but evidence on variability by location, artery size, or image quality is unknown. The evidence for quantification of atherosclerotic plaque is unfolding, with strong concordance reported between coronary CTA and intravascular ultrasound measurement of total plaque volume (r >0.90). Statistical variance is higher for smaller plaque volumes. Limited data are available on how technical or patient-specific factors result in measurement variability by compositional subgroups. Coronary artery dimensions vary by age, sex, heart size, coronary dominance, and race and ethnicity. Accordingly, quantification programs excluding smaller arteries affect accuracy for women, patients with diabetes, and other patient subsets. Evidence is unfolding that quantification of atherosclerotic plaque is useful to enhance risk prediction, yet more evidence is required to define high-risk patients across varied populations and to determine whether such information is incremental to risk factors or currently used coronary computed tomography techniques (eg, coronary artery calcium scoring or visual assessment of plaque burden or stenosis). In summary, there is promise for the utility of coronary CTA quantification of atherosclerosis, especially if it can lead to targeted and more intensive cardiovascular prevention, notably for those patients with nonobstructive coronary artery disease and high-risk plaque features. The new quantification techniques available to imagers must not only provide sufficient added value to improve patient care, but also add minimal and reasonable cost to alleviate the financial burden on our patients and the health care system.
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Affiliation(s)
- Solomon Bienstock
- Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Fay Lin
- Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ron Blankstein
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathon Leipsic
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Rhanderson Cardoso
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Amir Ahmadi
- Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Annetine Gelijns
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Krishna Patel
- Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lauren A Baldassarre
- Department of Cardiovascular Medicine and Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Michael Hadley
- Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gina LaRocca
- Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Javier Sanz
- Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jagat Narula
- Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Leslee J Shaw
- Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Valentin Fuster
- Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Javed S, Mei Y, Zhang Y, Liu C, Liu S. Multi-slice CT analysis of the length of left main coronary artery: its relation to sex, age, diameter and branching pattern of left main coronary artery, and coronary dominance. Surg Radiol Anat 2023:10.1007/s00276-023-03193-w. [PMID: 37402958 DOI: 10.1007/s00276-023-03193-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/26/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE The objective of this research was to analyze and correlate the length of the left main coronary artery (LMCA) with significant clinical parameters using multi-slice CT (MSCT). MATERIALS AND METHODS 1500 patients (851 males and 649 females; mean age 57.38 ± 11.03 [SD]; age range: 5-85 years) who underwent MSCT scans from September 2020 to March 2022 were retrospectively included. The data were applied to generate three-dimensional (3D) simulations of a coronary tree using the syngo.via post-processing workstation. The reconstructed images were then interpreted, and the collected data were subjected to statistical analysis. RESULTS The results showed 1206 (80.4%) cases with medium LMCA, 133 (8.9%) with long LMCA, and 161 (10.7%) with short LMCA. The average diameter of LMCA at its midpoint was 4.69 ± 0.74 mm. The most frequent type of division of LMCA was bifurcation in 1076 (71.7%) cases; in 424 (28.3%) cases, the LMCA was divided into three or more branches. The dominance was right in 1339 (89.3%), left in 78 (5.2%), and co-dominant in 83 (5.5%) cases. There was a positive correlation between the length and branching patterns of LMCA, χ2 = 113.993, P = 0.000 (< 0.05). Other variables like age, sex, diameter of LMCA, and coronary dominance did not show any significant correlation. CONCLUSION This study has demonstrated a significant association between the length and the branching pattern of LMCA, which may be essential in diagnosing and treating coronary artery patients.
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Affiliation(s)
- Saeed Javed
- Research Center for Sectional and Imaging Anatomy, Shandong Key Laboratory of Digital Human and Clinical Anatomy, Department of Anatomy and Neurobiology, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
| | - Yixuan Mei
- Research Center for Sectional and Imaging Anatomy, Shandong Key Laboratory of Digital Human and Clinical Anatomy, Department of Anatomy and Neurobiology, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Department of Medical Imaging, Dongying People's Hospital, Dongying, 257091, China
| | - Yi Zhang
- Department of Medical Imaging, Shandong Provincial Hospital, Shandong First Medical University, Jinan, 250021, Shandong, China
- Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan, 250014, Shandong, China
| | - Cheng Liu
- Department of Medical Imaging, Shandong Provincial Hospital, Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Shuwei Liu
- Research Center for Sectional and Imaging Anatomy, Shandong Key Laboratory of Digital Human and Clinical Anatomy, Department of Anatomy and Neurobiology, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.
- Shandong University School of Medicine, 44#, Wenhua Xi Road, Jinan, 250012, Shandong, China.
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Małota Z, Sadowski W, Pieszko K, Zimoląg R, Czekała F, Malinowska R, Hiczkiewicz J. The Comparative Method Based on Coronary Computed Tomography Angiography for Assessing the Hemodynamic Significance of Coronary Artery Stenosis. Cardiovasc Eng Technol 2023; 14:364-379. [PMID: 36869267 PMCID: PMC10412489 DOI: 10.1007/s13239-023-00658-2] [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: 12/02/2021] [Accepted: 02/06/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE An important aspect in the prevention and treatment of coronary artery disease is the functional evaluation of narrowed blood vessels. Medical image-based Computational Fluid Dynamic methods are currently increasingly being used in the clinical setting for flow studies of cardio vascular system. The aim of our study was to confirm the feasibility and functionality of a non-invasive computational method providing information about hemodynamic significance of coronary stenosis. METHODS A comparative method was used to simulate the flow energy losses in real (stenotic) and reconstructed models without (reference) stenosis of the coronary arteries under stress test conditions, i.e. for maximum blood flow and minimal, constant vascular resistance. In addition to the absolute pressure drop in the stenotic arteries (FFRsten) and in the reconstructed arteries (FFRrec), a new energy flow reference index (EFR) was also defined, which expresses the total pressure changes caused by stenosis in relation to the pressure changes in normal coronary arteries, which also allows a separate assessment of the haemodynamic significance of the atherosclerotic lesion itself. The article presents the results obtained from flow simulations in coronary arteries, reconstructed on the basis of 3D segmentation of cardiac CT images of 25 patients from retrospective data collection, with different degrees of stenoses and different areas of their occurrence. RESULTS The greater the degree of narrowing of the vessel, the greater drop of flow energy. Each parameter introduces an additional diagnostic value. In contrast to FFRsten, the EFR indices that are calculated on the basis of a comparison of stenosed and reconstructed models, are associated directly with localization, shape and geometry of stenosis only. Both FFRsten and EFR showed very significant positive correlation (P < 0.0001) with coronary CT angiography-derived FFR, with a correlation coefficient of 0.8805 and 0.9011 respectively. CONCLUSION The study presented promising results of non-invasive, comparative test to support of prevention of coronary disease and functional evaluation of stenosed vessels.
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Affiliation(s)
- Zbigniew Małota
- Institute of Heart Prostheses, Professor Zbigniew Religa Foundation of Cardiac Surgery Development, Zabrze, Poland.
| | - Wojciech Sadowski
- Institute of Heart Prostheses, Professor Zbigniew Religa Foundation of Cardiac Surgery Development, Zabrze, Poland
| | - Konrad Pieszko
- Department of Interventional Cardiology and Cardiac Surgery, Collegium Medicum, University of Zielona Góra, Góra, Poland
| | - Rafał Zimoląg
- Clinical Department of Cardiology, Multidisciplinary Hospital, Independent Public Healthcare Center in Nowa Sól, Nowa Sól, Poland
| | - Filip Czekała
- Clinical Department of Cardiology, Multidisciplinary Hospital, Independent Public Healthcare Center in Nowa Sól, Nowa Sól, Poland
| | - Renata Malinowska
- Clinical Department of Cardiology, Multidisciplinary Hospital, Independent Public Healthcare Center in Nowa Sól, Nowa Sól, Poland
| | - Jarosław Hiczkiewicz
- Department of Interventional Cardiology and Cardiac Surgery, Collegium Medicum, University of Zielona Góra, Góra, Poland
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20
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Intravascular Imaging-Based Physiologic Assessment. Interv Cardiol Clin 2023; 12:289-298. [PMID: 36922069 DOI: 10.1016/j.iccl.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Intravascular imaging (IVI), including intravascular ultrasound (IVUS) and optical coherence tomography (OCT), is clinically useful for assessing the luminal size, lesion length, and plaque characteristics, as well as for evaluating stent deployment; however, it is not designed to estimate myocardial ischemia accurately. Thus, several types of IVI-derived fractional flow reserve (FFR) (IVI-derived FFR) have been developed and reported. In general, the algorithms of virtual FFR are based on basic fluid dynamics equations (mainly Poiseuille and Borda-Carnot equations) and original microvascular models (fixed velocity or calculating coronary flow reserve). Although the models and assumptions used in the past reports were mostly based on the standard population (not independent patient data), the developed software calculated FFR with high accuracy (88% to 94%) with strong correlations between IVI-derived FFR and wire-based FFR (0.69 to 0.89). Given several other less invasive virtual FFR methods currently available for clinical use, IVI-derived FFR would be limited for the sole use of pre-percutaneous coronary intervention (PCI) physiological evaluation; however, it may play a unique role at PCI guidance and optimization, potentially allowing comprehensive and time/cost-saving assessment of both anatomical and physiological lesion properties using a single diagnostic device.
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21
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Lyu JJ, Liu Y, Gurm HS, Shih A, Zheng Y. Electroplating a miniature diamond wheel for grinding of the calcified plaque inside arteries. Med Eng Phys 2023; 113:103969. [PMID: 36966003 DOI: 10.1016/j.medengphy.2023.103969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/17/2023] [Accepted: 03/12/2023] [Indexed: 03/16/2023]
Abstract
A miniature grinding wheel (0.85 mm diameter) was fabricated by nickel (Ni)-diamond electroplating on a thin (0.65 mm outer diameter) flexible hollow stainless steel drive shaft to remove the calcified plaque in coronary and peripheral arteries by atherectomy procedure. To coat electrically nonconductive diamond grits, the drive shaft was submerged in a pile of diamond grit during Ni electroplating. The electroplating current density and temperature were investigated for better surface finishing and Faraday efficiency. The electroplating time to obtain the designed coating thickness was modeled based on Faraday's law of electrolysis and the geometry of drive shaft, wheel, and diamond grit. To validate the miniature wheel performance in atherectomy, grinding experiments were conducted on an atherectomy cardiovascular simulator with a calcified plaque surrogate. The wheel motion, material removal rate, and wheel surface wear were studied via high-speed camera imaging and laser confocal microscopy. The grinding wheel with 80,000 rpm rotational speed had an orbital speed of 14,300 rpm around the 1.5 mm diameter plaque surrogate lumen. After grinding for 120 s, the plaque surrogate inner diameter was enlarged to 3.03 mm, and no wear or loss of diamond abrasive was observed on the grinding wheel. This study demonstrated that the proposed electroplating process for fabricating miniature grinding wheels could effectively remove the calcified plaque surrogate. This research could lead to a more effective and safer atherectomy device with sub-mm miniature diamond wheels to treat lesions deep in coronary and peripheral arteries.
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Affiliation(s)
| | - Yao Liu
- Shanxi Key Laboratory of Advanced Manufacturing Technology, North University of China, Taiyuan, Shanxi 030051, China
| | - Hitinder S Gurm
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Albert Shih
- Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - Yihao Zheng
- Mechanical & Materials Engineering, Worcester Polytechnic Institute, Worcester, MA 01609, USA.
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22
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Opfermann JD, Contento JM, Mass PN, Krieger A, Berul CI, Kumthekar RN. A novel videoscope and tool kit for percutaneous pericardial access under direct visualization. Biomed Eng Online 2023; 22:19. [PMID: 36855095 PMCID: PMC9976548 DOI: 10.1186/s12938-023-01085-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/21/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Pericardial access is necessary for the application of epicardial cardiac therapies including ablation catheters, pacing and defibrillation leads, and left atrial appendage closure systems. Pericardial access under fluoroscopic guidance is difficult in patients without pericardial effusions and may result in coronary artery damage, ventricular injury, or perforation with potentially life-threatening pericardial bleeding in up to 10% of cases. There is a clinical need for a pericardial access technique to safely deliver epicardial cardiac therapies. METHODS In this paper, we describe the design and evaluation of a novel videoscope and tool kit to percutaneously access the pericardial space under direct visualization. Imaging is performed by a micro-CMOS camera with an automatic gain adjustment software to prevent image saturation. Imaging quality is quantified using known optical targets, while tool performance is evaluated in pediatric insufflation and pericardial access simulators. Device safety and efficacy is demonstrated by infant porcine preclinical studies (N = 6). RESULTS The videoscope has a resolution of 400 × 400 pixels, imaging rate of 30 frames per second, and fits within the lumen of a 14G needle. The tool can resolve features smaller than 39.4 µm, achieves a magnification of 24x, and has a maximum of 3.5% distortion within the field of view. Successful pericardial access was achieved in pediatric simulators and acute in vivo animal studies. During in vivo testing, it took the electrophysiologist an average of 66.83 ± 32.86 s to insert the pericardial access tool into the thoracic space and visualize the heart. After visualizing the heart, it took an average of 136.67 ± 80.63 s to access the pericardial space under direct visualization. The total time to pericardial access measured from needle insertion was 6.7 × quicker than pericardial access using alternative direct visualization techniques. There was no incidence of ventricular perforation. CONCLUSIONS Percutaneous pericardial access under direct visualization is a promising technique to access the pericardial space without complications in simulated and in vivo animal models.
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Affiliation(s)
- Justin D. Opfermann
- grid.21107.350000 0001 2171 9311Department of Mechanical Engineering, Johns Hopkins University, 3400 N. Charles Street, Baltimore, MD 21218 USA
| | - Jacqueline M. Contento
- grid.239560.b0000 0004 0482 1586Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, USA
| | - Paige N. Mass
- grid.239560.b0000 0004 0482 1586Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, USA
| | - Axel Krieger
- grid.21107.350000 0001 2171 9311Department of Mechanical Engineering, Johns Hopkins University, 3400 N. Charles Street, Baltimore, MD 21218 USA
| | - Charles I. Berul
- grid.239560.b0000 0004 0482 1586Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, USA ,grid.239560.b0000 0004 0482 1586Division of Cardiology, Children’s National Hospital, Washington, USA ,grid.4367.60000 0001 2355 7002George Washington School of Medicine, Washington, USA
| | - Rohan N. Kumthekar
- grid.240344.50000 0004 0392 3476Division of Cardiology, Nationwide Children’s Hospital, Columbus, USA ,grid.261331.40000 0001 2285 7943Department of Pediatrics, The Ohio State University College of Medicine, Columbus, USA
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23
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Intravascular Imaging During Percutaneous Coronary Intervention: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 81:590-605. [PMID: 36754518 DOI: 10.1016/j.jacc.2022.11.045] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 02/09/2023]
Abstract
Coronary angiography has historically served as the gold standard for diagnosis of coronary artery disease and guidance of percutaneous coronary intervention (PCI). Adjunctive use of contemporary intravascular imaging (IVI) technologies has emerged as a complement to conventional angiography-to further characterize plaque morphology and optimize the performance of PCI. IVI has utility for preintervention lesion and vessel assessment, periprocedural guidance of lesion preparation and stent deployment, and postintervention assessment of optimal endpoints and exclusion of complications. The role of IVI in reducing major adverse cardiac events in complex lesion subsets is emerging, and further studies evaluating broader use are underway or in development. This paper provides an overview of currently available IVI technologies, reviews data supporting their utilization for PCI guidance and optimization across a variety of lesion subsets, proposes best practices, and advocates for broader use of these technologies as a part of contemporary practice.
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24
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Al Hageh C, Chacar S, Ghassibe-Sabbagh M, Platt DE, Henschel A, Hamdan H, Gauguier D, El Murr Y, Alefishat E, Chammas E, O’Sullivan S, Abchee A, Nader M, Zalloua PA. Elevated Lp(a) Levels Correlate with Severe and Multiple Coronary Artery Stenotic Lesions. Vasc Health Risk Manag 2023; 19:31-41. [PMID: 36703868 PMCID: PMC9871050 DOI: 10.2147/vhrm.s394134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/21/2022] [Indexed: 01/19/2023] Open
Abstract
Backgrounds and Aims The role of Lipoprotein(a) (Lp(a)) in increasing the risk of cardiovascular diseases is reported in several populations. The aim of this study is to investigate the correlation of high Lp(a) levels with the degree of coronary artery stenosis. Methods Two hundred and sixty-eight patients were enrolled for this study. Patients who underwent coronary artery angiography and who had Lp(a) measurements available were included in this study. Binomial logistic regressions were applied to investigate the association between Lp(a) and stenosis in the four major coronary arteries. The effect of LDL and HDL Cholesterol on modulating the association of Lp(a) with coronary artery disease (CAD) was also evaluated. Multinomial regression analysis was applied to assess the association of Lp(a) with the different degrees of stenosis in the four major coronary arteries. Results Our analyses showed that Lp(a) is a risk factor for CAD and this risk is significantly apparent in patients with HDL-cholesterol ≥35 mg/dL and in non-obese patients. A large proportion of the study patients with elevated Lp(a) levels had CAD even when exhibiting high HDL serum levels. Increased HDL with low Lp(a) serum levels were the least correlated with stenosis. A significantly higher levels of Lp(a) were found in patients with >50% stenosis in at least two major coronary vessels arguing for pronounced and multiple stenotic lesions. Finally, the derived variant (rs1084651) of the LPA gene was significantly associated with CAD. Conclusion Our study highlights the importance of Lp(a) levels as an independent biological marker of severe and multiple coronary artery stenosis.
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Affiliation(s)
- Cynthia Al Hageh
- Department of Molecular Biology and Genetics, College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Stephanie Chacar
- Department of Physiology and Immunology, College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Michella Ghassibe-Sabbagh
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon
| | - Daniel E Platt
- Computational Biology Center, IBM TJ Watson Research Centre, Yorktown Hgts, NY, USA
| | - Andreas Henschel
- Department of Electrical Engineering and Computer, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Hamdan Hamdan
- Department of Physiology and Immunology, College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Dominique Gauguier
- Université Paris Cité, INSERM UMR 1124, Paris, 75006, France,McGill University and Genome Quebec Innovation Centre, Montreal, QC, H3A 0G1, Canada
| | - Yara El Murr
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon
| | - Eman Alefishat
- Department of Pharmacology, College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates,Center for Biotechnology, Khalifa University of Science and Technology, Abu Dhabi, 127788, United Arab Emirates
| | - Elie Chammas
- School of Medicine, Lebanese University, Beirut, Lebanon
| | - Siobhán O’Sullivan
- Department of Molecular Biology and Genetics, College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Antoine Abchee
- Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Moni Nader
- Department of Physiology and Immunology, College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates,Center for Biotechnology, Khalifa University of Science and Technology, Abu Dhabi, 127788, United Arab Emirates
| | - Pierre A Zalloua
- Department of Molecular Biology and Genetics, College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates,Center for Biotechnology, Khalifa University of Science and Technology, Abu Dhabi, 127788, United Arab Emirates,Harvard T.H. Chan School of Public Health, Boston, MA, USA,Correspondence: Pierre A Zalloua; Moni Nader, College of Medicine and Health Sciences, Khalifa University for Science and Technology, PO Box 127788, Abu Dhabi, United Arab Emirates, Email ;
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25
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Kato Y, Noda C, Ambale-Venkatesh B, Ortman JM, Kassai Y, Lima JAC, Liu CY. The mechanisms of arterial signal intensity profile in non-contrast coronary MRA (NC-MRCA): a 3D printed phantom investigation and clinical translations. Int J Cardiovasc Imaging 2023; 39:209-220. [PMID: 36598690 DOI: 10.1007/s10554-022-02700-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/22/2022] [Indexed: 01/12/2023]
Abstract
Signal intensity (SI) drop has been proposed as an indirect stenosis assessment in non-contrast coronary MRA (NC-MRCA) but it uses unproven assumptions. We aimed to clarify the mechanisms that govern the SI in vitro and develop a stenosis detection method in vivo. Flow phantom tubes with/without stenosis were scanned under two spatial resolutions (0.5/1.0 mm3) on a 3.0 T MRI. Thirty-two coronary arteries from 11 volunteers were prospectively scanned with an EKG- and respiratory-gated 3D NC-MRCA with a resolution of 1.0 mm3, with coronary computed tomography angiography (CTA) as reference. The normalized SI along the centerline of the tubes or the coronary arteries was assessed against the distance from the orifice using a linear regression model. Its coefficient (SI decay slope) and goodness-of-fit (R2) were extracted to assess the effect of flow velocity and stenosis on the SI profile curve. The R2 was utilized for the stenosis detection. Phantom study: A slow flow velocity caused a steep SI decay slope. The SI drop revealed only at the inlet and outlet of stenosis due to the flow turbulence/vortex and yielded low R2, in which shape changed by the resolution. Clinical study: The R2 cutoff to detect ≥ 50% stenosis for the left and right coronary arteries were 0.64 and 0.20 with a sensitivity/specificity of 71.5/71.5 and 66.7/100 (%), respectively. The SI drop did not reflect the actual stenosis position and not suitable for the stenosis localization. The R2 cutoff represents an alternative method to detect stenoses on NC-MRCA at vessel level.Trial registration: ClinicalTrials.gov; NCT03768999, registered on December 7, 2018.
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Affiliation(s)
- Yoko Kato
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chikara Noda
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Jason M Ortman
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yoshimori Kassai
- Canon Medical Systems Corporation, 1385 Shimoishigami, Otawara-shi, Tochigi, 324-8550, Japan
| | - Joao A C Lima
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chia-Ying Liu
- Canon Medical Systems Corporation, 1385 Shimoishigami, Otawara-shi, Tochigi, 324-8550, Japan.
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26
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Hernandez AM, Burkett GW, Pham N, Abbey CK, Boone JM. Performance of high-resolution CT for detection and discrimination tasks related to stenotic lesions - A phantom study using model observers. Med Phys 2022; 50:2037-2048. [PMID: 36583447 DOI: 10.1002/mp.16194] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/04/2022] [Accepted: 12/15/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Accurate detection and grading of atheromatous stenotic lesions within the cardiac, renal, and intracranial vasculature is imperative for early recognition of disease and guiding treatment strategies. PURPOSE In this work, a stenotic lesion phantom was used to compare high resolution and normal resolution modes on the same CT scanner in terms of detection and size discrimination performance. MATERIALS AND METHODS The phantom is comprised of three acrylic cylinders (each 15.0 cm in diameter and 1.3 cm thick) with a matching array of holes in each module. The outer two modules contain holes that are slightly larger than the corresponding hole in the central module to simulate stenotic narrowing in vasculature. The stack of modules was submerged in an iodine solution simulating contrast-enhanced stenotic lesions with a range of lumen diameters (1.32-10.08 mm) and stenosis severity (0%, 50%, 60%, 70%, and 80%). The phantom was imaged on the Canon Aquilion Precision high-resolution CT scanner in high-resolution (HR) mode (0.25 mm × 0.50 mm detector element size) and normal-resolution (NR) mode (0.50 mm × 0.50 mm) using 120 kV and two dose levels (14 and 21 mGy SSDE) with 30 repeat scans acquired for each combination. Filtered back-projection (FBP) and a hybrid-iterative reconstruction (AIDR) were used with the FC18 kernel, as well as a deep learning algorithm (AiCE) which is only available for HR. A non-prewhitening model observer with an eye filter was implemented to quantify performance for detection and size discrimination tasks in the axial plane. RESULTS Detection performance improved with increasing diameter, dose, and for AIDR in comparison to FBP for a fixed resolution mode. Performance in the HR mode was generally higher than NR for the smaller lumen diameters (1-5 mm) with decreasing differences as the diameter increased. Performance in NR mode surpassed HR mode for lumen diameters greater than ∼4 mm and ∼5 mm for 14 mGy and 21 mGy, respectively. AiCE provided consistently higher detection performance compared with AIDR-FC18 (48% higher for a 6 mm lumen diameter). Discrimination performance increased with increasing nominal diameter, dose, and for larger differences in stenosis severity. When comparing discrimination performance in HR to NR modes, the largest relative differences occur at the smallest nominal diameters and smallest differences in stenosis severity. The AiCE reconstruction algorithm produced the highest overall discrimination performance values, and these were significantly higher than AIDR-FC18 for nominal diameters of 7.14 and 10.08 mm. CONCLUSIONS HR mode outperforms NR for detection up to a specific diameter and the results improve with AiCE and for higher dose levels. For the task of size discrimination, HR mode consistently outperforms NR if AIDR-FC18 is used for dose levels of at least 21 mGy, and the results improve with AiCE and for the smallest differences in stenosis severity investigated (50% vs. 60%). High-resolution CT appears to be beneficial for detecting smaller simulated lumen diameters (<5 mm) and is generally advantageous for discrimination tasks related to stenotic lesions, which inherently contain information at higher frequencies, given the right reconstruction algorithm and dose level.
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Affiliation(s)
- Andrew M Hernandez
- Department of Radiology, University of California Davis, Sacramento, California, USA
| | - George W Burkett
- Department of Radiology, University of California Davis, Sacramento, California, USA
| | - Nancy Pham
- Department of Radiology, University of California Los Angeles, Los Angeles, California, USA
| | - Craig K Abbey
- Department of Psychological & Brain Sciences, University of California Santa Barbara, Santa Barbara, California, USA
| | - John M Boone
- Department of Radiology, University of California Davis, Sacramento, California, USA.,Department of Biomedical Engineering, University of California Davis, Davis, California, USA
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Moniripiri M, Hassani Soukht Abandani M, Firoozabadi B. Simulation of LDL permeation into multilayer wall of a coronary bifurcation using WSS-dependent model: effects of hemorheology. Biomech Model Mechanobiol 2022; 22:711-727. [PMID: 36525181 DOI: 10.1007/s10237-022-01676-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022]
Abstract
Atherosclerosis, due to the permeation of low-density lipoprotein (LDL) particles into the arterial wall, is one of the most common and deadly diseases in today's world. Due to its importance, numerous studies have been conducted on the factors affecting this disease. In this study, using numerical simulation, the effects of Wall Shear Stress (WSS), non-Newtonian behavior of blood, different values of hematocrit and blood pressure on LDL permeation into the arterial wall layers are investigated in a 4-layer wall model of a coronary bifurcation. To obtain the velocity and concentration fields in the fluid domain, the Navier-Stokes, Brinkman, and mass transfer equations are numerically solved in the lumen and wall layers. Results show that it is important to consider the effects of WSS on transport properties of endothelium layer in bifurcations and this leads to completely different concentration profiles compared to the constant properties model. Our computations show that a giant accumulation of LDL in the intima layer of the outer wall of the left anterior descending artery, especially in low WSS regions, may lead to atherosclerosis. It is also, necessary to consider the non-Newtonian behavior of blood in bifurcations due to its direct effect on WSS. A pressure-induced increase in the half-width of leaky junctions may be responsible for the higher risk of atherosclerosis in hypertension. In addition, it is shown that the dominant mechanism in LDL permeation into the wall is convection, and also, hypertension increases the effect of mass transfer by convection mechanism more than the diffusion mechanism. Furthermore, our results are consistent with various clinical studies.
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Affiliation(s)
- Mohammad Moniripiri
- Center of Excellence in Energy Conversion, School of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | | | - Bahar Firoozabadi
- Center of Excellence in Energy Conversion, School of Mechanical Engineering, Sharif University of Technology, Tehran, Iran.
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28
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Wang WL, Chang FL, Yu PH. Effect of different injection rates and doses of contrast medium on the image quality of computed tomographic angiography in African grey parrots (Psittacus erithacus). BMC Vet Res 2022; 18:428. [PMID: 36482409 PMCID: PMC9733312 DOI: 10.1186/s12917-022-03524-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/22/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Atherosclerosis is a common cardiovascular disease in parrots but the antemortem diagnosis is challenging. In human medicine, computed tomography angiography (CTA) has been used widely for the diagnosis of atherosclerosis. By adjusting the injection rate and total dose of contrast medium, the image quality can be improved. To test the effects of different injection conditions on the image quality of major arteries, 10 African grey parrots (Psittacus erithacus) were used. Three injection rates (0.3, 0.4, 0.5 mL/s) and three doses (740, 370, 222 mg of iodine/bird) were tested while the other variables of the studies were fixed. RESULT A higher injection dose led to a significantly higher attenuation, image noise and diameter, with a lower signal-to-noise ratio and contrast-to-noise ratio of the six major arteries. The 370 mg of iodine/bird group showed significantly better subjective image quality. Furthermore, with increasing injection rates, the prevalence of heterogeneity decreased. However, we found an increased risk of injection failure for the 0.5 mL/s groups. CONCLUSION We recommend a combination of 370 mg of iodine/bird with 0.4 mL/s for clinical use to achieve better image quality for CTA.
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Affiliation(s)
- Wen-Lin Wang
- grid.19188.390000 0004 0546 0241Institute of Veterinary Clinical Science, School of Veterinary Medicine, National Taiwan University, Number 153, Section 3, Keelung Road, Da’an District, Taipei, 10672 Taiwan ,grid.19188.390000 0004 0546 0241National Taiwan University Veterinary Hospital, Number 153, Section 3, Keelung Road, Da’an District, Taipei, 10672 Taiwan
| | - Fang-Lun Chang
- grid.19188.390000 0004 0546 0241National Taiwan University Veterinary Hospital, Number 153, Section 3, Keelung Road, Da’an District, Taipei, 10672 Taiwan
| | - Pin-Huan Yu
- grid.19188.390000 0004 0546 0241Institute of Veterinary Clinical Science, School of Veterinary Medicine, National Taiwan University, Number 153, Section 3, Keelung Road, Da’an District, Taipei, 10672 Taiwan ,grid.19188.390000 0004 0546 0241National Taiwan University Veterinary Hospital, Number 153, Section 3, Keelung Road, Da’an District, Taipei, 10672 Taiwan
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Jenndahl L, Österberg K, Bogestål Y, Simsa R, Gustafsson-Hedberg T, Stenlund P, Petronis S, Krona A, Fogelstrand P, Strehl R, Håkansson J. Personalized tissue-engineered arteries as vascular graft transplants: A safety study in sheep. Regen Ther 2022; 21:331-341. [PMID: 36110971 PMCID: PMC9463533 DOI: 10.1016/j.reth.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 07/04/2022] [Accepted: 08/09/2022] [Indexed: 11/23/2022] Open
Abstract
Patients with cardiovascular disease often need replacement or bypass of a diseased blood vessel. With disadvantages of both autologous blood vessels and synthetic grafts, tissue engineering is emerging as a promising alternative of advanced therapy medicinal products for individualized blood vessels. By reconditioning of a decellularized blood vessel with the recipient’s own peripheral blood, we have been able to prevent rejection without using immunosuppressants and prime grafts for efficient recellularization in vivo. Recently, decellularized veins reconditioned with autologous peripheral blood were shown to be safe and functional in a porcine in vivo study as a potential alternative for vein grafting. In this study, personalized tissue engineered arteries (P-TEA) were developed using the same methodology and evaluated for safety in a sheep in vivo model of carotid artery transplantation. Five personalized arteries were transplanted to carotid arteries and analyzed for safety and patency as well as with histology after four months in vivo. All grafts were fully patent without any occlusion or stenosis. The tissue was well cellularized with a continuous endothelial cell layer covering the luminal surface, revascularized adventitia with capillaries and no sign of rejection or infection. In summary, the results indicate that P-TEA is safe to use and has potential as clinical grafts. Safety and functionality evaluation of a tissue engineered ATMP in a sheep model of carotid transplantation. Efficient cellularization of a personalized tissue engineered artery in vivo. Personalized tissue engineered artery fully patent after four months in vivo.
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Affiliation(s)
- Lachmi Jenndahl
- VERIGRAFT AB, Arvid Wallgrensbacke 20, 413 46, Göteborg, Sweden
| | - Klas Österberg
- Sahlgrenska Academy, Institution of Medicine, Department of Molecular and Clinical Medicine, Blå Stråket 5 B Wallenberg Laboratory, 41345 Gothenburg, Sweden
| | - Yalda Bogestål
- RISE Research Institutes of Sweden, Materials and Production, Brinellgatan 4, 504 62 Borås, Sweden
| | - Robin Simsa
- VERIGRAFT AB, Arvid Wallgrensbacke 20, 413 46, Göteborg, Sweden.,Department of Molecular and Clinical Medicine/Wallenberg Laboratory, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Patrik Stenlund
- RISE Research Institutes of Sweden, Materials and Production, Brinellgatan 4, 504 62 Borås, Sweden
| | - Sarunas Petronis
- RISE Research Institutes of Sweden, Materials and Production, Brinellgatan 4, 504 62 Borås, Sweden
| | - Annika Krona
- RISE Research Institutes of Sweden, Agriculture and Food, Box 5401, 402 29 Gothenburg, Sweden
| | - Per Fogelstrand
- Department of Molecular and Clinical Medicine/Wallenberg Laboratory, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Raimund Strehl
- VERIGRAFT AB, Arvid Wallgrensbacke 20, 413 46, Göteborg, Sweden
| | - Joakim Håkansson
- RISE Research Institutes of Sweden, Materials and Production, Brinellgatan 4, 504 62 Borås, Sweden.,Gothenburg University, Department of Laboratory Medicine, Institute of Biomedicine, Gothenburg, Sweden
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30
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Sarma A, Brumfiel TA, Chitalia Y, Desai JP. Kinematic Modeling and Jacobian-based Control of the COAST Guidewire Robot. IEEE TRANSACTIONS ON MEDICAL ROBOTICS AND BIONICS 2022; 4:967-975. [PMID: 37790986 PMCID: PMC10544820 DOI: 10.1109/tmrb.2022.3216026] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Manual guidewire navigation and placement for minimally invasive surgeries suffer from technical challenges due to imprecise tip motion control to traverse highly tortuous vasculature. Robotically steerable guidewires can address these challenges by actuating a compliant tip through multiple degrees-of-freedom for maneuvering through vascular pathways. In this paper, we detail the kinematic mapping of a COaxially Aligned STeerable (COAST) guidewire robot that is capable of executing follow-the-leader motion in three dimensional vascular pathways. We also develop an analytical Jacobian model to perform velocity kinematics for the robot and finally, we implement Jacobian-based control to demonstrate follow-the-leader motion of the guidewire in free space, within 3D-printed phantoms, and within ex vivo animal vasculature.
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Affiliation(s)
- Achraj Sarma
- Medical Robotics and Automation (RoboMed) Laboratory, Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Timothy A Brumfiel
- Medical Robotics and Automation (RoboMed) Laboratory, Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Yash Chitalia
- Medical Robotics and Automation (RoboMed) Laboratory, Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Jaydev P Desai
- Medical Robotics and Automation (RoboMed) Laboratory, Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
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31
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Rams D, Batko J, Bartuś K, Filip G, Kowalewski M, Litwinowicz R. Left Internal Mammary Artery Operative Topography for MIDCAB and TECAB Procedures. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:499-505. [PMID: 36539946 DOI: 10.1177/15569845221137578] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The left internal mammary artery (LIMA) is a common arterial graft in minimally invasive coronary surgery (MICS), such as minimally invasive coronary artery bypass grafting (MIDCAB) or totally endoscopic coronary artery bypass (TECAB). The aim of this study was to perform an analysis of the LIMA operative topography during MICS. METHODS A total of 104 computed tomography angiographies were analyzed retrospectively using 3-dimensional reconstruction and visualization software. Measurements were developed in relation to the anatomical midpoint of the sternal body (SBMP). Parameters were evaluated as lengths, distances, diagonals, or categorical descriptions. RESULTS A total of 208 internal mammary arteries of each side were analyzed with the following results: (1) LIMA width = 2.7 mm, (2) SBMP-LIMA bifurcation length = 6.2 cm, (3) SBMP-LIMA distance = 3.2 ± 0.5 cm, (4) xiphoid midpoint-LIMA distance = 3.5 ± 0.7 cm, (5) sternal line-LIMA distance = 1.7 ± 0.3 cm, (6) xiphoid end projection-LIMA bifurcation length = 2.2 ± 1.0 cm, (7) midsternal line-LIMA bifurcation distance = 3.3 ± 0.8 cm, (8) xiphoid end-LIMA bifurcation diagonal = 4.1 ± 0.9 cm, (9) LIMA-left coronary artery distance = 7.0 ± 1.4 cm at the proximal and 7.1 ± 1.3 cm at the distal segment, and (10) LIMA-left anterior descending artery distance = 5.5 ± 1.1 cm at proximal, 4.3 cm at middle, and 4.2 ± 1.5 cm at distal segment. The extent of LIMA bifurcation ranged from the level of 5 (1%) to 7 (6%) rib cartilages. CONCLUSIONS Based on the detailed surgical anatomy of LIMA, it was concluded that the fourth intercostal space should be considered as an appropriate approach for MIDCAB or TECAB in the studied region.
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Affiliation(s)
- Daniel Rams
- Jagiellonian University Medical College, Krakow, Poland.,CAROL - Cardiothoracic Anatomy Research Operative Lab, Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Jakub Batko
- Jagiellonian University Medical College, Krakow, Poland.,CAROL - Cardiothoracic Anatomy Research Operative Lab, Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Krzysztof Bartuś
- Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.,John Paul II Hospital in Krakow, Poland
| | - Grzegorz Filip
- Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.,John Paul II Hospital in Krakow, Poland
| | - Mariusz Kowalewski
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw, Poland.,Thoracic Research Centre, Innovative Medical Forum, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Radosław Litwinowicz
- CAROL - Cardiothoracic Anatomy Research Operative Lab, Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.,Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.,John Paul II Hospital in Krakow, Poland.,Thoracic Research Centre, Innovative Medical Forum, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland
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32
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Punamiya K, Jha T, Punamiya V, Pradhan J. IVUS determination of normal left main stem artery size and plaque burden, and correlation with body surface area in an Indian population. ASIAINTERVENTION 2022; 8:116-122. [PMID: 36798833 PMCID: PMC9890579 DOI: 10.4244/aij-d-22-00041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/15/2022] [Indexed: 11/16/2022]
Abstract
Background There is a scarcity of data regarding the normal size of the left main stem coronary artery (LMS) in the Indian population; further data are needed to help determine the optimal device size during percutaneous coronary intervention (PCI). Aims The aim of our study was to determine the normal size of the LMS and to calculate the mean plaque burden (PB) in the left main arteries which are angiographically normal or insignificantly diseased, using intravascular ultrasound (IVUS). We hoped to establish a correlation between LMS size and body surface area (BSA). Methods We collected demographic and coronary artery data from 140 patients who underwent IVUS-guided PCI in the left anterior descending and circumflex arteries over a 2-year period from 2019 to 2020, where a pullback sequence of the LMS was available. The reference and luminal vessel diameters, the reference and luminal vessel areas and the mean plaque burden (PB) were obtained. Regression analysis was used to develop a correlation between BSA and LMS diameter. Results The IVUS-determined mean reference diameter of the LMS was 5.53±0.63 mm and the mean luminal diameter was 4.62±0.65 mm. The mean reference vessel area was 24.79±5.5 mm2 and the luminal vessel area was 17.19±4.89 mm2. The mean PB was found to be 29.21% in patients with an angiographically normal left main and 32.29% in patients with angiographically insignificant left main stenosis. A linear correlation was noted between the left main reference and luminal vessel diameters; the correlation equations derived were 3.57+1.01 BSA and 2.95+0.87 BSA, respectively. Conclusions The mean reference and luminal diameters of LMS in the Indian population are on par with the size of LMS in other ethnicities. The vessel compensates for up to 40% PB with vessel remodelling. Hence, a PB of 40% is a good landing zone for stent deployment.
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Affiliation(s)
- Kirti Punamiya
- Breach Candy Hospital Trust, 60A, Bhulabhai Desai Marg, Breach Candy, Mumbai, Maharashtra 400026, India
| | - Tanya Jha
- Cardiology, Breach Candy Hospital Trust, Mumbai, India
| | - Varun Punamiya
- First Faculty of Medicine Charles University, Prague, Czech Republic
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Herbert R, Elsisy M, Rigo B, Lim HR, Kim H, Choi C, Kim S, Ye SH, Wagner WR, Chun Y, Yeo WH. Fully implantable batteryless soft platforms with printed nanomaterial-based arterial stiffness sensors for wireless continuous monitoring of restenosis in real time. NANO TODAY 2022; 46:101557. [PMID: 36855693 PMCID: PMC9970263 DOI: 10.1016/j.nantod.2022.101557] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Atherosclerosis is a common cause of coronary artery disease and a significant factor in broader cardiovascular diseases, the leading cause of death. While implantation of a stent is a prevalent treatment of coronary artery disease, a frequent complication is restenosis, where the stented artery narrows and stiffens. Although early detection of restenosis can be achieved by continuous monitoring, no available device offers such capability without surgeries. Here, we report a fully implantable soft electronic system without batteries and circuits, which still enables continuous wireless monitoring of restenosis in real-time with a set of nanomembrane strain sensors in an electronic stent. The low-profile system requires minimal invasive implantation to deploy the sensors into a blood vessel through catheterization. The entirely printed, nanomaterial-based set of soft membrane strain sensors utilizes a sliding mechanism to offer enhanced sensitivity and detection of low strain while unobtrusively integrating with an inductive stent for passive wireless sensing. The performance of the soft sensor platform is demonstrated by wireless monitoring of restenosis in an artery model and an ex-vivo study in a coronary artery of ovine hearts. The capacitive sensor-based artery implantation system offers unique advantages in wireless, real-time monitoring of stent treatments and arterial health for cardiovascular disease.
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Affiliation(s)
- Robert Herbert
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
- IEN Center for Human-Centric Interfaces and Engineering at the Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Moataz Elsisy
- Department of Industrial Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Bruno Rigo
- IEN Center for Human-Centric Interfaces and Engineering at the Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA 30332, USA
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Hyo-Ryoung Lim
- Major of Human Biocovergence, Division of Smart Healthcare, College of Information Technology and Convergence, Pukyong National University, Busan 48513, Republic of Korea
| | - Hyeonseok Kim
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
- IEN Center for Human-Centric Interfaces and Engineering at the Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Chanyeong Choi
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
- IEN Center for Human-Centric Interfaces and Engineering at the Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Seungil Kim
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
- Departments of Surgery, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Sang-Ho Ye
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
- Departments of Surgery, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - William R. Wagner
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
- Departments of Surgery, University of Pittsburgh, Pittsburgh, PA 15260, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Youngjae Chun
- Department of Industrial Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA 15260, USA
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Woon-Hong Yeo
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
- IEN Center for Human-Centric Interfaces and Engineering at the Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA 30332, USA
- Wallace H. Coulter Department of Biomedical Engineering, Parker H. Petit Institute for Bioengineering and Biosciences, Georgia Institute of Technology, Atlanta, GA 30332, USA
- Institute for Materials, Neural Engineering Center, Institute for Robotics and Intelligent Machines, Georgia Institute of Technology, Atlanta, GA 30332, USA
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Hwang JC, Kim M, Kim S, Seo H, An S, Jang EH, Han SY, Kim MJ, Kim NK, Cho SW, Lee S, Park JU. In situ diagnosis and simultaneous treatment of cardiac diseases using a single-device platform. SCIENCE ADVANCES 2022; 8:eabq0897. [PMID: 36103536 PMCID: PMC9473581 DOI: 10.1126/sciadv.abq0897] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/28/2022] [Indexed: 06/07/2023]
Abstract
The in situ diagnosis of cardiac activities with simultaneous therapeutic electrical stimulation of the heart is key to preventing cardiac arrhythmia. Here, we present an unconventional single-device platform that enables in situ monitoring even in a wet condition and control of beating heart motions without interferences to the recording signal. This platform consists of the active-matrix array of pressure-sensitive transistors for detecting cardiac beatings, biocompatible, low-impedance electrodes for cardiac stimulations, and an alginate-based hydrogel adhesive for attaching this platform conformally to the epicardium. In contrast to conventional electrophysiological sensing using electrodes, the pressure-sensitive transistors measured mechanophysiological characteristics by monitoring the spatiotemporal distributions of cardiac pressures during heart beating motions. In vivo tests show mechanophysiological readings having good correlation with electrocardiography and negligible interference with the electrical artifacts caused during cardiac stimulations. This platform can therapeutically synchronize the rhythm of abnormal heartbeats through efficient pacing of cardiac arrhythmia.
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Affiliation(s)
- Jae Chul Hwang
- Department of Materials Science and Engineering, Yonsei University, Seoul 03722, Republic of Korea
- Center for Nanomedicine, Institute for Basic Science (IBS), Yonsei University, Seoul 03722, Republic of Korea
| | - Moohyun Kim
- Department of Materials Science and Engineering, Yonsei University, Seoul 03722, Republic of Korea
- Center for Nanomedicine, Institute for Basic Science (IBS), Yonsei University, Seoul 03722, Republic of Korea
| | - Sumin Kim
- Department of Materials Science and Engineering, Yonsei University, Seoul 03722, Republic of Korea
- Center for Nanomedicine, Institute for Basic Science (IBS), Yonsei University, Seoul 03722, Republic of Korea
| | - Hunkyu Seo
- Department of Materials Science and Engineering, Yonsei University, Seoul 03722, Republic of Korea
- Center for Nanomedicine, Institute for Basic Science (IBS), Yonsei University, Seoul 03722, Republic of Korea
| | - Soohwan An
- Center for Nanomedicine, Institute for Basic Science (IBS), Yonsei University, Seoul 03722, Republic of Korea
- Department of Biotechnology, Yonsei University, Seoul 03722, Republic of Korea
| | - Eui Hwa Jang
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul 03722, Republic of Korea
| | - Seung Yeop Han
- Center for Nanomedicine, Institute for Basic Science (IBS), Yonsei University, Seoul 03722, Republic of Korea
- Department of Biotechnology, Yonsei University, Seoul 03722, Republic of Korea
| | - Mi Jung Kim
- Department of Materials Science and Engineering, Yonsei University, Seoul 03722, Republic of Korea
- KIURI Institute, Yonsei University, Seoul 03722, Republic of Korea
| | - Nam Kyun Kim
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul 03722, Republic of Korea
| | - Seung-Woo Cho
- Center for Nanomedicine, Institute for Basic Science (IBS), Yonsei University, Seoul 03722, Republic of Korea
- Department of Biotechnology, Yonsei University, Seoul 03722, Republic of Korea
| | - Sak Lee
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul 03722, Republic of Korea
| | - Jang-Ung Park
- Department of Materials Science and Engineering, Yonsei University, Seoul 03722, Republic of Korea
- Center for Nanomedicine, Institute for Basic Science (IBS), Yonsei University, Seoul 03722, Republic of Korea
- KIURI Institute, Yonsei University, Seoul 03722, Republic of Korea
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Eslami P, Seo JH, Rahsepar AA, Shafique A, Rollison SF, Lardo AC, Mittal R, Chen MY. A Noninvasive Assessment of Flow Based on Contrast Dispersion in Computed Tomography Angiography: A Computational and Experimental Phantom Study. J Biomech Eng 2022; 144:091009. [PMID: 35237785 PMCID: PMC8990739 DOI: 10.1115/1.4053997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 12/27/2021] [Indexed: 11/08/2022]
Abstract
Transluminal attenuation gradient (TAG), defined as the gradient of the contrast agent attenuation drop along the vessel, is an imaging biomarker that indicates stenosis in the coronary arteries. The transluminal attenuation flow encoding (TAFE) equation is a theoretical platform that quantifies blood flow in each coronary artery based on computed tomography angiography (CTA) imaging. This formulation couples TAG (i.e., contrast dispersion along the vessel) with fluid dynamics. However, this theoretical concept has never been validated experimentally. The aim of this proof-of-principle phantom study is to validate TAFE based on CTA imaging. Dynamic CTA images were acquired every 0.5 s. The average TAFE estimated flow rates were compared against four predefined pump values in a straight (20, 25, 30, 35, and 40 ml/min) and a tapered phantom (25, 35, 45, and 55 ml/min). Using the TAFE formulation with no correction, the flow rates were underestimated by 33% and 81% in the straight and tapered phantoms, respectively. The TAFE formulation was corrected for imaging artifacts focusing on partial volume averaging and radial variation of contrast enhancement. After corrections, the flow rates estimated in the straight and tapered phantoms had an excellent Pearson correlation of r = 0.99 and 0.87 (p < 0.001), respectively, with only a 0.6%±0.2 mL/min difference in estimation of the flow rate. In this proof-of-concept phantom study, we corrected the TAFE formulation and showed a good agreement with the actual pump values. Future clinical validations are needed for feasibility of TAFE in clinical use.
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Affiliation(s)
- Parastou Eslami
- Department of Radiology, Harvard Medical School, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA 02114
| | - Jung-Hee Seo
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD 21218
| | - Amir Ali Rahsepar
- Division of Cardiology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD 21205
| | - Asim Shafique
- School of Osteopathic Medicine, Rowan University, Stratford, NJ 08084
| | - Shirley F. Rollison
- National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD 2089
| | - Albert C. Lardo
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218
| | - Rajat Mittal
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD 21218; Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD 21287
| | - Marcus Y. Chen
- National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD 2089
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Alalawi LH, Dookhan CM, Verghese D, Manubolu VS, Aldana-Bitar J, Lakshmanan S, Ahmad K, Shafter A, Alchokhachi Z, Ghanem A, Golub IS, Budoff M, Roy S. Assessment of left main coronary artery disease: a comparison between invasive and noninvasive. Coron Artery Dis 2022; 33:490-498. [PMID: 35757932 DOI: 10.1097/mca.0000000000001154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Left main coronary artery disease has significant therapeutic as well as prognostic implications. The presence of left main coronary artery stenosis is strongly associated with poor short- and long-term prognoses. Accurate identification of left main stenosis is extremely important since it would be the main factor to guide management. There are several modalities used to determine the presence of atherosclerosis and the degree of stenosis in a left main coronary artery. Newer modalities allow for an accurate evaluation of left main stenosis and atherosclerosis. In this review, we go through different invasive and noninvasive modalities to diagnose left main stenosis, shedding more light into coronary computed tomography angiography, and its accuracy in this specific diagnosis.
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Affiliation(s)
- Luay H Alalawi
- The Lundquist Institute, Harbor-UCLA Medical Center, Torrance, California
| | - Christina M Dookhan
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Dhiran Verghese
- The Lundquist Institute, Harbor-UCLA Medical Center, Torrance, California
| | - Venkat S Manubolu
- The Lundquist Institute, Harbor-UCLA Medical Center, Torrance, California
| | - Jairo Aldana-Bitar
- The Lundquist Institute, Harbor-UCLA Medical Center, Torrance, California
| | | | - Khadije Ahmad
- The Lundquist Institute, Harbor-UCLA Medical Center, Torrance, California
| | - Ahmad Shafter
- The Lundquist Institute, Harbor-UCLA Medical Center, Torrance, California
| | - Zahra Alchokhachi
- The Lundquist Institute, Harbor-UCLA Medical Center, Torrance, California
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ahmed Ghanem
- The Lundquist Institute, Harbor-UCLA Medical Center, Torrance, California
| | - Ilana S Golub
- The Lundquist Institute, Harbor-UCLA Medical Center, Torrance, California
| | - Matthew Budoff
- The Lundquist Institute, Harbor-UCLA Medical Center, Torrance, California
| | - Sion Roy
- The Lundquist Institute, Harbor-UCLA Medical Center, Torrance, California
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Automated Identification of Coronary Arteries in Assisting Inexperienced Readers: Comparison between Two Commercial Vendors. Diagnostics (Basel) 2022; 12:diagnostics12081987. [PMID: 36010337 PMCID: PMC9406865 DOI: 10.3390/diagnostics12081987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/14/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022] Open
Abstract
Background: to assess the performance and speed of two commercially available advanced cardiac software packages in the automated identification of coronary vessels as an aiding tool for inexperienced readers. Methods: Hundred and sixty patients undergoing coronary CT angiography (CCTA) were prospectively enrolled from February until September 2021 and randomized in two groups, each one composed by 80 patients. Patients in group 1 were scanned on Revolution EVO CT Scanner (GE Healthcare), while patients in group 2 had the CCTA performed on Brilliance iCT (Philips Healthcare); each examination was evaluated on the respective vendor proprietary advanced cardiac software (software 1 and 2, respectively). Two inexperienced readers in cardiac imaging verified the software performance in the automated identification of the three major coronary vessels: (RCA, LCx, and LAD) and in the number of identified coronary segments. Time of analysis was also recorded. Results: software 1 correctly and automatically nominated 202/240 (84.2%) of the three main coronary vessels, while software 2 correctly identified 191/240 (79.6%) (p = 0.191). Software 1 achieved greater performances in recognizing the LCx (81.2% versus 67.5%; p = 0.048), while no differences have been reported in detecting the RCA (p = 0.679), and the LAD (p = 0.618). On a per-segment analysis, software 1 outperformed software 2, automatically detecting 942/1062 (88.7%) coronary segments, while software 2 detected 797/1078 (73.9%) (p < 0.001). Average reconstruction and detection time was of 13.8 s for software 1 and 21.9 s for software 2 (p < 0.001). Conclusions: automated cardiac software packages are a reliable and time-saving tool for inexperienced reader. Software 1 outperforms software 2 and might therefore better assist inexperienced CCTA readers in automated identification of the three main vessels and coronaries segments, with a consistent time saving of the reading session.
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Badillo-Alvarado AH, Martín-Tovar EA, Molina-Salinas GM, Sandoval-Méndez AC, Sarricolea-Puch A. Association between the cardiac contact distance and the maximum dose at the left anterior descending coronary artery in post mastectomized patients. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2022; 61:407-423. [PMID: 35819511 DOI: 10.1007/s00411-022-00983-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 06/26/2022] [Indexed: 06/15/2023]
Abstract
The clinical information on the relationship between the cardiac contact distance (CCD), the maximum dose (Dmax) delivered to the left anterior descending (LAD) coronary artery and the mean heart dose has mostly focused on patients with breast-conserving surgery (BCS), being scarce in postmastectomy patients. The aim of this study is to determine the association between the CCD and the Dmax delivered to the LAD. The secondary objective was to evaluate the dosimetric results of comparing three-dimensional conformal radiotherapy (3D-CRT) to intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) techniques for post mastectomized breast cancer patients with irradiation to the left chest wall. 53 cases of women who received adjuvant standard fractionated postmastectomy radiotherapy (PMRT) were used. Three types of plans were created for each patient: 3D-CRT, seven equidistant IMRT fields, and four partial VMAT arcs. Correlations were evaluated using Pearson's correlation coefficient. Plans made with IMRT and VMAT showed improved homogeneity and conformity. Associations between CCD and Dmax to LAD were positive for all three plan types. Compared to 3D-CRT, the modulated intensity plans obtained better dose homogeneity and conformity to the target volume. The LAD and heart doses were significantly lower for IMRT and VMAT plans. The CCD can be used as a predictor of the maximum and mean doses of the LAD. Modulated intensity techniques allow for better dose distribution and dose reduction to the heart and LAD.
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Affiliation(s)
- A H Badillo-Alvarado
- División de Oncología y Uronefrología, Departamento de Radioterapia, Unidad Médica de Alta Especialidad, Hospital de Especialidades del Centro Médico Nacional "Ignacio García Téllez", Instituto Mexicano del Seguro Social, CP 97150, Mérida, Yucatán, México
| | - E A Martín-Tovar
- División de Oncología y Uronefrología, Departamento de Radioterapia, Unidad Médica de Alta Especialidad, Hospital de Especialidades del Centro Médico Nacional "Ignacio García Téllez", Instituto Mexicano del Seguro Social, CP 97150, Mérida, Yucatán, México.
| | - G M Molina-Salinas
- Unidad de Investigación Médica Yucatán, Unidad Médica de Alta Especialidad Hospital de Especialidades 1 Mérida, Yucatán, Instituto Mexicano del Seguro Social, CP 97150, Mérida, Yucatán, México
| | - A C Sandoval-Méndez
- División de Oncología y Uronefrología, Departamento de Radioterapia, Unidad Médica de Alta Especialidad, Hospital de Especialidades del Centro Médico Nacional "Ignacio García Téllez", Instituto Mexicano del Seguro Social, CP 97150, Mérida, Yucatán, México
| | - A Sarricolea-Puch
- División de Oncología y Uronefrología, Departamento de Radioterapia, Unidad Médica de Alta Especialidad, Hospital de Especialidades del Centro Médico Nacional "Ignacio García Téllez", Instituto Mexicano del Seguro Social, CP 97150, Mérida, Yucatán, México
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Assessment of coronary spasms with transluminal attenuation gradient in coronary computed tomography angiography. PLoS One 2022; 17:e0271189. [PMID: 35802711 PMCID: PMC9269916 DOI: 10.1371/journal.pone.0271189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 06/24/2022] [Indexed: 11/20/2022] Open
Abstract
Purpose To evaluate the imaging features of coronary spasm, including transluminal attenuation gradient (TAG) on coronary computed tomography angiography (CCTA), in patients with vasospastic angina (VA). Methods A total of 43 patients with a high clinical likelihood of VA were included in the study. All the subjects underwent double CCTA acquisition: CCTA without a vasodilator (‘baseline CT’) and CCTA during continuous intravenous nitrate infusion (‘IV nitrate CT’). A catheterized ergonovine provocation test was used to determine true VA patients. Coronary spasm is classified into focal- and diffuse-types according to morphological differences. We measured TAG and contrast enhancement of the proximal ostium (ProxHU) of each coronary artery for both the baseline and IV nitrate CT. Results Twenty-four patients (55.8%) showed positive results of coronary vasospasm on the provocation test. Thirty-eight vessels showed coronary spasms (29.5%): Focal-type in nine vessels (24%), and diffuse-type in 29 (76%). In the baseline CT, LCX showed significantly lower (steeper) TAG in spasm(+) vessels than in spasm(-) vessels, while LAD and RCA showed no significant differences in TAG. The ProxHU of LAD showed significantly lower values in spasm(+) vessels than in spasm(-) vessels, while the other vessels did not show significant differences in ProxHU. For IV nitrate CT, there were no significant differences in either the TAG and ProxHU between spasm(+) and (-) vessels for all the three vessel types. In subgroup analysis for spasm(+) vessels, diffuse spasms showed significantly lower TAG than focal spasms, while the ProxHU did not differ between the two types of spasm. Conclusions A relatively large percentage of coronary spasms present as diffuse type, and the TAG values significantly differed according to the morphological type of the coronary spasm.
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Nooraeen A, Ghalichi F, Taghizadeh H, Guidoin R. Probing the possibility of lesion formation/progression in vicinity of a primary atherosclerotic plaque: A fluid-solid interaction study and angiographic evidences. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2022; 38:e3605. [PMID: 35481668 DOI: 10.1002/cnm.3605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 04/14/2022] [Indexed: 06/14/2023]
Abstract
It is shown that certain locations in the arterial tree, such as coronary and cerebral arteries, are more prevalent to plaque formation. Endothelial activation and consequent plaque development are attributed to local hemodynamic parameters such as wall shear stress (WSS), oscillatory shear index (OSI), relative residence time (RRT), and stress phase angle. After a certain level of plaque progression, these hemodynamic parameters are disturbed before and after the plaque. In the current study, it is hypothesized that the vicinity of a primary lesion is susceptible for further degeneration and second plaque formation. A fluid-solid interaction (FSI) model of the coronary artery with different levels of asymmetric constriction, is simulated and the trend of hemodynamic parameters were studied in both of the plaque side (PS) and the opposite wall (facing the plaque [PF]). Also, a novel factor is introduced that can identify the high-risk regions associated with WSS oscillations to negative values. Our results indicate that when more than half of the artery is constricted, the downstream of the plaque is highly exposed to endothelial pathogenesis the PS, such that negative WSS, and as well, critical values of OSI and RRT, that is, -1.2 Pa, 0.42 and 6.5 s, respectively arise in this region. PS endothelial cells in this region exposed to the highest risk of atherosclerosis based on the proposed index (3 out of 3). As well, three cases of angiographic images are provided that confirms existence of secondary lesion close to the primary one as predicted by our computational simulations.
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Affiliation(s)
- Ahmad Nooraeen
- Tissue Mechanics Lab, Faculty of Biomedical Engineering, Sahand University of Technology, Tabriz, Iran
| | - Farzan Ghalichi
- Faculty of Biomedical Engineering, Sahand University of Technology, Tabriz, Iran
| | - Hadi Taghizadeh
- Tissue Mechanics Lab, Faculty of Biomedical Engineering, Sahand University of Technology, Tabriz, Iran
| | - Robert Guidoin
- Department of Surgery, Université Laval and Division of Regenerative Medicine, CHU de Québec Research Centre, Quebec, Canada
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Herz S, Stefanescu MR, Lohr D, Vogel P, Kosmala A, Terekhov M, Weng AM, Grunz JP, Bley TA, Schreiber LM. Effects of image homogeneity on stenosis visualization at 7 T in a coronary artery phantom study: With and without B1-shimming and parallel transmission. PLoS One 2022; 17:e0270689. [PMID: 35767553 PMCID: PMC9242506 DOI: 10.1371/journal.pone.0270689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 06/15/2022] [Indexed: 11/18/2022] Open
Abstract
Background To investigate the effects of B1-shimming and radiofrequency (RF) parallel transmission (pTX) on the visualization and quantification of the degree of stenosis in a coronary artery phantom using 7 Tesla (7 T) magnetic resonance imaging (MRI). Methods Stenosis phantoms with different grades of stenosis (0%, 20%, 40%, 60%, 80%, and 100%; 5 mm inner vessel diameter) were produced using 3D printing (clear resin). Phantoms were imaged with four different concentrations of diluted Gd-DOTA representing established arterial concentrations after intravenous injection in humans. Samples were centrally positioned in a thorax phantom of 30 cm diameter filled with a custom-made liquid featuring dielectric properties of muscle tissue. MRI was performed on a 7 T whole-body system. 2D-gradient-echo sequences were acquired with an 8-channel transmit 16-channel receive (8 Tx / 16 Rx) cardiac array prototype coil with and without pTX mode. Measurements were compared to those obtained with identical scan parameters using a commercially available 1 Tx / 16 Rx single transmit coil (sTX). To assess reproducibility, measurements (n = 15) were repeated at different horizontal angles with respect to the B0-field. Results B1-shimming and pTX markedly improved flip angle homogeneity across the thorax phantom yielding a distinctly increased signal-to-noise ratio (SNR) averaged over a whole slice relative to non-manipulated RF fields. Images without B1-shimming showed shading artifacts due to local B1+-field inhomogeneities, which hampered stenosis quantification in severe cases. In contrast, B1-shimming and pTX provided superior image homogeneity. Compared with a conventional sTX coil higher grade stenoses (60% and 80%) were graded significantly (p<0.01) more precise. Mild to moderate grade stenoses did not show significant differences. Overall, SNR was distinctly higher with B1-shimming and pTX than with the conventional sTX coil (inside the stenosis phantoms 14%, outside the phantoms 32%). Both full and half concentration (10.2 mM and 5.1 mM) of a conventional Gd-DOTA dose for humans were equally suitable for stenosis evaluation in this phantom study. Conclusions B1-shimming and pTX at 7 T can distinctly improve image homogeneity and therefore provide considerably more accurate MR image analysis, which is beneficial for imaging of small vessel structures.
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Affiliation(s)
- Stefan Herz
- Comprehensive Heart Failure Center (CHFC), Chair of Molecular and Cellular Imaging, University Hospital Würzburg, Würzburg, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
- * E-mail:
| | - Maria R. Stefanescu
- Comprehensive Heart Failure Center (CHFC), Chair of Molecular and Cellular Imaging, University Hospital Würzburg, Würzburg, Germany
| | - David Lohr
- Comprehensive Heart Failure Center (CHFC), Chair of Molecular and Cellular Imaging, University Hospital Würzburg, Würzburg, Germany
| | - Patrick Vogel
- Department of Experimental Physics V, University of Würzburg, Würzburg, Germany
| | - Aleksander Kosmala
- Comprehensive Heart Failure Center (CHFC), Chair of Molecular and Cellular Imaging, University Hospital Würzburg, Würzburg, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Maxim Terekhov
- Comprehensive Heart Failure Center (CHFC), Chair of Molecular and Cellular Imaging, University Hospital Würzburg, Würzburg, Germany
| | - Andreas M. Weng
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Jan-Peter Grunz
- Comprehensive Heart Failure Center (CHFC), Chair of Molecular and Cellular Imaging, University Hospital Würzburg, Würzburg, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Thorsten A. Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Laura M. Schreiber
- Comprehensive Heart Failure Center (CHFC), Chair of Molecular and Cellular Imaging, University Hospital Würzburg, Würzburg, Germany
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Ekblad MO, Gissler M, Korhonen PE. New theory about the pathophysiology of preeclampsia derived from the paradox of positive effects of maternal smoking. J Hypertens 2022; 40:1223-1230. [PMID: 35703884 DOI: 10.1097/hjh.0000000000003142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate if maternal height affects the link between the inverse association on smoking during pregnancy and preeclampsia. STUDY DESIGN The study population consisted of all women with singleton pregnancies (n = 803 698) in Finland during the years 2004-2018, excluding women with unknown smoking and diagnosis of prepregnancy chronic hypertension. Information on smoking and background factors were derived from the Finnish Medical Birth Register. Smoking was categorized in three classes: no, quitted in the first trimester and continued throughout the pregnancy. Information on preeclampsia was derived from the Finnish Hospital Discharge Register and the Finnish Medical Birth Register. Multiple logistic regression models were used to estimate first the association between smoking and preeclampsia, and finally whether maternal height modified the association. RESULTS In the standard comparison, we found evidence of an association between preeclampsia and continued smoking [adjusted odds ratio = 0.74, 95% confidence interval (95% CI) = 0.67-0.81], but no association was found between quitted smoking and preeclampsia. Thus, the interaction of continued smoking and maternal height by z-scores was estimated. Among taller mothers, continued smoking was associated with a higher risk for preeclampsia than in smoking mothers with average height (β = 0.33, SE = 0.14, P = 0.02). CONCLUSION Our results partly challenge the smoking-preeclampsia paradox: smoking seems not to protect tall mothers against preeclampsia. We speculate the findings through a new theory about the pathophysiology of preeclampsia. It seems that tall pregnant smokers must raise their blood pressure aggressively to ensure perfusion in the dysfunctional placenta.
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Affiliation(s)
- Mikael O Ekblad
- Department of General Practice, Institute of Clinical Medicine, University of Turku and Turku University Hospital, Turku
| | - Mika Gissler
- THL Finnish Institute for Health and Welfare, Information Services Department, Helsinki.,Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,Karolinska Institute, Department of Molecular Medicine and Surgery.,Region Stockholm, Academic Primary Healthcare Centre, Stockholm, Sweden
| | - Päivi E Korhonen
- Department of General Practice, Institute of Clinical Medicine, University of Turku and Turku University Hospital, Turku
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Importance of the heart rate in ultra-high-resolution coronary CT angiography with 0.35 s gantry rotation time. Jpn J Radiol 2022; 40:781-790. [PMID: 35396666 DOI: 10.1007/s11604-022-01265-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/08/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE We investigated the effects of the heart rate (HR) on the motion artifact in coronary computed tomography angiography (CCTA) with ultra-high-resolution-CT (U-HRCT), and we clarified the upper limit of optimal HR in CCTA with U-HRCT in a comparison with conventional-resolution-CT (CRCT) on a cardiac phantom and in patients with CCTA. MATERIALS AND METHODS A pulsating cardiac phantom equipped with coronary models was scanned at static and HR simulations of 40-90 beats/min (bpm) at 10-bpm intervals using U-HRCT and CRCT, respectively. The sharpness and lumen diameter of the coronary model were quantitatively compared between U-HRCT and CRCT stratified by HR in the phantom study. We also assessed the visual inspections of clinical images in CCTA with U-HRCT. RESULTS At the HRs ≤ 60 bpm, the error of the lumen diameter of the U-HRCT tended to be smaller than that of the CRCT. However, at the HRs > 60 bpm, the inverse was shown. For the image sharpness, the U-HRCT was significantly superior to the CRCT (p < 0.05). In the visual assessment, the scores were negatively correlated with HRs in patients (Spearman r = - 0.71, p < 0.01). A receiver-operating characteristic analysis revealed the HR of 61 bpm as the optimal cutoff of the non-diagnostic image quality, with an area under the curve of 0.87, 95% sensitivity, and 71% specificity. CONCLUSION At HRs ≤ 60 bpm, U-HRCT was more accurate in the imaging of coronary arteries than CRCT. The upper limit of the optimal HR in CCTA with U-HRCT was approx. 60 bpm.
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Welch T, Rampersad F, Motilal S, Seecheran NA. Comparison of cardiac CT angiography coronary artery dimensions and ethnicity in Trinidad: the CADET pilot study. Open Heart 2022; 9:openhrt-2021-001922. [PMID: 35354659 PMCID: PMC8968509 DOI: 10.1136/openhrt-2021-001922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/07/2022] [Indexed: 11/11/2022] Open
Abstract
Background This study aimed to determine if there were any significant differences in coronary artery (CA) dimensions at prespecified segments during cardiac CT angiography (CCTA) compared with ethnicity at an academic tertiary medical centre in Trinidad and Tobago. Methods Patients (n=170) who underwent CCTA from July 2016 to June 2021 at the Eric Williams Medical Sciences Complex were selected based on predefined selection criteria. The size of the left main and proximal, mid and distal diameters of the left anterior descending, left circumflex and right coronary artery (RCA) were measured using quantitative coronary angiography, syngo.CT Coronary Analysis (Siemens Healthineers AG, Erlangen, Germany). Routine medical history, cardiovascular medications and anthropometric data were also recorded. Comparisons were performed using an independent sample t-test and analysis of variance for continuous variables. Results One hundred and seventy participants were enrolled in this study. There were no statistically significant associations between gender and CA dimensions; however, there were significant associations between South Asian and Caribbean black ethnicities for almost all CA dimensions except for the distal RCA segment. These findings were replicated when the analysis was adjusted for body surface area with the addition of the mid-RCA segment, which was bordering near-significance (p value 0.051). Conclusions Significantly smaller CA dimensions were observed in South Asian patients compared with Caribbean black patients undergoing CCTA. This pilot study could be clinically significant for Trinidadian patients at risk of developing coronary artery disease. Trial registration number NCT04774861.
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Affiliation(s)
- Tonya Welch
- Department of Clinical Medical Sciences, The University of the West Indies, Saint Augustine, Trinidad and Tobago
| | - Fidel Rampersad
- Department of Clinical Medical Sciences, The University of the West Indies, Saint Augustine, Trinidad and Tobago
| | - Shastri Motilal
- Department of Clinical Medical Sciences, The University of the West Indies, Saint Augustine, Trinidad and Tobago
| | - Naveen Anand Seecheran
- Department of Clinical Medical Sciences, The University of the West Indies, Saint Augustine, Trinidad and Tobago
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Park S, Park SJ, Park DW. Percutaneous Coronary Intervention for Left Main Coronary Artery Disease. JACC: ASIA 2022; 2:119-138. [PMID: 36339118 PMCID: PMC9627854 DOI: 10.1016/j.jacasi.2021.12.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/09/2021] [Accepted: 12/17/2021] [Indexed: 11/26/2022]
Abstract
For several decades, coronary artery bypass grafting has been regarded as the standard choice of revascularization for significant left main coronary artery (LMCA) disease. However, in conjunction with remarkable advancement of device technology and adjunctive pharmacology, percutaneous coronary intervention (PCI) offers a more expeditious approach with rapid recovery and is a safe and effective alternative in appropriately selected patients with LMCA disease. Several landmark randomized clinical trials showed that PCI with drug-eluting stents for LMCA disease is a safe option with similar long-term survival rates to coronary artery bypass grafting surgery, especially in those with low and intermediate anatomic risk. Although it is expected that the updated evidence from recent randomized clinical trials will determine the next guidelines for the foreseeable future, there are still unresolved and unmet issues of LMCA revascularization and PCI strategy. This paper provides a comprehensive review on the evolution and an update on the management of LMCA disease. With advancements in PCI, clinical outcomes after left main PCI have progressively improved. Unmet needs still exist between clinical practice and the current evidence for left main PCI. Better decision making of revascularization choice and PCI optimization should be emphasized to improve outcomes of LMCA disease. Further research will provide further evidence to resolve conflicting issues on left main PCI.
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Chaszczewski KJ, Nicholson GT, Shahanavaz S, Dori Y, Gillespie MJ, O'Byrne ML, Rome JJ, Glatz AC. Stent Angioplasty for Post-Operative Coronary Artery Stenosis in Infants. World J Pediatr Congenit Heart Surg 2022; 13:203-207. [PMID: 35238698 DOI: 10.1177/21501351221074617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION While frequently performed in the adult population, percutaneous coronary artery stent angioplasty (CSA) in infants is rare. CSA in infants is challenging because of limited options in terms of appropriately sized (length and diameter) stents, concern about stenting vessels with significant growth potential and limited data regarding durability of benefit. We report a multicenter case series of infants who underwent CSA. METHODS A multicenter, retrospective case series of infants who underwent percutaneous CSA to treat post-operative coronary artery stenoses was performed. RESULTS Six infants from 3 institutions who underwent post-operative CSA were identified. The anatomic diagnoses were d-transposition of the great arteries in 3 cases, anomalous left coronary artery from the pulmonary artery in 2 and supravalvar aortic stenosis in 1. All infants were critically ill at the time of CSA. Diameters of coronary artery stents used ranged from 2.25 to 2.75 mm. There were no procedural complications. All stents were patent immediately after placement and the clinical condition improved or stabilized in all patients. Follow-up angiography was available for 3 patients at 4 to 16 months post-CSA, at which time 67% (2/3) remained patent. CONCLUSION CSA is a feasible and effective therapy for critically ill infants with post-surgical coronary obstruction. Treatment appears to allow at least short-term reperfusion to facilitate recovery of ventricular function and potential development of collateral circulation when longer-term stent patency is not achieved. Longer-term stent patency and coronary artery health remain unanswered questions.
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Affiliation(s)
- Kasey J Chaszczewski
- 5506Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.,Section of Pediatric Cardiology, The Herma Heart Institute, Milwaukee, WI, USA.,6572Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - George T Nicholson
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Shabana Shahanavaz
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA. Work completed at: Department of Pediatrics, Division of Cardiology, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Yoav Dori
- 6572Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Matthew J Gillespie
- 6572Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Michael L O'Byrne
- 6572Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,6567Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Leonard Davis Institute and Center for Cardiovascular Outcomes, Quality, and Evaluative Research, University of Pennsylvania, Philadelphia, PA, USA
| | - Jonathan J Rome
- 6572Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew C Glatz
- 6572Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,6567Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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SHINDE SHUBHAM, MUKHOPADHYAY SUDIPTO, MUKHOPADHYAY SUMANTO. INVESTIGATION OF FLOW IN AN IDEALIZED CURVED ARTERY: COMPARATIVE STUDY USING CFD AND FSI WITH NEWTONIAN AND NON-NEWTONIAN FLUIDS. J MECH MED BIOL 2022. [DOI: 10.1142/s0219519422500105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Artery curvatures, where disturbed flow patterns are expected, are preferred sites of formation of atherosclerosis. Experimental studies have shown that low and oscillating wall shear stress (WSS) plays an important role in the development and progression of atherosclerosis. Accurate estimation of these biomechanical parameters is important to assess the risk of atherosclerosis formation. The coupled effects of non-Newtonian behavior of blood and artery wall flexibility for the transient blood flow through an idealized curved coronary artery are investigated using computational fluid dynamics (CFD) as well as fluid–structure interaction (FSI) simulations. The choice of fluid model, Carreau and Newtonian, was found to impact the time averaged and minimum WSS values. The effects of wall deformation on time averaged wall shear tress were negligible. However, a comparison of temporal minima of WSS along the curvature showed significant variations between CFD and FSI simulations. Since low WSS values are crucial in the prediction of atherosclerosis development, it is concluded that both the non-Newtonian behavior of blood and the wall flexibility should be considered for computational studies.
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Affiliation(s)
- SHUBHAM SHINDE
- Department of Mechanical Engineering, Indian Institute of Technology Jodhpur, Jodhpur, Rajasthan 342037, India
| | - SUDIPTO MUKHOPADHYAY
- Department of Mechanical Engineering, Indian Institute of Technology Jodhpur, Jodhpur, Rajasthan 342037, India
| | - SUMANTO MUKHOPADHYAY
- Department of Interventional Cardiology, St. Bartholomew Hospital, London, United Kingdom
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Puladi B, Vogt F, Dinekov M, Köhler C. Variants of arterial supply to the inferior (diaphragmatic) surface of the ventricles of the heart and the influence on age at death. Clin Anat 2022; 35:404-411. [PMID: 35112400 DOI: 10.1002/ca.23846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 11/08/2022]
Abstract
Coronary artery systems of the inferior wall of the ventricles vary considerably. Schlesinger's concept distinguishes dominance of the right or left coronary artery or balanced type. Left coronary artery dominance has been reported to be associated with increased mortality. Early angiography studies have shown that the anterior interventricular artery (AIVA), a branch of the left coronary artery, often continues on the inferior surface of the heart and may replace the inferior interventricular artery. Others considered an AIVA on the inferior surface of the heart a rare variant. A long AIVA is a strong predictor of death in acute anterior wall myocardial infarction. We determined coronary artery variance at the inferior surface of the ventricles in 134 dissected human hearts and analyzed a possible association between coronary artery variance and age at death. The AIVA extended to the inferior side in 64.9% of the hearts, but rarely reached the basal half of the inferior interventricular groove. Most frequently (53.03%), it extended into the apical two-fifths of the length of the inferior ventricular walls. An AIVA extending to the apical 40% of the length of the inferior ventricular walls may therefore be considered a common variant. In 20.1% of the hearts, a right inferior diagonal artery was also found. Statistical analysis neither revealed an association between mean AIVA length at the inferior ventricular surface and type of coronary artery dominance nor an association between AIVA length at the inferior ventricular surface or coronary artery dominance type and age at death.
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Affiliation(s)
- Behrus Puladi
- University of Cologne, Germany, Faculty of Medicine and University Hospital Cologne, Center Anatomy, Department II
| | - Felix Vogt
- Medical Clinic I, University Hospital RWTH Aachen, Aachen, Germany
| | - Maja Dinekov
- University of Cologne, Germany, Faculty of Medicine and University Hospital Cologne, Center Anatomy, Department II
| | - Christoph Köhler
- University of Cologne, Germany, Faculty of Medicine and University Hospital Cologne, Center Anatomy, Department II
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El Koussa R, Graft J, Linder S, Bansal VK. Outcomes of Endovascular Stenting in Symptomatic Vertebral Artery Ostial Stenosis. Cureus 2022; 14:e21465. [PMID: 35223249 PMCID: PMC8858421 DOI: 10.7759/cureus.21465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 11/05/2022] Open
Abstract
Vertebral artery ostial stenosis is implicated in one-fifth of all posterior circulation cerebrovascular accidents. However, uniform treatment guidelines and data on the different treatment modalities are still lacking. Endovascular stenting is an emerging therapy for symptomatic vertebral artery ostial stenosis when medical management fails. This manuscript will examine the safety and efficacy of endovascular revascularization with drug-eluting stents in a series of ten consecutive patients that had failed medical management. We also report the rate of complications and in-stent restenosis, as well as the rate of recurrent cerebrovascular accidents.
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Gao Z, Wang L, Soroushmehr R, Wood A, Gryak J, Nallamothu B, Najarian K. Vessel segmentation for X-ray coronary angiography using ensemble methods with deep learning and filter-based features. BMC Med Imaging 2022; 22:10. [PMID: 35045816 PMCID: PMC8767756 DOI: 10.1186/s12880-022-00734-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 01/04/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Automated segmentation of coronary arteries is a crucial step for computer-aided coronary artery disease (CAD) diagnosis and treatment planning. Correct delineation of the coronary artery is challenging in X-ray coronary angiography (XCA) due to the low signal-to-noise ratio and confounding background structures. METHODS A novel ensemble framework for coronary artery segmentation in XCA images is proposed, which utilizes deep learning and filter-based features to construct models using the gradient boosting decision tree (GBDT) and deep forest classifiers. The proposed method was trained and tested on 130 XCA images. For each pixel of interest in the XCA images, a 37-dimensional feature vector was constructed based on (1) the statistics of multi-scale filtering responses in the morphological, spatial, and frequency domains; and (2) the feature maps obtained from trained deep neural networks. The performance of these models was compared with those of common deep neural networks on metrics including precision, sensitivity, specificity, F1 score, AUROC (the area under the receiver operating characteristic curve), and IoU (intersection over union). RESULTS With hybrid under-sampling methods, the best performing GBDT model achieved a mean F1 score of 0.874, AUROC of 0.947, sensitivity of 0.902, and specificity of 0.992; while the best performing deep forest model obtained a mean F1 score of 0.867, AUROC of 0.95, sensitivity of 0.867, and specificity of 0.993. Compared with the evaluated deep neural networks, both models had better or comparable performance for all evaluated metrics with lower standard deviations over the test images. CONCLUSIONS The proposed feature-based ensemble method outperformed common deep convolutional neural networks in most performance metrics while yielding more consistent results. Such a method can be used to facilitate the assessment of stenosis and improve the quality of care in patients with CAD.
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Affiliation(s)
- Zijun Gao
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, USA.
| | - Lu Wang
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, USA
| | - Reza Soroushmehr
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, USA
- Michigan Institute for Data Science (MIDAS), University of Michigan, Ann Arbor, USA
- Michigan Center for Integrative Research in Critical Care (MCIRCC), University of Michigan, Ann Arbor, USA
| | - Alexander Wood
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, USA
| | - Jonathan Gryak
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, USA
- Michigan Institute for Data Science (MIDAS), University of Michigan, Ann Arbor, USA
| | - Brahmajee Nallamothu
- Department of Internal Medicine, University of Michigan, Ann Arbor, USA
- Division of Cardiovascular Diseases, University of Michigan, Ann Arbor, USA
| | - Kayvan Najarian
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, USA
- Michigan Institute for Data Science (MIDAS), University of Michigan, Ann Arbor, USA
- Department of Emergency Medicine, University of Michigan, Ann Arbor, USA
- Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, USA
- Michigan Center for Integrative Research in Critical Care (MCIRCC), University of Michigan, Ann Arbor, USA
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