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Hell MM, Wild MG, Baldus S, Rudolph T, Treede H, Petronio AS, Modine T, Andreas M, Coisne A, Duncan A, Franco LN, Praz F, Ruge H, Conradi L, Zierer A, Anselmi A, Dumonteil N, Nickenig G, Piñón M, Barth S, Adamo M, Dubois C, Torracca L, Maisano F, Lurz P, von Bardeleben RS, Hausleiter J. Transapical Mitral Valve Replacement: 1-Year Results of the Real-World Tendyne European Experience Registry. JACC Cardiovasc Interv 2024; 17:648-661. [PMID: 38385922 DOI: 10.1016/j.jcin.2023.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/23/2023] [Accepted: 12/15/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND Early studies of the Tendyne transcatheter mitral valve replacement (TMVR) showed promising results in a small selective cohort. OBJECTIVES The authors present 1-year data from the currently largest commercial, real-world cohort originating from the investigator-initiated TENDER (Tendyne European Experience) registry. METHODS All patients from the TENDER registry eligible for 1-year follow-up were included. The primary safety endpoint was 1-year cardiovascular mortality. Primary performance endpoint was reduction of mitral regurgitation (MR) up to 1 year. RESULTS Among 195 eligible patients undergoing TMVR (median age 77 years [Q1-Q3: 71-81 years], 60% men, median Society of Thoracic Surgeons Predicted Risk of Mortality 5.6% [Q1-Q3: 3.6%-8.9%], 81% in NYHA functional class III or IV, 94% with MR 3+/4+), 31% had "real-world" indications for TMVR (severe mitral annular calcification, prior mitral valve treatment, or others) outside of the instructions for use. The technical success rate was 95%. The cardiovascular mortality rate was 7% at 30 day and 17% at 1 year (all-cause mortality rates were 9% and 29%, respectively). Reintervention or surgery following discharge was 4%, while rates of heart failure hospitalization reduced from 68% in the preceding year to 25% during 1-year follow-up. Durable MR reduction to ≤1+ was achieved in 98% of patients, and at 1 year, 83% were in NYHA functional class I or II. There was no difference in survival and major adverse events between on-label use and "real-world" indications up to 1 year. CONCLUSIONS This large, real-world, observational registry reports high technical success, durable and complete MR elimination, significant clinical benefits, and a 1-year cardiovascular mortality rate of 17% after Tendyne TMVR. Outcomes were comparable between on-label use and "real-world" indications, offering a safe and efficacious treatment option for patients without alternative treatments. (Tendyne European Experience Registry [TENDER]; NCT04898335).
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Affiliation(s)
- Michaela M Hell
- Department of Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Mirjam G Wild
- Medizinische Klinik I, LMU University Hospital, Munich, Germany
| | - Stephan Baldus
- Department of Cardiology, Heart Center, University Hospital Cologne, Cologne, Germany
| | - Tanja Rudolph
- Department of Cardiology, Heart- und Diabetes Center Northrhine-Westfalia, Bad Oeynhausen, Ruhr-University Bochum, Bochum, Germany
| | - Hendrik Treede
- Department of Cardiovascular Surgery, Universitätsmedizin Mainz of the Johannes Gutenberg University, Mainz, Germany
| | | | - Thomas Modine
- CHU Bordeaux, Hopital Cardiologique Haut Leveque, Pessac, France
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Augustin Coisne
- Université de Lille, Inserm, CHU Lille, Institut Pasteur de Lille, Lille, France
| | - Alison Duncan
- Heart Division, Royal Brompton Hospital, London, United Kingdom
| | - Luis Nombela Franco
- Cardiovascular Institute, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria, San Carlos (IdISSC), Madrid, Spain
| | - Fabien Praz
- Department of Cardiology, Inselspital University Hospital Bern, Bern, Switzerland
| | - Hendrik Ruge
- Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, School of Medicine & Health, Technical University of Munich, Munich, Germany
| | - Lenard Conradi
- University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Andreas Zierer
- Department for Cardiac, Vascular, and Thoracic Surgery, Johannes Kepler University Linz, Kepler University Hospital, Linz, Austria
| | - Amedeo Anselmi
- Division of Thoracic and Cardiovascular Surgery, University Hospital of Rennes, University of Rennes, Rennes, France
| | - Nicolas Dumonteil
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | | | - Miguel Piñón
- Servicio Cirugía Cardíaca. Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Sebastian Barth
- Klinik für Kardiologie, Rhön-Klinikum Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
| | - Marianna Adamo
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Christophe Dubois
- Department of Cardiovascular Medicine, University Hospital Leuven and Department of Cardiovascular Sciences, Leuven, Belgium
| | - Lucia Torracca
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Francesco Maisano
- Valve Center, IRCCS Ospedale San Raaffaele and University Vita Salute, Milan, Italy
| | - Philipp Lurz
- Department of Cardiology, University Medical Center Mainz, Mainz, Germany; Department of Cardiology, Heart Center Leipzig, Leipzig, Germany
| | | | - Jörg Hausleiter
- Medizinische Klinik I, LMU University Hospital, Munich, Germany; German Center for Cardiovascular Research, partner site Munich Heart Alliance, Munich, Germany
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Wolf EV, Halfmann MC, Varga-Szemes A, Fink N, Kloeckner R, Bockius S, Allmendinger T, Hagenauer J, Koehler T, Kreitner KF, Schoepf UJ, Münzel T, Düber C, Gori T, Yang Y, Hell MM, Emrich T. Photon-Counting Detector CT Virtual Monoenergetic Images for Coronary Artery Stenosis Quantification: Phantom and In Vivo Evaluation. AJR Am J Roentgenol 2024; 222:e2330481. [PMID: 38197760 DOI: 10.2214/ajr.23.30481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND. Calcium blooming causes stenosis overestimation on coronary CTA. OBJECTIVE. The purpose of this article was to evaluate the impact of virtual monoenergetic imaging (VMI) reconstruction level on coronary artery stenosis quantification using photon-counting detector (PCD) CT. METHODS. A phantom containing two custom-made vessels (representing 25% and 50% stenosis) underwent PCD CT acquisitions without and with simulated cardiac motion. A retrospective analysis was performed of 33 patients (seven women, 26 men; mean age, 71.3 ± 9.0 [SD] years; 64 coronary artery stenoses) who underwent coronary CTA by PCD CT followed by invasive coronary angiography (ICA). Scans were reconstructed at nine VMI energy levels (40-140 keV). Percentage diameter stenosis (PDS) was measured, and bias was determined from the ground-truth stenosis percentage in the phantom and ICA-derived quantitative coronary angiography measurements in patients. Extent of blooming artifact was measured in the phantom and in calcified and mixed plaques in patients. RESULTS. In the phantom, PDS decreased for 25% stenosis from 59.9% (40 keV) to 13.4% (140 keV) and for 50% stenosis from 81.6% (40 keV) to 42.3% (140 keV). PDS showed lowest bias for 25% stenosis at 90 keV (bias, 1.4%) and for 50% stenosis at 100 keV (bias, -0.4%). Blooming artifacts decreased for 25% stenosis from 61.5% (40 keV) to 35.4% (140 keV) and for 50% stenosis from 82.7% (40 keV) to 52.1% (140 keV). In patients, PDS for calcified plaque decreased from 70.8% (40 keV) to 57.3% (140 keV), for mixed plaque decreased from 69.8% (40 keV) to 56.3% (140 keV), and for noncalcified plaque was 46.6% at 40 keV and 54.6% at 140 keV. PDS showed lowest bias for calcified plaque at 100 keV (bias, 17.2%), for mixed plaque at 140 keV (bias, 5.0%), and for noncalcified plaque at 40 keV (bias, -0.5%). Blooming artifacts decreased for calcified plaque from 78.4% (40 keV) to 48.6% (140 keV) and for mixed plaque from 73.1% (40 keV) to 44.7% (140 keV). CONCLUSION. For calcified and mixed plaque, stenosis severity measurements and blooming artifacts decreased at increasing VMI reconstruction levels. CLINICAL IMPACT. PCD CT with VMI reconstruction helps overcome current limitations in stenosis quantification on coronary CTA.
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Affiliation(s)
- Elias V Wolf
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstraβe 1, 55131 Mainz, Germany
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - Moritz C Halfmann
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstraβe 1, 55131 Mainz, Germany
- German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany
| | - Akos Varga-Szemes
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - Nicola Fink
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
- Department of Radiology, University Hospital, LMU Munich, München, Germany
| | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstraβe 1, 55131 Mainz, Germany
- Department for Interventional Radiology, University Hospital of Lübeck, Lübeck, Germany
| | - Stefanie Bockius
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstraβe 1, 55131 Mainz, Germany
| | | | | | | | - Karl-Friedrich Kreitner
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstraβe 1, 55131 Mainz, Germany
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - Thomas Münzel
- German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Christoph Düber
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstraβe 1, 55131 Mainz, Germany
| | - Tommaso Gori
- German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Yang Yang
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstraβe 1, 55131 Mainz, Germany
| | - Michaela M Hell
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Tilman Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstraβe 1, 55131 Mainz, Germany
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
- German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany
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Hell MM, Emrich T, Lurz P, von Bardeleben RS, Schmermund A. Cardiac CT Beyond Coronaries: Focus on Structural Heart Disease. Curr Heart Fail Rep 2023; 20:484-492. [PMID: 38019324 PMCID: PMC10746749 DOI: 10.1007/s11897-023-00635-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 11/30/2023]
Abstract
PURPOSE OF REVIEW Cardiac computed tomography (CT) is an established non-invasive imaging tool for the assessment of coronary artery disease. Furthermore, it plays a key role in the preinterventional work-up of patients presenting with structural heart disease. RECENT FINDINGS CT is the gold standard for preprocedural annular assessment, device sizing, risk determination of annular injury, coronary occlusion or left ventricular outflow tract obstruction, calcification visualization and quantification of the target structure, and prediction of a co-planar fluoroscopic angulation for transcatheter interventions in patients with structural heart disease. It is further a key imaging modality in postprocedural assessment for prosthesis thrombosis, degeneration, or endocarditis. CT plays an integral part in the imaging work-up of novel transcatheter therapies for structural heart disease and postprocedural assessment for prosthesis thrombosis or endocarditis. This review provides a comprehensive overview of the key role of CT in the context of structural heart interventions.
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Affiliation(s)
- Michaela M Hell
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany.
| | - Tilman Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany
| | - Philipp Lurz
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany
| | | | - Axel Schmermund
- Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Germany
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4
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Wolf EV, Halfmann MC, Schoepf UJ, Zsarnoczay E, Fink N, Griffith JP, Aquino GJ, Willemink MJ, O’Doherty J, Hell MM, Suranyi P, Kabakus IM, Baruah D, Varga-Szemes A, Emrich T. Intra-individual comparison of coronary calcium scoring between photon counting detector- and energy integrating detector-CT: Effects on risk reclassification. Front Cardiovasc Med 2023; 9:1053398. [PMID: 36741832 PMCID: PMC9892711 DOI: 10.3389/fcvm.2022.1053398] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 12/28/2022] [Indexed: 01/20/2023] Open
Abstract
Purpose To compare coronary artery calcium volume and score (CACS) between photon-counting detector (PCD) and conventional energy integrating detector (EID) computed tomography (CT) in a phantom and prospective patient study. Methods A commercially available CACS phantom was scanned with a standard CACS protocol (120 kVp, slice thickness/increment 3/1.5 mm, and a quantitative Qr36 kernel), with filtered back projection on the EID-CT, and with monoenergetic reconstruction at 70 keV and quantum iterative reconstruction off on the PCD-CT. The same settings were used to prospectively acquire data in patients (n = 23, 65 ± 12.1 years), who underwent PCD- and EID-CT scans with a median of 5.5 (3.0-12.5) days between the two scans in the period from August 2021 to March 2022. CACS was quantified using a commercially available software solution. A regression formula was obtained from the aforementioned comparison and applied to simulate risk reclassification in a pre-existing cohort of 514 patients who underwent a cardiac EID-CT between January and December 2021. Results Based on the phantom experiment, CACS PCD-CT showed a more accurate measurement of the reference CAC volumes (overestimation of physical volumes: PCD-CT 66.1 ± 1.6% vs. EID-CT: 77.2 ± 0.5%). CACS EID-CT and CACS PCD-CT were strongly correlated, however, the latter measured significantly lower values in the phantom (CACS PCD-CT : 60.5 (30.2-170.3) vs CACS EID-CT 74.7 (34.6-180.8), p = 0.0015, r = 0.99, mean bias -9.7, Limits of Agreement (LoA) -36.6/17.3) and in patients (non-significant) (CACS PCD-CT : 174.3 (11.1-872.7) vs CACS EID-CT 218.2 (18.5-876.4), p = 0.10, r = 0.94, mean bias -41.1, LoA -315.3/232.5). The systematic lower measurements of Agatston score on PCD-CT system led to reclassification of 5.25% of our simulated patient cohort to a lower classification class. Conclusion CACS PCD-CT is feasible and correlates strongly with CACS EID-CT , however, leads to lower CACS values. PCD-CT may provide results that are more accurate for CACS than EID-CT.
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Affiliation(s)
- Elias V. Wolf
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany,Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Moritz C. Halfmann
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany,German Centre for Cardiovascular Research, Partner Site Rhine-Main, Mainz, Germany
| | - U. Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Emese Zsarnoczay
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States,MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Center, Semmelweis University, Budapest, Hungary
| | - Nicola Fink
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States,Department of Radiology, University Hospital Munich, LMU Munich, Munich, Germany
| | - Joseph P. Griffith
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Gilberto J. Aquino
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Martin J. Willemink
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, United States,Segmed, Inc., Palo Alto, CA, United States
| | - Jim O’Doherty
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States,Siemens Medical Solutions USA, Inc., Malvern, PA, United States
| | - Michaela M. Hell
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Pal Suranyi
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Ismael M. Kabakus
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Dhiraj Baruah
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Tilman Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany,Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States,German Centre for Cardiovascular Research, Partner Site Rhine-Main, Mainz, Germany,*Correspondence: Tilman Emrich,
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5
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Wild MG, Kreidel F, Hell MM, Praz F, Mach M, Adam M, Reineke D, Ruge H, Ludwig S, Conradi L, Rudolph TK, Bleiziffer S, Kellermair J, Zierer A, Nickenig G, Weber M, Petronio AS, Giannini C, Dahle G, Rein KA, Coisne A, Vincentelli A, Dubois C, Duncan A, Quarto C, Unbehaun A, Amat‐Santos I, Cobiella J, Dumonteil N, Estevez‐Loureiro R, Fumero A, Geisler T, Lurz P, Mangieri A, Monivas V, Noack T, Nombela Franco L, Pinon MA, Stolz L, Tchétché D, Walter T, Unsöld B, Baldus S, Andreas M, Hausleiter J, Bardeleben RS. Transapical mitral valve implantation for treatment of symptomatic mitral valve disease: a real‐world multicentre experience. Eur J Heart Fail 2022; 24:899-907. [DOI: 10.1002/ejhf.2434] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/27/2021] [Accepted: 01/10/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Mirjam G. Wild
- Medizinische Klinik I LMU University Hospital Munich Germany
- Department of Cardiology Inselspital University Hospital Bern Bern Switzerland
| | - Felix Kreidel
- Department of Cardiology University Medical Center Mainz Mainz Germany
| | - Michaela M. Hell
- Department of Cardiology University Medical Center Mainz Mainz Germany
| | - Fabien Praz
- Department of Cardiology Inselspital University Hospital Bern Bern Switzerland
| | - Markus Mach
- Department of Cardiac Surgery Medical University of Vienna Vienna Vienna Austria
| | - Matti Adam
- Department of Cardiology University Hospital Cologne Cologne Germany
| | - David Reineke
- Department of Cardiac Surgery Inselspital University Hospital Bern Bern Switzerland
| | - Hendrik Ruge
- Department of Cardiovascular Surgery German Heart Center, Munich, Technical University Munich Germany
| | - Sebastian Ludwig
- Department of Cardiology University Hospital Hamburg Hamburg Germany
| | - Leonard Conradi
- Department of Cardiology University Hospital Hamburg Hamburg Germany
| | - Tanja K. Rudolph
- Department of Cardiology Heart‐ und Diabetes Center Nordrhine‐Westfalia, Bad Oeynhausen, Ruhr‐University Bochum Germany
| | - Sabine Bleiziffer
- Department of Cardiology Heart‐ und Diabetes Center Nordrhine‐Westfalia, Bad Oeynhausen, Ruhr‐University Bochum Germany
| | - Jörg Kellermair
- Department of Cardiology Kepler University Hospital Linz Austria
| | - Andreas Zierer
- Department of Cardiology Kepler University Hospital Linz Austria
| | - Georg Nickenig
- Department of Cardiac Surgery University Hospital Bonn Bonn Germany
| | - Marcel Weber
- Department of Cardiology University Hospital Bonn Bonn Germany
| | | | | | - Gry Dahle
- Department of Cardiothoracic surgery Oslo University Hospital Oslo Norway
| | - Kjell A. Rein
- Department of Cardiothoracic surgery Oslo University Hospital Oslo Norway
| | - Augustin Coisne
- Université Lille, Inserm, CHU Lille, Institut Pasteur de Lille U1011‐ EGID Lille France
| | - André Vincentelli
- Université Lille, Inserm, CHU Lille, Institut Pasteur de Lille U1011‐ EGID Lille France
| | - Christophe Dubois
- Department of cardiovascular medicine acute and interventional cardiology, UZ Leuven Leuven Belgium
| | - Alison Duncan
- Department of Cardiology Royal Brompton Hospital London United Kingdom
| | - Cesare Quarto
- Department of Cardiac Surgery Royal Brompton Hospital London United Kingdom
| | - Axel Unbehaun
- Department of Cardiac Surgery German Heart Center Berlin Germany
| | - Ignacio Amat‐Santos
- Department of Cardiology CIBER‐CV, University Clinic Hospital Valladolid Valladolid Spain
| | - Javier Cobiella
- Department of Cardiology Hospital Clínico San Carlos Madrid Spain
| | | | | | - Andrea Fumero
- Department of Biomedical Sciences Humanitas University, Pieve Emanuele‐Milan, Italy; Humanitas Research Hospital IRCCS Rozzano‐Milan Italy
| | - Tobias Geisler
- Department of Cardiology University Hospital Tuebingen Tuebingen Germany
| | - Philipp Lurz
- Department of Cardiology Heart Center Leipzig Leipzig Germany
| | - Antonio Mangieri
- Department of Biomedical Sciences Humanitas University, Pieve Emanuele‐Milan, Italy; Humanitas Research Hospital IRCCS Rozzano‐Milan Italy
| | - Vanessa Monivas
- Department of Cardiology Puerta de Hierro Hospital Madrid Spain
| | - Thilo Noack
- University Department of Cardiac Surgery Heart Center Leipzig Leipzig Germany
| | | | - Miguel A. Pinon
- Department of Cardiology University Hospital Alvaro Cunqueiro Vigo Spain
| | - Lukas Stolz
- Medizinische Klinik I LMU University Hospital Munich Germany
| | | | - Thomas Walter
- Department of Cardiac Surgery University Hospital Frankfurt Frankfurt Germany
| | - Bernhard Unsöld
- Department of Internal Medicine II University Hospital Regensburg Regensburg Germany
| | - Stephan Baldus
- Department of Cardiology University Hospital Cologne Cologne Germany
| | - Martin Andreas
- Department of Cardiac Surgery Medical University of Vienna Vienna Vienna Austria
| | - Jörg Hausleiter
- Medizinische Klinik I LMU University Hospital Munich Germany
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Geyer M, Keller K, Tamm AR, Born S, Bachmann K, Ruf TF, Kreidel F, Hahad O, Petrescu A, Schnitzler K, Schmitt VH, da Rocha E Silva JG, Hell MM, Schulz E, Münzel T, von Bardeleben RS. Early symptomatic benefit indicates long-term prognosis after transcatheter mitral valve edge-to-edge repair in functional and degenerative etiology. Int J Cardiol 2021; 344:141-146. [PMID: 34563598 DOI: 10.1016/j.ijcard.2021.09.038] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/04/2021] [Accepted: 09/17/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Mitral regurgitation (MR) is common in patients with heart failure and constitutes an independent risk factor for adverse prognosis besides NYHA-class. The predictive value of dyspnea reduction after transcatheter mitral valve repair (TMVr) on outcome has not been investigated up to now. METHODS AND RESULTS We enrolled 627 consecutive patients (47.0% female, 57.4% functional MR; median follow-up 486 days[IQR 157/961]; survival status available in 96.8%; symptoms assessed in n = 556 at baseline / n = 406 at 1 month) treated with isolated percutaneous mitral valve edge-to-edge repair in our center from 06/2010-03/2018 (exclusion of combined forms of TMVr) in a monocentric retrospective analysis. Survival was 97.6% at discharge, 73.9% after 1, 54.5% after 3, 37.6% after 5 and 21.7% after 7-years. Before TMVr, NYHA-classes III/IV were found in 89.0%. Of these, 74.7% reported symptomatic relief (reduction in NYHA-class) one month after procedure (NYHA class recorded in 406 patients at 30 days). NYHA-classes III/IV were documented in 37.2% (p < 0.001) at 30 days and in 36.6% (p < 0.001) at 1 year without significant changes between the follow-ups. Dyspnea reduction was accompanied by significantly improved long-term survival (1 year, 89.1 vs 71.2%, p = 0.001, 2 years: 75.5 vs 58.7%, p = 0.039) and was identified as an independent predictor for lower mortality (1-year HR for increased mortality by missing symptomatic improvement 2.94 [95%CI 1.53-5.65], p = 0.001; long-term HR 1.95 [95%CI 1.29-2.94], p = 0.001) independently in both etiologies of MR. CONCLUSION TMVr by edge-to-edge therapy enables early and sustainable symptomatic improvement in nearly 75% of the symptomatic patients. The simple assessment of postinterventional changes in NYHA-class might serve as an independent predictor for mid- and long-term prognosis in both FMR and DMR.
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Affiliation(s)
- Martin Geyer
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.
| | - Karsten Keller
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Medical Clinic VII, Department of Sports Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Alexander R Tamm
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Sonja Born
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Kevin Bachmann
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Tobias Friedrich Ruf
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Felix Kreidel
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Omar Hahad
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Germany
| | - Aniela Petrescu
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Katharina Schnitzler
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Volker H Schmitt
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | | | - Michaela M Hell
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Eberhard Schulz
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Germany
| | - Ralph Stephan von Bardeleben
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.
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7
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da Rocha E Silva JG, Ruf TF, Hell MM, Tamm A, Geyer M, Munzel T, von Bardeleben RS, Kreidel F. Transgastric imaging-The key to successful periprocedural TEE guiding for edge-to-edge repair of the tricuspid valve. Echocardiography 2021; 38:1948-1958. [PMID: 34729813 DOI: 10.1111/echo.15196] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/11/2021] [Accepted: 08/22/2021] [Indexed: 11/28/2022] Open
Abstract
Intraprocedural transesophageal echocardiography (TEE) guidance plays an essential role in transcatheter repair therapy of the tricuspid valve (TV). So far, several different imaging concepts are in use. We propose an imaging protocol that fully addresses the morphological complexity of the TV and further offers efficacious workarounds for the frequently occurring restrictions of TV imaging in edge-to-edge repair of the TV. As a tertiary referral center with a large experience of more than 250 cases of transcatheter edge-to-edge repair (TEER) of the TV performed at the Heart Valve Center in Mainz/Germany, we have constantly adapted our peri-interventional echocardiographic approach to accomplish both. As a key measure for success, we intensely rely on the transgastric acoustic windows that not only deliver high-resolution information on the morphology of the TV and all relevant procedural steps but also help to avoid the frequent shadowing artifacts experienced in transesophageal imaging.
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Affiliation(s)
| | - Tobias F Ruf
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany
| | - Michaela M Hell
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany
| | - Alexander Tamm
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany
| | - Martin Geyer
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany
| | - Thomas Munzel
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany
| | | | - Felix Kreidel
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany
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8
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Geyer M, Schmitt VH, Keller K, Born S, Bachmann K, Schnitzler K, Hell MM, Tamm AR, Ruf TF, Kreidel F, Petrescu A, Da Rocha E Silva JG, Schulz E, Munzel T, Von Bardeleben RS. Impact of diabetes mellitus on long-term survival after transcatheter mitral valve edge-to-edge repair. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Diabetes mellitus (DM) represents a notable risk factor after surgical and interventional procedures but data on the influence of DM on long-term survival after Transcatheter Edge-to-edge Repair (TEER) for Mitral valve Regurgitation (MR) are sparse.
Purpose
To compare the outcome of patients with and without DM after TEER.
Methods
Retrospective monocentric assessment of patients after successful treatment of MR by TEER (exclusion of combined forms of transcatheter repair) between 06/2010 and 03/2018. Patients were stratified for DM at baseline and observed regarding mortality during follow-up. Cox regression analyses were performed for survival analyses.
Results
627 patients (47.0% females, 88.2% aged ≥70 years) and among these 174 subjects with DM (27.3%) were included with a median follow-up period of 486 days [IQR 157–916 days]). Within the investigation period, 20 patients (3.2%) were lost to follow-up. Patients with DM more often presented severe comorbidities like obesity (27.3% vs. 9.2%, p<0.001), arterial hypertension (91.4% vs. 83.7%, p=0.013), renal insufficiency (63.8% vs. 43.9%, p<0.001), coronary artery disease (77.0% vs. 59.8%, p<0.001) or peripheral artery disease (14.4% vs. 8.4%, p=0.026) and had a higher median logistic Euroscore I (29.4% [20.0/43.0] vs. 25.0% [16.7/36.6], p=0.001) as well as reduced systolic function (LVEF 35% [30/50] vs. 45% [30/55], p<0.001). No statistical differences in short- and long-term survival were detected between patients with and without DM (in-hospital mortality 1.7 vs. 2.6%, p=0.771; at 30-days 5.0 vs. 6.0%, p=0.842, 1-year 28.7 vs. 25.0%, p=0.419, 3-years 49.2 vs. 44.1%, p=0.554, 5-years 69.0 vs. 68.3%, p=0.497). By calculating cox regression analyses, DM was not predictive for a higher mortality, even after adjustment for other risk factors (HR 1-year 1.17 [95% CI 0.80–1.71], p=0.419; HR long-term 1.13 [95% CI 0.86–1.49], p=0.373) in the total cohort, as well as after stratification for the underlying mitral valve pathology (functional MR: 1-year HR 0.99 [95% CI 0.01–1.62], p=0.969, long-term HR 0.903 [95% CI 0.63–1.29, p=0.571; primary MR: 1-year HR 1.48 [95% CI 0.66–3.35, p=0.344, long-term HR1.66 [95% CI 0.89–3.09], p=0.110).
Conclusions
Even though DM-patients presented with a more vulnerable clinical profile, no relevant differences in short- and long-term mortality after TEER for MR were found. Although being factored in most common risk scores, DM could not be associated with an adverse prognosis after transcatheter therapy of MR.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Geyer
- University Medical Center Mainz, Mainz, Germany
| | - V H Schmitt
- University Medical Center Mainz, Mainz, Germany
| | - K Keller
- University Medical Center Mainz, Mainz, Germany
| | - S Born
- University Medical Center Mainz, Mainz, Germany
| | - K Bachmann
- University Medical Center Mainz, Mainz, Germany
| | | | - M M Hell
- University Medical Center Mainz, Mainz, Germany
| | - A R Tamm
- University Medical Center Mainz, Mainz, Germany
| | - T F Ruf
- University Medical Center Mainz, Mainz, Germany
| | - F Kreidel
- University Medical Center Mainz, Mainz, Germany
| | - A Petrescu
- University Medical Center Mainz, Mainz, Germany
| | | | - E Schulz
- General Hospital of Celle, Celle, Germany
| | - T Munzel
- University Medical Center Mainz, Mainz, Germany
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9
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Nous FMA, Geisler T, Kruk MBP, Alkadhi H, Kitagawa K, Vliegenthart R, Hell MM, Hausleiter J, Nguyen PK, Budde RPJ, Nikolaou K, Kepka C, Manka R, Sakuma H, Malik SB, Coenen A, Zijlstra F, Klotz E, van der Harst P, Artzner C, Dedic A, Pugliese F, Bamberg F, Nieman K. Dynamic Myocardial Perfusion CT for the Detection of Hemodynamically Significant Coronary Artery Disease. JACC Cardiovasc Imaging 2021; 15:75-87. [PMID: 34538630 PMCID: PMC8741746 DOI: 10.1016/j.jcmg.2021.07.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/14/2021] [Accepted: 07/21/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES In this international, multicenter study, using third-generation dual-source computed tomography (CT), we investigated the diagnostic performance of dynamic stress CT myocardial perfusion imaging (CT-MPI) in addition to coronary CT angiography (CTA) compared to invasive coronary angiography (ICA) and invasive fractional flow reserve (FFR). BACKGROUND CT-MPI combined with coronary CTA integrates coronary artery anatomy with inducible myocardial ischemia, showing promising results for the diagnosis of hemodynamically significant coronary artery disease in single-center studies. METHODS At 9 centers in Europe, Japan, and the United States, 132 patients scheduled for ICA were enrolled; 114 patients successfully completed coronary CTA, adenosine-stress dynamic CT-MPI, and ICA. Invasive FFR was performed in vessels with 25% to 90% stenosis. Data were analyzed by independent core laboratories. For the primary analysis, for each coronary artery the presence of hemodynamically significant obstruction was interpreted by coronary CTA with CT-MPI compared to coronary CTA alone, using an FFR of ≤0.80 and angiographic severity as reference. Territorial absolute myocardial blood flow (MBF) and relative MBF were compared using C-statistics. RESULTS ICA and FFR identified hemodynamically significant stenoses in 74 of 289 coronary vessels (26%). Coronary CTA with ≥50% stenosis demonstrated a per-vessel sensitivity, specificity, and accuracy for the detection of hemodynamically significant stenosis of 96% (95% CI: 91–100), 72% (95% CI: 66–78), and 78% (95% CI: 73–83), respectively. Coronary CTA with CT-MPI showed a lower sensitivity (84%; 95% CI: 75–92) but higher specificity (89%; 95% CI: 85–93) and accuracy (88%; 95% CI: 84–92). The areas under the receiver-operating characteristic curve of absolute MBF and relative MBF were 0.79 (95% CI: 0.71–0.86) and 0.82 (95% CI: 0.74–0.88), respectively. The median dose-length product of CT-MPI and coronary CTA were 313 mGy·cm and 138 mGy·cm, respectively. CONCLUSIONS Dynamic CT-MPI offers incremental diagnostic value over coronary CTA alone for the identification of hemodynamically significant coronary artery disease. Generalized results from this multicenter study encourage broader consideration of dynamic CT-MPI in clinical practice. (Dynamic Stress Perfusion CT for Detection of Inducible Myocardial Ischemia [SPECIFIC]; NCT02810795)
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Affiliation(s)
- Fay M A Nous
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Cardiology, Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Tobias Geisler
- Department of Cardiology, University of Tuebingen, Tuebingen, Germany
| | - Mariusz B P Kruk
- Coronary Disease and Structural Heart Diseases Department, Institute of Cardiology, Warsaw, Poland
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Kakuya Kitagawa
- Department of Advanced Diagnostic Imaging, Mie University Graduate School of Medicine, Tsu, Japan
| | - Rozemarijn Vliegenthart
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Michaela M Hell
- Department of Cardiology, Faculty of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Jörg Hausleiter
- Department of Cardiology, Ludwig-Maximilians University, Munich, Germany
| | - Patricia K Nguyen
- Veterans Affairs Palo Alto Healthcare System, Cardiology Section, Palo Alto, California, USA; Stanford University, Division of Cardiovascular Medicine, Stanford, California, USA; Stanford Cardiovascular Institute, Stanford, California, USA
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Cardiology, Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Cezary Kepka
- Coronary Disease and Structural Heart Diseases Department, Institute of Cardiology, Warsaw, Poland
| | - Robert Manka
- Department of Cardiology, University Heart Center and Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Hajime Sakuma
- Department of Radiology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Sachin B Malik
- Veterans Affairs Palo Alto Healthcare System, Thoracic and Cardiovascular Imaging Section, Palo Alto, California, USA; Stanford University, Division of Cardiovascular Imaging (Affiliated), Stanford, California, USA
| | - Adriaan Coenen
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Cardiology, Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Felix Zijlstra
- Department of Cardiology, Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Pim van der Harst
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Christoph Artzner
- Department of Cardiology, University of Tuebingen, Tuebingen, Germany
| | - Admir Dedic
- Department of Cardiology, Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Francesca Pugliese
- Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts National Institute for Health Research Biomedical Research Centre, Queen Mary University of London, London, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, Barts Health National Health Service Trust, West Smithfield, London, United Kingdom
| | - Fabian Bamberg
- Department of Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Koen Nieman
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Cardiology, Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; Stanford University School of Medicine and Cardiovascular Institute, Stanford, California, USA.
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10
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Hell MM, Emrich T, Kreidel F, Kreitner KF, Schoepf UJ, Münzel T, von Bardeleben RS. Computed tomography imaging needs for novel transcatheter tricuspid valve repair and replacement therapies. Eur Heart J Cardiovasc Imaging 2021; 22:601-610. [PMID: 33247897 DOI: 10.1093/ehjci/jeaa308] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 08/27/2020] [Accepted: 10/30/2020] [Indexed: 01/03/2023] Open
Abstract
Transcatheter tricuspid valve therapies are an emerging field in structural heart interventions due to the rising number of patients with severe tricuspid regurgitation and the high risk for surgical treatment. Computed tomography (CT) allows exact measurements of the annular plane, evaluation of adjacent structures, assessment of the access route, and can also be used to identify optimal fluoroscopic projection planes to enhance periprocedural imaging. This review provides an overview of current transcatheter tricuspid valve repair and replacement therapies and to what extent CT can support these interventions.
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Affiliation(s)
- Michaela M Hell
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Tilman Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany.,Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Felix Kreidel
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Karl-Friedrich Kreitner
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Thomas Münzel
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Ralph Stephan von Bardeleben
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Langenbeckstraße 1, 55131 Mainz, Germany
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11
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Hell MM, Steinmann B, Scherkamp T, Arnold MB, Achenbach S, Marwan M. Analysis of left ventricular function, left ventricular outflow tract and aortic valve area using computed tomography: Influence of reconstruction parameters on measurement accuracy. Br J Radiol 2021; 94:20201306. [PMID: 34233477 PMCID: PMC8523190 DOI: 10.1259/bjr.20201306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objectives: Computed tomography (CT) allows reproducible assessment of left ventricular (LV) function, left ventricular outflow tract area (LVOTarea) and aortic valve area (AVA). We evaluated the influence of image reconstruction parameters on these measurements. Methods: We analyzed 45 contrast-enhanced, retrospectively ECG-gated CT datasets acquired on a third-generation dual source system. A standard filtered-back-projection data set (20 cardiac phases (5% steps, 0–95%), 0.6-mm-slice thickness, 512 × 512 matrix) and eight reconstructions with modified slice thickness (1–8 mm), number of cardiac phases (5, 10), matrix size (256×256) and an iterative reconstruction (IR) algorithm were obtained. LV parameters (ejection fraction (EF), stroke volume (SV), end-diastolic (EDV), end-systolic volumes (ESV)), LVOTarea and AVA were assessed. Results: Differences in LV parameters, LVOTarea and AVA, were only minimal between standard reconstructions and those with modified matrix size, IR algorithm and ≤2 mm slice thickness, while reconstructions with 8-mm slice thickness significantly overestimated SV (p < 0.001) and EDV (p = 0.016). AVA planimetry in reconstructions with ≥5 mm slice thickness was not feasible in 56% of patients. A decrease in the number of reconstructed phases (10 or 5) underestimated EF, SV, EDV, LVOTarea and AVA and overestimated ESV. Conclusions: Modifications of reconstruction parameters (except a slice thickness ≤2 mm) have only a marginal effect on LV, LVOTarea and AVA assessment. However, a reduced number of reconstructions per cardiac cycle may significantly influence measurements. Advances in knowledge: Substantial modifications in number of reconstructions per cardiac cycle significantly affect the assessment of LV function, LVOTarea and AVA also in modern CT scanners.
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Affiliation(s)
- Michaela M Hell
- Department of Cardiology, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany.,Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany
| | - Bettine Steinmann
- Department of Cardiology, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Tassilo Scherkamp
- Department of Cardiology, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Martin B Arnold
- Department of Cardiology, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Mohamed Marwan
- Department of Cardiology, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
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12
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Tamm AR, Hell MM, Geyer M, Kreidel F, da Rocha E Silva JG, Seidl M, Ruf TF, Kornberger A, Beiras-Fernandez A, Münzel T, von Bardeleben RS. Minimizing Paravalvular Regurgitation With the Novel SAPIEN 3 Ultra TAVR Prosthesis: A Real-World Comparison Study. Front Cardiovasc Med 2021; 8:623146. [PMID: 33816574 PMCID: PMC8015438 DOI: 10.3389/fcvm.2021.623146] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/25/2021] [Indexed: 12/15/2022] Open
Abstract
Objectives: We investigated performance and outcome of the latest-generation balloon-expandable SAPIEN 3 Ultra prosthesis (S3U) compared to the established SAPIEN 3 prosthesis (S3) in a real-world cohort, with focus on paravalvular regurgitation (PVR). Background: PVR is an adverse prognostic indicator of short- and long-term survival after transcatheter aortic valve replacement (TAVR). The S3U has been designed to improve sealing. Methods: We enrolled 343 consecutive patients presenting with severe native aortic valve stenosis eligible for a balloon-expandable prosthesis. The established S3 was implanted in the first 200 patients, the following 143 patients received the novel S3U after introduction in our institution. Primary endpoint was PVR after TAVR. Furthermore, we investigated procedural parameters and in-hospital and 30-day outcome. Results: PVR was significantly lower in the S3U cohort compared to the S3 cohort. They differed in their rate of mild PVR (11.2 vs. 48.0%, p < 0.001), whereas at least moderate PVR was similarly low in both cohorts (0.7 vs. 0.5%, p = 0.811). A significant reduction of post-dilatation rate, fluoroscopy time, and amount of contrast was observed in patients treated with the novel S3U (p < 0.001). The rate of adverse events in the in-hospital course and at 30 days were similarly low. At 30 days more patients receiving S3U improved in NYHA class (improvement ≥2 grades 34.6 vs. 19.9%, p = 0.003). Conclusion: The current study provides evidence that the novel S3U strongly minimizes PVR, thereby demonstrating the efficacy of improved sealing. Further studies will have to address if the observed reduction of PVR with S3U has prognostic significance.
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Affiliation(s)
- Alexander R Tamm
- Center of Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Michaela M Hell
- Center of Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Martin Geyer
- Center of Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Felix Kreidel
- Center of Cardiology, University Medical Center Mainz, Mainz, Germany
| | | | - Meike Seidl
- Center of Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Tobias F Ruf
- Center of Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Angela Kornberger
- Department of Cardiac and Vascular Surgery, University Medical Center Mainz, Mainz, Germany
| | | | - Thomas Münzel
- Center of Cardiology, University Medical Center Mainz, Mainz, Germany
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13
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Hell MM, Schlundt C, Bittner D, Marwan M, Achenbach S. Determination of optimal fluoroscopic angulations for aorto-coronary ostial interventions from coronary computed tomography angiography. J Cardiovasc Comput Tomogr 2020; 15:366-371. [PMID: 33349564 DOI: 10.1016/j.jcct.2020.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 09/17/2020] [Revised: 11/20/2020] [Accepted: 12/08/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND An optimal aorto-coronary angiographic projection, characterized by an orthogonal visualization of the proximal coronary artery, is crucial for interventional success. We determined the distribution of optimal C-arm positions and assessed their feasibility by invasive coronary angiography. METHODS Orthogonal aorto-coronary ostial angulations were determined in 310 CT data sets. In 100 patients undergoing subsequent invasive angiography, we assessed if the CT-predicted angulations were achievable by the C-arm system. If the predicted projection was not achievable due to mechanical constraints of the C-arm system, the most close, achievable angulation was determined. Patient characteristics were analyzed regarding the distribution of optimal angulations and its feasibility by the C-arm system. RESULTS For the left ostium, CT revealed a mean angulation of LAO 23 ± 21°/cranial 25 ± 23° (90% of patients with a LAO/cranial angulation, 3% LAO/caudal, 4% RAO/cranial, 3% RAO/caudal) and were achievable by the C-arm system in 87% of patients. For the right ostium, the mean CT-predicted orthogonal angulation was LAO 36 ± 37°/cranial 36 ± 51° (84% LAO/cranial, 2% LAO/caudal, 14% RAO/caudal) and achievable by the C-arm system in 45% of patients. For the left ostium, a higher body weight was associated with a steeper LAO/cranial angulation being less feasible by the C-arm system due to mechanical constraints. CONCLUSIONS Orthogonal aorto-left coronary angulations show a relative narrow distribution predominately in LAO/cranial position whereas a wider range of angulations was found for the right coronary ostium. The feasibility of CT-predicted angulations by the C-arm system is more restricted for the right than the left coronary ostium.
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Affiliation(s)
- Michaela M Hell
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany; Department of Cardiology, University Medical Center Mainz, Johannes-Gutenberg University Mainz, Mainz, Germany.
| | - Christian Schlundt
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Daniel Bittner
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Mohamed Marwan
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
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14
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Hell MM, Francis JM, d'Arcy J, Robson MD, Neubauer S, Achenbach S, Myerson SG. Magnetic resonance phase contrast velocity mapping for flow quantification in irregular heart rhythms using radial k-space ultrashort echo time imaging. Int J Cardiol 2020; 317:211-215. [PMID: 32439365 DOI: 10.1016/j.ijcard.2020.05.031] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 05/06/2020] [Accepted: 05/11/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Phase contrast velocity mapping sequences utilising ultrashort echo time (UTE) radial k-space sequences have been used to reduce intravoxel dephasing at high velocities. We evaluated the accuracy of the UTE flow sequence for mitral regurgitation (MR) quantification, including patients with atrial fibrillation. METHODS Forty patients underwent cardiac MRI for indirect MR quantification by assessment of aortic flow using a UTE phase contrast sequence (TE 0.65 ms) combined with left ventricular stroke volume. Retrospective ECG-gating was used in sinus rhythm (30 patients), prospective ECG-triggering in atrial fibrillation (10). MR was also quantified by a standard phase contrast sequence (TE 2.85 ms, standard flow method) and by comparing stroke volumes (volumetric method). RESULTS UTE flow-derived MR measurement showed modest agreement in sinus rhythm (95% limits of agreement: ±38.2 ml; ±29.8%) and atrial fibrillation (±33.7 ml; ±30.3%) compared to standard flow assessment. There was little systematic bias in sinus rhythm (mean offset -4.4 ml /-3.5% compared to standard flow assessment), but a slight bias towards greater regurgitation in atrial fibrillation (+15.2 ml /+14.0%). There were wider limits of agreement between the UTE flow method and volumetric method than between the regular flow method and the volumetric method in sinus rhythm (±48.4 ml; ±36.4%; mean offset: -12.2 ml /-9.0%) and similar limits of agreement in atrial fibrillation (±29.6 ml; 25.8%; +12.0 ml /+10.3%). CONCLUSIONS UTE flow imaging is inferior to conventional flow techniques for MR assessment in patients with sinus rhythm as well as atrial fibrillation. However, the number of atrial fibrillation patients in this initial study is small.
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Affiliation(s)
- Michaela M Hell
- Department of Cardiology, Faculty of Medicine, University of Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany.
| | - Jane M Francis
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, United Kingdom.
| | - Joanna d'Arcy
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, United Kingdom.
| | - Matthew D Robson
- Perspectum Diagnostics, 23 - 38 Hythe Bridge St, Oxford OX1 2ET, United Kingdom.
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, United Kingdom.
| | - Stephan Achenbach
- Department of Cardiology, Faculty of Medicine, University of Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany.
| | - Saul G Myerson
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, United Kingdom.
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Hell MM, Gilg MD, Röther J, Blachutzik F, Achenbach S, Schlundt C. Dual-axis rotational coronary angiography versus conventional coronary angiography: a randomized comparison. Clin Res Cardiol 2020; 110:258-269. [PMID: 32936322 DOI: 10.1007/s00392-020-01743-5] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 08/06/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Dual-axis of rotational coronary angiography (RA), with one single cine acquisition during continuous C-arm motion along a pre-described path, is an alternative to conventional coronary angiography (CA). We assessed the performance of RA versus CA in a modern, experienced cath lab setting. METHODS Sixty-seven patients with suspected coronary artery disease undergoing invasive coronary angiography were randomized to CA (n = 35) or dual-axis RA (n = 32). CA was performed with four left and two right coronary artery acquisitions with manual contrast medium injection. In RA, one cine acquisition each was performed for the left (5 projections) and right coronary artery (3 projections) with a fixed amount of contrast medium applied by a power injector. In both groups, single cine acquisitions in additional angulations were performed to fully interpret the coronary system, if necessary. Procedural parameters and outcome were compared. RESULTS Mean age was 63 ± 12 years (64% males). Six additional projections were required in the RA group compared to 13 in the CA group (p = 0.173). Fluoroscopy duration (CA: 3 ± 3 min, RA: 3 ± 2 min, p = 0.748) and dose area product (CA: 1291 ± 761 µGym2, RA: 1476 ± 679 µGym2, p = 0.235) did not differ significantly between both groups. For CA, the amount of contrast medium (42 ± 13 vs. 46 ± 8 ml, p = 0.022) and procedure time (8 ± 5 vs. 11 ± 3 min, p < 0.001) were significantly lower. No major adverse event occurred during hospital stay. CONCLUSIONS Dual-axis RA represents a feasible and safe alternative method to CA for obtaining coronary angiograms. However, no superiority was observed when performed by an experienced interventionalist with a modern system.
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Affiliation(s)
- Michaela M Hell
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany. .,Department of Cardiology, University Medical Center Mainz, Johannes-Gutenberg University, Mainz, Germany.
| | - Melanie D Gilg
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Jens Röther
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.,Medizinische Klinik, St. Theresien Krankenhaus, Nürnberg, Germany
| | - Florian Blachutzik
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.,Department of Cardiology, Justus-Liebig University Giessen, Giessen, Germany
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Christian Schlundt
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
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16
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Marwan M, Koenig S, Schreiber K, Ammon F, Goeller M, Bittner D, Achenbach S, Hell MM. Quantification of epicardial adipose tissue by cardiac CT: Influence of acquisition parameters and contrast enhancement. Eur J Radiol 2019; 121:108732. [DOI: 10.1016/j.ejrad.2019.108732] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 10/15/2019] [Accepted: 10/28/2019] [Indexed: 10/25/2022]
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17
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Commandeur F, Goeller M, Razipour A, Cadet S, Hell MM, Kwiecinski J, Chen X, Chang HJ, Marwan M, Achenbach S, Berman DS, Slomka PJ, Tamarappoo BK, Dey D. Fully Automated CT Quantification of Epicardial Adipose Tissue by Deep Learning: A Multicenter Study. Radiol Artif Intell 2019; 1:e190045. [PMID: 32090206 DOI: 10.1148/ryai.2019190045] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/20/2019] [Accepted: 06/25/2019] [Indexed: 12/15/2022]
Abstract
Purpose To evaluate the performance of deep learning for robust and fully automated quantification of epicardial adipose tissue (EAT) from multicenter cardiac CT data. Materials and Methods In this multicenter study, a convolutional neural network approach was trained to quantify EAT on non-contrast material-enhanced calcium-scoring CT scans from multiple cohorts, scanners, and protocols (n = 850). Deep learning performance was compared with the performance of three expert readers and with interobserver variability in a subset of 141 scans. The deep learning algorithm was incorporated into research software. Automated EAT progression was compared with expert measurements for 70 patients with baseline and follow-up scans. Results Automated quantification was performed in a mean (± standard deviation) time of 1.57 seconds ± 0.49, compared with 15 minutes for experts. Deep learning provided high agreement with expert manual quantification for all scans (R = 0.974; P < .001), with no significant bias (0.53 cm3; P = .13). Manual EAT volumes measured by two experienced readers were highly correlated (R = 0.984; P < .001) but with a bias of 4.35 cm3 (P < .001). Deep learning quantifications were highly correlated with the measurements of both experts (R = 0.973 and R = 0.979; P < .001), with significant bias for reader 1 (5.11 cm3; P < .001) but not for reader 2 (0.88 cm3; P = .26). EAT progression by deep learning correlated strongly with manual EAT progression (R = 0.905; P < .001) in 70 patients, with no significant bias (0.64 cm3; P = .43), and was related to an increased noncalcified plaque burden quantified from coronary CT angiography (5.7% vs 1.8%; P = .026). Conclusion Deep learning allows rapid, robust, and fully automated quantification of EAT from calcium scoring CT. It performs as well as an expert reader and can be implemented for routine cardiovascular risk assessment.© RSNA, 2019See also the commentary by Schoepf and Abadia in this issue.
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Affiliation(s)
- Frederic Commandeur
- Biomedical Imaging Research Institute (F.C., A.R., D.D.) and Department of Imaging and Medicine (S.C., J.K., X.C., D.S.B., P.J.S., B.K.T.), Cedars-Sinai Medical Center, 8700 Beverly Blvd, Taper A238, Los Angeles, CA 90048; Department of Cardiology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany (M.G., M.M.H., M.M., S.A.); and Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea (H.J.C.)
| | - Markus Goeller
- Biomedical Imaging Research Institute (F.C., A.R., D.D.) and Department of Imaging and Medicine (S.C., J.K., X.C., D.S.B., P.J.S., B.K.T.), Cedars-Sinai Medical Center, 8700 Beverly Blvd, Taper A238, Los Angeles, CA 90048; Department of Cardiology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany (M.G., M.M.H., M.M., S.A.); and Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea (H.J.C.)
| | - Aryabod Razipour
- Biomedical Imaging Research Institute (F.C., A.R., D.D.) and Department of Imaging and Medicine (S.C., J.K., X.C., D.S.B., P.J.S., B.K.T.), Cedars-Sinai Medical Center, 8700 Beverly Blvd, Taper A238, Los Angeles, CA 90048; Department of Cardiology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany (M.G., M.M.H., M.M., S.A.); and Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea (H.J.C.)
| | - Sebastien Cadet
- Biomedical Imaging Research Institute (F.C., A.R., D.D.) and Department of Imaging and Medicine (S.C., J.K., X.C., D.S.B., P.J.S., B.K.T.), Cedars-Sinai Medical Center, 8700 Beverly Blvd, Taper A238, Los Angeles, CA 90048; Department of Cardiology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany (M.G., M.M.H., M.M., S.A.); and Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea (H.J.C.)
| | - Michaela M Hell
- Biomedical Imaging Research Institute (F.C., A.R., D.D.) and Department of Imaging and Medicine (S.C., J.K., X.C., D.S.B., P.J.S., B.K.T.), Cedars-Sinai Medical Center, 8700 Beverly Blvd, Taper A238, Los Angeles, CA 90048; Department of Cardiology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany (M.G., M.M.H., M.M., S.A.); and Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea (H.J.C.)
| | - Jacek Kwiecinski
- Biomedical Imaging Research Institute (F.C., A.R., D.D.) and Department of Imaging and Medicine (S.C., J.K., X.C., D.S.B., P.J.S., B.K.T.), Cedars-Sinai Medical Center, 8700 Beverly Blvd, Taper A238, Los Angeles, CA 90048; Department of Cardiology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany (M.G., M.M.H., M.M., S.A.); and Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea (H.J.C.)
| | - Xi Chen
- Biomedical Imaging Research Institute (F.C., A.R., D.D.) and Department of Imaging and Medicine (S.C., J.K., X.C., D.S.B., P.J.S., B.K.T.), Cedars-Sinai Medical Center, 8700 Beverly Blvd, Taper A238, Los Angeles, CA 90048; Department of Cardiology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany (M.G., M.M.H., M.M., S.A.); and Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea (H.J.C.)
| | - Hyuk-Jae Chang
- Biomedical Imaging Research Institute (F.C., A.R., D.D.) and Department of Imaging and Medicine (S.C., J.K., X.C., D.S.B., P.J.S., B.K.T.), Cedars-Sinai Medical Center, 8700 Beverly Blvd, Taper A238, Los Angeles, CA 90048; Department of Cardiology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany (M.G., M.M.H., M.M., S.A.); and Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea (H.J.C.)
| | - Mohamed Marwan
- Biomedical Imaging Research Institute (F.C., A.R., D.D.) and Department of Imaging and Medicine (S.C., J.K., X.C., D.S.B., P.J.S., B.K.T.), Cedars-Sinai Medical Center, 8700 Beverly Blvd, Taper A238, Los Angeles, CA 90048; Department of Cardiology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany (M.G., M.M.H., M.M., S.A.); and Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea (H.J.C.)
| | - Stephan Achenbach
- Biomedical Imaging Research Institute (F.C., A.R., D.D.) and Department of Imaging and Medicine (S.C., J.K., X.C., D.S.B., P.J.S., B.K.T.), Cedars-Sinai Medical Center, 8700 Beverly Blvd, Taper A238, Los Angeles, CA 90048; Department of Cardiology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany (M.G., M.M.H., M.M., S.A.); and Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea (H.J.C.)
| | - Daniel S Berman
- Biomedical Imaging Research Institute (F.C., A.R., D.D.) and Department of Imaging and Medicine (S.C., J.K., X.C., D.S.B., P.J.S., B.K.T.), Cedars-Sinai Medical Center, 8700 Beverly Blvd, Taper A238, Los Angeles, CA 90048; Department of Cardiology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany (M.G., M.M.H., M.M., S.A.); and Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea (H.J.C.)
| | - Piotr J Slomka
- Biomedical Imaging Research Institute (F.C., A.R., D.D.) and Department of Imaging and Medicine (S.C., J.K., X.C., D.S.B., P.J.S., B.K.T.), Cedars-Sinai Medical Center, 8700 Beverly Blvd, Taper A238, Los Angeles, CA 90048; Department of Cardiology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany (M.G., M.M.H., M.M., S.A.); and Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea (H.J.C.)
| | - Balaji K Tamarappoo
- Biomedical Imaging Research Institute (F.C., A.R., D.D.) and Department of Imaging and Medicine (S.C., J.K., X.C., D.S.B., P.J.S., B.K.T.), Cedars-Sinai Medical Center, 8700 Beverly Blvd, Taper A238, Los Angeles, CA 90048; Department of Cardiology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany (M.G., M.M.H., M.M., S.A.); and Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea (H.J.C.)
| | - Damini Dey
- Biomedical Imaging Research Institute (F.C., A.R., D.D.) and Department of Imaging and Medicine (S.C., J.K., X.C., D.S.B., P.J.S., B.K.T.), Cedars-Sinai Medical Center, 8700 Beverly Blvd, Taper A238, Los Angeles, CA 90048; Department of Cardiology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany (M.G., M.M.H., M.M., S.A.); and Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea (H.J.C.)
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Commandeur F, Goeller M, Razipour A, Cadet S, Hell MM, Kwiecinski J, Chen X, Chang HJ, Marwan M, Achenbach S, Berman DS, Slomka PJ, Tamarappoo BK, Dey D. 5963Automated quantification of epicardial adipose tissue from non-contrast CT on multi-center and multi-vendor data using deep learning. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0104] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Epicardial adipose tissue (EAT), a metabolically active visceral fat depot surrounding the coronary arteries, has been shown to promote the development of atherosclerosis in underlying coronary vasculature.
Purpose
We evaluate the performance of deep learning (DL), a sub-group of machine learning algorithms, for robust and fully automated quantification of EAT on multi-center cardiac CT data.
Methods
In this study, 850 non-contrast calcium scoring CT scans, from multiple cohorts, scanners and protocols, with manual measurements of EAT from 3 different readers were considered. The DL method was based on a convolutional neural network trained to reproduce the expert measurement. DL global performance was first assessed using all the scans, and then compared to inter-observer variability on a subset of 141 scans. Finally, automated EAT progression was compared to manual measurement using baseline and follow-up serial scans available for 70 subjects. The proposed model was validated using 10-fold cross validation.
Results
Automated quantification was performed in 1.57±0.49 seconds compared to 15 minutes for manual measurement. DL provided high agreement with expert manual quantification for all scans (R=0.974, p<0.001) with no significant bias (0.53 cm3, p=0.13). EAT volume was higher in patients with hypertension (+18.02 cm3, p<0.001, N=442), with diabetes (+18.33 cm3, p<0.001, N=75) and with hypercholesterolemia (+7.33 cm3, p=0.039, N=508). Manual EAT volumes measured by two experienced readers on 141 scans were highly correlated (R=0.984, p<0.001) but presented a significant difference of 4.35 cm3 (p<0.001). On these 141 scans, DL quantifications were highly correlated to both experts' measurements (R=0.973, p<0.001; R=0.979, p<0.001) with significant and non-significant bias for readers 1 and 2 (5.19 cm3, p<0.001; 0.84 cm3, p=0.26), respectively. In 70 subjects, EAT progression quantified by DL correlated strongly with EAT progression measured by the expert reader (R=0.905, p<0.001) with no significant bias (0.64 cm3, p=0.43), and was related to increased non-calcified plaque burden quantified from coronary CT angiography (5.7% vs 1.8%, p=0.026).
Automated vs. manual EAT volume
Conclusion
Deep learning allows rapid, robust and fully automated quantification of EAT from calcium scoring CT. It performs as an expert reader and can be implemented for routine cardiovascular risk assessment.
Acknowledgement/Funding
1R01HL133616/01EX1012B/Adelson Medical Research Foundation
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Affiliation(s)
- F Commandeur
- Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, United States of America
| | - M Goeller
- Friedrich Alexander University, Department of Cardiology, Erlangen, Germany
| | - A Razipour
- Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, United States of America
| | - S Cadet
- Cedars-Sinai Medical Center, Department of Imaging and Medicine, Los Angeles, United States of America
| | - M M Hell
- Friedrich Alexander University, Department of Cardiology, Erlangen, Germany
| | - J Kwiecinski
- Cedars-Sinai Medical Center, Department of Imaging and Medicine, Los Angeles, United States of America
| | - X Chen
- Cedars-Sinai Medical Center, Department of Imaging and Medicine, Los Angeles, United States of America
| | - H J Chang
- Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - M Marwan
- Friedrich Alexander University, Department of Cardiology, Erlangen, Germany
| | - S Achenbach
- Friedrich Alexander University, Department of Cardiology, Erlangen, Germany
| | - D S Berman
- Cedars-Sinai Medical Center, Department of Imaging and Medicine, Los Angeles, United States of America
| | - P J Slomka
- Cedars-Sinai Medical Center, Department of Imaging and Medicine, Los Angeles, United States of America
| | - B K Tamarappoo
- Cedars-Sinai Medical Center, Department of Imaging and Medicine, Los Angeles, United States of America
| | - D Dey
- Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, United States of America
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Abstract
Due to its high temporal and isotropic spatial resolution, CT has become firmly established for pre-procedural imaging in the context of structural heart disease interventions. CT allows to very exactly measure dimensions of the target structure, CT can provide information regarding the access route and, as a very valuable addition, volumetric CT data sets can be used to identify fluoroscopic projection angulations to optimally visualize the target structure and place devices. This review provides an overview of current methods and applications of pre-interventional CT to support adult cardiac interventions including transcatheter aortic valve implantation, percutaneous mitral valve intervention, left atrial appendage occlusion and paravalvular leak closure.
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Affiliation(s)
- Michaela M Hell
- Department of Cardiology, Faculty of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) , Erlangen , Germany
| | - Stephan Achenbach
- Department of Cardiology, Faculty of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) , Erlangen , Germany
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20
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Hell MM, Motwani M, Otaki Y, Cadet S, Gransar H, Miranda-Peats R, Valk J, Slomka PJ, Cheng VY, Rozanski A, Tamarappoo BK, Hayes S, Achenbach S, Berman DS, Dey D. Quantitative global plaque characteristics from coronary computed tomography angiography for the prediction of future cardiac mortality during long-term follow-up. Eur Heart J Cardiovasc Imaging 2018; 18:1331-1339. [PMID: 28950315 DOI: 10.1093/ehjci/jex183] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 06/22/2017] [Indexed: 11/14/2022] Open
Abstract
Aims Adverse plaque characteristics determined by coronary computed tomography angiography (CTA) have been associated with future cardiac events. Our aim was to investigate whether quantitative global per-patient plaque characteristics from coronary CTA can predict subsequent cardiac death during long-term follow-up. Methods and results Out of 2748 patients without prior history of coronary artery disease undergoing CTA with dual-source CT, 32 patients suffered cardiac death (mean follow-up of 5 ± 2 years). These patients were matched to 32 controls by age, gender, risk factors, and symptoms (total 64 patients, 59% male, age 69 ± 10 years). Coronary CTA data sets were analysed by semi-automated software to quantify plaque characteristics over the entire coronary tree, including total plaque volume, volumes of non-calcified plaque (NCP), low-density non-calcified plaque (LD-NCP, attenuation <30 Hounsfield units), calcified plaque (CP), and corresponding burden (plaque volume × 100%/vessel volume), as well as stenosis and contrast density difference (CDD, maximum percent difference in luminal attenuation/cross-sectional area compared to proximal cross-section). In patients who died from cardiac cause, NCP, LD-NCP, CP and total plaque volumes, quantitative stenosis, and CDD were significantly increased compared to controls (P < 0.025 for all). NCP > 146 mm³ [hazards ratio (HR) 2.24; 1.09-4.58; P = 0.027], LD-NCP > 10.6 mm³ (HR 2.26; 1.11-4.63; P = 0.025), total plaque volume > 179 mm³ (HR 2.30; 1.12-4.71; P = 0.022), and CDD > 35% in any vessel (HR 2.85;1.4-5.9; P = 0.005) were associated with increased risk of future cardiac death, when adjusted for segment involvement score. Conclusion Among quantitative global plaque characteristics, total, non-calcified, and low-density plaque volumes as well as CDD predict cardiac death in long-term follow-up.
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Affiliation(s)
- Michaela M Hell
- Department of Cardiology, Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054 Erlangen, Germany
| | - Manish Motwani
- Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute and Departments of Imaging and Medicine, 8700 Beverly Blvd., Los Angeles, CA 90048, USA
| | - Yuka Otaki
- Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute and Departments of Imaging and Medicine, 8700 Beverly Blvd., Los Angeles, CA 90048, USA
| | - Sebastien Cadet
- Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute and Departments of Imaging and Medicine, 8700 Beverly Blvd., Los Angeles, CA 90048, USA
| | - Heidi Gransar
- Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute and Departments of Imaging and Medicine, 8700 Beverly Blvd., Los Angeles, CA 90048, USA
| | - Romalisa Miranda-Peats
- Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute and Departments of Imaging and Medicine, 8700 Beverly Blvd., Los Angeles, CA 90048, USA
| | - Jacob Valk
- Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute and Departments of Imaging and Medicine, 8700 Beverly Blvd., Los Angeles, CA 90048, USA
| | - Piotr J Slomka
- Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute and Departments of Imaging and Medicine, 8700 Beverly Blvd., Los Angeles, CA 90048, USA
| | - Victor Y Cheng
- Oklahoma Heart Institute, 1265 S. Utica Avenue Suite 300, Tulsa, OK 74104, USA
| | - Alan Rozanski
- Mount Sinai St Lukes Hospital Cardiology, Division of Cardiology, 1111 Amsterdam Ave FL 3, New York, NY 10025, USA
| | - Balaji K Tamarappoo
- Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute and Departments of Imaging and Medicine, 8700 Beverly Blvd., Los Angeles, CA 90048, USA
| | - Sean Hayes
- Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute and Departments of Imaging and Medicine, 8700 Beverly Blvd., Los Angeles, CA 90048, USA
| | - Stephan Achenbach
- Department of Cardiology, Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054 Erlangen, Germany
| | - Daniel S Berman
- Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute and Departments of Imaging and Medicine, 8700 Beverly Blvd., Los Angeles, CA 90048, USA
| | - Damini Dey
- Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, CA 90048, USA
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Hell MM, Biburger L, Marwan M, Schuhbaeck A, Achenbach S, Lell M, Uder M, Arnold M. Prediction of fluoroscopic angulations for transcatheter aortic valve implantation by CT angiography: influence on procedural parameters. Eur Heart J Cardiovasc Imaging 2018; 18:906-914. [PMID: 27461209 DOI: 10.1093/ehjci/jew144] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 04/26/2016] [Accepted: 06/16/2016] [Indexed: 11/14/2022] Open
Abstract
Aims Repeated angiograms to achieve an exactly orthogonal visualization of the aortic valve plane can substantially contribute to the total contrast amount required for transcatheter aortic valve implantation (TAVI). We investigated whether pre-procedural identification of an optimal fluoroscopic projection by cardiac computed tomography (CT) can significantly reduce the amount of a procedure-related contrast agent compared with angiographic determination of suitable angulations. Methods and results Eighty consecutive patients (81 ± 5 years, 55% male) with symptomatic severe aortic valve stenosis and normal renal function who underwent cardiac CT prior to TAVI were prospectively randomized. In 40 patients, a CT-predicted suitable angulation was used for the first aortic angiogram (CT cohort); in the other 40 patients, the first aortogram was acquired at LAO 10°/cranial 10 (angiography cohort). Additional aortograms were performed if no satisfactory view of the aortic valve plane was obtained. The number of aortograms needed to achieve a satisfactory fluoroscopic projection (1.2 ± 0.6 vs. 3.2 ± 1.7; P < 0.001) and the total amount of contrast agent per TAVI procedure were significantly lower in the CT cohort (95 ± 21 vs. 125 ± 36 mL; P < 0.001). Incidence of acute kidney injury was not significantly different. There was no significant difference regarding radiation dose, time of procedure, degree of post-procedural aortic regurgitation, complications and 30-day mortality between the cohorts. Conclusion Pre-procedural identification of a suitable fluoroscopic projection by cardiac CT significantly reduces a procedural contrast agent volume required for TAVI.
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Affiliation(s)
- Michaela M Hell
- Department of Cardiology, Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054 Erlangen, Germany
| | - Lukas Biburger
- Department of Cardiology, Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054 Erlangen, Germany
| | - Mohamed Marwan
- Department of Cardiology, Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054 Erlangen, Germany
| | - Annika Schuhbaeck
- Department of Cardiology, Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054 Erlangen, Germany
| | - Stephan Achenbach
- Department of Cardiology, Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054 Erlangen, Germany
| | - Michael Lell
- Department of Radiology, Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Maximilliansplatz 1, 91054 Erlangen, Germany
| | - Michael Uder
- Department of Radiology, Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Maximilliansplatz 1, 91054 Erlangen, Germany
| | - Martin Arnold
- Department of Cardiology, Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054 Erlangen, Germany
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Hell MM, Orchard E, Westaby S, Myerson SG. Unusual coarctation repair with double lumen distal arch. Eur Heart J 2018; 39:1038. [PMID: 29420728 DOI: 10.1093/eurheartj/ehy019] [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] [Received: 10/26/2017] [Accepted: 01/12/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Michaela M Hell
- Faculty of Medicine, Department of Cardiology, University of Erlangen-Nürnberg, Germany
| | - Elizabeth Orchard
- Cardiac Directorate, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 9DU, UK
| | - Stephen Westaby
- Cardiac Directorate, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 9DU, UK
| | - Saul G Myerson
- Cardiac Directorate, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 9DU, UK.,University of Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK
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Dankerl P, Hammon M, Seuss H, Tröbs M, Schuhbaeck A, Hell MM, Cavallaro A, Achenbach S, Uder M, Marwan M. Computer-aided evaluation of low-dose and low-contrast agent third-generation dual-source CT angiography prior to transcatheter aortic valve implantation (TAVI). Int J Comput Assist Radiol Surg 2016; 12:795-802. [PMID: 27604759 DOI: 10.1007/s11548-016-1470-8] [Citation(s) in RCA: 8] [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: 03/10/2016] [Accepted: 08/04/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate the performance of computer-aided evaluation software for a comprehensive workup of patients prior to transcatheter aortic valve implantation (TAVI) using low-contrast agent and low radiation dose third-generation dual-source CT angiography. METHODS We evaluated 30 consecutive patients scheduled for TAVI. All patients underwent ECG-triggered high-pitch dual-source CT angiography of the aortic root and aorta with a standardized contrast agent volume (30 ml Imeron350, flow rate 4 ml/s) and low-dose (100 kv/350 mAs) protocol. An expert (10 years of experience) manually evaluated aortic root and iliac access dimensions (distance between coronary ostia and aortic annulus, minimal/maximal diameters and area-derived diameter of the aortic annulus) and best CT-predicted fluoroscopic projection angle as the reference standard. Utilizing computer-aided software (syngo.via), the same pre-TAVI workup was performed and compared to the reference standard. RESULTS Mean CTDI[Formula: see text] was 3.46 mGy and mean DLP 217.6 ± 12.1 mGy cm, corresponding to a mean effective dose of 3.7 ± 0.2 mSv. Computer-aided evaluation was successful in all but one patient. Compared to the reference standard, Bland-Altman analysis indicated very good agreement for the distances between aortic annulus and coronary ostia (RCA: mean difference 0.8 mm; 95 % CI 0.4-1.2 mm; LM: mean difference 0.9 mm; 95 % CI 0.5-1.3 mm); however, we demonstrated a systematic overestimation of annulus- derived diameter using the software (mean difference 44.4 mm[Formula: see text]; 95 % CI 30.4-58.3 mm[Formula: see text]). Based on respective annulus dimensions, the recommended prosthesis size (Edwards SAPIEN 3) matched in 26 out of the 29 patients (90 %). CT-derived fluoroscopic projection angles showed an excellent agreement for both methods. Out of 58 iliac arteries, 15 (25 %) arteries could not be segmented by the software. Preprocessing time of the software was 71 ± 11 s (range 51-96 s), and reading time with the software was 118 ± 31 s (range 68-201 s). CONCLUSION In the workup of pre-TAVI CT angiography, computer-aided evaluation of low-contrast, low-dose examinations is feasible with good agreement and quick reading time. However, a systematic overestimation of the aortic annulus area is observed.
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Affiliation(s)
- Peter Dankerl
- Department of Radiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 1, 91054, Erlangen, Germany
| | - Matthias Hammon
- Department of Radiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 1, 91054, Erlangen, Germany.
| | - Hannes Seuss
- Department of Radiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 1, 91054, Erlangen, Germany
| | - Monique Tröbs
- Department of Cardiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany
| | - Annika Schuhbaeck
- Department of Cardiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany
| | - Michaela M Hell
- Department of Cardiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany
| | - Alexander Cavallaro
- Department of Radiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 1, 91054, Erlangen, Germany
| | - Stephan Achenbach
- Department of Cardiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany
| | - Michael Uder
- Department of Radiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 1, 91054, Erlangen, Germany
| | - Mohamed Marwan
- Department of Cardiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany
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Hell MM, Biburger L, Marwan M, Schuhbaeck A, Achenbach S, Arnold M. Prediction of fluoroscopic angulation for transcatheter aortic valve implantation by CT angiography: Influence on procedural parameters. J Cardiovasc Comput Tomogr 2016. [DOI: 10.1016/j.jcct.2015.12.028] [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: 11/28/2022]
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Hell MM, Ding X, Rubeaux M, Slomka P, Gransar H, Terzopoulos D, Hayes S, Marwan M, Achenbach S, Berman DS, Dey D. Epicardial adipose tissue volume but not density is an independent predictor for myocardial ischemia. J Cardiovasc Comput Tomogr 2016; 10:141-9. [PMID: 26817413 DOI: 10.1016/j.jcct.2016.01.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [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: 09/30/2015] [Revised: 12/18/2015] [Accepted: 01/11/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Epicardial adipose tissue (EAT) volume is associated with plaque formation and cardiovascular event risk, its density may reflect tissue composition and metabolic activity. OBJECTIVES Global and regional associations between EAT volume and density, ischemia and coronary calcium were investigated using a novel automatic quantitative measurement software. METHODS 71 patients with an intermediate pre-test probability for coronary artery disease and inducible ischemia by SPECT were matched to two same-gender controls (total of 213 patients, 90% male, age 60 ± 10 years). Non-contrast CT for assessment of EAT volume, density (in Hounsfield Unit [HU]) and coronary calcium score (CCS) was performed. RESULTS Global EAT volume was significantly increased in ischemic patients compared to controls (96 ± 49 vs. 82 ± 36 cm(3), p = 0.04), density showed no significant difference (-75.6 ± 4.3 vs. -75.1 ± 4.1HU, p = 0.63). EAT volume and density differed significantly between coronary territories (LAD: 37 ± 18 cm(3), -77.8 ± 4.5HU; LCx: 16 ± 9 cm(3), -73.9 ± 4.1HU; RCA: 36 ± 17 cm(3), -71.7 ± 4.8HU, p < 0.001). For regional ischemia, only LCx territory showed a significantly higher EAT volume (18 ± 8 vs. 16 ± 9 cm(3), p = 0.048). Multivariable logistic regression revealed a significant association with ischemia for EAT volume (OR 2.09 (1.0; 4.3), p = 0.049) and CCS (OR 1.43 (1.1; 1.9), p = 0.006). EAT volume significantly improved discrimination of ischemia over CCS (Integrated Discrimination Improvement: 3.5%, 95%CI: 1.1-6.1%, p = 0.004). Hypertension was the only risk factor significantly influencing EAT volume and density (98 ± 48 vs. 78 ± 31 cm(3), p = 0.002, -76.0 ± 4.1 vs. -74.5 ± 4.1 HU, p = 0.01). CONCLUSIONS EAT volume is associated with myocardial ischemia and improves the discriminative power for independent ischemia prediction over CCS. In hypertensive patients, EAT is characterized by lower density and higher volumes.
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Affiliation(s)
- Michaela M Hell
- Department of Cardiology, University of Erlangen-Nuremberg, Ulmenweg 18, 91054 Erlangen, Germany.
| | - Xiaowei Ding
- Computer Science Department, Henry Samueli School of Engineering and Applied Science at UCLA, Los Angeles, CA, USA.
| | - Mathieu Rubeaux
- Cedars-Sinai Medical Center, Departments of Imaging and Medicine, Division of Cardiology and the Cedars-Sinai Heart Institute, Los Angeles, CA, USA.
| | - Piotr Slomka
- Cedars-Sinai Medical Center, Departments of Imaging and Medicine, Division of Cardiology and the Cedars-Sinai Heart Institute, Los Angeles, CA, USA.
| | - Heidi Gransar
- Cedars-Sinai Medical Center, Departments of Imaging and Medicine, Division of Cardiology and the Cedars-Sinai Heart Institute, Los Angeles, CA, USA.
| | - Demetri Terzopoulos
- Computer Science Department, Henry Samueli School of Engineering and Applied Science at UCLA, Los Angeles, CA, USA.
| | - Sean Hayes
- Cedars-Sinai Medical Center, Departments of Imaging and Medicine, Division of Cardiology and the Cedars-Sinai Heart Institute, Los Angeles, CA, USA.
| | - Mohamed Marwan
- Department of Cardiology, University of Erlangen-Nuremberg, Ulmenweg 18, 91054 Erlangen, Germany.
| | - Stephan Achenbach
- Department of Cardiology, University of Erlangen-Nuremberg, Ulmenweg 18, 91054 Erlangen, Germany.
| | - Daniel S Berman
- Cedars-Sinai Medical Center, Departments of Imaging and Medicine, Division of Cardiology and the Cedars-Sinai Heart Institute, Los Angeles, CA, USA.
| | - Damini Dey
- Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, CA, USA.
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Hell MM, Achenbach S, Schuhbaeck A, Klinghammer L, May MS, Marwan M. CT-based analysis of pericoronary adipose tissue density: Relation to cardiovascular risk factors and epicardial adipose tissue volume. J Cardiovasc Comput Tomogr 2015; 10:52-60. [PMID: 26256553 DOI: 10.1016/j.jcct.2015.07.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [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: 08/19/2014] [Revised: 07/07/2015] [Accepted: 07/24/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pericoronary adipose tissue (PCAT) can promote atherosclerosis. Metabolically active and inactive PCAT may display different CT densities. However, CT density could be influenced by partial volume effects and image interpolation. OBJECTIVE To investigate whether PCAT density values in CT displays differences that are larger than those attributable to interpolation and partial volume effects, which would manifest themselves through the relationship between PCAT density and distance from the contrast-enhanced coronary lumen. METHODS PCAT density analysis was performed (417 non-atherosclerotic segments, 63 patients) using dual-source CT with a threshold-based measurement method. Changes in PCAT density values depending on distance from the contrast-enhanced coronary lumen and the influence of cardiovascular risk profile were analyzed. RESULTS Mean PCAT density was -78.1 ± 5.6 HU. PCAT density decreased from proximal to distal segments in the LAD (-78.0 ± 7.3 vs. -82.4 ± 7.7 HU; p < 0.001). PCAT density was higher close to the lumen compared to more peripheral locations (-76.0 ± 6.7 vs. -78.5 ± 5.4 HU; p < 0.001). Decreasing PCAT density was significantly associated with higher epicardial adipose tissue (EAT) volume and body mass index. There was a trend of lower PCAT values with a family history of coronary artery disease. CONCLUSION CT-measured attenuation of PCAT is influenced by EAT volume and body mass index. A decrease of PCAT attenuation with increasing distance from the vessel and from proximal to distal segments may suggest variations in CT density of PCAT due to partial volume effects and image interpolation rather than solely due to differences in tissue composition or metabolic activity.
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Affiliation(s)
- Michaela M Hell
- Department of Cardiology, University of Erlangen, Ulmenweg 18, 91054 Erlangen, Germany.
| | - Stephan Achenbach
- Department of Cardiology, University of Erlangen, Ulmenweg 18, 91054 Erlangen, Germany
| | - Annika Schuhbaeck
- Department of Cardiology, University of Erlangen, Ulmenweg 18, 91054 Erlangen, Germany
| | - Lutz Klinghammer
- Department of Cardiology, University of Erlangen, Ulmenweg 18, 91054 Erlangen, Germany
| | - Matthias S May
- Department of Radiology, University of Erlangen, Maximiliansplatz 1, 91054 Erlangen, Germany
| | - Mohamed Marwan
- Department of Cardiology, University of Erlangen, Ulmenweg 18, 91054 Erlangen, Germany
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Hell MM, Bittner D, Schuhbaeck A, Muschiol G, Brand M, Lell M, Uder M, Achenbach S, Marwan M. Prospectively ECG-triggered high-pitch coronary angiography with third-generation dual-source CT at 70 kVp tube voltage: feasibility, image quality, radiation dose, and effect of iterative reconstruction. J Cardiovasc Comput Tomogr 2014; 8:418-25. [PMID: 25439789 DOI: 10.1016/j.jcct.2014.09.003] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [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: 07/28/2014] [Revised: 08/28/2014] [Accepted: 09/03/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Low tube voltage reduces radiation exposure in coronary CT angiography (CTA). Using 70 kVp tube potential has so far not been possible because CT systems were unable to provide sufficiently high tube current with low voltage. OBJECTIVE We evaluated feasibility, image quality (IQ), and radiation dose of coronary CTA using a third-generation dual-source CT system capable of producing 450 mAs tube current at 70 kVp tube voltage. METHODS Coronary CTA was performed in 26 consecutive patients with suspected coronary artery disease, selected for body weight <100 kg and heart rate <60 beats/min. High-pitch spiral acquisition was used. Filtered back projection (FBP) and iterative reconstruction (IR) algorithms were applied. IQ was assessed using a 4-point rating scale (1 = excellent, 4 = nondiagnostic) and objective parameters. RESULTS Mean age was 62 ± 9 years (46% males; mean body mass index, 27.7 ± 3.8 kg/m(2); mean heart rate, 54 ± 5 beats/min). Mean dose-length product was 20.6 ± 1.9 mGy × cm; mean estimated effective radiation dose was 0.3 ± 0.03 mSv. Diagnostic IQ was found in 365 of 367 (FBP) and 366 of 367 (IR) segments (P nonsignificant). IQ was rated "excellent" in 53% (FBP) and 86% (IR) segments (P = .001) and "nondiagnostic" in 2 (FBP) and 1 segment (IR) (P nonsignificant). Mean IQ score was lesser in FBP vs IR (1.5 ± 0.4 vs 1.1 ± 0.2; P < .001). Image noise was lower in IR vs FBP (60 ± 10 HU vs 74 ± 8 HU; P < .001). CONCLUSION In patients <100 kg and with a regular heart rate <60 beats/min, third-generation dual-source CT using high-pitch spiral acquisition and 70 kVp tube voltage is feasible and provides both robust IQ and very low radiation exposure.
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Affiliation(s)
- Michaela M Hell
- Department of Cardiology, University of Erlangen, Erlangen, Germany.
| | - Daniel Bittner
- Department of Cardiology, University of Erlangen, Erlangen, Germany
| | | | - Gerd Muschiol
- Department of Cardiology, University of Erlangen, Erlangen, Germany
| | - Michael Brand
- Department of Radiology, University of Erlangen, Erlangen, Germany
| | - Michael Lell
- Department of Radiology, University of Erlangen, Erlangen, Germany
| | - Michael Uder
- Department of Radiology, University of Erlangen, Erlangen, Germany
| | | | - Mohamed Marwan
- Department of Cardiology, University of Erlangen, Erlangen, Germany
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