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Rosu-Bubulac M, Trankle CR, Mankad P, Grizzard JD, Ellenbogen KA, Jordan JH, Weiss E. Institutional experience report on the target contouring workflow in the radiotherapy department for stereotactic arrhythmia radioablation delivered on conventional linear accelerators. Strahlenther Onkol 2024; 200:83-96. [PMID: 37872398 DOI: 10.1007/s00066-023-02159-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 09/17/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE In stereotactic arrhythmia radioablation (STAR), the target is defined using multiple imaging studies and a multidisciplinary team consisting of electrophysiologist, cardiologist, cardiac radiologist, and radiation oncologist collaborate to identify the target and delineate it on the imaging studies of interest. This report describes the workflow employed in our radiotherapy department to transfer the target identified based on electrophysiology and cardiology imaging to the treatment planning image set. METHODS The radiotherapy team was presented with an initial target in cardiac axes orientation, contoured on a wideband late gadolinium-enhanced (WB-LGE) cardiac magnetic resonance (CMR) study, which was subsequently transferred to the computed tomography (CT) scan used for treatment planning-i.e., the average intensity projection (AIP) image set derived from a 4D CT-via an axial CMR image set, using rigid image registration focused on the target area. The cardiac and the respiratory motion of the target were resolved using ciné-CMR and 4D CT imaging studies, respectively. RESULTS The workflow was carried out for 6 patients and resulted in an internal target defined in standard anatomical orientation that encompassed the cardiac and the respiratory motion of the initial target. CONCLUSION An image registration-based workflow was implemented to render the STAR target on the planning image set in a consistent manner, using commercial software traditionally available for radiation therapy.
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Affiliation(s)
- Mihaela Rosu-Bubulac
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, USA.
| | - Cory R Trankle
- Department of Internal Medicine, Division of Cardiology, Virginia Commonwealth University, Richmond, VA, USA
- Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Pranav Mankad
- Department of Internal Medicine, Division of Cardiology, Virginia Commonwealth University, Richmond, VA, USA
- Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - John D Grizzard
- Department of Radiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Kenneth A Ellenbogen
- Department of Internal Medicine, Division of Cardiology, Virginia Commonwealth University, Richmond, VA, USA
- Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Jennifer H Jordan
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, USA
- Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Elisabeth Weiss
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, USA
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Aston A, Harowicz MR, Grizzard JD, Bottinor W. Massive Mysteries. Am J Cardiol 2023; 204:178-182. [PMID: 37544141 PMCID: PMC10528874 DOI: 10.1016/j.amjcard.2023.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 07/11/2023] [Indexed: 08/08/2023]
Abstract
Papillary fibroelastomas are benign masses often originating from the endocardium of the aortic and mitral valves. Rarely, these neoplasms are found in areas of the heart embryonically distinct from the aortic and mitral valves. Diagnosis of a papillary fibroelastoma relies on multimodal imaging as well as histologic assessment. A case series of papillary fibroelastomas in unusual locations is presented, highlighting the role of multimodal imaging techniques in identifying these intra-cardiac masses. Differential diagnoses, imaging characteristics, histopathology, and preferred management strategies for cardiac masses are reviewed. The unique imaging qualities of cardiac masses are discussed.
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Affiliation(s)
- Adam Aston
- Department of Internal Medicine, Virginia Commonwealth University Health System, Richmond, Virginia
| | - Michael R Harowicz
- Department of Radiology, Duke University Hospital, Durham, North Carolina
| | - John D Grizzard
- Department of Radiology, Virginia Commonwealth University Health System, Richmond, Virginia
| | - Wendy Bottinor
- Department of Cardiology, Virginia Commonwealth University Health System, Richmond, Virginia.
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Canada JM, Weiss E, Grizzard JD, Trankle CR, Gharai LR, Dana F, Buckley LF, Carbone S, Kadariya D, Ricco A, Jordan JH, Evans RK, Garten RS, Van Tassell BW, Hundley WG, Abbate A. Influence of extracellular volume fraction on peak exercise oxygen pulse following thoracic radiotherapy. Cardio-Oncology 2022; 8:1. [PMID: 35042565 PMCID: PMC8764840 DOI: 10.1186/s40959-021-00127-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/30/2021] [Indexed: 12/20/2022]
Abstract
Background Radiation-induced myocardial fibrosis increases heart failure (HF) risk and is associated with a restrictive cardiomyopathy phenotype. The myocardial extracellular volume fraction (ECVF) using contrast-enhanced cardiac magnetic resonance (CMR) quantifies the extent of fibrosis which, in severe cases, results in a noncompliant left ventricle (LV) with an inability to augment exercise stroke volume (SV). The peak exercise oxygen pulse (O2Pulse), a noninvasive surrogate for exercise SV, may provide mechanistic insight into cardiac reserve. The relationship between LV ECVF and O2Pulse following thoracic radiotherapy has not been explored. Methods Patients who underwent thoracic radiotherapy for chest malignancies with significant incidental heart dose (≥5 Gray (Gy), ≥10% heart) without a pre-cancer treatment history of HF underwent cardiopulmonary exercise testing to determine O2Pulse, contrast-enhanced CMR, and N-terminal pro-brain natriuretic peptide (NTproBNP) measurement. Multivariable-analyses were performed to identify factors associated with O2Pulse normalized for age/gender/anthropometrics. Results Thirty patients (median [IQR] age 63 [57–67] years, 18 [60%] female, 2.0 [0.6–3.8] years post-radiotherapy) were included. The peak VO2 was 1376 [1057–1552] mL·min− 1, peak HR = 150 [122–164] bpm, resulting in an O2Pulse of 9.2 [7.5–10.7] mL/beat or 82 (66–96) % of predicted. The ECVF, LV ejection fraction, heart volume receiving ≥10 Gy, and NTproBNP were independently associated with %O2Pulse (P < .001). Conclusions In patients with prior radiotherapy heart exposure, %-predicted O2Pulse is inversely associated markers of diffuse fibrosis (ECVF), ventricular wall stress (NTproBNP), radiotherapy heart dose, and positively related to LV function. Increased LV ECVF may reflect a potential etiology of impaired LV SV reserve in patients receiving thoracic radiotherapy for chest malignancies. Supplementary Information The online version contains supplementary material available at 10.1186/s40959-021-00127-6.
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Kwiatkowski SG, Gertz ZM, Grizzard JD, Rezai Gharai L, Tchoukina I, Trankle CR. Right Atrial Compression From Biodebris Associated With Long-Term Left Ventricular Assist Device Support. JACC Case Rep 2022; 4:101656. [PMID: 36507294 PMCID: PMC9730033 DOI: 10.1016/j.jaccas.2022.08.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 08/03/2022] [Accepted: 08/15/2022] [Indexed: 11/08/2022]
Abstract
Biodebris surrounding HVAD (Medtronic) intrapericardial centrifugal-flow left ventricular assist device outflow cannulas is common and appears to accumulate over time. We recently encountered 2 patients on long-term HVAD support with right atrial compression from such biodebris, prompting a review of our institution's HVAD cohort to better understand this phenomenon. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Sara G. Kwiatkowski
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Zachary M. Gertz
- Division of Cardiology, Virginia Commonwealth University Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - John D. Grizzard
- Department of Radiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Leila Rezai Gharai
- Department of Radiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Inna Tchoukina
- Division of Cardiology, Virginia Commonwealth University Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Cory R. Trankle
- Division of Cardiology, Virginia Commonwealth University Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA,Address for correspondence: Dr Cory R. Trankle, Virginia Commonwealth University Pauley Heart Center, Virginia Commonwealth University, PO Box 980036, 1200 E Broad Street, Richmond, Virginia 23298, USA. @Sarakwiat
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Kutkut I, Worrall E, Pal N, Shah PR, Grizzard JD, Naz NA, Gertz ZM. Coronary Air Embolism and Pneumomediastinum After a MitraClip Procedure. JACC Cardiovasc Interv 2022; 15:1770-1772. [DOI: 10.1016/j.jcin.2022.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/16/2022] [Accepted: 06/28/2022] [Indexed: 11/25/2022]
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Abstract
Hereditary cardiomyopathy comprises a heterogeneous group of diseases of the cardiac muscle that are characterized by the presence of genetic mutations. Cardiac MRI is central to evaluation of patients with cardiomyopathy owing to its ability to allow evaluation of many different tissue properties in a single examination. For example, cine MRI is the standard of care for assessment of myocardial structure and function. It clearly shows regions of asymmetric wall thickening that are typical of hypertrophic cardiomyopathy and allows it to be differentiated from other hereditary disorders such as Fabry disease or transthyretin cardiac amyloidosis that produce concentric hypertrophy. Late gadolinium enhancement provides a different tissue property and allows these latter two causes of concentric hypertrophy to be distinguished on the basis of their enhancement appearances (Fabry disease shows midwall basal inferolateral enhancement, and amyloidosis shows global subendocardial enhancement). Native T1 mapping may similarly allow differentiation between Fabry disease and amyloidosis without the use of contrast material. T2*-weighted MRI is important in the detection and quantification of iron overload cardiomyopathy. Other hereditary entities for which comprehensive MRI has proven essential include Danon disease, familial dilated cardiomyopathy, hereditary muscular dystrophy, arrhythmogenic right ventricular cardiomyopathy, and ventricular noncompaction. As a result of the diagnostic power of cardiac MRI, cardiac MRI examinations are being requested with increasing frequency, not only in academic centers but also in community practices. The genetic background, pathophysiologic characteristics, and clinical presentation of patients with hereditary cardiomyopathy are described; the characteristic cardiac MRI features of hereditary cardiomyopathy are discussed; and the role of MRI in risk stratification, treatment, and prognostication in patients with cardiomyopathy is reviewed. ©RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Shaimaa A Fadl
- From the Department of Radiology, Virginia Commonwealth University Health Systems, 1250 E Marshall St, Richmond, VA 23219 (S.A.F., L.R.G., F.D., E.K.P., J.D.G.); Department of Radiology, University of New Mexico, Albuquerque, NM (J.W.R.); and Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ont, Canada (K.H.)
| | - Jonathan W Revels
- From the Department of Radiology, Virginia Commonwealth University Health Systems, 1250 E Marshall St, Richmond, VA 23219 (S.A.F., L.R.G., F.D., E.K.P., J.D.G.); Department of Radiology, University of New Mexico, Albuquerque, NM (J.W.R.); and Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ont, Canada (K.H.)
| | - Leila Rezai Gharai
- From the Department of Radiology, Virginia Commonwealth University Health Systems, 1250 E Marshall St, Richmond, VA 23219 (S.A.F., L.R.G., F.D., E.K.P., J.D.G.); Department of Radiology, University of New Mexico, Albuquerque, NM (J.W.R.); and Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ont, Canada (K.H.)
| | - Kate Hanneman
- From the Department of Radiology, Virginia Commonwealth University Health Systems, 1250 E Marshall St, Richmond, VA 23219 (S.A.F., L.R.G., F.D., E.K.P., J.D.G.); Department of Radiology, University of New Mexico, Albuquerque, NM (J.W.R.); and Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ont, Canada (K.H.)
| | - Franklin Dana
- From the Department of Radiology, Virginia Commonwealth University Health Systems, 1250 E Marshall St, Richmond, VA 23219 (S.A.F., L.R.G., F.D., E.K.P., J.D.G.); Department of Radiology, University of New Mexico, Albuquerque, NM (J.W.R.); and Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ont, Canada (K.H.)
| | - Elizabeth Kate Proffitt
- From the Department of Radiology, Virginia Commonwealth University Health Systems, 1250 E Marshall St, Richmond, VA 23219 (S.A.F., L.R.G., F.D., E.K.P., J.D.G.); Department of Radiology, University of New Mexico, Albuquerque, NM (J.W.R.); and Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ont, Canada (K.H.)
| | - John D Grizzard
- From the Department of Radiology, Virginia Commonwealth University Health Systems, 1250 E Marshall St, Richmond, VA 23219 (S.A.F., L.R.G., F.D., E.K.P., J.D.G.); Department of Radiology, University of New Mexico, Albuquerque, NM (J.W.R.); and Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ont, Canada (K.H.)
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Kwiatkowski SG, Aulakh VS, Kapoor K, Wei X, Grizzard JD, Hundley WG, Gordon SW, Trankle CR. Case report: paradoxically reversible perfusion defects on vasodilator stress imaging in a case of metastatic coronary compression. Eur Heart J Case Rep 2022; 6:ytac124. [PMID: 35434511 PMCID: PMC9007428 DOI: 10.1093/ehjcr/ytac124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/21/2021] [Accepted: 03/17/2022] [Indexed: 11/13/2022]
Abstract
Background Patients with malignancy who experience metastasis to cardiac structures may exhibit ST-segment elevations and acute coronary syndrome (ACS) through poorly understood pathophysiologic mechanisms. We present a case in which vasodilator stress cardiovascular magnetic resonance provides unique insight into one such patient who suffered from recurrent episodes resembling ACS. Case summary A 58-year-old male with metastatic lung adenocarcinoma presented with refractory angina and dynamic inferior electrocardiogram changes. The patient was referred for adenosine stress cardiovascular magnetic resonance, revealing multiple territories of abnormal perfusion during rest with improvement during adenosine infusion. Subsequent computed tomography displayed tumour encasement of the right coronary artery. Taken together, vasodilator-responsive extrinsic compression of multiple epicardial coronary arteries was suspected. Outpatient oncology follow-up for chemoimmunotherapy initiation was arranged with the hope that reducing tumour burden might alleviate coronary compression. However, in the ensuing months, the patient’s disease advanced beyond the point of which his symptoms could be controlled medically, and he was ultimately enrolled in hospice care. Discussion Encasement of coronary arteries can result in anginal symptoms if their position impairs coronary arterial flow. The presented case highlights the unique manner in which these lesions might behave on stress cardiac magnetic resonance imaging. Clinicians who encounter such unusual findings on vasodilator stress imaging should consider metastatic lesions to the cardiac structures on the differential diagnosis.
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Affiliation(s)
- Sara G Kwiatkowski
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Vikrant S Aulakh
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Kunal Kapoor
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Xin Wei
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - John D Grizzard
- Department of Radiology, Virginia Commonwealth University, Richmond, VA, USA
| | - W Gregory Hundley
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Sarah W Gordon
- Division of Hematology/Oncology/Palliative Care, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Cory R Trankle
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
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Pandya A, Yu YJ, Ge Y, Nagel E, Kwong RY, Bakar RA, Grizzard JD, Merkler AE, Ntusi N, Petersen SE, Rashedi N, Schwitter J, Selvanayagam JB, White JA, Carr J, Raman SV, Simonetti OP, Bucciarelli-Ducci C, Sierra-Galan LM, Ferrari VA, Bhatia M, Kelle S. Evidence-based cardiovascular magnetic resonance cost-effectiveness calculator for the detection of significant coronary artery disease. J Cardiovasc Magn Reson 2022; 24:1. [PMID: 34986851 PMCID: PMC8734365 DOI: 10.1186/s12968-021-00833-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/30/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Although prior reports have evaluated the clinical and cost impacts of cardiovascular magnetic resonance (CMR) for low-to-intermediate-risk patients with suspected significant coronary artery disease (CAD), the cost-effectiveness of CMR compared to relevant comparators remains poorly understood. We aimed to summarize the cost-effectiveness literature on CMR for CAD and create a cost-effectiveness calculator, useable worldwide, to approximate the cost-per-quality-adjusted-life-year (QALY) of CMR and relevant comparators with context-specific patient-level and system-level inputs. METHODS We searched the Tufts Cost-Effectiveness Analysis Registry and PubMed for cost-per-QALY or cost-per-life-year-saved studies of CMR to detect significant CAD. We also developed a linear regression meta-model (CMR Cost-Effectiveness Calculator) based on a larger CMR cost-effectiveness simulation model that can approximate CMR lifetime discount cost, QALY, and cost effectiveness compared to relevant comparators [such as single-photon emission computed tomography (SPECT), coronary computed tomography angiography (CCTA)] or invasive coronary angiography. RESULTS CMR was cost-effective for evaluation of significant CAD (either health-improving and cost saving or having a cost-per-QALY or cost-per-life-year result lower than the cost-effectiveness threshold) versus its relevant comparator in 10 out of 15 studies, with 3 studies reporting uncertain cost effectiveness, and 2 studies showing CCTA was optimal. Our cost-effectiveness calculator showed that CCTA was not cost-effective in the US compared to CMR when the most recent publications on imaging performance were included in the model. CONCLUSIONS Based on current world-wide evidence in the literature, CMR usually represents a cost-effective option compared to relevant comparators to assess for significant CAD.
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Affiliation(s)
- Ankur Pandya
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, 718 Huntington Ave, 2nd Floor, Boston, MA, 02115, USA.
| | - Yuan-Jui Yu
- National Taiwan University Hospital, Taipei, Taiwan
| | - Yin Ge
- Cardiovascular Division of the Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK (German Centre for Cardiovascular Research) Centre for Cardiovascular Imaging, Partner Site RheinMain, University Hospital Frankfurt/Main, Frankfurt am Main, Germany
| | - Raymond Y Kwong
- Cardiovascular Division of the Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Rafidah Abu Bakar
- Department of Cardiology, National Heart Institute, Kuala Lumpur, Malaysia
| | - John D Grizzard
- Department of Radiology, Virginia Commonwealth University Medical Center, Main Hospital, Richmond, VA, USA
| | - Alexander E Merkler
- Department of Neurology, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Ntobeko Ntusi
- Department of Medicine, University of Cape Town & Groote Schuur Hospital, Cape Town, South Africa
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK
| | - Nina Rashedi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Juerg Schwitter
- Division of Cardiology, Cardiovascular Department, CMR Center University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, UniL, Lausanne, Switzerland
| | - Joseph B Selvanayagam
- Department of Medicine, School of Medicine and Public Health, Flinders University, Adelaide, Australia
- Department of Heart Health, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - James A White
- Division of Cardiology, Department of Cardiac Sciences, Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Canada
| | - James Carr
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Subha V Raman
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Orlando P Simonetti
- Departments of Internal Medicine and Radiology, The Ohio State University, Columbus, OH, USA
| | - Chiara Bucciarelli-Ducci
- Royal Brompton and Harefield Hospitals, Guys' and St Thomas NHS Hospitals and School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Lilia M Sierra-Galan
- Cardiovascular Division, Department of Cardiology, American British Cowdray Medical Center, Mexico City, Mexico
| | - Victor A Ferrari
- Cardiovascular Division and Penn Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania Medical Center, Philadelphia, PA, USA
| | - Mona Bhatia
- Department of Imaging, Fortis Escorts Heart Institute, New Delhi, India
| | - Sebastian Kelle
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
- Department of Internal Medicine and Cardiology, DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, German Heart Institute Berlin (DHZB), Berlin, Germany
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Shenoy C, Grizzard JD, Shah DJ, Kassi M, Reardon MJ, Zagurovskaya M, Kim HW, Parker MA, Kim RJ. Cardiovascular magnetic resonance imaging in suspected cardiac tumour: a multicentre outcomes study. Eur Heart J 2021; 43:71-80. [PMID: 34545397 PMCID: PMC8720142 DOI: 10.1093/eurheartj/ehab635] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/25/2021] [Accepted: 09/09/2021] [Indexed: 12/11/2022] Open
Abstract
AIMS Cardiovascular magnetic resonance (CMR) imaging is a key diagnostic tool for the evaluation of patients with suspected cardiac tumours. Patient management is guided by the CMR diagnosis, including no further testing if a mass is excluded or if only a pseudomass is found. However, there are no outcomes studies validating this approach. METHODS AND RESULTS In this multicentre study of patients undergoing clinical CMR for suspected cardiac tumour, CMR diagnoses were assigned as no mass, pseudomass, thrombus, benign tumour, or malignant tumour. A final diagnosis was determined after follow-up using all available data. The primary endpoint was all-cause mortality. Among 903 patients, the CMR diagnosis was no mass in 25%, pseudomass in 16%, thrombus in 16%, benign tumour in 17%, and malignant tumour in 23%. Over a median of 4.9 years, 376 patients died. Compared with the final diagnosis, the CMR diagnosis was accurate in 98.4% of patients. Patients with CMR diagnoses of pseudomass and benign tumour had similar mortality to those with no mass, whereas those with malignant tumour [hazard ratio (HR) 3.31 (2.40-4.57)] and thrombus [HR 1.46 (1.00-2.11)] had greater mortality. The CMR diagnosis provided incremental prognostic value over clinical factors including left ventricular ejection fraction, coronary artery disease, and history of extracardiac malignancy (P < 0.001). CONCLUSION In patients with suspected cardiac tumour, CMR has high diagnostic accuracy. Patients with CMR diagnoses of no mass, pseudomass, and benign tumour have similar long-term mortality. The CMR diagnosis is a powerful independent predictor of mortality incremental to clinical risk factors.
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Affiliation(s)
- Chetan Shenoy
- University of Minnesota Medical Center, Cardiovascular Division, Department of Medicine, 420 Delaware St MMC 508, Minneapolis, MN, USA
| | - John D Grizzard
- Virginia Commonwealth University Medical Center, 1250 E. Marshall Street, Richmond, VA, USA
| | - Dipan J Shah
- Houston Methodist Hospital, 6550 Fannin St Suite 1901, Houston, TX, USA
| | - Mahwash Kassi
- Houston Methodist Hospital, 6550 Fannin St Suite 1901, Houston, TX, USA
| | - Michael J Reardon
- Houston Methodist Hospital, 6550 Fannin St Suite 1901, Houston, TX, USA
| | - Marianna Zagurovskaya
- Virginia Commonwealth University Medical Center, 1250 E. Marshall Street, Richmond, VA, USA
| | - Han W Kim
- Duke University Medical Center, Duke Medical Pavilion, 10 Medicine Circle, Rm IE-58 Durham, NC 27710, USA
| | - Michele A Parker
- Duke University Medical Center, Duke Medical Pavilion, 10 Medicine Circle, Rm IE-58 Durham, NC 27710, USA
| | - Raymond J Kim
- Duke University Medical Center, Duke Medical Pavilion, 10 Medicine Circle, Rm IE-58 Durham, NC 27710, USA
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Gertz ZM, Trankle CR, Grizzard JD, Quader MA, Medalion B, Parris KE, Shah KB. An interventional approach to left ventricular assist device outflow graft obstruction. Catheter Cardiovasc Interv 2021; 98:969-974. [PMID: 33586847 DOI: 10.1002/ccd.29556] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/21/2021] [Accepted: 02/02/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND LVADs provide life-sustaining treatment for patients with heart failure, but their complexity allows for complications. One complication, LVAD outflow graft obstruction, may be misdiagnosed as intraluminal thrombus, when more often it is extraluminal compression from biodebris accumulation. It can often be treated endovascularly with stenting. This case series describes diagnostic and procedural techniques for the treatment of left ventricular assist device (LVAD) outflow graft obstruction. METHODS We present four patients with LVADs who developed LVAD outflow graft obstruction within the bend relief-covered segment. All were initially diagnosed with computed tomographic angiography (CTA). All underwent invasive evaluation with intravascular ultrasound (IVUS), then were treated with stenting. After misdiagnosing a twist, we developed the technique of balloon "graftoplasty" to ensure suitability for stent delivery in subsequent cases. RESULTS All patients presented with low-flow alarms and symptoms of low output, and were diagnosed with outflow graft obstruction by CTA. In all four, IVUS confirmed an extraluminal etiology. Patient 1 was treated with stenting and had a good outcome. Patient 2's obstruction was from twisting, rather than biodebris accumulation, and had sub-optimal stent expansion and ultimately required surgery. Balloon "graftoplasty" was used in subsequent cases to ensure subsequent stent expansion. Patients 3 and 4 were successfully stented. All improved after treatment. CONCLUSIONS In patients with LVAD outflow graft obstruction, IVUS can distinguish intraluminal thrombus from extraluminal compression. Balloon "graftoplasty" can ensure that the outflow graft will respond to stenting. Many cases of LVAD outflow graft obstruction should be amenable to endovascular treatment.
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Affiliation(s)
- Zachary M Gertz
- Division of Cardiology, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Cory R Trankle
- Division of Cardiology, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - John D Grizzard
- Department of Radiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Mohammed A Quader
- Division of Cardiothoracic Surgery, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Benjamin Medalion
- Division of Cardiothoracic Surgery, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Kendall E Parris
- Division of Cardiology, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Keyur B Shah
- Division of Cardiology, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
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Alley R, Grizzard JD, Rao K, Markley R, Trankle CR. Inflammatory Episodes of Desmoplakin Cardiomyopathy Masquerading as Myocarditis: Unique Features on Cardiac Magnetic Resonance Imaging. JACC Cardiovasc Imaging 2020; 14:1466-1469. [PMID: 32950456 DOI: 10.1016/j.jcmg.2020.07.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 06/29/2020] [Accepted: 07/09/2020] [Indexed: 01/04/2023]
Affiliation(s)
- Reid Alley
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - John D Grizzard
- Department of Radiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Krishnasree Rao
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Roshanak Markley
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Cory R Trankle
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA.
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Canada JM, Trankle CR, Carbone S, Buckley LF, Chazal MD, Billingsley H, Evans RK, Garten R, Van Tassell BW, Kadariya D, Mauro A, Toldo S, Mezzaroma E, Arena R, Hundley WG, Grizzard JD, Weiss E, Abbate A. Determinants of Cardiorespiratory Fitness Following Thoracic Radiotherapy in Lung or Breast Cancer Survivors. Am J Cardiol 2020; 125:988-996. [PMID: 31928717 DOI: 10.1016/j.amjcard.2019.12.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/07/2019] [Accepted: 12/13/2019] [Indexed: 12/22/2022]
Abstract
We measured peak oxygen consumption (VO2) in previous recipients of thoracic radiotherapy and assessed the determinants of cardiorespiratory fitness with an emphasis on cardiac and pulmonary function. Cancer survivors who have received thoracic radiotherapy with incidental cardiac involvement often experience impaired cardiorespiratory fitness, as measured by reduced peak VO2, a marker of impaired cardiovascular reserve. We enrolled 25 subjects 1.8 (0.1 to 8.2) years following completion of thoracic radiotherapy with significant heart exposure (at least 10% of heart volume receiving at least 5 Gray). All subjects underwent cardiopulmonary exercise testing, Doppler echocardiography, and circulating biomarkers assessment. The cohort included 16 Caucasians (64%), 15 women (60%) with a median age of 63 (59 to 66) years. The peak VO2 was 16.8 (13.5 to 21.9) ml·kg-1·min-1 or moderately reduced at 62% (50% to 93%) of predicted. The mean cardiac radiation dose was 5.4 (3.7 to 14.7) Gray, and it significantly correlated inversely with peak VO2 (R = -0.445, p = 0.02). Multivariate regression analysis revealed the diastolic functional reserve index and the N-terminal pro-brain natriuretic peptide (NTproBNP) serum levels were independent predictors of peak VO2 (ß = +0.813, p <0.01 and ß = -0.414, p = 0.04, respectively). In conclusion, patients who had received thoracic radiation display a dose-dependent relation between the cardiac radiation dose received and the impairment in peak VO2, the reduction in diastolic functional reserve index, and elevation of NTproBNP.
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Chiabrando JG, Bonaventura A, Vecchié A, Wohlford GF, Mauro AG, Jordan JH, Grizzard JD, Montecucco F, Berrocal DH, Brucato A, Imazio M, Abbate A. Management of Acute and Recurrent Pericarditis. J Am Coll Cardiol 2020; 75:76-92. [DOI: 10.1016/j.jacc.2019.11.021] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/04/2019] [Accepted: 11/05/2019] [Indexed: 12/21/2022]
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Trankle CR, Grizzard JD, Shah KB, Rezai Gharai L, Dana F, Kang MS, Andreae AE, Desai K, Quader MA, Gertz ZM. Left Ventricular Assist Device Outflow Graft Compression: Incidence, Clinical Associations and Potential Etiologies. J Card Fail 2019; 25:545-552. [PMID: 31085224 DOI: 10.1016/j.cardfail.2019.05.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 03/13/2019] [Accepted: 05/04/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Left ventricular assist devices (LVADs) have revolutionized the treatment of advanced heart failure, but proliferation of device therapy has unmasked potential complications. Reports have emerged of outflow graft narrowing due to extrinsic compression. METHODS AND RESULTS The records of patients with LVADs that had been implanted at our institution were reviewed. Those who had postimplantation computed tomography angiographies sufficient to analyze the outflow graft lumen were identified, and the studies were analyzed to characterize the outflow graft lumen. We identified 241 patients; 110 (46%) had suitable computed tomography angiographies. Of those, 15 (14%) had evidence of outflow graft lumen narrowing, all in HeartMate devices and all within the portion covered by the bend relief. Of the 15, 3 underwent invasive examination, all without intraluminal thrombus but, rather, with biodebris between the bend relief and the outflow graft. Patients with HeartWare devices had a wide range of biodebris accumulation surrounding the outflow graft but no cases of lumen narrowing. On multivariable analysis, 1) time from device implant to scan, 2) nonischemic cardiomyopathy and 3) age at implant were significantly associated with higher risk of graft narrowing. CONCLUSION Outflow graft narrowing can be seen in a number of patients with HeartMate LVADs within the portion covered by the bend relief. In the limited number of patients who underwent invasive evaluation, the narrowing was found to arise from extrinsic compression rather than intraluminal thrombus. The clinical significance of this requires further investigation.
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Affiliation(s)
- Cory R Trankle
- Division of Cardiology, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - John D Grizzard
- Department of Radiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Keyur B Shah
- Division of Cardiology, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Leila Rezai Gharai
- Department of Radiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Franklin Dana
- Department of Radiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Matthew S Kang
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Andrew E Andreae
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Kevin Desai
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Mohammed A Quader
- Division of Cardiothoracic Surgery, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Zachary M Gertz
- Division of Cardiology, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA.
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Trankle CR, Quader MA, Grizzard JD, Tang DG, Shah KB, Paris K, Shepard CK, Gertz ZM. Internal Versus External Compression of a Left Ventricular Assist Device Outflow Graft. Circ Heart Fail 2018; 11:e004959. [DOI: 10.1161/circheartfailure.118.004959] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - John D. Grizzard
- Pauley Heart Center and Department of Radiology (J.D.G.), Virginia Commonwealth University, Richmond
| | - Daniel G. Tang
- and Division of Cardiothoracic Surgery (M.A.Q., D.G.T., C.K.S.)
| | - Keyur B. Shah
- Division of Cardiology (C.R.T., K.B.S., K.P., Z.M.G.)
| | - Kendall Paris
- Division of Cardiology (C.R.T., K.B.S., K.P., Z.M.G.)
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Gertz ZM, Strife BJ, Shah PR, Parris K, Grizzard JD. CT angiography for planning of percutaneous closure of a sinus venosus atrial septal defect using a covered stent. J Cardiovasc Comput Tomogr 2018; 12:174-175. [DOI: 10.1016/j.jcct.2017.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 09/09/2017] [Indexed: 11/25/2022]
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Trankle CR, Bhardwaj HL, Paulsen WH, Grizzard JD, Shah RD, Gertz ZM. Hypoxemia Due to Patent Foramen Ovale in the Setting of New Right Hemidiaphragmatic Paralysis. JACC Cardiovasc Interv 2017; 10:e195-e197. [DOI: 10.1016/j.jcin.2017.04.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 04/28/2017] [Indexed: 12/01/2022]
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Klem I, Heiberg E, Van Assche L, Parker MA, Kim HW, Grizzard JD, Arheden H, Kim RJ. Sources of variability in quantification of cardiovascular magnetic resonance infarct size - reproducibility among three core laboratories. J Cardiovasc Magn Reson 2017; 19:62. [PMID: 28800739 PMCID: PMC5553600 DOI: 10.1186/s12968-017-0378-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 08/01/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute myocardial infarct (AMI) size depicted by late gadolinium enhancement cardiovascular magnetic resonance (CMR) is increasingly used as an efficacy endpoint in randomized trials comparing AMI therapies. Infarct size is quantified using manual planimetry (MANUAL), visual scoring (VISUAL), or automated techniques using signal-intensity thresholding (AUTO). Although AUTO is considered the most reproducible, prior studies did not account for the subjective determination of endocardial/epicardial borders, which all methods require. For MANUAL and VISUAL, prior studies did not address how to treat intermediate signal intensities due to partial volume. METHODS To assess sources of variability, AMI size was measured in 30 patients and 12 controls by 3 core-laboratories using 8 methods, each separated by more than 2 months time (n = 720 evaluations). The methods were: (1,2) AUTOSegment, AUTOFWHM (using Segment software or the full-width-at-half-maximum algorithm, respectively); (3,4) AUTO-UCSegment, AUTO-UCFWHM (user correction for endocardial border pixels, no-reflow, etc.); (5) MANUAL; (6) MANUAL-ISI (adjustment for intermediate signal-intensities); (7) VISUAL; (8) VISUAL-ISI. RESULTS Mean infarct size varied between 16.8% and 27.2% of LV mass depending on method. Even automated techniques with no user interaction for infarct borders resulted in significant within-patient variability given the need to subjectively trace endocardial/epicardial contours. The coefficient-of-variation (CV) was 10.6% and 14.6% for AUTOSegment and AUTOFWHM, respectively. For manual and visual categories, reproducibility was improved when intermediate signal-intensities were considered (MANUAL-ISI vs MANUAL: CV = 8.3% vs 14.4%; p = 0.03; VISUAL-ISI vs VISUAL: CV = 8.4% vs 10.9%; p = 0.01). For AUTO-UCSegment, MANUAL-ISI, and VISUAL-ISI (best technique in each category) within-patient variability due to the quantification method was less than 10% of total variability, and the required sample sizes for detecting a 5% absolute difference in infarct size were 62, 63, and 62 patients, respectively. CONCLUSION Among CMR core-laboratories, an important source of variability in infarct size quantification is the subjective delineation of endocardial/epicardial borders. When intermediate signal intensities are considered in manual planimetry and visual scoring, reproducibility and impact on sample size are similar to automated techniques.
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Affiliation(s)
- Igor Klem
- Duke Cardiovascular Magnetic Resonance Center, Division of Cardiology, Duke University Medical Center, Durham, USA
| | - Einar Heiberg
- Department of Clinical Physiology, Lund University Hospital, Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Lowie Van Assche
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, USA
| | - Michele A. Parker
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, USA
| | - Han W. Kim
- Duke Cardiovascular Magnetic Resonance Center, Division of Cardiology, Duke University Medical Center, Durham, USA
| | - John D. Grizzard
- Department of Radiology, Virginia Commonwealth University Health Systems, Richmond, USA
| | - Håkan Arheden
- Department of Clinical Physiology, Lund University, Lund University Hospital, Lund, Sweden
| | - Raymond J. Kim
- Duke Cardiovascular Magnetic Resonance Center, Duke South Clinic, Division of Cardiology, Department of Radiology, Duke University Medical Center, Trent Drive, RM 4229, DUMC-3934, Durham, NC 27710 USA
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Padala SK, Sharma PS, Paulsen WHJ, Kasirajan V, Grizzard JD, Sackett M, Ellenbogen KA. Late Dehiscence of Left Atrial Appendage Closure Device. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.116.004291. [PMID: 27864311 DOI: 10.1161/circep.116.004291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 09/28/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Santosh K Padala
- From the Division of Cardiology, Pauley Heart Center (S.K.P., P.S.S., W.H.J.P., K.A.E.), Division of Cardiothoracic Surgery, Pauley Heart Center (V.K.), and Department of Radiology (J.D.G.), Virginia Commonwealth University, Richmond; and Division of Cardiology, Centra Lynchburg General Hospital, VA (M.S.).
| | - Parikshit S Sharma
- From the Division of Cardiology, Pauley Heart Center (S.K.P., P.S.S., W.H.J.P., K.A.E.), Division of Cardiothoracic Surgery, Pauley Heart Center (V.K.), and Department of Radiology (J.D.G.), Virginia Commonwealth University, Richmond; and Division of Cardiology, Centra Lynchburg General Hospital, VA (M.S.)
| | - Walter H J Paulsen
- From the Division of Cardiology, Pauley Heart Center (S.K.P., P.S.S., W.H.J.P., K.A.E.), Division of Cardiothoracic Surgery, Pauley Heart Center (V.K.), and Department of Radiology (J.D.G.), Virginia Commonwealth University, Richmond; and Division of Cardiology, Centra Lynchburg General Hospital, VA (M.S.)
| | - Vigneshwar Kasirajan
- From the Division of Cardiology, Pauley Heart Center (S.K.P., P.S.S., W.H.J.P., K.A.E.), Division of Cardiothoracic Surgery, Pauley Heart Center (V.K.), and Department of Radiology (J.D.G.), Virginia Commonwealth University, Richmond; and Division of Cardiology, Centra Lynchburg General Hospital, VA (M.S.)
| | - John D Grizzard
- From the Division of Cardiology, Pauley Heart Center (S.K.P., P.S.S., W.H.J.P., K.A.E.), Division of Cardiothoracic Surgery, Pauley Heart Center (V.K.), and Department of Radiology (J.D.G.), Virginia Commonwealth University, Richmond; and Division of Cardiology, Centra Lynchburg General Hospital, VA (M.S.)
| | - Matthew Sackett
- From the Division of Cardiology, Pauley Heart Center (S.K.P., P.S.S., W.H.J.P., K.A.E.), Division of Cardiothoracic Surgery, Pauley Heart Center (V.K.), and Department of Radiology (J.D.G.), Virginia Commonwealth University, Richmond; and Division of Cardiology, Centra Lynchburg General Hospital, VA (M.S.)
| | - Kenneth A Ellenbogen
- From the Division of Cardiology, Pauley Heart Center (S.K.P., P.S.S., W.H.J.P., K.A.E.), Division of Cardiothoracic Surgery, Pauley Heart Center (V.K.), and Department of Radiology (J.D.G.), Virginia Commonwealth University, Richmond; and Division of Cardiology, Centra Lynchburg General Hospital, VA (M.S.)
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20
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Klem I, Heiberg E, van Assche L, Wagner G, Parker M, Kim HW, Grizzard JD, Arheden H, Kim R. Sources of variability in quantification of CMR infarct size and their impact on sample size calculations - reproducibility among three core laboratories. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328891 DOI: 10.1186/1532-429x-17-s1-p84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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21
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Ivanov A, Yossef J, Mohamed A, Socolow J, Gulkarov I, Worku B, Chattranukulchai P, Tortolani A, Sacchi T, Ghosn MG, Shah DJ, Grizzard JD, Biederman RW, Klem I, Heitner J. Evaluating change of function after revascularization in patients with multi vessel coronary artery disease, severely reduced left ventricular systolic function and no scar on CMR imaging. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328931 DOI: 10.1186/1532-429x-17-s1-p169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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22
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Tamene AM, Saxena R, Grizzard JD, Shenoy C. Asymptomatic progression of an atherosclerotic giant right coronary artery aneurysm over 12 years: characterization using cardiovascular magnetic resonance and computed tomography imaging. Circulation 2015; 131:e360-2. [PMID: 25737505 DOI: 10.1161/circulationaha.114.012275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ashenafi M Tamene
- From Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, Minneapolis (A.M.T., C.S.); North Memorial Heart and Vascular Institute, Minneapolis, MN (R.S.); and Department of Radiology, Virginia Commonwealth University Medical Center, Richmond, VA (J.D.G.)
| | - Retu Saxena
- From Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, Minneapolis (A.M.T., C.S.); North Memorial Heart and Vascular Institute, Minneapolis, MN (R.S.); and Department of Radiology, Virginia Commonwealth University Medical Center, Richmond, VA (J.D.G.)
| | - John D Grizzard
- From Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, Minneapolis (A.M.T., C.S.); North Memorial Heart and Vascular Institute, Minneapolis, MN (R.S.); and Department of Radiology, Virginia Commonwealth University Medical Center, Richmond, VA (J.D.G.)
| | - Chetan Shenoy
- From Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, Minneapolis (A.M.T., C.S.); North Memorial Heart and Vascular Institute, Minneapolis, MN (R.S.); and Department of Radiology, Virginia Commonwealth University Medical Center, Richmond, VA (J.D.G.).
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Simprini LA, Afroz A, Cooper MA, Klem I, Jensen C, Kim RJ, Srichai MB, Heitner JF, Sood M, Chandy E, Shah DJ, Lopez-Mattei J, Biederman RW, Grizzard JD, Fuisz A, Ghafourian K, Farzaneh-Far A, Weinsaft J. Routine cine-CMR for prosthesis-associated mitral regurgitation: a multicenter comparison to echocardiography. J Heart Valve Dis 2014; 23:575-582. [PMID: 25799706 PMCID: PMC5057384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Mitral regurgitation (MR) is an important complication after prosthetic mitral valve (PMV) implantation. Transthoracic echocardiography is widely used to screen for native MR, but can be limited with PMV. Cine-cardiac magnetic resonance (CMR) holds the potential for the non-invasive assessment of regurgitant severity based on MR-induced inter-voxel dephasing. The study aim was to evaluate routine cine-CMR for the visual assessment of PMV-associated MR. METHODS Routine cine-CMR was performed at nine sites. A uniform protocol was used to grade MR based on jet size in relation to the left atrium (mild < 1/3, moderate 1/3-2/3, severe > 2/3). MR was graded in each long-axis orientation, with overall severity based on cumulative grade. Cine-CMR was also scored for MR density and pulmonary vein systolic flow reversal (PVSFR). Visual interpretation was compared to quantitative analysis in a single-center (derivation) cohort, and to transesophageal echocardiography (TEE) in a multicenter (validation) cohort. RESULTS The population comprised 85 PMV patients (59% mechanical valves, 41% bioprostheses). Among the derivation cohort (n = 25), quantitative indices paralleled visual scores, with stepwise increases in jet size and density in relation to visually graded MR severity (both p = 0.001). Patients with severe MR had an almost three-fold increase in quantitative jet area (p = 0.002), and a two-fold increase in density (p = 0.04) than did other patients. Among the multicenter cohort, cine-CMR and TEE (Δ =. 2 ± 3 days) demonstrated moderate agreement (κ = 0.44); 64% of discordances differed by ≤ 1 grade (Δ = 1.2 ± 0.5). Using a TEE reference, cine-CMR yielded excellent diagnostic performance for severe MR (sensitivity, negative predictive value = 100%). Patients with visually graded severe MR also had more frequent PVSFR (p < 0.001), denser jets (p < 0.001), and larger left atria (p = 0.01) on cine-CMR. CONCLUSION Cine-CMR is useful for the assessment of PMV-associated MR, which manifests concordant quantitative and qualitative changes in size and density of inter-voxel dephasing. Visual MR assessment based on jet size provides an accurate non-invasive means of screening for TEE-evidenced severe MR.
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Falcao RA, Christopher S, Oddi C, Reznikov L, Grizzard JD, Abouzaki NA, Varma A, Van Tassell BW, Dinarello CA, Abbate A. Interleukin-10 in patients with ST-segment elevation myocardial infarction. Int J Cardiol 2014; 172:e6-8. [DOI: 10.1016/j.ijcard.2013.12.126] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 12/20/2013] [Indexed: 11/26/2022]
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25
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Klem I, Heiberg E, Grizzard JD, Van Assche LM, Parker M, Arheden H, Kim RJ. Comparison of methods for DE-CMR infarct size quantification - reproducibility among three core labs. J Cardiovasc Magn Reson 2013. [PMCID: PMC3559789 DOI: 10.1186/1532-429x-15-s1-p180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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26
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Krishna CS, Grizzard JD, Brinster DR. Aggressive progression of penetrating atheromatous ulcer of the descending thoracic aorta. Heart Surg Forum 2012; 15:E174-6. [PMID: 22698611 DOI: 10.1532/hsf98.20111172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The treatment of acute aortic pathologies continues to evolve with enhanced imaging capabilities. This case report highlights the rapid progression of penetrating atherosclerotic ulcer to pseudoaneurysm development and subsequent treatment with thoracic endovascular stent graft.
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Affiliation(s)
- C Sai Krishna
- Division of Cardiothoracic and Vascular Surgery, Virginia Commonwealth University Medical Center, Richmond, VA 23298-0068, USA
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Van Tassell BW, Bhardwaj HL, Grizzard JD, Kontos MC, Bogaard H, Gomez-Arroyo J, Toldo S, Mezzaroma E, Voelkel NF, Abbate A. Right ventricular systolic dysfunction in patients with reperfused ST-segment elevation acute myocardial infarction. Int J Cardiol 2012; 155:314-6. [DOI: 10.1016/j.ijcard.2011.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 11/29/2011] [Accepted: 12/02/2011] [Indexed: 11/25/2022]
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Throckmorton AL, Carr JP, Tahir SA, Tate R, Downs EA, Bhavsar SS, Wu Y, Grizzard JD, Moskowitz WB. Mechanical Cavopulmonary Assistance of a Patient-Specific Fontan Physiology: Numerical Simulations, Lumped Parameter Modeling, and Suction Experiments. Artif Organs 2011; 35:1036-47. [DOI: 10.1111/j.1525-1594.2011.01339.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abbate A, Kontos MC, Grizzard JD, Biondi-Zoccai GG, Van Tassell BW, Robati R, Roach LM, Arena RA, Roberts CS, Varma A, Gelwix CC, Salloum FN, Hastillo A, Dinarello CA, Vetrovec GW. Interleukin-1 blockade with anakinra to prevent adverse cardiac remodeling after acute myocardial infarction (Virginia Commonwealth University Anakinra Remodeling Trial [VCU-ART] Pilot study). Am J Cardiol 2010; 105:1371-1377.e1. [PMID: 20451681 DOI: 10.1016/j.amjcard.2009.12.059] [Citation(s) in RCA: 298] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Revised: 12/22/2009] [Accepted: 12/22/2009] [Indexed: 02/08/2023]
Abstract
Acute myocardial infarction (AMI) initiates an intense inflammatory response in which interleukin-1 (IL-1) plays a central role. The IL-1 receptor antagonist is a naturally occurring antagonist, and anakinra is the recombinant form used to treat inflammatory diseases. The aim of the present pilot study was to test the safety and effects of IL-1 blockade with anakinra on left ventricular (LV) remodeling after AMI. Ten patients with ST-segment elevation AMI were randomized to either anakinra 100 mg/day subcutaneously for 14 days or placebo in a double-blind fashion. Two cardiac magnetic resonance (CMR) imaging and echocardiographic studies were performed during a 10- to 14-week period. The primary end point was the difference in the interval change in the LV end-systolic volume index (LVESVi) between the 2 groups on CMR imaging. The secondary end points included differences in the interval changes in the LV end-diastolic volume index, and C-reactive protein levels. A +2.0 ml/m(2) median increase (interquartile range +1.0, +11.5) in the LVESVi on CMR imaging was seen in the placebo group and a -3.2 ml/m(2) median decrease (interquartile range -4.5, -1.6) was seen in the anakinra group (p = 0.033). The median difference was 5.2 ml/m(2). On echocardiography, the median difference in the LVESVi change was 13.4 ml/m(2) (p = 0.006). Similar differences were observed in the LV end-diastolic volume index on CMR imaging (7.6 ml/m(2), p = 0.033) and echocardiography (9.4 ml/m(2), p = 0.008). The change in C-reactive protein levels between admission and 72 hours after admission correlated with the change in the LVESVi (R = +0.71, p = 0.022). In conclusion, in the present pilot study of patients with ST-segment elevation AMI, IL-1 blockade with anakinra was safe and favorably affected by LV remodeling. If confirmed in larger trials, IL-1 blockade might represent a novel therapeutic strategy to prevent heart failure after AMI.
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Abstract
Magnetic resonance is known to be a superior modality for the evaluation of pericardial disease and intracardiac masses because of its unmatched capacity for tissue characterization and high spatial resolution. New real-time sequences complement the standard morphologic imaging of the pericardium with dynamic image acquisitions that also can provide hemodynamic information indicative of constriction. Magnetic resonance also is becoming increasingly recognized as a superior modality for the detection and characterization of intracardiac thrombus. This article reviews the use of magnetic resonance imaging for the evaluation of pericardial disease and the detection of intracardiac thrombus, with particular emphasis on the newer pulse sequences currently available for cardiac imaging.
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Affiliation(s)
- John D Grizzard
- Non-invasive Cardiovascular Imaging, Department of Radiology, Virginia Commonwealth University Medical Center, Richmond, VA 23298-0615, USA.
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Brinster DR, Grizzard JD, Dash A. Lupus Aortitis Leading to Aneurysmal Dilatation in the Aortic Root and Ascending Aorta. Heart Surg Forum 2009; 12:E105-8. [DOI: 10.1532/hsf98.20081123] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
This article provides the reader with a clinically relevant practical approach to obtaining high-quality magnetic resonance angiograms of the lower extremities. The physics underlying this imaging are discussed as they relate to practical matters such as contrast timing schemes. Model protocols for various scanners are presented, and the rationale for the choices. In addition to the standard core protocol, alternative protocols are presented, so that the reader will have a sense of the full palette of options available, and be readily able to appreciate the relative advantages and disadvantages of each. Applications of these protocols in imaging various disorders then are discussed, with clinical exams presented. Pearls and pitfalls regarding imaging techniques and various tricks of the trade also are discussed.
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Affiliation(s)
- Dipan J Shah
- Saint Thomas Heart Institute, Nashville, TN, USA.
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Malhotra AK, Camacho M, Ivatury RR, Davis IC, Komorowski DJ, Leung DA, Grizzard JD, Aboutanos MB, Duane TM, Cockrell C, Wolfe LG, Borchers CT, Martin NR. Computed Tomographic Angiography for the Diagnosis of Blunt Carotid/Vertebral Artery Injury. Ann Surg 2007; 246:632-42; discussion 642-3. [PMID: 17893500 DOI: 10.1097/sla.0b013e3181568cab] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Computed tomographic angiography (CTA) by 16-channel multidetector scanner is increasingly replacing conventional digital subtraction angiography (DSA) for diagnosing or excluding blunt carotid/vertebral injuries (BCVI). To date there has been only 1 study in which all patients received both examinations. That study reported a high accuracy for 16-detector CTA. The current prospective parallel comparative study aims at validating this high accuracy and examining the rates of evaluability of CTA performed with a 16-detector scanner with image reconstruction by modern imaging software. METHODS Patients at risk for BCVI (facial/cervical-spinal fractures; unexplained neurologic deficit; anisocoria; lateral neck soft tissue injury; clinical suspicion) underwent both CTA (16-channel multidetector scanner) and DSA. Results of the 2 studies and the clinical course were prospectively recorded. RESULTS During the 40-month study period ending March 2007, approximately 7000 blunt trauma patients were evaluated and of these 119 (1.7%) consecutive patients meeting inclusion criteria were screened by CTA. Ninety-two patients underwent confirmatory DSA. Twenty-three (22%) DSA identified 26 BCVI (vertebral, 13; carotid, 13). Among these 23 CTAs, 17 identified 19 BCVIs (vertebral, 10; carotid, 9) (true positives), and 6 failed to identify 7 BCVIs (vertebral, 3; carotid, 4) (false negatives). Sixty-nine of the 92 DSA were normal. Of these 69 CTAs, 10 were falsely suspicious for 11 BCVIs (vertebral, 7; carotid, 4) (false positives), and 56 were normal (true negatives). The remaining 3 CTAs were nonevaluable (mistimed contrast, 1; streak artifact, 2). Sixteen of 89 (18%) evaluable CTAs, were suboptimal (mistimed contrast, 9; streak artifacts, 4; motion artifact, 2; body habitus, 1). Excluding the 3 nonevaluable CTAs, the sensitivity, specificity, positive and negative predictive values of CTA for diagnosing or excluding BCVI were 74%, 86%, 65%, and 90% respectively. One patient with grade II carotid artery injuries (by CTA and DSA) on antiplatelet agent developed stroke related to carotid artery injuries. CONCLUSIONS Current CTA technology cannot reliably diagnose or exclude BCVI. Twenty percent of CTAs are either nonevaluable or suboptimal. Until more data are available and the technique is standardized, the current trend towards using CTA to screen for and/or diagnose these rare but potentially devastating injuries is dangerous.
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Affiliation(s)
- Ajai K Malhotra
- Department of Surgery, Division of Trauma, Critical Care and Emergency General Surgery, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA 23298, USA.
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Abstract
Hypereosinophilic syndrome (HES) is a rare disorder that can manifest in various organ systems. We report the case of a 54-year-old woman with a remote history of seizure disorder who presented with early signs of right-sided heart failure. Laboratory studies showed significant eosinophilia (8 x 10(9) l(-1)). Computed tomography showed heterogeneity of the liver, mild ascites, moderate pleural effusion, multiple small pulmonary emboli, and a large right ventricular mass. Cardiac magnetic resonance imaging demonstrated that the right ventricular mass was due to thrombus and extensive endomyocardial fibrosis, consistent with Loeffler's endocarditis. Bone marrow biopsy showed marked eosinophilia but no abnormal myeloid maturation or a lymphoproliferative disorder; flow cytometry showed no clonality. Extensive infectious, immunologic, and toxicological studies were negative. Despite resolution of peripheral eosinophilia with medical management, including corticosteroids and cytotoxic agents, anticoagulation for pulmonary emboli and ventricular thrombus, and conventional treatment for heart failure, she developed worsening anasarca and died from ventricular fibrillation within 4 weeks of presentation. Autopsy confirmed the diagnosis. Loeffler's endocarditis, usually a late manifestation of HES, is characterized by fibrous thickening of the endocardium, leading to apical obliteration and restrictive cardiomyopathy, resulting in heart failure, thromboembolic events, or atrial fibrillation. HES is a potentially fatal disease with less than 50% reported 10-year survival. This case presentation is unusual in its rapidly progressive course leading to sudden death.
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Affiliation(s)
- Bo H Chao
- Department of Internal Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia, USA.
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Kenigsberg DN, Kalahasty G, Grizzard JD, Wood MA, Ellenbogen KA. Images in cardiovascular medicine. Intracardiac correlate of the epsilon wave in a patient with arrhythmogenic right ventricular dysplasia. Circulation 2007; 115:e538-9. [PMID: 17533186 DOI: 10.1161/circulationaha.106.685594] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- David N Kenigsberg
- Division of Cardiology, Virginia Commonwealth University Medical Center, PO Box 980053, Richmond, VA 23298-0053, USA
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Abstract
The tremendous progress in the field of cardiac imaging has drawn the interest of many radiologists, but has left them uncertain as to how obtain the training necessary to become expert practitioners. This review addresses the challenges in establishing a cardiac imaging service including equipment issues, training and credentialing issues, as well as referrals and reimbursement.
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Affiliation(s)
- John D Grizzard
- Department of Radiology, Virginia Commonwealth University Medical Center, Main Hospital, Richmond, Va 23298-0615 , USA.
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Kenigsberg DN, Lee BP, Grizzard JD, Ellenbogen KA, Wood MA. Accuracy of Intracardiac Echocardiography for Assessing the Esophageal Course Along the Posterior Left Atrium: A Comparison to Magnetic Resonance Imaging. J Cardiovasc Electrophysiol 2007; 18:169-73. [PMID: 17212594 DOI: 10.1111/j.1540-8167.2006.00699.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Atrioesophageal fistula is a potentially fatal complication of ablation in the left atrium (LA) to treat atrial fibrillation. OBJECTIVE The objective of our study was to systematically evaluate the diagnostic potential of intracardiac echocardiography (ICE) for accurately assessing the esophageal course along the posterior LA. METHODS Thirty-five patients underwent magnetic resonance imaging (MRI) before and ICE during pulmonary vein (PV) isolation to visualize the esophagus. The location of the esophagus was determined in relation to the PVs and anatomic regions of the LA by both ICE and MRI. Using the MRI images as a reference, the accuracy of ICE localization was assessed. RESULTS The most common location for the esophagus to appear was the mid-posterior wall (80% of patients by ICE, 71% of patients by MRI), followed by the left posterior wall (71% of patients by ICE, 63% of patients by MRI) and the right posterior wall (60% of patients by ICE, 51% of patients by MRI). The esophagus was seen to course near the left PV antrums (left superior PV antrum 34% of patients by ICE and MRI; left inferior PV antrum 34% of patients by ICE, 37% of patients by MRI), left superior PV (17% of patients by ICE, 20% of patients by MRI), left inferior PV (17% of patients by ICE and MRI), right inferior PV antrum (29% of patients by ICE, 37% of patients by MRI) and the right inferior PV (3% of patients by ICE, 17% of patients by MRI). The sensitivity for esophageal location by ICE compared to that by MRI ranged between 33% (right inferior PV) and 92% (left superior PV antrum, left inferior PV antrum, and mid-posterior wall). The specificity for esophageal location by ICE compared to that by MRI ranged between 60% (mid-posterior wall) and 100% (right inferior PV). The positive predictive value ranged between 80% (left inferior PV) and 100% (right inferior PV). The negative predictive value ranged between 84% (right inferior PV antrum) and 96% (left superior PV antrum). CONCLUSION Phased array ICE provides rapid, real-time localization of the esophagus during LA ablation that is comparable to MRI.
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Affiliation(s)
- David N Kenigsberg
- Division of Cardiology, Virginia Commonwealth University Medical Center, Richmond, Virginia 23298-0053, USA
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Abstract
This article provides the reader with a clinically relevant practical approach to obtaining high-quality magnetic resonance angiograms of the lower extremities. The physics underlying this imaging are discussed as they relate to practical matters such as contrast timing schemes. Model protocols for various scanners are presented, and the rationale for the choices. In addition to the standard core protocol, alternative protocols are presented, so that the reader will have a sense of the full palette of options available, and be readily able to appreciate the relative advantages and disadvantages of each. Applications of these protocols in imaging various disorders then are discussed, with clinical exams presented. Pearls and pitfalls regarding imaging techniques and various tricks of the trade also are discussed.
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Affiliation(s)
- Dipan J Shah
- Nashville Cardiovascular MRI Institute, The Heart Group, PLLC, 1195 Old Hickory Boulevard, Suite 101, Brentwood, Nashville, TN 37027, USA.
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Abstract
MRI is known to be a superior modality for evaluating pericardial disease and masses because of its unmatched capacity for tissue characterization and high spatial resolution. New real-time sequences now complement the standard morphologic imaging of the pericardium with dynamic image acquisitions that also can provide hemodynamic information indicative of constriction. In the evaluation of masses, recently developed rapid imaging sequences have shortened examination times and improved lesion characterization. The full spectrum of pericardial disease and cardiac masses is reviewed, and the role of MRI explored.
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Affiliation(s)
- John D Grizzard
- Department of Radiology, Noninvasive Cardiovascular Imaging, Virginia Commonwealth University Medical Center, 1250 East Marshall Street, Post Office Box 980615, Richmond, VA 23298, USA.
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Abstract
Congenital coalition between the lunate and triquetrum is a common anomaly that may have several different radiographic appearances. We report seven patients with partial coalition and rounded radiolucencies in the subarticular region of both bones. The most likely cause of this combination of findings is abnormal differentiation of the joint space and remnants of misplaced synovial tissue that formed during the disorganized process of joint development.
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Grizzard JD, D'Ercole AJ, Wilkins JR, Moats-Staats BM, Williams RW. Affinity-labeled somatomedin-C receptors and binding proteins from the human fetus. J Clin Endocrinol Metab 1984; 58:535-43. [PMID: 6198334 DOI: 10.1210/jcem-58-3-535] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
We investigated the ontogeny of the human placental membrane somatomedin-C (Sm-C)/insulin-like growth factor I (IGF-I) receptor by affinity labeling with the cross-linking agent disuccinimidyl suberate (DSS). Specific Sm-C receptors, identified from as early as 6 weeks gestation, demonstrated no apparent structural changes through the course of gestation. Second trimester human fetal brain membranes cross-linked to [125I]Sm-C exhibited an identical pattern of receptor binding. These findings in both placenta and fetal brain membrane are consistent with the proposed heterotetrameric structure of the Sm-C/IGF-I receptor. Using a similar DSS cross-linking technique, we identified Sm-C-binding proteins in second trimester amniotic fluid [apparent molecular mass (Mr), 38,000 and 35,000] and term cord plasma (Mr, 41,000, 38,000, and 35,000). Identically sized binding components (Mr, 35,000-45,000) were also found in membrane preparations of preterm placenta and brain after cross-linking. Evidence that these binding species represent contamination of preterm membrane preparations with soluble amniotic fluid and/or fetal plasma Sm-C-binding proteins and that they are not derived from membrane receptors is as follows: (1) these binding species, like amniotic fluid and cord plasma binding proteins, were insensitive to competition with insulin (in concentrations as high as 0.6 mg/ml), a characteristic not shared with membrane receptor binding components; (2) these binding species were largely removed from placental membranes by extensive washing and appeared in the supernate when membrane preparations were incubated at 4 C for 18 h, indicating that they were soluble and not an integral part of the particulate membrane; (3) limited proteolysis of placental membrane preparations did not result in the appearance of similar binding species; and (4) preparation of preterm placental membranes in the presence of protease inhibitors did not eliminate these binding species. Use of traditional methodology to study binding of somatomedin to receptors in membranes prepared from preterm human tissues may be misleading because of contamination by amniotic fluid and/or plasma-derived binding proteins.
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