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Cheng Z, Zhang H, Pu J, Schoenhagen P, Zhao L, Qiao H, Yang B, Wu W, Zhang C, Wang R, Liu Y, Ma X. Impact on early outcome after endovascular repair of type B dissection without proximal landing zone using Castor single-branched stent graft-a retrospective cohort study. Cardiovasc Diagn Ther 2024; 14:18-28. [PMID: 38434554 PMCID: PMC10904308 DOI: 10.21037/cdt-23-379] [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: 09/18/2023] [Accepted: 01/05/2024] [Indexed: 03/05/2024]
Abstract
Background The early safety and efficacy of Castor branch stents have been demonstrated. However, the effect of aortic arch morphology on endovascular therapy remains an unresolved issue. This study aims to assess the impact of aortic arch morphology on the early outcomes of endovascular repair using Castor stent graft in patients who have acute type B aortic dissection involving the left subclavian artery (LSA). Methods This is a retrospective cohort study. From January 2019 to December 2021, forty-one patients scheduled for thoracic endovascular aortic repair (TEVAR) of TBADs from Beijing Anzhen Hospital were enrolled in this retrospective cohort study and divided into two groups based on the length of the proximal landing zone left common carotid artery-LSA (PLZ LCCA-LSA), specifically the distance between the LCCA and the LSA (group A ≤10 mm and group B >10 mm). The study recorded technical success, mortality and aortic-related post-operative adverse events. Morphological indices were analyzed including the bird-beak configuration. The bird-beak configuration refers to the wedge-shaped gap between the undersurface of the endograft and the lesser curvature of the arch. The relationship between the risk of bird-beak configuration and PLZ was assessed with logistic regression analysis. Meanwhile, the relationship between the risk of aortic-related adverse events and bird-beak configuration was assessed with logistic regression analysis. Follow-up data were analyzed by Kaplan-Meier life table analysis. Results The study included 41 patients with a mean age of 63.1±9.2 years, of which 80.5% were male. 18 patients from group A and 23 patients from group B were included in the comparative analysis. There were no significant differences in aortic-related adverse events, bird-beak phenomenon and re-intervention between groups A and B in 30-day outcomes. Six-month outcomes: aortic-related adverse events and the bird-beak phenomenon were observed in 11 (26.8%) and 12 (29.3%) patients, respectively. There was a significant difference in the occurrence of aortic-related adverse events (P=0.036) and bird-beak phenomenon (P=0.002) between groups A and B. In comparison to group B, the aortic-related adverse event rate was significantly higher in group A, with event-free rates of 83.3%, 83.3%, and 72.2% at 1, 3, and 6 months, respectively (P=0.020). Multivariable logistic regression analyses revealed that PLZ LCCA-LSA length [odds ratio (OR) 0.79; 95% CI: 0.64 to 0.97; P=0.026] was significantly associated with the occurrence of the bird-beak configuration, and bird-beak (OR 17.19; 95% CI: 2.24 to 131.81; P=0.006) was a significant risk factor for aortic-related adverse events. Conclusions TEVAR with LSA revascularization has good early outcomes. However, it is more susceptible to aortic adverse events when the PLZ LCCA-LSA is less than 10 mm in length. This should be carefully considered, taking into account the risks and benefits.
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Affiliation(s)
- Zhang Cheng
- Department of Interventional Diagnosis and Treatment, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hongbo Zhang
- Department of Interventional Diagnosis and Treatment, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Junzhou Pu
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Paul Schoenhagen
- Cardiovascular Imaging, Miller Pavilion Desk J1-4, Cleveland Clinic, Cleveland, OH, USA
| | - Lei Zhao
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Huanyu Qiao
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Bo Yang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wenhui Wu
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chen Zhang
- Department of Interventional Diagnosis and Treatment, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ruihai Wang
- Department of Surgery, Tangshan Workers Hospital, Tangshan, China
| | - Yongmin Liu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaohai Ma
- Department of Interventional Diagnosis and Treatment, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Zhang H, Tian J, Zhang C, Wang H, Hui K, Wang T, Chai S, Schoenhagen P, Zhao L, Ma X. Discrimination models with radiomics features derived from cardiovascular magnetic resonance images for distinguishing hypertensive heart disease from hypertrophic cardiomyopathy. Cardiovasc Diagn Ther 2024; 14:129-142. [PMID: 38434569 PMCID: PMC10904305 DOI: 10.21037/cdt-23-350] [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: 08/21/2023] [Accepted: 12/01/2023] [Indexed: 03/05/2024]
Abstract
Background Discriminating hypertrophic cardiomyopathy (HCM) and hypertensive heart disease (HHD) is challenging, because both are characterized by left ventricular hypertrophy (LVH). Radiomics might be effective to differentiate HHD from HCM. Therefore, this study aimed to investigate discriminators and build discrimination models between HHD and HCM using multiparametric cardiac magnetic resonance (CMR) findings and radiomics score (radscore) derived from late gadolinium enhancement (LGE) and cine images. Methods In this single center, retrospective study, 421 HCM patients [median and interquartile range (IQR), 50.0 (38.0-59.0) years; male, 70.5%] from January 2017 to September 2021 and 200 HHD patients [median and IQR, 44.5 (35.0-57.0) years; male, 88.5%] from September 2015 to July 2022 were consecutively included and randomly stratified into a training group and a validation group at a ratio of 6:4. Multiparametric CMR findings were obtained using cvi42 software and radiomics features using Python software. After dimensional reduction, the radscore was calculated by summing the remaining radiomics features weighted by their coefficients. Multiparametric CMR findings and radscore that were statistically significant in univariate logistic regression were used to build combined discrimination models via multivariate logistic regression. Results After multivariate logistic regression, the maximal left ventricular end diastolic wall thickness (LVEDWT), left ventricular ejection fraction (LVEF), presence of LGE, cine radscore and LGE radscore were identified as significant characteristics and used to build a combined discrimination model. This model achieved an area under the receiver operator characteristic curve (AUC) of 0.979 (0.968-0.990) in the training group and 0.981 (0.967-0.995) in the validation group, significantly better than the model using multiparametric CMR findings alone (P<0.001). Conclusions Radiomics features derived from cardiac cine and LGE images can effectively discriminate HHD from HCM.
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Affiliation(s)
- Hongbo Zhang
- Department of Interventional Diagnosis and Treatment, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jie Tian
- Department of Interventional Diagnosis and Treatment, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chen Zhang
- Department of Interventional Diagnosis and Treatment, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Haoru Wang
- Department of Radiology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Keyao Hui
- Department of Interventional Diagnosis and Treatment, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Tongming Wang
- School of Automation, Beijing Institute of Technology, Beijing, China
| | - Senchun Chai
- School of Automation, Beijing Institute of Technology, Beijing, China
| | - Paul Schoenhagen
- Cardiovascular Imaging, Miller Pavilion Desk J1-4, Cleveland Clinic, Cleveland, OH, USA
| | - Lei Zhao
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaohai Ma
- Department of Interventional Diagnosis and Treatment, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Ali AH, Nakhla M, Cho L, Seballos R, Lang R, Feinleib S, Flamm S, Schoenhagen P, Wang T, Desai MY. Use of Coronary Artery Calcium Quantification and Distribution for Coronary Vascular Disease Risk Reclassification in a Primary Prevention Setting. Am J Cardiol 2023; 206:303-308. [PMID: 37722228 DOI: 10.1016/j.amjcard.2023.08.054] [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: 07/15/2023] [Revised: 08/06/2023] [Accepted: 08/13/2023] [Indexed: 09/20/2023]
Abstract
In a large screening program of asymptomatic middle-aged individuals, we sought to assess the degree of risk reclassification provided by comparing multiethnic study on subclinical atherosclerosis coronary artery calcium scoring (CACS) versus atherosclerotic cardiovascular disease (ASCVD) and Reynolds risk score (RRS) score. All 5,324 consecutive patients (aged 57 ± 8 years, 76% male) who underwent CACS screening at the Cleveland Clinic as part of a primary prevention executive health between March 16 and October 21 were included. The 10-year ASCVD, RRS, and multiethnic study on subclinical atherosclerosis CACS (MESA-CACS) risk scores were calculated and categorized as <1, 1 to 4.99, 5 to 9.99, and ≥10%. Compared with ASCVD, using MESA-CACS resulted in a downgraded risk in 1,667 subjects (31%), whereas 738 (14%) had an upgrade in risk (total of 45% reclassification). Similarly, compared with RRS, using MESA-CACS resulted in an upgraded risk in 797 (15%) and a downgrade in 1,380 (26%) subjects (total of 41% reclassification). However, by further dividing by the distribution of the coronary calcification, ASCVD overestimates the risk only for patients with coronary artery calcium (CAC) in 0 or 1 coronary artery only, whereas MESA-CACS overestimates if the CAC was noted in ≥2 arteries. Similarly, RRS only overestimates the risk for patients with 0 CAC, whereas it underestimates the risk for patients with any CAC. In conclusion, the use of MESA-CACS, along with CAC distribution in primary prevention clinics, results in differential and significant reclassification of traditional scores when calculating the 10-years coronary vascular disease risk. Overall, RRS underestimates and ASCVD overestimates the cardiovascular disease risk compared with MESA-CACS.
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Affiliation(s)
- Adel Hajj Ali
- Heart Vascular Thoracic Institute (HVTI), Cleveland Clinic, Cleveland, Ohio
| | - Michael Nakhla
- Heart Vascular Thoracic Institute (HVTI), Cleveland Clinic, Cleveland, Ohio
| | - Leslie Cho
- Heart Vascular Thoracic Institute (HVTI), Cleveland Clinic, Cleveland, Ohio
| | - Raul Seballos
- Heart Vascular Thoracic Institute (HVTI), Cleveland Clinic, Cleveland, Ohio
| | - Richard Lang
- Heart Vascular Thoracic Institute (HVTI), Cleveland Clinic, Cleveland, Ohio
| | - Steve Feinleib
- Heart Vascular Thoracic Institute (HVTI), Cleveland Clinic, Cleveland, Ohio
| | - Scott Flamm
- Heart Vascular Thoracic Institute (HVTI), Cleveland Clinic, Cleveland, Ohio
| | - Paul Schoenhagen
- Heart Vascular Thoracic Institute (HVTI), Cleveland Clinic, Cleveland, Ohio
| | - Tom Wang
- Heart Vascular Thoracic Institute (HVTI), Cleveland Clinic, Cleveland, Ohio
| | - Milind Y Desai
- Heart Vascular Thoracic Institute (HVTI), Cleveland Clinic, Cleveland, Ohio.
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Chen PH, Nakamura K, Obuchowski N, Juan MCY, Zhang S, Flamm SD, Desai MY, Hovest T, Meese T, Schoenhagen P. Identification of acute aortic syndromes based on cross-sectional variability of Hounsfield units. Int J Cardiol 2023; 382:91-95. [PMID: 37080465 DOI: 10.1016/j.ijcard.2023.04.028] [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: 03/07/2023] [Accepted: 04/17/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND A characteristic feature of communicating aortic dissections (CD) is the dissection flap between the true and false lumen. However, in intramural hematomas (IMH) a flap is not visible. We aimed to determine if cross-sectional HU variability allow reliable identification of aortic dissections including IMH. METHODS We included 362 patients presenting with acute chest pain (CP) or respiratory distress (RD) and underwent contrast-enhanced CTA with or without ECG-gating. In the derivation group we included 72 CP patients with and 74 without AAS. In the validation group we included 108 CP or RD patients with and 108 without AAS. The adventitial border of the aorta was visually identified and measurements were performed at 6 locations along the ascending and descending aorta. At each cross-section 5 circular ROI measurements of HU were made and the maximum HU difference calculated. RESULTS In the derivation and validation group the maximum difference in HUs at any one location was significantly higher for AAS subjects than controls (validation group: median = 128.5 vs. 34.0, p-value Wilcoxon two-sample test <0.001). In the validation group, the estimated AUC was 0.939 with 95% CIs of [0.906, 0.972], indicating that the maximum difference in HUs is a strong predictor of AAS (p < 0.001). CONCLUSION Our data provide evidence that cross-sectional variability of Hounsfield Unit reliably identifies aortic dissection including IMH in dedicated ECG-gated aorta scans but also non-gated chest CTs with limited aortic contrast enhancement. These results suggest that this approach could be feasible for an automated algorithm for identification of AAS.
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Affiliation(s)
- Po-Hao Chen
- Cleveland Clinic, Imaging Institute, Cleveland, OH, USA
| | - Kunio Nakamura
- Cleveland Clinic, Department of Biomedical Engineering, Cleveland, OH, USA
| | - Nancy Obuchowski
- Cleveland Clinic, Department of Quantitative Health Sciences, Cleveland, OH, USA
| | | | | | - Scott D Flamm
- Cleveland Clinic, Imaging Institute, Cleveland, OH, USA; Cleveland Clinic, Heart, Vascular & Thoracic Institute, Cleveland, OH, USA
| | - Milind Y Desai
- Cleveland Clinic, Imaging Institute, Cleveland, OH, USA; Cleveland Clinic, Heart, Vascular & Thoracic Institute, Cleveland, OH, USA
| | - Torey Hovest
- Cleveland Clinic, Innovations, Cleveland Clinic, Cleveland, OH, USA
| | - Thad Meese
- Cleveland Clinic, Innovations, Cleveland Clinic, Cleveland, OH, USA
| | - Paul Schoenhagen
- Cleveland Clinic, Imaging Institute, Cleveland, OH, USA; Cleveland Clinic, Heart, Vascular & Thoracic Institute, Cleveland, OH, USA.
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Ali AH, Nakhla M, Cho L, Seballos RJ, Feinleib SE, Flamm SD, Schoenhagen P, Wang TKM, Desai MY. CAROTID ARTERY PLAQUE ON VASCULAR SCREENING DUPLEX AMONG PATIENTS UNDERGOING CORONARY ARTERY CALCIUM SCORING AS PART OF EXECUTIVE HEALTH MANAGEMENT. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02179-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Ali AH, Cho L, Seballos RJ, Feinleib SE, Flamm SD, Schoenhagen P, Wang TKM, Desai MY. USE OF CORONARY ARTERY CALCIUM QUANTIFICATION AND DISTRIBUTION FOR CORONARY VASCULAR DISEASE RISK RECLASSIFICATION. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02242-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Wang TKM, Bolen M, Kwon D, Schoenhagen P, Popovic Z, Klein AL. PERICARDIAL LATE GADOLINIUM ENHANCEMENT GRADING ON CARDIAC MAGNETIC RESONANCE IMAGING: INTER-READER AGREEMENT AND UTILITY OF FAT-SATURATED SEQUENCES. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01920-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Ding Y, Zhang C, Wu W, Pu J, Zhao X, Zhang H, Zhao L, Schoenhagen P, Liu S, Ma X. A radiomics model based on aortic computed tomography angiography: the impact on predicting the prognosis of patients with aortic intramural hematoma (IMH). Quant Imaging Med Surg 2023; 13:598-609. [PMID: 36819258 PMCID: PMC9929381 DOI: 10.21037/qims-22-480] [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: 05/14/2022] [Accepted: 11/16/2022] [Indexed: 12/13/2022]
Abstract
Background The prognosis of aortic intramural hematoma (IMH) is unpredictable, but computed tomography angiography (CTA) plays an important role of high diagnostic performance in the initial diagnosis and during follow-up of patients. In this study, we investigated the value of a radiomics model based on aortic CTA for predicting the prognosis of patients with medically treated IMH. Method A total of 120 patients with IMH were enrolled in this study. The follow-up duration ranged from 32 to 1,346 days (median 232 days). Progression of these patients was classified as follows: destabilization, which refers to deterioration in the aortic condition, including significant increases in the thickness of the IMH, the progression of IMH to a penetrating aortic ulcer (PAU), aortic dissection (AD), or rupture; or stabilization, which refers to an unchanged appearance or a decrease in the size or disappearance of the IMH. The patients were divided into a training cohort (n=84) and a validation cohort (n=36). Six different machine learning classifiers were applied: random forest (RF), K-nearest neighbor (KNN), Gaussian Naive Bayes, decision tree, logistic regression, and support vector machine (SVM). The clinical-radiomics combined nomogram model was established by multivariate logistic regression. The area under the receiver operating characteristic (ROC) curve (AUC) was implemented to evaluate the discrimination performance of the models. The calibration curves and Hosmer-Lemeshow test were used for evaluating model calibration. DeLong's test was performed to compare the AUC performance of models. Results Among all of the patients, 60 patients showed destabilization and 60 patients remained stable. A total of 12 radiomic features were retained after application of the least absolute shrinkage and selection operator (LASSO). These features were used for the machine learning model construction. The SVM-radial basis function (SVM-RBF) model obtained the best performance with an AUC of 0.765 (95% CI, 0.593-0.906). In the validation cohort, the combined clinical-radiomics model [AUC =0.787; 95% confidence interval (CI), 0.619-0.923] showed a significantly higher performance than did the clinical model (AUC =0.596; 95% CI, 0.413-0.796; P=0.021) and had a similar performance to the radiomics model (AUC =0.765; 95% CI, 0.589-0.906; P=0.672). Conclusions A quantitative nomogram based on radiomic features of CTA images can be used to predict disease progression in patients with IMH and may help improve clinical decision-making.
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Affiliation(s)
- Yan Ding
- Department of Interventional Diagnosis and Treatment, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chen Zhang
- Department of Interventional Diagnosis and Treatment, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wenhui Wu
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Junzhou Pu
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xinghan Zhao
- Department of Interventional Diagnosis and Treatment, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hongbo Zhang
- Department of Interventional Diagnosis and Treatment, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lei Zhao
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Paul Schoenhagen
- Cardiovascular Imaging, Miller Pavilion Desk J1-4, Cleveland Clinic, Cleveland, OH, USA
| | | | - Xiaohai Ma
- Department of Interventional Diagnosis and Treatment, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Xu B, Saijo Y, Reyaldeen RM, Vega Brizneda M, Chan N, Gillinov AM, Pettersson GB, Unai S, Flamm SD, Schoenhagen P, Grimm RA, Obuchowski N, Griffin BP. Novel Multi-Parametric Mitral Annular Calcification Score Predicts Outcomes in Mitral Valve Dysfunction. Curr Probl Cardiol 2023; 48:101456. [PMID: 36265589 DOI: 10.1016/j.cpcardiol.2022.101456] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 10/13/2022] [Indexed: 01/04/2023]
Abstract
The objective of the study was to construct a multi-parametric mitral annular calcification (MAC) score using computed tomography (CT) features for prediction of outcomes in patients undergoing mitral valve surgery. We constructed a multi-parametric MAC score, which ranges between 2 and 12, and consists of Agatston calcium score (1 point: <1000 Agatston units (AU); 2 points: 1000-<3000 AU; 3 points: 3000-5000 AU; 4 points: >5000 AU), quantitative MAC circumferential angle (1 point: <90°; 2 points: 90-<180°; 3 points: 180-<270°; 4 points: 270-360°), involvement of trigones (1 point: 1 trigone; 2 points: both trigones), and 1 point each for myocardial infiltration and left ventricular outflow tract extension/involvement of aorto-mitral curtain. The association between MAC score and clinical outcomes was evaluated. The study cohort consisted of 334 patients undergoing mitral valve surgery (128 mitral valve repairs, 206 mitral valve replacements) between January 2011 and September 2019, who had both non-contrast gated CT scan and evidence of MAC. The mean age was 72 ± 11 years, with 58% of subjects being female. MAC score was a statistically significant predictor of total operation time (P<0.001), cross-clamp time (P = 0.001) and in-hospital complications (P = 0.003). Additionally, MAC score was a significant predictor of time to all-cause death (P = 0.046). A novel multi-parametric score based on CT features allowed systematic assessment of MAC, and predicted clinical outcomes in patients with mitral valve dysfunction undergoing mitral valve surgery.
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Affiliation(s)
- Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland, OH, USA, 44195, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA, 44195.
| | - Yoshihito Saijo
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland, OH, USA, 44195, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA, 44195
| | - Reza M Reyaldeen
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland, OH, USA, 44195, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA, 44195
| | - Maria Vega Brizneda
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland, OH, USA, 44195, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA, 44195
| | - Nicholas Chan
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland, OH, USA, 44195, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA, 44195
| | - A Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA, 44195
| | - Gösta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA, 44195
| | - Shinya Unai
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA, 44195
| | - Scott D Flamm
- Cardiovascular Imaging Laboratory, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA, 44195
| | - Paul Schoenhagen
- Cardiovascular Imaging Laboratory, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA, 44195
| | - Richard A Grimm
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland, OH, USA, 44195, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA, 44195
| | - Nancy Obuchowski
- the Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA, 44195
| | - Brian P Griffin
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland, OH, USA, 44195, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA, 44195
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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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Patel D, Vatterott P, Piccini J, Epstein LM, Hakmi S, Syed I, Koweek LM, Bolen M, Schoenhagen P, Tarakji KG, Francis N, Shao M, Wilkoff BL. Prospective Evaluation of the Correlation Between Gated Cardiac Computed Tomography Detected Vascular Fibrosis and Ease of Transvenous Lead Extraction. Circ Arrhythm Electrophysiol 2022; 15:e010779. [PMID: 36306341 PMCID: PMC10503543 DOI: 10.1161/circep.121.010779] [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: 12/02/2021] [Accepted: 09/30/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Difficulty of lead extraction does not track well with procedural complications, but several small retrospective studies have lead fibrosis on computed tomography as an important indicator of difficult lead extraction. The purpose of the present study was to apply a standardized gated cardiac computed tomography (CT) protocol to assess fibrosis and study it prospectively to examine the need for powered sheaths and risk outcomes. METHODS We performed a prospective, blinded, multicenter, international study at high-volume lead extraction centers and included patients referred for transvenous lead extraction with at least one lead with a dwell time >1 year and ability to receive a cardiac CT. The degree of fibrosis (as measured by amount of lead adherence to vessel wall) was graded on a scale of 1 to 4 by dedicated CT readers in 3 zones (vein entry to superior vena cava, superior vena cava, and right atrium to lead tip). The primary outcome of the study was number of extractions requiring powered sheaths at zone 2 for each fibrosis group. RESULTS A total of 200 patients were enrolled in the trial with 196 completing full gated CT and lead extraction analysis. The primary endpoint of powered sheath (laser and mechanical) sheath use was significantly higher in patients with higher fibrosis seen on CT (scores 3+4; 67.8%) at the zone 2 compared to patients with lower fibrosis (scores 1+2; 38.6%; P<0.001). There were 5 major complications with 3 vascular lacerations all occurring in zone 2 in the study. CONCLUSIONS Gated, contrasted CT can predict the need for powered sheaths by identification of fibrosis but did not identify an absolute low-risk cohort who would not need powered sheaths. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03772704.
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Affiliation(s)
- Divyang Patel
- Cleveland Clinic, OH (D.P., M.B., P.S., K.G.T., M.S., B.L.W.)
| | | | | | | | - Samer Hakmi
- University Heart Center Hamburg, Germany (S.H.)
| | - Imran Syed
- Allina Health Minneapolis, MN (P.V., I.S.)
| | | | - Michael Bolen
- Cleveland Clinic, OH (D.P., M.B., P.S., K.G.T., M.S., B.L.W.)
| | | | | | | | - Mingyuan Shao
- Cleveland Clinic, OH (D.P., M.B., P.S., K.G.T., M.S., B.L.W.)
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12
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Aggarwal A, Patel D, Kumar A, Schoenhagen P, Flanagan P, Kalahasti V. A Very Unusual Cause for Presyncope after Bypass: What a Surprise. CASE 2022; 6:73-76. [PMID: 35492290 PMCID: PMC9050601 DOI: 10.1016/j.case.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
VG aneurysms can present with varied symptoms such as dyspnea, chest pain, and syncope. Tomographic imaging can be complementary in noninvasive assessment of SVG pathology.
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13
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Kleb C, Jain V, Sheth C, Wolski K, Kapadia S, Grimm R, Desai M, Krishnaswamy A, Kassis N, Sheng C, Zheng H, Cywinski J, Menon KVN, Eghtesad B, Diago Uso T, Quintini C, Schoenhagen P, Harb SC, Sharma V, Fares M. Comparison of Coronary Artery Calcium Scoring with Dobutamine Stress Echo for Detection of Coronary Artery Disease Before Liver Transplantation. Ann Transplant 2021; 26:e934163. [PMID: 34934037 PMCID: PMC8711211 DOI: 10.12659/aot.934163] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Dobutamine stress echocardiography (DSE) is commonly used for cardiovascular assessment before orthotopic liver transplantation (OLT). The coronary artery calcium score (CACS) is a useful screening tool for coronary artery disease (CAD). We aimed to compare the sensitivity and specificity of DSE and CACS for CAD in OLT candidates. Material/Methods A total of 265 of the 1589 patients who underwent OLT at our center between 2008 and 2019 had preoperative coronary angiography (CAG). Of these, 173 had DSE and 133 had a CT scan suitable for CACS calculation within 1 year of OLT. Patients with a nondiagnostic DSE were excluded (n=100). Two reviewers evaluated CACS on CT scans. The sensitivity/specificity of DSE and CACS for detection of angiographically significant CAD were calculated for patients with both tests (n=36). A separate analysis compared the sensitivity/specificity of a diagnostic DSE (n=73) and CACS (n=133) against CAG for all patients with either test. Results Sensitivity and specificity were 57.1% and 89.7%, respectively, for DSE, compared with 71.4% and 62.1% for CACS at ≥100 Agatston score. For the analysis of all patients with either test, the sensitivity/specificity of DSE for detection of CAD and CACS were 30.8% and 85.0% and 80.0% and 62.8%, respectively. On ROC analysis, CACS was a satisfactory predictor of obstructive CAD (AUC, 0.76±0.06, 95% CI, 0.66–0.87; P<0.001). Conclusions CACS may be an important tool for cardiovascular assessment in patients undergoing OLT. DSE was nondiagnostic in a large percentage of OLT candidates, limiting its use in this population.
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Affiliation(s)
- Cerise Kleb
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Vardhmaan Jain
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Chirag Sheth
- Department of Internal Medicine, Sutter Tracy Community Hospital, Tracy, CA, USA
| | - Kathy Wolski
- Department of Cardiovascular Medicine, Heart and Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Richard Grimm
- Department of Cardiovascular Medicine, Heart and Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Milind Desai
- Department of Cardiovascular Medicine, Heart and Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart and Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Nicholas Kassis
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Calvin Sheng
- Department of Cardiovascular Medicine, Heart and Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Huili Zheng
- Department of Statistics, National University Heart Centre Singapore, Singapore, Singapore
| | - Jacek Cywinski
- Department of Anesthesia, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - K V Narayanan Menon
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Bijan Eghtesad
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Teresa Diago Uso
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Cristiano Quintini
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Paul Schoenhagen
- Department of Diagnostic Radiology, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Serge C Harb
- Department of Cardiovascular Medicine, Heart and Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Vikram Sharma
- Department of Cardiology, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Maan Fares
- Department of Cardiovascular Medicine, Heart and Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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14
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Labarbera MA, Atta-Fosu T, Feeny AK, Firouznia M, Mchale M, Cantlay C, Roach T, Axtell A, Schoenhagen P, Barnard J, Smith JD, Van Wagoner DR, Madabhushi A, Chung MK. New Radiomic Markers of Pulmonary Vein Morphology Associated With Post-Ablation Recurrence of Atrial Fibrillation. IEEE J Transl Eng Health Med 2021; 10:1800209. [PMID: 34976444 PMCID: PMC8716081 DOI: 10.1109/jtehm.2021.3134160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/08/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022]
Abstract
Objective: To identify radiomic and clinical features associated with post-ablation recurrence of AF, given that cardiac morphologic changes are associated with persistent atrial fibrillation (AF), and initiating triggers of AF often arise from the pulmonary veins which are targeted in ablation. Methods: Subjects with pre-ablation contrast CT scans prior to first-time catheter ablation for AF between 2014-2016 were retrospectively identified. A training dataset (D1) was constructed from left atrial and pulmonary vein morphometric features extracted from equal numbers of consecutively included subjects with and without AF recurrence determined at 1 year. The top-performing combination of feature selection and classifier methods based on C-statistic was evaluated on a validation dataset (D2), composed of subjects retrospectively identified between 2005-2010. Clinical models ([Formula: see text]) were similarly evaluated and compared to radiomic ([Formula: see text]) and radiomic-clinical models ([Formula: see text]), each independently validated on D2. Results: Of 150 subjects in D1, 108 received radiofrequency ablation and 42 received cryoballoon. Radiomic features of recurrence included greater right carina angle, reduced anterior-posterior atrial diameter, greater atrial volume normalized to height, and steeper right inferior pulmonary vein angle. Clinical features predicting recurrence included older age, greater BMI, hypertension, and warfarin use; apixaban use was associated with reduced recurrence. AF recurrence was predicted with radio-frequency ablation models on D2 subjects with C-statistics of 0.68, 0.63, and 0.70 for radiomic, clinical, and combined feature models, though these were not prognostic in patients treated with cryoballoon. Conclusions: Pulmonary vein morphology associated with increased likelihood of AF recurrence within 1 year of catheter ablation was identified on cardiac CT. Significance: Radiomic and clinical features-based predictive models may assist in identifying atrial fibrillation ablation candidates with greatest likelihood of successful outcome.
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Affiliation(s)
- Michael A. Labarbera
- Cleveland Clinic Lerner College of MedicineCase Western Reserve UniversityClevelandOH44106USA
| | - Thomas Atta-Fosu
- Department of Biomedical EngineeringCase Western Reserve UniversityClevelandOH44106USA
| | - Albert K. Feeny
- Cleveland Clinic Lerner College of MedicineCase Western Reserve UniversityClevelandOH44106USA
| | - Marjan Firouznia
- Department of Biomedical EngineeringCase Western Reserve UniversityClevelandOH44106USA
| | - Meghan Mchale
- Department of Cardiovascular and Metabolic SciencesLerner Research Institute, Cleveland ClinicClevelandOH44106USA
| | - Catherine Cantlay
- Department of Cardiovascular and Metabolic SciencesLerner Research Institute, Cleveland ClinicClevelandOH44106USA
| | - Tyler Roach
- Department of Cardiovascular and Metabolic SciencesLerner Research Institute, Cleveland ClinicClevelandOH44106USA
| | - Alexis Axtell
- Department of Cardiovascular and Metabolic SciencesLerner Research Institute, Cleveland ClinicClevelandOH44106USA
| | - Paul Schoenhagen
- Department of Cardiovascular Medicine, Heart, VascularThoracic Institute, Cleveland ClinicClevelandOH44106USA
| | - John Barnard
- Department of Quantitative Health SciencesLerner Research Institute, Cleveland ClinicClevelandOH44106USA
| | - Jonathan D. Smith
- Department of Cardiovascular and Metabolic SciencesLerner Research Institute, Cleveland ClinicClevelandOH44106USA
| | - David R. Van Wagoner
- Department of Cardiovascular and Metabolic SciencesLerner Research Institute, Cleveland ClinicClevelandOH44106USA
| | - Anant Madabhushi
- Department of Biomedical EngineeringCase Western Reserve UniversityClevelandOH44106USA
- Louis Stokes Cleveland Veterans Administration Medical CenterClevelandOH44106USA
| | - Mina K. Chung
- Department of Cardiovascular and Metabolic SciencesLerner Research Institute, Cleveland ClinicClevelandOH44106USA
- Department of Cardiovascular Medicine, Heart, VascularThoracic Institute, Cleveland ClinicClevelandOH44106USA
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15
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Perry JW, Schoenhagen P, Huang SSL, Kirksey L, Rowse JW, Smolock CJ, Lyden SP, Hardy DM, Caputo FJ. Standardizing Methods of Reading CT Maximum Aortic Diameters Amongst Experts Reduces Variations and Discordance, Improving Accuracy. Ann Vasc Surg 2021; 79:264-272. [PMID: 34656714 DOI: 10.1016/j.avsg.2021.07.049] [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: 06/09/2021] [Revised: 07/14/2021] [Accepted: 07/19/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND There is no consensus on the method of obtaining abdominal aortic aneurysm (AAA) maximum diameters based on computed tomographic angiography, and the reproducibility and accuracy of different methods have recently been debated due to advancements in imaging. This study compared the two most common methods based on orthogonal planes and centerline of flow to determine the discordances and accuracy amongst experiences readers. METHODS The computed tomographic angiography max diameters of 148 AAAs were measured by three experienced observers, including a vascular surgeon, a radiologist and an imaging cardiologist. Observers used two different methods with standardized protocols: multiplanar reformations based on orthogonal planes, and a software using 3D aortic reconstructions to create centerline flow lumen providing diameters based on cross sections perpendicular to this lumen. Agreements and reliability of measurement methods were assessed by intra-class correlation coefficient and Bland - Altman analysis. Discordances between measurements of the methods and the original reported measurement, as well as outside hospitals were compared. RESULTS The average age of the cohort was 75 years and aortic diameters ranged from 3.8 to 9.6 cm. For orthogonal readings, there were agreements within 3 mm between 86% and 92% of the time, while centerline - reading agreement was between 88% and 94%, which was not statistically significant. The intra-class correlation coefficient was high between method type and between readers. Within methods, agreement was between 0.96 and 0.97, while within - reader agreement measures was between 0.96 and 0.98. In comparison to the original and the outside hospital reports, 10% ≥ of the original and 20% ≥ of the outside hospital reported measurements were discordant between the readers. CONCLUSION Maximal AAA measurements can have substantial variability leading to clinical significance and change in patient management and outcomes. Based on the results, orthogonal and centerline measurement methods have equally high agreements and concordance within 3 mm and low variations at a high volume center. However, when compared to the official read reports, there is high discordance rates that can significantly alter patient outcomes. A standardized method of measurement maximum diameter can reduce variations and discordances among different methods.
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Affiliation(s)
- John W Perry
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, The Cleveland Clinic, Cleveland, OH..
| | - Paul Schoenhagen
- Department of Cardiovascular Imaging, Imaging Institute, The Cleveland Clinic, Cleveland, OH
| | - Steve Shih Lin Huang
- Department of Nuclear Medicine, Imaging Institute, The Cleveland Clinic, Cleveland, OH
| | - Levester Kirksey
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, The Cleveland Clinic, Cleveland, OH
| | - Jarrad W Rowse
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, The Cleveland Clinic, Cleveland, OH
| | - Christopher J Smolock
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, The Cleveland Clinic, Cleveland, OH
| | - Sean P Lyden
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, The Cleveland Clinic, Cleveland, OH
| | - David M Hardy
- Department of Surgery, Cardiovascular Institute, South Georgia Medical Center, Valdosta, GA
| | - Francis J Caputo
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, The Cleveland Clinic, Cleveland, OH
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16
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Matta M, Ayoub C, Abou Hassan OK, Layoun H, Cremer PC, Hussein A, Schoenhagen P, Saliba WI, Rodriguez LL, Griffin BP, Kapadia SR, Harb SC. Anatomic and Functional Determinants of Atrial Functional Mitral Regurgitation. Structural Heart 2021. [DOI: 10.1080/24748706.2021.1943765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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17
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Wang TKM, Flamm SD, Schoenhagen P, Griffin BP, Rodriguez LL, Grimm RA, Xu B. Diagnostic and Prognostic Performance of Aortic Valve Calcium Score with Cardiac CT for Aortic Stenosis: A Meta-Analysis. Radiol Cardiothorac Imaging 2021; 3:e210075. [PMID: 34498008 PMCID: PMC8415142 DOI: 10.1148/ryct.2021210075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/29/2021] [Accepted: 08/02/2021] [Indexed: 04/12/2023]
Abstract
PURPOSE To evaluate the diagnostic and prognostic performance of the aortic valve calcium score (AVCS) with the Agatston method using CT in aortic stenosis (AS) and to assess mean AVCS according to AS severity. MATERIALS AND METHODS In this meta-analysis, PubMed, Embase, and Cochrane were searched from January 1, 1980, to December 31, 2020, for studies reporting sensitivity and specificity of AVCS using CT for severe AS, mean AVCS in severe and nonsevere AS, and/or hazard ratios for all-cause mortality in AS. Data were pooled using random effect models and meta-analysis software. RESULTS Twelve studies (six diagnostic, three prognostic, and 10 reporting mean AVCS by AS severity) were included for analysis. A total of 4101 patients (2255 with severe AS) were described in these 12 studies. Pooled sensitivity and specificity were 82% (95% CI: 80, 84) and 78% (95% CI: 75, 81), respectively. Pooled mean AVCS were 3219 (95% CI: 2795, 3643) for severe AS, compared with 1252 (95% CI: 863, 1640) for nonsevere AS, 1808 (95% CI: 1163, 2452) for moderate AS, and 584 (95% CI: 309, 859) for mild AS. Pooled hazard ratio for AVCS as a binary threshold to predict mortality was 2.11 (95% CI: 1.11, 4.12). CONCLUSION AVCS had moderate to high sensitivity and specificity for identifying severe AS and was also a useful prognostic imaging marker in AS. Mean AVCS categorized by AS severity may help guide clinical management.Keywords CT, Aortic Valve, Valves, Meta-Analysis© RSNA, 2021.
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18
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Layoun H, Schoenhagen P, Wang TKM, Puri R, Kapadia SR, Harb SC. Roles of Cardiac Computed Tomography in Guiding Transcatheter Tricuspid Valve Interventions. Curr Cardiol Rep 2021; 23:114. [PMID: 34269899 DOI: 10.1007/s11886-021-01547-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/09/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The field of transcatheter tricuspid valve interventions (TTVI) is rapidly evolving to meet a well-defined but unmet clinical need. Severe tricuspid regurgitation is common and is associated with significant morbidity and mortality. Surgical options are limited and of high risk. The success of TTVI depends on careful procedural planning, and cardiac computed tomography (CCT) plays an emerging key role. RECENT FINDINGS TTVI technologies have various targets, including the leaflets, annulus, and venae cavae, along with valve replacement. Based on the planned procedure, CCT allows for device sizing, careful assessment of the access route, and comprehensive analysis of relevant adjacent anatomic structures to enhance procedural safety. It can also evaluate right-sided heart function, and its data can be for fusion imaging and 3D printing. Procedural planning is key to TTVI's success and is highly dependent on high-quality CCT data. This review details the comprehensive roles of CCT, specifics of the dedicated TTVI protocol, and its limitations.
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Affiliation(s)
- Habib Layoun
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Paul Schoenhagen
- Department of Diagnostic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tom Kai Ming Wang
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Serge C Harb
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
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19
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Matta M, Layoun H, Abou Hassan OK, Rodriguez L, Schoenhagen P, Kanj M, Griffin BP, Kapadia SR, Harb SC. Mechanistic Insights Into Significant Atrial Functional Tricuspid Regurgitation. JACC Cardiovasc Imaging 2021; 14:2049-2050. [PMID: 34274272 DOI: 10.1016/j.jcmg.2021.05.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 11/26/2022]
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20
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Wang T, Flamm S, Schoenhagen P, Griffin B, Rodriguez L, Grimm R, Xu B. Diagnostic And Prognostic Performance Of Aortic Valve Calcium Score By Cardiac Computed Tomography For Severe Aortic Stenosis: A Meta-analysis. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Xu B, Kocyigit D, Godoy-Rivas C, Betancor J, Rodriguez LL, Menon V, Jaber W, Grimm R, Flamm SD, Schoenhagen P, Svensson LG, Griffin BP. Outcomes of contemporary imaging-guided management of sinus of Valsalva aneurysms. Cardiovasc Diagn Ther 2021; 11:770-780. [PMID: 34295704 DOI: 10.21037/cdt-20-630] [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: 07/10/2020] [Accepted: 09/08/2020] [Indexed: 11/06/2022]
Abstract
Background Sinus of Valsalva aneurysms (SVAs) are rare. We assessed the role of multimodality imaging in guiding the contemporary management. Methods A single-center retrospective cohort study over a 20-year period was performed. Results Between January 1997 and June 2017, 103 patients were diagnosed with SVAs (median age: 58 years). Eighty patients presented with non-ruptured SVAs, and 23 with ruptured SVAs. Seventy-six patients underwent surgery, and 27 were conservatively managed. The median durations of follow-up were: 48 months (surgical group) vs. 37.5 months (conservative group). There was no mortality directly attributable to SVA surgery. There were no late complications in the conservative group. Transthoracic echocardiography (TTE) was the first-line imaging investigation (100.0% in surgical group vs. 92.6% in conservative group, P=0.019). Additional imaging studies included: (I) transesophageal echocardiography (TEE): 93.4% in surgical group vs. 22.2% in conservative group, P<0.001; (II) multi-detector cardiac computed tomography (MDCT): 61.8% in surgical group vs. 37.0% in conservative group, P=0.041; (III) cardiac magnetic resonance (CMR): 22.4% in surgical group vs. 14.8% in conservative group, P=0.579. At diagnosis, SVA diameters were: TTE: 4.80 cm (range, 3.30 cm); TEE: 5.40 cm (range, 4.00 cm); MDCT: 5.20 cm (range, 3.90 cm); CMR: 4.80 cm (range, 3.70 cm). Conclusions In a 20-year cohort, proper selection for surgery and conservative management resulted in excellent outcomes for SVAs. TTE was the first-line imaging investigation for assessment of SVAs, although many patients underwent an additional imaging investigation. The contemporary outcomes of imaging-guided SVA management were excellent.
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Affiliation(s)
- Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Duygu Kocyigit
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - L Leonardo Rodriguez
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Venu Menon
- Section of Clinical Cardiology, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Wael Jaber
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Richard Grimm
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Scott D Flamm
- Cardiovascular Imaging Laboratory, Imaging Institute, and Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Paul Schoenhagen
- Cardiovascular Imaging Laboratory, Imaging Institute, and Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brian P Griffin
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
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22
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Smolka S, Alashi A, Marwan M, Fava A, Hutt E, Schoenhagen P, Popovic Z, Cremer P, Rodriguez LL, Flamm S, Achenbach S, Desai M. INCREMENTAL PROGNOSTIC UTILITY OF CT-FFR IN PATIENTS WITHOUT KNOWN CORONARY ARTERY DISEASE UNDERGOING CORONARY COMPUTED TOMOGRAPHIC ANGIOGRAPHY. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02639-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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Atta-Fosu T, LaBarbera M, Ghose S, Schoenhagen P, Saliba W, Tchou PJ, Lindsay BD, Desai MY, Kwon D, Chung MK, Madabhushi A. A new machine learning approach for predicting likelihood of recurrence following ablation for atrial fibrillation from CT. BMC Med Imaging 2021; 21:45. [PMID: 33750343 PMCID: PMC7941998 DOI: 10.1186/s12880-021-00578-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 05/11/2020] [Accepted: 02/28/2021] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To investigate left atrial shape differences on CT scans of atrial fibrillation (AF) patients with (AF+) versus without (AF-) post-ablation recurrence and whether these shape differences predict AF recurrence. METHODS This retrospective study included 68 AF patients who had pre-catheter ablation cardiac CT scans with contrast. AF recurrence was defined at 1 year, excluding a 3-month post-ablation blanking period. After creating atlases of atrial models from segmented AF+ and AF- CT images, an atlas-based implicit shape differentiation method was used to identify surface of interest (SOI). After registering the SOI to each patient model, statistics of the deformation on the SOI were used to create shape descriptors. The performance in predicting AF recurrence using shape features at and outside the SOI and eight clinical factors (age, sex, left atrial volume, left ventricular ejection fraction, body mass index, sinus rhythm, and AF type [persistent vs paroxysmal], catheter-ablation type [Cryoablation vs Irrigated RF]) were compared using 100 runs of fivefold cross validation. RESULTS Differences in atrial shape were found surrounding the pulmonary vein ostia and the base of the left atrial appendage. In the prediction of AF recurrence, the area under the receiver-operating characteristics curve (AUC) was 0.67 for shape features from the SOI, 0.58 for shape features outside the SOI, 0.71 for the clinical parameters, and 0.78 combining shape and clinical features. CONCLUSION Differences in left atrial shape were identified between AF recurrent and non-recurrent patients using pre-procedure CT scans. New radiomic features corresponding to the differences in shape were found to predict post-ablation AF recurrence.
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Affiliation(s)
- Thomas Atta-Fosu
- Center for Computational Imaging and Personalized Diagnostics, Department of Biomedical Engineering, Case Western Reserve University, 2071 Martin Luther King Drive, Cleveland, OH, 44106-7207, USA.
| | - Michael LaBarbera
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Soumya Ghose
- Center for Computational Imaging and Personalized Diagnostics, Department of Biomedical Engineering, Case Western Reserve University, 2071 Martin Luther King Drive, Cleveland, OH, 44106-7207, USA
| | - Paul Schoenhagen
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Walid Saliba
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Patrick J Tchou
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bruce D Lindsay
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Milind Y Desai
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Deborah Kwon
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mina K Chung
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.,Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Anant Madabhushi
- Center for Computational Imaging and Personalized Diagnostics, Department of Biomedical Engineering, Case Western Reserve University, 2071 Martin Luther King Drive, Cleveland, OH, 44106-7207, USA.,Louis Stokes Cleveland Veterans Administration Medical Center, Cleveland, OH, USA
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Firouznia M, Feeny AK, LaBarbera MA, McHale M, Cantlay C, Kalfas N, Schoenhagen P, Saliba W, Tchou P, Barnard J, Chung MK, Madabhushi A. Machine Learning-Derived Fractal Features of Shape and Texture of the Left Atrium and Pulmonary Veins From Cardiac Computed Tomography Scans Are Associated With Risk of Recurrence of Atrial Fibrillation Postablation. Circ Arrhythm Electrophysiol 2021; 14:e009265. [PMID: 33576688 DOI: 10.1161/circep.120.009265] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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] [Indexed: 01/06/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Marjan Firouznia
- Department of Biomedical Engineering (M.F., A.M.), Case Western Reserve University
| | - Albert K Feeny
- Cleveland Clinic Lerner College of Medicine (A.K.F., M.A.L., P.S., M.K.C.), Case Western Reserve University
| | - Michael A LaBarbera
- Cleveland Clinic Lerner College of Medicine (A.K.F., M.A.L., P.S., M.K.C.), Case Western Reserve University
| | - Meghan McHale
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute (M.M., P.S., W.S., P.T., M.K.C.).,Cardiovascular and Metabolic Sciences, Lerner Research Institute (M.M., C.C., N.K., M.K.C.), Diagnostic Radiology, Cleveland Clinic
| | - Catherine Cantlay
- Cardiovascular and Metabolic Sciences, Lerner Research Institute (M.M., C.C., N.K., M.K.C.), Diagnostic Radiology, Cleveland Clinic
| | - Natalie Kalfas
- Cardiovascular and Metabolic Sciences, Lerner Research Institute (M.M., C.C., N.K., M.K.C.), Diagnostic Radiology, Cleveland Clinic
| | - Paul Schoenhagen
- Cleveland Clinic Lerner College of Medicine (A.K.F., M.A.L., P.S., M.K.C.), Case Western Reserve University.,Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute (M.M., P.S., W.S., P.T., M.K.C.).,Imaging Institute (P.S.), Diagnostic Radiology, Cleveland Clinic
| | - Walid Saliba
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute (M.M., P.S., W.S., P.T., M.K.C.)
| | - Patrick Tchou
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute (M.M., P.S., W.S., P.T., M.K.C.)
| | - John Barnard
- Quantitative Health Sciences, Lerner Research Institute (J.B.), Diagnostic Radiology, Cleveland Clinic
| | - Mina K Chung
- Cleveland Clinic Lerner College of Medicine (A.K.F., M.A.L., P.S., M.K.C.), Case Western Reserve University.,Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute (M.M., P.S., W.S., P.T., M.K.C.)
| | - Anant Madabhushi
- Department of Biomedical Engineering (M.F., A.M.), Case Western Reserve University.,Cardiovascular and Metabolic Sciences, Lerner Research Institute (M.M., C.C., N.K., M.K.C.), Diagnostic Radiology, Cleveland Clinic.,Louis Stokes Cleveland Veterans Administration Medical Center, OH (A.M.)
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Ramchand J, Bansal A, Saeedan MB, Wang TKM, Agarwal R, Kanj M, Wazni O, Svensson LG, Desai MY, Harb SC, Schoenhagen P, Burrell LM, Griffin BP, Popović ZB, Kalahasti V. Incidental Thoracic Aortic Dilation on Chest Computed Tomography in Patients With Atrial Fibrillation. Am J Cardiol 2021; 140:78-82. [PMID: 33144160 DOI: 10.1016/j.amjcard.2020.10.059] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 10/23/2022]
Abstract
Patients with atrial fibrillation (AF) have risk factors that predispose to thoracic aneurysmal disease (TAD) and atherosclerosis. In this study in patients with AF, we assessed the occurrence of incidental TAD and assessed if a validated predictive score used to predict AF, the CHARGE-AF score, was associated with greater aortic dimensions. We also assessed the prevalence of coronary calcification. We conducted a cross-sectional study of 1,000 consecutive patients with AF undergoing chest multidetector CT during evaluation for pulmonary vein isolation. A dilated aortic root or ascending aorta (AA, dimension/ body surface area >2.05 cm/m2) were found in 195 (20%). A total of 12 (1%) had significant aortic aneurysmal enlargement of > 5.0 cm. Advancing age, a bicuspid aortic valve, hypertension, and male gender were associated with increased aortic dimensions. Aortic root dimensions increased linearly (p < 0.001) and ascending aortic dimensions increased nonlinearly across CHARGE-AF deciles (p < 0.001). Nearly two-thirds (63%) had coronary calcification, 38% of whom were not on lipid-lowering therapy. In conclusion, in patients with AF undergoing gated chest CT, 1 in 5 had previously undetected TAD, with a small proportion having significantly aneurysmal dimensions approaching surgical thresholds. Risk factors previously established to increase the propensity to develop AF are also associated with increased TAD. These findings raise the need to consider a surveillance strategy for TAD in patients with AF, particularly in those with other risk factors for aortic disease. A high prevalence of coronary calcium was also detected, representing an opportunity to optimize statin therapy in patients with AF.
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26
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Kapadia S, Krishnaswamy A, Layoun H, Griffin BP, Wierup P, Schoenhagen P, Harb SC. Tricuspid annular dimensions in patients with severe mitral regurgitation without severe tricuspid regurgitation. Cardiovasc Diagn Ther 2021; 11:68-80. [PMID: 33708479 DOI: 10.21037/cdt-20-903] [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] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background Concomitant TV repair during mitral valve (MV) surgery based on tricuspid valve annulus (TVA) dilation, rather than the degree of tricuspid regurgitation (TR), is beneficial and supported by the valve guidelines. We sought to determine TVA geometry and dimensions in controls and assess the changes that occur in patients with severe primary (PMR) and secondary (SMR) mitral regurgitation without TR. Methods We analyzed cardiac computed tomographic angiography (CCTA) of 125 consecutive subjects: 50 controls with normal coronary CCTA and no valvular dysfunction, 50 PMR patients referred for robotic repair, and 25 SMR patients referred for transcatheter therapy. Patients with >2+ TR on echocardiography were excluded. Annular measurements were performed using dedicated software and compared. Correlations and determinants of TVA dimensions were analyzed. Results Patients with SMR were older and had significantly more comorbidities. In controls, the TVA was larger and more planar and eccentric compared to the MV annulus (all P<0.01). Dimensions of both annuli correlated significantly (r≥0.5; P<0.001 for all dimensions) in controls and patients with severe MR. In both PMR and SMR, the TVA enlarged in all dimensions (P<0.01) with a trend towards becoming more circular. On multivariable regression, the MV annular area was the primary determinant of the TVA area (adjusted β=0.430, P<0.001). Conclusions Substantial changes in TVA dimensions are encountered in patients with severe MR even in the absence of severe TR such that TVA and MVA dimensions remain correlated. Close attention to the TVA in patients with severe MR is warranted.
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Affiliation(s)
- Sohum Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Habib Layoun
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brian P Griffin
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Per Wierup
- Department of Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, OH, USA
| | - Paul Schoenhagen
- Department of Diagnostic Radiology, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Serge C Harb
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
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Hussain M, Hanna M, Rodriguez L, Griffin B, Watson C, Phelan D, Schoenhagen P, Jaber W, Cremer P, Collier P. Subthreshold Aortic Valve Calcium Scores in Severe Aortic Stenosis and Transthyretin Cardiac Amyloidosis. JACC Case Rep 2020; 2:2205-2209. [PMID: 34317140 PMCID: PMC8299830 DOI: 10.1016/j.jaccas.2020.10.002] [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: 07/21/2020] [Revised: 09/29/2020] [Accepted: 10/05/2020] [Indexed: 01/15/2023]
Abstract
We have clinically observed that some patients with transthyretin cardiac amyloidosis and severe aortic stenosis may have lesser degrees of calcification than one might expect. We report a case series of 3 patients with transthyretin cardiac amyloidosis and severe aortic stenosis despite discordant aortic valve calcium scores. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Muzna Hussain
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.,School of Medicine, Dentistry, and Biomedical Sciences, Wellcome-Wolfson Institute of Experimental Medicine, Queen's University, Belfast, United Kingdom
| | - Mazen Hanna
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Leonardo Rodriguez
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brian Griffin
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Chris Watson
- School of Medicine, Dentistry, and Biomedical Sciences, Wellcome-Wolfson Institute of Experimental Medicine, Queen's University, Belfast, United Kingdom
| | - Dermot Phelan
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina
| | - Paul Schoenhagen
- Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, Ohio
| | - Wael Jaber
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Paul Cremer
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Patrick Collier
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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Hussain M, Hanna M, Griffin BP, Conic J, Patel J, Fava AM, Watson C, Phelan DM, Jellis C, Grimm RA, Rodriguez LL, Schoenhagen P, Hachamovitch R, Jaber WA, Cremer PC, Collier P. Aortic Valve Calcium in Patients With Transthyretin Cardiac Amyloidosis. Circ Cardiovasc Imaging 2020; 13:e011433. [DOI: 10.1161/circimaging.120.011433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Muzna Hussain
- Department of Cardiovascular Medicine, Heart and Vascular Institute (M. Hussain, M. Hanna, B.P.G., J.C., J.P., A.M.F., C.J., R.A.G., L.L.R., R.H., W.A.J., P.C.C.), Cleveland Clinic, OH
- School of Medicine, Dentistry and Biomedical Sciences, Wellcome-Wolfson Institute of Experimental Medicine, Queen’s University, Belfast, United Kingdom (M. Hussain, C.W.)
| | - Mazen Hanna
- Department of Cardiovascular Medicine, Heart and Vascular Institute (M. Hussain, M. Hanna, B.P.G., J.C., J.P., A.M.F., C.J., R.A.G., L.L.R., R.H., W.A.J., P.C.C.), Cleveland Clinic, OH
| | - Brian P. Griffin
- Department of Cardiovascular Medicine, Heart and Vascular Institute (M. Hussain, M. Hanna, B.P.G., J.C., J.P., A.M.F., C.J., R.A.G., L.L.R., R.H., W.A.J., P.C.C.), Cleveland Clinic, OH
| | - Juilijana Conic
- Department of Cardiovascular Medicine, Heart and Vascular Institute (M. Hussain, M. Hanna, B.P.G., J.C., J.P., A.M.F., C.J., R.A.G., L.L.R., R.H., W.A.J., P.C.C.), Cleveland Clinic, OH
| | - Jay Patel
- Department of Cardiovascular Medicine, Heart and Vascular Institute (M. Hussain, M. Hanna, B.P.G., J.C., J.P., A.M.F., C.J., R.A.G., L.L.R., R.H., W.A.J., P.C.C.), Cleveland Clinic, OH
| | - Agostina M. Fava
- Department of Cardiovascular Medicine, Heart and Vascular Institute (M. Hussain, M. Hanna, B.P.G., J.C., J.P., A.M.F., C.J., R.A.G., L.L.R., R.H., W.A.J., P.C.C.), Cleveland Clinic, OH
| | - Chris Watson
- School of Medicine, Dentistry and Biomedical Sciences, Wellcome-Wolfson Institute of Experimental Medicine, Queen’s University, Belfast, United Kingdom (M. Hussain, C.W.)
| | - Dermot M. Phelan
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, NC (D.M.P.)
| | - Christine Jellis
- Department of Cardiovascular Medicine, Heart and Vascular Institute (M. Hussain, M. Hanna, B.P.G., J.C., J.P., A.M.F., C.J., R.A.G., L.L.R., R.H., W.A.J., P.C.C.), Cleveland Clinic, OH
| | - Richard A. Grimm
- Department of Cardiovascular Medicine, Heart and Vascular Institute (M. Hussain, M. Hanna, B.P.G., J.C., J.P., A.M.F., C.J., R.A.G., L.L.R., R.H., W.A.J., P.C.C.), Cleveland Clinic, OH
| | - L. Leonardo Rodriguez
- Department of Cardiovascular Medicine, Heart and Vascular Institute (M. Hussain, M. Hanna, B.P.G., J.C., J.P., A.M.F., C.J., R.A.G., L.L.R., R.H., W.A.J., P.C.C.), Cleveland Clinic, OH
| | | | - Rory Hachamovitch
- Department of Cardiovascular Medicine, Heart and Vascular Institute (M. Hussain, M. Hanna, B.P.G., J.C., J.P., A.M.F., C.J., R.A.G., L.L.R., R.H., W.A.J., P.C.C.), Cleveland Clinic, OH
| | - Wael A. Jaber
- Department of Cardiovascular Medicine, Heart and Vascular Institute (M. Hussain, M. Hanna, B.P.G., J.C., J.P., A.M.F., C.J., R.A.G., L.L.R., R.H., W.A.J., P.C.C.), Cleveland Clinic, OH
| | - Paul C. Cremer
- Department of Cardiovascular Medicine, Heart and Vascular Institute (M. Hussain, M. Hanna, B.P.G., J.C., J.P., A.M.F., C.J., R.A.G., L.L.R., R.H., W.A.J., P.C.C.), Cleveland Clinic, OH
| | - Patrick Collier
- Staff Cardiovascular Medicine, Associate Director of the Echo Lab, Co-Director Cardio-oncology Center, Associate Professor of Medicine, Case Western Reserve University, Lerner College of Medicine, Cleveland, OH (P.C.)
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Ouyang Z, Schoenhagen P, Wazni O, Tchou P, Saliba WI, Suh JH, Xia P. Analysis of cardiac motion without respiratory motion for cardiac stereotactic body radiation therapy. J Appl Clin Med Phys 2020; 21:48-55. [PMID: 32918386 PMCID: PMC7592981 DOI: 10.1002/acm2.13002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/14/2020] [Accepted: 07/21/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose/objective(s) To study the heart motion using cardiac gated computed tomographies (CGCT) to provide guidance on treatment planning margins during cardiac stereotactic body radiation therapy (SBRT). Materials/methods Ten patients were selected for this study, who received CGCT scans that were acquired with intravenous contrast under a voluntary breath‐hold using a dual source CT scanner. For each patient, CGCT images were reconstructed in multiple phases (10%–90%) of the cardiac cycle and the left ventricle (LV), right ventricle (RV), ascending aorta (AAo), ostia of the right coronary artery (O‐RCA), left coronary artery (O‐LCA), and left anterior descending artery (LAD) were contoured at each phase. For these contours, the centroid displacements from their corresponding average positions were measured at each phase in the superior–inferior (SI), medial–lateral (ML), and anterior–posterior (AP). The average volumes as well as the maximum to minimum ratios were analyzed for the LV and RV. Results For the six contoured substructures, more than 90% of the measured displacements were <5 mm. For these patients, the average volumes ranged from 191.25 to 429.51 cc for LV and from 91.76 to 286.88 cc for RV. For each patient, the ratios of maximum to minimum volumes within a cardiac cycle ranged from 1.15 to 1.54 for LV and from 1.34 to 1.84 for RV. Conclusion Based on this study, cardiac motion is variable depending on the specific substructure of the heart but is mostly within 5 mm. Depending on the location (central or peripheral) of the treatment target and treatment purposes, the treatment planning margins for targets and risk volumes should be adjusted accordingly. In the future, we will further assess heart motion and its dosimetric impact.
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Affiliation(s)
- Zi Ouyang
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Paul Schoenhagen
- Department of Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Oussama Wazni
- Department of Cardiovascular Medicine, Miller Family Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Patrick Tchou
- Department of Cardiovascular Medicine, Miller Family Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Walid I Saliba
- Department of Cardiovascular Medicine, Miller Family Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - John H Suh
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ping Xia
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
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Kapadia S, Krishnaswamy A, Wierup P, Schoenhagen P, Harb S. Tricuspid Annulus Three-dimensional Geometry And Dimensions In Normal, Degenerative, And Functional Mitral Regurgitation. J Cardiovasc Comput Tomogr 2020. [DOI: 10.1016/j.jcct.2020.06.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kapadia S, Krishnaswamy A, Wierup P, Schoenhagen P, Harb S. Mitral Annulus Three-dimensional Configuration And Size In Normal, Degenerative, And Functional Mitral Regurgitation. J Cardiovasc Comput Tomogr 2020. [DOI: 10.1016/j.jcct.2020.06.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Choi JW, van Rosendael AR, Bax AM, van den Hoogen IJ, Gianni U, Baskaran L, Andreini D, De Cecco CN, Earls J, Ferencik M, Hecht H, Leipsic JA, Maurovich-Horvat P, Nicol E, Pontone G, Raman S, Schoenhagen P, Arbab-Zadeh A, Choi AD, Feuchtner G, Weir-McCall J, Chinnaiyan K, Whelton S, Min JK, Villines TC, Al’Aref SJ. The Journal of Cardiovascular Computed Tomography year in review – 2019. J Cardiovasc Comput Tomogr 2020; 14:107-117. [DOI: 10.1016/j.jcct.2020.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/08/2020] [Indexed: 12/20/2022]
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Xu B, Kocyigit D, Betancor J, Tan C, Rodriguez ER, Schoenhagen P, Flamm SD, Rodriguez LL, Svensson LG, Griffin BP. Sinus of Valsalva Aneurysms: A State-of-the-Art Imaging Review. J Am Soc Echocardiogr 2020; 33:295-312. [PMID: 32143779 DOI: 10.1016/j.echo.2019.11.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 07/20/2019] [Revised: 10/18/2019] [Accepted: 11/12/2019] [Indexed: 12/16/2022]
Abstract
Cardiovascular imaging has an important role in the assessment and management of aortic root and thoracic aorta ectasia and aneurysms. Sinus of Valsalva aneurysms are rare entities. Unique complications associated with sinus of Valsalva aneurysms make them different from traditional aortic root aneurysms. Established guidelines on the diagnosis and management of sinus of Valsalva aneurysms are lacking. This article reviews the applications of multimodality cardiovascular imaging (echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging) for the dedicated assessment and imaging-guided management of sinus of Valsalva aneurysms.
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Affiliation(s)
- Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Duygu Kocyigit
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Carmela Tan
- Department of Cardiovascular Anatomical Pathology, Cleveland Clinic, Cleveland, Ohio
| | - E Rene Rodriguez
- Department of Cardiovascular Anatomical Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Paul Schoenhagen
- Cardiovascular Imaging Laboratory, Imaging Institute, and Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Scott D Flamm
- Cardiovascular Imaging Laboratory, Imaging Institute, and Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - L Leonardo Rodriguez
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brian P Griffin
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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Hussain M, Hanna M, Griffin BP, Patel J, Fava A, Watson C, Phelan D, Jellis CL, Grimm RA, Rodriguez L, Schoenhagen P, Hachamovitch R, Jaber WA, Cremer P, Collier P. AORTIC VALVE CALCIUM SCORE CUT-OFFS USED TO IDENTIFY HEMODYNAMICALLY SEVERE AORTIC STENOSIS MAY NOT APPLY IN PATIENTS WITH CARDIAC AMYLOIDOSIS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32791-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Xu M, Ruddy TD, Schoenhagen P, Bartel T, Di Bartolomeo R, Kodolitsch Y, Escaned J, Shen C, He Y. The CatLet score and outcome prediction in acute myocardial infarction for patients undergoing primary percutaneous intervention: A proof‐of‐concept study. Catheter Cardiovasc Interv 2020; 96:E220-E229. [PMID: 31943728 DOI: 10.1002/ccd.28724] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 01/02/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Ming‐Xing Xu
- Division of CardiologyFirst Affiliated Hospital of Soochow University Suzhou China
| | - Terrence D. Ruddy
- Division of Cardiology, Heart InstituteUniversity of Ottawa Ottawa Canada
| | | | - Thomas Bartel
- Department of Cardiovascular MedicineHeart & Vascular Institute, Cleveland Clinic Abu Dhabi Abu Dhabi United Arab Emirates
| | - Roberto Di Bartolomeo
- Cardio‐Thoracic and Vascular Department, Division of Cardiac Surgery, S. Orsola HospitalUniversity of Bologna Bologna Italy
| | - Yskert Kodolitsch
- Department of CardiologyUniversity Hospital Hamburg‐Eppendorf Hamburg Germany
| | - Javier Escaned
- Department of CardiologyHospital San Carlos Madrid Spain
| | - Chengxing Shen
- Department of CardiologyShanghai Jiaotong University Affiliated Sixth People's Hospital Shanghai China
| | - Yong‐Ming He
- Division of CardiologyFirst Affiliated Hospital of Soochow University Suzhou China
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Xu MX, Teng RL, Ruddy TD, Schoenhagen P, Bartel T, Di Bartolomeo R, Aksoy O, Desai M, von Kodolitsch Y, Escaned J, McCullough PA, Vasudevan A, Shen CX, Zhao X, Zhou YF, Xu HF, Cheng XJ, He YM. The CatLet score: a new coronary angiographic scoring tool accommodating the variable coronary anatomy for the first time. J Thorac Dis 2019; 11:5199-5209. [PMID: 32030237 DOI: 10.21037/jtd.2019.12.18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The SYNTAX score for decision makings or outcome predictions in coronary artery disease does not account for the variations in the coronary anatomy, which is a clear fallacy for patients with less typical anatomy than suggested by the SYNTAX score. The current study aimed to derive a new coronary angiographic scoring system accommodating the variability in the coronary anatomy. Methods The 17-myocardial segment model and laws of competitive blood supply and flow conservation were utilized to derive this new scoring system. Results We obtained 6 types of RCA dominance, 3 types of diagonal size and 3 types of left anterior descending artery (LAD) length, which together resulted in a total of 54 patterns of coronary artery circulation to account for the variability in the coronary anatomy among individuals. A Coronary Artery Tree description and Lesion EvaluaTion (CatLet) angiographic scoring system has been designed based on the above-mentioned reclassification scheme (htpp://www.catletscore.com, IE browser is required to run this calculator). Conclusions This new CatLet angiographic scoring system accommodated the variability in the coronary anatomy and standardized the collection of the coronary angiographic data, which could facilitate the comparison and exchange of these data between different catheter labs. Its utility for predicting the clinical outcomes and standardizing the angiographic data collection will be investigated in a series of clinical trials enrolling "all-comers" with coronary artery disease (CAD).
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Affiliation(s)
- Ming-Xing Xu
- Division of Cardiology, First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Ruo-Ling Teng
- Division of Cardiology, First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Terrence D Ruddy
- Division of Cardiology, Heart Institute, University of Ottawa, Ottawa, Canada
| | | | - Thomas Bartel
- Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Roberto Di Bartolomeo
- Cardio-Thoracic and Vascular Department, Division of Cardiac Surgery, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Olcay Aksoy
- Division of Cardiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Milind Desai
- Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Javier Escaned
- Department of Cardiology, Hospital San Carlos, Madrid, Spain
| | - Peter A McCullough
- Division of Cardiology, Heart & Vascular Institute, Baylor University Medical Center, Dallas, TX, USA
| | - Anupama Vasudevan
- Division of Cardiology, Heart & Vascular Institute, Baylor University Medical Center, Dallas, TX, USA
| | - Cheng-Xing Shen
- Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200233, China
| | - Xin Zhao
- Division of Cardiology, First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Ya-Feng Zhou
- Division of Cardiology, First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Hai-Feng Xu
- Division of Cardiology, First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Xu-Jie Cheng
- Division of Cardiology, First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Yong-Ming He
- Division of Cardiology, First Affiliated Hospital of Soochow University, Suzhou 215006, China
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Desai MY, Cremer PC, Schoenhagen P. Thoracic Aortic Calcification: Diagnostic, Prognostic, and Management Considerations. JACC Cardiovasc Imaging 2019; 11:1012-1026. [PMID: 29976300 DOI: 10.1016/j.jcmg.2018.03.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/26/2018] [Accepted: 03/20/2018] [Indexed: 12/18/2022]
Abstract
Thoracic aortic calcification (TAC) is associated with adverse cardiovascular outcomes, and for the cardiovascular imager, is predominantly encountered in 4 settings: 1) incidentally, for example, during a coronary artery calcium scan; 2) as part of dedicated screening; 3) in the evaluation of an embolic event; or 4) in procedural planning. This review focuses on TAC in these contexts. Within atherosclerosis, TAC is common, variable in extent, and begins in the intima with a patchy distribution. In metabolic disorders, aortitis, and radiation-associated cardiovascular disease, calcification preferentially involves the media and is often more concentric. As an incidental finding, atherosclerotic TAC provides limited incremental discriminative value, and current data do not support screening. After an embolic event, the demonstration of thoracic atheroma provides diagnostic clarity, but has limited treatment implications. Before any procedure, the plan often changes if the most severe form of TAC, a porcelain aorta, is discovered.
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Affiliation(s)
- Milind Y Desai
- Department of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Paul C Cremer
- Department of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Paul Schoenhagen
- Department of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Cardiovascular Section, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
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Alashi A, Huttcenteno E, Schoenhagen P, Popovic ZB, Cremer P, Kalahasti V, Jellis C, Renapurkar R, Rodriguez LL, Flamm SD, Desai MY. P6152Incremental prognostic utility of functionally non-significant coronary stenosis in patients undergoing coronary computed tomogram angiography. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In patients with suspected coronary artery disease (CAD) who underwent coronary computed tomographic angiography (CCTA), the prognostic value of nonobstructive stenosis is not entirely understood.
Aims
We sought to assess the long-term incremental prognostic utility of functionally non-significant CAD in patients without known prior CAD who underwent CCTA.
Methods
We included 2142 consecutive patients (51±14 years, 53% men) without prior documented CAD who underwent CCTA between 2008–2016 (excluding anomalous coronaries and functionally significant CAD). Traditional risk factors were recorded and pretest likelihood of CAD was calculated. All epicardial coronary arteries were classified as follows: No plaque, minimal luminal irregularities (<25%), mild (25–49%) stenosis and moderate (50–69%) stenosis. All moderate stenoses were confirmed to be not functionally significant by follow-up stress testing/invasive angiography with fractional flow reserve assessment. Plaque was characterized as noncalcified, calcified or mixed. High-risk plaque features (spotty calcification, napkin ring, low attenuation plaque and positive remodeling) were recorded. During follow-up, a composite of death or myocardial infarction was recorded.
Results
188 (9%) patients had low, 1712 (80%) had intermediate and 242 (11%) patients had high pre-test likelihood of CAD. 45%, 10%, 52% and 22% had hypertension, diabetes, Dyslipedimia and history of smoking respectively. Breakdown of CAD severity was: 1197 (56%) none, 480 (22%) minimal, 267 (13%) mild and 198 (9%) moderate stenoses. 82 (4%) had noncalcified, 245 (11%) had calcified and 618 (29%) had mixed plaque. 465 (22%) had high-risk plaque features. At 6±3 years, 90 (4%) patients had composite events (68 deaths) and 24 (1%) needed coronary revascularization >90 days post-CCTA. 880 (41%) were on statins post-CCTA. Results of multivariable Cox Survival Analysis are shown in Figure 1A. Kaplan-Meier survival curves for a) more severe CAD and b) high-risk plaque features (vs. not) are shown in Figure 1B and C. Longer-term event rates for increasing CAD were 2.8%, 4.6%, 6% and 9.6%, respectively.
Conclusion
In mostly low/intermediate risk patients without documented CAD who underwent CCTA, a higher burden of nonobstructive coronary plaque (or presence of high-risk features) provide incremental prognostic value. Initiating statin therapy following detection of plaque on CCTA was associated with improved longer-term freedom from composite events.
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Affiliation(s)
- A Alashi
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - E Huttcenteno
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - P Schoenhagen
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - Z B Popovic
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - P Cremer
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - V Kalahasti
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - C Jellis
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - R Renapurkar
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - L L Rodriguez
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - S D Flamm
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - M Y Desai
- Cleveland Clinic Foundation, Cleveland, United States of America
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Parikh P, Shah N, Ahmed H, Schoenhagen P, Fares M. Coronary artery calcium scoring: Its practicality and clinical utility in primary care. Cleve Clin J Med 2019; 85:707-716. [PMID: 30192734 DOI: 10.3949/ccjm.85a.17097] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Coronary artery calcium scoring is useful as a risk-stratification tool in coronary artery disease, and it outperforms other risk-assessment methods. American College of Cardiology/American Heart Association guidelines give the test a IIB recommendation in clinical scenarios in which risk stratification is uncertain. However, if the test is not used in the appropriate clinical setting, misinterpretation of the results can lead to unnecessary cardiac testing. This review provides the primary care provider with basic knowledge about the test's clinical utility, interpretation, risks, and limitations.
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Affiliation(s)
- Parth Parikh
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA.,Clinical Instructor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Nishant Shah
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Haitham Ahmed
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.,Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Paul Schoenhagen
- Department of Diagnostic Radiology, Imaging Institute, and Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.,Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Maan Fares
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA. .,Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
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Doherty JU, Kort S, Mehran R, Schoenhagen P, Soman P. ACC/AATS/AHA/ASE/ASNC/HRS/SCAI/SCCT/SCMR/STS 2019 Appropriate Use Criteria for Multimodality Imaging in the Assessment of Cardiac Structure and Function in Nonvalvular Heart Disease : A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and the Society of Thoracic Surgeons. J Nucl Cardiol 2019; 26:1392-1413. [PMID: 31250324 DOI: 10.1007/s12350-019-01751-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 12/12/2022]
Abstract
This document is the second of 2 companion appropriate use criteria (AUC) documents developed by the American College of Cardiology, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons. The first document (J Am Coll Cardiol 2017;70:1647-1672) addresses the evaluation and use of multimodality imaging in the diagnosis and management of valvular heart disease, whereas this document addresses this topic with regard to structural (nonvalvular) heart disease. While dealing with different subjects, the 2 documents do share a common structure and feature some clinical overlap. The goal of the companion AUC documents is to provide a comprehensive resource for multimodality imaging in the context of structural and valvular heart disease, encompassing multiple imaging modalities.Using standardized methodology, the clinical scenarios (indications) were developed by a diverse writing group to represent patient presentations encountered in everyday practice and included common applications and anticipated uses. Where appropriate, the scenarios were developed on the basis of the most current American College of Cardiology/American Heart Association Clinical Practice Guidelines.A separate, independent rating panel scored the 102 clinical scenarios in this document on a scale of 1 to 9. Scores of 7 to 9 indicate that a modality is considered appropriate for the clinical scenario presented. Midrange scores of 4 to 6 indicate that a modality may be appropriate for the clinical scenario, and scores of 1 to 3 indicate that a modality is considered rarely appropriate for the clinical scenario.The primary objective of the AUC is to provide a framework for the assessment of these scenarios by practices that will improve and standardize physician decision making. AUC publications reflect an ongoing effort by the American College of Cardiology to critically and systematically create, review, and categorize clinical situations in which diagnostic tests and procedures are utilized by physicians caring for patients with cardiovascular diseases. The process is based on the current understanding of the technical capabilities of the imaging modalities examined.
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Affiliation(s)
| | - Smadar Kort
- American Society of Echocardiography, Morrisville, NC, USA
| | - Roxana Mehran
- Society for Cardiovascular Angiography and Interventions, Washington, DC, USA
| | | | - Prem Soman
- American Society of Nuclear Cardiology, Bethesda, MD, USA
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Reiber JHC, Pereira GTR, Bezerra HG, De Sutter J, Schoenhagen P, Stillman AE, Van de Veire NRL. Cardiovascular imaging 2018 in the International Journal of Cardiovascular Imaging. Int J Cardiovasc Imaging 2019; 35:1175-1188. [DOI: 10.1007/s10554-019-01579-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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42
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Alashi A, Lang R, Seballos R, Feinleib S, Sukol R, Cho L, Schoenhagen P, Griffin BP, Flamm SD, Desai MY. Reclassification of coronary heart disease risk in a primary prevention setting: traditional risk factor assessment vs. coronary artery calcium scoring. Cardiovasc Diagn Ther 2019; 9:214-220. [PMID: 31275811 DOI: 10.21037/cdt.2019.04.05] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 12/25/2022]
Abstract
Background In a primary prevention screening program of asymptomatic middle-aged subjects, we sought to assess the degree of risk-reclassification provided by traditional risk assessment vs. coronary artery calcification scoring (CACS). Methods A total of 1,806 consecutive asymptomatic subjects (age 55 years, 76% men), who underwent comprehensive screening in a primary prevention clinic between 3/2016 and 9/2017 were included. Standard risk factors, C-reactive protein (CRP) and CAC scoring were performed. % 10-year coronary heart disease (CHD) risk was calculated using Reynolds Risk Score (RRS), atherosclerotic cardiovascular disease (ASCVD) score and multiethnic study on subclinical atherosclerosis (MESA) CACS were calculated. % 10-year CHD risk for all scores was categorized as follows: <1%, 1-5%, 6-10% and >10%. Results Mean CRP, RRS, ASCVD and MESA-CACS were 2.1±4.2, 3.7±4, 4.9±6, 4.9±5; 54% had CAC of 0, while 21% had CAC >75th percentile. There was a significant, but modest correlation between MESA-CAC score and (I) RRS (r=0.62) and (II) ASCVD scores (r=0.65, both P<0.001). Compared to MESA-CAC, for RRS, (I) 188 (10%) patients had a downgrade in risk and (II) 538 (30%) patients had an upgrade in risk (40% reclassification of risk). Similarly, compared to MESA-CAC, for ASCVD score, (I) 412 (23%) patients had a downgrade in risk and (II) 329 (18%) patients had a downgrade in risk (41% reclassification of risk). Conclusions In a primary prevention screening program of asymptomatic middle-aged patients, RRS overestimates and ASCVHD underestimates 10-year CHD risk vs. MESA-CACS. Addition of CACS results in significant risk reclassification.
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Affiliation(s)
- Alaa Alashi
- Cardiovascular Imaging Laboratory, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Richard Lang
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Raul Seballos
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Roxanne Sukol
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Leslie Cho
- Cardiovascular Imaging Laboratory, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Paul Schoenhagen
- Cardiovascular Imaging Laboratory, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Primary Prevention, Cleveland Clinic, Cleveland, OH, USA
| | - Brian P Griffin
- Cardiovascular Imaging Laboratory, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Scott D Flamm
- Cardiovascular Imaging Laboratory, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Primary Prevention, Cleveland Clinic, Cleveland, OH, USA
| | - Milind Y Desai
- Cardiovascular Imaging Laboratory, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Primary Prevention, Cleveland Clinic, Cleveland, OH, USA
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Varian K, Xu WD, Lin W, Unai S, Tong MZ, Soltesz E, Krishnaswamy A, Kapadia S, Feitell S, Hanna M, Joyce E, Schoenhagen P, Starling RC, Taylor DO, Perez AL. Minimally invasive biventricular mechanical circulatory support with Impella pumps as a bridge to heart transplantation: a first-in-the-world case report. ESC Heart Fail 2019; 6:552-554. [PMID: 30968544 PMCID: PMC6487727 DOI: 10.1002/ehf2.12412] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 09/24/2018] [Accepted: 01/06/2019] [Indexed: 01/06/2023] Open
Abstract
Cardiogenic shock from biventricular failure that requires acute mechanical circulatory support carries high 30 day mortality. Acute mechanical circulatory support can serve as bridge to orthotopic heart transplant (OHT) in selected patients. We report a patient with biventricular failure secondary to rapidly progressive cardiac sarcoidosis refractory to medical management who was bridged to OHT with Impella 5.0 and Impella RP-temporary left and right ventricular assist devices, respectively. This is the first successful bridge to transplantation using these devices in biventricular heart failure and cardiogenic shock. We discuss considerations for using this strategy over veno-arterial extracorporeal membrane oxygenation or surgically implanted assist devices in patients with cardiogenic shock and biventricular failure as a bridge to OHT.
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Affiliation(s)
- Kenneth Varian
- Section of Heart Failure and Cardiac Transplant Medicine, Kaufman Center for Heart Failure Treatment and Recovery, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH, 44195, USA
| | - Weining David Xu
- Section of Heart Failure and Cardiac Transplant Medicine, Kaufman Center for Heart Failure Treatment and Recovery, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH, 44195, USA
| | - Weiqin Lin
- Section of Heart Failure and Cardiac Transplant Medicine, Kaufman Center for Heart Failure Treatment and Recovery, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH, 44195, USA
| | - Shinya Unai
- Department of Cardiovascular Surgery, Kaufman Center for Heart Failure Treatment and Recovery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Michael Z Tong
- Department of Cardiovascular Surgery, Kaufman Center for Heart Failure Treatment and Recovery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Edward Soltesz
- Department of Cardiovascular Surgery, Kaufman Center for Heart Failure Treatment and Recovery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Amar Krishnaswamy
- Section of Interventional Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Samir Kapadia
- Section of Interventional Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Scott Feitell
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, NY, USA
| | - Mazen Hanna
- Section of Heart Failure and Cardiac Transplant Medicine, Kaufman Center for Heart Failure Treatment and Recovery, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH, 44195, USA
| | - Emer Joyce
- Section of Heart Failure and Cardiac Transplant Medicine, Kaufman Center for Heart Failure Treatment and Recovery, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH, 44195, USA
| | - Paul Schoenhagen
- Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Randall C Starling
- Section of Heart Failure and Cardiac Transplant Medicine, Kaufman Center for Heart Failure Treatment and Recovery, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH, 44195, USA
| | - David O Taylor
- Section of Heart Failure and Cardiac Transplant Medicine, Kaufman Center for Heart Failure Treatment and Recovery, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH, 44195, USA
| | - Antonio L Perez
- Section of Heart Failure and Cardiac Transplant Medicine, Kaufman Center for Heart Failure Treatment and Recovery, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH, 44195, USA
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Rao S, Suntharos P, Liu W, Schoenhagen P, Worley S, Komarlu R. ROLE OF MULTIMODALITY IMAGING PRIOR TO BALLOON SIZING FOR PLANNED PERCUTANEOUS PULMONARY VALVE IMPLANTATION. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32256-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Doherty JU, Kort S, Mehran R, Schoenhagen P, Soman P, Dehmer GJ, Doherty JU, Schoenhagen P, Bashore TM, Bhave NM, Calnon DA, Carabello B, Conte J, Dickfeld T, Edmundowicz D, Ferrari VA, Hall ME, Ghoshhajra B, Mehrotra P, Naqvi TZ, Reece TB, Starling RC, Szerlip M, Tzou WS, Wong JB, Doherty JU, Dehmer GJ, Bailey SR, Bhave NM, Brown AS, Daugherty SL, Dean LS, Desai MY, Duvernoy CS, Gillam LD, Hendel RC, Kramer CM, Lindsay BD, Manning WJ, Patel MR, Sachdeva R, Wann LS, Winchester DE, Wolk MJ. ACC/AATS/AHA/ASE/ASNC/HRS/SCAI/SCCT/SCMR/STS 2019 Appropriate Use Criteria for Multimodality Imaging in the Assessment of Cardiac Structure and Function in Nonvalvular Heart Disease: A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and the Society of Thoracic Surgeons. J Am Soc Echocardiogr 2019; 32:553-579. [PMID: 30744922 DOI: 10.1016/j.echo.2019.01.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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] [Indexed: 01/26/2023]
Abstract
This document is the second of 2 companion appropriate use criteria (AUC) documents developed by the American College of Cardiology, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons. The first document1 addresses the evaluation and use of multimodality imaging in the diagnosis and management of valvular heart disease, whereas this document addresses this topic with regard to structural (nonvalvular) heart disease. While dealing with different subjects, the 2 documents do share a common structure and feature some clinical overlap. The goal of the companion AUC documents is to provide a comprehensive resource for multimodality imaging in the context of structural and valvular heart disease, encompassing multiple imaging modalities. Using standardized methodology, the clinical scenarios (indications) were developed by a diverse writing group to represent patient presentations encountered in everyday practice and included common applications and anticipated uses. Where appropriate, the scenarios were developed on the basis of the most current American College of Cardiology/American Heart Association Clinical Practice Guidelines. A separate, independent rating panel scored the 102 clinical scenarios in this document on a scale of 1 to 9. Scores of 7 to 9 indicate that a modality is considered appropriate for the clinical scenario presented. Midrange scores of 4 to 6 indicate that a modality may be appropriate for the clinical scenario, and scores of 1 to 3 indicate that a modality is considered rarely appropriate for the clinical scenario. The primary objective of the AUC is to provide a framework for the assessment of these scenarios by practices that will improve and standardize physician decision making. AUC publications reflect an ongoing effort by the American College of Cardiology to critically and systematically create, review, and categorize clinical situations in which diagnostic tests and procedures are utilized by physicians caring for patients with cardiovascular diseases. The process is based on the current understanding of the technical capabilities of the imaging modalities examined.
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Doherty JU, Kort S, Mehran R, Schoenhagen P, Soman P, Dehmer GJ, Doherty JU, Schoenhagen P, Bashore TM, Bhave NM, Calnon DA, Carabello B, Conte J, Dickfeld T, Edmundowicz D, Ferrari VA, Hall ME, Ghoshhajra B, Mehrotra P, Naqvi TZ, Reece TB, Starling RC, Szerlip M, Tzou WS, Wong JB. ACC/AATS/AHA/ASE/ASNC/HRS/SCAI/SCCT/SCMR/STS 2019 Appropriate Use Criteria for Multimodality Imaging in the Assessment of Cardiac Structure and Function in Nonvalvular Heart Disease. J Am Coll Cardiol 2019; 73:488-516. [DOI: 10.1016/j.jacc.2018.10.038] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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47
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Alashi A, Lang R, Seballos R, Feinleib S, Sukol R, Roselli EE, Svensson LG, Kalahasti V, Schoenhagen P, Flamm SD, Griffin BP, Desai MY. Dilation of the Proximal Thoracic Aorta in an Asymptomatic Primary Prevention Population Undergoing Noncontrast Chest Computed Tomography. Circulation 2019; 139:557-558. [PMID: 30586688 DOI: 10.1161/circulationaha.118.036191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 11/16/2022]
Affiliation(s)
- Alaa Alashi
- Aorta Center, Heart and Vascular Institute (A.A., E.E.R., L.G.S., V.K., P.S., S.D.F., B.P.G., M.Y.D.), Cleveland Clinic, OH
| | - Richard Lang
- Department of Preventive Medicine (R.L., R.S., S.F., R.S.), Cleveland Clinic, OH
| | - Raul Seballos
- Department of Preventive Medicine (R.L., R.S., S.F., R.S.), Cleveland Clinic, OH
| | - Steven Feinleib
- Department of Preventive Medicine (R.L., R.S., S.F., R.S.), Cleveland Clinic, OH
| | - Roxanne Sukol
- Department of Preventive Medicine (R.L., R.S., S.F., R.S.), Cleveland Clinic, OH
| | - Eric E Roselli
- Aorta Center, Heart and Vascular Institute (A.A., E.E.R., L.G.S., V.K., P.S., S.D.F., B.P.G., M.Y.D.), Cleveland Clinic, OH
| | - Lars G Svensson
- Aorta Center, Heart and Vascular Institute (A.A., E.E.R., L.G.S., V.K., P.S., S.D.F., B.P.G., M.Y.D.), Cleveland Clinic, OH
| | - Vidyasagar Kalahasti
- Aorta Center, Heart and Vascular Institute (A.A., E.E.R., L.G.S., V.K., P.S., S.D.F., B.P.G., M.Y.D.), Cleveland Clinic, OH.,Imaging Institute (V.K., P.S., S.D.F., M.Y.D.), Cleveland Clinic, OH
| | - Paul Schoenhagen
- Aorta Center, Heart and Vascular Institute (A.A., E.E.R., L.G.S., V.K., P.S., S.D.F., B.P.G., M.Y.D.), Cleveland Clinic, OH.,Imaging Institute (V.K., P.S., S.D.F., M.Y.D.), Cleveland Clinic, OH
| | - Scott D Flamm
- Aorta Center, Heart and Vascular Institute (A.A., E.E.R., L.G.S., V.K., P.S., S.D.F., B.P.G., M.Y.D.), Cleveland Clinic, OH.,Imaging Institute (V.K., P.S., S.D.F., M.Y.D.), Cleveland Clinic, OH
| | - Brian P Griffin
- Aorta Center, Heart and Vascular Institute (A.A., E.E.R., L.G.S., V.K., P.S., S.D.F., B.P.G., M.Y.D.), Cleveland Clinic, OH
| | - Milind Y Desai
- Aorta Center, Heart and Vascular Institute (A.A., E.E.R., L.G.S., V.K., P.S., S.D.F., B.P.G., M.Y.D.), Cleveland Clinic, OH.,Imaging Institute (V.K., P.S., S.D.F., M.Y.D.), Cleveland Clinic, OH
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Kaul R, Hanna M, Schoenhagen P, Johnston D, Donnelly J, Rodriguez R, Tan C, Hammer D. An unusual case of ANP amyloid associated with atrial thrombus. Amyloid 2019; 26:164-165. [PMID: 31343300 DOI: 10.1080/13506129.2019.1583197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Risheek Kaul
- a Department of Internal Medicine, Cleveland Clinic , Cleveland , OH , USA
| | - Mazen Hanna
- b Heart and Vascular Institute, Cleveland Clinic , Cleveland , OH , USA
| | - Paul Schoenhagen
- b Heart and Vascular Institute, Cleveland Clinic , Cleveland , OH , USA
| | - Douglas Johnston
- b Heart and Vascular Institute, Cleveland Clinic , Cleveland , OH , USA
| | - Joseph Donnelly
- b Heart and Vascular Institute, Cleveland Clinic , Cleveland , OH , USA
| | - Rene Rodriguez
- c Department of Anatomic Pathology, Cleveland Clinic , Cleveland , OH , USA
| | - Carmela Tan
- c Department of Anatomic Pathology, Cleveland Clinic , Cleveland , OH , USA
| | - Donald Hammer
- b Heart and Vascular Institute, Cleveland Clinic , Cleveland , OH , USA
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Blanke P, Weir-McCall JR, Achenbach S, Delgado V, Hausleiter J, Jilaihawi H, Marwan M, Norgaard BL, Piazza N, Schoenhagen P, Leipsic JA. Computed tomography imaging in the context of transcatheter aortic valve implantation (TAVI) / transcatheter aortic valve replacement (TAVR): An expert consensus document of the Society of Cardiovascular Computed Tomography. J Cardiovasc Comput Tomogr 2019; 13:1-20. [DOI: 10.1016/j.jcct.2018.11.008] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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50
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Blanke P, Weir-McCall JR, Achenbach S, Delgado V, Hausleiter J, Jilaihawi H, Marwan M, Nørgaard BL, Piazza N, Schoenhagen P, Leipsic JA. Computed Tomography Imaging in the Context of Transcatheter Aortic Valve Implantation (TAVI)/Transcatheter Aortic Valve Replacement (TAVR). JACC Cardiovasc Imaging 2019; 12:1-24. [DOI: 10.1016/j.jcmg.2018.12.003] [Citation(s) in RCA: 192] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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