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Stein T, Taron J, Verloh N, Doppler M, Rau A, Hagar MT, Faby S, Baltas D, Westermann D, Ayx I, Schönberg SO, Nikolaou K, Schlett CL, Bamberg F, Weiss J. Photon-counting computed tomography of coronary and peripheral artery stents: a phantom study. Sci Rep 2023; 13:14806. [PMID: 37684412 PMCID: PMC10491813 DOI: 10.1038/s41598-023-41854-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
Accurate small vessel stent visualization using CT remains challenging. Photon-counting CT (PCD-CT) may help to overcome this issue. We systematically investigate PCD-CT impact on small vessel stent assessment compared to energy-integrating-CT (EID). 12 water-contrast agent filled stents (3.0-8 mm) were scanned with patient-equivalent phantom using clinical PCD-CT and EID-CT. Images were reconstructed using dedicated vascular kernels. Subjective image quality was evaluated by 5 radiologists independently (5-point Likert-scale; 5 = excellent). Objective image quality was evaluated by calculating multi-row intensity profiles including edge rise slope (ERS) and coefficient-of-variation (CV). Highest overall reading scores were found for PCD-CT-Bv56 (3.6[3.3-4.3]). In pairwise comparison, differences were significant for PCD-CT-Bv56 vs. EID-CT-Bv40 (p ≤ 0.04), for sharpness and blooming respectively (all p < 0.05). Highest diagnostic confidence was found for PCD-CT-Bv56 (p ≤ 0.2). ANOVA revealed a significant effect of kernel strength on ERS (p < 0.001). CV decreased with stronger PCD-CT kernels, reaching its lowest in PCD-CT-Bv56 and highest in EID-CT reconstruction (p ≤ 0.05). We are the first study to verify, by phantom setup adapted to real patient settings, PCD-CT with a sharp vascular kernel provides the most favorable image quality for small vessel stent imaging. PCD-CT may reduce the number of invasive coronary angiograms, however, more studies needed to apply our results in clinical practice.
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Affiliation(s)
- Thomas Stein
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Jana Taron
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Niklas Verloh
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Doppler
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alexander Rau
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Muhammad Taha Hagar
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sebastian Faby
- Computed Tomography, Siemens Healthcare GmbH, Forchheim, Germany
| | - Dimos Baltas
- Division of Medical Physics, Department of Radiation Oncology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology, Interdisciplinary Vascular Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Isabelle Ayx
- Department of Radiology and Nuclear Medicine, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Stefan O Schönberg
- Department of Radiology and Nuclear Medicine, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany
| | - Christopher L Schlett
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jakob Weiss
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Mushtaq S, Gigante C, Conte E, Capovilla TM, Sonck J, Tanzilli A, Barbato E, Monizzi G, Belmonte M, De Bruyne B, Bartorelli AL, Schillaci M, Marchetti D, Carerj ML, Pontone G, Collet C, Andreini D. Preoperative angiography-derived fractional flow reserve may predict coronary artery bypass grafting occlusion and disease progression. J Cardiovasc Med (Hagerstown) 2023; 24:651-658. [PMID: 37605957 DOI: 10.2459/jcm.0000000000001509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
BACKGROUND Graft occlusion after coronary artery bypass grafting (CABG) has been associated with competitive flow of native coronary arteries. OBJECTIVES To assess with coronary computed tomography angiography (CCTA) graft occlusion and coronary artery disease (CAD) progression of native vessels after CABG and their relationship with angiography-derived vessel fractional flow reserve (vFFR) performed before surgery. METHODS Between 2006 and 2018, serial vFFR analyses were obtained before CABG in each major native coronary vessel from two institutions. All patients underwent follow-up CCTA. RESULTS In 171 consecutive patients, serial preoperative angiograms were suitable for vFFR analysis of 298 grafted and 59 nongrafted vessels. Median time between CABG and CCTA was 2.1 years. Preoperative vFFR was assessed in 131 left anterior descending artery (LAD), 132 left circumflex artery (LCX) and 94 right coronary aretry (RCA) and was less than 0.80 in 255 of 298 bypassed vessels. Graft occlusion was observed at CCTA in 28 of 298 grafts. The median preoperative vFFR value of native coronaries was higher in occluded compared with patent grafts (0.75 vs. 0.60, P < 0.001) and was associated with graft. The best vFFR cut-off to predict graft occlusion was 0.67. Progression of CAD was higher in grafted than in nongrafted vessels (89.6 vs. 47.5%, P < 0.001). Pre-CABG vFFR predicted disease progression of grafted native vessels (AUC = 0.83). CONCLUSION Preoperative vFFR derived from invasive coronary angiography was able to predict graft occlusion and CAD progression of grafted coronary arteries.
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Affiliation(s)
| | | | | | | | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples
| | | | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples
| | | | | | | | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences
| | - Matteo Schillaci
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- University of Milan, Milan
| | - Davide Marchetti
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- University of Milan, Milan
| | - Maria Ludovica Carerj
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Diagnostic and Interventional Radiology Unit, Department of Biomedical Sciences and Morphological and Functional Imaging, 'G. Martino' University Hospital Messina, Messina
| | - Gianluca Pontone
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences
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Eriksen E, Neghabat O, Larsen TH, Saeed S, Bleie Ø. Long-term multimodality imaging follow-up of ST-segment elevation myocardial infarction patients treated with bioresorbable vascular scaffold: advantages and challenges. Coron Artery Dis 2023; 34:415-424. [PMID: 37191924 DOI: 10.1097/mca.0000000000001249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND Multislice computed tomography (MSCT) offers a non-invasive method of imaging bioresorbable scaffolds (BRS). OBJECTIVES To investigate the advantages and challenges using MSCT in the follow-up after BRS implantation. METHOD The BRS cohort consisting of 31 patients in the 'BRS in STEMI' trial was examined by multimodality imaging and followed long-term. Minimum lumen area (MLA) and average lumen area (ALA) were examined 12 and 36 months after BRS implantation with MSCT. Optical coherence tomography (OCT) at 12 months was used as a reference. RESULTS Measured by MSCT, the mean MLA was 0.05 ± 1.32 mm² ( P = 0.85), but ALA was 1.32 (±2.59 mm², P = 0.015) greater than by OCT. ALA and MLA did not change significantly from 12 to 36 months. MSCT identified all cases of restenosis but missed one patient with massive malapposition. CONCLUSION Our data support using MSCT in the follow-up after BRS implantation. Invasive investigation should still be considered for patients with unexplained symptoms.
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Affiliation(s)
- Erlend Eriksen
- Department of Heart Disease, Haukeland University Hospital
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Omeed Neghabat
- Department of Cardiology, Aarhus University Hospital
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Terje H Larsen
- Department of Heart Disease, Haukeland University Hospital
- Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Sahrai Saeed
- Department of Heart Disease, Haukeland University Hospital
| | - Øyvind Bleie
- Department of Heart Disease, Haukeland University Hospital
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Gupta H, Spanopoulous B, Lubat E, Krinsky G, Rutledge J, Fortier JH, Grau J, Tayal R. Real-world approach to comprehensive artificial intelligence-aided CT evaluation of coronary artery disease in 530 patients: A retrospective study. Heliyon 2023; 9:e19974. [PMID: 37809738 PMCID: PMC10559546 DOI: 10.1016/j.heliyon.2023.e19974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/29/2023] [Accepted: 09/07/2023] [Indexed: 10/10/2023] Open
Abstract
Purpose Recent guidelines provide broader support for the use of less invasive imaging modalities for the evaluation of patients with stable chest pain. Coronary CT angiography (CCTA) uses increasingly sophisticated techniques to improve evaluation of coronary lesions. The purpose of this study is to describe one center's experience implementing AI-assisted advanced imaging techniques to diagnose coronary artery disease. Materials & methods Retrospective study of patients who had AI-assisted CCTA interpretation, including a subgroup who underwent fractional flow reserve CT (FFR-CT) and invasive coronary angiography. Descriptive statistics summarized baseline characteristics and univariate statistics compared findings between groups of patients with and without anatomically and hemodynamically significant lesions based on FFR-CT. For patients who underwent invasive coronary angiography, concordance between CCTA and angiography was evaluated. Results Of 532 included patients, AI-assisted CCTA identified statistically significant difference in calcification scores, plaque types and total plaque volume between lesions <50% and ≥50% stenosis. CCTA results were mostly concordant with invasive coronary angiography. Importantly, we identified a subset of patients with less than 50% anatomical stenosis that demonstrated physiologically significant stenosis on FFR-CT and invasive coronary angiography. Conclusions AI-assisted CCTA and other advanced techniques are a tool to support high quality diagnostic assessment of coronary lesions in a clinical environment. Combined CCTA with FFRCT in mild to moderate coronary stenosis identifies patients with hemodynamically significant stenosis even when quantitative stenosis is <50%. Implementation of AI-assisted coronary CT angiography is feasible in a community hospital setting, but these technologies do not replace the need for expert review and clinical correlation.
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Affiliation(s)
| | | | | | | | | | | | - Juan Grau
- The Valley Hospital, Ridgewood, NJ, USA
- The University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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Jepson BM, Rigsby CK, Hlavacek AM, Prakash A, Priya S, Barfuss S, Chelliah A, Binka E, Nicol E, Ghoshhajra B, Han BK. Proposed competencies for the performance of cardiovascular computed tomography in pediatric and adult congenital heart disease. J Cardiovasc Comput Tomogr 2023; 17:295-301. [PMID: 37625911 DOI: 10.1016/j.jcct.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/25/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023]
Abstract
Cardiovascular computed tomography (CCT) is rated appropriate by published guidelines for the initial evaluation and follow up of congenital heart disease (CHD) and is an essential modality in cardiac imaging programs for patients of all ages. However, no recommended core competencies exist to guide CCT in CHD imaging training pathways, curricula development, or establishment of a more formal educational platform. To fill this gap, a group of experienced congenital cardiac imagers, intentionally inclusive of adult and pediatric cardiologists and radiologists, was formed to propose core competencies fundamental to the expert-level performance of CCT in pediatric acquired and congenital heart disease and adult CHD. The 2020 SCCT Guideline for Training Cardiology and Radiology Trainees as Independent Practitioners (Level II) and Advanced Practitioners (Level III) in Cardiovascular Computed Tomography (1) for adult imaging were used as a framework to define pediatric and CHD-specific competencies. Established competencies will be immediately relevant for advanced cardiac imaging fellowships in both cardiology and radiology training pathways. Proposed future steps include radiology and cardiology society collaboration to establish provider certification levels, training case-volume recommendations, and continuing medical education (CME) requirements for expert-level performance of CCT in pediatric and adult CHD.
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Affiliation(s)
- Bryan M Jepson
- University of Utah, Intermountain Primary Children's Hospital, Salt Lake City, UT, USA
| | - Cynthia K Rigsby
- Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Anthony M Hlavacek
- Shawn Jenkins Children's Hospital, Department of Pediatrics, Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Ashwin Prakash
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sarv Priya
- University of Iowa Hospitals & Clinics, Carver College of Medicine, Iowa City, IA, USA
| | - Spencer Barfuss
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Anjali Chelliah
- Division of Pediatric Cardiology, Goryeb Children's Hospital, Atlantic Health System, Morristown, NJ and Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Edem Binka
- University of Utah, Intermountain Primary Children's Hospital, Salt Lake City, UT, USA
| | - Edward Nicol
- Royal Brompton and Harefield Hospitals, Imperial College of London School of Medicine, UK; School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
| | - Brian Ghoshhajra
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - B Kelly Han
- University of Utah, Intermountain Primary Children's Hospital, Salt Lake City, UT, USA.
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Pergola V, Mattesi G, Cozza E, Pradegan N, Tessari C, Dellino CM, Savo MT, Amato F, Cecere A, Perazzolo Marra M, Tona F, Guaricci AI, De Conti G, Gerosa G, Iliceto S, Motta R. New Non-Invasive Imaging Technologies in Cardiac Transplant Follow-Up: Acquired Evidence and Future Options. Diagnostics (Basel) 2023; 13:2818. [PMID: 37685356 PMCID: PMC10487200 DOI: 10.3390/diagnostics13172818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Heart transplantation (HT) is the established treatment for end-stage heart failure, significantly enhancing patients' survival and quality of life. To ensure optimal outcomes, the routine monitoring of HT recipients is paramount. While existing guidelines offer guidance on a blend of invasive and non-invasive imaging techniques, certain aspects such as the timing of echocardiographic assessments and the role of echocardiography or cardiac magnetic resonance (CMR) as alternatives to serial endomyocardial biopsies (EMBs) for rejection monitoring are not specifically outlined in the guidelines. Furthermore, invasive coronary angiography (ICA) is still recommended as the gold-standard procedure, usually performed one year after surgery and every two years thereafter. This review focuses on recent advancements in non-invasive and contrast-saving imaging techniques that have been investigated for HT patients. The aim of the manuscript is to identify imaging modalities that may potentially replace or reduce the need for invasive procedures such as ICA and EMB, considering their respective advantages and disadvantages. We emphasize the transformative potential of non-invasive techniques in elevating patient care. Advanced echocardiography techniques, including strain imaging and tissue Doppler imaging, offer enhanced insights into cardiac function, while CMR, through its multi-parametric mapping techniques, such as T1 and T2 mapping, allows for the non-invasive assessment of inflammation and tissue characterization. Cardiac computed tomography (CCT), particularly with its ability to evaluate coronary artery disease and assess graft vasculopathy, emerges as an integral tool in the follow-up of HT patients. Recent studies have highlighted the potential of nuclear myocardial perfusion imaging, including myocardial blood flow quantification, as a non-invasive method for diagnosing and prognosticating CAV. These advanced imaging approaches hold promise in mitigating the need for invasive procedures like ICA and EMB when evaluating the benefits and limitations of each modality.
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Affiliation(s)
- Valeria Pergola
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy; (G.M.); (C.M.D.); (M.T.S.); (F.A.); (A.C.); (M.P.M.); (F.T.); (S.I.)
| | - Giulia Mattesi
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy; (G.M.); (C.M.D.); (M.T.S.); (F.A.); (A.C.); (M.P.M.); (F.T.); (S.I.)
| | - Elena Cozza
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy; (G.M.); (C.M.D.); (M.T.S.); (F.A.); (A.C.); (M.P.M.); (F.T.); (S.I.)
| | - Nicola Pradegan
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy; (N.P.); (C.T.); (G.G.)
| | - Chiara Tessari
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy; (N.P.); (C.T.); (G.G.)
| | - Carlo Maria Dellino
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy; (G.M.); (C.M.D.); (M.T.S.); (F.A.); (A.C.); (M.P.M.); (F.T.); (S.I.)
| | - Maria Teresa Savo
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy; (G.M.); (C.M.D.); (M.T.S.); (F.A.); (A.C.); (M.P.M.); (F.T.); (S.I.)
| | - Filippo Amato
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy; (G.M.); (C.M.D.); (M.T.S.); (F.A.); (A.C.); (M.P.M.); (F.T.); (S.I.)
| | - Annagrazia Cecere
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy; (G.M.); (C.M.D.); (M.T.S.); (F.A.); (A.C.); (M.P.M.); (F.T.); (S.I.)
| | - Martina Perazzolo Marra
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy; (G.M.); (C.M.D.); (M.T.S.); (F.A.); (A.C.); (M.P.M.); (F.T.); (S.I.)
| | - Francesco Tona
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy; (G.M.); (C.M.D.); (M.T.S.); (F.A.); (A.C.); (M.P.M.); (F.T.); (S.I.)
| | - Andrea Igoren Guaricci
- Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital “Policlinico” of Bari, 70124 Bari, Italy;
| | | | - Gino Gerosa
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy; (N.P.); (C.T.); (G.G.)
| | - Sabino Iliceto
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy; (G.M.); (C.M.D.); (M.T.S.); (F.A.); (A.C.); (M.P.M.); (F.T.); (S.I.)
| | - Raffaella Motta
- Unit of Radiology, Department of Medicine, Medical School, University of Padua, 35122 Padua, Italy;
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Perone F, Bernardi M, Redheuil A, Mafrica D, Conte E, Spadafora L, Ecarnot F, Tokgozoglu L, Santos-Gallego CG, Kaiser SE, Fogacci F, Sabouret A, Bhatt DL, Paneni F, Banach M, Santos R, Biondi Zoccai G, Ray KK, Sabouret P. Role of Cardiovascular Imaging in Risk Assessment: Recent Advances, Gaps in Evidence, and Future Directions. J Clin Med 2023; 12:5563. [PMID: 37685628 PMCID: PMC10487991 DOI: 10.3390/jcm12175563] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/14/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Optimal risk assessment for primary prevention remains highly challenging. Recent registries have highlighted major discrepancies between guidelines and daily practice. Although guidelines have improved over time and provide updated risk scores, they still fail to identify a significant proportion of at-risk individuals, who then miss out on effective prevention measures until their initial ischemic events. Cardiovascular imaging is progressively assuming an increasingly pivotal role, playing a crucial part in enhancing the meticulous categorization of individuals according to their risk profiles, thus enabling the customization of precise therapeutic strategies for patients with increased cardiovascular risks. For the most part, the current approach to patients with atherosclerotic cardiovascular disease (ASCVD) is homogeneous. However, data from registries (e.g., REACH, CORONOR) and randomized clinical trials (e.g., COMPASS, FOURIER, and ODYSSEY outcomes) highlight heterogeneity in the risks of recurrent ischemic events, which are especially higher in patients with poly-vascular disease and/or multivessel coronary disease. This indicates the need for a more individualized strategy and further research to improve definitions of individual residual risk, with a view of intensifying treatments in the subgroups with very high residual risk. In this narrative review, we discuss advances in cardiovascular imaging, its current place in the guidelines, the gaps in evidence, and perspectives for primary and secondary prevention to improve risk assessment and therapeutic strategies using cardiovascular imaging.
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Affiliation(s)
- Francesco Perone
- Cardiac Rehabilitation Unit, Rehabilitation Clinic “Villa delle Magnolie”, Castel Morrone, 81020 Caserta, Italy;
| | - Marco Bernardi
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00185 Rome, Italy; (M.B.); (D.M.); (L.S.)
| | - Alban Redheuil
- Laboratoire d’Imagerie Biomédicale, Sorbonne University, INSERM 1146, CNRS 7371, 75005 Paris, France;
| | - Dario Mafrica
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00185 Rome, Italy; (M.B.); (D.M.); (L.S.)
| | - Edoardo Conte
- Cardiology Department, Galeazzi-Sant’Ambrogio Hospital IRCCS, 20100 Milan, Italy;
| | - Luigi Spadafora
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00185 Rome, Italy; (M.B.); (D.M.); (L.S.)
| | - Fiona Ecarnot
- Department of Cardiology, University Hospital Besancon, University of Franche-Comté, 25000 Besancon, France;
| | - Lale Tokgozoglu
- Department of Cardiology, Medical Faculty, Hacettepe University, 06230 Ankara, Turkey;
| | - Carlos G. Santos-Gallego
- Atherothrombosis Research Unit, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, NY 10029, USA;
| | - Sergio Emanuel Kaiser
- Discipline of Clinical and Experimental Pathophysiology, Rio de Janeiro State University, Rio de Janeiro 23070-200, Brazil;
| | - Federica Fogacci
- Hypertension and Cardiovascular Risk Research Group, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy;
| | | | - Deepak L. Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, NY 10029, USA;
| | - Francesco Paneni
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland;
- Center for Translational and Experimental Cardiology (CTEC), University Hospital Zurich and University of Zurich, 8091 Zurich, Switzerland
| | - Maciej Banach
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz (MUL), Rzgowska 281/289, 93-338 Lodz, Poland;
- Cardiovascular Research Centre, University of Zielona Gora, 65-417 Zielona Gora, Poland
| | - Raul Santos
- Heart Institute, University of Sao Paulo Medical School, São Paulo 05403-903, Brazil;
| | - Giuseppe Biondi Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 00185 Roma, Italy;
- Mediterranea Cardiocentro, 80122 Napoli, Italy
| | - Kausik K. Ray
- Imperial Centre for Cardiovascular Disease Prevention and Imperial Clinical Trials Unit, Department of Public Health and Primary Care, Imperial College London, London SW7 2BX, UK;
| | - Pierre Sabouret
- Heart Institute, Cardiology Department, Paris and National College of French Cardiologists, Pitié-Salpétrière Hospital, Sorbonne University, 75013 Paris, France
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Zhou J, Xin T, Tan Y, Pang J, Chen T, Wang H, Zhao J, Liu C, Xie C, Wang M, Wang C, Liu Y, Zhang J, Liu Y, Shanfu C, Li C, Cong H. Comparison of two diagnostic strategies for patients with stable chest pain suggestive of chronic coronary syndrome: rationale and design of the double-blind, pragmatic, randomized and controlled OPERATE Trial. BMC Cardiovasc Disord 2023; 23:416. [PMID: 37612631 PMCID: PMC10464280 DOI: 10.1186/s12872-023-03424-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/01/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND To achieve potential financial savings and avoid exposing the patients to unnecessary risk, an optimal diagnostic strategy to identify low risk individual who may derive minimal benefit from further cardiac imaging testing (CIT) is important for patients with stable chest pain (SCP) suggestive of chronic coronary syndrome (CCS). Although several diagnostic strategies have been recommended by the most recent guidelines, few randomized controlled trials (RCTs) have prospectively investigated the actual effect of applying these strategies in clinical practice. METHODS OPERATE (OPtimal Evaluation of stable chest pain to Reduce unnecessAry utilization of cardiac imaging TEsting) trial is an investigator-initiated, multicenter, coronary computed tomography angiography (CCTA)-based, 2-arm parallel-group, double-blind, pragmatic and confirmative RCT planning to include 800 subjects with SCP suggestive of CCS. After enrollment, all subjects will be randomized to two arms (2016 U.K. National Institute of Health and Care Excellence guideline-determined and 2019 European Society of Cardiology guideline-determined diagnostic strategy) on a 1:1 basis. According to each strategy, CCTA should be referred and deferred for a subject in high and low risk group, respectively. The primary (effectiveness) endpoint is CCTA without obstructive coronary artery disease. Safety of each strategy will be mainly assessed by 1-year major adverse cardiovascular event rates. DISCUSSION The OPERATE trial will provide comparative effectiveness and safety evidences for two different diagnostic strategies for patients with SCP suggestive of CCS, with the intension of improving the diagnostic yield of CCTA at no expense of safety. CLINICAL TRIAL REGISTRATION ClinicalTrial.org Identifier NCT05640752.
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Affiliation(s)
- Jia Zhou
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China.
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China.
| | - Ting Xin
- Department of Cardiology, Tianjin First Central Hospital, Tianjin, China
| | - Yahang Tan
- Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jianzhong Pang
- Department of Cardiology, Tianjin Second Teaching Hospital of Tianjin University of Traditional Chinese, Tianjin, China
| | - Tao Chen
- Department of Emergency, Hebei Petrochina Central Hospital, Langfang, Hebei, China
| | - Hao Wang
- Department of Clinical Epidemiology and Evidence-Based Medicine, Friendship Hospital, Capital Medical University, Beijing, China
| | - Jia Zhao
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Chang Liu
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
| | - Cun Xie
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Minghui Wang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Chengjian Wang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Yuanying Liu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Jie Zhang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Yankun Liu
- Department of Cardiology, Tianjin Second Teaching Hospital of Tianjin University of Traditional Chinese, Tianjin, China
| | - Chen Shanfu
- Department of Cardiology, Tianjin Second Teaching Hospital of Tianjin University of Traditional Chinese, Tianjin, China
| | - Chunjie Li
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Hongliang Cong
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China.
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China.
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Bartorelli AL, Andreini D, Giustino G, Dangas G. Coronary CT as a first-line investigation in chronic coronary syndromes: pros and cons. EUROINTERVENTION 2023; 19:459-461. [PMID: 37605808 PMCID: PMC10436067 DOI: 10.4244/eij-e-23-00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Affiliation(s)
- Antonio L Bartorelli
- IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Daniele Andreini
- IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Gennaro Giustino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Alexander M, Lan NSR, Dallo MJ, Briffa TG, Sanfilippo FM, Hooper A, Bartholomew H, Hii L, Hillis GS, McQuillan BM, Dwivedi G, Rankin JM, Ihdayhid AR. Clinical outcomes and health care costs of transferring rural Western Australians for invasive coronary angiography, and a cost-effective alternative care model: a retrospective cross-sectional study. Med J Aust 2023; 219:155-161. [PMID: 37403443 DOI: 10.5694/mja2.52018] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/20/2023] [Accepted: 05/10/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVES To examine the severity of coronary artery disease (CAD) in people from rural or remote Western Australia referred for invasive coronary angiography (ICA) in Perth and their subsequent management; to estimate the cost savings were computed tomography coronary angiography (CTCA) offered in rural centres as a first line investigation for people with suspected CAD. DESIGN Retrospective cohort study. SETTING, PARTICIPANTS Adults with stable symptoms in rural and remote WA referred to Perth public tertiary hospitals for ICA evaluation during the 2019 calendar year. MAIN OUTCOME MEASURES Severity and management of CAD (medical management or revascularisation); health care costs by care model (standard care or a proposed alternative model with local CTCA assessment). RESULTS The mean age of the 1017 people from rural and remote WA who underwent ICA in Perth was 62 years (standard deviation, 13 years); 680 were men (66.9%), 245 were Indigenous people (24.1%). Indications for referral were non-ST elevation myocardial infarction (438, 43.1%), chest pain with normal troponin level (394, 38.7%), and other (185, 18.2%). After ICA assessment, 619 people were medically managed (60.9%) and 398 underwent revascularisation (39.1%). None of the 365 patients (35.9%) without obstructed coronaries (< 50% stenosis) underwent revascularisation; nine patients with moderate CAD (50-69% stenosis; 7%) and 389 with severe CAD (≥ 70% stenosis or occluded vessel; 75.5%) underwent revascularisation. Were CTCA used locally to determine the need for referral, 527 referrals could have been averted (53%), the ICA:revascularisation ratio would have improved from 2.6 to 1.6, and 1757 metropolitan hospital bed-days (43% reduction) and $7.3 million in health care costs (36% reduction) would have been saved. CONCLUSION Many rural and remote Western Australians transferred for ICA in Perth have non-obstructive CAD and are medically managed. Providing CTCA as a first line investigation in rural centres could avert half of these transfers and be a cost-effective strategy for risk stratification of people with suspected CAD.
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Affiliation(s)
| | - Nick S R Lan
- Fiona Stanley Hospital, Perth, WA
- The University of Western Australia, Perth, WA
| | | | | | | | - Andrew Hooper
- Medical Royal Flying Doctor Service Western Australia, Perth, WA
| | | | | | - Graham S Hillis
- Royal Perth Hospital, Perth, WA
- The University of Western Australia, Perth, WA
| | - Brendan M McQuillan
- The University of Western Australia, Perth, WA
- Sir Charles Gairdner Hospital, Perth, WA
| | - Girish Dwivedi
- Fiona Stanley Hospital, Perth, WA
- Harry Perkins Institute of Medical Research, Perth, WA
| | | | - Abdul Rahman Ihdayhid
- Fiona Stanley Hospital, Perth, WA
- Harry Perkins Institute of Medical Research, Perth, WA
- Curtin Medical School, Curtin University, Perth, WA
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Natale L, Vliegenthart R, Salgado R, Bremerich J, Budde RPJ, Dacher JN, Francone M, Kreitner KF, Loewe C, Nikolaou K, Peebles C, Velthuis BK, Catalano C. Cardiac radiology in Europe: status and vision by the European Society of Cardiovascular Radiology (ESCR) and the European Society of Radiology (ESR). Eur Radiol 2023; 33:5489-5497. [PMID: 36905466 PMCID: PMC10006558 DOI: 10.1007/s00330-023-09533-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/21/2022] [Accepted: 11/09/2022] [Indexed: 03/12/2023]
Abstract
Cardiac computed tomography (CT) and cardiac magnetic resonance imaging (MRI) are routine radiological examinations for diagnosis and prognosis of cardiac disease. The expected growth in cardiac radiology in the coming years will exceed the current scanner capacity and trained workforce. The European Society of Cardiovascular Radiology (ESCR) focuses on supporting and strengthening the role of cardiac cross-sectional imaging in Europe from a multi-modality perspective. Together with the European Society of Radiology (ESR), the ESCR has taken the initiative to describe the current status of, a vision for, and the required activities in cardiac radiology to sustain, increase and optimize the quality and availability of cardiac imaging and experienced radiologists across Europe. KEY POINTS: • Providing adequate availability for performing and interpreting cardiac CT and MRI is essential, especially with expanding indications. • The radiologist has a central role in non-invasive cardiac imaging examinations which encompasses the entire process from selecting the best modality to answer the referring physician's clinical question to long-term image storage. • Optimal radiological education and training, knowledge of the imaging process, regular updating of diagnostic standards, and close collaboration with colleagues from other specialties are essential.
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Affiliation(s)
- Luigi Natale
- Department of Radiological Sciences - Institute of Radiology, Catholic University of Rome, "A. Gemelli" University Hospital, Rome, Italy
| | - Rozemarijn Vliegenthart
- Department of Radiology, Medical Imaging Center, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - Rodrigo Salgado
- Department of Radiology, Antwerp University Hospital & Antwerp University, Holy Heart Lier, Belgium
| | - Jens Bremerich
- Department of Radiology, University of Basel Hospital, Basel, Switzerland
| | - Riccardo P J Budde
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Jean-Nicholas Dacher
- Department of Radiology, Normandie University, UNIROUEN, INSERM U1096 - Rouen University Hospital, Rouen, France
| | - Marco Francone
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
| | - Karl-Friedrich Kreitner
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Christian Loewe
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University of Tuebingen, Tübingen, Germany
| | - Charles Peebles
- Department of Cardiothoracic Radiology, University Hospital Southampton, Southampton, UK
| | - Birgitta K Velthuis
- Department of Radiology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Carlo Catalano
- Department of Radiological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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Berry C, Kramer CM, Kunadian V, Patel TR, Villines T, Kwong RY, Raharjo DE. Great Debate: Computed tomography coronary angiography should be the initial diagnostic test in suspected angina. Eur Heart J 2023; 44:2366-2375. [PMID: 36917627 PMCID: PMC10327881 DOI: 10.1093/eurheartj/ehac597] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Affiliation(s)
- Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, 126 University Place, University of Glasgow, Glasgow, G128TA, UK
- Golden Jubilee National Hospital, Agamemnon Street, Clydebank, G81 4DY, UK
| | - Christopher M Kramer
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, 1215 Lee St., Box 800158, Charlottesville, VA 22908, USA
- Department of Radiology and Medical Imaging, University of Virginia Health System, 1215 Lee St., Box 800170, Charlottesville, VA 22908, USA
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, 4th Floor William Leech Building, Newcastle upon Tyne NE2 4HH, UK
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Toral R Patel
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, 1215 Lee St., Box 800158, Charlottesville, VA 22908, USA
| | - Todd Villines
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, 1215 Lee St., Box 800158, Charlottesville, VA 22908, USA
| | - Raymond Y Kwong
- Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Daniell Edward Raharjo
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, 4th Floor William Leech Building, Newcastle upon Tyne NE2 4HH, UK
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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63
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Nayfeh M, Ahmed AI, Al Rifai M, Alahdab F, Nagueh SF, Chamsi-Pasha MA, Mahmarian JJ, Chang SM, Zoghbi WA, Al-Mallah MH. Temporal trends in the use of cardiac computerized tomography angiography and transesophageal echocardiography for left atrial appendage thrombus detection. J Cardiovasc Comput Tomogr 2023; 17:289-290. [PMID: 37061438 DOI: 10.1016/j.jcct.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/17/2023]
Affiliation(s)
- Malek Nayfeh
- Houston Methodist DeBakey Heart & Vascular Center, USA
| | | | | | - Fares Alahdab
- Houston Methodist DeBakey Heart & Vascular Center, USA
| | | | | | | | - Su Min Chang
- Houston Methodist DeBakey Heart & Vascular Center, USA
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Mushtaq S, Pontone G, Conte E, Trabattoni D, Galli S, Gili S, Troiano S, Teruzzi G, Baggiano A, Bonomi A, Mallia V, Marchetti D, Schillaci M, Melotti E, Belmonte M, Guaricci AI, Gigante C, Pepi M, Bartorelli AL, Andreini D. Diagnostic accuracy of subendocardial vs. transmural myocardial perfusion defect for the detection of in-stent restenosis or progression of coronary artery disease after percutaneous coronary intervention. J Cardiovasc Comput Tomogr 2023; 17:277-280. [PMID: 37248106 DOI: 10.1016/j.jcct.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/03/2023] [Accepted: 05/17/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND The ADVANTAGE study demonstrated in a cohort of stented patients a diagnostic accuracy of stress myocardial CT perfusion (CTP) significantly higher than that of coronary CT angiography (CCTA) for the detection of in-stent restenosis (ISR) or CAD progression vs. quantitative coronary angiography (QCA). This is a pre-defined subanalysis of the ADVANTAGE aimed at assessing the difference in terms of diagnostic accuracy vs. QCA of a subendocardial vs. a transmural perfusion defect using static stress CTP. METHODS We enrolled consecutive patients who previously underwent coronary stenting and were referred for QCA. All patients underwent stress CTP and rest CTP + CCTA. The diagnostic accuracy of CCTA and CTP were evaluated in territory-based and patient-based analyses. We compared the diagnostic accuracy of "subendocardial" perfusion defect, defined as hypo-enhancement encompassing >25% but <50% of the transmural myocardial thickness within a specific coronary territory vs. "transmural" perfusion defect, defined as hypo-enhancement encompassing >50% of the transmural thickness. RESULTS In 150 patients (132 men, mean age 65.1 ± 9.1 years), the diagnostic accuracy of subendocardial vs. transmural perfusion defect in a vessel-based analysis was 93.5% vs. 87.7%, respectively (p < 0.0001). The sensitivity and specificity of subendocardial vs. transmural defect were 87.9% vs. 46.9% (p < 0.001) and 94.9% vs. 97.9% (p = 0.004), respectively. In a patient-based analysis, the diagnostic accuracy of the subendocardial vs. transmural approach was 86.6% vs. 68% (p < 0.0001). CONCLUSIONS This study shows that detection of a subendocardial perfusion defect as compared to a transmural defect is significantly more accurate to identify coronary territories with ISR or CAD progression.
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Affiliation(s)
| | - Gianluca Pontone
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Edoardo Conte
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Division of Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | | | | | | | | | | | | | - Alice Bonomi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Vincenzo Mallia
- Division of Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Davide Marchetti
- Division of Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Matteo Schillaci
- Division of Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Eleonora Melotti
- Division of Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Marta Belmonte
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Andrea Igoren Guaricci
- University Cardiology Unit, Interdisciplinary Department of Medicine, University Aldo Moro of Bari, Bari, Italy
| | | | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Antonio L Bartorelli
- Division of Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
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Pugliese L, Ricci F, Sica G, Scaglione M, Masala S. Non-Contrast and Contrast-Enhanced Cardiac Computed Tomography Imaging in the Diagnostic and Prognostic Evaluation of Coronary Artery Disease. Diagnostics (Basel) 2023; 13:2074. [PMID: 37370969 DOI: 10.3390/diagnostics13122074] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/07/2023] [Accepted: 06/11/2023] [Indexed: 06/29/2023] Open
Abstract
In recent decades, cardiac computed tomography (CT) has emerged as a powerful non-invasive tool for risk stratification, as well as the detection and characterization of coronary artery disease (CAD), which remains the main cause of morbidity and mortality in the world. Advances in technology have favored the increasing use of cardiac CT by allowing better performance with lower radiation doses. Coronary artery calcium, as assessed by non-contrast CT, is considered to be the best marker of subclinical atherosclerosis, and its use is recommended for the refinement of risk assessment in low-to-intermediate risk individuals. In addition, coronary CT angiography (CCTA) has become a gate-keeper to invasive coronary angiography (ICA) and revascularization in patients with acute chest pain by allowing the assessment not only of the extent of lumen stenosis, but also of its hemodynamic significance if combined with the measurement of fractional flow reserve or perfusion imaging. Moreover, CCTA provides a unique incremental value over functional testing and ICA by imaging the vessel wall, thus allowing the assessment of plaque burden, composition, and instability features, in addition to perivascular adipose tissue attenuation, which is a marker of vascular inflammation. There exists the potential to identify the non-obstructive lesions at high risk of progression to plaque rupture by combining all of these measures.
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Affiliation(s)
- Luca Pugliese
- Radiology Unit, Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea University Hospital, 00189 Rome, Italy
| | - Francesca Ricci
- Radiology Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Giacomo Sica
- Radiology Unit, Monaldi Hospital, 80131 Napoli, Italy
| | - Mariano Scaglione
- Radiology Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Salvatore Masala
- Radiology Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
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Varadarajan V, Gidding S, Wu C, Carr J, Lima JA. Imaging Early Life Cardiovascular Phenotype. Circ Res 2023; 132:1607-1627. [PMID: 37289903 PMCID: PMC10501740 DOI: 10.1161/circresaha.123.322054] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/30/2023] [Indexed: 06/10/2023]
Abstract
The growing epidemics of obesity, hypertension, and diabetes, in addition to worsening environmental factors such as air pollution, water scarcity, and climate change, have fueled the continuously increasing prevalence of cardiovascular diseases (CVDs). This has caused a markedly increasing burden of CVDs that includes mortality and morbidity worldwide. Identification of subclinical CVD before overt symptoms can lead to earlier deployment of preventative pharmacological and nonpharmacologic strategies. In this regard, noninvasive imaging techniques play a significant role in identifying early CVD phenotypes. An armamentarium of imaging techniques including vascular ultrasound, echocardiography, magnetic resonance imaging, computed tomography, noninvasive computed tomography angiography, positron emission tomography, and nuclear imaging, with intrinsic strengths and limitations can be utilized to delineate incipient CVD for both clinical and research purposes. In this article, we review the various imaging modalities used for the evaluation, characterization, and quantification of early subclinical cardiovascular diseases.
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Affiliation(s)
- Vinithra Varadarajan
- Division of Cardiology, Department of Medicine Johns Hopkins University, Baltimore, MD
| | | | - Colin Wu
- Department of Medicine, National Heart, Lung and Blood Institute, Bethesda, MD
| | - Jeffrey Carr
- Department Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN
| | - Joao A.C. Lima
- Division of Cardiology, Department of Medicine Johns Hopkins University, Baltimore, MD
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Wang C, Zhang X, Liu C, Zhang C, Sun G, Zhou J. Coronary Artery Calcium Score Improves Risk Assessment of Symptomatic Patients in Low-Risk Group Based on Current Guidelines. Rev Cardiovasc Med 2023; 24:162. [PMID: 39077531 PMCID: PMC11264117 DOI: 10.31083/j.rcm2406162] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/05/2023] [Accepted: 02/13/2023] [Indexed: 07/31/2024] Open
Abstract
Background The guidelines for evaluation and diagnosis of stable chest pain (SCP) released by American societies in 2021 (2021 GL) and European Society of Cardiology (ESC) in 2019 both recommended the estimation of pretest probability (PTP) by ESC-PTP model. Further risk assessment for the low-risk group according to 2021 GL (ESC-PTP ≤ 15%) is important but still remains unclear. Thus, the present study intended to comprehensively investigate the diagnostic and prognostic value of coronary artery calcium score (CACS) in these low-risk patients. Methods From January 2017 to June 2019, we initially enrolled 8265 patients who were referred for CACS and coronary computed tomography angiography (CCTA) for the assessment of SCP. PTP of each patient was estimated by ESC-PTP model. Patients with ESC-PTP ≤ 15% were finally included and followed up for major adverse cardiovascular event (MACE) and utilization of invasive procedures until June 2022. The degree of coronary artery disease (CAD) on CCTA was defined as no CAD (0%), nonobstructive CAD (1-49%) and obstructive CAD ( ≥ 50%). Multivariate Cox proportional hazards and Logistic regression models were used to calculate adjusted hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CIs), respectively. Results A total of 5183 patients with ESC-PTP ≤ 15% were identified and 1.6% experienced MACE during the 4-year follow-up. The prevalence of no CAD and obstructive CAD decreased and increased significantly (p < 0.0001) in patients with higher CACS, respectively, and 62% had nonobstructive CAD among those with CACS > 0, resulting in dramatically increasing ORs for any stenosis ≥ 50% and > 0% across CACS strata. Higher CACS was also associated with an elevated risk of MACE (adjusted HR of 3.59, 13.47 and 6.58 when comparing CACS = 0-100, CACS > 100 and CACS > 0 to CACS = 0, respectively) and intensive utilization of invasive procedures. Conclusions In patients for whom subsequent testing should be deferred according to 2021 GL, high CACS conveyed a significant probability of substantial stenoses and clinical endpoints, respectively. These findings support the potential role of CACS as a further risk assessment tool to improve clinical management in these low-risk patients.
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Affiliation(s)
- Chengjian Wang
- Department of Cardiology, Tianjin Chest Hospital, 300222 Tianjin, China
| | - Xiaomeng Zhang
- Department of Emergency, Tianjin University Jinnan Hospital, 300350 Tianjin, China
| | - Chang Liu
- Thoracic Clinical College, Tianjin Medical University, 300070 Tianjin, China
| | - Chao Zhang
- Department of Emergency, Tianjin University Jinnan Hospital, 300350 Tianjin, China
| | - Guolei Sun
- Department of Emergency, Tianjin University Jinnan Hospital, 300350 Tianjin, China
| | - Jia Zhou
- Department of Cardiology, Tianjin Chest Hospital, 300222 Tianjin, China
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Liu M, Li R, Bai C, Chen Q, Yin Y, Chen Y, Zhou X, Zhao X. Predictive value of DEEPVESSEL-fractional flow reserve and quantitative plaque analysis based on coronary CT angiography for major adverse cardiac events. Clin Radiol 2023:S0009-9260(23)00179-4. [PMID: 37258332 DOI: 10.1016/j.crad.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/26/2023] [Accepted: 04/25/2023] [Indexed: 06/02/2023]
Abstract
AIM To investigate the predictive value of the combination of DEEPVESSEL-fractional flow reserve (DVFFR) and quantitative plaque analysis using coronary computed tomographic angiography (CCTA) for major adverse cardiac events (MACE). METHOD In this retrospective study, data from 69 vessels from 58 consecutive patients were collected. These patients who underwent coronary angiography (CAG) with DVFFR were divided into MACE-positive and MACE-negative groups. DVFFR measurements were obtained from CCTA images acquired before CAG, and an FFR or DVFFR value ≤ 0.80 was considered haemodynamically significant. CCTA images were analysed quantitatively using automated software to obtain the following indices: total plaque volume (TPV) and burden (TPB), calcified plaque volume (CPV) and burden (CPB), non-calcified plaque volume (NCPV) and burden (NCPB), low-attenuation plaque (LAP), minimum lumen area (MLA), stenosis grade (SG) and lesion length (LL). Univariate and multivariate logistic regression, correlation, and receiver operating characteristic (ROC) analyses were used for statistical analysis. RESULTS DVFFR was highly correlated with invasive FFR (R=0.728), and the Bland-Altman plot showed good agreement between DVFFR and FFR (95% CI: -0.109-0.087) on a per-vessel level. DVFFR showed a high diagnostic performance in identifying abnormal haemodynamic vessels, with an area under the ROC curve (AUC) of 0.984. In multivariate analysis, the following biomarkers were predictors of MACE: DVFFR ≤ 0.8, SG, TPB, NCPB, and LL values. The combination of the above independent risk factors yielded the most valuable prediction for MACE (AUC:0.888). CONCLUSIONS DVFFR was highly correlated with FFR with satisfactory diagnostic accuracy. DVFFR, together with plaque analysis indices, yielded valuable predictions for MACE.
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Affiliation(s)
- M Liu
- Department of Interventional Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - R Li
- Department of Interventional Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - C Bai
- Department of Interventional Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Q Chen
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Y Yin
- Keya Medical, Shenzhen, China
| | - Y Chen
- Keya Medical, Shenzhen, China
| | - X Zhou
- Department of Interventional Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - X Zhao
- Department of Interventional Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China.
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Xie Q, Zhou L, Li Y, Zhang R, Wei H, Ma G, Tang Y, Xiao P. Comparison of prognosis between coronary computed tomography angiography versus invasive coronary angiography for stable coronary artery disease: a systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:1010536. [PMID: 37215543 PMCID: PMC10196209 DOI: 10.3389/fcvm.2023.1010536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 04/21/2023] [Indexed: 05/24/2023] Open
Abstract
Background The impact of using invasive coronary angiography (ICA) or coronary computed tomography angiography (CCTA) as an initial examination on the incidence of major adverse cardiovascular events (MACEs) in patients with stable coronary artery disease and the occurrence of major operation-related complications is uncertain. Objective This study aimed to explore the effects of ICA vs. CCTA on MACEs, all-cause death, and major operation-related complications. Methods A systematic search of electronic databases (PubMed and Embase) was conducted for randomized controlled trials and observational studies comparing MACEs between ICA and CCTA from January 2012 to May 2022. The primary outcome measure was analyzed using a random-effects model as a pooled odds ratio (OR). The main observations were MACEs, all-cause death, and major operation-related complications. Results A total of six studies, comprising 26,548 patients, met the inclusion criteria (ICA n = 8,472; CCTA n = 18,076). There were statistically significant differences between ICA and CCTA for MACE [OR 1.37; 95% confidence interval (CI), 1.06-1.77; p = 0.02], all-cause death (OR 1.56; 95% CI, 1.38-1.78; p < 0.00001), and major operation-related complications (OR 2.10; 95% CI, 1.23-3.61; p = 0.007) among patients with stable coronary artery disease. Subgroup analysis demonstrated statistically significant results in the impact of ICA or CCTA on MACEs according to the length of follow-up. Compared to CCTA, ICA was related to a higher incidence of MACEs in the subgroup with a short follow-up (≤3 years) (OR 1.74; 95% CI, 1.54-1.96; p < 0.00001). Conclusions Among patients with stable coronary artery disease, an initial examination with ICA was significantly associated with the risk of MACEs, all-cause death, and major procedure-related complications compared to CCTA in this meta-analysis.
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Affiliation(s)
- Qingya Xie
- Department of Cardiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China
| | - Lingling Zhou
- Department of Orthopaedic Surgery, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Ying Li
- State Key Laboratory of Natural Medicines, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Ruizhe Zhang
- Department of Cardiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China
| | - Han Wei
- Department of Cardiology, Nanjing Drum Tower Hospital Group Suqian Hospital, Suqian, China
| | - Gaoxiang Ma
- State Key Laboratory of Natural Medicines, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Yuping Tang
- Department of Orthopaedic Surgery, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Pingxi Xiao
- Department of Cardiology, The Forth Affiliated Hospital, Nanjing Medical University, Nanjing, China
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Renker M, Steinbach R, Schoepf UJ, Fischer-Rasokat U, Choi YH, Hamm CW, Rolf A, Kim WK. Comparison of First-generation and Third-generation Dual-source Computed Tomography for Detecting Coronary Artery Disease in Patients Evaluated for Transcatheter Aortic Valve Replacement. J Thorac Imaging 2023; 38:165-173. [PMID: 37015832 DOI: 10.1097/rti.0000000000000699] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
PURPOSE This study compared image quality and evaluability of coronary artery disease (CAD) in routine preparatory imaging for transcatheter aortic valve replacement using 64-slice (first-generation) to 192-slice (third-generation) dual-source computed tomography(DSCT). MATERIALS AND METHODS The CT data sets of 192 patients (122 women, median age 82 y) without severe renal dysfunction or known CAD were analyzed retrospectively. Half were examined using first-generation DSCT (June 2014 to February 2016) and the other half with third-generation DSCT (April 2016 to April 2017). Per protocol, contrast material (110 [110 to 120] vs. 70 [70 to 70] mL, P <0.001) and radiation dose of multiphasic retrospectively gated thoracic CT angiography (dose-length-product, 1001 [707 to 1312] vs. 727 [474 to 1369] mGy×cm, P <0.001) were significantly lower with third-generation DSCT. Significant CAD was defined as CAD-RADS ≥4 by CT. Invasive coronary angiography served as the reference standard (CAD is defined as ≥70% stenosis or fractional flow reserve ≤0.80). RESULTS In comparison with first-generation DSCT, third-generation DSCT showed significantly better subjective (3 [interquartile range 2 to 3] vs. 4 [3 to 4.25] on a 5-point scale, P <0.001) and objective image quality (signal-to-noise ratio of left coronary artery 12.8 [9.9 to 16.4] vs. 15.2 [12.4 to 19.0], P <0.001). Accuracy (72.9% vs. 91.7%, P =0.001), specificity (59.7% vs. 88.3%, P <0.001), positive (61.0% vs. 83.3%, P <0.001), and negative predictive value (91.9% vs. 98.2%, P =0.045) for detecting CAD per-patient were significantly better using third-generation DSCT, while sensitivity was similar (92.3% vs. 97.2%, P =0.129). CONCLUSIONS Coronary artery evaluation with CT angiography before TAVI is feasible in selected patients. Compared with first-generation DSCT, state-of-the-art third-generation DSCT technology is superior for this purpose, allowing for less contrast medium and radiation dose while providing better image quality and improved diagnostic performance.
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Affiliation(s)
- Matthias Renker
- Departments of Cardiology
- Cardiac Surgery, Campus Kerckhoff of the Justus Liebig University Giessen, Bad Nauheim
- German Centre for Cardiovascular Research (DZHK), Partner Site RheinMain, Bad Nauheim
| | | | - U Joseph Schoepf
- Department of Radiology and Radiological Sciences, Heart and Vascular Center, Medical University of South Carolina, Charleston, SC
| | | | - Yeong-Hoon Choi
- Cardiac Surgery, Campus Kerckhoff of the Justus Liebig University Giessen, Bad Nauheim
- German Centre for Cardiovascular Research (DZHK), Partner Site RheinMain, Bad Nauheim
| | - Christian W Hamm
- Departments of Cardiology
- German Centre for Cardiovascular Research (DZHK), Partner Site RheinMain, Bad Nauheim
- Department of Radiology and Radiological Sciences, Heart and Vascular Center, Medical University of South Carolina, Charleston, SC
| | - Andreas Rolf
- Departments of Cardiology
- German Centre for Cardiovascular Research (DZHK), Partner Site RheinMain, Bad Nauheim
- Department of Radiology and Radiological Sciences, Heart and Vascular Center, Medical University of South Carolina, Charleston, SC
| | - Won-Keun Kim
- Departments of Cardiology
- Cardiac Surgery, Campus Kerckhoff of the Justus Liebig University Giessen, Bad Nauheim
- German Centre for Cardiovascular Research (DZHK), Partner Site RheinMain, Bad Nauheim
- Department of Radiology and Radiological Sciences, Heart and Vascular Center, Medical University of South Carolina, Charleston, SC
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Paalimäki-Paakki K, Virtanen M, Henner A, Vähänikkilä H, Nieminen MT, Schroderus-Salo T, Kääriäinen M. Effects of a 360° virtual counselling environment on patient anxiety and CCTA process time: A randomised controlled trial. Radiography (Lond) 2023; 29 Suppl 1:S13-S23. [PMID: 36280541 DOI: 10.1016/j.radi.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/27/2022] [Accepted: 09/30/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION This study investigated whether a 360° virtual counselling environment (360°VCE) was more effective at decreasing patients' anxiety than routine standard of care counselling for patients undergoing coronary computed tomography angiography (CCTA), and if there was any difference in the process times for both of these groups. METHODS A total of 86 patients underwent CCTA in this randomised controlled trial. Patients were randomly assigned to intervention and control groups. The 360°VCE was developed using spherical panoramic images and non-immersive 360° technology. The primary outcome, anxiety, was measured using the State-Trait Anxiety Inventory (STAI). The secondary outcome, CCTA process time, was measured from the time of arrival in the department until end of examination. RESULTS Pre-scan anxiety was lower among patients in the 360°VCE group immediately before CCTA in comparison to patients in the control group (p = 0.015). Women demonstrated higher levels of anxiety than men in both groups. No between-group differences were discerned in CCTA process time. CONCLUSION Access to 360°VCE can reduce patients' pre-CCTA anxiety levels. IMPLICATIONS FOR PRACTICE The presented results can be used to improve patient counselling and care, reduce anxiety among patients undergoing CCTA, and optimise the CCTA examination procedure.
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Affiliation(s)
- Karoliina Paalimäki-Paakki
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland; Degree Programme of Radiography and Radiation Therapy, Oulu University of Applied Sciences, Oulu, Finland.
| | - Mari Virtanen
- School of Rehabilitation and Examination, Helsinki Metropolia University of Applied Sciences, Helsinki, Finland
| | - Anja Henner
- Degree Programme of Radiography and Radiation Therapy, Oulu University of Applied Sciences, Oulu, Finland
| | - Hannu Vähänikkilä
- Northern Finland Birth Cohorts, Arctic Biobank, Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Miika T Nieminen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Tanja Schroderus-Salo
- Degree Programme of Radiography and Radiation Therapy, Oulu University of Applied Sciences, Oulu, Finland
| | - Maria Kääriäinen
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Oulu University Hospital, Oulu, Finland
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Renker M, Schoepf UJ, Kim WK. Combined CT Coronary Artery Assessment and TAVI Planning. Diagnostics (Basel) 2023; 13:diagnostics13071327. [PMID: 37046545 PMCID: PMC10093468 DOI: 10.3390/diagnostics13071327] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 03/04/2023] [Accepted: 03/24/2023] [Indexed: 04/05/2023] Open
Abstract
Computed tomography angiography (CTA) of the aorta and the iliofemoral arteries is crucial for preprocedural planning of transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis (AS), because it provides details on a variety of aspects required for heart team decision-making. In addition to providing relevant diagnostic information on the degree of aortic valve calcification, CTA allows for a customized choice of the transcatheter heart valve system and the TAVI access route. Furthermore, current guidelines recommend the exclusion of relevant coronary artery disease (CAD) prior to TAVI. The feasibility of coronary artery assessment with CTA in patients scheduled for TAVI has been established previously, and accumulating data support its value. In addition, fractional flow reserve determined from CTA (CT–FFR) and machine learning-based CT–FFR were recently shown to improve its diagnostic yield for this purpose. However, the utilization of CTA for coronary artery evaluation remains limited in this specific population of patients due to the relatively high risk of CAD coexistence with severe AS. Therefore, the current diagnostic work-up prior to TAVI routinely includes invasive catheter coronary angiography at most centers. In this article, the authors address technological prerequisites and CT protocol considerations, discuss pitfalls, review the current literature regarding combined CTA coronary artery assessment and preprocedural TAVI evaluation, and provide an overview of unanswered questions and future research goals within the field.
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Affiliation(s)
- Matthias Renker
- Department of Cardiology, Campus Kerckhoff of the Justus Liebig University Giessen, 61231 Bad Nauheim, Germany
- Department of Cardiac Surgery, Campus Kerckhoff of the Justus Liebig University Giessen, 61231 Bad Nauheim, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Rhine-Main, 61231 Bad Nauheim, Germany
| | - U. Joseph Schoepf
- Heart & Vascular Center, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Won Keun Kim
- Department of Cardiology, Campus Kerckhoff of the Justus Liebig University Giessen, 61231 Bad Nauheim, Germany
- Department of Cardiac Surgery, Campus Kerckhoff of the Justus Liebig University Giessen, 61231 Bad Nauheim, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Rhine-Main, 61231 Bad Nauheim, Germany
- Department of Cardiology, Justus Liebig University Giessen, 35392 Giessen, Germany
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Serruys PW, Kotoku N, Nørgaard BL, Garg S, Nieman K, Dweck MR, Bax JJ, Knuuti J, Narula J, Perera D, Taylor CA, Leipsic JA, Nicol ED, Piazza N, Schultz CJ, Kitagawa K, Bruyne BD, Collet C, Tanaka K, Mushtaq S, Belmonte M, Dudek D, Zlahoda-Huzior A, Tu S, Wijns W, Sharif F, Budoff MJ, Mey JD, Andreini D, Onuma Y. Computed tomographic angiography in coronary artery disease. EUROINTERVENTION 2023; 18:e1307-e1327. [PMID: 37025086 PMCID: PMC10071125 DOI: 10.4244/eij-d-22-00776] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 11/14/2022] [Indexed: 04/05/2023]
Abstract
Coronary computed tomographic angiography (CCTA) is becoming the first-line investigation for establishing the presence of coronary artery disease and, with fractional flow reserve (FFRCT), its haemodynamic significance. In patients without significant epicardial obstruction, its role is either to rule out atherosclerosis or to detect subclinical plaque that should be monitored for plaque progression/regression following prevention therapy and provide risk classification. Ischaemic non-obstructive coronary arteries are also expected to be assessed by non-invasive imaging, including CCTA. In patients with significant epicardial obstruction, CCTA can assist in planning revascularisation by determining the disease complexity, vessel size, lesion length and tissue composition of the atherosclerotic plaque, as well as the best fluoroscopic viewing angle; it may also help in selecting adjunctive percutaneous devices (e.g., rotational atherectomy) and in determining the best landing zone for stents or bypass grafts.
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Affiliation(s)
| | - Nozomi Kotoku
- Department of Cardiology, University of Galway, Galway, Ireland
| | - Bjarne L Nørgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, UK
| | - Koen Nieman
- Department of Radiology and Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Juhani Knuuti
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Divaka Perera
- School of Cardiovascular Medicine and Sciences, British Heart Foundation Centre of Research Excellence, King's College London, London, UK
| | | | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Edward D Nicol
- Royal Brompton Hospital, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Nicolo Piazza
- Department of Medicine, Division of Cardiology, McGill University Health Center, Montreal, Quebec, Canada
| | - Carl J Schultz
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, WA, Australia
- Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia
| | - Kakuya Kitagawa
- Department of Advanced Diagnostic Imaging, Mie University Graduate School of Medicine, Mie, Japan
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Department of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Kaoru Tanaka
- Department of Radiology, Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | | | | | - Darius Dudek
- Szpital Uniwersytecki w Krakowie, Krakow, Poland
| | - Adriana Zlahoda-Huzior
- Digital Innovations & Robotics Hub, Krakow, Poland
- Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland
| | - Shengxian Tu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - William Wijns
- Department of Cardiology, University of Galway, Galway, Ireland
- The Lambe Institute for Translational Medicine, The Smart Sensors Laboratory and CURAM, Galway, University of Galway, Galway, Ireland
| | - Faisal Sharif
- Department of Cardiology, University of Galway, Galway, Ireland
| | - Matthew J Budoff
- Division of Cardiology, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Johan de Mey
- Department of Radiology, Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | - Daniele Andreini
- Division of Cardiology and Cardiac Imaging, IRCCS Galeazzi Sant'Ambrogio, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Yoshinobu Onuma
- Department of Cardiology, University of Galway, Galway, Ireland
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Madan N, Hur DJ, Gannon MP, Gupta S, Weir-McCall JR, Johns C, Kumar A, Nagpal P, Fentanes E, Lee J, Choi AD, Ferencik M, Maroules CD, Villines TC, Nicol ED. Contemporary cardiovascular computed tomography (CCT) training: Serial surveys of the international CCT community by the Fellow and Resident Leaders of the Society of Cardiovascular Computed Tomography (SCCT) Committee (FiRST) and SCCT Future Leaders Program (FLP). J Cardiovasc Comput Tomogr 2023:S1934-5925(23)00091-6. [PMID: 37015851 DOI: 10.1016/j.jcct.2023.03.006] [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: 11/07/2022] [Revised: 02/28/2023] [Accepted: 03/17/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND As cardiovascular computed tomography (CCT) practice evolves, the demand for specialists continues to increase. However, CCT training remains variable globally with limited contemporaneous data to understand this heterogeneity. We sought to understand the role of CCT globally and the training available to underpin its use. METHODS We performed two consecutive surveys of cardiology and radiology physicians, two years apart, utilizing the Society of Cardiovascular Computed Tomography (SCCT) website, weblinks, social media platforms, and meeting handouts to maximize our response rate. We compared United States (US)-based vs. international responses to understand global similarities and differences in practice and training in the surveys. RESULTS 235 respondents (37% trainees and 63% educators/non-trainees) initiated the first survey with 174 (74%) completing the core survey, with 205 providing their work location (114 US and 91 international). Eighty-four percent (92/110) of educator respondents stated a need for increased training opportunities to meet growing demand. Dedicated training fellowships are heterogenous, with limited access to structural heart imaging training, despite structural scanning being performed within institutions. The lack of a standardized curriculum was identified as the main obstacle to effective CCT learning, particularly in the US, with web-based learning platforms being the most popular option for improving access to CCT training. 148 trainees initiated the second survey with 107 (72%) completing the core components (51% North America, 49% international). Only 68% said they would be able to meet their required CCT education needs via their training program. Obstacles in obtaining CCT training again included a lack of a developed curriculum (51%), a lack of dedicated training time (35%), and a lack of local faculty expertise (31%). There was regional variability in access to CCT training, and, in contrast to the first survey, most (89%) felt 1:1 live review of cases with trained/expert reader was most useful for improving CCT training alongside formal curriculum/live lectures (72%). CONCLUSIONS There is a need to expand dedicated CCT training globally to meet the demand for complex CCT practice. Access to CCT education (didactic and 1:1 case-based teaching from expert faculty), implementation of recently published global training curricula, and increased teaching resources (web-based) as an adjunct to existing experiential learning opportunities, are all deemed necessary to address current educational shortfalls.
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Affiliation(s)
- Nidhi Madan
- Division of Cardiology, Nebraska Methodist Health System, Omaha, NE, USA
| | - David J Hur
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA; Division of Cardiology, VA Connecticut Healthcare System, West Haven, CT, USA.
| | - Michael P Gannon
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Sumit Gupta
- Department of Radiology, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Jonathan R Weir-McCall
- School of Clinical Medicine, University of Cambridge, Cambridge, UK; Department of Radiology, Royal Papworth Hospital, Cambridge, UK
| | - Claire Johns
- Marketing and Communications, Society of Cardiovascular Computed Tomography, Arlington, VA, USA
| | - Arnav Kumar
- Brigham and Women's Hospital, Boston, MA, USA
| | - Prashant Nagpal
- Cardiovascular Imaging, Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | | | - James Lee
- Henry Ford Heart and Vascular Institute, Detroit, MI, USA
| | - Andrew D Choi
- The George Washington University School of Medicine, Washington, DC, USA
| | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | | | - Todd C Villines
- Division of Cardiovascular Medicine, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Edward D Nicol
- Departments of Cardiology and Radiology, Royal Brompton Hospital, London, UK; School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
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Li W, Lu H, Wen Y, Zhou M, Shuai T, You Y, Zhao J, Liao K, Lu C, Li J, Li Z, Diao K, He Y. Reducing both radiation and contrast doses for overweight patients in coronary CT angiography with 80-kVp and deep learning image reconstruction. Eur J Radiol 2023; 161:110736. [PMID: 36804314 DOI: 10.1016/j.ejrad.2023.110736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE To investigate the use of an 80-kVp tube voltage combined with a deep learning image reconstruction (DLIR) algorithm in coronary CT angiography (CCTA) for overweight patients to reduce radiation and contrast doses in comparison with the 120-kVp protocol and adaptive statistical iterative reconstruction (ASIR-V). METHODS One hundred consecutive CCTA patients were prospectively enrolled and randomly divided into a low-dose group (n = 50) with 80-kVp, smart mA for noise index (NI) of 36 HU, contrast dose rate of 18 mgI/kg/s and DLIR and 60 % ASIR-V and a standard-dose group (n = 50) with 120-kVp, smart mA for NI of 25 HU, contrast dose rate of 32 mgI/kg/s and 60 % ASIR-V. The radiation and contrast dose, subjective image quality score, attenuation values, noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were compared. RESULTS The low-dose group achieved a significant reduction in the effective radiation dose (1.01 ± 0.45 mSv vs 1.85 ± 0.40 mSv, P < 0.001) and contrast dose (33.69 ± 3.87 mL vs 59.11 ± 5.60 mL, P < 0.001) compared to the standard-dose group. The low-dose group with DLIR presented similar enhancement but lower noise, higher SNR and CNR and higher subjective quality scores than the standard-dose group. Moreover, the same patient comparison in the low-dose group between different reconstructions showed that DLIR images had slightly and consistently higher CT values in small vessels, indicating better defined vessels, much lower image noise, higher SNR and CNR and higher subjective quality scores than ASIR-V images (all P < 0.001). CONCLUSIONS The application of 80-kVp and DLIR allows for significant radiation and dose reduction while further improving image quality in CCTA for overweight patients.
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Affiliation(s)
- Wanjiang Li
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Haiyan Lu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yuting Wen
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Minggang Zhou
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Tao Shuai
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yongchun You
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Jin Zhao
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Kai Liao
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Chunyan Lu
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | | | - Zhenlin Li
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Kaiyue Diao
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
| | - Yong He
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
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76
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Hashikata T, Kameda R, Ako J. Clinical Implication and Optimal Management of Myocardial Bridging: Role of Cardiovascular Imaging. Interv Cardiol Clin 2023; 12:281-288. [PMID: 36922068 DOI: 10.1016/j.iccl.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Myocardial bridging (MB) was historically considered a benign structure as most people with MB are clinically asymptomatic. Recently, however, mounting evidence indicates that MB can cause adverse cardiac events owing to arterial systolic compression/diastolic restriction, atherosclerotic plaque progression upstream from MB, and/or vasospastic angina. In MB patients with refractory angina, the optimal treatment strategy should be determined individually based on versatile anatomic and hemodynamical assessments that often require multidisciplinary diagnostic approaches. The present review summarizes the clinical implication and management of MB, highlighting the role of imaging modalities currently available in this arena.
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Affiliation(s)
- Takehiro Hashikata
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan.
| | - Ryo Kameda
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan
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77
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Lorenzatti D, Piña P, Csecs I, Schenone AL, Gongora CA, Garcia MJ, Blaha MJ, Budoff MJ, Williams MC, Dey D, Berman DS, Virani SS, Slipczuk L. Does Coronary Plaque Morphology Matter Beyond Plaque Burden? Curr Atheroscler Rep 2023; 25:167-180. [PMID: 36808390 DOI: 10.1007/s11883-023-01088-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE OF REVIEW Imaging of adverse coronary plaque features by coronary computed tomography angiography (CCTA) has advanced greatly and at a fast pace. We aim to describe the evolution, present and future in plaque analysis, and its value in comparison to plaque burden. RECENT FINDINGS Recently, it has been demonstrated that in addition to plaque burden, quantitative and qualitative assessment of coronary plaque by CCTA can improve the prediction of future major adverse cardiovascular events in diverse coronary artery disease scenarios. The detection of high-risk non-obstructive coronary plaque can lead to higher use of preventive medical therapies such as statins and aspirin, help identify culprit plaque, and differentiate between myocardial infarction types. Even more, over traditional plaque burden, plaque analysis including pericoronary inflammation can potentially be useful tools for tracking disease progression and response to medical therapy. The identification of the higher risk phenotypes with plaque burden, plaque characteristics, or ideally both can allow the allocation of targeted therapies and potentially monitor response. Further observational data are now required to investigate these key issues in diverse populations, followed by rigorous randomized controlled trials.
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Affiliation(s)
- Daniel Lorenzatti
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Pamela Piña
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine, Bronx, NY, USA
- Cardiology Division, CEDIMAT Cardiovascular Center, Santo Domingo, Dominican Republic
| | - Ibolya Csecs
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Aldo L Schenone
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Carlos A Gongora
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mario J Garcia
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Michelle C Williams
- BHF Centre of Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, Queen's Medical Research Institute University of Edinburgh, Edinburgh, UK
| | - Damini Dey
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Berman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Salim S Virani
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Section of Cardiology, Department of Medicine, The Aga Khan University, Karachi, Pakistan
| | - Leandro Slipczuk
- Cardiology Division, Montefiore Healthcare Network/Albert Einstein College of Medicine, Bronx, NY, USA.
- Clinical Cardiology, Advanced Cardiac Imaging, CV Atherosclerosis and Lipid Disorder Center, Montefiore Health System, NewYork, USA.
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78
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Kitada R, Otsuka K, Fukuda D. Role of plaque imaging for identification of vulnerable patients beyond the stage of myocardial ischemia. Front Cardiovasc Med 2023; 10:1095806. [PMID: 37008333 PMCID: PMC10063905 DOI: 10.3389/fcvm.2023.1095806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/21/2023] [Indexed: 03/19/2023] Open
Abstract
Chronic coronary syndrome (CCS) is a progressive disease, which often first manifests as acute coronary syndrome (ACS). Imaging modalities are clinically useful in making decisions about the management of patients with CCS. Accumulating evidence has demonstrated that myocardial ischemia is a surrogate marker for CCS management; however, its ability to predict cardiovascular death or nonfatal myocardial infarction is limited. Herein, we present a review that highlights the latest knowledge available on coronary syndromes and discuss the role and limitations of imaging modalities in the diagnosis and management of patients with coronary artery disease. This review covers the essential aspects of the role of imaging in assessing myocardial ischemia and coronary plaque burden and composition. Furthermore, recent clinical trials on lipid-lowering and anti-inflammatory therapies have been discussed. Additionally, it provides a comprehensive overview of intracoronary and noninvasive cardiovascular imaging modalities and an understanding of ACS and CCS, with a focus on histopathology and pathophysiology.
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79
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Layton GR, Ladak SS, Abbasciano R, McQueen LW, George SJ, Murphy GJ, Zakkar M. The Role of Preservation Solutions upon Saphenous Vein Endothelial Integrity and Function: Systematic Review and UK Practice Survey. Cells 2023; 12:815. [PMID: 36899951 PMCID: PMC10001248 DOI: 10.3390/cells12050815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 02/19/2023] [Accepted: 02/22/2023] [Indexed: 03/08/2023] Open
Abstract
The long saphenous vein is the most used conduit in cardiac surgery, but its long-term patency is limited by vein graft disease (VGD). Endothelial dysfunction is a key driver of VGD; its aetiology is multi-factorial. However emerging evidence identifies vein conduit harvest technique and preservation fluids as causal in their onset and propagation. This study aims to comprehensively review published data on the relationship between preservation solutions, endothelial cell integrity and function, and VGD in human saphenous veins harvested for CABG. The review was registered with PROSPERO (CRD42022358828). Electronic searches of Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE databases were undertaken from inception until August 2022. Papers were evaluated in line with registered inclusion and exclusion criteria. Searches identified 13 prospective, controlled studies for inclusion in the analysis. All studies used saline as a control solution. Intervention solutions included heparinised whole blood and saline, DuraGraft, TiProtec, EuroCollins, University of Wisconsin (UoW), buffered, cardioplegic and Pyruvate solutions. Most studies demonstrated that normal saline appears to have negative effects on venous endothelium and the most effective preservation solutions identified in this review were TiProtec and DuraGraft. The most used preservation solutions in the UK are heparinised saline or autologous whole blood. There is substantial heterogeneity both in practice and reporting of trials evaluating vein graft preservation solutions, and the quality of existing evidence is low. There is an unmet need for high quality trials evaluating the potential for these interventions to improve long-term patency in venous bypass grafts.
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Affiliation(s)
- Georgia R. Layton
- Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Shameem S. Ladak
- Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK
| | | | - Liam W. McQueen
- Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Sarah J. George
- Department of Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol BS2 1UDD, UK
| | - Gavin J. Murphy
- Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Mustafa Zakkar
- Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK
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80
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Maroules CD, Rybicki FJ, Ghoshhajra BB, Batlle JC, Branch K, Chinnaiyan K, Hamilton-Craig C, Hoffmann U, Litt H, Meyersohn N, Shaw LJ, Villines TC, Cury RC. 2022 use of coronary computed tomographic angiography for patients presenting with acute chest pain to the emergency department: An expert consensus document of the Society of cardiovascular computed tomography (SCCT): Endorsed by the American College of Radiology (ACR) and North American Society for cardiovascular Imaging (NASCI). J Cardiovasc Comput Tomogr 2023; 17:146-163. [PMID: 36253281 DOI: 10.1016/j.jcct.2022.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/22/2022]
Abstract
Coronary computed tomography angiography (CTA) improves the quality of care for patients presenting with acute chest pain (ACP) to the emergency department (ED), particularly in patients with low to intermediate likelihood of acute coronary syndrome (ACS). The Society of Cardiovascular Computed Tomography Guidelines Committee was formed to develop recommendations for acquiring, interpreting, and reporting of coronary CTA to ensure appropriate, safe, and efficient use of this modality. Because of the increasing use of coronary CTA testing for the evaluation of ACP patients, the Committee has been charged with the development of the present document to assist physicians and technologists. These recommendations were produced as an educational tool for practitioners evaluating acute chest pain patients in the ED, in the interest of developing systematic standards of practice for coronary CTA based on the best available data or broad expert consensus. Due to the highly variable nature of medical care, approaches to patient selection, preparation, protocol selection, interpretation or reporting that differs from these guidelines may represent an appropriate variation based on a legitimate assessment of an individual patient's needs.
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Affiliation(s)
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Brian B Ghoshhajra
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Juan C Batlle
- Department of Radiology, Baptist Cardiac and Vascular Institute, Miami, FL, USA
| | - Kelley Branch
- Department of Cardiology, University of Washington School of Medicine, Seattle, WA, USA
| | | | | | - Udo Hoffmann
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Harold Litt
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Nandini Meyersohn
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Todd C Villines
- Department of Cardiology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Ricardo C Cury
- Department of Radiology, Baptist Cardiac and Vascular Institute, Miami, FL, USA
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81
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Contemporary Review of Multi-Modality Cardiac Imaging Evaluation of Infective Endocarditis. Life (Basel) 2023; 13:life13030639. [PMID: 36983795 PMCID: PMC10052933 DOI: 10.3390/life13030639] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023] Open
Abstract
Infective endocarditis (IE) remains to be a heterogeneous disease with high morbidity and mortality rates, which can affect native valves, prosthetic valves, and intra-cardiac devices, in addition to causing systemic complications. The combination of clinical, laboratory, and cardiac imaging evaluation is critical for early diagnosis and risk stratification of IE. This can facilitate timely medical and surgical management to improve patient outcomes. Key imaging findings for IE include vegetations, valve perforation, prosthetic valve dehiscence, pseudoaneurysms, abscesses, and fistulae. Transthoracic echocardiography continues to be the first-line imaging modality of choice, while transesophageal echocardiography subsequently provides an improved structural assessment and characterization of lesions to facilitate management decision in IE. Recent advances in other imaging modalities, especially cardiac computed tomography and 18F-fluorodeox-yglucose positron emission tomography, and to a lesser extent cardiac magnetic resonance imaging and other nuclear imaging techniques, have demonstrated important roles in providing complementary IE diagnostic and prognostic information. This review aims to discuss the individual and integrated utilities of contemporary multi-modality cardiac imaging for the assessment and treatment guidance of IE.
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82
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Alasnag M, Tash A. Commentary on the FASTTRACK CABG study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 50:41-42. [PMID: 36854640 DOI: 10.1016/j.carrev.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023]
Affiliation(s)
- Mirvat Alasnag
- Cardiac Center, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia.
| | - Adel Tash
- Ministry of Health/National Heart Center, Riyadh, Saudi Arabia
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83
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A spatiotemporal analysis of the left coronary artery biomechanics using fluid-structure interaction models. Med Biol Eng Comput 2023; 61:1533-1548. [PMID: 36790640 DOI: 10.1007/s11517-023-02791-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 01/24/2023] [Indexed: 02/16/2023]
Abstract
Biomechanics plays a critical role in coronary artery disease development. FSI simulation is commonly used to understand the hemodynamics and mechanical environment associated with atherosclerosis pathology. To provide a comprehensive characterization of patient-specific coronary biomechanics, an analysis of FSI simulation in the spatial and temporal domains was performed. In the current study, a three-dimensional FSI model of the LAD coronary artery was built based on a patient-specific geometry using COMSOL Multiphysics. The effect of myocardial bridging was simulated. Wall shear stress and its derivatives including time-averaged wall shear stress, wall shear stress gradient, and OSI were calculated across the cardiac cycle in multiple locations. Arterial wall strain (radial, circumferential, and longitudinal) and von Mises stress were calculated. To assess perfusion, vFFR was calculated. The results demonstrated the FSI model could identify regional and transient differences in biomechanical parameters within the coronary artery. The addition of myocardial bridging caused a notable change in von Mises stress and an increase in arterial strain during systole. The analysis performed in this manner takes greater advantage of the information provided in the space and time domains and can potentially assist clinical evaluation.
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84
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Baumann S, Overhoff D, Tesche C, Korosoglou G, Kelle S, Nassar M, Buss SJ, Andre F, Renker M, Schoepf UJ, Akin I, Waldeck S, Schoenberg SO, Lossnitzer D. [Morphological and functional diagnostics of coronary artery disease by computed tomography]. Herz 2023; 48:39-47. [PMID: 35244729 PMCID: PMC9892087 DOI: 10.1007/s00059-022-05098-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/05/2021] [Accepted: 01/17/2022] [Indexed: 02/05/2023]
Abstract
Computed tomography coronary angiography (cCTA) is a safe option for the noninvasive exclusion of significant coronary stenoses in patients with a low or moderate pretest probability for coronary artery disease (CAD). Furthermore, it also allows functional and morphological assessment of coronary stenoses. The European Society of Cardiology (ESC) guidelines on the diagnosis and management of chronic coronary syndrome published in 2019 have strengthened the importance of cCTA in this context and for this reason it has experienced a considerable upgrade. The determination of the Agatston score is a clinically established method for quantifying coronary calcification and influences the initiation of drug treatment. With technologies, such as the introduction of electrocardiography (ECG)-controlled dose modulation and iterative image reconstruction, cCTA can be performed with high image quality and low radiation exposure. Anatomic imaging of coronary stenoses alone is currently being augmented by innovative techniques, such as myocardial CT perfusion imaging or CT-fractional flow reserve (FFR) but the clinical value of these methods merits further investigation. The cCTA could therefore develop into a gatekeeper with respect to the indications for invasive coronary diagnostics and interventions.
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Affiliation(s)
- S Baumann
- First Department of Medicine - Cardiology, University Medical Centre Mannheim, Mannheim, Germany and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Deutschland
| | - D Overhoff
- Department for Radiology and Neuroradiology, German Federal Armed Forces Central Hospital Koblenz, Koblenz, Deutschland
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, Heidelberg University, Heidelberg, Deutschland
| | - C Tesche
- Department of Internal Medicine, Cardiology, St. Johannes Hospital, Dortmund, Deutschland
| | - G Korosoglou
- Department of Cardiology & Vascular Medicine, GRN Hospital Weinheim, Weinheim, Deutschland
| | - S Kelle
- Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Berlin, Deutschland
| | - M Nassar
- Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Berlin, Deutschland
| | - S J Buss
- The Radiology Center, Sinsheim, Eberbach, Erbach, Walldorf, Heidelberg, Heidelberg, Deutschland
| | - F Andre
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Deutschland
| | - M Renker
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Deutschland
| | - U J Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - I Akin
- First Department of Medicine - Cardiology, University Medical Centre Mannheim, Mannheim, Germany and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Deutschland
| | - S Waldeck
- Department for Radiology and Neuroradiology, German Federal Armed Forces Central Hospital Koblenz, Koblenz, Deutschland
| | - S O Schoenberg
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, Heidelberg University, Heidelberg, Deutschland
| | - D Lossnitzer
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Deutschland.
- Klinik für Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland.
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85
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Zhou B, Tang Z, Huang X, Zhu H, Li X, Xiong H, Yu J, Liao R, Zhang D. Subtraction coronary CT angiography in patients with high heart rate. Acta Cardiol 2023; 78:99-108. [PMID: 35384795 DOI: 10.1080/00015385.2022.2061111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
All the previous subtraction coronary CT angiography (CCTA) had strict heart rate (HR) inclusion criteria. In this study, a new subtraction method was applied to patients with various HR. The post-contrast scan time was respectively 3.5 s after ascending aorta peak enhancement while HR >80 bpm, 4 s while 65≤ HR ≤80 bpm and 4.5 s while HR <65 bpm. Forty-six patients who underwent the new subtraction protocol were enrolled and patients were stratified into the high HR group (≥70 bpm) and low HR group (<70 bpm). Eighteen patients with 15 severe calcification segments and 25 stent segments further received invasive coronary angiography (ICA). In all included patients, the coronary artery enhancement was compared between the high and low HR groups. In patients with ICA performed, the image quality improvement and diagnostic effectiveness for detection of significant coronary segments stenosis (>50%) were compared between the conventional CCTA and subtraction CCTA and between the high HR group and low HR group, respectively. All enrolled patients got sufficient coronary artery enhancement. In patients with ICA performed, receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) for the diagnosis of significant stenosis was 0.93 in subtraction CCTA and 0.73 in conventional CCTA (p < 0.05). Furthermore, there were no significant differences in image quality improvement, specificity, positive predictive value and accuracy between the high HR group and low HR group. The new subtraction CCTA method broadened the clinical availability for patients with high HR.
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Affiliation(s)
- Bi Zhou
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Zhuoyue Tang
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Xianlong Huang
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Hongzhang Zhu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiaojiao Li
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Hua Xiong
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Jiayi Yu
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Ruikun Liao
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Dan Zhang
- Department of Radiology, Chongqing General Hospital, Chongqing, China
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86
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Reduced Iodinated Contrast Media Administration in Coronary CT Angiography on a Clinical Photon-Counting Detector CT System: A Phantom Study Using a Dynamic Circulation Model. Invest Radiol 2023; 58:148-155. [PMID: 36165932 DOI: 10.1097/rli.0000000000000911] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE The aim of this study was to evaluate strategies to reduce contrast media volumes for coronary computed tomography (CT) angiography on a clinical first-generation dual-source photon-counting detector (PCD)-CT system using a dynamic circulation phantom. MATERIALS AND METHODS Coronary CT angiograph is an established method for the assessment of coronary artery disease that relies on the administration of iodinated contrast media. Reduction of contrast media volumes while maintaining diagnostic image quality is desirable. In this study, a dynamic phantom containing a 3-dimensional-printed model of the thoracic aorta and coronary arteries was evaluated using a clinical contrast injection protocol with stepwise reduced contrast agent concentrations (100%, 75%, 50%, 40%, 30%, and 20% contrast media content of the same 50 mL bolus, resulting in iodine delivery rates of 1.5, 1.1, 0.7, 0.6, 0.4 and 0.3 gl/s) on a first-generation, dual-source PCD-CT. Polychromatic images (T3D) and virtual monoenergetic images were reconstructed in the range of 40 to 70 keV in 5-keV steps. Attenuation and noise were measured in the coronary arteries and background material and the contrast-to-noise ratio (CNR) were calculated. Attenuation of 350 HU and a CNR of the reference protocol at 70 keV were regarded as sufficient for simulation of diagnostic purposes. Vessel sharpness and noise power spectra were analyzed for the aforementioned reconstructions. RESULTS The standard clinical contrast protocol (bolus with 100% contrast) yielded diagnostic coronary artery attenuation for all tested reconstructions (>398 HU). A 50% reduction in contrast media concentration demonstrated sufficient attenuation of the coronary arteries at 40 to 55 keV (>366 HU). Virtual monoenergetic image reconstructions of 40 to 45 and 40 keV allowed satisfactory attenuation of the coronary arteries for contrast concentrations of 40% and 30% of the original protocol. A reduction of contrast agent concentration to 20% of the initial concentration provided insufficient attenuation in the target vessels for all reconstructions. The highest CNR was found for virtual monoenergetic reconstructions at 40 keV for all contrast media injection protocols, yielding a sufficient CNR at a 50% reduction of contrast agent concentration. CONCLUSIONS Using virtual monoenergetic image reconstructions at 40 keV on a dual-source PCD-CT system, contrast media concentration could be reduced by 50% to obtain diagnostic attenuation and objective image quality for coronary CT angiography in a dynamic vessel phantom. These initial feasibility study results have to be validated in clinical studies.
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87
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Yashima S, Takaoka H, Iwahana T, Nishikawa Y, Ota J, Aoki S, Kinoshita M, Takahashi M, Sasaki H, Suzuki-Eguchi N, Goto H, Suzuki K, Kobayashi Y. Evaluation of extracellular volume by computed tomography is useful for prediction of prognosis in dilated cardiomyopathy. Heart Vessels 2023; 38:185-194. [PMID: 35963911 DOI: 10.1007/s00380-022-02154-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/27/2022] [Indexed: 01/10/2023]
Abstract
Cardiac computed tomography (CT) is useful for the screening of coronary artery stenosis, and extracellular volume fraction (ECV) analysis by CT using new dedicated software is now available. Here, we evaluated the utility of ECV analysis using cardiac CT to predict patient prognosis in cases with dilated cardiomyopathy (DCM). We analyzed 70 cases with DCM and cardiac computed tomography (CT) with available late-phase images. We evaluated the ECV of the left ventricular myocardium (LVM) using commercially available software (Ziostation 2, Ziosoft Inc, Japan). ECV on LVM was 33.96 ± 5.04%. Major adverse cardiac events (MACE) occurred in 21 cases (30%). ECV of the LVM on CT, endo-systolic volume, and rate of significant valvular disease were significantly higher in cases with MACE than in those without (37.16 ± 5.91% vs. 32.59 ± 3.95%, 194 ± 109 vs. 138 ± 78 ml and 57% vs. 20%, all P values < 0.05). LVEF was significantly lower in cases with MACE than in those without (23 ± 8 vs. 31 ± 11%, P = 0.0024). The best cut-off value of ECV on LVM for prediction of MACE was 32.26% based on receiver operating characteristics analysis. Cases with ECV ≥ 32.26% had significantly higher MACE based on Kaplan-Meier analysis (P = 0.0032). Only ECV on LVM was an independent predictor of MACE based on a multivariate Cox proportional hazards model (P = 0.0354). Evaluation of ECV on LVM by CT is useful for predicting MACE in patients with DCM.
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Affiliation(s)
- Satomi Yashima
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Hiroyuki Takaoka
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Japan.
| | - Togo Iwahana
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Yusei Nishikawa
- Department of Cardiovascular Medicine, Eastern Chiba Medical Center, Togane, Japan
| | - Joji Ota
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Shuhei Aoki
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Makiko Kinoshita
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Manami Takahashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Haruka Sasaki
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Noriko Suzuki-Eguchi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Hiroki Goto
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Katsuya Suzuki
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
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Meng J, Jiang H, Ren K, Zhou J. Comparison of risk assessment strategies incorporating coronary artery calcium score with estimation of pretest probability to defer cardiovascular testing in patients with stable chest pain. BMC Cardiovasc Disord 2023; 23:53. [PMID: 36709263 PMCID: PMC9884410 DOI: 10.1186/s12872-023-03076-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/17/2023] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The risk assessment of patients with stable chest pain (SCP) to defer further cardiovascular testing is crucial, but the most appropriate risk assessment strategy remains unknown. We aimed to compare current strategies to identify low risk SCP patients. METHODS 5289 symptomatic patients who had undergone coronary artery calcium score (CACS) and coronary computed tomographic angiography scan were identified and followed. Pretest probability (PTP) of obstructive coronary artery disease (CAD) for every patient was estimated according to European Society of Cardiology (ESC)-PTP model and CACS-weighted clinical likelihood (CACS-CL) model, respectively. Based on the 2019 ESC guideline-determined risk assessment strategy (ESC strategy) and CACS-CL model-based risk assessment strategy (CACS-CL strategy), all patients were divided into low and high risk group, respectively. Area under receiver operating characteristic curve (AUC), integrated discrimination improvement (IDI) and net reclassification improvement (NRI) was used. RESULTS CACS-CL model provided more robust estimation of PTP than ESC-PTP model did, with a larger AUC (0.838 versus 0.735, p < 0.0001), positive IDI (9%, p < 0.0001) and less discrepancy between observed and predicted probabilities. As a result, compared to ESC strategy which only applied CACS-CL model to patients with borderline ESC-PTP, CACS-CL strategy incorporating CACS with estimation of PTP to entire SCP patients indicated a positive NRI (19%, p < 0.0001) and a stronger association to major adverse cardiovascular events, with hazard ratios: 3.97 (95% confidence intervals: 2.75-5.72) versus 5.11 (95% confidence intervals: 3.40-7.69). CONCLUSION The additional use of CACS for all SCP patients in CACS-CL strategy improved the risk assessment of SCP patients to identify individuals at low risk.
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Affiliation(s)
- Jia Meng
- grid.412648.d0000 0004 1798 6160Department of Kidney Disease and Blood Purification, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Hantao Jiang
- grid.417020.00000 0004 6068 0239Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Kai Ren
- grid.417020.00000 0004 6068 0239Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Jia Zhou
- grid.417020.00000 0004 6068 0239Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
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89
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Chiocchi M, Cavallo AU, Pugliese L, Cesareni M, Pasquali D, Accardo G, De Stasio V, Spiritigliozzi L, Benelli L, D’Errico F, Cerimele C, Floris R, Garaci F, Di Donna C. Cardiac Computed Tomography Evaluation of Association of Left Ventricle Disfunction and Epicardial Adipose Tissue Density in Patients with Low to Intermediate Cardiovascular Risk. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020232. [PMID: 36837434 PMCID: PMC9960536 DOI: 10.3390/medicina59020232] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/06/2023] [Accepted: 01/19/2023] [Indexed: 01/28/2023]
Abstract
Background and objectives: Epicardial adipose tissue density (EAD) has been associated with coronary arteries calcium score, a higher load of coronary artery disease (CAD) and plaque vulnerability. This effect can be related to endocrine and paracrine effect of molecules produced by epicardial adipose tissue (EAT), that may influence myocardial contractility. Using coronary computed tomography angiography (CCT) the evaluation of EAD is possible in basal scans. The aim of the study is to investigate possible associations between EAD and cardiac function. Material and Methods: 93 consecutive patients undergoing CCT without and with contrast medium for known or suspected coronary CAD were evaluated. EAD was measured on basal scans, at the level of the coronary ostia, the lateral free wall of the left ventricle, at the level of the cardiac apex, and at the origin of the posterior interventricular artery. Cardiac function was evaluated in post-contrast CT scans in order to calculate ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV), and stroke volume (SV). Results: A statistically significant positive correlation between EAD and ejection fraction (r = 0.29, p-value < 0.01) was found. Additionally, a statistically significant negative correlation between EAD and ESV (r = -0.25, p-value < 0.01) was present. Conclusion: EAD could be considered a new risk factor associated with reduced cardiac function. The evaluation of this parameter with cardiac CT in patients with low to intermediate cardiovascular risk is possible.
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Affiliation(s)
- Marcello Chiocchi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
- Correspondence: ; Tel.: +39-3473154183
| | - Armando Ugo Cavallo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
- Division of Radiology, Istituto Dermopatico dell’Immacolata, 00167 Rome, Italy
| | - Luca Pugliese
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Matteo Cesareni
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Daniela Pasquali
- Dipartimento di Scienze Mediche e Chirurgiche Avanzate, Università degli Studi della Campania Luigi Vanvitelli, 81100 Caserta, Italy
| | - Giacomo Accardo
- ASL Salerno Ds 63 Poliambulatorio Costa d’Amalfi, 84013 Salerno, Italy
| | - Vincenzo De Stasio
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Luigi Spiritigliozzi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Leonardo Benelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Francesca D’Errico
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Cecilia Cerimele
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Roberto Floris
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Francesco Garaci
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
- IRCSS San Raffaele, 03043 Cassino, Italy
| | - Carlo Di Donna
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
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90
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Dong X, Li N, Zhu C, Wang Y, Shi K, Pan H, Wang S, Shi Z, Geng Y, Wang W, Zhang T. Diagnosis of coronary artery disease in patients with type 2 diabetes mellitus based on computed tomography and pericoronary adipose tissue radiomics: a retrospective cross-sectional study. Cardiovasc Diabetol 2023; 22:14. [PMID: 36691047 PMCID: PMC9869509 DOI: 10.1186/s12933-023-01748-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/18/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Patients with type 2 diabetes mellitus (T2DM) are highly susceptible to cardiovascular disease, and coronary artery disease (CAD) is their leading cause of death. We aimed to assess whether computed tomography (CT) based imaging parameters and radiomic features of pericoronary adipose tissue (PCAT) can improve the diagnostic efficacy of whether patients with T2DM have developed CAD. METHODS We retrospectively recruited 229 patients with T2DM but no CAD history (146 were diagnosed with CAD at this visit and 83 were not). We collected clinical information and extracted imaging manifestations from CT images and 93 radiomic features of PCAT from all patients. All patients were randomly divided into training and test groups at a ratio of 7:3. Four models were constructed, encapsulating clinical factors (Model 1), clinical factors and imaging indices (Model 2), clinical factors and Radscore (Model 3), and all together (Model 4), to identify patients with CAD. Receiver operating characteristic curves and decision curve analysis were plotted to evaluate the model performance and pairwise model comparisons were performed via the DeLong test to demonstrate the additive value of different factors. RESULTS In the test set, the areas under the curve (AUCs) of Model 2 and Model 4 were 0.930 and 0.929, respectively, with higher recognition effectiveness compared to the other two models (each p < 0.001). Of these models, Model 2 had higher diagnostic efficacy for CAD than Model 1 (p < 0.001, 95% CI [0.129-0.350]). However, Model 4 did not improve the effectiveness of the identification of CAD compared to Model 2 (p = 0.776); similarly, the AUC did not significantly differ between Model 3 (AUC = 0.693) and Model 1 (AUC = 0.691, p = 0.382). Overall, Model 2 was rated better for the diagnosis of CAD in patients with T2DM. CONCLUSIONS A comprehensive diagnostic model combining patient clinical risk factors with CT-based imaging parameters has superior efficacy in diagnosing the occurrence of CAD in patients with T2DM.
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Affiliation(s)
- Xiaolin Dong
- Department of Radiology, Fourth Affiliated Hospital of Harbin Medical University, No. 37, YiYuan Street, NanGang District, Harbin, 150001 Heilongjiang China
| | - Na Li
- Department of Radiology, Fourth Affiliated Hospital of Harbin Medical University, No. 37, YiYuan Street, NanGang District, Harbin, 150001 Heilongjiang China
| | - Chentao Zhu
- Department of Radiology, Fourth Affiliated Hospital of Harbin Medical University, No. 37, YiYuan Street, NanGang District, Harbin, 150001 Heilongjiang China
| | - Yujia Wang
- Department of Interventional and Vascular, Fourth Affiliated Hospital of Harbin Medical University, No. 37, YiYuan Street, NanGang District, Harbin, 150001 Heilongjiang China
| | - Ke Shi
- Department of Radiology, Fourth Affiliated Hospital of Harbin Medical University, No. 37, YiYuan Street, NanGang District, Harbin, 150001 Heilongjiang China
| | - Hong Pan
- Department of Radiology, Fourth Affiliated Hospital of Harbin Medical University, No. 37, YiYuan Street, NanGang District, Harbin, 150001 Heilongjiang China
| | - Shuting Wang
- Department of Radiology, Fourth Affiliated Hospital of Harbin Medical University, No. 37, YiYuan Street, NanGang District, Harbin, 150001 Heilongjiang China
| | - Zhenzhou Shi
- Department of Radiology, Fourth Affiliated Hospital of Harbin Medical University, No. 37, YiYuan Street, NanGang District, Harbin, 150001 Heilongjiang China
| | - Yayuan Geng
- Shukun (Beijing) Network Technology Co., Ltd, Jinhui Building, Qiyang Road, Beijing, 100102 China
| | - Wei Wang
- The MRI Room, First Affiliated Hospital of Harbin Medical University, No. 23, YouZheng Street, NanGang District, Harbin, 150001 Heilongjiang China
| | - Tong Zhang
- Department of Radiology, Fourth Affiliated Hospital of Harbin Medical University, No. 37, YiYuan Street, NanGang District, Harbin, 150001 Heilongjiang China
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91
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Takahashi M, Takaoka H, Ota J, Yashima S, Kinoshita M, Suzuki-Eguchi N, Sasaki H, Goto H, Aoki S, Kitahara H, Sano K, Kobayashi Y. An Increased Diagnostic Accuracy of Significant Coronary Artery Stenosis Using 320-slice Computed Tomography with Model-based Iterative Reconstruction in Cases with Severely Calcified Coronary Arteries. Intern Med 2023; 62:169-176. [PMID: 35676040 PMCID: PMC9908388 DOI: 10.2169/internalmedicine.9509-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Objective High-quality images can be obtained with 320-slice computed tomography (CT) with model-based iterative reconstruction (MBIR). We therefore investigated the diagnostic accuracy of 320-slice CT with MBIR for detecting significant coronary artery stenosis. Methods This was a retrospective study of 160 patients who underwent coronary CT and invasive coronary angiography (ICA). The first 100 consecutive patients (Group 1) underwent 320-slice CT without MBIR or small-focus scanning. The next 60 consecutive patients (Group 2) underwent 320-slice CT with both MBIR and small-focus scanning. Patients who underwent coronary artery bypass surgery were excluded. The diagnostic performance of 320-slice CT without MBIR or small-focus scanning and 320-slice CT with both of them, with ICA regarded as a reference standard, was compared to detect significant coronary artery stenosis (≥70% on CT, ≥75% on ICA). Results In a patient-based analysis, the sensitivity, specificity, and overall accuracy of detection of significant stenosis on CT against ICA were 95%, 85%, and 91% in Group 1, and 93%, 83%, and 90% in Group 2, respectively. No significant differences were observed between the two groups in the patient- and segment-based analyses. However, among cases with a severe coronary artery calcium score >400 (31 cases in Group 1 and 28 in Group 2), the specificity and overall accuracy were significantly higher (all p<0.01) in Group 2 than in Group 1 according to the segment-based analysis. Conclusion The diagnostic accuracy of the detection of coronary artery stenosis on CT was improved using 320-slice CT with MBIR.
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Affiliation(s)
- Manami Takahashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
| | - Hiroyuki Takaoka
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
| | - Joji Ota
- Department of Radiology, Chiba University Hospital, Japan
| | - Satomi Yashima
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
| | - Makiko Kinoshita
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
| | - Noriko Suzuki-Eguchi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
| | - Haruka Sasaki
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
| | - Hiroki Goto
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
| | - Shuhei Aoki
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
| | - Hideki Kitahara
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
| | - Koichi Sano
- Department of Cardiovascular Medicine, Eastern Chiba Medical Center, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
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92
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Coronary Artery Stent Evaluation by CTA: Impact of Deep Learning Reconstruction and Subtraction Technique. AJR Am J Roentgenol 2023; 220:63-72. [PMID: 35946861 DOI: 10.2214/ajr.22.27983] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND. Coronary CTA with hybrid iterative reconstruction (HIR) is prone to false-positive results for in-stent restenosis due to stent-related blooming artifact. OBJECTIVE. The purpose of this study is to assess the impact of deep learning reconstruction (DLR), subtraction images, and the combination of DLR and subtraction images on the diagnostic performance of coronary CTA for the detection of in-stent restenosis. METHODS. This prospective study included patients with coronary stents who underwent coronary CTA between March 2020 and August 2021. CTA used a technique with two breath-holds (noncontrast and contrast-enhanced acquisitions). Conventional and subtraction images were reconstructed for HIR and DLR. The maximum visible instent lumen diameter was measured. Two readers independently evaluated images for in-stent restenosis (≥ 50% stenosis). A simulated assessment of combined conventional and subtraction images was generated, reflecting assessment of conventional and subtraction images in the presence or absence of severe misregistration artifact, respectively. Invasive angiography served as reference standard. RESULTS. The study enrolled 30 patients (22 men and eight women; mean age, 63.6 ± 7.4 [SD] years) with a total of 59 stents; severe misregistration artifact was present for 32 stents. Maximum visible in-stent lumen diameter was higher for DLR than for HIR (2.3 ± 0.5 vs 2.1 ± 0.5 mm, p < .001), and among stents without severe misregistration artifact, it was higher for subtraction than conventional DLR (3.0 ± 0.5 vs 2.4 ± 0.5, p < .001). Among conventional CTA with HIR, conventional CTA with DLR, combination (conventional and subtraction) approach with HIR, and combination (conventional and subtraction) approach with DLR, the highest patient-level diagnostic performance measures were as follows: for reader 1, sensitivity was identical (62.5%), specificity was highest for combination with DLR (90.1%), PPV was highest for combination with DLR (71.4%), NPV was highest for combination with DLR (87.0%), and accuracy was highest for combination with DLR (83.3%); for reader 2, sensitivity was identical (50.0%), specificity was highest for combination with HIR or DLR (both 95.5%), PPV was highest for combination with HIR or DLR (both 80.0%), NPV was highest for combination with HIR or DLR (84.0%), and accuracy was highest for combination with HIR or DLR (both 83.3%). CONCLUSION. The combined DLR and subtraction technique yielded optimal diagnostic performance for detecting in-stent restenosis by coronary CTA. CLINICAL IMPACT. The described technique could guide patient selection for invasive coronary stent evaluation.
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93
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Pedersen ER, Hovland S, Karaji I, Berge C, Mohamed Ali A, Lekven OC, Kuiper KJ, Rotevatn S, Larsen TH. Coronary calcium score in the initial evaluation of suspected coronary artery disease. Heart 2022; 109:695-701. [PMID: 36549683 DOI: 10.1136/heartjnl-2022-321682] [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: 07/24/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE We evaluated coronary artery calcium (CAC) scoring as an initial diagnostic tool in outpatients and in patients presenting at the emergency department due to suspected coronary artery disease (CAD). METHODS 10 857 patients underwent CAC scoring and coronary CT angiography (CCTA) at Haukeland University Hospital in Norway during 2013-2020. Based on CCTA, obstructive CAD was defined as at least one coronary stenosis ≥50%. High-risk CAD included obstructive stenoses of the left main stem, the proximal left ascending artery or affecting all three major vascular territories with at least one proximal segment involved. RESULTS Median age was 58 years and 49.5% were women. The overall prevalence of CAC=0 was 45.0%. Among those with CAC=0, 1.8% had obstructive CAD and 0.6% had high-risk CAD on CCTA. Overall, the sensitivity, specificity, positive predictive value and negative predictive value (NPV) of CAC=0 for obstructive CAD were 95.3%, 53.4%, 30.0% and 98.2%, respectively. However, among patients <45 years of age, although the NPV was high at 98.9%, the sensitivity of CAC=0 for obstructive CAD was only 82.3%. CONCLUSIONS In symptomatic patients, CAC=0 correctly ruled out obstructive CAD and high-risk CAD in 98.2% and 99.4% of cases. This large registry-based cross-sectional study supports the incorporation of CAC testing in the early triage of patients with chest pain and as a gatekeeper to further cardiac testing. However, a full CCTA may be needed for safely ruling out obstructive CAD in the youngest patients (<45 years of age).
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Affiliation(s)
- Eva Ringdal Pedersen
- Department of Clinical Science, University of Bergen, Bergen, Norway .,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Siren Hovland
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Iman Karaji
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Christ Berge
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Abukar Mohamed Ali
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | - Kier Jan Kuiper
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Svein Rotevatn
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Terje Hjalmar Larsen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.,Department of Biomedicine, University of Bergen, Bergen, Norway
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Nishikawa Y, Takaoka H, Kanaeda T, Takahira H, Suzuki S, Aoki S, Goto H, Suzuki K, Yashima S, Takahashi M, Kinoshita M, Sasaki H, Suzuki-Eguchi N, Sano K, Kobayashi Y. A new composite indicator consisting of left ventricular extracellular volume, N-terminal fragment of B-type natriuretic peptide, and left ventricular end-diastolic volume is useful for predicting reverse remodeling after catheter ablation for atrial fibrillation. Heart Vessels 2022; 38:721-730. [PMID: 36534159 DOI: 10.1007/s00380-022-02220-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022]
Abstract
Recently, myocardial extracellular volume (ECV) analysis has been measurable on computed tomography (CT) using new software. We evaluated the use of cardiac CT to estimate the myocardial ECV of left ventricular (LV) myocardium (LVM) to predict reverse remodeling (RR) in cases of atrial fibrillation (AF) after catheter ablation (CA). Four hundred and seven patients underwent CA for AF in our institution from April 2014 to Feb 2021. Of these, 33 patients (8%) with an LVEF ≤ 50% and who had undergone CT were included in our study. We estimated the LVM ECV using commercial software to analyze the CT data. RR was defined as an improvement in LVEF to > 50% after CA. LVEF increased to > 50% in 24 patients (73%) after CA. In all 24 patients, LVM ECV, LV end-diastolic and end-systolic volumes (LVEDV and LVESV), and the n-terminal fragment of pro-B-type natriuretic peptide (NT-proBNP) were significantly lower than in the other nine patients (P = 0.0037, 0.0273, 0.0443, and < 0.0001). On receiver operating characteristic curve analysis, the best cut-off of ECV, LVEDV, LVESV and NT-proBNP for the prediction of RR were 37.73%, 120 mL, 82 mL, and 1267 pg/mL, respectively. We newly defined the ENL (ECV, NT-proBNP, and LVEDV) score as the summed score for the presence or absence (1 or 0; maximum score = 3) of ECV, NT-proBNP, and LVEDV values less than or equal to each best cut-off value, and found that this score gave the highest area under the curve for the prediction of RR (0.9583, P < 0.0001). The ENL score may be useful for predicting RR in patients with AF undergoing CA.
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95
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Tummala R, Han D, Friedman J, Hayes S, Thomson L, Gransar H, Slomka P, Rozanski A, Dey D, Berman D. Association between plaque localization in proximal coronary segments and MACE outcomes in patients with mild CAC: Results from the EISNER study. Am J Prev Cardiol 2022; 12:100423. [PMID: 36199447 PMCID: PMC9529495 DOI: 10.1016/j.ajpc.2022.100423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 11/28/2022] Open
Abstract
Objective Coronary artery calcium score (CAC) is a validated tool to predict and reclassify cardiovascular risk. Additional metrics such as regional distribution and extent of CAC over Agatston CAC score may allow further risk stratification. In this study, we evaluate the prognostic significance of proximal CAC involvement in asymptomatic population from the prospective EISNER (Early-Identification of Subclinical Atherosclerosis by Noninvasive Imaging Research) registry, focusing on patients with mild CAC (score 1-99). Methods This study included a total of 2,047 adult asymptomatic subject who underwent baseline CAC scan and 14-year follow-up for MACE, defined as myocardial infarction, late revascularization, or cardiac death. Proximal involvement was defined as presence of CAC in the LM, proximal LAD, LCX or RCA. CAC was categorized as 0, 1-99, and ≥100. Results 1,090 (53.2%) subjects had no CAC, 576 (28.1%) had CAC 1-99, and 381 (18.7%) had CAC ≥100. Proximal involvement was seen in 67.2% of subjects with CAC 1-99 and 97.3% of subjects with CAC ≥100. In the CAC 1-99 category, the presence of proximal CAC was associated with increased MACE risk after adjustment for CAC score, CAC extent and conventional risk factors compared to those without proximal CAC (HR: 2.84 95% CI: 1.29-6.25, p=0.009). Conclusion In asymptomatic subjects with CAC scores of 1-99, the presence and extent of proximal CAC plaques provides strong independent prognostic information in predicting MACE
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Affiliation(s)
- Ramyashree Tummala
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Donghee Han
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - John Friedman
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sean Hayes
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Louise Thomson
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Heidi Gransar
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Piotr Slomka
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alan Rozanski
- Division of Cardiology, Mount Sinai Morningside Hospital, New York, New York
| | - Damini Dey
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel Berman
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Corresponding author at: 8700 Beverly Blvd, Los Angeles, California, 90048, United States
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96
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Liu Z, Yang J, Chen Y. The Chinese Experience of Imaging in Cardiac Intervention: A Bird's Eye Review. J Thorac Imaging 2022; 37:374-384. [PMID: 36162061 DOI: 10.1097/rti.0000000000000680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Recent scientific and technological advances have greatly contributed to the development of medical imaging that could enable specific functions. It has become the primary focus of cardiac intervention in preoperative assessment, intraoperative guidance, and postoperative follow-up. This review provides a contemporary overview of the Chinese experience of imaging in cardiac intervention in recent years.
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Affiliation(s)
- Zinuan Liu
- Senior Department of Cardiology, The Sixth Medical Center of PLA General Hospital
- Medical School of Chinese PLA, Beijing, P.R. China
| | - Junjie Yang
- Senior Department of Cardiology, The Sixth Medical Center of PLA General Hospital
| | - Yundai Chen
- Senior Department of Cardiology, The Sixth Medical Center of PLA General Hospital
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97
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Pons-Lladó G, Kellman P. State-of-the-Art of Myocardial Perfusion by CMR: A Practical View. Rev Cardiovasc Med 2022; 23:325. [PMID: 39077124 PMCID: PMC11267340 DOI: 10.31083/j.rcm2310325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 07/31/2024] Open
Abstract
Ischemic heart disease (IHD) outstands among diseases threatening public health. Essential for its management are the continuous advances in medical and interventional therapies, although a prompt and accurate diagnosis and prognostic stratification are equally important. Besides information on the anatomy of coronary arteries, well covered nowadays by invasive and non-invasive angiographic techniques, there are also other components of the disease with clinical impact, as the presence of myocardial necrosis, the extent of pump function impairment, and the presence and extent of inducible myocardial ischemia, that must be considered in every patient. Cardiovascular Magnetic Resonance (CMR) is a multiparametric diagnostic imaging technique that provides reliable information on these issues. Regarding the detection and grading of inducible ischemia in particular, the technique has been widely adopted in the form of myocardial perfusion sequences under vasodilator stress, which is the subject of this review. While the analysis of images is conventionally performed by visual inspection of dynamic first-pass studies, with the inherent dependency on the operator capability, the recent introduction of a reliable application of quantitative perfusion (QP) represents a significant advance in the field. QP is based on a dual-sequence strategy for conversion of signal intensities into contrast agent concentration units and includes a full automatization of processes such as myocardial blood flow (MBF) calculation (in mL/min/g), generation of a pixel-wise flow mapping, myocardial segmentation, based on machine learning, and allocation of MBF values to myocardial segments. The acquisition of this protocol during induced vasodilation and at rest gives values of stress/rest MBF (in mL/min/g) and myocardial perfusion reserve (MPR), both global and per segment. Dual-sequence QP has been successfully validated against different reference methods, and its prognostic value has been shown in large longitudinal studies. The fact of the whole process being automated, without operator interaction, permits to conceive new interesting scenarios of integration of CMR into systems of entirely automated diagnostic workflow in patients with IHD.
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Affiliation(s)
- Guillem Pons-Lladó
- Head (Emeritus), Cardiac Imaging Unit, Cardiology Department, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Clínica Creu Banca, 08034 Barcelona, Spain
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892, USA
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Febbo J, Eaton RP, Wann S, Schade DS. Extending Coronary Artery Calcium Scanning with CT Coronary Angiography in the Primary Care Setting. Am J Med 2022; 135:1037-1039. [PMID: 35472393 DOI: 10.1016/j.amjmed.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/01/2022] [Indexed: 11/15/2022]
Affiliation(s)
| | - R Philip Eaton
- Division of Endocrinology, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque
| | - Samuel Wann
- Division of Endocrinology, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque
| | - David S Schade
- Division of Endocrinology, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque.
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99
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Jonas RA, Weerakoon S, Fisher R, Griffin WF, Kumar V, Rahban H, Marques H, Karlsberg RP, Jennings RS, Crabtree TR, Choi AD, Earls JP. Interobserver variability among expert readers quantifying plaque volume and plaque characteristics on coronary CT angiography: a CLARIFY trial sub-study. Clin Imaging 2022; 91:19-25. [PMID: 35986973 DOI: 10.1016/j.clinimag.2022.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/21/2022] [Accepted: 08/07/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND The difference between expert level (L3) reader and artificial intelligence (AI) performance for quantifying coronary plaque and plaque components is unknown. OBJECTIVE This study evaluates the interobserver variability among expert readers for quantifying the volume of coronary plaque and plaque components on coronary computed tomographic angiography (CCTA) using an artificial intelligence enabled quantitative CCTA analysis software as a reference (AI-QCT). METHODS This study uses CCTA imaging obtained from 232 patients enrolled in the CLARIFY (CT EvaLuation by ARtificial Intelligence For Atherosclerosis, Stenosis and Vascular MorphologY) study. Readers quantified overall plaque volume and the % breakdown of noncalcified plaque (NCP) and calcified plaque (CP) on a per vessel basis. Readers categorized high risk plaque (HRP) based on the presence of low-attenuation-noncalcified plaque (LA-NCP) and positive remodeling (PR; ≥1.10). All CCTAs were analyzed by an FDA-cleared software service that performs AI-driven plaque characterization and quantification (AI-QCT) for comparison to L3 readers. Reader generated analyses were compared among readers and to AI-QCT generated analyses. RESULTS When evaluating plaque volume on a per vessel basis, expert readers achieved moderate to high interobserver consistency with an intra-class correlation coefficient of 0.78 for a single reader score and 0.91 for mean scores. There was a moderate trend between readers 1, 2, and 3 and AI with spearman coefficients of 0.70, 0.68 and 0.74, respectively. There was high discordance between readers and AI plaque component analyses. When quantifying %NCP v. %CP, readers 1, 2, and 3 achieved a weighted kappa coefficient of 0.23, 0.34 and 0.24, respectively, compared to AI with a spearman coefficient of 0.38, 0.51, and 0.60, respectively. The intra-class correlation coefficient among readers for plaque composition assessment was 0.68. With respect to HRP, readers 1, 2, and 3 achieved a weighted kappa coefficient of 0.22, 0.26, and 0.17, respectively, and a spearman coefficient of 0.36, 0.35, and 0.44, respectively. CONCLUSION Expert readers performed moderately well quantifying total plaque volumes with high consistency. However, there was both significant interobserver variability and high discordance with AI-QCT when quantifying plaque composition.
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Affiliation(s)
- Rebecca A Jonas
- Department of Internal Medicine, Thomas Jefferson University Medical Center, Philadelphia, PA, USA
| | - Shaneke Weerakoon
- Department of Cardiology, The George Washington University School of Medicine, Washington, DC, USA
| | - Rebecca Fisher
- Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - William F Griffin
- Department of Radiology, The George Washington University School of Medicine, Washington, DC, USA
| | - Vishak Kumar
- Department of Cardiology, The George Washington University School of Medicine, Washington, DC, USA
| | - Habib Rahban
- Cardiovascular Research Foundation of Southern California, Beverly Hills, CA, USA
| | - Hugo Marques
- Centro Hospitalar Universitario de Lisboa Central - Servico de Radiologia do Hospital de Santa Marta, Lisboa, Portugal; Nova Medical School - Faculdade de Ciencias Medicas -, Lisboa, Portugal
| | - Ronald P Karlsberg
- Cardiovascular Research Foundation of Southern California, Beverly Hills, CA, USA
| | | | | | - Andrew D Choi
- Department of Cardiology, The George Washington University School of Medicine, Washington, DC, USA; Department of Radiology, The George Washington University School of Medicine, Washington, DC, USA
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100
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Kaluski E, Ghosh P, Rahman H. Left mammary graft imaging via right wrist access: Seeking a better & safer path? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 44:30-31. [PMID: 35985931 DOI: 10.1016/j.carrev.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Edo Kaluski
- Division of Cardiovascular Disease, Robert Packer Hospital and the Guthrie Health Services; Sayre PA and The Geisinger Commonwealth School of Medicine, Scranton, PA, USA.
| | - Priyanka Ghosh
- Division of Cardiovascular Disease, Robert Packer Hospital and the Guthrie Health Services; Sayre PA and The Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Hammad Rahman
- Division of Cardiovascular Disease, Robert Packer Hospital and the Guthrie Health Services; Sayre PA and The Geisinger Commonwealth School of Medicine, Scranton, PA, USA.
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