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Lewis S, Huang J, Patel N, Folks R, Galt J, Cooke CD, Zheng Z, Zhang R, Garcia E, Nye J, Piccinelli M, Moncayo V, Bhatt K, Mitchell A. Myocardial perfusion imaging-derived left ventricular strain: Regional abnormalities associated with transthyretin cardiac amyloidosis. Am Heart J Plus 2024; 40:100377. [PMID: 38510504 PMCID: PMC10945994 DOI: 10.1016/j.ahjo.2024.100377] [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] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/17/2024] [Accepted: 02/19/2024] [Indexed: 03/22/2024]
Abstract
Background Transthyretin (ATTR) cardiac amyloidosis is associated with an apical-sparing strain pattern on TTE. We hypothesize that strain indices derived from myocardial perfusion imaging (MPI) can identify this abnormality. Methods A group with ATTR amyloidosis was compared to age-matched controls with LVH but without amyloidosis who underwent PET or SPECT MPI. Strain values were used to calculate the apical strain index (ASI), apex-to-base ratio (ABR), and ejection fraction to global strain ratio in multiple planes. Results A direct comparison using Welch's t-tests reveals 6 statistically significant metrics. After regression analysis, the circumferential ASI and ABR at rest remain significantly greater in the ATTR group compared to controls. Conclusion MPI-derived strain from the circumferential plane at rest may distinguish cardiac amyloidosis from other forms of LVH. If these findings are confirmed with validation studies, routine MPI-derived strain analysis could identify patients with subclinical amyloidosis who may benefit from further testing.
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Affiliation(s)
- Steven Lewis
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jingwen Huang
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Nidhi Patel
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Russell Folks
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - James Galt
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - C. David Cooke
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Ziduo Zheng
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health at Emory University, Atlanta, GA, USA
| | - Rebecca Zhang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health at Emory University, Atlanta, GA, USA
| | - Ernest Garcia
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Jonathon Nye
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Department of Radiology and Radiological Science, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Valeria Moncayo
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Kunal Bhatt
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Adam Mitchell
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
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Piccinelli M, Cooke CD, Folks R, Garcia EV. 4D display of CT LV endocardial and epicardial models morphed from PET Rb-82 perfusion studies accurately quantifies segmental myocardial thickening. J Nucl Cardiol 2023; 30:2314-2326. [PMID: 37131093 PMCID: PMC10658716 DOI: 10.1007/s12350-023-03269-5] [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] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 03/29/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND MPI-derived LV wall thickening assessments for diagnostic purposes has been part of clinical guidelines for two decades. It relies on visual evaluation of tomographic slices or regional quantification displayed in 2D polar maps. 4D displays have not entered clinical usage nor have they been validated on their potential to provide equivalent information. The purpose of this work was to validate a 4D realistic display recently designed to quantitatively represent the thickening information from gated MPI into CT-morphed endocardial and epicardial moving surfaces. METHODS Forty patients who underwent 82Rb PET were selected based on LV perfusion quantification. CTA templates of heart anatomy were selected to represent the LV anatomy. Generic CT-derived LV endocardial and epicardial surfaces were modified to represent the end diastolic (ED) phase according to PET-derived ED LV dimensions and wall thickness. These CT myocardial surfaces were then morphed by means of thin plate spline (TPS) techniques, according to the gated PET slices count changes (WThPET) and LV wall motion (WMoPET). A geometric thickening (GeoTh) equivalent to LV WThPET was defined on epicardial and endocardial CT surfaces over the cardiac cycle and the two measures compared. WThPET and GeoTh correlations were performed on a case-by-case basis, by segment and by pooling all 17 segments. Pearson's correlation coefficients (PCC) were calculated to assess the equivalence of the two measures. RESULTS Two cohorts of patients (normal and abnormal) were identified based on SSS. R coefficients were as follows: for all pooled segments PCCstress and PCCrest were respectively 0.91 and 0.89 (normal), and 0.9 and 0.91 (abnormal); when individual 17 segments were considered mean PCCstress = 0.92 [0.81-0.98] and mean PCCrest = 0.93 [0.83-0.98] for the abnormal perfusion group; mean PCCstress = 0.89 [0.78-0.97] and mean PCCrest = 0.89 [0.77-0.97] for the normal. When individual studies were considered, R was always > .70 with the exception of five abnormal studies. Inter-user analysis was also conducted. CONCLUSIONS Our novel technique for the visualization of LV wall thickening by means of 4D CT endocardial and epicardial surface models accurately replicated 82Rb slice thickening results showing promise for its usage for diagnostic purposes.
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Affiliation(s)
- Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, GA, 30322, USA.
| | - C David Cooke
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, GA, 30322, USA
| | - Russell Folks
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, GA, 30322, USA
| | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, GA, 30322, USA
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Huang J, Mitchell AJ, Garcia EV, Cooke CD, Folks R, Pernetz M, Goyal A, Piccinelli M, Nye JA. Left Ventricular Strain from Myocardial Perfusion PET Imaging: Method Development and Comparison to 2-Dimensional Echocardiography. J Nucl Med 2023; 64:932-939. [PMID: 36522185 PMCID: PMC10241013 DOI: 10.2967/jnumed.122.264516] [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] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 12/12/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
This study aimed to develop a measure of longitudinal, radial, and circumferential myocardial strain at rest and regadenoson during pharmacologic stress using 82Rb PET electrocardiography-gated myocardial perfusion imaging (MPI). Methods: We retrospectively identified 80 patients who underwent rest and regadenoson-stress CT attenuation-corrected 82Rb PET and had a standard resting transthoracic echocardiogram (TTE) with global longitudinal strain (GLS) analysis within 3 mo. A method was developed to compute longitudinal, radial, and circumferential strain from PET MPI at stress and rest. PET MPI-derived strain and left ventricular function were compared with resting TTE measures as the clinical reference standard. Interobserver agreement of PET MPI strain and left ventricular ejection fraction processing was reported. Results: Longitudinal strain assessed with resting TTE GLS showed good correlation with PET MPI at stress (r = 0.68, P < 0.001) and rest (r = 0.58, P < 0.001). Resting TTE GLS also correlated with PET MPI radial strain at stress (r = -0.70, P < 0.001) and rest (r = -0.59, P < 0.001) and circumferential strain at stress (r = 0.67, P < 0.001) and rest (r = 0.69, P < 0.001). The left ventricular ejection fraction showed good correlation between resting TTE and PET MPI at stress (r = 0.83, P < 0.001) and rest (r = 0.80, P < 0.001). Bland-Altman analysis indicated positive bias of TTE GLS compared with PET MPI longitudinal strain at stress (mean difference = 5.1%, 95% CI = [-2.5, 12.7]) and rest (mean difference = 4.2%, 95% CI = [-4.3, 12.8]). Reproducibility of PET MPI longitudinal strain showed good agreement at stress (concordance correlation coefficient = 0.73, P < 0.001) and rest (concordance correlation coefficient = 0.74, P < 0.001), with Bland-Altman analysis showing a small bias in the longitudinal direction at stress (mean difference = -0.2%) and rest (mean difference = -1.0%). Conclusion: Strain measured with PET MPI using an automated technique correlated well with resting GLS strain obtained by TTE, and the measure is reproducible. Strain from PET MPI should be investigated further to establish reference ranges and assess its value in routine clinical practice.
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Affiliation(s)
- Jingwen Huang
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Adam J Mitchell
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia;
| | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; and
| | - C David Cooke
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; and
| | - Russell Folks
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; and
| | - Maria Pernetz
- Emory Adult Congenital Heart Center, Emory University School of Medicine, Atlanta, Georgia
| | - Abhinav Goyal
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; and
| | - Jonathon A Nye
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; and
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Garcia EV, Piccinelli M. Preparing for the Artificial Intelligence Revolution in Nuclear Cardiology. Nucl Med Mol Imaging 2023; 57:51-60. [PMID: 36998588 PMCID: PMC10043081 DOI: 10.1007/s13139-021-00733-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 12/18/2021] [Accepted: 12/19/2021] [Indexed: 10/19/2022] Open
Abstract
A major opportunity in nuclear cardiology is the many significant artificial intelligence (AI) applications that have recently been reported. These developments include using deep learning (DL) for reducing the needed injected dose and acquisition time in perfusion acquisitions also due to DL improvements in image reconstruction and filtering, SPECT attenuation correction using DL without need for transmission images, DL and machine learning (ML) use for feature extraction to define myocardial left ventricular (LV) borders for functional measurements and improved detection of the LV valve plane and AI, ML, and DL implementations for MPI diagnosis, prognosis, and structured reporting. Although some have, most of these applications have yet to make it to widespread commercial distribution due to the recency of their developments, most reported in 2020. We must be prepared both technically and socio-economically to fully benefit from these and a tsunami of other AI applications that are coming.
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Affiliation(s)
- Ernest V. Garcia
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 101 Woodruff Circle, Room 1203, GA 30322 Atlanta, USA
| | - Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 101 Woodruff Circle, Room 1203, GA 30322 Atlanta, USA
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Bremner JD, Piccinelli M, Garcia EV, Moncayo VM, Elon L, Nye JA, Cooke CD, Washington BP, Ortega RA, Desai SR, Okoh AK, Cheung B, Soyebo BO, Shallenberger LH, Raggi P, Shah AJ, Daaboul O, Jajeh MN, Ziegler C, Driggers EG, Murrah N, De Cecco CN, van Assen M, Krafty RT, Quyyumi AA, Vaccarino V. A Pilot Study of Neurobiological Mechanisms of Stress and Cardiovascular Risk. Med Res Arch 2023; 11:3787. [PMID: 37484871 PMCID: PMC10361343 DOI: 10.18103/mra.v11i4.3787] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Objective Coronary heart disease is a leading cause of death and disability. Although psychological stress has been identified as an important potential contributor, mechanisms by which stress increases risk of heart disease and mortality are not fully understood. The purpose of this study was to assess mechanisms by which stress acts through the brain and heart to confer increased CHD risk. Methods Coronary Heart Disease patients (N=10) underwent cardiac imaging with [Tc-99m] sestamibi single photon emission tomography at rest and during a public speaking mental stress task. Patients returned for a second day and underwent positron emission tomography imaging of the brain, heart, bone marrow, aorta (indicating inflammation) and subcutaneous adipose tissue, after injection of [18F]2-fluoro-2-deoxyglucose for assessment of glucose uptake followed mental stress. Patients with (N=4) and without (N=6) mental stress-induced myocardial ischemia were compared for glucose uptake in brain, heart, adipose tissue and aorta with mental stress. Results Patients with mental stress-induced ischemia showed a pattern of increased uptake in the heart, medial prefrontal cortex, and adipose tissue with stress. In the heart disease group as a whole, activity increase with stress in the medial prefrontal brain and amygdala correlated with stress-induced increases in spleen (r=0.69, p=0.038; and r=0.69, p=0.04 respectfully). Stress-induced frontal lobe increased uptake correlated with stress-induced aorta uptake (r=0.71, p=0.016). Activity in insula and medial prefrontal cortex was correlated with post-stress activity in bone marrow and adipose tissue. Activity in other brain areas not implicated in stress did not show similar correlations. Increases in medial prefrontal activity with stress correlated with increased cardiac glucose uptake with stress, suggestive of myocardial ischemia (r=0.85, p=0.004). Conclusions These findings suggest a link between brain response to stress in key areas mediating emotion and peripheral organs involved in inflammation and hematopoietic activity, as well as myocardial ischemia, in Coronary Heart Disease patients.
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Affiliation(s)
- J. Douglas Bremner
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
- Department Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
- Atlanta VA Medical Center, Decatur, GA, USA
| | - Marina Piccinelli
- Department Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Ernest V. Garcia
- Department Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Valeria M. Moncayo
- Department Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Lisa Elon
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Jonathon A. Nye
- Department Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - C. David Cooke
- Department Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Brianna P. Washington
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Rebeca Alvarado Ortega
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Shivang R. Desai
- Department Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA
| | - Alexis K. Okoh
- Department Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA
| | - Brian Cheung
- Department Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA
| | - Britt O. Soyebo
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | | | - Paolo Raggi
- Mazankowski Alberta Heart Institute and the Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Amit J. Shah
- Department Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA
- Department of Epidemiology, Emory University, Atlanta, GA, USA
- Atlanta VA Medical Center, Decatur, GA, USA
| | - Obada Daaboul
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | | | - Carrie Ziegler
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | | | - Nancy Murrah
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Carlo N. De Cecco
- Department Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
- Department Biomedical Informatics, Emory University School of Medicine, Atlanta, GA
| | - Marly van Assen
- Department Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Robert T. Krafty
- Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Arshed A. Quyyumi
- Department Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA
| | - Viola Vaccarino
- Department Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA
- Department of Epidemiology, Emory University, Atlanta, GA, USA
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Tappero S, Barletta F, Piccinelli M, Cano Garcia C, Incesu RB, Morra S, Chierigo F, Tian Z, Parodi S, Dell’Oglio P, Briganti A, De Cobelli O, Chun F, Graefen M, Mirone V, Saad F, Shariat S, Suardi N, Borghesi M, Terrone C, Karakiewicz P. Adenocarcinoma of the bladder: Assessment of survival benefit associated with radical cystectomy and comparison with urothelial bladder cancer. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01336-2] [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] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Chierigo F, Tappero S, Panunzio A, Sorce G, Hoeh B, Piccinelli M, Hohenhorst L, Tian Z, Parodi S, Guano G, Briganti A, Chun F, Graefen M, Antonelli A, Saad F, Shariat S, De Cobelli O, Suardi N, Borghesi M, Terrone C, Karakiewicz P. Effect of chemotherapy in sarcomatoid bladder cancer patients treated with radical cystectomy. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01337-4] [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] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Panunzio A, Tappero S, Piccinelli M, Cano Garcia C, Barletta F, Incesu RB, Law K, Tian Z, Tafuri A, Bourdeau I, Cerruto M, Antonelli A, Karakiewicz P. Regional differences in stage distribution and rates of treatment for adrenocortical carcinoma across United States SEER registries. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01139-9] [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] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Cano Garcia C, Flammia R, Piccinelli M, Panunzio A, Tappero S, Barletta F, Incesu RB, Law K, Tian Z, Saad F, Kapoor A, Shariat S, Tilki D, Briganti A, Terrone C, Antonelli A, De Cobelli O, Hoeh B, Kluth L, Chun F, Karakiewicz P. Differences in survival of clear cell metastatic renal cell carcinoma patients according to partial vs. radical nephrectomy. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00377-9] [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] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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10
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Chierigo F, Tappero S, Panunzio A, Cano Garcia C, Barletta F, Piccinelli M, Incesu RB, Parodi S, Dell’Oglio P, Antonelli A, Graefen M, Chun F, Briganti A, De Cobelli O, Saad F, Shariat S, Suardi N, Borghesi M, Terrone C, Karakiewicz P. Sarcomatoid vs. urothelial bladder cancer: Impact of radical cystectomy on cancer control outcomes. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01338-6] [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] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Vaccarino V, Shah AJ, Moncayo V, Nye JA, Piccinelli M, Ko YA, Ma X, Murrah N, Shallenberger L, Driggers E, Jajeh N, Haffar A, Al-Abboud O, Raggi P, Hall MH, Sloan RP, Goldberg J, Smith NL, Garcia EV, Quyyumi AA, Bremner JD, Bliwise DL. Obstructive sleep apnea, myocardial perfusion and myocardial blood flow: A study of older male twins. PLoS One 2022; 17:e0278420. [PMID: 36449510 PMCID: PMC9710778 DOI: 10.1371/journal.pone.0278420] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/15/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) has been associated with incidence of cardiovascular disease and with nocturnal angina, but evidence of a link with coronary atherosclerosis and myocardial ischemia is limited and previous studies may have been affected by selection bias or unmeasured confounding factors. METHODS We performed overnight polysomnography in 178 older male twins. The Apnea/Hypopnea Index (AHI) was calculated to assess OSA from the overnight sleep evaluation. AHI ≥15 was used as indicator of moderate/severe OSA. The following day, twins underwent myocardial perfusion imaging with [82Rb]-chloride positron emission tomography. Quantitative and semiquantitative measures of myocardial perfusion and absolute myocardial blood flow were obtained. RESULTS The mean age was 68 years and 40% of the sample had an AHI≥15, which indicates moderate to severe OSA. Abnormal myocardial perfusion, both with stress and at rest, was more common in twins with elevated AHI. After adjusting for clinical, lifestyle and behavioral factors, and previous history of cardiovascular disease, twins with AHI ≥15 had 3.6 higher odds (95% CI, 1.5-8.9) of an abnormal total severity score, defined as a score ≥100, and for each 5-point increment in AHI, the odds of abnormality increased by 20% (95% CI, 7%-34%). Twin pairs where both twins had OSA exhibited the greatest risk. There were no differences in measures of ischemia and absolute myocardial blood flow and flow reserve by AHI status. CONCLUSIONS OSA is associated with myocardial perfusion abnormalities that suggest prior subclinical myocardial scarring or infarction. Early environmental factors that affect both twins equally may play a role and should be further explored.
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Affiliation(s)
- Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America,Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, United States of America,* E-mail:
| | - Amit J. Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America,Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, United States of America,Atlanta Veterans Affairs Health Care System, Decatur, Georgia, United States of America
| | - Valeria Moncayo
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Jonathon A. Nye
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Xin Ma
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Nancy Murrah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Lucy Shallenberger
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Emily Driggers
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Nour Jajeh
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Ammer Haffar
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Omar Al-Abboud
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Paolo Raggi
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Martica H. Hall
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Richard P. Sloan
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
| | - Jack Goldberg
- Seattle Epidemiologic Research and Information Center, Office of Research and Development, United States Department of Veterans Affairs, Seattle, Washington, United States of America
| | - Nicholas L. Smith
- Seattle Epidemiologic Research and Information Center, Office of Research and Development, United States Department of Veterans Affairs, Seattle, Washington, United States of America,Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Ernest V. Garcia
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Arshed A. Quyyumi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - J. Douglas Bremner
- Atlanta Veterans Affairs Health Care System, Decatur, Georgia, United States of America,Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, United States of America,Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Donald L. Bliwise
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, United States of America
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Nye JA, Piccinelli M, Hwang D, Cooke CD, Paeng JC, Lee JM, Cho SG, Folks R, Haber M, Bom HS, Koo BK, Garcia EV. Determination of [N-13]-ammonia extraction fraction in patients with coronary artery disease by calibration to invasive coronary and fractional flow reserve. J Nucl Cardiol 2022; 29:2210-2219. [PMID: 34036523 PMCID: PMC10630982 DOI: 10.1007/s12350-021-02628-4] [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] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 03/30/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study presents a new extraction fraction (EF) model based on physiological measures of invasive coronary flow reserve (CFR) and fractional flow reserve (FFR) in patients with suspected coronary artery disease (CAD) and normal index microcirculatory resistance (IMR). To ascertain the clinical relevance of the new EFs, flow measurements using the newly patient-determined EFs were compared to flow measurements using traditional animal-determined EFs. METHODS 39 patients were retrospectively selected that included a total of 91 vascular territories with invasive coronary angiography physiological measures. [N-13]-ammonia dynamic rest/adenosine-stress PET imaging was conducted in all patients and absolute myocardial flow was estimated using four published compartmental models. The extraction fraction during hyperemic flow was iteratively estimated by maximizing the agreement between invasive CFR and FFR with the non-invasive analogs myocardial flow reserve (MFR) and relative flow reserve (RFR) at similar physiological states, respectively. RESULTS Using the new patient-determined EFs, agreement between CFR vs MFR for Model 1 and 2 was moderate and poor for Model 3 and 4. All models showed moderate agreement for FFR vs RFR. When using published models of animal-determined EFs, agreement between CFR vs MFR remained moderate for Model 1 and 2, and poor for Model 3 and 4. Similarly, all models showed moderate agreement for FFR vs RFR using animal-determined EF values. None of the observed differences were statistically significant. CONCLUSIONS Flow measurements using extraction fraction correction for [N-13]-ammonia based on calibration to invasive intracoronary angiography physiological measures in patients with CAD were not discordant from those reported in the literature. Either patient-determined or traditional animal-determined EF correction, when used with the appropriate flow model, yields moderate agreement with invasive measurements of coronary flow reserve and fractional flow reserve.
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Affiliation(s)
- Jonathon A Nye
- Department of Radiology and Imaging Sciences, Emory School of Medicine, Emory University, 1841 Clifton Rd. NE, Atlanta, GA, 30329, USA.
| | - Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory School of Medicine, Emory University, 1841 Clifton Rd. NE, Atlanta, GA, 30329, USA
| | - Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - C David Cooke
- Department of Radiology and Imaging Sciences, Emory School of Medicine, Emory University, 1841 Clifton Rd. NE, Atlanta, GA, 30329, USA
| | - Jin Chul Paeng
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea
| | - Joo Myung Lee
- Samsung Medical Center, Heart Vascular Stroke Institute, Seoul, Korea
| | - Sang-Geon Cho
- Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Russell Folks
- Department of Radiology and Imaging Sciences, Emory School of Medicine, Emory University, 1841 Clifton Rd. NE, Atlanta, GA, 30329, USA
| | - Michael Haber
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Hee-Seung Bom
- Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory School of Medicine, Emory University, 1841 Clifton Rd. NE, Atlanta, GA, 30329, USA
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Tappero S, Sorce G, Panunzio A, Chierigo F, Parodi S, Piccinelli M, Guano G, Mantica G, Suardi N, Borghesi M, Montorsi F, Antonelli A, De Cobelli O, Terrone C, Karakiewicz P. Effect of chemotherapy in sarcomatoid bladder cancer patients treated with radical cystectomy. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01129-6] [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] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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14
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Vaccarino V, Shah AJ, Moncayo V, Nye J, Piccinelli M, Ko YA, Ma X, Murrah N, Shallenberger L, Driggers E, Levantsevych OM, Hammadah M, Lima BB, Young A, O'Neal W, Alkhalaf M, Haffar A, Raggi P, Goldberg J, Smith NL, Garcia EV, Quyyumi AA, Bremner JD. Posttraumatic Stress Disorder, Myocardial Perfusion, and Myocardial Blood Flow: A Longitudinal Twin Study. Biol Psychiatry 2022; 91:615-625. [PMID: 34865854 PMCID: PMC8918004 DOI: 10.1016/j.biopsych.2021.09.016] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/31/2021] [Accepted: 09/17/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND The link between posttraumatic stress disorder (PTSD) and ischemic heart disease remains elusive owing to a shortage of longitudinal studies with a clinical diagnosis of PTSD and objective measures of cardiac compromise. METHODS We performed positron emission tomography in 275 twins who participated in two examinations approximately 12 years apart. At both visits, we obtained a clinical diagnosis of PTSD, which was classified as long-standing (both visit 1 and visit 2), late onset (only visit 2), and no PTSD (no PTSD at both visits). With positron emission tomography, we assessed myocardial flow reserve (MFR), which, in absence of significant coronary stenoses, indexes coronary microvascular function. We compared positron emission tomography data at visit 2 across the three categories of longitudinally assessed PTSD and examined changes between the two visits. RESULTS Overall, 80% of the twins had no or minimal obstructive coronary disease. Yet, MFR was depressed in twins with PTSD and was progressively lower across groups with no PTSD (2.13), late-onset PTSD (1.97), and long-standing PTSD (1.93) (p = .01). A low MFR (a ratio <2.0) was present in 40% of the twins without PTSD, in 56% of those with late-onset PTSD, and in 72% of those with long-standing PTSD (p < .001). Associations persisted in multivariable analysis, when examining changes in MFR between visit 1 and visit 2, and within twin pairs. Results were similar by zygosity. CONCLUSIONS Longitudinally, PTSD is associated with reduced coronary microcirculatory function and greater deterioration over time. The association is especially noted among twins with chronic, long-standing PTSD and is not confounded by shared environmental or genetic factors.
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Affiliation(s)
- Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
| | - Amit J Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; Atlanta Veterans Affairs Health Care System, Decatur, Georgia
| | - Valeria Moncayo
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Jonathon Nye
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Xin Ma
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Nancy Murrah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Lucy Shallenberger
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Emily Driggers
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Oleksiy M Levantsevych
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Muhammad Hammadah
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Bruno B Lima
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - An Young
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Wesley O'Neal
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Mhmtjamil Alkhalaf
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Ammer Haffar
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Paolo Raggi
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Jack Goldberg
- Seattle Epidemiologic Research and Information Center, United States Department of Veterans Affairs Office of Research and Development, Seattle, Washington
| | - Nicholas L Smith
- Seattle Epidemiologic Research and Information Center, United States Department of Veterans Affairs Office of Research and Development, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington
| | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Arshed A Quyyumi
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - J Douglas Bremner
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia; Atlanta Veterans Affairs Health Care System, Decatur, Georgia
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Piccinelli M, Dahiya N, Nye JA, Folks R, Cooke CD, Manatunga D, Hwang D, Paeng JC, Cho SG, Lee JM, Bom HS, Koo BK, Yezzi A, Garcia EV. Clinically viable myocardial CCTA segmentation for measuring vessel-specific myocardial blood flow from dynamic PET/CCTA hybrid fusion. Eur J Hybrid Imaging 2022; 6:4. [PMID: 35165793 PMCID: PMC8844325 DOI: 10.1186/s41824-021-00122-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/04/2021] [Indexed: 11/10/2022] Open
Abstract
Background Positron emission tomography (PET)-derived LV MBF quantification is usually measured in standard anatomical vascular territories potentially averaging flow from normally perfused tissue with those from areas with abnormal flow supply. Previously we reported on an image-based tool to noninvasively measure absolute myocardial blood flow at locations just below individual epicardial vessel to help guide revascularization. The aim of this work is to determine the robustness of vessel-specific flow measurements (MBFvs) extracted from the fusion of dynamic PET (dPET) with coronary computed tomography angiography (CCTA) myocardial segmentations, using flow measured from the fusion with CCTA manual segmentation as the reference standard. Methods Forty-three patients’ 13NH3 dPET, CCTA image datasets were used to measure the agreement of the MBFvs profiles after the fusion of dPET data with three CCTA anatomical models: (1) a manual model, (2) a fully automated segmented model and (3) a corrected model, where major inaccuracies in the automated segmentation were briefly edited. Pairwise accuracy of the normality/abnormality agreement of flow values along differently extracted vessels was determined by comparing, on a point-by-point basis, each vessel’s flow to corresponding vessels’ normal limits using Dice coefficients (DC) as the metric. Results Of the 43 patients CCTA fully automated mask models, 27 patients’ borders required manual correction before dPET/CCTA image fusion, but this editing process was brief (2–3 min) allowing a 100% success rate of extracting MBFvs in clinically acceptable times. In total, 124 vessels were analyzed after dPET fusion with the manual and corrected CCTA mask models yielding 2225 stress and 2122 rest flow values. Forty-seven vessels were analyzed after fusion with the fully automatic masks producing 840 stress and 825 rest flow samples. All DC coefficients computed globally or by territory were ≥ 0.93. No statistical differences were found in the normal/abnormal flow classifications between manual and corrected or manual and fully automated CCTA masks. Conclusion Fully automated and manually corrected myocardial CCTA segmentation provides anatomical masks in clinically acceptable times for vessel-specific myocardial blood flow measurements using dynamic PET/CCTA image fusion which are not significantly different in flow accuracy and within clinically acceptable processing times compared to fully manually segmented CCTA myocardial masks.
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16
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Rocco B, Assumma S, Morini E, Macchione N, Piacentini I, Bernardini P, Sarchi L, Stroppa D, Piccinelli M, Del Nero A, Sighinolfi M. Extreme stone case and UPJ obstruction: Robotic management. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)02275-8] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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17
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Nye JA, Piccinelli M, Hwang D, David Cooke C, Paeng JC, Lee JM, Cho SG, Folks R, Bom HS, Koo BK, Garcia EV. Dynamic cardiac PET motion correction using 3D normalized gradient fields in patients and phantom simulations. Med Phys 2021; 48:5072-5084. [PMID: 34174095 DOI: 10.1002/mp.15059] [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] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/06/2021] [Accepted: 06/09/2021] [Indexed: 11/09/2022] Open
Abstract
This work expands on the implementation of three-dimensional (3D) normalized gradient fields to correct for whole-body motion and cardiac creep in [N-13]-ammonia patient studies and evaluates its accuracy using a dynamic phantom simulation model. METHODS A full rigid-body algorithm was developed using 3D normalized gradient fields including a multi-resolution step and sampling off the voxel grid to reduce interpolation artifacts. Optimization was performed using a weighted similarity metric that accounts for opposing gradients between images of blood pool and perfused tissue without the need for segmentation. Forty-three retrospective dynamic [N-13]-ammonia PET/CT rest/adenosine-stress patient studies were motion corrected and the mean motion parameters plotted at each frame time point. Motion correction accuracy was assessed using a comprehensive dynamic XCAT simulation incorporating published physiologic parameters of the heart's trajectory following adenosine infusion as well as corrupted attenuation correction commonly observed in clinical studies. Accuracy of the algorithm was assessed objectively by comparing the errors between isosurfaces and centers of mass of the motion corrected XCAT simulations. RESULTS In the patient studies, the overall mean cranial-to-caudal translation was 7 mm at stress over the duration of the adenosine infusion. Noninvasive clinical measures of relative flow reserve and myocardial flow reserve were highly correlated with their invasive analogues. Motion correction accuracy assessed with the XCAT simulations showed an error of <1 mm in late perfusion frames that broadened gradually to <3 mm in earlier frames containing blood pool. CONCLUSION This work demonstrates that patients undergoing [N-13]-ammonia dynamic PET/CT exhibit a large cranial-to-caudal translation related to cardiac creep primarily at stress and to a lesser extent at rest, which can be accurately corrected by optimizing their 3D normalized gradient fields. Our approach provides a solution to the challenging condition where the image intensity and its gradients are opposed without the need for segmentation and remains robust in the presence of PET-CT mismatch.
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Affiliation(s)
- Jonathon A Nye
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Charles David Cooke
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Jin Chul Paeng
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea
| | - Joo Myung Lee
- Samsung Medical Center, Heart Vascular Stroke Institute, Seoul, Korea
| | - Sang-Geon Cho
- Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Russell Folks
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Hee-Seung Bom
- Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
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18
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Piccinelli M, Cho SG, Garcia EV, Alexanderson E, Lee JM, Cooke CD, Goyal N, Sanchez MS, Folks RD, Chen Z, Votaw J, Koo BK, Bom HS. Vessel-specific quantification of absolute myocardial blood flow, myocardial flow reserve and relative flow reserve by means of fused dynamic 13NH 3 PET and CCTA: Ranges in a low-risk population and abnormality criteria. J Nucl Cardiol 2020; 27:1756-1769. [PMID: 30374847 PMCID: PMC6488439 DOI: 10.1007/s12350-018-01472-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 09/15/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The goal of the present work is to present a novel methodology for the extraction of MBF, MFR and RFR along coronary arteries by means of multimodality image fusion of dynamic PET and CCTA images. BACKGROUND FFR is the reference standard to identify flow-limiting lesions, but its invasiveness limits broad application. New noninvasive methodologies are warranted to stratify patients and guide treatment. METHODS A group of 16 low-risk CAD subjects who underwent both 13NH3 PET and CCTA were analyzed. Image fusion techniques were employed to align the studies and CCTA-derived anatomy used to identify coronaries trajectories. MBF was calculated by means of a 1-tissue compartmental model for the standard vascular territories and along patient-specific vessel paths from the base to the apex of the heart. RESULTS Low-risk ranges for MBF. MFR and RFR for LAD, LCX and rPDA were computed for the entire cohort and separated by gender. Computed low-risk ranges were used to assess a prospective patient with suspected CAD. CONCLUSIONS Our vessel-specific functional indexes and 3D displays offer promise to more closely replicate what is commonly performed during a catheterization session and have the potential of providing effective noninvasive tools for the identification of flow-limiting lesions and image-guided therapy.
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Affiliation(s)
- Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, GA, 3032, USA.
| | - Sang-Geon Cho
- Department of Nuclear Medicine, Chonnam National University, Gwangju, Korea
| | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, GA, 3032, USA
| | - Erick Alexanderson
- Nuclear Cardiology Department, Instituto Nacional de Cardiologia, Mexico City, Mexico
| | - Joo Myung Lee
- Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Korea
| | - C David Cooke
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, GA, 3032, USA
| | - Nikhil Goyal
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, GA, 3032, USA
| | | | - Russel D Folks
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, GA, 3032, USA
| | - Zhengjia Chen
- Department of Biostatistics & Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, USA
| | - John Votaw
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, GA, 3032, USA
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Hee-Seung Bom
- Department of Nuclear Medicine, Chonnam National University, Gwangju, Korea
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19
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Piccinelli M, Galt J. Effect of reduced photon count levels and choice of normal data on semi-automated image assessment in cardiac SPECT: Doing more with fewer counts. J Nucl Cardiol 2020; 27:1483-1485. [PMID: 30411194 DOI: 10.1007/s12350-018-01499-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 10/16/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - James Galt
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA.
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20
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Affiliation(s)
- Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, GA, 30322, USA.
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21
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AlBadri A, Piccinelli M, Cho SG, Lee JM, Jaber W, De Cecco CN, Samady H, Koo BK, Bom HS, Garcia EV. Rationale and design of the quantification of myocardial blood flow using dynamic PET/CTA-fused imagery (DEMYSTIFY) to determine physiological significance of specific coronary lesions. J Nucl Cardiol 2020; 27:1030-1039. [PMID: 32026327 PMCID: PMC7332386 DOI: 10.1007/s12350-020-02052-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 01/13/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Coronary physiology assessments have been shown by multiple trials to add clinical value in detecting significant coronary artery disease and predicting cardiovascular outcomes. Fractional flow reserve (FFR) obtained during invasive coronary angiography (ICA) has become the new reference standard for hemodynamic significance detection. Absolute myocardial blood flow (MBF) quantification by means of dynamic positron emission tomography (dPET) has high diagnostic and prognostic values. FFR is an invasive measure and as such cannot be applied broadly, while MBF quantification is commonly performed on standard vascular territories intermixing normal flow from normal regions with abnormal flow from abnormal regions and consequently limiting its diagnostic power. OBJECTIVE The aim of this study is to provide physicians with reliable software tools for the non-invasive assessment of lesion-specific physiological significance for the entire coronary tree by combining PET-derived absolute flow data and coronary computed tomography angiography (CTA)-derived anatomy and coronary centerlines. METHODS The dynamic PET/CTA myocardial blood flow assessment with fused imagery (DEMYSTIFY) study is an observational prospective clinical study to develop algorithms and software tools to fuse coronary anatomy data obtained from CTA with dPET data to non-invasively measure absolute MBF, myocardial flow reserve, and relative flow reserve across specific coronary lesions. Patients (N = 108) will be collected from 4 institutions (Emory University Hospital, USA; Chonnam National University Hospital, South Korea; Samsung Medical Center, South Korea; Seoul National University Hospital, South Korea). These results will be compared to those obtained invasively in the catheterization laboratory and to a relatively novel non-invasive technique to estimate FFR based on CTA and computational fluid dynamics. CONCLUSIONS Success of these developments should lead to the following benefits: (1) eliminate unnecessary invasive coronary angiography in patients with no significant lesions, (2) avoid stenting physiologically insignificant lesions, (3) guide percutaneous coronary interventions process to the location of significant lesions, (4) provide a flow-color-coded 3D roadmap of the entire coronary tree to guide bypass surgery, and (5) use less radiation and lower the cost from unnecessary procedures. TRIAL REGISTRY The DEMYSTIFY study has been registered on ClinicalTrials.gov with registration number NCT04221594.
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Affiliation(s)
- Ahmed AlBadri
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Sang-Geon Cho
- Department of Nuclear Medicine, Chonnam National University, Gwangju, Korea
| | - Joo Myung Lee
- Samsung Medical Center, Heart Vascular Stroke Institute, Seoul, Korea
| | - Wissam Jaber
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Carlo N De Cecco
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Habib Samady
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Hee-Seung Bom
- Department of Nuclear Medicine, Chonnam National University, Gwangju, Korea
| | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA.
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Affiliation(s)
- Hak Seung Lee
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul 110-744, Republic of Korea
| | - Mineok Chang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul 110-744, Republic of Korea
| | - Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul 110-744, Republic of Korea
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23
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Bergersen AW, Chnafa C, Gallo D, Piccinelli M, Steinman DA, Valen-Sendstad K. Automated and objective removal of bifurcation aneurysms: Incremental improvements, and validation against healthy controls. J Biomech 2019; 96:109342. [PMID: 31630772 DOI: 10.1016/j.jbiomech.2019.109342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 03/15/2019] [Revised: 09/09/2019] [Accepted: 09/11/2019] [Indexed: 12/01/2022]
Abstract
Abnormal hemodynamic stresses are thought to correlate with aneurysm initiation, growth, and rupture. We have previously investigated the role of wall shear stress (WSS) and WSS gradients (WSSG) in search for a mechanistic link to formation of sidewall aneurysms using an automated and objective tool for aneurysm removal and arterial reconstruction in combination with computational fluid dynamics (CFD). However, we warned against the use of the tool for bifurcation type aneurysms because of a potential unrealistic reconstruction of the apex. We hypothesized that inclusion of additional morphological features from the surrounding vasculature could overcome these constraints. We extended the previously published method for removal and reconstruction of the bifurcation vasculature based on diverging and converging points of the parent and daughter artery centerlines, to also include two new centerlines between the daughter vessels, one of them passed through the bifurcation center. Validation was performed by comparing the efficacy of the two algorithms, using ten healthy models of the internal carotid artery terminus as ground truth. Qualitative results showed that the bifurcation apexes became smoother relative to the original algorithm; more consistent with the reference models. This was reflected quantitatively by a reduced maximum distance between the reference and reconstructed surfaces, although not statistically significant. Furthermore, the modified algorithm also quantitatively improved CFD derived WSS and WSSG, especially the latter. In conclusion, the modified algorithm does not perfectly reconstruct the bifurcation apex, but provides an incremental improvement, especially important for the derived hemodynamic metrics of interest in vascular pathobiology.
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Affiliation(s)
- Aslak W Bergersen
- Department of Computational Physiology, Simula Research Laboratory, Lysaker, Norway
| | - Christophe Chnafa
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada
| | - Diego Gallo
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy
| | - Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University, GA, USA
| | - David A Steinman
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada
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Piccinelli M, Cooke CD, Votaw J, Garcia EV. 352Quantification of vessel-specific fractional flow reserve by means of multimodality image fusion of PET/CCTA. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez146] [Citation(s) in RCA: 1] [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: 11/13/2022] Open
Affiliation(s)
- M Piccinelli
- Emory University, Department of Radiology and Imaging Sciences, Atlanta, United States of America
| | - C D Cooke
- Emory University, Department of Radiology and Imaging Sciences, Atlanta, United States of America
| | - J Votaw
- Emory University, Department of Radiology and Imaging Sciences, Atlanta, United States of America
| | - E V Garcia
- Emory University, Department of Radiology and Imaging Sciences, Atlanta, United States of America
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Piccinelli M, Dahiya N, Folks R, Yezzi A, Garcia E. 353Validation of automated algorithms for the detection of left and right ventricles in clinical CCTA in the context of PET/CCTA image fusion. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez146.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/13/2022] Open
Affiliation(s)
- M Piccinelli
- Emory University, Department of Radiology and Imaging Sciences, Atlanta, United States of America
| | - N Dahiya
- Georgia Institute of Technology, Department of Electrical Engineering, Atlanta, United States of America
| | - R Folks
- Emory University, Department of Radiology and Imaging Sciences, Atlanta, United States of America
| | - A Yezzi
- Georgia Institute of Technology, Department of Electrical Engineering, Atlanta, United States of America
| | - E Garcia
- Emory University, Department of Radiology and Imaging Sciences, Atlanta, United States of America
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Dahiya N, Yezzi A, Piccinelli M, Garcia E. Integrated 3D Anatomical Model for Automatic Myocardial Segmentation in Cardiac CT Imagery. Comput Methods Biomech Biomed Eng Imaging Vis 2019; 7:690-706. [PMID: 31890358 DOI: 10.1080/21681163.2019.1583607] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Segmentation of epicardial and endocardial boundaries is a critical step in diagnosing cardiovascular function in heart patients. The manual tracing of organ contours in Computed Tomography Angiography (CTA) slices is subjective, time-consuming and impractical in clinical setting. We propose a novel multi-dimensional automatic edge detection algorithm based on shape priors and principal component analysis (PCA). We have developed a highly customized parametric model for implicit representations of segmenting curves (3D) for Left Ventricle (LV), Right Ventricle (RV), and Epicardium (Epi) used simultaneously to achieve myocardial segmentation. We have combined these representations in a region-based image modeling framework with high level constraints enabling the modeling of complex cardiac anatomical structures to automatically guide the segmentation of endo/epicardial boundaries. Test results on 30 short-axis CTA datasets show robust segmentation with error (mean ± std mm) of (1.46 ± 0.41), (2.06 ± 0.65), (2.88 ± 0.59) for LV, RV and Epi respectively.
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Affiliation(s)
- N Dahiya
- Georgia Institute of Technology, North Ave NW, Atlanta, GA 30332, USA
| | - A Yezzi
- Georgia Institute of Technology, North Ave NW, Atlanta, GA 30332, USA
| | - M Piccinelli
- Emory University School of Medicine, 101 Woodruff Circle, Atlanta, GA, 30322, USA
| | - E Garcia
- Emory University School of Medicine, 101 Woodruff Circle, Atlanta, GA, 30322, USA
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Kumar A, Hung OY, Piccinelli M, Eshtehardi P, Corban MT, Sternheim D, Yang B, Lefieux A, Molony DS, Thompson EW, Zeng W, Bouchi Y, Gupta S, Hosseini H, Raad M, Ko YA, Liu C, McDaniel MC, Gogas BD, Douglas JS, Quyyumi AA, Giddens DP, Veneziani A, Samady H. Low Coronary Wall Shear Stress Is Associated With Severe Endothelial Dysfunction in Patients With Nonobstructive Coronary Artery Disease. JACC Cardiovasc Interv 2018; 11:2072-2080. [PMID: 30268874 DOI: 10.1016/j.jcin.2018.07.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [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: 04/30/2018] [Revised: 07/02/2018] [Accepted: 07/03/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES This study investigated the relationship between low wall shear stress (WSS) and severe endothelial dysfunction (EDFx). BACKGROUND Local hemodynamic forces such as WSS play an important role in atherogenesis through their effect on endothelial cells. The study hypothesized that low WSS independently predicts severe EDFx in patients with coronary artery disease (CAD). METHODS Forty-four patients with CAD underwent coronary angiography, fractional flow reserve, and endothelial function testing. Segments with >10% vasoconstriction after acetylcholine (Ach) infusion were defined as having severe EDFx. WSS, calculated using 3-dimensional angiography, velocity measurements, and computational fluid dynamics, was defined as low (<1 Pa), intermediate (1 to 2.5 Pa), or high (>2.5 Pa). RESULTS Median age was 52 years, 73% were women. Mean fractional flow reserve was 0.94 ± 0.06. In 4,510 coronary segments, median WSS was 3.67 Pa. A total of 24% had severe EDFx. A higher proportion of segments with low WSS had severe EDFx (71%) compared with intermediate WSS (22%) or high WSS (23%) (p < 0.001). Segments with low WSS demonstrated greater vasoconstriction in response to Ach than did intermediate or high WSS segments (-10.7% vs. -2.5% vs. +1.3%, respectively; p < 0.001). In a multivariable logistic regression analysis, female sex (odds ratio [OR]: 2.44; p = 0.04), diabetes (OR: 5.01; p = 0.007), and low WSS (OR: 9.14; p < 0.001) were independent predictors of severe EDFx. CONCLUSIONS In patients with nonobstructive CAD, segments with low WSS demonstrated more vasoconstriction in response to Ach than did intermediate or high WSS segments. Low WSS was independently associated with severe EDFx.
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Affiliation(s)
- Arnav Kumar
- Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Olivia Y Hung
- Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Marina Piccinelli
- Department of Radiology, Emory University School of Medicine, Atlanta, Georgia
| | - Parham Eshtehardi
- Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Michel T Corban
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - David Sternheim
- Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Boyi Yang
- Department of Mathematics and Computer Science, Emory University, Atlanta, Georgia
| | - Adrien Lefieux
- Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; Department of Mathematics and Computer Science, Emory University, Atlanta, Georgia
| | - David S Molony
- Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Elizabeth W Thompson
- Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Wenjie Zeng
- Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Yasir Bouchi
- Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Sonu Gupta
- Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Hossein Hosseini
- Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Mohamad Raad
- Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Chang Liu
- Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Michael C McDaniel
- Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Bill D Gogas
- Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - John S Douglas
- Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Arshed A Quyyumi
- Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Don P Giddens
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | - Alessandro Veneziani
- Department of Mathematics and Computer Science, Emory University, Atlanta, Georgia
| | - Habib Samady
- Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
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Piccinelli M, Santana C, Sirineni GKR, Folks RD, Cooke CD, Arepalli CD, Aguade-Bruix S, Keidar Z, Frenkel A, Israel O, Candell-Riera J, Garcia EV. Diagnostic performance of the quantification of myocardium at risk from MPI SPECT/CTA 2G fusion for detecting obstructive coronary disease: A multicenter trial. J Nucl Cardiol 2018; 25:1376-1386. [PMID: 28194728 DOI: 10.1007/s12350-017-0819-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 12/05/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The effective non-invasive identification of coronary artery disease (CAD) and its proper referral for invasive treatment are still unresolved issues. We evaluated our quantification of myocardium at risk (MAR) from our second generation 3D MPI/CTA fusion framework for the detection and localization of obstructive coronary disease. METHODS Studies from 48 patients who had rest/stress MPI, CTA, and ICA were analyzed from 3 different institutions. From the CTA, a 3D biventricular surface of the myocardium with superimposed coronaries was extracted and fused to the perfusion distribution. Significant lesions were identified from CTA readings and positioned on the fused display. Three estimates of MAR were computed on the 3D LV surface on the basis of the MPI alone (MARp), the CTA alone (MARa), and the fused information (MARf). The extents of areas at risk were used to generate ROC curves using ICA anatomical findings as reference standard. RESULTS Areas under the ROC curve (AUC) for CAD detection using MARf was 0.88 (CI = 0.75-0.95) and for MARp and MARa were, respectively 0.82 (CI = 0.69-0.92) and 0.75 (CI = 0.60-0.86) using the ≥70% stenosis criterion. AUCs for CAD localization (all vessels) using MARf showed significantly higher performance than either MARa or MARp or both. CONCLUSIONS Using ICA as the reference standard, MAR as the quantitative parameter, and AUC to measure diagnostic performance, MPI-CTA fusion imaging provided incremental diagnostic information compared to MPI or CTA alone for the diagnosis and localization of CAD.
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Affiliation(s)
- Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, GA, 30322, USA.
| | - Cesar Santana
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, GA, 30322, USA
| | | | - Russell D Folks
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, GA, 30322, USA
| | - C David Cooke
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, GA, 30322, USA
| | - Chesnal D Arepalli
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, GA, 30322, USA
| | | | | | | | - Ora Israel
- Rambam Health Care Campus, Haifa, Israel
| | | | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, GA, 30322, USA
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Xu H, Piccinelli M, Leshnower BG, Lefieux A, Taylor WR, Veneziani A. Coupled Morphological-Hemodynamic Computational Analysis of Type B Aortic Dissection: A Longitudinal Study. Ann Biomed Eng 2018; 46:927-939. [PMID: 29594688 DOI: 10.1007/s10439-018-2012-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 12/01/2017] [Accepted: 03/21/2018] [Indexed: 10/17/2022]
Abstract
Progressive false lumen aneurysmal degeneration in type B aortic dissection (TBAD) is a complex process with a multi-factorial etiology. Patient-specific computational fluid dynamics (CFD) simulations provide spatial and temporal hemodynamic quantities that facilitate understanding this disease progression. A longitudinal study was performed for a TBAD patient, who was diagnosed with the uncomplicated TBAD in 2006 and treated with optimal medical therapy but received surgery in 2010 due to late complication. Geometries of the aorta in 2006 and 2010 were reconstructed. With registration algorithms, we accurately quantified the evolution of the false lumen, while with CFD simulations we computed several hemodynamic indexes, including the wall shear stress (WSS), and the relative residence time (RRT). The numerical fluid model included large eddy simulation (LES) modeling for efficiently capturing the flow disturbances induced by the entry tears. In the absence of complete patient-specific data, the boundary conditions were based on a specific calibration method. Correlations between hemodynamics and the evolution field in time obtained by registration of the false lumen are discussed. Further testing of this methodology on a large cohort of patients may enable the use of CFD to predict whether patients, with originally uncomplicated TBAD, develop late complications.
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Affiliation(s)
- Huijuan Xu
- The George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, USA. .,Department of Mathematics and Computer Science, Emory University, Atlanta, USA.
| | - Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, USA
| | | | - Adrien Lefieux
- Department of Mathematics and Computer Science, Emory University, Atlanta, USA.,Department of Cardiology, Emory University, Atlanta, USA
| | - W Robert Taylor
- Department of Cardiology, Emory University, Atlanta, USA.,Atlanta VA Medical Center, Atlanta, USA
| | - Alessandro Veneziani
- Department of Mathematics and Computer Science, Emory University, Atlanta, USA.,School of Advanced Studies IUSS, Pavia, Italy
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Abstract
PURPOSE OF REVIEW Motion artifacts, due to cardiac and respiratory cycles, myocardial cardiac creep, or gross patient movements, have been extensively investigated in the context of relative myocardial perfusion imaging with SPECT and PET. These movements have been identified as a major source of errors in image quantification and diagnosis. Recently, as dynamic PET quantification for myocardial blood flow assessment has entered clinical practice, similar questions have arisen on the impact of motion on final blood flow values. RECENT FINDINGS While preliminary investigations have underlined the potential impact of these motions on MBF quantification, their correction on dynamic acquisition remains challenging and limited to research studies. Gross patient's body movements occur in a consistent number of cases, particularly during stress acquisition, typically involving a limited number of image frames. If undetected, these movements can lead to great differences in flow values and consequently misdiagnosis. Quality control routines can be applied to automatically inspect the shape of time activity curves and to help identify motion artifacts. Cyclic cardiac and respiratory motion may have a considerable impact on final flow values. Correction of gross body motion represents a priority in the context of optimizing absolute flow clinical routine utilization and protocol standardization.
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Affiliation(s)
- Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Woodruff Memorial Research Building, Room 1203-C, 101 Woodruff Circle, Atlanta, GA, 30322, USA.
| | - John R Votaw
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Woodruff Memorial Research Building, Room 1203-C, 101 Woodruff Circle, Atlanta, GA, 30322, USA.,, Alpharetta, USA
| | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Woodruff Memorial Research Building, Room 1203-C, 101 Woodruff Circle, Atlanta, GA, 30322, USA
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Kumar A, Hung OY, Eshtehardi P, Thompson E, Sternheim D, Gupta S, Chandran K, Molony DS, Piccinelli M, Lefieux A, Corban MT, McDaniel MC, Quyyumi AA, Gogas BD, Giddens DP, Veneziani A, Samady H. CRT-500.04 Lower Wall Shear Stress and Clinical Risk Factors are Associated with Endothelial Dysfunction in Patients with Non-Obstructive Coronary Artery Disease. JACC Cardiovasc Interv 2018. [DOI: 10.1016/j.jcin.2018.01.131] [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] [Indexed: 11/25/2022]
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Piccinelli M, Cooke DC, Garcia EV. Multimodality Image Fusion for Coronary Artery Disease Detection: Concepts and Latest Developments. ACTA ACUST UNITED AC 2018; 4:74-78. [PMID: 31890460 DOI: 10.17996/anc.18-00065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The debate on the role of anatomy and function in the assessment of coronary artery disease has been progressing for decades. While each imaging modality brings its own strengths and weaknesses, a multimodality image fusion approach combining an anatomical acquisition with a functional one has the potential of providing all the complementary information necessary to select the proper treatment. The technology has been available to physicians for a decade, but the recent introduction of positron emission tomography-derived absolute myocardial blood flow has further advanced the case for an image fusion diagnostic approach.
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Affiliation(s)
- Marina Piccinelli
- Department of Radiology and Imaging Science, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, Georgia, 30322, United States
| | - David C Cooke
- Department of Radiology and Imaging Science, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, Georgia, 30322, United States
| | - Ernest V Garcia
- Department of Radiology and Imaging Science, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, Georgia, 30322, United States
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Halfer-Cervini AM, Piccinelli M, Prosdocimi T, Baratelli-Zambruni L. SIBLING SPECIES IN ARTEMIA
(CRUSTACEA:BRANCHIOPODA). Evolution 2017; 22:373-381. [DOI: 10.1111/j.1558-5646.1968.tb05904.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/1967] [Indexed: 11/26/2022]
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Gogas BD, Yang B, Piccinelli M, Bouchi YH, King SB, Dib N, Giddens DP, Veneziani A, Samady H. Feasibility of Optical Coherence Tomography-Derived Computational Fluid Dynamics in Calcified Vessels to Assess Treatment With Orbital Atherectomy. JACC Cardiovasc Interv 2016; 9:e65-6. [PMID: 27056320 DOI: 10.1016/j.jcin.2015.12.270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/04/2015] [Revised: 12/17/2015] [Accepted: 12/18/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Bill D Gogas
- Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; Emory Cardiovascular Imaging & Biomechanics Core Laboratory, Emory University School of Medicine, Atlanta, Georgia
| | - Boyi Yang
- Department of Mathematics and Computer Science, Emory University School of Medicine, Atlanta, Georgia; Emory Cardiovascular Imaging & Biomechanics Core Laboratory, Emory University School of Medicine, Atlanta, Georgia
| | - Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; Emory Cardiovascular Imaging & Biomechanics Core Laboratory, Emory University School of Medicine, Atlanta, Georgia
| | - Yasir H Bouchi
- Emory Cardiovascular Imaging & Biomechanics Core Laboratory, Emory University School of Medicine, Atlanta, Georgia
| | - Spencer B King
- Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; Emory Cardiovascular Imaging & Biomechanics Core Laboratory, Emory University School of Medicine, Atlanta, Georgia; Saint Joseph's Heart and Vascular Institute, Atlanta, Georgia
| | - Nabil Dib
- University of Arizona College of Medicine, Phoenix, Arizona
| | - Don P Giddens
- Emory Cardiovascular Imaging & Biomechanics Core Laboratory, Emory University School of Medicine, Atlanta, Georgia; Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | - Alessandro Veneziani
- Department of Mathematics and Computer Science, Emory University School of Medicine, Atlanta, Georgia; Emory Cardiovascular Imaging & Biomechanics Core Laboratory, Emory University School of Medicine, Atlanta, Georgia
| | - Habib Samady
- Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; Emory Cardiovascular Imaging & Biomechanics Core Laboratory, Emory University School of Medicine, Atlanta, Georgia.
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Piccinelli M, Bom HS, Alexanderson E, Cooke D, Folks R, Manatunga D, Garcia E. NONINVASIVE VESSEL-SPECIFIC ABSOLUTE MYOCARDIAL BLOOD FLOW AND FLOW RESERVE BY MEANS OF DYNAMIC NH3 PET/CTA IMAGE FUSION: DEVELOPMENT OF NORMAL LIMITS. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)31668-0] [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] [Indexed: 11/26/2022]
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Gogas BD, Yang B, Piccinelli M, Giddens DP, King SB, Kereiakes DJ, Ellis SG, Stone GW, Veneziani A, Samady H. Novel 3-Dimensional Vessel and Scaffold Reconstruction Methodology for the Assessment of Strut-Level Wall Shear Stress After Deployment of Bioresorbable Vascular Scaffolds From the ABSORB III Imaging Substudy. JACC Cardiovasc Interv 2016; 9:501-3. [DOI: 10.1016/j.jcin.2016.01.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 01/05/2016] [Accepted: 01/06/2016] [Indexed: 11/16/2022]
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Hung OY, Molony D, Corban MT, Rasoul-Arzrumly E, Maynard C, Eshtehardi P, Dhawan S, Timmins LH, Piccinelli M, Ahn SG, Gogas BD, McDaniel MC, Quyyumi AA, Giddens DP, Samady H. Comprehensive Assessment of Coronary Plaque Progression With Advanced Intravascular Imaging, Physiological Measures, and Wall Shear Stress: A Pilot Double-Blinded Randomized Controlled Clinical Trial of Nebivolol Versus Atenolol in Nonobstructive Coronary Artery Disease. J Am Heart Assoc 2016; 5:JAHA.115.002764. [PMID: 26811165 PMCID: PMC4859395 DOI: 10.1161/jaha.115.002764] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background We hypothesized that nebivolol, a β‐blocker with nitric oxide–mediated activity, compared with atenolol, a β‐blocker without such activity, would decrease oxidative stress and improve the effects of endothelial dysfunction and wall shear stress (WSS), thereby reducing atherosclerosis progression and vulnerability in patients with nonobstructive coronary artery disease. Methods and Results In this pilot double‐blinded randomized controlled trial, 24 patients treated for 1 year with nebivolol 10 mg versus atenolol 100 mg plus standard medical therapy underwent baseline and follow‐up coronary angiography with assessments of inflammatory and oxidative stress biomarkers, microvascular function, endothelial function, and virtual histology intravascular ultrasound. WSS was calculated from computational fluid dynamics. Virtual histology intravascular ultrasound segments were assessed for vessel volumetrics and remodeling. There was a trend toward more low‐WSS segments in the nebivolol cohort (P=0.06). Low‐WSS regions were associated with greater plaque progression (P<0.0001) and constrictive remodeling (P=0.04); conversely, high‐WSS segments demonstrated plaque regression and excessive expansive remodeling. Nebivolol patients had decreased lumen and vessel areas along with increased plaque area, resulting in more constrictive remodeling (P=0.002). There were no significant differences in biomarker levels, microvascular function, endothelial function, or number of thin‐capped fibroatheromas per vessel. Importantly, after adjusting for β‐blocker, low‐WSS segments remained significantly associated with lumen loss and plaque progression. Conclusion Nebivolol, compared with atenolol, was associated with greater plaque progression and constrictive remodeling, likely driven by more low‐WSS segments in the nebivolol arm. Both β‐blockers had similar effects on oxidative stress, microvascular function, and endothelial function. Clinical Trial Registration URL: https://clinicaltrials.gov/. Unique identifier: NCT01230892.
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Affiliation(s)
- Olivia Y Hung
- Division of Cardiology, Department of Medicine, Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, GA (O.Y.H., M.T.C., E.R.A., P.E., S.D., L.H.T., S.G.A., B.D.G., M.C.M.D., A.A.Q., H.S.)
| | - David Molony
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA (D.M., L.H.T., D.P.G.)
| | - Michel T Corban
- Division of Cardiology, Department of Medicine, Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, GA (O.Y.H., M.T.C., E.R.A., P.E., S.D., L.H.T., S.G.A., B.D.G., M.C.M.D., A.A.Q., H.S.)
| | - Emad Rasoul-Arzrumly
- Division of Cardiology, Department of Medicine, Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, GA (O.Y.H., M.T.C., E.R.A., P.E., S.D., L.H.T., S.G.A., B.D.G., M.C.M.D., A.A.Q., H.S.)
| | - Charles Maynard
- Department of Health Services, University of Washington, Seattle, WA (C.M.)
| | - Parham Eshtehardi
- Division of Cardiology, Department of Medicine, Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, GA (O.Y.H., M.T.C., E.R.A., P.E., S.D., L.H.T., S.G.A., B.D.G., M.C.M.D., A.A.Q., H.S.)
| | - Saurabh Dhawan
- Division of Cardiology, Department of Medicine, Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, GA (O.Y.H., M.T.C., E.R.A., P.E., S.D., L.H.T., S.G.A., B.D.G., M.C.M.D., A.A.Q., H.S.)
| | - Lucas H Timmins
- Division of Cardiology, Department of Medicine, Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, GA (O.Y.H., M.T.C., E.R.A., P.E., S.D., L.H.T., S.G.A., B.D.G., M.C.M.D., A.A.Q., H.S.) Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA (D.M., L.H.T., D.P.G.)
| | - Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA (M.P.)
| | - Sung Gyun Ahn
- Division of Cardiology, Department of Medicine, Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, GA (O.Y.H., M.T.C., E.R.A., P.E., S.D., L.H.T., S.G.A., B.D.G., M.C.M.D., A.A.Q., H.S.) Division of Cardiology, Department of Internal Medicine, Yonsei UniversityWonju College of Medicine, Wonju, Republic of Korea (S.G.A.)
| | - Bill D Gogas
- Division of Cardiology, Department of Medicine, Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, GA (O.Y.H., M.T.C., E.R.A., P.E., S.D., L.H.T., S.G.A., B.D.G., M.C.M.D., A.A.Q., H.S.)
| | - Michael C McDaniel
- Division of Cardiology, Department of Medicine, Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, GA (O.Y.H., M.T.C., E.R.A., P.E., S.D., L.H.T., S.G.A., B.D.G., M.C.M.D., A.A.Q., H.S.)
| | - Arshed A Quyyumi
- Division of Cardiology, Department of Medicine, Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, GA (O.Y.H., M.T.C., E.R.A., P.E., S.D., L.H.T., S.G.A., B.D.G., M.C.M.D., A.A.Q., H.S.)
| | - Don P Giddens
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA (D.M., L.H.T., D.P.G.)
| | - Habib Samady
- Division of Cardiology, Department of Medicine, Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, GA (O.Y.H., M.T.C., E.R.A., P.E., S.D., L.H.T., S.G.A., B.D.G., M.C.M.D., A.A.Q., H.S.)
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Hashimoto A, Nakata T, Moroi M, Tamaki N, Nishimura T, Hasebe N, Kikuchi K, Salgado C, Jimenez-Heffernan A, Lopez-Martin J, Ramos-Font C, Sanchez De Mora E, Rivera F, Lopez-Aguilar R, Martinez A, Manovel A, Soriano E, Mushtaq S, Pontone G, Bertella E, Conte E, Segurini C, Volpato V, Beltrama V, Pepi M, Annoni A, Andreini D, Leen A, Scholte A, De Graaf M, Van Den Hoogen I, Kharagjitsingh A, Wolterbeek R, Kroft L, Jukema J, Bax J, Piccinelli M, Santana C, Sirineni G, Cooke C, Aguade Bruix S, Keidar Z, Frenkel A, Israel O, Candell Riera J, Garcia E, Sharma A, Bajwa A, Bhatnagar U, Thompson E, Patil S, Thompson R, Khoorshed A, Spencer F, Farncombe T, Tandon V, Singnurkar A, Gulenchyn K, Benito Gonzalez TF, Delgado Sanchez-Gracian C, Trinidad Lopez C, Mera Fernandez D, Villanueva Campos AM, Bustos Fiore A, Alonso Fernandez V, Mayorga Bajo A, Martinez Paz E, Iglesias Garriz I. Moderated Poster Session 1: Sunday 3 May 2015, 10:00-11:00 * Room: Moderated Poster Area. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Yang B, Gogas B, Esposito G, Hung O, Arzrumly ER, Piccinelli M, King S, Giddens D, Veneziani A, Samady H. NOVEL IN-HUMAN FOUR DIMENSIONAL WALL SHEAR STRESS CALCULATION OF A CORONARY BIORESORBABLE SCAFFOLD USING OPTICAL COHERENCE TOMOGRAPHY IMAGES AND BLOOD FLOW SIMULATIONS. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61832-0] [Citation(s) in RCA: 3] [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] [Indexed: 11/26/2022]
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Gogas BD, Yang B, Passerini T, Veneziani A, Piccinelli M, Esposito G, Rasoul-Arzrumly E, Awad M, Mekonnen G, Hung OY, Holloway B, McDaniel M, Giddens D, King SB, Samady H. Computational fluid dynamics applied to virtually deployed drug-eluting coronary bioresorbable scaffolds: Clinical translations derived from a proof-of-concept. Glob Cardiol Sci Pract 2014; 2014:428-36. [PMID: 25780796 PMCID: PMC4355516 DOI: 10.5339/gcsp.2014.56] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 10/07/2014] [Accepted: 12/11/2014] [Indexed: 11/23/2022] Open
Abstract
Background: Three-dimensional design simulations of coronary metallic stents utilizing mathematical and computational algorithms have emerged as important tools for understanding biomechanical stent properties, predicting the interaction of the implanted platform with the adjacent tissue, and informing stent design enhancements. Herein, we demonstrate the hemodynamic implications following virtual implantation of bioresorbable scaffolds using finite element methods and advanced computational fluid dynamics (CFD) simulations to visualize the device-flow interaction immediately after implantation and following scaffold resorption over time. Methods and Results: CFD simulations with time averaged wall shear stress (WSS) quantification following virtual bioresorbable scaffold deployment in idealized straight and curved geometries were performed. WSS was calculated at the inflow, endoluminal surface (top surface of the strut), and outflow of each strut surface post-procedure (stage I) and at a time point when 33% of scaffold resorption has occurred (stage II). The average WSS at stage I over the inflow and outflow surfaces was 3.2 and 3.1 dynes/cm2 respectively and 87.5 dynes/cm2 over endoluminal strut surface in the straight vessel. From stage I to stage II, WSS increased by 100% and 142% over the inflow and outflow surfaces, respectively, and decreased by 27% over the endoluminal strut surface. In a curved vessel, WSS change became more evident in the inner curvature with an increase of 63% over the inflow and 66% over the outflow strut surfaces. Similar analysis at the proximal and distal edges demonstrated a large increase of 486% at the lateral outflow surface of the proximal scaffold edge. Conclusions: The implementation of CFD simulations over virtually deployed bioresorbable scaffolds demonstrates the transient nature of device/flow interactions as the bioresorption process progresses over time. Such hemodynamic device modeling is expected to guide future bioresorbable scaffold design.
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Affiliation(s)
| | | | - Tiziano Passerini
- Department of Mathematics and Computer Science, Emory University, Atlanta, Georgia
| | | | | | | | | | - Mosaab Awad
- Andreas Gruentzig Cardiovascular Center, Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
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Zhou W, Hou X, Piccinelli M, Tang X, Tang L, Cao K, Garcia EV, Zou J, Chen J. 3D fusion of LV venous anatomy on fluoroscopy venograms with epicardial surface on SPECT myocardial perfusion images for guiding CRT LV lead placement. JACC Cardiovasc Imaging 2014; 7:1239-48. [PMID: 25440593 DOI: 10.1016/j.jcmg.2014.09.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [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: 03/25/2014] [Revised: 07/29/2014] [Accepted: 09/02/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The aim of this study was to develop a 3-dimensional (3D) fusion tool kit to integrate left ventricular (LV) venous anatomy on fluoroscopy venograms with LV epicardial surface on single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) for guiding cardiac resynchronization therapy (CRT) LV lead placement. BACKGROUND LV lead position is important for CRT response. For LV lead placement into viable regions with late activation, it is important to visualize both LV venous anatomy and myocardium. METHODS Major LV veins were manually identified on fluoroscopic venograms and automatically reconstructed into a 3D anatomy. 3D LV epicardial surface was extracted from SPECT MPI. SPECT-vein fusion that consisted of geometric alignment, landmark-based registration, and vessel-surface overlay was developed to fuse the 3D venous anatomy with the epicardial surface. The accuracy of this tool was evaluated using computed tomography (CT) venograms. LV epicardial surfaces and veins were manually identified on the CT images and registered with the SPECT image by an independent operator. The locations of the fluoroscopic and CT veins on the SPECT epicardial surfaces were compared using absolute distances on SPECT short-axis slice and the 17-segment model. RESULTS Ten CRT patients were enrolled. The distance between the corresponding fluoroscopic and CT veins on the short-axis epicardial surfaces was 4.6 ± 3.6 mm (range 0 to 16.9 mm). The presence of the corresponding fluoroscopic and CT veins in the 17-segment model agreed well with a kappa value of 0.87 (95% confidence interval: 0.82 to 0.93). The tool kit was used to guide LV lead placement in a catheter laboratory and showed clinical feasibility and benefit to the patient. CONCLUSIONS A tool kit has been developed to reconstruct 3D LV venous anatomy from dual-view fluoroscopic venograms and to fuse it with LV epicardial surface on SPECT MPI. It is technically accurate for guiding LV lead placement by the 17-segment model and is feasible for clinical use in the catheterization laboratory.
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Affiliation(s)
- Weihua Zhou
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Xiaofeng Hou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Xiangyang Tang
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Lijun Tang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Kejiang Cao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Jiangang Zou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
| | - Ji Chen
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia.
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Piccinelli M, Faber TL, Arepalli CD, Appia V, Vinten-Johansen J, Schmarkey SL, Folks RD, Garcia EV, Yezzi A. Automatic detection of left and right ventricles from CTA enables efficient alignment of anatomy with myocardial perfusion data. J Nucl Cardiol 2014; 21:96-108. [PMID: 24185581 PMCID: PMC5207024 DOI: 10.1007/s12350-013-9812-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 10/15/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Accurate alignment between cardiac CT angiographic studies (CTA) and nuclear perfusion images is crucial for improved diagnosis of coronary artery disease. This study evaluated in an animal model the accuracy of a CTA fully automated biventricular segmentation algorithm, a necessary step for automatic and thus efficient PET/CT alignment. METHODS AND RESULTS Twelve pigs with acute infarcts were imaged using Rb-82 PET and 64-slice CTA. Post-mortem myocardium mass measurements were obtained. Endocardial and epicardial myocardial boundaries were manually and automatically detected on the CTA and both segmentations used to perform PET/CT alignment. To assess the segmentation performance, image-based myocardial masses were compared to experimental data; the hand-traced profiles were used as a reference standard to assess the global and slice-by-slice robustness of the automated algorithm in extracting myocardium, LV, and RV. Mean distances between the automated and the manual 3D segmented surfaces were computed. Finally, differences in rotations and translations between the manual and automatic surfaces were estimated post-PET/CT alignment. The largest, smallest, and median distances between interactive and automatic surfaces averaged 1.2 ± 2.1, 0.2 ± 1.6, and 0.7 ± 1.9 mm. The average angular and translational differences in CT/PET alignments were 0.4°, -0.6°, and -2.3° about x, y, and z axes, and 1.8, -2.1, and 2.0 mm in x, y, and z directions. CONCLUSIONS Our automatic myocardial boundary detection algorithm creates surfaces from CTA that are similar in accuracy and provide similar alignments with PET as those obtained from interactive tracing. Specific difficulties in a reliable segmentation of the apex and base regions will require further improvements in the automated technique.
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Affiliation(s)
- Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University, 101 Woodruff Circle, Room 1203C, Atlanta, GA, 30322, USA,
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Abstract
Coronary artery disease (CAD) is one of the leading causes of death in the US and a substantial health-care burden in all industrialized societies. In recent years we have witnessed a constant strive towards the development and the clinical application of novel or improved detection methods as well as therapies. Particularly, noninvasive imaging is a decisive component in the cardiovascular field. Image fusion is the ability of combining into a single integrated display the anatomical as well as the physiological data retrieved by separated modalities. Clinical evidence suggests that it represents a promising strategy in CAD assessment and risk stratification by significantly improving the diagnostic power of each modality independently considered and of the traditional side-by-side interpretation. Numerous techniques and approaches taken from the image registration field have been implemented and validated in the context of CAD assessment and management. Although its diagnostic power is widely accepted, additional technical developments are still needed to become a routinely used clinical tool.
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Affiliation(s)
- Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University, Atlanta 30322, GA, USA.
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Gogas BD, King SB, Timmins LH, Passerini T, Piccinelli M, Veneziani A, Kim S, Molony DS, Giddens DP, Serruys PW, Samady H. Biomechanical Assessment of Fully Bioresorbable Devices. JACC Cardiovasc Interv 2013; 6:760-1. [DOI: 10.1016/j.jcin.2013.04.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 03/29/2013] [Accepted: 04/17/2013] [Indexed: 10/26/2022]
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Eshtehardi P, Corban MT, Suo J, Piccinelli M, Timmins LH, Passerini T, Rasoul–Arzrumly E, McDaniel MC, Mekonnen G, Quyyumi AA, Veneziani A, Giddens DP, Samady H. HIGHER CORONARY WALL SHEAR STRESS IS ASSOCIATED WITH GREATER IMPAIRMENT IN MICROVASCULAR FUNCTION IN PATIENTS WITH NON–OBSTRUCTIVE CORONARY ARTERY DISEASE. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61843-4] [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] [Indexed: 11/26/2022]
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Mirabella L, Haggerty CM, Passerini T, Piccinelli M, Powell AJ, Del Nido PJ, Veneziani A, Yoganathan AP. Treatment planning for a TCPC test case: a numerical investigation under rigid and moving wall assumptions. Int J Numer Method Biomed Eng 2013; 29:197-216. [PMID: 23345252 DOI: 10.1002/cnm.2517] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 08/17/2012] [Indexed: 05/29/2023]
Abstract
The hemodynamics in patients with total cavopulmonary connections (TCPC) is generally very complex and characterized by patient-to-patient variability. To better understand its effect on patients' outcome, CFD models are widely used, also to test and optimize surgical options before their implementation. These models often assume rigid geometries, despite the motion experienced by thoracic vessels that could influence the hemodynamics predictions. By improving their accuracy and expanding the range of simulated interventions, the benefit of treatment planning for patients is expected to increase. We simulate three types of intervention on a patient-specific 3D model, and compare their predicted outcome with baseline condition: a decrease in pulmonary vascular resistance obtainable with medications; a surgical revision of the connection design; the introduction of a fenestration in the TCPC wall. The simulations are performed both with rigid wall assumption and including patient-specific TCPC wall motion, reconstructed from a 4DMRI dataset. The results show the effect of each option on clinically important metrics and highlight the impact of patient-specific wall motion. The largest differences between rigid and moving wall models are observed in measures of energetic efficiency of TCPC as well as in hepatic flow distribution and transit time of seeded particles through the connection.
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Affiliation(s)
- Lucia Mirabella
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, GA, USA
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Porpora A, Zunino P, Vergara C, Piccinelli M. Numerical treatment of boundary conditions to replace lateral branches in hemodynamics. Int J Numer Method Biomed Eng 2012; 28:1165-1183. [PMID: 23212795 DOI: 10.1002/cnm.2488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 03/28/2012] [Accepted: 03/29/2012] [Indexed: 06/01/2023]
Abstract
In this paper, we discuss a technique for weakly enforcing flow rate conditions in computational hemodynamics. In particular, we study the effectiveness of cutting lateral branches from the computational domain and replacing them with non-perturbing boundary conditions to simplify the geometrical reconstruction and the numerical simulation. All these features are investigated both in the case of rigid and compliant walls. Several numerical results are presented to discuss the reliability of the proposed method.
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Affiliation(s)
- A Porpora
- MOX, Dipartimento di Matematica "Francesco Brioschi", Politecnico di Milano, Italy
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Hui F, Piccinelli M, Passerini T, Spiotta A, Moskowitz S, Tong F, Veneziani A. E-048 Flow characteristics of three toroidal aneurysms. J Neurointerv Surg 2012. [DOI: 10.1136/neurintsurg-2012-010455c.48] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gupta D, Piccinelli M, Passerini T, Veneziani A, Brewster L, Laskar S, Nguyen D, Vega J, Taylor W. 105 Alterations in Flow and Shear Stress in the Thoracic Aorta with a Continuous-Flow Left Ventricular Assist Device. J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.109] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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