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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] [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] [Imported: 08/29/2023]
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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Management of type-A intramural hematoma: Does classification matter? Int J Cardiol 2020; 313:121-122. [DOI: 10.1016/j.ijcard.2020.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 11/20/2022] [Imported: 08/29/2023]
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Schoenhagen P, Ghoshhajra B, Achenbach S, Abbara S. Interpretation of ‘incidental’ cardiovascular findings in standard chest CTs impact of evolving scanner technology on educational requirements. J Cardiovasc Comput Tomogr 2016; 10:289-90. [DOI: 10.1016/j.jcct.2016.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 04/22/2016] [Indexed: 12/21/2022] [Imported: 08/29/2023]
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Schoenhagen P, Roselli EE, Harris CM, Eagleton M, Menon V. Online network of subspecialty aortic disease experts: Impact of “cloud” technology on management of acute aortic emergencies. J Thorac Cardiovasc Surg 2016; 152:39-42. [DOI: 10.1016/j.jtcvs.2016.02.057] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 02/22/2016] [Accepted: 02/26/2016] [Indexed: 10/22/2022] [Imported: 08/29/2023]
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Schoenhagen P, Mehta N. Big data, smart computer systems, and doctor–patient relationship. Eur Heart J 2016:ehw217. [DOI: 10.1093/eurheartj/ehw217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] [Imported: 08/29/2023] Open
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Natarajan N, Patel P, Bartel T, Kapadia S, Navia J, Stewart W, Tuzcu EM, Schoenhagen P. Peri-procedural imaging for transcatheter mitral valve replacement. Cardiovasc Diagn Ther 2016; 6:144-59. [PMID: 27054104 DOI: 10.21037/cdt.2016.02.04] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] [Imported: 08/29/2023]
Abstract
Mitral regurgitation (MR) has a high prevalence in older patient populations of industrialized nations. Common etiologies are structural, degenerative MR and functional MR secondary to myocardial remodeling. Because of co-morbidities and associated high surgical risk, open surgical mitral repair/replacement is deferred in a significant percentage of patients. For these patients transcatheter repair/replacement are emerging as treatment options. Because of the lack of direct visualization, pre- and intra-procedural imaging is critical for these procedures. In this review, we summarize mitral valve anatomy, trans-catheter mitral valve replacement (TMVR) options, and imaging in the context of TMVR.
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Matar R, Renapurkar R, Obuchowski N, Menon V, Piraino D, Schoenhagen P. Utility of hand-held devices in diagnosis and triage of cardiovascular emergencies. Observations during implementation of a PACS-based system in an acute aortic syndrome (AAS) network. J Cardiovasc Comput Tomogr 2015; 9:524-33. [PMID: 26277273 DOI: 10.1016/j.jcct.2015.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 07/15/2015] [Accepted: 07/26/2015] [Indexed: 11/26/2022] [Imported: 08/29/2023]
Abstract
BACKGROUND Prompt diagnosis and early referral to specialized centers is critical for patients presenting with cardiovascular emergencies, including acute aortic syndromes (AAS). Prior data has suggested that mobile access to imaging studies with hand-held devices can accelerate diagnosis and management. OBJECTIVE We conducted a study to determine the diagnostic accuracy of a hand-held device compared to conventional dedicated work-stations for diagnosing a spectrum of cardiovascular emergencies, predominantly acute aortic pathology. METHODS This study included 104 cases who underwent computed tomography (CT)-scan during "on-call'' hours between January, 2013 and August, 2014 for suspected AAS. Assessment was performed on a hand-held device independently by two readers using an iPhone5 connected via secure connection to web-based PACS servers. The subsequent interpretation from a dedicated workstation coupled with the diagnosis at the time of discharge was used as the reference standard for determining the presence or absence of an acute abnormality. Sensitivity and Specificity were calculated on a per patient basis. RESULTS Readers' sensitivity and specificity using the hand-held device to diagnose acute chest pathology were calculated. Hand-held device evaluation was determined to have a sensitivity of 85.2% and a specificity of 98.6% by reader A and a sensitivity of 96.3% and specificity of 100% by reader B. Of 103 cases interpreted by both readers, the readers agreed about the diagnosis in 98 cases (95.1%). CONCLUSION This study demonstrates that hand-held devices can be a potential useful tool to assist in diagnosis and triage of patients presenting with cardiovascular emergencies. Further studies are needed to assess the impact of screen size and resolution.
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Schoenhagen P, Desai MY. Computed Tomography-Based Fractional Flow Reserve (FFR-CT). Circ J 2015; 79:300-302. [DOI: 10.1253/circj.cj-14-1306] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] [Imported: 08/29/2023]
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Manual, semiautomated, and fully automated measurement of the aortic annulus for planning of transcatheter aortic valve replacement (TAVR/TAVI): analysis of interchangeability. J Cardiovasc Comput Tomogr 2014; 9:42-9. [PMID: 25533222 DOI: 10.1016/j.jcct.2014.11.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 10/11/2014] [Accepted: 11/04/2014] [Indexed: 11/21/2022] [Imported: 08/29/2023]
Abstract
BACKGROUND Preprocedural 3-dimensional CT imaging of the aortic annular plane plays a critical role for transcatheter aortic valve replacement (TAVR) planning; however, manual reconstructions are complex. Automated analysis software may improve reproducibility and agreement between readers but is incompletely validated. METHODS In 110 TAVR patients (mean age, 81 years; 37% female) undergoing preprocedural multidetector CT, automated reconstruction of the aortic annular plane and planimetry of the annulus was performed with a prototype of now commercially available software (syngo.CT Cardiac Function-Valve Pilot; Siemens Healthcare, Erlangen, Germany). Fully automated, semiautomated, and manual annulus measurements were compared. Intrareader and inter-reader agreement, intermodality agreement, and interchangeability were analyzed. Finally, the impact of these measurements on recommended valve size was evaluated. RESULTS Semiautomated analysis required major correction in 5 patients (4.5%). In the remaining 95.5%, only minor correction was performed. Mean manual annulus area was significantly smaller than fully automated results (P < .001 for both readers) but similar to semiautomated measurements (5.0 vs 5.4 vs 4.9 cm(2), respectively). The frequency of concordant recommendations for valve size increased if manual analysis was replaced with the semiautomated method (60% agreement was improved to 82.4%; 95% confidence interval for the difference [69.1%-83.4%]). CONCLUSIONS Semiautomated aortic annulus analysis, with minor correction by the user, provides reliable results in the context of TAVR annulus evaluation.
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Schoenhagen P, Weiner M. Ebola and art. Cardiovasc Diagn Ther 2014; 4:339-40. [PMID: 25414819 PMCID: PMC4221320 DOI: 10.3978/j.issn.2223-3652.2014.10.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 10/20/2014] [Indexed: 01/20/2023] [Imported: 08/29/2023]
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Schoenhagen P, Baker ME. Our preoccupation with ultra-low dose radiation exposure. Low contrast resolution and cardiovascular CT imaging. J Cardiovasc Comput Tomogr 2014; 8:426-8. [PMID: 25439790 DOI: 10.1016/j.jcct.2014.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 09/02/2014] [Indexed: 02/01/2023] [Imported: 08/29/2023]
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Schoenhagen P, Vince DG. Intravascular Photoacoustic Tomography of Coronary Atherosclerosis. J Am Coll Cardiol 2014; 64:391-3. [DOI: 10.1016/j.jacc.2014.05.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 05/20/2014] [Indexed: 11/26/2022] [Imported: 08/29/2023]
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Escobedo C, Schoenhagen P. Aortic root imaging in the era of transcatheter aortic valve implantation/transcatheter aortic valve replacement. ACTA ACUST UNITED AC 2014; 66:839-41. [PMID: 24773989 DOI: 10.1016/j.rec.2013.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Accepted: 05/02/2013] [Indexed: 10/26/2022] [Imported: 08/29/2023]
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Schoenhagen P, Botnar R. Plaque Trek. J Am Coll Cardiol 2014; 63:1000-1. [DOI: 10.1016/j.jacc.2013.10.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 10/28/2013] [Indexed: 11/27/2022] [Imported: 08/29/2023]
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Schoenhagen P, Li S, Wang S. Cloud publishing of scientific medical journals: current status and future direction. Cardiovasc Diagn Ther 2013; 3:188-9. [PMID: 24400200 PMCID: PMC3878114 DOI: 10.3978/j.issn.2223-3652.2013.12.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 11/10/2013] [Indexed: 01/20/2023] [Imported: 08/29/2023]
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Schoenhagen P, Zimmermann M, Falkner J. Advanced 3-D analysis, client-server systems, and cloud computing-Integration of cardiovascular imaging data into clinical workflows of transcatheter aortic valve replacement. Cardiovasc Diagn Ther 2013; 3:80-92. [PMID: 24282750 DOI: 10.3978/j.issn.2223-3652.2013.02.08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 02/25/2013] [Indexed: 11/14/2022] [Imported: 08/29/2023]
Abstract
Degenerative aortic stenosis is highly prevalent in the aging populations of industrialized countries and is associated with poor prognosis. Surgical valve replacement has been the only established treatment with documented improvement of long-term outcome. However, many of the older patients with aortic stenosis (AS) are high-risk or ineligible for surgery. For these patients, transcatheter aortic valve replacement (TAVR) has emerged as a treatment alternative. The TAVR procedure is characterized by a lack of visualization of the operative field. Therefore, pre- and intra-procedural imaging is critical for patient selection, pre-procedural planning, and intra-operative decision-making. Incremental to conventional angiography and 2-D echocardiography, multidetector computed tomography (CT) has assumed an important role before TAVR. The analysis of 3-D CT data requires extensive post-processing during direct interaction with the dataset, using advance analysis software. Organization and storage of the data according to complex clinical workflows and sharing of image information have become a critical part of these novel treatment approaches. Optimally, the data are integrated into a comprehensive image data file accessible to multiple groups of practitioners across the hospital. This creates new challenges for data management requiring a complex IT infrastructure, spanning across multiple locations, but is increasingly achieved with client-server solutions and private cloud technology. This article describes the challenges and opportunities created by the increased amount of patient-specific imaging data in the context of TAVR.
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Schoenhagen P, Ferris LE, Winker MA. Medical publishing in a digital world: New World, new standards? Cardiovasc Diagn Ther 2013; 2:258-60. [PMID: 24282724 DOI: 10.3978/j.issn.2223-3652.2012.09.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Accepted: 08/31/2012] [Indexed: 01/01/2023] [Imported: 08/29/2023]
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Schoenhagen P, Dewey M. CT assessment of coronary artery disease: trends and clinical implications. JACC Cardiovasc Imaging 2013; 6:1072-1074. [PMID: 24135321 DOI: 10.1016/j.jcmg.2013.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 06/18/2013] [Accepted: 07/09/2013] [Indexed: 12/01/2022] [Imported: 08/29/2023]
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Schoenhagen P, Falkner J, Piraino D. Transcatheter aortic valve repair, imaging, and electronic imaging health record. Curr Cardiol Rep 2013; 15:319. [PMID: 23250656 DOI: 10.1007/s11886-012-0319-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] [Imported: 08/29/2023]
Abstract
Degenerative aortic stenosis (AS) is a common valvular pathology in developed nations. Secondary to advanced age and often multiple co-morbidities, a significant percentage of patients are not considered surgical candidates. For these high-risk patients, transcatheter aortic valve replacement (TAVR) is a rapidly emerging less-invasive treatment alternative. Because of the lack of direct exposure and visualization of the operative field, pre-procedural planning and intra-procedural guidance relies on imaging. Large 3-dimensional data files are acquired, which are reconstructed on advanced workstations during review and interpretation. Optimally, the imaging data is organized into a comprehensive digital file as an integral part of the electronic health record (EHR) following the patient. This manuscript will discuss the role of image data management in the context of TAVR.
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Schoenhagen P, Lee G. An evolving journal. Cardiovasc Diagn Ther 2012; 2:186-7. [PMID: 24282715 PMCID: PMC3839180 DOI: 10.3978/j.issn.2223-3652.2012.09.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 09/03/2012] [Indexed: 01/20/2023] [Imported: 08/29/2023]
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Schoenhagen P, Isma’eel H, Mocumbi AO. 'Longitudinal' topics in Cardiovascular Diagnosis and Therapy (CDT). Cardiovasc Diagn Ther 2012; 2:83-4. [PMID: 24282701 PMCID: PMC3839149 DOI: 10.3978/j.issn.2223-3652.2012.06.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 06/08/2012] [Indexed: 01/20/2023] [Imported: 08/29/2023]
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Schoenhagen P. Communication of novel concepts. Cardiovasc Diagn Ther 2012; 2:1-2. [PMID: 24282689 PMCID: PMC3839172 DOI: 10.3978/j.issn.2223-3652.2012.02.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 02/05/2012] [Indexed: 01/20/2023] [Imported: 08/29/2023]
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Schoenhagen P, Hausleiter J, Achenbach S, Desai MY, Tuzcu EM. Computed tomography in the evaluation for transcatheter aortic valve implantation (TAVI). Cardiovasc Diagn Ther 2011; 1:44-56. [PMID: 24282684 DOI: 10.3978/j.issn.2223-3652.2011.08.01] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 08/22/2011] [Indexed: 01/16/2023] [Imported: 08/29/2023]
Abstract
If left untreated, symptomatic, severe aortic stenosis (AS) is associated with a dismal prognosis. Open-heart surgical valve replacement is the treatment of choice and is associated with excellent short and long-term outcome. However, many older patients with multiple co-morbidities and anticipated increased surgical risk are excluded from surgical intervention. For these patients, transcatheter aortic valve implantation (TAVI) is emerging as a viable treatment alternative. Transcatheter valvular heart procedures are characterized by lack of exposure and visualization of the operative field, therefore relying on image guidance, both for patient selection and preparation and the implantation procedure itself. This article describes the role of multi-detector row computed tomography (MDCT) for detailed assessment of the aortic valve, aortic root, and iliac arteries in the context of TAVI.
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Schoenhagen P. Cardiovascular Diagnosis and Therapy (CDT): yet another journal? Cardiovasc Diagn Ther 2011; 1:1-2. [PMID: 24282680 PMCID: PMC3839133 DOI: 10.3978/j.issn.2223-3652.2011.09.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 09/26/2011] [Indexed: 01/20/2023] [Imported: 08/29/2023]
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