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Conte E, Pizzamiglio F, Dessanai MA, Guarnieri G, Ardizzone V, Schillaci M, Dello Russo A, Casella M, Mushtaq S, Melotti E, Marchetti D, Volpato V, Drago G, Gigante C, Sforza C, Bartorelli AL, Pepi M, Pontone G, Tondo C, Andreini D. Prevalence and prognosis of structural heart disease among athletes with negative T waves and normal transthoracic echocardiography. Clin Res Cardiol 2024; 113:706-715. [PMID: 37582977 DOI: 10.1007/s00392-023-02282-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 07/31/2023] [Indexed: 08/17/2023]
Abstract
INTRODUCTION The aim of the present study was to evaluate the prevalence and prognosis of structural heart disease (SHD) among competitive athletes with negative T waves without pathological findings at transthoracic echocardiogram. METHODS From a prospective register of 450 athletes consecutively evaluated during a second-level cardiological examination, we retrospectively identified all subjects with the following inclusion criteria: (1) not previously known cardiovascular disease; (2) negative T waves in leads other than V1-V2; (3) normal transthoracic echocardiogram. Patients underwent cardiac MRI and CT. The primary endpoint was the diagnosis of definite SHD after multimodality imaging evaluation. A follow-up was collected for a combined end-point of sudden death, resuscitated sudden cardiac death and hospitalization for any cardiovascular causes. RESULTS A total of 55 competitive athletes were finally enrolled (50 males, 90%) with a mean age of 27.5 ± 14.1 years. Among the population enrolled 16 (29.1%) athletes had a final diagnosis of SHD. At multivariate analysis, only deep negative T waves remained statistically significant [OR (95% CI) 7.81 (1.24-49.08), p = 0.0285]. Contemporary identification of deep negative T waves and complex arrhythmias in the same patients appeared to have an incremental diagnostic value. No events were collected at 49.3 ± 12.3 months of follow-up. CONCLUSIONS In a cohort of athletes with negative T waves at ECG, cardiac MRI (and selected use of cardiac CT) enabled the identification of 16 (29.1%) subjects with SHD despite normal transthoracic echocardiography. Deep negative T waves and complex ventricular arrhythmias were the only clinical characteristic associated with SHD diagnosis.
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Affiliation(s)
- Edoardo Conte
- Centro Cardiologico Monzino IRCCS, Milan, Italy.
- Department of Biomedical Science for Health, University of Milan, Milan, Italy.
| | | | | | | | | | | | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti" Ancona, Ancona, Italy
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti" Ancona, Ancona, Italy
| | | | | | | | | | | | | | - Chiarella Sforza
- Department of Biomedical Science for Health, University of Milan, Milan, Italy
| | | | - Mauro Pepi
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - Claudio Tondo
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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Epstein R, Yomogida M, Donovan D, Butensky A, Aidala AA, Farooqi KM, Shah AM, Chelliah A, DiLorenzo MP. Trends in cardiac CT utilization for patients with pediatric and congenital heart disease: A multicenter survey study. J Cardiovasc Comput Tomogr 2024; 18:267-273. [PMID: 38360501 DOI: 10.1016/j.jcct.2024.02.002] [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: 11/06/2023] [Revised: 02/02/2024] [Accepted: 02/08/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND The use of cardiac CT (CCT) has increased dramatically in recent years among patients with pediatric and congenital heart disease (CHD), but little is known about trends and practice pattern variation in CCT utilization for this population among centers. METHODS A 21-item survey was created to assess CCT utilization in the pediatric/CHD population in calendar years 2011 and 2021. The survey was sent to all non-invasive cardiac imaging directors of pediatric cardiology centers in North America in September 2022. RESULTS Forty-one centers completed the survey. In 2021, 98% of centers performed CCT in pediatric and CHD patients (vs. 73% in 2011), and 61% of centers performed >100 CCTs annually (vs. 5% in 2011). While 62% of centers in 2021 utilized dual-source technology for high-pitch helical acquisition, 15% of centers reported primarily performing CCT on a 64-slice scanner. Anesthesia utilization, use of medications for heart rate control, and type of subspecialty training for physicians interpreting CCT varied widely among centers. 50% of centers reported barriers to CCT performance, with the most commonly cited concerns being radiation exposure, the need for anesthesia, and limited CT scan staffing or machine access. 37% (11/30) of centers with a pediatric cardiology fellowship program offer no clinical or didactic CCT training for categorical fellows. CONCLUSION While CCT usage in the CHD/pediatric population has risen significantly in the past decade, there is broad center variability in CCT acquisition techniques, staffing, workflow, and utilization. Potential areas for improvement include expanding CT scanner access and staffing, formal CCT education for pediatric cardiology fellows, and increasing utilization of existing technological advances.
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Affiliation(s)
- Rebecca Epstein
- Division of Cardiology, Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA.
| | - Maiko Yomogida
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Denis Donovan
- Division of Cardiology, Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA
| | - Adam Butensky
- Division of Cardiology, Department of Pediatrics, Columbia University Irving Medical Center and New York-Presbyterian Morgan Stanley Children's Hospital, USA
| | - Angela A Aidala
- Division of Cardiology, Department of Pediatrics, Goryeb Children's Hospital, Atlantic Health System, Morristown, NJ, USA
| | - Kanwal M Farooqi
- Division of Cardiology, Department of Pediatrics, Columbia University Irving Medical Center and New York-Presbyterian Morgan Stanley Children's Hospital, USA
| | - Amee M Shah
- Division of Cardiology, Department of Pediatrics, Columbia University Irving Medical Center and New York-Presbyterian Morgan Stanley Children's Hospital, USA
| | - Anjali Chelliah
- Division of Cardiology, Department of Pediatrics, Columbia University Irving Medical Center and New York-Presbyterian Morgan Stanley Children's Hospital, USA; Division of Cardiology, Department of Pediatrics, Goryeb Children's Hospital, Atlantic Health System, Morristown, NJ, USA
| | - Michael P DiLorenzo
- Division of Cardiology, Department of Pediatrics, Columbia University Irving Medical Center and New York-Presbyterian Morgan Stanley Children's Hospital, USA
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Rashmitha, Manjunath KN, Kulkarni A, Kulkarni V. Segmentation and Volumetric Analysis of Heart from Cardiac CT Images. Cardiovasc Eng Technol 2024:10.1007/s13239-024-00715-4. [PMID: 38689094 DOI: 10.1007/s13239-024-00715-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 01/02/2024] [Indexed: 05/02/2024]
Abstract
PURPOSE Cardiac CT is a valuable diagnostic tool in evaluating cardiovascular diseases. Accurate segmentation of the heart and its structures from cardiac CT and MRI images is essential for diagnosing functional abnormalities, treatment plans and cardiovascular diseases management. Accurate segmentation and quantitative assessments are still a challenge. Manual delineation of the heart from the scan images is labour-intensive, time-consuming, and error prone as it depends on the radiologist's experience. Thus, automated techniques are highly desirable as they can significantly improve the efficiency and accuracy of image analysis. METHOD This work addresses the above problems. A new, image-driven, fast, and fully automatic segmentation method was developed to segment the heart from CT images using a processing pipeline of adaptive median filter, multi-level thresholding, active contours, mathematical morphology, and the knowledge of human anatomy to delineate the regions of interest. RESULTS The algorithm proposed is simple to implement and validate and requires no human intervention. The method is tested on the 'Image CHD' DICOM images (multi-centre, clinically approved single-phase de-identified images), and the results obtained were validated against the ground truths provided with the dataset. The results show an average Dice score, Jaccard score, and Hausdorff distance of 0.866, 0.776, and 33.29 mm, respectively, for the segmentation of the heart's chambers, aorta, and blood vessels. The results and the ground truths were compared using Bland-Altmon plots. CONCLUSION The heart was correctly segmented from the CT images using the proposed method. Further this segmentation technique can be used to develop AI based solutions for segmentation.
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Affiliation(s)
- Rashmitha
- Department of Computer Science and Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - K N Manjunath
- Department of Computer Science and Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
| | - Anjali Kulkarni
- Consultant in Radiation Oncology, Clinical Informatics and Artificial Intelligence, Karkinos Healthcare, Bengaluru, India
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Teixeira BL, Cunha PS, Jacinto AS, Portugal G, Laranjo S, Valente B, Lousinha A, Cruz MC, Delgado AS, Brás M, Paulo M, Guerra C, Ramos R, Fontes I, Ferreira RC, Oliveira MM. Epicardial adipose tissue volume assessed by cardiac CT as a predictor of atrial fibrillation recurrence following catheter ablation. Clin Imaging 2024; 110:110170. [PMID: 38696998 DOI: 10.1016/j.clinimag.2024.110170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/14/2024] [Accepted: 04/22/2024] [Indexed: 05/04/2024]
Abstract
INTRODUCTION In patients with atrial fibrillation (AF), up to one third have recurrence after a first catheter ablation (CA). Epicardial adipose tissue (EAT) has been considered to be closely related to AF, with a potential role in its recurrence. We aimed to evaluate the association between the volume of EAT measured by cardiac computed tomography (CT) and AF recurrence after CA. METHODS Consecutive AF patients underwent a standardized cardiac CT protocol for quantification of EAT, thoracic adipose volume (TAV) and left atrium (LA) volume before CA. An appropriate cut-off of EAT was determined and risk recurrence was estimated. RESULTS 305 patients (63.6 % male, mean age 57.5 years, 28.2 % persistent AF) were followed for 24 months; 23 % had AF recurrence at 2-year mark, which was associated with higher EAT (p = 0.037) and LAV (p < 0.001). Persistent AF was associated with higher EAT volumes (p = 0.010), TAV (p = 0.003) and LA volumes (p < 0.001). EAT was predictive of AF recurrence (p = 0.044). After determining a cut-off of 92 cm3, survival analysis revealed that EAT volumes > 92 cm3 showed higher recurrence rates at earlier time points after the index ablation procedure (p = 0.006), with a HR of 1.95 (p = 0.008) of AF recurrence at 2-year. After multivariate adjustment, EAT > 92 cm3 remained predictive of AF recurrence (p = 0.028). CONCLUSION The volume of EAT measured by cardiac CT can predict recurrence of AF after ablation, with a volume above 92 cm3 yielding almost twice the risk of arrhythmia recurrence in the first two years following CA. Higher EAT and TAV are also associated with persistent AF.
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Affiliation(s)
- Bárbara Lacerda Teixeira
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Department, Santa Marta Hospital, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal; Clínica Universitária de Cardiologia, Centro Clínico Académico de Lisboa, Lisbon, Portugal. https://twitter.com/BarbaraLT94
| | - Pedro Silva Cunha
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Department, Santa Marta Hospital, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal; Clínica Universitária de Cardiologia, Centro Clínico Académico de Lisboa, Lisbon, Portugal; Instituto de Fisiologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Comprehensive Health Research Center, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Ana Sofia Jacinto
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Department, Santa Marta Hospital, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal; Clínica Universitária de Cardiologia, Centro Clínico Académico de Lisboa, Lisbon, Portugal
| | - Guilherme Portugal
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Department, Santa Marta Hospital, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal; Clínica Universitária de Cardiologia, Centro Clínico Académico de Lisboa, Lisbon, Portugal; Instituto de Fisiologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Sérgio Laranjo
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Department, Santa Marta Hospital, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal; Clínica Universitária de Cardiologia, Centro Clínico Académico de Lisboa, Lisbon, Portugal; NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisbon, Portugal; Comprehensive Health Research Center, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Bruno Valente
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Department, Santa Marta Hospital, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal; Clínica Universitária de Cardiologia, Centro Clínico Académico de Lisboa, Lisbon, Portugal
| | - Ana Lousinha
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Department, Santa Marta Hospital, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal; Clínica Universitária de Cardiologia, Centro Clínico Académico de Lisboa, Lisbon, Portugal; NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Madalena Coutinho Cruz
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Department, Santa Marta Hospital, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal; Clínica Universitária de Cardiologia, Centro Clínico Académico de Lisboa, Lisbon, Portugal
| | - Ana Sofia Delgado
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Department, Santa Marta Hospital, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Manuel Brás
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Department, Santa Marta Hospital, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Margarida Paulo
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Department, Santa Marta Hospital, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Cátia Guerra
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Department, Santa Marta Hospital, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Ruben Ramos
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Department, Santa Marta Hospital, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal; Clínica Universitária de Cardiologia, Centro Clínico Académico de Lisboa, Lisbon, Portugal
| | - Iládia Fontes
- Imagiology Department, Santa Marta Hospital, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Rui Cruz Ferreira
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Department, Santa Marta Hospital, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal; Clínica Universitária de Cardiologia, Centro Clínico Académico de Lisboa, Lisbon, Portugal
| | - Mário Martins Oliveira
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Department, Santa Marta Hospital, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal; Clínica Universitária de Cardiologia, Centro Clínico Académico de Lisboa, Lisbon, Portugal; Instituto de Fisiologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Comprehensive Health Research Center, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisbon, Portugal
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Conte E, Marchetti D, Melotti E, Schillaci M, Mushtaq S, Maffi V, Pontone G, Bartorelli A, Andreini D. Clinical and cardiac CT characteristics of congenital coronary abnormalities occasionally detected in a middle-aged population: A long-term follow-up study. J Cardiovasc Comput Tomogr 2024:S1934-5925(24)00076-5. [PMID: 38641453 DOI: 10.1016/j.jcct.2024.04.002] [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: 01/02/2024] [Revised: 02/27/2024] [Accepted: 04/11/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION Congenital coronary artery anomalies (CCAA) represent one of the most challenging conditions as their clinical presentation may range from sudden cardiac death to a complete subclinical form. The aim of the present study was to evaluate the diagnostic and prognostic role of cardiac CT (CCT) evaluation in patients with CCAA, focusing on anomalies of origin. MATERIAL AND METHODS The present is a retrospective analysis of a prospective clinical registry including a consecutive cohort of patients who underwent clinically indicated CCT from January 2007 to October 2015 for suspected but unknown coronary artery disease (CAD) and were diagnosed for having a congenital coronary abnormality compared to a control group matched for age, sex and segment stenosis score (SSS). Dedicated analysis of all CCT was performed for the present study and only coronary anomalies of origin were considered and included in the study. Two different composite end-points were identified for the present analysis: major cardiovascular events (MACE) and all-cause of death. RESULTS Among the 81 patients with CCAAs enrolled the most frequent anomaly was left main artery absence, which was identified in 41 individuals (50.6%). Forty-five subjects (55.5%) have an anomalous origin of the coronary artery from a different sinus of Valsalva and 45 subjects had also an anomalous course with the retro-aortic being the most common (32%). Eleven participants (13.6%) displayed also an intramural segment, while 10 (10.3%) had a slit-like ostial morphology. At multivariate analysis CT identification of ARCA, anomalous inter-arterial course and abnormal ostial morphology were significantly associated with MACE even when adjusted for age and SSS, without any differences in all-cause mortality between the two groups (6.2% vs 2.4% p = 0.2478). CONCLUSION The result of the present study is that CCT can be successfully used to define the anatomy and features of CAA. It suggested that in middle-aged patients, the identification of high risk characteristics at CT may have a prognostic value in term of cardiovascular events occurrence at follow-up even if the rate of events strictly linked to CCAA is low.
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Affiliation(s)
- Edoardo Conte
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical Science for Health, University of Milan, Milan, Italy.
| | | | | | | | | | - Vanessa Maffi
- Department of Biomedical Science for Health, University of Milan, Milan, Italy
| | - Gianluca Pontone
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | | | - Daniele Andreini
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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Duarte VE, Rajpal S. The Role of Multimodality Imaging in the Evaluation of Heart Failure and Surgical Transplant Planning of Patients with Adult Congenital Heart Disease. Heart Fail Clin 2024; 20:189-198. [PMID: 38462323 DOI: 10.1016/j.hfc.2024.01.002] [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] [Indexed: 03/12/2024]
Abstract
Cardiac imaging is pivotal in evaluating ventricular function, residual lesions, and long-term complications in patients with adult congenital heart disease (ACHD). Longitudinal imaging in ACHD is key for the timely identification of patients requiring evaluation for advanced therapies. The guidelines recommend routine imaging surveillance. In all patients undergoing evaluation with cardiac imaging, it is critical that studies are performed at centers with expertise and that the imaging protocols are tailored to the specific condition. The authors briefly highlight the utility and diagnostic yield of different modalities, review pertinent considerations for special populations, and focus on imaging for transplant planning.
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Affiliation(s)
- Valeria E Duarte
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin St, Smith Tower suite 1801, Houston, TX 77030, USA.
| | - Saurabh Rajpal
- Department of Cardiology, Division of Cardiovascular Medicine, The Ohio State University, 473 W 12th Avenue, Davis Heart and Lung Research Institute, Columbus, OH 43210, USA
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Greffier J, Pastor M, Si-Mohamed S, Goutain-Majorel C, Peudon-Balas A, Bensalah MZ, Frandon J, Beregi JP, Dabli D. Comparison of two deep-learning image reconstruction algorithms on cardiac CT images: A phantom study. Diagn Interv Imaging 2024; 105:110-117. [PMID: 37949769 DOI: 10.1016/j.diii.2023.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE The purpose of this study was to compare the performance of Precise IQ Engine (PIQE) and Advanced intelligent Clear-IQ Engine (AiCE) algorithms on image-quality according to the dose level in a cardiac computed tomography (CT) protocol. MATERIALS AND METHODS Acquisitions were performed using the CT ACR 464 phantom at three dose levels (volume CT dose indexes: 7.1/5.2/3.1 mGy) using a prospective cardiac CT protocol. Raw data were reconstructed using the three levels of AiCE and PIQE (Mild, Standard and Strong). The noise power spectrum (NPS) and task-based transfer function (TTF) for bone and acrylic inserts were computed. The detectability index (d') was computed to model the detectability of the coronary lumen (350 Hounsfield units and 4-mm diameter) and non-calcified plaque (40 Hounsfield units and 2-mm diameter). RESULTS Noise magnitude values were lower with PIQE than with AiCE (-13.4 ± 6.0 [standard deviation (SD)] % for Mild, -20.4 ± 4.0 [SD] % for Standard and -32.6 ± 2.6 [SD] % for Strong levels). The average NPS spatial frequencies shifted towards higher frequencies with PIQE than with AiCE (21.9 ± 3.5 [SD] % for Mild, 20.1 ± 3.0 [SD] % for Standard and 12.5 ± 3.5 [SD] % for Strong levels). The TTF values at fifty percent (f50) values shifted towards higher frequencies with PIQE than with AiCE for acrylic inserts but, for bone inserts, f50 values were found to be close. Whatever the dose and DLR level, d' values of both simulated cardiac lesions were higher with PIQE than with AiCE. For the simulated coronary lumen, d' values were better by 35.1 ± 9.3 (SD) % on average for all dose levels for Mild, 43.2 ± 5.0 (SD) % for Standard, and 62.6 ± 1.2 (SD) % for Strong levels. CONCLUSION Compared to AiCE, PIQE reduced noise, improved spatial resolution, noise texture and detectability of simulated cardiac lesions. PIQE seems to have a greater potential for dose reduction in cardiac CT acquisition.
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Affiliation(s)
- Joël Greffier
- IMAGINE UR UM 103, Montpellier University, Department of Medical Imaging, Nîmes University Hospital, 30029 Nîmes, France.
| | - Maxime Pastor
- IMAGINE UR UM 103, Montpellier University, Department of Medical Imaging, Nîmes University Hospital, 30029 Nîmes, France
| | - Salim Si-Mohamed
- University Lyon, INSA-Lyon, University Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69621, 69100 Villeurbanne, France; Department of Radiology, Louis Pradel Hospital, Hospices Civils de Lyon, 69500 Bron, France
| | | | - Aude Peudon-Balas
- Department of Medical Imaging, Centre Hospitalier de Perpignan, 66000 Perpignan, France
| | | | - Julien Frandon
- IMAGINE UR UM 103, Montpellier University, Department of Medical Imaging, Nîmes University Hospital, 30029 Nîmes, France
| | - Jean-Paul Beregi
- IMAGINE UR UM 103, Montpellier University, Department of Medical Imaging, Nîmes University Hospital, 30029 Nîmes, France
| | - Djamel Dabli
- IMAGINE UR UM 103, Montpellier University, Department of Medical Imaging, Nîmes University Hospital, 30029 Nîmes, France
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Longère B, Dacher JN. Enhancing cardiac CT imaging quality: Precision metrics for assessing image quality for AI-powered reconstructions. Diagn Interv Imaging 2024; 105:85-86. [PMID: 38052674 DOI: 10.1016/j.diii.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 11/24/2023] [Indexed: 12/07/2023]
Affiliation(s)
- Benjamin Longère
- CHU Lille, Department of Cardiothoracic Radiology, Univ. Lille, INSERM, Institut Pasteur Lille, U1011-European Genomic Institute for Diabetes (EGID), 59000 Lille, France.
| | - Jean-Nicolas Dacher
- Department of Radiology, Normandie University, UNIROUEN, INSERM U1096 - Rouen University Hospital, 76000 Rouen, France
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Schwartz MC, Alegria J, Paolillo J, Scherer M. Percutaneous Balloon Dilation of the Pulmonary Valve in a 79-Year-Old With Congenital Pulmonary Valve Stenosis. CASE (Phila) 2024; 8:193-196. [PMID: 38524995 PMCID: PMC10954575 DOI: 10.1016/j.case.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
•Congenital valvar PS is a rare cause of heart failure in the geriatric population. •Transcatheter PV dilation is an effective treatment of congenital PS in older adults. •Cardiac CT can be very useful in the evaluation of suspected valvar PS in adults.
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Affiliation(s)
- Matthew C. Schwartz
- Atrium Health, Sanger Heart and Vascular Institute, Charlotte, North Carolina
- Atrium Health, Congenital Heart Center, Levine Children's Hospital, Charlotte, North Carolina
| | - Jorge Alegria
- Atrium Health, Sanger Heart and Vascular Institute, Charlotte, North Carolina
| | - Joseph Paolillo
- Atrium Health, Sanger Heart and Vascular Institute, Charlotte, North Carolina
- Atrium Health, Congenital Heart Center, Levine Children's Hospital, Charlotte, North Carolina
| | - Markus Scherer
- Atrium Health, Sanger Heart and Vascular Institute, Charlotte, North Carolina
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Philippe D, Bernard A, Ricolfi F, Béjot Y, Duloquin G, Comby PO, Guenancia C. Prevalence of major embolic findings and incidental findings on early cardiac CT in patients with suspected ischemic stroke. Diagn Interv Imaging 2024:S2211-5684(24)00047-0. [PMID: 38431431 DOI: 10.1016/j.diii.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE The purpose of this study was to assess the type and prevalence of stroke and non-stroke-related findings diagnosed on early cardiac computed tomography (CT) in patients with suspected stroke. The secondary objective was to assess the clinical consequences on the management of patients with non-stroke-related conditions identified by early cardiac CT. MATERIALS AND METHODS This single-center, retrospective, observational study included 1111 consecutive patients with suspected ischemic stroke between November 2018 and March 2020 who underwent cardiac CT examination in addition to the usual brain CT protocol (i.e., non-enhanced brain CT, perfusion brain CT when needed, aortic arch and supra-aortic CT angiography, and post contrast brain CT). There were 562 women and 549 men with a median age of 74 years (range: 60-85 years). Of these, 415 (415/1111; 37.4%) patients had ischemic stroke and 692 (692/1111; 62.3%) had no stroke. Cardiac CT examinations were retrospectively reviewed for cardiac CT findings at high embolic risk and clinically significant extracardiac incidental findings. RESULTS Among 1111 included patients, 89 (89/1111; 8.0%) had a stroke-related condition identified on early cardiac CT. This was significantly more frequent in patients with ischemic stroke (66/415; 15.9%) by comparison with those without ischemic stroke (23/696; 3.3%) (P < 0.001), with 41 patients (41/415; 9.9%) diagnosed with left atrial thrombus. Cardiac CT revealed a clinically significant non-stroke-related finding in 173 patients (173/1111; 15.6%), including 17 pulmonary embolisms (1.5%), seven suspicious pulmonary lesions (0.6%), and three breast lesions suspected to be malignant (0.3%). Twenty out of 173 patients (20/173; 11.5%) with incidental findings on early cardiac CT had a change in their management. CONCLUSION This study shows that adding early cardiac CT to brain CT during the acute phase of an ischemic stroke leads to a higher rate of etiological diagnoses and highlights the major interest of looking at the bigger picture.
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Affiliation(s)
- Diane Philippe
- Department of Radiology, University Hospital, 21709 Dijon, France
| | | | - Frédéric Ricolfi
- Department of Radiology, University Hospital, 21709 Dijon, France
| | - Yannick Béjot
- PEC2 EA7460, Université de Bourgogne et de Franche-Comté, 21709 Dijon, France; Department of Neurology, University Hospital, 21709 Dijon, France
| | - Gauthier Duloquin
- PEC2 EA7460, Université de Bourgogne et de Franche-Comté, 21709 Dijon, France; Department of Neurology, University Hospital, 21709 Dijon, France
| | - Pierre-Olivier Comby
- Department of Radiology, University Hospital, 21709 Dijon, France; Department of Neurology, University Hospital, 21709 Dijon, France
| | - Charles Guenancia
- PEC2 EA7460, Université de Bourgogne et de Franche-Comté, 21709 Dijon, France; Department of Cardiology, University Hospital, 21709 Dijon, France.
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11
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Lee P, Dhillon G, Pourafkari M, DaBreo D, Jaff Z, Appireddy R, Jin A, Boissé Lomax L, Durafourt BA, Boyd JG, Nasirzadeh AR, Tampieri D, Jalini S. Non-ECG-gated cardiac CT angiography in acute stroke is feasible and detects sources of embolism. Int J Stroke 2024; 19:189-198. [PMID: 37515467 PMCID: PMC10811964 DOI: 10.1177/17474930231193335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/15/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND A significant portion of cryptogenic stroke is hypothesized to be secondary to cardiac embolism. However, transthoracic echocardiogram is usually delayed after stroke, and more detailed cardiac imaging is not routinely done. AIMS This study aimed to determine whether non-ECG-gated cardiac CT angiography (cCTA) during hyperacute stroke would provide diagnostic quality images and act as an adjunct modality of cardiac imaging to detect sources of emboli. METHODS In this single-center prospective cohort study, modified Code Stroke imaging was implemented with a 64-slice CT scanner, where the longitudinal axis of CT angiography was extended from the carina to the diaphragm. The primary outcomes of image quality, recruitment feasibility, impact on hyperacute time metrics, and additional radiation dose were assessed. Secondary outcomes consisted of detection of high-risk cardiac sources of embolism, mediastinal or lung pathology, and impact on etiologic classification. RESULTS One hundred and twenty eligible patients were enrolled, of which 105 (87.5%) had good/moderate quality images for motion artifact and 119 (99.2%) for contrast opacification. Total CT time, door-to-needle time, and door-to-groin puncture time were unchanged with the addition of cCTA. Eighty-nine patients received a final diagnosis of ischemic stroke, of which 12/89 (13.5%) had high-risk cardioembolic findings on cCTA. Incidental findings, such as pulmonary embolism (PE) (7/89, 7.9%) and malignancy (6/89, 6.7%), were observed. cCTA led to changes in management for 19/120 (15.8%) of all patients, and reclassification of stroke etiology for 8/89 (9%) of patients. CONCLUSIONS Non-ECG-gated cCTA can be feasibly incorporated into Code Stroke and provide diagnostic quality images without delays in hyperacute time metrics. It can detect high-risk cardiac sources, and other findings impacting patient care. This may help reclassify a subset of cryptogenic stroke cases and improve secondary prevention.
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Affiliation(s)
- Peter Lee
- School of Medicine, Queen’s University, Kingston, ON, Canada
| | - Gurmohan Dhillon
- Department of Radiology, Kingston Health Sciences Centre, Queen’s University, Kingston, ON, Canada
| | - Marina Pourafkari
- Department of Radiology, Kingston Health Sciences Centre, Queen’s University, Kingston, ON, Canada
| | - Dominique DaBreo
- Department of Radiology, Kingston Health Sciences Centre, Queen’s University, Kingston, ON, Canada
| | - Zardasht Jaff
- Division of Cardiology, Department of Medicine, Kingston Health Sciences Centre, Queen’s University, Kingston, ON, Canada
| | - Ramana Appireddy
- Division of Neurology, Department of Medicine, Kingston Health Sciences Centre, Queen’s University, Kingston, ON, Canada
| | - Albert Jin
- Division of Neurology, Department of Medicine, Kingston Health Sciences Centre, Queen’s University, Kingston, ON, Canada
| | - Lysa Boissé Lomax
- Division of Neurology, Department of Medicine, Kingston Health Sciences Centre, Queen’s University, Kingston, ON, Canada
| | - Bryce A Durafourt
- Division of Neurology, Department of Medicine, Kingston Health Sciences Centre, Queen’s University, Kingston, ON, Canada
| | - John Gordon Boyd
- Division of Neurology, Department of Medicine, Kingston Health Sciences Centre, Queen’s University, Kingston, ON, Canada
| | - Amir Reza Nasirzadeh
- Department of Radiology, Kingston Health Sciences Centre, Queen’s University, Kingston, ON, Canada
| | - Donatella Tampieri
- Department of Radiology, Kingston Health Sciences Centre, Queen’s University, Kingston, ON, Canada
| | - Shirin Jalini
- Division of Neurology, Department of Medicine, Kingston Health Sciences Centre, Queen’s University, Kingston, ON, Canada
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12
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Tomari S, Chew BLA, Soans B, Ai-Hadethi S, Ottavi T, Lillicrap T, Kashida YT, Ostman C, Levi CR, Parsons MW, Wu TY, Rinkel LA, Coutinho JM, Garcia-Esperon C, Spratt NJ. Role of cardiac computed tomography in hyperacute stroke assessment. J Stroke Cerebrovasc Dis 2024; 33:107470. [PMID: 38029458 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 11/01/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Incorporating cardiac CT with hyperacute stroke imaging may increase the yield for cardioembolic sources. It is not clarified whether stroke severity influences on rates of intracardiac thrombus. We aimed to investigate a National Institutes of Health Stroke Scale (NIHSS) threshold below which acute cardiac CT was unnecessary. METHODS Consecutive patients with suspected stroke who underwent multimodal brain imaging and concurrent non-gated cardiac CT with delayed timing were prospectively recruited from 1st December 2020 to 30th November 2021. We performed receiver operating characteristics analysis of the NIHSS and intracardiac thrombus on hyperacute cardiac CT. RESULTS A total of 314 patients were assessed (median age 69 years, 61% male). Final diagnoses were ischemic stroke (n=205; 132 etiology-confirmed stroke, independent of cardiac CT and 73 cryptogenic), transient ischemic attack (TIA) (n=21) and stroke-mimic syndromes (n=88). The total yield of cardiac CT was 8 intracardiac thrombus and 1 dissection. Cardiac CT identified an intracardiac thrombus in 6 (4.5%) with etiology-confirmed stroke, 2 (2.7%) with cryptogenic stroke, and none in patients with TIA or stroke-mimic. All of those with intracardiac thrombus had NIHSS ≥4 and this was the threshold below which hyperacute cardiac CT was not justified (sensitivity 100%, specificity 38%, positive predictive value 4.0%, negative predictive value 100%). CONCLUSIONS A cutoff NIHSS ≥4 may be useful to stratify patients for cardiac CT in the hyperacute stroke setting to optimize its diagnostic yield and reduce additional radiation exposure.
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Affiliation(s)
- Shinya Tomari
- Hunter Medical Research Institute, Newcastle, Australia.
| | | | - Barry Soans
- Department of Radiology, John Hunter Hospital, Newcastle, Australia
| | - Sinan Ai-Hadethi
- Department of Radiology, John Hunter Hospital, Newcastle, Australia
| | - Thomas Ottavi
- Department of Neurology, John Hunter Hospital, Newcastle, Australia
| | | | | | - Cecilia Ostman
- Department of Neurology, John Hunter Hospital, Newcastle, Australia
| | - Christopher R Levi
- Hunter Medical Research Institute, Newcastle, Australia; Department of Neurology, John Hunter Hospital, Newcastle, Australia; College of Health, Medicine, and Wellbeing, University of Newcastle, Newcastle, Australia
| | - Mark W Parsons
- College of Health, Medicine, and Wellbeing, University of Newcastle, Newcastle, Australia; University of New South Wales South, Western Sydney Clinical School, Ingham Institute for Applied Medical Research, Department of Neurology, Liverpool Hospital, Sydney, Australia
| | - Teddy Y Wu
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Leon A Rinkel
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; This study was performed at John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Carlos Garcia-Esperon
- Hunter Medical Research Institute, Newcastle, Australia; Department of Neurology, John Hunter Hospital, Newcastle, Australia; College of Health, Medicine, and Wellbeing, University of Newcastle, Newcastle, Australia.
| | - Neil J Spratt
- Hunter Medical Research Institute, Newcastle, Australia; Department of Neurology, John Hunter Hospital, Newcastle, Australia; College of Health, Medicine, and Wellbeing, University of Newcastle, Newcastle, Australia.
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13
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Passaniti G, Prandi FR, Sharma S, Kini A, Lerakis S. Echo HALT: do we really need a cardiac CT? Int J Cardiovasc Imaging 2024; 40:81-82. [PMID: 37983001 DOI: 10.1007/s10554-023-03009-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 11/21/2023]
Abstract
Leaflet thrombosis is usually an incidental finding and Cardiac CT is the gold standard for its diagnosis, but the classic features of hypoattenuation leaflet thickening (HALT) and hypoattenuation affecting motion (HAM) can also be seen on echocardiography and more specifically on trans-esophageal echocardiography. We describe a case of transcatheter aortic valve thrombosis where both the diagnosis and treatment were based exclusively on the echocardiographic evaluation, without the need of cardiac CT, with good outcome for the patient.
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Affiliation(s)
- Giulia Passaniti
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- CAST, Cardiology Division, A.U.O. Policlinico "G. Rodolico-San Marco", Catania, 95123, Italy
| | - Francesca Romana Prandi
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Tor Vergata University, Rome, 00133, Italy
| | - Samin Sharma
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Annapoorna Kini
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Stamatios Lerakis
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
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14
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Fabrizio R, Mascitti L, Furci C. An atypical case of iatrogenic LAD dissection following PCI: Diagnostic and management challenges. Radiol Case Rep 2024; 19:35-38. [PMID: 37886026 PMCID: PMC10598716 DOI: 10.1016/j.radcr.2023.09.085] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 09/23/2023] [Accepted: 09/26/2023] [Indexed: 10/28/2023] Open
Abstract
Iatrogenic coronary artery dissection is listed among the rare complications of interventional cardiology procedures, such as diagnostic angiography and percutaneous coronary intervention (PCI), which are worldwide routine in clinical practice. Although extremely infrequent, they can lead to severe myocardial injury and even to death. In the following case, we present an iatrogenic left anterior descending coronary artery (LAD) dissection, which led to an ischemic dilated cardiopathy. This case was radiologically and clinically worthy of note for the atypical site of dissection, the lack of symptoms although the ischemic damage and the global management requiring a multidisciplinary approach.
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Affiliation(s)
- Renato Fabrizio
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milano MI, Italy
| | - Laura Mascitti
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milano MI, Italy
| | - Carmela Furci
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milano MI, Italy
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15
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Aurigemma GP, Gentile BA, Dickey JB, Fitzgibbons TP, Tighe DA, Kakouros N, Kovell LC, Gottbrecht MF, Narvaez-Guerra O, Qureshi W, Gerson DS, Parker MW. Insights Into the Standard Echocardiographic Views From Multimodality Imaging: Ventricles, Pericardium, Valves, and Atria. J Am Soc Echocardiogr 2023; 36:1266-1289. [PMID: 37549797 DOI: 10.1016/j.echo.2023.07.011] [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: 12/17/2022] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/09/2023]
Abstract
The widespread use of cardiac computed tomography and cardiac magnetic resonance imaging in patients undergoing echocardiography presents an opportunity to correlate the images side by side. Accordingly, the aim of this report is to review aspects of the standard echocardiographic examination alongside similarly oriented images from the two tomographic imaging modalities. It is hoped that this exercise will enhance understanding of the structures depicted by echocardiography as they relate to other structures in the thorax. In addition to reviewing basic cardiac anatomy, the authors take advantage of these correlations with computed tomography and cardiac magnetic resonance imaging to better understand the issue of foreshortening, a common pitfall in transthoracic echocardiography. The authors also highlight an important role that three-dimensional echocardiography can potentially play in the future, especially as advances in image processing permit higher fidelity multiplanar reconstruction images.
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Affiliation(s)
- Gerard P Aurigemma
- Division of Cardiovascular Medicine, Department of Medicine, UMass Chan Medical School and UMass Memorial Healthcare, Worcester, Massachusetts.
| | - Bryon A Gentile
- Division of Cardiovascular Medicine, Department of Medicine, UMass Chan Medical School and UMass Memorial Healthcare, Worcester, Massachusetts
| | - John B Dickey
- Division of Cardiovascular Medicine, Department of Medicine, UMass Chan Medical School and UMass Memorial Healthcare, Worcester, Massachusetts
| | - Timothy P Fitzgibbons
- Division of Cardiovascular Medicine, Department of Medicine, UMass Chan Medical School and UMass Memorial Healthcare, Worcester, Massachusetts
| | - Dennis A Tighe
- Division of Cardiovascular Medicine, Department of Medicine, UMass Chan Medical School and UMass Memorial Healthcare, Worcester, Massachusetts
| | - Nikolaos Kakouros
- Division of Cardiovascular Medicine, Department of Medicine, UMass Chan Medical School and UMass Memorial Healthcare, Worcester, Massachusetts
| | - Lara C Kovell
- Division of Cardiovascular Medicine, Department of Medicine, UMass Chan Medical School and UMass Memorial Healthcare, Worcester, Massachusetts
| | - Matthew F Gottbrecht
- Division of Cardiovascular Medicine, Department of Medicine, UMass Chan Medical School and UMass Memorial Healthcare, Worcester, Massachusetts
| | - Offdan Narvaez-Guerra
- Division of Cardiovascular Medicine, Department of Medicine, UMass Chan Medical School and UMass Memorial Healthcare, Worcester, Massachusetts
| | - Waqas Qureshi
- Division of Cardiovascular Medicine, Department of Medicine, UMass Chan Medical School and UMass Memorial Healthcare, Worcester, Massachusetts
| | - David S Gerson
- Department of Radiology, UMass Chan Medical School and UMass Memorial Healthcare, Worcester, Massachusetts
| | - Matthew W Parker
- Division of Cardiovascular Medicine, Department of Medicine, UMass Chan Medical School and UMass Memorial Healthcare, Worcester, Massachusetts
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16
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Khan I, Berge CA, Eskerud I, Larsen TH, Pedersen ER, Lønnebakken MT. Epicardial adipose tissue volume, plaque vulnerability and myocardial ischemia in non-obstructive coronary artery disease. Int J Cardiol Heart Vasc 2023; 49:101240. [PMID: 38173787 PMCID: PMC10761305 DOI: 10.1016/j.ijcha.2023.101240] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/17/2023] [Accepted: 06/20/2023] [Indexed: 01/05/2024]
Abstract
Background Epicardial adipose tissue (EAT) accumulation has been associated with inflammation, atherosclerosis and microvascular dysfunction. Whether increased EAT volume is associated with coronary plaque vulnerability and demand myocardial ischemia in patients with non-obstructive coronary artery disease (CAD) is less explored. Methods In 125 patients (median age 63[58, 69] years and 58% women) with chest pain and non-obstructive CAD, EAT volume was quantified on non-contrast cardiac CT images. EAT volume in the highest tertile (>125 ml) was defined as high EAT volume. Total coronary plaque volume and plaque vulnerability were quantified by coronary CT angiography (CCTA). Demand myocardial ischemia was detected by contrast dobutamine stress echocardiography. Results High EAT volume was more common in men and associated with higher BMI, hypertension, increased left ventricular mass index (LVMi), C-reactive protein (CRP) and positive remodelling (all p < 0.05). There was no difference in age, coronary calcium score, total and non-calcified plaque volume or presence of demand myocardial ischemia between groups (all p ≥ 0.34). In a multivariable model, obesity (p = 0.006), hypertension (p = 0.007) and LVMi (p = 0.016) were independently associated with high EAT volume. Including plaque vulnerability in an alternative model, positive remodelling (p = 0.038) was independently associated with high EAT volume. Conclusion In non-obstructive CAD, high EAT volume was associated with cardiometabolic risk factors, inflammation and plaque vulnerability, while there was no association with demand myocardial ischemia or coronary plaque volume. Following our results, the role of EAT volume as a biomarker in non-obstructive CAD remains unclear.
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Affiliation(s)
- Ingela Khan
- Department of Clinical Science, University of Bergen, Jonas Lies veg 87, 5021 Bergen, Norway
| | - Caroline A. Berge
- Department of Clinical Science, University of Bergen, Jonas Lies veg 87, 5021 Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Haukelandsveien 22, 5021 Bergen, Norway
| | - Ingeborg Eskerud
- Department of Clinical Science, University of Bergen, Jonas Lies veg 87, 5021 Bergen, Norway
| | - Terje H. Larsen
- Department of Heart Disease, Haukeland University Hospital, Haukelandsveien 22, 5021 Bergen, Norway
- Institute of Biomedicine, University of Bergen, Jonas Lies vei 91, 5009 Bergen, Norway
| | - Eva R. Pedersen
- Department of Clinical Science, University of Bergen, Jonas Lies veg 87, 5021 Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Haukelandsveien 22, 5021 Bergen, Norway
| | - Mai Tone Lønnebakken
- Department of Clinical Science, University of Bergen, Jonas Lies veg 87, 5021 Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Haukelandsveien 22, 5021 Bergen, Norway
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17
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Prabhu N, Guile B, Tang M, Lee L, Landeras L, Lang RM, Sarswat N, Addetia K. Anomalous right coronary artery from the main pulmonary artery (ARCAPA): Incidental finding in an asymptomatic septuagenarian. Radiol Case Rep 2023; 18:3720-3723. [PMID: 37636543 PMCID: PMC10447924 DOI: 10.1016/j.radcr.2023.07.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 07/21/2023] [Accepted: 07/29/2023] [Indexed: 08/29/2023] Open
Abstract
Anomalous right coronary artery (RCA) from the main pulmonary artery (ARCAPA) is a rare finding. Clinical presentations range from asymptomatic to sudden death. We present the case of ARCAPA in a septuagenarian initially suspected on a screening chest computed tomography (CT) and later confirmed on cardiac CT. A summary of important points related to this entity is also discussed.
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Affiliation(s)
- Nicole Prabhu
- Heart & Vascular Center, University of Chicago Medicine, Chicago, IL, USA
| | - Brittney Guile
- Heart & Vascular Center, University of Chicago Medicine, Chicago, IL, USA
| | - Maxine Tang
- Heart & Vascular Center, University of Chicago Medicine, Chicago, IL, USA
| | - Linda Lee
- Heart & Vascular Center, University of Chicago Medicine, Chicago, IL, USA
| | - Luis Landeras
- Heart & Vascular Center, University of Chicago Medicine, Chicago, IL, USA
| | - Roberto M. Lang
- Heart & Vascular Center, University of Chicago Medicine, Chicago, IL, USA
| | - Nitasha Sarswat
- Heart & Vascular Center, University of Chicago Medicine, Chicago, IL, USA
| | - Karima Addetia
- Heart & Vascular Center, University of Chicago Medicine, Chicago, IL, USA
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18
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Yang E, Balkhy HH, Patel B, Cotella J, Landeras L, Addetia K, Slivnick JA. Cardiovascular computed tomography for the detection of quadricuspid aortic valve: A case report. Radiol Case Rep 2023; 18:3544-3548. [PMID: 37547798 PMCID: PMC10403715 DOI: 10.1016/j.radcr.2023.06.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/20/2023] [Accepted: 06/23/2023] [Indexed: 08/08/2023] Open
Abstract
Aortic regurgitation (AR) represents a significant cause of morbidity and mortality. Due to its low cost and widespread availability, echocardiography remains the frontline for aortic valve (AV) assessment. However, poor sonographic windows may limit the assessment of valve morphology with this technique. Cardiovascular computed tomography (CCT) is increasingly utilized prior to structural AV interventions. Due to its excellent spatial resolution, CCT provides exceptional characterization of aortic leaflets. Accordingly, we present a case of a quadricuspid valve diagnosed by CCT. Here, CCT led to a new diagnosis of quadricuspid valve, highlighting the potential for CCT for the characterization of aortic leaflet morphology. CCT may be particularly useful in patients with contraindications to transesophageal echocardiography or those undergoing structural or robotic interventions.
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19
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Devgun J, De Potter T, Fabbricatore D, Wang DD. Pre-cath Laboratory Planning for Left Atrial Appendage Occlusion - Optional or Essential? Card Electrophysiol Clin 2023; 15:141-150. [PMID: 37076226 DOI: 10.1016/j.ccep.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
In the wake of rapid advancement in cardiovascular procedural technologies, physician-led preprocedural planning utilizing multi-modality imaging training is increasingly recognized as invaluable for procedural accuracy. Left atrial appendage occlusion (LAAO) is one such procedure in which complications such as device leak, cardiac injury, and device embolization can be decreased substantially with incorporation of physician driven imaging and digital tools. We discuss the benefits of cardiac CT and 3D printing in preprocedural planning for the Heart Team, as well as novel applications by physicians of intraprocedural 3D angiography and dynamic fusion imaging. Furthermore, incorporation of computational modeling and artificial intelligence (AI) may yield promise. For optimal patient-centric procedural success, we advocate for standardized preprocedural imaging planning by physicians within the Heart Team as an essential part of LAAO.
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Affiliation(s)
- Jasneet Devgun
- Division of Cardiology, Henry Ford Health System, 2799 West Grand Boulevard, Clara Ford Pavilion, Detroit, MI 48202, USA
| | - Tom De Potter
- Cardiovascular Center, Onze-Lieve-Vrouwziekenhuis Hospital, Moorselbaan 164, Aalst 9300, Belgium
| | - Davide Fabbricatore
- Cardiovascular Center, Onze-Lieve-Vrouwziekenhuis Hospital, Moorselbaan 164, Aalst 9300, Belgium
| | - Dee Dee Wang
- Division of Cardiology, Henry Ford Health System, 2799 West Grand Boulevard, Clara Ford Pavilion, Detroit, MI 48202, USA.
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20
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Saeed S, Mohamed Ali A, Wasim D, Saeed N, Lunde T, Solheim E, Vegsundvåg J, Imazio M. Natural Course of Electrocardiogram Changes and the Value of Multimodality Imaging in Acute Pericarditis. Cardiology 2023; 148:219-227. [PMID: 36948161 DOI: 10.1159/000530207] [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: 08/21/2022] [Accepted: 03/14/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND ECG is the initial diagnostic tool that in combination with typical symptoms often raises the suspicion of pericarditis. Echocardiography remains the first-line imaging modality for assessment of pericardial diseases, particularly effusion/tamponade, constrictive physiology, and assessment of regional wall motion abnormalities as differential diagnoses. However, cardiac CT and cardiac magnetic resonance may be necessary in complicated cases and to identify pericardial inflammation in specific settings (atypical presentation, new onset constriction), as well as myocardial involvement and monitoring the disease activity. SUMMARY In acute pericarditis, the most commonly used ECG criteria recommended by international guidelines are the widespread ST-segment elevation or PR depression. However, the classic ECG pattern of widespread ST-segment elevation or PR depression can be seen in less than 60% of patients. In addition, ECG changes are often temporally dynamic, evolve rapidly during the course of disease, and may be influenced by a number of factors such as disease severity, time (stage) of presentation, degree of myocardial involvement, and the treatment initiated. Overall, temporal dynamic changes on ECG during acute pericarditis or myopericarditis have received limited attention. Hence, the aim of this brief clinical review was to increase awareness about the various ECG changes observed during the course of acute pericarditis. KEY MESSAGES ECG may be normal at presentation or for days after the index episode of chest pain, but serial ECGs can reveal specific patterns of temporally dynamic ST elevation in patients with pericarditis or myopericarditis, particularly during new episodes of chest pain.
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Affiliation(s)
- Sahrai Saeed
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Abukar Mohamed Ali
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Daanyaal Wasim
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Nasir Saeed
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Torbjørn Lunde
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Eivind Solheim
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | - Massimo Imazio
- Cardiology, Cardiothoracic Department, University Hospital "Santa Maria Della Misericordia", ASUFC, Udine, Italy
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Muñiz ÁM, Cecconi A, Avial MCM, Rico PF, Muñiz SH, Santin EM, Jimenez-Borreguero LJ, Alfonso F. Calretinin stain for the accurate diagnosis of atypical Cardiac Myxoma. Int J Cardiovasc Imaging 2023; 39:461-462. [PMID: 36394681 DOI: 10.1007/s10554-022-02725-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 08/31/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Álvaro Montes Muñiz
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP. Universidad Autónoma de Madrid, CIBER-CV, 28006, Madrid, Spain
| | - Alberto Cecconi
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP. Universidad Autónoma de Madrid, CIBER-CV, 28006, Madrid, Spain
| | - María Cristina Martínez Avial
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP. Universidad Autónoma de Madrid, CIBER-CV, 28006, Madrid, Spain
| | | | | | | | - Luis Jesus Jimenez-Borreguero
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP. Universidad Autónoma de Madrid, CIBER-CV, 28006, Madrid, Spain.
| | - Fernando Alfonso
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP. Universidad Autónoma de Madrid, CIBER-CV, 28006, Madrid, Spain
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22
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Zafar MR, Sharma A, Sunder SS, Karthikeyan B, Nagahama M, Atia A, Bahuva R, Pokharel S, Iyer V, Kattel S, Sharma UC. Left atrial appendage volume as a prognostic Indicator of long-term mortality in Cancer survivors treated with thoracic radiation. Cardiooncology 2023; 9:2. [PMID: 36641509 PMCID: PMC9840329 DOI: 10.1186/s40959-023-00155-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 01/09/2023] [Indexed: 01/16/2023]
Abstract
BACKGROUND Cancer survivors with prior chest radiation therapy (CXRT) frequently present with atrial fibrillation, heart failure, and have higher overall long-term mortality. There are no data examining the utility of left atrial (LA) and LA appendage (LAA) volume-indices to predict clinical outcomes in these patients. OBJECTIVES We examined the prognostic value of cardiac phase-dependent 3-D volume-rendered cardiac computerized tomography (CT)-derived LA and LAA volume-indices to predict mortality and major adverse cardiac events (MACE) in cancer survivors treated with thoracic irradiation. METHOD We screened 625 consecutive patients with severe aortic stenosis who had undergone transcatheter aortic valve replacement from 2012 to 2017. Based on the gated cardiac CT image quality, we included 184 patients (CXRT:43, non-CXRT:141) for further analysis. We utilized multiplane-3D-reconstructed cardiac CT images to calculate LA and LAA volume-indices, and examined the prognostic role of CCT-derived LA and LAA volume-indices in predicting the all-cause mortality, cardiovascular (CV) mortality, and MACE. We used multivariate cox-proportional hazard analysis to identify the clinical predictors of survival. RESULTS Overall, the CXRT group had significantly elevated LAA volume-index compared to non-CXRT group (CXRT:11.2 ± 8.9 ml/m2; non-CXRT:8.6 ± 4.5 ml/m2, p = 0.03). On multivariate cox-proportional hazard analysis, the elevated LAA volume and LAA volume-index were the strongest predictors of reduced survival in CXRT group compared to non-CXRT group (LAA volume: RR = 1.03,95% CI 1.0-1.01, p = 0.01; and LAA volume index: RR = 1.05, 95% CI 1.0-1.01, p = 0.03). LAA volume > 21.9 ml was associated with increased mortality. In contrast, LA volume was not a significant predictor of mortality. CONCLUSION We describe a novel technique to assess LA and LAA volume using 3-D volume-rendered cardiac CT. This study shows enlarged LAA volume rather than LA volume carries a poor prognosis in cancer-survivors treated with prior CXRT. Compared to conventionally reported markers, LAA volume of > 21.9 ml was incremental to that of other risk factors.
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Affiliation(s)
- Meer R. Zafar
- grid.273335.30000 0004 1936 9887Department of Medicine, Division of Cardiology, Jacob’s School of Medicine and Biomedical Sciences, Buffalo, NY USA
| | - Ashutosh Sharma
- grid.273335.30000 0004 1936 9887Department of Medicine, Division of Cardiology, Jacob’s School of Medicine and Biomedical Sciences, Buffalo, NY USA
- grid.425214.40000 0000 9963 6690Department of Medicine at the Icahn School of Medicine, Mount Sinai Health System, New York, NY USA
| | - Sunitha Shyam Sunder
- grid.273335.30000 0004 1936 9887Department of Medicine, Division of Cardiology, Jacob’s School of Medicine and Biomedical Sciences, Buffalo, NY USA
| | - Badri Karthikeyan
- grid.273335.30000 0004 1936 9887Department of Medicine, Division of Cardiology, Jacob’s School of Medicine and Biomedical Sciences, Buffalo, NY USA
| | - Makoto Nagahama
- grid.273335.30000 0004 1936 9887Department of Medicine, Division of Cardiology, Jacob’s School of Medicine and Biomedical Sciences, Buffalo, NY USA
- grid.415875.a0000 0004 0368 6175Division of Cardiology, Lehigh Valley Health Network, Allentown, PA USA
| | - Andrew Atia
- grid.273335.30000 0004 1936 9887Department of Medicine, Division of Cardiology, Jacob’s School of Medicine and Biomedical Sciences, Buffalo, NY USA
| | - Ronak Bahuva
- grid.273335.30000 0004 1936 9887Department of Medicine, Division of Cardiology, Jacob’s School of Medicine and Biomedical Sciences, Buffalo, NY USA
| | - Saraswati Pokharel
- grid.240614.50000 0001 2181 8635Department of Pathology and Laboratory Medicine, Roswell Park Comprehensive Cancer Centre, Buffalo, NY USA
| | - Vijay Iyer
- grid.273335.30000 0004 1936 9887Department of Medicine, Division of Cardiology, Jacob’s School of Medicine and Biomedical Sciences, Buffalo, NY USA
| | - Sharma Kattel
- grid.273335.30000 0004 1936 9887Department of Medicine, Division of Cardiology, Jacob’s School of Medicine and Biomedical Sciences, Buffalo, NY USA
- grid.47100.320000000419368710Department of Medicine, Division of Cardiology, Yale School of Medicine, New Haven, CT USA
| | - Umesh C. Sharma
- grid.273335.30000 0004 1936 9887Department of Medicine, Division of Cardiology, Jacob’s School of Medicine and Biomedical Sciences, Buffalo, NY USA
- Advanced Cardiovascular Imaging, Division of Cardiovascular Medicine, 875 Ellicott Street, Buffalo, New York, 14203 USA
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23
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Pack JD, Xu M, Wang G, Baskaran L, Min J, De Man B. Cardiac CT blooming artifacts: clinical significance, root causes and potential solutions. Vis Comput Ind Biomed Art 2022; 5:29. [PMID: 36484886 PMCID: PMC9733770 DOI: 10.1186/s42492-022-00125-0] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/03/2022] [Indexed: 12/13/2022] Open
Abstract
This review paper aims to summarize cardiac CT blooming artifacts, how they present clinically and what their root causes and potential solutions are. A literature survey was performed covering any publications with a specific interest in calcium blooming and stent blooming in cardiac CT. The claims from literature are compared and interpreted, aiming at narrowing down the root causes and most promising solutions for blooming artifacts. More than 30 journal publications were identified with specific relevance to blooming artifacts. The main reported causes of blooming artifacts are the partial volume effect, motion artifacts and beam hardening. The proposed solutions are classified as high-resolution CT hardware, high-resolution CT reconstruction, subtraction techniques and post-processing techniques, with a special emphasis on deep learning (DL) techniques. The partial volume effect is the leading cause of blooming artifacts. The partial volume effect can be minimized by increasing the CT spatial resolution through higher-resolution CT hardware or advanced high-resolution CT reconstruction. In addition, DL techniques have shown great promise to correct for blooming artifacts. A combination of these techniques could avoid repeat scans for subtraction techniques.
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Affiliation(s)
- Jed D. Pack
- grid.418143.b0000 0001 0943 0267GE Research, Niskayuna, NY 12309 USA
| | - Mufeng Xu
- grid.33647.350000 0001 2160 9198Rensselaer Polytechnic Institute, Troy, NY 12180 USA
| | - Ge Wang
- grid.33647.350000 0001 2160 9198Rensselaer Polytechnic Institute, Troy, NY 12180 USA
| | - Lohendran Baskaran
- grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY 10065 USA ,grid.419385.20000 0004 0620 9905National Heart Centre, Singapore, 169609 Singapore
| | - James Min
- grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY 10065 USA ,Cleerly, New York, NY 10065 USA
| | - Bruno De Man
- grid.418143.b0000 0001 0943 0267GE Research, Niskayuna, NY 12309 USA
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Ma J, Zheng Y, Xu S, Teng H, Lv L, Li Y, Liang Y, Zhang Y. The value of cardiac CT in the diagnosis of unroofed coronary sinus syndrome. BMC Cardiovasc Disord 2022; 22:516. [PMID: 36460953 PMCID: PMC9716674 DOI: 10.1186/s12872-022-02966-2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Unroofed coronary sinus syndrome (UCSS) is a rare cardiovascular malformation with nonspecific clinical manifestations that easily causes misdiagnosis and missed diagnosis. The aim of this study is to present the different features of UCSS by various CCT (cardiac CT) postprocessing techniques and evaluate the diagnostic advantages of CCT. METHODS 9 UCSS patients who were diagnosed by imaging and undergone both CCT and transthoracic echocardiography (TTE) were included in this study, and their CCT images were reviewed. The UCSS images were classified by multiplanar reformations, maximum intensity projection, volume rendering and cinematic rendering. The size of CS roof defect was also measured. RESULTS Only 4 of 9 CCT confirmed UCSS patients were detected by TTE (4/9, 44.4%), the sensitivity of TTE was lower compared to CCT by Fisher's exact test (P < 0.05). UCSS was classified according to the Kirklin and Barratt Boyes's method, including 1 case was classified as type I, 4 cases as type II, 1 case as type III, 2 cases as type IV, 1 case as type V (variant type), and TTE was undiagnosed in all type III-V patients. Additionally, CCT showed 12 extra malformations in these patients, only 5 of them were found by TTE (5/12, 41.7%), and TTE missed all extracardiac malformations. The mean size of CS roof defect was 3.04 ± 1.57 cm. CONCLUSIONS CCT with various postprocessing technologies has excellent value in diagnosing and differentiating subtypes of UCSS, measuring size of coronary sinus defect, describing accompanying cardiovascular abnormalities.
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Affiliation(s)
- Junqing Ma
- grid.452402.50000 0004 1808 3430Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Yongze Zheng
- grid.452402.50000 0004 1808 3430Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Sunan Xu
- grid.452402.50000 0004 1808 3430Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Hewei Teng
- grid.452402.50000 0004 1808 3430Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Lei Lv
- grid.452402.50000 0004 1808 3430Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Yanpei Li
- grid.452402.50000 0004 1808 3430Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Yongfeng Liang
- grid.452402.50000 0004 1808 3430Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Yang Zhang
- grid.452402.50000 0004 1808 3430Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
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Reyaldeen R, Kaur S, Krishnaswamy A, Ramchand J, Layoun H, Schoenhagen P, Miyasaka R, Unai S, Kapadia SR, Harb SC. Role of Cardiac Computed Tomography in Planning Transcatheter Mitral Valve Replacement (TMVR). Curr Cardiol Rep 2022; 24:1917-1932. [PMID: 36334213 DOI: 10.1007/s11886-022-01794-2] [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] [Accepted: 10/05/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE OF REVIEW Transcatheter mitral valve replacement (TMVR) is an evolving and rapidly expanding field within structural interventions, offering renewed treatment options for patients with high-risk mitral valve disease. We aim to highlight and illustrate the importance of cardiac CT in the planning of TMVR. RECENT FINDINGS As TMVR has evolved, so has the specific nuances of cardiac CT planning, we now understand the importance of accurate annular sizing and valve simulation to predict complications such as neo-LVOT obstruction and paravalvular leak (PVL). More so than any other modality, cardiac CT remains instrumental in accurately planning TVMR from feasibility, device sizing, access, and fluoroscopic angles. Cardiac CT remains the key modality in TMVR evaluation, often the first step in determining patient eligibility through comprehensive procedural planning as well as informing potential outcomes and prognosis. In this review, we discuss the critical role of cardiac computed tomography (CT) and the specific considerations involved in TMVR.
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Affiliation(s)
- Reza Reyaldeen
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Simrat Kaur
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Jay Ramchand
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Habib Layoun
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Paul Schoenhagen
- Department of Diagnostic Radiology, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Rhonda Miyasaka
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Shinya Unai
- Department of Thoracic and Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Serge C Harb
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.
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26
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Shaikh K, Ahmed A, Gransar H, Lee J, Leipsic J, Nakanishi R, Alla V, Bax JJ, Chow BJW, Berman DS, Maffei E, Lin FY, Ahmad A, DeLago A, Pontone G, Feuchtner G, Marques H, Min JK, Hausleiter J, Hadamitzky M, Kaufmann PA, de Araújo Gonçalves P, Cury RC, Kim YJ, Chang HJ, Rubinshtein R, Villines TC, Lu Y, Shaw LJ, Acenbach S, Al Mallah MH, Andreini D, Cademartiri F, Callister TQ, Budoff MJ. Extent of subclinical atherosclerosis on coronary computed tomography and impact of statins in patients with diabetes without known coronary artery disease: Results from CONFIRM registry. J Diabetes Complications 2022; 36:108309. [PMID: 36444796 DOI: 10.1016/j.jdiacomp.2022.108309] [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: 04/17/2022] [Revised: 09/06/2022] [Accepted: 09/13/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Absence of subclinical atherosclerosis is considered safe to defer statin therapy in general population. However, impact of statins on atherosclerotic cardiovascular disease in patients with diabetes stratified by coronary artery calcium (CAC) scores and extent of non-obstructive CAD on coronary computed tomography angiography (CCTA) has not been evaluated. METHODS CONFIRM (Coronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multi-center Registry) study enrolled consecutive adults 18 years of age between 2005 and 2009 who underwent 364-detector row CCTA for suspected CAD. The long-term registry includes data on 12,086 subjects who underwent CCTA at 17 centers in 9 countries. In this sub-study of CONFIRM registry, patients with diabetes mellitus (DM) and without diabetes mellitus with normal CCTA or non-obstructive plaque (<50 % diameter stenosis) for whom data on baseline statin use was available were included. CAC score was calculated using Agatston score. The magnitude of non-obstructive coronary artery disease on CCTA was quantified using segment involvement score (SIS). Primary outcome was major cardiovascular events (MACE) which included all-cause mortality, myocardial infarction, and target vessel re-vascularization. RESULTS A total of 7247 patients (Mean age 56.8 years) with a median follow up of 5 years were included. For DM patients, baseline statin therapy significantly reduced MACE for patients with CAC ≥100 (HR: 0.24; 95 % CI 0.07-0.87; p = 0.03) and SIS≥3 (HR: 0.23; 95 % CI 0.06-0.83; p = 0.024) compared to those not on statin therapy. Among Diabetics with lower CAC (<100) and SIS (≤3) scores, MACE was similar in statin and non-statin groups. In contrast, among non-DM patients, MACE was similar in statin and no statin groups irrespective of baseline CAC (1-99 or ≥100) and SIS. CONCLUSION In this large multicenter cohort of patients, the presence and extent of subclinical atherosclerosis as assessed by CAC and SIS identified patients most likely to derive benefit from statin therapy.
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Affiliation(s)
- Kashif Shaikh
- Lundquist Institute of Biomedical Sciences at Harbor-UCLA Medical Center, USA; University of Tennessee, Department of Medicine, Division of Cardiology, Knoxville, USA.
| | - Arslan Ahmed
- Creighton University Department of Medicine, Division of Cardiology, USA
| | - Heidi Gransar
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - JuHwan Lee
- CHA University Gumi CHA Hospital, South Korea
| | - Jonathon Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Rine Nakanishi
- Lundquist Institute of Biomedical Sciences at Harbor-UCLA Medical Center, USA
| | - Venkata Alla
- Creighton University Department of Medicine, Division of Cardiology, USA
| | - Jeroen J Bax
- Heart Center, University of Turku and Turku University Hospital, Turku, Finland
| | - Benjamin J W Chow
- Department of Medicine and Radiology, University of Ottawa, ON, Canada
| | - Daniel S Berman
- Creighton University Department of Medicine, Division of Cardiology, USA
| | - Erica Maffei
- Department of Radiology, Fondazione Monasterio/CNR, Pisa/Massa, Italy.
| | - Fay Y Lin
- Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Aiza Ahmad
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | | | | | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal
| | - James K Min
- Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Joerg Hausleiter
- Medizinische Klinik I der Ludwig-Maximilians-UniversitätMünchen, Munich, Germany
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital, Zurich, Switzerland; University of Zurich, Switzerland
| | | | - Ricardo C Cury
- Department of Radiology, Miami Cardiac and Vascular Institute, Miami, FL, USA
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Hyuk-Jae Chang
- Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Ronen Rubinshtein
- Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Todd C Villines
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Yao Lu
- Department of Healthcare Policy and Research, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Leslee J Shaw
- Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Stephen Acenbach
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nuremburg, Germany
| | - Mouaz H Al Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | | | | | | | - Matthew J Budoff
- Lundquist Institute of Biomedical Sciences at Harbor-UCLA Medical Center, USA
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Nirmal N, Hamilton M, Parry A, Spentzou G. Cardiac Strangulation by Epicardial Pacing Wires. Heart Lung Circ 2022; 31:e161-2. [PMID: 35985945 DOI: 10.1016/j.hlc.2022.05.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/24/2022] [Indexed: 01/27/2023]
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28
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Kaiser Y, van der Toorn JE, Singh SS, Zheng KH, Kavousi M, Sijbrands EJG, Stroes ESG, Vernooij MW, de Rijke YB, Boekholdt SM, Bos D. Lipoprotein(a) is associated with the onset but not the progression of aortic valve calcification. Eur Heart J 2022; 43:3960-3967. [PMID: 35869873 PMCID: PMC9840475 DOI: 10.1093/eurheartj/ehac377] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 05/10/2022] [Accepted: 06/30/2022] [Indexed: 01/19/2023] Open
Abstract
AIM Lipoprotein(a) [Lp(a)] is a potential causal factor in the pathogenesis of aortic valve disease. However, the relationship of Lp(a) with new onset and progression of aortic valve calcium (AVC) has not been studied. The purpose of the study was to assess whether high serum levels of Lp(a) are associated with AVC incidence and progression. METHODS AND RESULTS A total of 922 individuals from the population-based Rotterdam Study (mean age 66.0±4.2 years, 47.7% men), whose Lp(a) measurements were available, underwent non-enhanced cardiac computed tomography imaging at baseline and after a median follow-up of 14.0 [interquartile range (IQR) 13.9-14.2] years. New-onset AVC was defined as an AVC score >0 on the follow-up scan in the absence of AVC on the first scan. Progression was defined as the absolute difference in AVC score between the baseline and follow-up scan. Logistic and linear regression analyses were performed to evaluate the relationship of Lp(a) with baseline, new onset, and progression of AVC. All analyses were corrected for age, sex, body mass index, smoking, hypertension, dyslipidaemia, and creatinine. AVC progression was analysed conditional on baseline AVC score expressed as restricted cubic splines. Of the 702 individuals without AVC at baseline, 415 (59.1%) developed new-onset AVC on the follow-up scan. In those with baseline AVC, median annual progression was 13.5 (IQR = 5.2-37.8) Agatston units (AU). Lipoprotein(a) concentration was independently associated with baseline AVC [odds ratio (OR) 1.43 for each 50 mg/dL higher Lp(a); 95% confidence interval (CI) 1.15-1.79] and new-onset AVC (OR 1.30 for each 50 mg/dL higher Lp(a); 95% CI 1.02-1.65), but not with AVC progression (β: -71 AU for each 50 mg/dL higher Lp(a); 95% CI -117; 35). Only baseline AVC score was significantly associated with AVC progression (P < 0.001). CONCLUSION In the population-based Rotterdam Study, Lp(a) is robustly associated with baseline and new-onset AVC but not with AVC progression, suggesting that Lp(a)-lowering interventions may be most effective in pre-calcific stages of aortic valve disease.
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Affiliation(s)
- Yannick Kaiser
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands,Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Janine E van der Toorn
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands,Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sunny S Singh
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands,Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands,Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Kang H Zheng
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Eric J G Sijbrands
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Erik S G Stroes
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Meike W Vernooij
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Yolanda B de Rijke
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Daniel Bos
- Corresponding author. Tel: +31 10 44875, Fax: +31 10 70 44657,
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Saucedo-Orozco H, Torres IP, Vera SAC, Frausto AA, Godínez JAA, Guarner-Lans V, Rubio E, López MES. Correlation Between Cardiac Computed Tomography and Histopathology for Evaluating Patients with Aortic Valve Disease. Acad Radiol 2022; 29 Suppl 4:S25-S32. [PMID: 33455860 DOI: 10.1016/j.acra.2020.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND The use of cardiac computed tomography (cardiac CT) and the quantification of the Agatston score for the evaluation of calcium of the aortic valve (AVC) has increased in different clinical contexts for diagnostic and prognostic purposes. This study aims to evaluate the correlation between cardiac CT and histopathology for the quantification of AVC. METHODS Ninety patients diagnosed with severe aortic valve dysfunction, of any etiology and regardless of the predominant type of injury, were included. Before the surgical event, a Cardiac CT were performed with Agatston Score measurement. The removed native valve was evaluated by a Pathologist, who provided a qualitative and quantitative evaluation of valve calcium. Calcium density was also analyzed by quantifying the area in pixel units obtained from photomicrographs. Follow-up was performed for four years after the aortic valve replacement. RESULTS Ninety patients were analyzed. The degenerative etiology predominated 63.3% (57 patients). The calcium load was different for the gender (p = 0.01) and type of valve injury (p = 0.0013). There was a positive correlation between the Agatston score, and the percentage of calcium reported by the pathologist in a conventional qualitative way (rs = 0.75, p < 0.001) and between the AVC and the Cote et al. score (rs = 0.77, p < 0.001). There was no difference in survival after aortic valve replacement concerning valve calcium load. Left ventricular dysfunction showed a significant difference in survival (p = 0.003, Log-rank). CONCLUSION There is a moderately high correlation between the Agatston score quantified by Cardiac CT and the histopathological evaluation. The severity of the calcification did not prove to be a predictor of death in the postsurgical follow-up.
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Affiliation(s)
| | - Israel Pérez Torres
- Department of Cardiovascular Medicine, Instituto Nacional de Cardiología "Ignacio Chávez", México City, México
| | - Sergio Andrés Criales Vera
- Department of Computed Tomography, Instituto Nacional de Cardiología "Ignacio Chávez", México City, México
| | - Alberto Arana Frausto
- Department of Pathology, Instituto Nacional de Cardiología "Ignacio Chávez", México City, México
| | | | - Verónica Guarner-Lans
- Department of Physiology, Instituto Nacional de Cardiología "Ignacio Chávez", México City, México
| | - Esther Rubio
- Department of Physiology, Instituto Nacional de Cardiología "Ignacio Chávez", México City, México
| | - Maria Elena Soto López
- Department Immunology, Instituto Nacional de Cardiología "Ignacio Chávez", Juan Badiano 1, Col. Sección XVI, Del. Tlalpan, México City, 14080, México.
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Devgun J, De Potter T, Fabbricatore D, Wang DD. Pre-cath Laboratory Planning for Left Atrial Appendage Occlusion - Optional or Essential? Interv Cardiol Clin 2022; 11:143-152. [PMID: 35361459 DOI: 10.1016/j.iccl.2021.11.003] [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: 06/14/2023]
Abstract
In the wake of rapid advancement in cardiovascular procedural technologies, physician-led preprocedural planning utilizing multi-modality imaging training is increasingly recognized as invaluable for procedural accuracy. Left atrial appendage occlusion (LAAO) is one such procedure in which complications such as device leak, cardiac injury, and device embolization can be decreased substantially with incorporation of physician driven imaging and digital tools. We discuss the benefits of cardiac CT and 3D printing in preprocedural planning for the Heart Team, as well as novel applications by physicians of intraprocedural 3D angiography and dynamic fusion imaging. Furthermore, incorporation of computational modeling and artificial intelligence (AI) may yield promise. For optimal patient-centric procedural success, we advocate for standardized preprocedural imaging planning by physicians within the Heart Team as an essential part of LAAO.
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Affiliation(s)
- Jasneet Devgun
- Division of Cardiology, Henry Ford Health System, 2799 West Grand Boulevard, Clara Ford Pavilion, Detroit, MI 48202, USA
| | - Tom De Potter
- Cardiovascular Center, Onze-Lieve-Vrouwziekenhuis Hospital, Moorselbaan 164, Aalst 9300, Belgium
| | - Davide Fabbricatore
- Cardiovascular Center, Onze-Lieve-Vrouwziekenhuis Hospital, Moorselbaan 164, Aalst 9300, Belgium
| | - Dee Dee Wang
- Division of Cardiology, Henry Ford Health System, 2799 West Grand Boulevard, Clara Ford Pavilion, Detroit, MI 48202, USA.
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Andreini D, Conte E, Mushtaq S, Magatelli M, Traversari F, Gigante C, Belmonte M, Gaudenzi-Asinelli M, Annoni A, Formenti A, Mancini ME, Guglielmo M, Baggiano A, Melotti E, Muscogiuri G, Rondinelli M, Pontone G, Bartorelli AL, Pepi M, Genovese S. Plaque assessment by coronary CT angiography may predict cardiac events in high risk and very high risk diabetic patients: A long-term follow-up study. Nutr Metab Cardiovasc Dis 2022; 32:586-595. [PMID: 35109998 DOI: 10.1016/j.numecd.2021.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 06/14/2021] [Revised: 11/04/2021] [Accepted: 11/23/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS The aim of the present study is to evaluate whether advanced coronary atherosclerosis analysis by CCTA may improve prognostic stratification among diabetic patients at high cardiovascular risk (CV risk). METHODS AND RESULTS The study population consisted of 265 consecutive diabetic patients at high CV risk who underwent CCTA for suspected CAD between January 2011 and December 2016. For every patients both traditional and advanced, qualitative and quantitative coronary plaque analysis were performed. The occurrence of cardiac death, ACS, and non-urgent revascularization were recorded at follow-up. Among the 265 patients enrolled, 21 were lost to follow-up, whereas 244 (92%) had a complete follow-up (mean 45 ± 22 months) and were classified at high (n = 67) or very high cardiovascular risk (n = 177), according to ESC Guidelines. A total of 63 events were recorded (3 Cardiac Death, 3 NSTEMI, 8 unstable angina, 36 late non-urgent revascularization and 13 non-cardiac death) in 57 different patients. Elevated fibro-fatty plaque volume was the only predictor of events over age, gender and traditional risk factor when ACS and MACE were considered as end-points [HR (95% CI) 6.01 (1.65-21.87), p = 0.006 and 3.46 (2.00-5.97); p < 0.001]. CONCLUSION The present study confirms the prognostic role of advance coronary atherosclerosis evaluation beyond risk factors and stenosis severity, even in diabetics. Despite the very high cardiovascular risk of study population, a not negligible portion (23%) of patients exhibited totally normal coronaries.
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Affiliation(s)
- Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy.
| | | | | | - Marco Magatelli
- Cardiology Division, Castiglione delle Siviere Hospital, Mantova, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
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Gartenberg AJ, Glatz AC, Nunes M, Griffin L, Rigsby CK, Armstrong AK, Casey SA, Witt DR, Schmidt CW, Lesser J, Han BK. Variation in Advanced Diagnostic Imaging Practice Patterns and Associated Risks Prior to Superior Cavopulmonary Connection: A Multicenter Analysis. Pediatr Cardiol 2022; 43:497-507. [PMID: 34812909 DOI: 10.1007/s00246-021-02746-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/29/2021] [Indexed: 10/19/2022]
Abstract
Single ventricle patients typically undergo some form of advanced diagnostic imaging prior to superior cavopulmonary connection (SCPC). We sought to evaluate variability of diagnostic practice and associated comprehensive risk. A retrospective evaluation across 4 institutions was performed (1/1/2010-9/30/2016) comparing the primary modalities of cardiac catheterization (CC), cardiac magnetic resonance (CMR), and cardiac computed tomography (CT). Associated risks included anesthesia/sedation, vascular access, total room time, contrast agent usage, radiation exposure, and adverse events (AEs). Of 617 patients undergoing SCPC, 409 (66%) underwent at least one advanced diagnostic imaging study in the 60 days prior to surgery. Seventy-eight of these patients (13%) were analyzed separately because of a concomitant cardiac intervention during CC. Of 331 (54%) with advanced imaging and without catheterization intervention, diagnostic CC was most common (59%), followed by CT (27%) and CMR (14%). Primary modality varied significantly by institution (p < 0.001). Median time between imaging and SCPC was 13 days (IQR 3-33). Anesthesia/sedation varied significantly (p < 0.001). Pre-procedural vascular access did not vary significantly across modalities (p = 0.111); procedural access varied between CMR/CT and CC, in which central access was used in all procedures. Effective radiation dose was significantly higher for CC than CT (p < 0.001). AE rate varied significantly, with 12% CC, 6% CMR, and 1% CT (p = 0.004). There is significant practice variability in the use of advanced diagnostic imaging prior to SCPC, with important differences in associated procedural risk. Future studies to identify differences in diagnostic accuracy and long-term outcomes are warranted to optimize diagnostic protocols.
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Karmally S, Pancholy B, Lau R, Raparia K, Pursnani S. IgG4-related disease: Coronary arteritis masquerading as coronary "masses". J Cardiovasc Comput Tomogr 2022; 16:e29-e30. [PMID: 35027285 DOI: 10.1016/j.jcct.2021.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 10/19/2022]
Affiliation(s)
| | | | - Richard Lau
- Kaiser Permanente, Santa Clara, California, USA.
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Xu Y, Sushmit A, Lyu Q, Li Y, Cao X, Maltz JS, Wang G, Yu H. Cardiac CT motion artifact grading via semi-automatic labeling and vessel tracking using synthetic image-augmented training data. J Xray Sci Technol 2022; 30:433-445. [PMID: 35342075 DOI: 10.3233/xst-211109] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Cardiac CT provides critical information for the evaluation of cardiovascular diseases. However, involuntary patient motion and physiological movement of the organs during CT scanning cause motion blur in the reconstructed CT images, degrading both cardiac CT image quality and its diagnostic value. In this paper, we propose and demonstrate an effective and efficient method for CT coronary angiography image quality grading via semi-automatic labeling and vessel tracking. These algorithms produce scores that accord with those of expert readers to within 0.85 points on a 5-point scale. We also train a neural network model to perform fully-automatic motion artifact grading. We demonstrate, using XCAT simulation tools to generate realistic phantom CT data, that supplementing clinical data with synthetic data improves the scoring performance of this network. With respect to ground truth scores assigned by expert operators, the mean square error of grading motion of the right coronary artery is reduced by 36% by synthetic data supplementation. This demonstrates that augmentation of clinical training data with realistically synthesized images can potentially reduce the number of clinical studies needed to train the network.
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Affiliation(s)
- Yongshun Xu
- Department of Electrical and Computer Engineering, University of Massachusetts Lowell, Lowell, MA, USA
| | - Asif Sushmit
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Qing Lyu
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Ying Li
- Molecular Imaging and Computed Tomography, GE Healthcare, 3000 N Grandview Boulevard, Waukesha, WI, USA
| | - Ximiao Cao
- Molecular Imaging and Computed Tomography, GE Healthcare, 3000 N Grandview Boulevard, Waukesha, WI, USA
| | - Jonathan S Maltz
- Molecular Imaging and Computed Tomography, GE Healthcare, 3000 N Grandview Boulevard, Waukesha, WI, USA
- Molecular Biophysics and Integrated Bioimaging, Lawrence Berkeley National Laboratory, University of California, Berkeley, CA, USA
| | - Ge Wang
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Hengyong Yu
- Department of Electrical and Computer Engineering, University of Massachusetts Lowell, Lowell, MA, USA
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Conte E, Carbucicchio C, Catto V, Kochi AN, Mushtaq S, De Iuliis PG, Guglielmo M, Baggiano A, Sattin T, Pontone G, Pepi M, Tondo C, Andreini D. Live integration of comprehensive cardiac CT with electroanatomical mapping in patients with refractory ventricular tachycardia. J Cardiovasc Comput Tomogr 2021; 16:262-265. [PMID: 34991995 DOI: 10.1016/j.jcct.2021.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/13/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Aim of the present study was to verify the feasibility and accuracy of live integration of myocardial fibrosis evaluated at CCT with EAM (electro-anatomical mapping). METHODS We prospectively enrolled a consecutive cohort of patients with clinical indication to EAM before radiofrequency catheter ablation (RFCA) of refractory ventricular tachycardia (VT) and an absolute contraindication to cardiac magnetic resonance. All patients underwent per protocol CCT for myocardial fibrosis and coronary anatomy evaluation. Diagnostic performance was assessed for myocardial fibrosis evaluation with CCT vs EAM. Live integration feasibility of CCT vs EAM was evaluated for every patients. RESULTS A total of 19 patients were included in the present study with 323 myocardial segments analyzed for myocardial fibrosis at CCT. In all patients CCT data were successfully integrated with EAM during RFCA procedure. All patients had myocardial fibrosis correctly identified at CCT vs EAM on a per-patients basis. A diagnostic accuracy on a per-segment basis of 94.1% for detection of any type of myocardial fibrosis at CCT vs EAM was recorded. CONCLUSIONS CCT identification of myocardial fibrosis is feasible and accurate vs EAM in a very selected high risk patients with clinical indication to RFCA of VT and contraindication to CMR.
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Affiliation(s)
- Edoardo Conte
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | | | | | | | | | | | - Andrea Baggiano
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | | | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Claudio Tondo
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy.
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Saengsin K, Pickard SS, Prakash A. Utility of cardiac CT in infants with congenital heart disease: Diagnostic performance and impact on management. J Cardiovasc Comput Tomogr 2021; 16:345-349. [PMID: 34949532 DOI: 10.1016/j.jcct.2021.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 08/13/2021] [Revised: 10/24/2021] [Accepted: 12/13/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Advances in cardiac CT (CCT) scanner technology allow imaging without anesthesia, and with low radiation dose, making it an attractive technique in infants with congenital heart disease. However, the utility of CCT using a dual-source scanner with respect to diagnostic performance and impact on management has not been systematically studied in this population. METHODS Retrospective review of infants who underwent CCT to determine the utility of CCT with respect to the following: answering the primary diagnostic question, providing new diagnostic information, prompting a change in management, and concordance with catheterization or surgical inspection. RESULTS A total of 156 infants underwent 172 scans at a median age of 64 days, (IQR 4-188) from Jan 2016-Dec 2019. The most frequent diagnostic question was related to the pulmonary arteries (43%), followed by the aortic arch (30%), pulmonary veins (26%), coronary arteries (17%), patent ductus arteriosus (10%) and others (9%). A high-pitch spiral scan was frequently used (90%). The median effective radiation dose was low (0.66 mSv) and general anesthesia was used infrequently (23%). CCT answered the primary diagnostic question in 168/172 (98%) and added to the diagnostic information already available by echocardiography in 161/172 (96%) scans. CCT led to a change in management following 78/172 (53%) scans and had an impact on management following 167/172 (97%) scans. On follow-up, after 107/172 (62%) scans, subjects underwent cardiac surgery, and after 55/172 (32%) scans, they had cardiac catheterization. CCT findings were concordant with catheterization and/or surgical inspection in 156/159 (98%) scans. CONCLUSIONS In infants with complex congenital heart disease, CCT was accurate, answered the diagnostic questions in nearly all cases, and frequently added diagnostic information that impacted management. Radiation exposure was low, and anesthesia was needed infrequently.
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Affiliation(s)
| | - Sarah S Pickard
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Ashwin Prakash
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
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Blaha MJ, Dzaye O. Subthreshold coronary artery calcium - Redefining the coronary artery calcium score of zero? J Cardiovasc Comput Tomogr 2021; 16:155-157. [PMID: 34862148 DOI: 10.1016/j.jcct.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, USA.
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, USA
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Ozden Tok Ö, Ikonomidis I, Papadopoulos K, Göktekin Ö, Bingöl G, Di Salvo G. High take off left main coronary artery accompanied by multicryptic left ventricle myocardium detected by cardiac computerized tomography in a young male: case report. BMC Cardiovasc Disord 2021; 21:557. [PMID: 34800981 PMCID: PMC8605532 DOI: 10.1186/s12872-021-02341-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 10/22/2021] [Indexed: 11/29/2022] Open
Abstract
Background Myocardial crypts are discrete, narrow, blood filled invaginations within the left ventricular myocardium and high-take-off coronary artery are rare manifestations where coronary arteries originate above the sinotubuler junction. Case presentation A 41-year-old man with multiple coronary artery disease risk factors admitted to our outpatient department with progressive dyspnea and atypical chest pain. Physical examination revealed no pathological findings. His blood examination revealed only mild to moderately high IgE and LDL levels. Transthoracic echocardiography (TTE) was normal. His treadmill test was normal, yet in the 3rd stage of the test he had an atypically located chest pain which was relieved in the resting period. As he had multiple cardiovascular risk factors, we performed a coronary CT angiography to exclude coronary artery disease. Coronary CT angiography(CCTA) demonstrated multiple myocardial crypts, a muscular VSD like defect which were not detectable with TTE and a high take off left main coronary artery (LMCA). After CCTA, we repeated the TTE to investigate the crypts and VSD-like defect which were clear on CCTA, yet a precise TTE hardly showed crypts and didn’t confirm a shunt between the left and right ventricle. We defined the defect as ‘spontaneously closed muscular VSD’. None of these pathologies were clinically relevant with the patient’s symptoms, thus pneumonology started a montelukast therapy for 1 year and we decided to follow up the patient, as multiple crypts may indicate an early phase hypertrophic cardiomyopathy. Conclusions Considering that a high take-off LMCA is a congenital anomaly, encountering multiple crypts which are also congenital pathologies, is plausible, as congenital anomalies may accompany eachother. Echocardiography is a very useful, practical imaging tool but regrettably may be suboptimal due to various patient and method related reasons. Target combination of different cardiovascular imaging tools like echocardiography, cardiac CT(CCT), may be utilized in order to ensure a comprehensive diagnosis particularly.
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Affiliation(s)
- Özge Ozden Tok
- Cardiology Department, Memorial Bahcelievler Hospital, Istanbul, Turkey
| | - Ignatios Ikonomidis
- Echocardiography Laboratory, 2nd Cardiology Department, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Konstantinos Papadopoulos
- Echocardiography Laboratory, European Interbalkan Medical Center, Asklypiou 10 str, 57001, Pylaia, Thessaloniki, Greece.
| | - Ömer Göktekin
- Cardiology Department, Memorial Bahcelievler Hospital, Istanbul, Turkey
| | - Gülsüm Bingöl
- Cardiology Department, Memorial Bahcelievler Hospital, Istanbul, Turkey
| | - Giovanni Di Salvo
- Department of Pediatric Cardiology, University of Padova, Padua, Italy
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Siddamsetti S, Kumar S, Gautam S. Incidentally detected accessory left atrial appendage in a patient being planned for left atrial appendage closure. HeartRhythm Case Rep 2021; 7:709-11. [PMID: 34712572 DOI: 10.1016/j.hrcr.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Tridandapani S, Banait-Deshmane S, Aziz MU, Bhatti P, Singh SP. Coronary computed tomographic angiography: A review of the techniques, protocols, pitfalls, and radiation dose. J Med Imaging Radiat Sci 2021; 52:S1-S11. [PMID: 34565701 DOI: 10.1016/j.jmir.2021.08.014] [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: 05/17/2021] [Revised: 08/13/2021] [Accepted: 08/28/2021] [Indexed: 11/26/2022]
Abstract
Coronary computed tomographic angiography (CCTA) is a viable alternative to catheter coronary angiography for several clinical indications, chiefly because it is fast and non-invasive. For effective clinical use of CCTA, various technical and patient factors should be considered. In this brief review article, we discuss the indication and contraindications for CCTA, technical requirements for CCTA including radiation dose, patient preparation principles, image post-processing, and pitfalls and artifacts of CCTA.
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Affiliation(s)
- Srini Tridandapani
- Department of Radiology, University of Alabama, Birmingham, AL, USA; School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA.
| | | | | | - Pamela Bhatti
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Satinder P Singh
- Department of Radiology, University of Alabama, Birmingham, AL, USA
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Goo HW. Imaging Findings of Coronary Artery Fistula in Children: A Pictorial Review. Korean J Radiol 2021; 22:2062-2072. [PMID: 34564965 PMCID: PMC8628148 DOI: 10.3348/kjr.2021.0336] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/09/2021] [Accepted: 07/21/2021] [Indexed: 11/25/2022] Open
Abstract
Coronary artery fistula, defined as an abnormal communication between the coronary arteries and a cardiac chamber (most commonly) or a thoracic great vessel, may result in hemodynamically significant problems due to vascular shunting in children. Echocardiography, cardiac catheterization, cardiac MRI, and cardiac CT may be used to evaluate coronary artery fistula in children. Recently, CT has played a pivotal role for the accurate diagnosis of coronary artery fistula in children. Surgical or interventional treatment is performed for hemodynamically significant coronary artery fistulas. In this pictorial review, the detailed imaging findings of coronary artery fistula in children are described.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Baş S, Alkara U, Aliyev B. Evaluation of complex congenital heart disease with prospective ECG-gated cardiac CT in a single heartbeat at low tube voltage (70 kV) and adaptive statistical iterative reconstruction in infants: a single center experience. Int J Cardiovasc Imaging 2021; 38:413-422. [PMID: 34487310 DOI: 10.1007/s10554-021-02390-1] [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: 07/18/2021] [Accepted: 08/21/2021] [Indexed: 10/20/2022]
Abstract
The purpose of this study is to evaluate the radiation dose, image quality, and diagnostic accuracy of prospective ECG-gated cardiac CT at 70 kV and adaptive statistical iterative reconstruction (ASIR), with a single source, 512 slice MDCT in the diagnosis of complex congenital heart disease in infants. We retrospectively evaluated 47 infants (ages 1 day to 353 days) with prospective ECG-gated cardiac CT that was performed on a single source 512 slice CT at low tube voltage (70 kV) using a wide detector aperture, adaptive statistical iterative reconstruction algorithm (ASIR), and specific reconstruction software reducing coronary motion artifacts (SnapShot Freeze). All cardiac images were obtained during the first pass of contrast material through the anatomic structures of interest and the targets for the center of the acquisition window were set 45% of the R-R interval during one cardiac cycle without sedation and breath-hold. The median effective dose measured in our study was 0.64 ± 0.16 mSv. The average subjective overall image quality score was 4.34 ± 0.31 (range 3-5). For the determination of objective image quality, Mean Noise (HU), SNR, and CNR values emerged as 20.8, 28.7(for pulmonary artery), and 27.1, respectively. Diagnostic accuracy was 100% for the main purposes for the main clinical indication. During cardiac CT examination, pathologies in addition to cardiac anomalies were found in 9/47 of cases (7 severe airway obstructions,1 posterior diaphragmatic hernia, 1 vertebral anomaly). Prospective ECG-gated cardiac CT scan at 70 kV and ASIR in infants with complex CHD provides low radiation dose (submillisievert) in a single heartbeat with a good objective and subjective image quality. It also provides important benefits in the diagnosis of additional pathology.
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Affiliation(s)
- Serap Baş
- Gaziosmanpaşa Hospital, Department of Radiology, Istanbul Yeni Yuzyil University, Merkez Mah. Çukurçeşme Cad. No:51 Gaziosmapaşa, 34245, Istanbul, Turkey.
| | - Utku Alkara
- Gaziosmanpaşa Hospital, Department of Radiology, Istanbul Yeni Yuzyil University, Merkez Mah. Çukurçeşme Cad. No:51 Gaziosmapaşa, 34245, Istanbul, Turkey
| | - Bahruz Aliyev
- Gaziosmanpaşa Hospital, Department of Pediatric Cardiology, Istanbul Yeni Yuzyil University, Istanbul, Turkey
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Nagpal P, Siembida JM, Nagle SK, Priya S. Left ventricular assist device pseudo-thrombosis due to use of metal artifact reduction algorithm on cardiac CT. J Cardiovasc Comput Tomogr 2021:S1934-5925(21)00417-2. [PMID: 34483066 DOI: 10.1016/j.jcct.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 11/23/2022]
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Asadian S, Rezaeian N, Hosseini L, Toloueitabar Y, Hemmati Komasi MM. The role of cardiac CT and MRI in the diagnosis and management of primary cardiac lymphoma: A comprehensive review. Trends Cardiovasc Med 2021; 32:408-420. [PMID: 34454052 DOI: 10.1016/j.tcm.2021.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/05/2021] [Accepted: 08/20/2021] [Indexed: 12/18/2022]
Abstract
Primary cardiac tumors comprise a distinct category of disorders that result in significant cardiac complications. Primary cardiac lymphomas (PCLs) constitute the second most frequent primary malignancy involving the heart. Without treatment, survival may be limited to just a few months; however, a timely therapeutic schedule may prolong the five-year survival. Accordingly, robust diagnostic modalities are essential to improve prognosis. We herein review the literature available in PubMed, MEDLINE, Cochrane, Google Scholar and Scopus databases. Our review demonstrated that cardiac computed tomography (CT) and magnetic resonance imaging (MRI) employ multiple advanced sequences for tumor characterization with or without a contrast agent. These methods assist not only in differentiating PCLs from other cardiac masses such as cardiac thrombi but also in defining the extent of PCLs and conducting a safe biopsy. Cardiac magnetic resonance (CMR) and CT imaging provide essential knowledge regarding PCLs and cardiotoxicity induced by therapeutic regimens. The application of these robust imaging modalities aids in the early diagnosis of PCLs, accelerates the initiation of the treatment program, and improves patient outcomes significantly. Also presented is our introduction into novel techniques and the feasibility of their use to diagnose and treat cardiac masses, particularly PCLs. It should be mentioned that the paramount role of FDG-PET was not the focus of this paper.
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Affiliation(s)
- Sanaz Asadian
- Rajaie Cardiovascular Medical and Research Center, Tehran, Iran
| | - Nahid Rezaeian
- Rajaie Cardiovascular Medical and Research Center, Tehran, Iran.
| | - Leila Hosseini
- Rajaie Cardiovascular Medical and Research Center, Tehran, Iran
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Madigan CG, Adams MB, Chu CC, Dinkha LR, Farrell SJ, Hoard RT, Keithler AN, Loudermilk KA, Rouse J, Walker BL, Williams SG, Wyatt AC, Gore RS, Thomas DM. Comparing downstream consequences of normal exercise stress echocardiograms and cardiac computed tomography angiography scans in patients suspected of having of obstructive coronary artery disease: a retrospective cohort study of Tricare beneficiaries. Int J Cardiovasc Imaging 2021; 37:3583-3588. [PMID: 34357521 PMCID: PMC8604872 DOI: 10.1007/s10554-021-02343-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 07/05/2021] [Indexed: 11/25/2022]
Abstract
To compare overall number of downstream tests and total costs between negative exercise stress echocardiograms (ESE) or cardiac computed tomography angiography scans (CCTA) in symptomatic Tricare beneficiaries suspected of having coronary artery disease (CAD). This is a retrospective cohort study examining 651 propensity-matched patients who underwent ESE or CCTA with normal results between 2008 and 2014 at the United States’ largest Department of Defense hospital. The total number of additional downstream tests over the next five years was determined. The total costs associated with each arm, inclusive of the initial test and all subsequent tests, were calculated using the 2018 Medicare Physician Fee Schedule. 18.5 percent of patients with a normal ESE result underwent some additional form of cardiac testing over the five years after initial testing compared to 12.8 percent of patients with a normal CCTA. The absolute difference in total number of downstream tests between both study groups was 5.7 percent (p = 0.03). When factoring the costs of the initial test as well as the downstream tests, the ESE group was associated with overall lower costs compared to the CCTA group, 351 United States Dollars (USD) versus 496 USD (p < 0.0001). This study demonstrates that, when compared to CCTA, ESE is associated with a higher total number of downstream tests, but overall lower total costs when chosen as initial testing strategy for suspected CAD.
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Affiliation(s)
- Cory G Madigan
- Department of Cardiology, Brooke Army Medical Center, San Antonio, TX, USA.
| | - Michael B Adams
- Department of Cardiology, Brooke Army Medical Center, San Antonio, TX, USA
| | - Chu-Chiao Chu
- Department of Cardiology, Brooke Army Medical Center, San Antonio, TX, USA
| | - Laith R Dinkha
- Department of Cardiology, Brooke Army Medical Center, San Antonio, TX, USA
| | - Samuel J Farrell
- Department of Cardiology, Brooke Army Medical Center, San Antonio, TX, USA
| | - Robert T Hoard
- Department of Cardiology, Brooke Army Medical Center, San Antonio, TX, USA
| | - Andrea N Keithler
- Department of Cardiology, Brooke Army Medical Center, San Antonio, TX, USA
| | - Kevin A Loudermilk
- Department of Cardiology, Brooke Army Medical Center, San Antonio, TX, USA
| | - Jessica Rouse
- Department of Cardiology, Brooke Army Medical Center, San Antonio, TX, USA
| | - Brandon L Walker
- Department of Cardiology, Brooke Army Medical Center, San Antonio, TX, USA
| | - Susan G Williams
- Department of Cardiology, Brooke Army Medical Center, San Antonio, TX, USA
| | - Andrew C Wyatt
- Department of Cardiology, Brooke Army Medical Center, San Antonio, TX, USA
| | - Rosco S Gore
- Department of Cardiology, Brooke Army Medical Center, San Antonio, TX, USA
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Zorzi A, Brunetti G, Cardaioli F, D'Arcangelo F, Fabris T, Gambato M, Iliceto S, Martini A, Mattesi G, Peluso C, Polacco M, Sartori C, Lorenzoni G, Feltracco P, Angeli P, Burra P, Cillo U, Pontisso P. Coronary artery calcium on standard chest computed tomography predicts cardiovascular events after liver transplantation. Int J Cardiol 2021; 339:219-224. [PMID: 34181996 DOI: 10.1016/j.ijcard.2021.06.046] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/16/2021] [Accepted: 06/23/2021] [Indexed: 11/24/2022]
Abstract
AIMS Cardiac complications are a leading cause of mortality after orthotopic liver transplantation (LT) and pre-operative risk stratification is challenging. We evaluated whether coronary artery calcium (CAC) score calculated on a standard (non-thin layer, non-ECG gated) chest computed tomography (CT) predicted cardiac outcome after LT. METHODS We included a consecutive series of LT recipients who underwent pre-operative cardiac evaluation including stress-testing or cardiac catheterization in high-risk patients. Patients with a history of coronary artery disease or coronary revascularization were excluded. The CAC score was calculated from the chest CT routinely performed before LT. CAC values were not available at the time of pre-transplant cardiac evaluation and did not affect LT eligibility. The primary end-point included peri-operative arrhythmic cardiac arrest and sustained ventricular arrhythmias; heart failure, myocardial infarction and cardiac death within 1-year after LT. RESULTS The study population consisted of 301 patients (median age 56 years, 76% males). At chest CT, 49% had CAC = 0; 27% had CAC = 1-99, 15% had CAC = 100-399 and 9% CAC > 400. The primary end-point incidence increased from 7% in patients with CAC = 0 to 27% in patients with CAC > 400 (p = 0.007). At multivariable analysis including traditional risk factors, CAC remained an independent predictor of cardiac events (p = 0.01). CONCLUSIONS CAC score calculated on a standard chest CT stratified the risk of cardiac events in patients who underwent LT after negative pre-transplant cardiac evaluation. These findings suggest that evaluation of CAC from a standard chest CT performed for other reasons can be used as an early cardiac risk stratification tool before LT.
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Affiliation(s)
- Alessandro Zorzi
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy.
| | - Giulia Brunetti
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy.
| | - Francesco Cardaioli
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy.
| | - Francesca D'Arcangelo
- Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Italy.
| | - Tommaso Fabris
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy.
| | - Martina Gambato
- Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Italy.
| | - Sabino Iliceto
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy.
| | - Andrea Martini
- Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Italy.
| | - Giulia Mattesi
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy.
| | - Claudia Peluso
- Hepatobiliary Surgery and Liver Transplant Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Italy.
| | - Marina Polacco
- Hepatobiliary Surgery and Liver Transplant Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Italy.
| | - Chiara Sartori
- Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Italy.
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy.
| | - Paolo Feltracco
- Unit of Anestestesiology and Intensive Care in Complex Surgery and Transplants, Department of Medicine, University of Padova, Italy.
| | - Paolo Angeli
- Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Italy.
| | - Patrizia Burra
- Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Italy.
| | - Umberto Cillo
- Hepatobiliary Surgery and Liver Transplant Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Italy.
| | - Patrizia Pontisso
- Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Italy.
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Reyaldeen R, Tong MZY, Lo Presti S, Krishnaswamy A, Wittry MD, Harb SC. Multi-modality imaging and 3D printing to facilitate the management of complex, recurrent infarct VSD. J Cardiovasc Comput Tomogr 2021:S1934-5925(21)00083-6. [PMID: 34130929 DOI: 10.1016/j.jcct.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/29/2021] [Accepted: 06/03/2021] [Indexed: 11/21/2022]
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Budoff MJ, Bhatt DL, Kinninger A, Lakshmanan S, Muhlestein JB, Le VT, May HT, Shaikh K, Shekar C, Roy SK, Tayek J, Nelson JR. Effect of icosapent ethyl on progression of coronary atherosclerosis in patients with elevated triglycerides on statin therapy: final results of the EVAPORATE trial. Eur Heart J 2021; 41:3925-3932. [PMID: 32860032 PMCID: PMC7654934 DOI: 10.1093/eurheartj/ehaa652] [Citation(s) in RCA: 228] [Impact Index Per Article: 76.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/10/2020] [Accepted: 07/29/2020] [Indexed: 01/09/2023] Open
Abstract
Aims Despite the effects of statins in reducing cardiovascular events and slowing progression of coronary atherosclerosis, significant cardiovascular (CV) risk remains. Icosapent ethyl (IPE), a highly purified eicosapentaenoic acid ethyl ester, added to a statin was shown to reduce initial CV events by 25% and total CV events by 32% in the REDUCE-IT trial, with the mechanisms of benefit not yet fully explained. The EVAPORATE trial sought to determine whether IPE 4 g/day, as an adjunct to diet and statin therapy, would result in a greater change from baseline in plaque volume, measured by serial multidetector computed tomography (MDCT), than placebo in statin-treated patients. Methods and results A total of 80 patients were enrolled in this randomized, double-blind, placebo-controlled trial. Patients had to have coronary atherosclerosis as documented by MDCT (one or more angiographic stenoses with ≥20% narrowing), be on statin therapy, and have persistently elevated triglyceride (TG) levels. Patients underwent an interim scan at 9 months and a final scan at 18 months with coronary computed tomographic angiography. The pre-specified primary endpoint was change in low-attenuation plaque (LAP) volume at 18 months between IPE and placebo groups. Baseline demographics, vitals, and laboratory results were not significantly different between the IPE and placebo groups; the median TG level was 259.1 ± 78.1 mg/dL. There was a significant reduction in the primary endpoint as IPE reduced LAP plaque volume by 17%, while in the placebo group LAP plaque volume more than doubled (+109%) (P = 0.0061). There were significant differences in rates of progression between IPE and placebo at study end involving other plaque volumes including fibrous, and fibrofatty (FF) plaque volumes which regressed in the IPE group and progressed in the placebo group (P < 0.01 for all). When further adjusted for age, sex, diabetes status, hypertension, and baseline TG, plaque volume changes between groups remained significantly different, P < 0.01. Only dense calcium did not show a significant difference between groups in multivariable modelling (P = 0.053). Conclusions Icosapent ethyl demonstrated significant regression of LAP volume on MDCT compared with placebo over 18 months. EVAPORATE provides important mechanistic data on plaque characteristics that may have relevance to the REDUCE-IT results and clinical use of IPE.
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Affiliation(s)
- Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA 90502, USA
| | - Deepak L Bhatt
- Department of Medicine, Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA, USA
| | - April Kinninger
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA 90502, USA
| | - Suvasini Lakshmanan
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA 90502, USA
| | - Joseph B Muhlestein
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT, USA
| | - Viet T Le
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT, USA.,Department of Medicine, Rocky Mountain University of Health Profession, Provo, UT, USA
| | - Heidi T May
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT, USA
| | - Kashif Shaikh
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA 90502, USA
| | - Chandana Shekar
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA 90502, USA
| | - Sion K Roy
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA 90502, USA
| | - John Tayek
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA 90502, USA
| | - John R Nelson
- California Cardiovascular Institute, Fresno, CA, USA
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Courand PY, Bozio A, Ninet J, Boussel L, Bakloul M, Galoin-Bertail C, Metton O, Mitchell J, de Montclos TP, Walton C, Di Filippo S. Diagnosis and treatment of anomalous aortic origin of coronary artery: A twenty-year retrospective study of experience and decision-making in children and young adults. Int J Cardiol 2021; 337:54-61. [PMID: 33945804 DOI: 10.1016/j.ijcard.2021.04.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/27/2020] [Revised: 04/24/2021] [Accepted: 04/29/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND Anomalous aortic origin of a coronary artery, particularly in the presence of inter-arterial course between the great arteries, has been found to be associated with sudden death in young people. METHODS This study reports a single-center experience in the management of anomalous aortic origin of a coronary artery, with or without inter-arterial course, by focusing specifically on presentation, diagnosis, and patient outcome. RESULTS From March 1993 to February 2018, 100 patients (70 males) were diagnosed with anomalous aortic origin of a coronary artery, including 27 left coronary artery from the right sinus, 60 right coronary artery from the left sinus, and 13 other anomalies. Patients with inter-arterial course between the great arteries presented more frequently with syncope and/or sudden death compared to patients without (23.4% vs. 0%, p = 0.026). Diagnosis was reached using first-line transthoracic echocardiography in 65% of cases. Surgical repair was performed in 61 patients (61%). All operated patients (60 direct implantations, 1 unroofing) had been diagnosed with inter-arterial course between the great arteries, and were asymptomatic at a mean (±SD) postoperative follow-up of 4.9 ± 5.3 years. CONCLUSIONS An inter-arterial course of the anomalous right or left coronary arteries arising from the opposite sinus is associated with life-threatening events. Direct reimplantation of coronary artery is reliable, and should be discussed even in asymptomatic patients.
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Affiliation(s)
- Pierre-Yves Courand
- Fédération de cardiologie, Hôpital de la Croix-Rousse et Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France; Université de Lyon, CREATIS, CNRS UMR5220, INSERM U1044, INSA-Lyon, Université Claude Bernard Lyon 1, France
| | - Andre Bozio
- Service de cardiologie congénitale, Hôpital Louis Pradel, Hospices civils de Lyon, 69317 Lyon cedex 04, France; Université Claude Bernard Lyon I, 69677 Lyon, France
| | - Jean Ninet
- Service de chirurgie cardiaque, Hôpital Louis Pradel Hospices civils de Lyon, 69317 Lyon cedex 04, France
| | - Loic Boussel
- Service de radiologie, Hôpital de la Croix-Rousse, Hospices civils de Lyon, 69317 Lyon cedex 04, France
| | - Mohamed Bakloul
- Service de cardiologie congénitale, Hôpital Louis Pradel, Hospices civils de Lyon, 69317 Lyon cedex 04, France; Université Claude Bernard Lyon I, 69677 Lyon, France
| | - Claire Galoin-Bertail
- Service de cardiologie congénitale, Hôpital Louis Pradel, Hospices civils de Lyon, 69317 Lyon cedex 04, France; Université Claude Bernard Lyon I, 69677 Lyon, France
| | - Olivier Metton
- Service de chirurgie cardiaque, Hôpital Louis Pradel Hospices civils de Lyon, 69317 Lyon cedex 04, France
| | - Julia Mitchell
- Service de chirurgie cardiaque, Hôpital Louis Pradel Hospices civils de Lyon, 69317 Lyon cedex 04, France
| | - Thomas Perouse de Montclos
- Service de cardiologie congénitale, Hôpital Louis Pradel, Hospices civils de Lyon, 69317 Lyon cedex 04, France; Université Claude Bernard Lyon I, 69677 Lyon, France
| | - Camille Walton
- Service de cardiologie congénitale, Hôpital Louis Pradel, Hospices civils de Lyon, 69317 Lyon cedex 04, France; Université Claude Bernard Lyon I, 69677 Lyon, France
| | - Sylvie Di Filippo
- Service de cardiologie congénitale, Hôpital Louis Pradel, Hospices civils de Lyon, 69317 Lyon cedex 04, France; Université Claude Bernard Lyon I, 69677 Lyon, France.
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Hassan AY, Kassem HH, Kandil HI, Meshaal MS, Salem MA, Mohamed AS. Impact of Cardiac Computed Tomographic Angiography on Diagnostic and Therapeutic Decisions in Patients with Suspected Prosthetic Heart Valve Dysfunction. J Saudi Heart Assoc 2021; 33:85-94. [PMID: 33936942 PMCID: PMC8084306 DOI: 10.37616/2212-5043.1231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction Computed Tomography (CT) scan is a helpful tool to assess the coronary arteries and the great vessels. However, its routine use in the assessment of patients with suspected prosthetic valve dysfunction (PVD) has not been studied thoroughly. Objective To determine the impact of routine cardiac computed tomography angiography (CCTA) on diagnostic and therapeutic decisions in patients with suspected PVD. Methods and results This was a prospective cohort study that was conducted on 50 consecutive patients with suspected PVD who underwent both 64-slice ECG-gated CT and transesophageal echocardiography (TEE). The gold standard was the intraoperative findings. Surgery was performed in forty-six patients. ECG-gated CT showed findings that were not detected by TEE in sixteen patients (32%) namely aortic root abscess, aortic pseudoaneurysm, paravalvular leakage (PVL), sclero-calcific disruption of sutures as cause of PVL, mechanical prosthesis occluder malfunction, an underlying thrombus as cause of malfunction and finally presence of aortic dissection. Furthermore, CTA findings dictated treatment changes in fourteen patients (28%). Conclusion This study demonstrates that ECG-gated CTA has a complementary role to TEE in patients with suspected PVD. CCTA is more accurate in diagnosis of periannular complications (Aortic root abscess and Pseudo-aneurysm) and in delineating their anatomical relation to surrounding cardiac structures. Therefore CCTA can have important role in deciding and planning the method of correction whether surgical or percutaneous and has to be considered after TEE in patients with a high suspicion on PVD.
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