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Dawoud F, Schuleri KH, Spragg DD, Horáček BM, Berger RD, Halperin HR, Lardo AC. Insights from Novel Noninvasive CT and ECG Imaging Modalities on Electromechanical Myocardial Activation in a Canine Model of Ischemic Dyssynchronous Heart Failure. J Cardiovasc Electrophysiol 2016; 27:1454-1461. [PMID: 27578532 DOI: 10.1111/jce.13091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 08/12/2016] [Accepted: 08/17/2016] [Indexed: 01/26/2023]
Abstract
INTRODUCTION The interplay between electrical activation and mechanical contraction patterns is hypothesized to be central to reduced effectiveness of cardiac resynchronization therapy (CRT). Furthermore, complex scar substrates render CRT less effective. We used novel cardiac computed tomography (CT) and noninvasive electrocardiographic imaging (ECGI) techniques in an ischemic dyssynchronous heart failure (DHF) animal model to evaluate electrical and mechanical coupling of cardiac function, tissue viability, and venous accessibility of target pacing regions. METHODS AND RESULTS Ischemic DHF was induced in 6 dogs using coronary occlusion, left bundle ablation and tachy RV pacing. Full body ECG was recorded during native rhythm followed by volumetric first-pass and delayed enhancement CT. Regional electrical activation were computed and overlaid with segmented venous anatomy and scar regions. Reconstructed electrical activation maps show consistency with LBBB starting on the RV and spreading in a "U-shaped" pattern to the LV. Previously reported lines of slow conduction are seen parallel to anterior or inferior interventricular grooves. Mechanical contraction showed large septal to lateral wall delay (80 ± 38 milliseconds vs. 123 ± 31 milliseconds, P = 0.0001). All animals showed electromechanical correlation except dog 5 with largest scar burden. Electromechanical decoupling was largest in basal lateral LV segments. CONCLUSION We demonstrated a promising application of CT in combination with ECGI to gain insight into electromechanical function in ischemic dyssynchronous heart failure that can provide useful information to study regional substrate of CRT candidates.
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Affiliation(s)
- Fady Dawoud
- Division of Cardiology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Karl H Schuleri
- Division of Cardiology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - David D Spragg
- Division of Cardiology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - B Milan Horáček
- Department of Electrical and Computer Engineering, Dalhousie University, Halifax, NS, Canada
| | - Ronald D Berger
- Division of Cardiology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Henry R Halperin
- Division of Cardiology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Albert C Lardo
- Division of Cardiology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA
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Gan Y, Tsay D, Amir SB, Marboe CC, Hendon CP. Automated classification of optical coherence tomography images of human atrial tissue. JOURNAL OF BIOMEDICAL OPTICS 2016; 21:101407. [PMID: 26926869 PMCID: PMC5995000 DOI: 10.1117/1.jbo.21.10.101407] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 02/05/2016] [Indexed: 05/02/2023]
Abstract
Tissue composition of the atria plays a critical role in the pathology of cardiovascular disease, tissue remodeling, and arrhythmogenic substrates. Optical coherence tomography (OCT) has the ability to capture the tissue composition information of the human atria. In this study, we developed a region-based automated method to classify tissue compositions within human atria samples within OCT images. We segmented regional information without prior information about the tissue architecture and subsequently extracted features within each segmented region. A relevance vector machine model was used to perform automated classification. Segmentation of human atrial ex vivo datasets was correlated with trichrome histology and our classification algorithm had an average accuracy of 80.41% for identifying adipose, myocardium, fibrotic myocardium, and collagen tissue compositions.
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Affiliation(s)
- Yu Gan
- Columbia University, Department of Electrical Engineering, 500 West 120th Street, New York, New York 10027, United States
| | - David Tsay
- Columbia NY Presbyterian Hospital, 630 West 168th Street, New York, New York 10032, United States
| | - Syed B. Amir
- Columbia University, Department of Electrical Engineering, 500 West 120th Street, New York, New York 10027, United States
| | - Charles C. Marboe
- Columbia University Medical Center, 630 West 168th Street, New York, New York 10032, United States
| | - Christine P. Hendon
- Columbia University, Department of Electrical Engineering, 500 West 120th Street, New York, New York 10027, United States
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53
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CT myocardial perfusion imaging: current status and future directions. Clin Radiol 2016; 71:739-49. [DOI: 10.1016/j.crad.2016.03.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 03/08/2016] [Accepted: 03/10/2016] [Indexed: 01/15/2023]
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Smulders MW, Kietselaer BL, Schalla S, Bucerius J, Jaarsma C, van Dieijen-Visser MP, Mingels AM, Rocca HPBL, Post M, Das M, Crijns HJ, Wildberger JE, Bekkers SC. Acute chest pain in the high-sensitivity cardiac troponin era: A changing role for noninvasive imaging? Am Heart J 2016; 177:102-11. [PMID: 27297855 DOI: 10.1016/j.ahj.2016.03.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 03/30/2016] [Indexed: 02/07/2023]
Abstract
Management of patients with acute chest pain remains challenging. Cardiac biomarker testing reduces the likelihood of erroneously discharging patients with acute myocardial infarction (AMI). Despite normal contemporary troponins, physicians have still been reluctant to discharge patients without additional testing. Nowadays, the extremely high negative predictive value of current high-sensitivity cardiac troponin (hs-cTn) assays challenges this need. However, the decreased specificity of hs-cTn assays to diagnose AMI poses a new problem as noncoronary diseases (eg, pulmonary embolism, myocarditis, cardiomyopathies, hypertension, renal failure, etc) may also cause elevated hs-cTn levels. Subjecting patients with noncoronary diseases to unnecessary pharmacological therapy or invasive procedures must be prevented. Attempts to improve the positive predictive value to diagnose AMI by defining higher initial cutoff values or dynamic changes over time inherently lower the sensitivity of troponin assays. In this review, we anticipate a potential changing role of noninvasive imaging from ruling out myocardial disease when troponin values are normal toward characterizing myocardial disease when hs-cTn values are (mildly) abnormal.
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Oliveira DCLD, Assunção FB, Santos AASMDD, Nacif MS. Cardiac Magnetic Resonance and Computed Tomography in Hypertrophic Cardiomyopathy: an Update. Arq Bras Cardiol 2016; 107:163-72. [PMID: 27305111 PMCID: PMC5074069 DOI: 10.5935/abc.20160081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 02/04/2016] [Indexed: 01/18/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiovascular
disease and represents the main cause of sudden death in young patients. Cardiac
magnetic resonance (CMR) and cardiac computed tomography (CCT) are noninvasive
imaging methods with high sensitivity and specificity, useful for the
establishment of diagnosis and prognosis of HCM, and for the screening of
patients with subclinical phenotypes. The improvement of image analysis by CMR
and CCT offers the potential to promote interventions aiming at stopping the
natural course of the disease. This study aims to describe the role of RCM and
CCT in the diagnosis and prognosis of HCM, and how these methods can be used in
the management of these patients.
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56
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Abegunewardene N, Kreitner KF, Oberholzer K, Vosseler M, Schmidt KH, Wimmer E, Elsäßer A, Gori T, Düber C, Münzel T, Horstick G. Serial assessments of microvascular obstruction by contrast-enhanced magnetic resonance predict contractile recovery and clinical outcome after reperfused acute myocardial infarction. Clin Hemorheol Microcirc 2016; 62:345-57. [DOI: 10.3233/ch-151975] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Nico Abegunewardene
- Department of Internal Medicine II, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Karl-Friedrich Kreitner
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Katja Oberholzer
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Markus Vosseler
- Department of Internal Medicine II, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Kai-Helge Schmidt
- Department of Internal Medicine II, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Eva Wimmer
- Department of Internal Medicine II, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Amelie Elsäßer
- Institute for Medical Biometry, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Tommaso Gori
- Department of Internal Medicine II, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Christoph Düber
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Thomas Münzel
- Department of Internal Medicine II, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Georg Horstick
- Department of Internal Medicine II, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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Khurelsukh K, Kim YH, Seon HJ, Song JH, Park SY, Moon SM, Kim SH, Sim DS, Ahn Y. Non-contrast cardiac CT immediately after percutaneous coronary intervention: does it predict the risk of left ventricular remodeling in patients with ST-elevation myocardial infarction? Int J Cardiovasc Imaging 2016; 32 Suppl 1:147-54. [PMID: 27139462 DOI: 10.1007/s10554-016-0900-6] [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: 04/16/2016] [Accepted: 04/19/2016] [Indexed: 10/21/2022]
Abstract
To assess the clinical utility of non-contrast cardiac CT (CCT) immediately after successful percutaneous coronary intervention (PCI) for predicting the risk of left ventricle (LV) remodeling in the management of patients with acute myocardial infarction (AMI), 35 patients with AMI underwent non-contrast CCT immediately after PCI. Volume and transmural extent of myocardial delayed enhancement (DE) were assessed on non-contrast CCT. Serial echocardiography and serologic biomarkers were evaluated at baseline and at 2 and 12 months after AMI. Based on an increase in left ventricular end-diastolic volume (LVEDV) ≥20 % at 2 months, patients were classified into two groups: LV remodeling (group 1, n = 14) and no LV remodeling (group 2, n = 21). Clinical characteristics, imaging parameters, and serologic biomarkers were compared between the two groups. Higher incidence of hypertension, longer time to reperfusion, and higher Killip classification at admission were observed for group 1 than for group 2, but these differences were not statistically significant (P > 0.05). Greater volume and transmural extent of DE on non-contrast CCT and poorer resolution of ST-segment elevation on ECG were observed in group 1 compared to group 2, but these results were not statistically significant (P > 0.05). Measurement of biochemical markers showed that probrain natriuretic peptide (proBNP), initial high sensitivity C reactive protein (hs-CRP), and maximum troponin T level were significantly higher in group 1 than in group 2 (P < 0.05) at 2 months. Based on the trend of greater volume and transmural extent of DE in group 1 compared to group 2, non-contrast CCT immediately after PCI, in combination with serologic biomarkers (proBNP, hs-CRP, and troponin T) might be useful for managing patients with AMI.
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Affiliation(s)
- Khulan Khurelsukh
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebongro, Dong-Gu, Gwangju, 61469, South Korea
| | - Yun-Hyeon Kim
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebongro, Dong-Gu, Gwangju, 61469, South Korea.
| | - Hyun Ju Seon
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebongro, Dong-Gu, Gwangju, 61469, South Korea
| | - Jang Hyun Song
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebongro, Dong-Gu, Gwangju, 61469, South Korea
| | - Seo Yeon Park
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebongro, Dong-Gu, Gwangju, 61469, South Korea
| | - Sung Min Moon
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebongro, Dong-Gu, Gwangju, 61469, South Korea
| | - Soo Hyun Kim
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebongro, Dong-Gu, Gwangju, 61469, South Korea
| | - Doo Sun Sim
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
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Regional infarction identification from cardiac CT images: a computer-aided biomechanical approach. Int J Comput Assist Radiol Surg 2016; 11:1573-83. [PMID: 27072840 DOI: 10.1007/s11548-016-1404-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 03/24/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Regional infarction identification is important for heart disease diagnosis and management, and myocardial deformation has been shown to be effective for this purpose. Although tagged and strain-encoded MR images can provide such measurements, they are uncommon in clinical routine. On the contrary, cardiac CT images are more available with lower costs, but they only provide motion of cardiac boundaries and additional constraints are required to obtain the myocardial strains. The goal of this study is to verify the potential of contrast-enhanced CT images on computer-aided regional infarction identification. METHODS We propose a biomechanical approach combined with machine learning algorithms. A hyperelastic biomechanical model is used with deformable image registration to estimate 3D myocardial strains from CT images. The regional strains and CT image intensities are input to a classifier for regional infarction identification. Cross-validations on ten canine image sequences with artificially induced infarctions were used to study the performances of using different feature combinations and machine learning algorithms. RESULTS Radial strain, circumferential strain, first principal strain, and image intensity were shown to be discriminative features. The highest identification accuracy ([Formula: see text] %) was achieved when combining radial strain with image intensity. Random forests gave better results than support vector machines on less discriminative features. Random forests also performed better when all strains were used together. CONCLUSION Although CT images cannot directly measure myocardial deformation, with the use of a biomechanical model, the estimated strains can provide promising identification results especially when combined with CT image intensity.
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Estimating coronary blood flow using CT transluminal attenuation flow encoding: Formulation, preclinical validation, and clinical feasibility. J Cardiovasc Comput Tomogr 2015; 9:559-66.e1. [DOI: 10.1016/j.jcct.2015.03.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 03/03/2015] [Accepted: 03/30/2015] [Indexed: 11/18/2022]
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Watabe H, Sato A, Nishina H, Hoshi T, Sugano A, Kakefuda Y, Takaiwa Y, Aihara H, Fumikura Y, Noguchi Y, Aonuma K. Enhancement patterns detected by multidetector computed tomography are associated with microvascular obstruction and left ventricular remodelling in patients with acute myocardial infarction. Eur Heart J 2015; 37:684-92. [PMID: 26385959 DOI: 10.1093/eurheartj/ehv467] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 08/20/2015] [Indexed: 12/22/2022] Open
Abstract
AIMS This study evaluated the clinical value of myocardial contrast-delayed enhancement (DE) with multidetector computed tomography (MDCT) for detecting microvascular obstruction (MVO) and left ventricular (LV) remodelling revealed by DE magnetic resonance imaging after acute myocardial infarction (AMI). METHODS AND RESULTS In 92 patients with first AMI, MDCT without iodine reinjection was performed immediately following successful percutaneous coronary intervention (PCI). Delayed-enhancement magnetic resonance imaging performed in the acute and chronic phases was used to detect MVO and LV remodelling (any increase in LV end-systolic volume at 6 months after infarction compared with baseline). Patients were divided into two groups according to the presence (n = 33) or absence (n = 59) of heterogeneous enhancement (HE). Heterogeneous enhancement was defined as concomitant presence of hyper- and hypoenhancement within the infarcted myocardium on MDCT. Microvascular obstruction and LV remodelling were detected in 49 (53%) and 29 (32%) patients, respectively. In a multivariable analysis, HE and a relative CT density >2.20 were significant independent predictors for MVO [odds ratio (OR) 13.5; 95% confidence interval (CI), 2.15-84.9; P = 0.005 and OR 12.0; 95% CI, 2.94-49.2; P < 0.001, respectively). The presence of HE and relative CT density >2.20 showed a high positive predictive value of 93%, and the absence of these two findings yielded a high negative predictive value of 90% for the predictive value of MVO. Heterogeneous enhancement was significantly associated with LV remodelling (OR 6.75; 95% CI, 1.56-29.29; P = 0.011). CONCLUSION Heterogeneous enhancement detected by MDCT immediately after primary PCI may provide promising information for predicting MVO and LV remodelling in patients with AMI.
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Affiliation(s)
- Hiroaki Watabe
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Akira Sato
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Hidetaka Nishina
- Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Tomoya Hoshi
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Akinori Sugano
- Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Yuki Kakefuda
- Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Yui Takaiwa
- Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Hideaki Aihara
- Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Yuko Fumikura
- Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Yuichi Noguchi
- Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Kazutaka Aonuma
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
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Imaging in Deciphering Histological Substrates in Hypertrophic Cardiomyopathy. CURRENT CARDIOVASCULAR IMAGING REPORTS 2015. [DOI: 10.1007/s12410-015-9355-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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62
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Diagnostic accuracy of late iodine enhancement on cardiac computed tomography with a denoise filter for the evaluation of myocardial infarction. Int J Cardiovasc Imaging 2015. [DOI: 10.1007/s10554-015-0716-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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63
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Alternative technique using dual source CT imaging for assessment of myocardial perfusion. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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64
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Jang Y, Cho I, Hartaigh BWÓ, Park SI, Hong Y, Shin S, Ha S, Jeon B, Jung H, Shim H, Min JK, Chang HJ, Jang Y, Chung N. Viability assessment after conventional coronary angiography using a novel cardiovascular interventional therapeutic CT system: Comparison with gross morphology in a subacute infarct swine model. J Cardiovasc Comput Tomogr 2015; 9:321-328. [PMID: 26088379 DOI: 10.1016/j.jcct.2015.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 03/30/2015] [Accepted: 04/18/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Given the lack of promptness and inevitable use of additional contrast agents, the myocardial viability imaging procedures have not been used widely for determining the need to performing revascularization. OBJECTIVE This study is aimed to evaluate the feasibility of myocardial viability assessment, consecutively with diagnostic invasive coronary angiography (ICA) without use of additional contrast agent, using a novel hybrid system comprising ICA and multislice CT (MSCT). METHODS In all, 14 Yucatan miniature swine models (female; age, 3 months; weight, 28-30 kg) were subjected to ICA followed by balloon occlusion (90 minutes) and reperfusion of the left anterior descending coronary artery. Two weeks after induction of myocardial infarction, delayed hyperenhancement (DHE) images were obtained, using a novel combined machine comprising ICA and 320-channel MSCT scanner (Aquilion ONE, Toshiba), after 2, 5, 7, 10, 15, and 20 minutes after conventional ICA. The heart was sliced in 10-mm consecutive sections in the short-axis plane and was embedded in a solution of 1% triphenyltetrazolium chloride (TTC). Infarct size was determined as TTC-negative areas as a percentage of total left ventricular area. On MSCT images, infarct size per slice was calculated by dividing the DHE area by the total slice area (%) and compared with histochemical analyses. RESULTS Serial MSCT scans revealed a peak CT attenuation of the infarct area (222.5 ± 36.5 Hounsfield units) with a maximum mean difference in CT attenuation between the infarct areas and normal myocardium of at 2 minutes after contrast injection (106.4; P for difference = 0.002). Furthermore, the percentage difference of infarct size by MSCT vs histopathologic specimen was significantly lower at 2 (8.5% ± 1.8%) and 5 minutes (9.5% ± 1.9%) than those after 7 minutes. Direct comparisons of slice-matched DHE area by MSCT demonstrated excellent correlation with TTC-derived infarct size (r = 0.952; P < .001). Bland-Altman plots of the differences between DHE by MSCT and TTC-derived infarct measurements plotted against their means showed good agreement between the 2 methods. CONCLUSION The feasibility of myocardial viability assessment by DHE using MSCT after conventional ICA was proven in experimental models, and the optimal viability images were obtained after 2 to 5 minutes after the final intracoronary injection of contrast agent for conventional ICA.
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Affiliation(s)
- Yeonggul Jang
- Brain Korea 21 Project for Medical Science, Yonsei University, Seoul, Korea
| | - Iksung Cho
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemungu, Seoul 120-752, Korea
| | - Bríain W Ó Hartaigh
- Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA.,Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, Adler Geriatric Center, New Haven, CT, USA
| | - Se-Il Park
- Cardiovascular Product Evaluation Center, Yonsei University College of Medicine, Seoul, Korea
| | - Youngtaek Hong
- Brain Korea 21 Project for Medical Science, Yonsei University, Seoul, Korea
| | - Sanghoon Shin
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemungu, Seoul 120-752, Korea
| | - Seongmin Ha
- Brain Korea 21 Project for Medical Science, Yonsei University, Seoul, Korea
| | - Byunghwan Jeon
- Brain Korea 21 Project for Medical Science, Yonsei University, Seoul, Korea
| | - Hoyup Jung
- Department of Computer Science and Engineering, Hankuk University of Foreign Studies, Kyonggi, 449-791, Korea
| | - Hackjoon Shim
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - James K Min
- Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Hyuk-Jae Chang
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemungu, Seoul 120-752, Korea.,Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yangsoo Jang
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemungu, Seoul 120-752, Korea
| | - Namsik Chung
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemungu, Seoul 120-752, Korea.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
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Alexanderson-Rosas E, Guinto-Nishimura GY, Cruz-Mendoza JR, Oropeza-Aguilar M, De La Fuente-Mancera JC, Barrero-Mier AF, Monroy-Gonzalez A, Juarez-Orozco LE, Cano-Zarate R, Meave-Gonzalez A. Current and future trends in multimodality imaging of coronary artery disease. Expert Rev Cardiovasc Ther 2015; 13:715-31. [PMID: 25912725 DOI: 10.1586/14779072.2015.1039991] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Nowadays, there is a wide array of imaging studies available for the evaluation of coronary artery disease, each with its particular indications and strengths. Cardiac single photon emission tomography is mostly used to evaluate myocardial perfusion, having experienced recent marked improvements in image acquisition. Cardiac PET has its main utility in perfusion imaging, atherosclerosis and endothelial function evaluation, and viability assessment. Cardiovascular computed tomography has long been used as a reference test for non-invasive evaluation of coronary lesions and anatomic characterization. Cardiovascular magnetic resonance is currently the reference standard for non-invasive ventricular function evaluation and myocardial scarring delineation. These specific strengths have been enhanced with the advent of hybrid equipment, offering a true integration of different imaging modalities into a single, simultaneous and comprehensive study.
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Affiliation(s)
- Erick Alexanderson-Rosas
- Department of Nuclear Cardiology, Instituto Nacional de Cardiología 'Ignacio Chávez', Mexico City, Mexico
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Truong QA, Thai WE, Wai B, Cordaro K, Cheng T, Beaudoin J, Xiong G, Cheung JW, Altman R, Min JK, Singh JP, Barrett CD, Danik S. Myocardial scar imaging by standard single-energy and dual-energy late enhancement CT: Comparison with pathology and electroanatomic map in an experimental chronic infarct porcine model. J Cardiovasc Comput Tomogr 2015; 9:313-20. [PMID: 25977115 DOI: 10.1016/j.jcct.2015.03.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 02/27/2015] [Accepted: 03/16/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Myocardial scar is a substrate for ventricular tachycardia and sudden cardiac death. Late enhancement CT imaging can detect scar, but it remains unclear whether newer late enhancement dual-energy (LE-DECT) acquisition has benefit over standard single-energy late enhancement (LE-CT). OBJECTIVE We aim to compare late enhancement CT using newer LE-DECT acquisition and single-energy LE-CT acquisitions with pathology and electroanatomic map (EAM) in an experimental chronic myocardial infarction (MI) porcine study. METHODS In 8 pigs with chronic myocardial infarction (59 ± 5 kg), we performed dual-source CT, EAM, and pathology. For CT imaging, we performed 3 acquisitions at 10 minutes after contrast administration: LE-CT 80 kV, LE-CT 100 kV, and LE-DECT with 2 postprocessing software settings. RESULTS Of the sequences, LE-CT 100 kV provided the best contrast-to-noise ratio (all P ≤ .03) and correlation to pathology for scar (ρ = 0.88). LE-DECT overestimated scar (both P = .02), whereas LE-CT images did not (both P = .08). On a segment basis (n = 136), all CT sequences had high specificity (87%-93%) and modest sensitivity (50%-67%), with LE-CT 100 kV having the highest specificity of 93% for scar detection compared to pathology and agreement with EAM (κ = 0.69). CONCLUSIONS Standard single-energy LE-CT, particularly 100 kV, matched better to pathology and EAM than dual-energy LE-DECT for scar detection. Larger human trials as well as more technical studies that optimize varying different energies with newer hardware and software are warranted.
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Affiliation(s)
- Quynh A Truong
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and the New York-Presbyterian Hospital, 413 E. 69th Street, Suite 108, New York, NY 10021, USA; Division of Cardiology, Weill Cornell Medical College and the New York-Presbyterian Hospital, New York, NY, USA.
| | - Wai-Ee Thai
- Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Bryan Wai
- Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kevin Cordaro
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Teresa Cheng
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jonathan Beaudoin
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Guanglei Xiong
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and the New York-Presbyterian Hospital, 413 E. 69th Street, Suite 108, New York, NY 10021, USA
| | - Jim W Cheung
- Division of Cardiology, Weill Cornell Medical College and the New York-Presbyterian Hospital, New York, NY, USA
| | - Robert Altman
- Al-Sabah Arrhythmia Institute, Mount Sinai St. Luke's-Roosevelt Hospital Center, New York, NY, USA
| | - James K Min
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and the New York-Presbyterian Hospital, 413 E. 69th Street, Suite 108, New York, NY 10021, USA; Division of Cardiology, Weill Cornell Medical College and the New York-Presbyterian Hospital, New York, NY, USA
| | - Jagmeet P Singh
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Conor D Barrett
- Al-Sabah Arrhythmia Institute, Mount Sinai St. Luke's-Roosevelt Hospital Center, New York, NY, USA
| | - Stephan Danik
- Al-Sabah Arrhythmia Institute, Mount Sinai St. Luke's-Roosevelt Hospital Center, New York, NY, USA
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Abstract
Cardiac multidetector computed tomography (MDCT) has become a useful noninvasive modality for anatomical imaging of coronary artery disease (CAD). Currently, the main clinical advantage of coronary computed tomography angiography (CCTA) appears to be related to its high negative predictive value at low or intermediate pretest probability for CAD. With the development of technical aspects of MDCT, clinical practice and research are increasingly shifting toward defining the clinical implication of plaque morphology, myocardial perfusion, and patient outcomes. The presence of positive vessel remodeling, low-attenuation plaques, napkin-ring sign, or spotty calcification on CCTA could be useful information on high-risk vulnerable plaques. The napkin-ring sign, especially, showed higher accuracy for the detection of thin-cap fibroatheroma. Recently, it was reported that cardiac 3D single-photon emission tomography/CT fusion imaging, noninvasive fractional flow reserve computed from CT, and integrated CCTA and CT myocardial perfusion were associated with improved diagnostic accuracy for the detection of hemodynamically significant CAD. Furthermore, several randomized, large clinical trials have evaluated the clinical value of CCTA for chest pain triage in the emergency department or long-term reduction in death, myocardial infarction, or hospitalization for unstable angina. In this review we discuss the role of cardiac MDCT beyond coronary angiography, including a comparison with other currently available imaging modalities used to examine atherosclerotic plaque and myocardial perfusion.
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Affiliation(s)
- Akira Sato
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
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Contrast-Enhanced C-arm Computed Tomography Imaging of Myocardial Infarction in the Interventional Suite. Invest Radiol 2015; 50:384-91. [PMID: 25635589 DOI: 10.1097/rli.0000000000000138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Cardiac C-arm computed tomography (CT) uses a standard C-arm fluoroscopy system rotating around the patient to provide CT-like images during interventional procedures without moving the patient to a conventional CT scanner. We hypothesized that C-arm CT can be used to visualize and quantify the size of perfusion defects and late enhancement resulting from a myocardial infarction (MI) using contrast-enhanced techniques similar to previous CT and magnetic resonance imaging studies. MATERIALS AND METHODS A balloon occlusion followed by reperfusion in a coronary artery was used to study acute and subacute MI in 12 swine. Electrocardiographically gated C-arm CT images were acquired the day of infarct creation (n = 6) or 4 weeks after infarct creation (n = 6). The images were acquired immediately after contrast injection, then at 1 minute, and every 5 minutes up to 30 minutes with no additional contrast. The volume of the infarct as measured on C-arm CT was compared against pathology. RESULTS The volume of acute MI, visualized as a combined region of hyperenhancement with a hypoenhanced core, correlated well with pathologic staining (concordance correlation, 0.89; P < 0.0001; mean [SD] difference, 0.67 [2.98]cm3). The volume of subacute MI, visualized as a region of hyperenhancement, correlated well with pathologic staining at imaging times 5 to 15 minutes after contrast injection (concordance correlation, 0.82; P < 0.001; mean difference, -0.64 [1.94]cm3). CONCLUSIONS C-arm CT visualization of acute and subacute MI is possible in a porcine model, but improvement in the imaging technique is important before clinical use. Visualization of MI in the catheterization laboratory may be possible and could provide 3-dimensional images for guidance during interventional procedures.
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69
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Ling Z, McManigle J, Zipunnikov V, Pashakhanloo F, Khurram IM, Zimmerman SL, Philips B, Marine JE, Spragg DD, Ashikaga H, Calkins H, Nazarian S. The association of left atrial low-voltage regions on electroanatomic mapping with low attenuation regions on cardiac computed tomography perfusion imaging in patients with atrial fibrillation. Heart Rhythm 2015; 12:857-64. [PMID: 25595922 DOI: 10.1016/j.hrthm.2015.01.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Previous studies have shown that contrast-enhanced multidetector computed tomography (CE-MDCT) could identify ventricular fibrosis after myocardial infarction. However, whether CE-MDCT can characterize atrial low-voltage regions remains unknown. OBJECTIVE The purpose of this study was to examine the association of CE-MDCT image attenuation with left atrial (LA) low bipolar voltage regions in patients undergoing repeat ablation for atrial fibrillation recurrence. METHODS We enrolled 20 patients undergoing repeat ablation for atrial fibrillation recurrence. All patients underwent preprocedural 3-dimensional CE-MDCT of the LA, followed by voltage mapping (>100 points) of the LA during the ablation procedure. Epicardial and endocardial contours were manually drawn around LA myocardium on multiplanar CE-MDCT axial images. Segmented 3-dimensional images of the LA myocardium were reconstructed. Electroanatomic map points were retrospectively registered to the corresponding CE-MDCT images. RESULTS A total of 2028 electroanatomic map points obtained in sinus rhythm from the LA endocardium were registered to the segmented LA wall CE-MDCT images. In a linear mixed model, each unit increase in the local image attenuation ratio was associated with 25.2% increase in log bipolar voltage (P = .046) after adjusting for age, sex, body mass index, and LA volume, as well as clustering of data by patient and LA regions. CONCLUSION We demonstrate that the image attenuation ratio derived from CE-MDCT is associated with LA bipolar voltage. The potential ability to image fibrosis via CE-MDCT may provide a useful alternative in patients with contraindications to magnetic resonance imaging.
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Affiliation(s)
- Zhiyu Ling
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; Department of Medicine/Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - John McManigle
- Department of Medicine/Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Vadim Zipunnikov
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Irfan M Khurram
- Department of Medicine/Cardiology, Johns Hopkins University, Baltimore, Maryland
| | | | - Binu Philips
- Department of Medicine/Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Joseph E Marine
- Department of Medicine/Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - David D Spragg
- Department of Medicine/Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Hiroshi Ashikaga
- Department of Medicine/Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Hugh Calkins
- Department of Medicine/Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Saman Nazarian
- Department of Medicine/Cardiology, Johns Hopkins University, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland.
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Pattanayak P, Bleumke DA. Tissue characterization of the myocardium: state of the art characterization by magnetic resonance and computed tomography imaging. Radiol Clin North Am 2014; 53:413-23. [PMID: 25727003 DOI: 10.1016/j.rcl.2014.11.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Late gadolinium enhancement (LGE) is a simple, robust, well-validated method for assessing scar in acute and chronic myocardial infarction. LGE is useful for distinguishing between ischemic and nonischemic cardiomyopathy. Specific LGE patterns are seen in nonischemic cardiomyopathy. Patient studies using T1 mapping have varied in study, design, and acquisition sequences. Despite the differences in technique, a clear pattern that has been seen is that in cardiac disease postcontrast T1 times are shorter. Extracellular volume fraction measured with cardiac computed tomography represents a new approach to the clinical assessment of diffuse myocardial fibrosis by evaluating the distribution of iodinated contrast.
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Affiliation(s)
- Puskar Pattanayak
- Laboratory of Diagnostic Radiology Research, National Institutes of Health, 10 Center Drive, Bethesda, MD 20814, USA
| | - David A Bleumke
- Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD 20814, USA.
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Udholm S, Laugesen S, Agger P, Hønge J, Smerup M, Udholm N, Bøtker HE, Bøttcher M. Delayed uptake and washout of contrast in non-viable infarcted myocardium shown with dynamic computed tomography. Cardiovasc Diagn Ther 2014; 4:350-6. [PMID: 25414821 DOI: 10.3978/j.issn.2223-3652.2014.09.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 09/12/2014] [Indexed: 01/27/2023]
Abstract
BACKGROUND Assessment of ischemic but potentially viable myocardium plays an important role in the planning of coronary revascularization. Until now SPECT, PET, and MRI have been used to identify viable myocardium. Computed tomography (CT) is increasingly used to diagnose coronary atherosclerosis. OBJECTIVE To evaluate the feasibility of CT enhancement as a viability marker by investigating myocardial contrast distribution over time in pigs with experimentally induced antero-septal myocardial infarctions. METHODS Twelve pigs were subjected to 60 min of balloon occlusion of the left anterior descending artery, followed by removal of the balloon and reperfusion. Four pigs died due to refractory ventricular fibrillation. After 6 weeks, dynamic cardiac CT was performed assessing both wall motion and contrast attenuation. Measurements of attenuation values in Hounsfield units (HU) in the infarct zone and the normal lateral wall were performed at 20 s, and 1, 3, 5, 8 and 12 min after contrast injection. RESULTS We found highly significant differences in attenuation values between the two zones at all-time points except t =1 min (ANOVA P=0.85). The normal myocardium showed higher uptake- and washout-rates of contrast than the infarct zone (84±15 vs. 58±8 at 20 s, P=0.0001 and 27±12 vs. 81±13 at 12 min, P=0.0001). Specifically, the ratio between early (20 s) and late (12 min) uptake is a valid marker of viable myocardium. In all animals this ration was above one in the normal zone and below one in the infarct zone. CONCLUSIONS Delayed infarct related uptake and washout of contrast shows promise for future clinical application of CT in a combined assessment of coronary atherosclerosis and myocardial viability.
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Affiliation(s)
- Sebastian Udholm
- 1 Department of Cardiothoracic & Vascular Surgery T, 2 Department of Cardiology, Cardiac Imaging Center, Aarhus University Hospital, DK-8200 Aarhus N, Denmark ; 3 Cardiac Imaging Center, Hospital Unit West, Denmark
| | - Sofie Laugesen
- 1 Department of Cardiothoracic & Vascular Surgery T, 2 Department of Cardiology, Cardiac Imaging Center, Aarhus University Hospital, DK-8200 Aarhus N, Denmark ; 3 Cardiac Imaging Center, Hospital Unit West, Denmark
| | - Peter Agger
- 1 Department of Cardiothoracic & Vascular Surgery T, 2 Department of Cardiology, Cardiac Imaging Center, Aarhus University Hospital, DK-8200 Aarhus N, Denmark ; 3 Cardiac Imaging Center, Hospital Unit West, Denmark
| | - Jesper Hønge
- 1 Department of Cardiothoracic & Vascular Surgery T, 2 Department of Cardiology, Cardiac Imaging Center, Aarhus University Hospital, DK-8200 Aarhus N, Denmark ; 3 Cardiac Imaging Center, Hospital Unit West, Denmark
| | - Morten Smerup
- 1 Department of Cardiothoracic & Vascular Surgery T, 2 Department of Cardiology, Cardiac Imaging Center, Aarhus University Hospital, DK-8200 Aarhus N, Denmark ; 3 Cardiac Imaging Center, Hospital Unit West, Denmark
| | - Nichlas Udholm
- 1 Department of Cardiothoracic & Vascular Surgery T, 2 Department of Cardiology, Cardiac Imaging Center, Aarhus University Hospital, DK-8200 Aarhus N, Denmark ; 3 Cardiac Imaging Center, Hospital Unit West, Denmark
| | - Hans Erik Bøtker
- 1 Department of Cardiothoracic & Vascular Surgery T, 2 Department of Cardiology, Cardiac Imaging Center, Aarhus University Hospital, DK-8200 Aarhus N, Denmark ; 3 Cardiac Imaging Center, Hospital Unit West, Denmark
| | - Morten Bøttcher
- 1 Department of Cardiothoracic & Vascular Surgery T, 2 Department of Cardiology, Cardiac Imaging Center, Aarhus University Hospital, DK-8200 Aarhus N, Denmark ; 3 Cardiac Imaging Center, Hospital Unit West, Denmark
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Zhao L, Ma X, Ge H, Zhang C, Wang Z, Teraoka K, Fan Z. Diagnostic performance of computed tomography for detection of concomitant coronary disease in hypertrophic cardiomyopathy. Eur Radiol 2014; 25:767-75. [DOI: 10.1007/s00330-014-3465-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 08/04/2014] [Accepted: 10/07/2014] [Indexed: 11/28/2022]
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Langer C, Both M, Harders H, Lutz M, Eden M, Kühl C, Sattler B, Jansen O, Schaefer P, Frey N. Late enhanced computed tomography in Hypertrophic Cardiomyopathy enables accurate left-ventricular volumetry. Eur Radiol 2014; 25:575-84. [PMID: 25316053 DOI: 10.1007/s00330-014-3434-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 08/22/2014] [Accepted: 09/04/2014] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Late enhancement (LE) multi-slice computed tomography (leMDCT) was introduced for the visualization of (intra-) myocardial fibrosis in Hypertrophic Cardiomyopathy (HCM). LE is associated with adverse cardiac events. This analysis focuses on leMDCT derived LV muscle mass (LV-MM) which may be related to LE resulting in LE proportion for potential risk stratification in HCM. METHODS N=26 HCM-patients underwent leMDCT (64-slice-CT) and cardiovascular magnetic resonance (CMR). In leMDCT iodine contrast (Iopromid, 350 mg/mL; 150mL) was injected 7 minutes before imaging. Reconstructed short cardiac axis views served for planimetry. The study group was divided into three groups of varying LV-contrast. LeMDCT was correlated with CMR. RESULTS The mean age was 64.2 ± 14 years. The groups of varying contrast differed in weight and body mass index (p < 0.05). In the group with good LV-contrast assessment of LV-MM resulted in 147.4 ± 64.8 g in leMDCT vs. 147.1 ± 65.9 in CMR (p > 0.05). In the group with sufficient contrast LV-MM appeared with 172 ± 30.8 g in leMDCT vs. 165.9 ± 37.8 in CMR (p > 0.05). Overall intra-/inter-observer variability of semiautomatic assessment of LV-MM showed an accuracy of 0.9 ± 8.6 g and 0.8 ± 9.2 g in leMDCT. All leMDCT-measures correlated well with CMR (r > 0.9). CONCLUSIONS LeMDCT primarily performed for LE-visualization in HCM allows for accurate LV-volumetry including LV-MM in > 90% of the cases. KEY POINTS • LeMDCT of relatively low contrast allows for LV planimetry in HCM. • The correlation of leMDCT-based LV volumetry with gold-standard CMR was excellent (r > 0.9). • LeMDCT requires approximately 2.0mL/kgBW of dye to achieve acceptable contrast.
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Affiliation(s)
- Christoph Langer
- Department of Cardiology, Angiology and Critical Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Christian-Albrechts-Universität Kiel, Schittenhelmstr. 12, 24105, Kiel, Germany,
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Quantification of myocardial delayed enhancement and wall thickness in hypertrophic cardiomyopathy: Multidetector computed tomography versus magnetic resonance imaging. Eur J Radiol 2014; 83:1778-85. [DOI: 10.1016/j.ejrad.2014.05.035] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 05/23/2014] [Accepted: 05/27/2014] [Indexed: 11/18/2022]
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Jablonowski R, Wilson MW, Do L, Hetts SW, Saeed M. Multidetector CT measurement of myocardial extracellular volume in acute patchy and contiguous infarction: validation with microscopic measurement. Radiology 2014; 274:370-8. [PMID: 25247406 DOI: 10.1148/radiol.14140131] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To provide proof of concept that expansion of myocardial extracellular volume (MECV), measured at contrast material-enhanced multidetector computed tomography (CT), can be used as a (a) marker for viability based on histologic confirmation and (b) predictor of severity of myocardial injury. MATERIALS AND METHODS Animals cared for in compliance with Institutional Animal Care and Use Committee served as controls (group 1, n = 6) or were subjected to microinfarction by using 16-mm(3) (60 000 count) microemboli (group 2) and 32-mm(3) (120 000 count) microemboli (group 3), contiguous infarct with left anterior descending artery (LAD) occlusion followed by reperfusion (group 4), or the combination of LAD occlusion and 32-mm(3) microemboli followed by reperfusion (group 5) (n = 7 per group). MECV calculations were based on regional measurements of signal attenuation at contrast-enhanced multidetector CT and counterstaining of infarct at microscopy. Two-way analysis of variance and Student t tests were used to determine significant differences (P < .05). Data were presented as means ± standard deviations. RESULTS Mean signal attenuation at equilibrium state of contrast media distribution (10 minutes) was significantly different among blood (137 HU ± 10), myocardial muscle (77 HU ± 12, P < .05), and skeletal muscle (35 HU ± 12, P < .05). Patchy microinfarct, contiguous infarct, and microinfarct with preexisting contiguous infarct can be differentiated on the basis of mean MECV (24% ± 3 [group 1] vs 36% ± 3 [group 2], P < .01, and 55% ± 5 [group 4], 56% ± 4 [group 5] vs 41% ± 3 [group 3], P < .05). Microscopy measurements confirmed multidetector CT quantitative measurements and differences in patterns of infarct caused by obstruction of major and minor coronary arteries. Regression analysis revealed excellent correlation between regional MECV using multidetector CT and microscopy (r(2) = 0.92). CONCLUSION Contrast-enhanced multidetector CT is a suitable noninvasive imaging technique for assessing MECV in acute patchy and contiguous infarct caused by obstruction of major and minor coronary vessels.
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Affiliation(s)
- Robert Jablonowski
- From the Department of Radiology and Biomedical Imaging, School of Medicine, University of California-San Francisco, 185 Berry St, Suite 350, Campus Box 0946, San Francisco, CA 94107-5705
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Abstract
Learning objectives: =To understand the use of cardiovascular imaging for diagnosis, evaluation of prognosis and for supporting treatment decisions and monitoring therapy in patients with dilated cardiomyopathy by providing morphologic, functional and etiologic information, including refined assessment of ventricular function. =To provide to the clinical cardiologist the information on what to expect from each imaging modality and how to work together with the cardiovascular imaging expert to fully explore the potential of complementary imaging techniques. = To provide a look into the future role of new imaging modalities such as molecular imaging.
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Affiliation(s)
- João Silva Marques
- Department of Cardiology, University Hospital Santa Maria, Lisbon Academic Medical Centre, CCUL, University of Lisbon, Lisbon, Portugal
| | - Fausto J Pinto
- Department of Cardiology, University Hospital Santa Maria, Lisbon Academic Medical Centre, CCUL, University of Lisbon, Lisbon, Portugal
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77
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Diagnostic accuracy of late iodine-enhancement dual-energy computed tomography for the detection of chronic myocardial infarction compared with late gadolinium-enhancement 3-T magnetic resonance imaging. Invest Radiol 2014; 48:851-6. [PMID: 23907104 DOI: 10.1097/rli.0b013e31829d91a8] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The purpose of the study was to compare the performance of late iodine-enhancement (LIE) dual-energy computed tomography (DECT) linear blending and selective myocardial iodine mapping for the detection of chronic myocardial infarction (CMI) with late gadolinium-enhancement (LGE) 3-T magnetic resonance imaging. MATERIALS AND METHODS This study was approved by the institutional review board, and the patients gave informed consent. A total of 20 patients with a history of CMI underwent cardiac LIE-DECT and LGE-MRI. Images of the LIE-DECT were reconstructed as 100 kilovolt (peak) (kV[p]), 140 kV(p), and weighted-average (WA; linear blending) images from low- and high-kilovoltage peak data using 3 different weighting factors (0.8, 0.6, 0.3). Additional color-coded myocardial iodine distribution maps were calculated. The images were reviewed for the presence of late enhancement, transmural extent, signal characteristics, infarct volume, and subjective image quality. RESULTS Segmental analysis of LIE-DECT data from 100 kV(p), WA of 0.8, and WA of 0.6 showed identical results for the identification of CMI (89% sensitivity, 98% specificity, 96% accuracy) and correctly identified all segments with transmural scarring detected through LGE-MRI. Weighted average of 0.6 received the best subjective image quality rating (15/20 votes) and average measured infarct size correlated best with LGE-MRI (5.7% difference). In comparison with LGE-MRI, iodine distribution maps were susceptible to false-positive and false-negative findings (52% sensitivity, 88% specificity, 81% accuracy), overestimating quantity of transmural scars by 78% while underestimating infarct volume by 55%. CONCLUSIONS Late iodine enhancement cardiac dual-energy computed tomography correlates well with LGE-MRI for detecting CMI, whereas iodine distribution analysis provides inferior accuracy. Linear blending further improves image quality and enables more precise estimation of scar volume.
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Qu X, Fang W, Gong K, Ye J, Guan S, Li R, Xu Y, Shen Y, Zhang M, Liu H, Xie W. Clinical significance of a single multi-slice CT assessment in patients with coronary chronic total occlusion lesions prior to revascularization. PLoS One 2014; 9:e98242. [PMID: 24905494 PMCID: PMC4048204 DOI: 10.1371/journal.pone.0098242] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 04/29/2014] [Indexed: 11/18/2022] Open
Abstract
Accurate assessment of coronary chronic total occlusion (CTO) lesion is essential to design an appropriate procedural strategy before revascularization. The present study aims to evaluate the significance of a single multislice computed tomography (MSCT) examination in patients with CTO lesion. We retrospectively analyzed the clinical data of 23 CTO lesions in twenty patients underwent computed tomography coronary angiography (CTCA) and SPECT. The CTCA was more powerful and sensitive to determine the CTO lesion length (100% v.s 47.8%) and to identify the length and location of calcification in occluded vessels compared with the coronary angiography (CAG). The LVEF measured by MSCT was comparable to that from the gated SPECT. Myocardial perfusion imaging showed that the location of the early defect region identified by MSCT was corresponded to the nuclide filling defect on the stressed 201thallium-SPECT imaging. The late hyperenhancement on MSCT was presented as incomplete nuclide filling on the 99mTc-MIBI imaging. The results suggested that a single MSCT examination in previous myocardial infarction without revascularization facilitates to provide some valuable information on the nature of the occluded lesion, myocardial perfusion and globe cardiac function, which would be helpful to design appropriate revascularization strategy in these subjects.
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Affiliation(s)
- Xinkai Qu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Weiyi Fang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
- * E-mail:
| | - Kaizheng Gong
- Department of Cardiology, The Second Clinical Medical School of Yangzhou University, Jiangsu Province, China
| | - Jianding Ye
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Shaofeng Guan
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ruogu Li
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yingjia Xu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Shen
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Min Zhang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hua Liu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Wenhui Xie
- Department of Nuclear medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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Abstract
Magnetic resonance (MR) imaging plays an important role in evaluation of various aspects of myocardial infarction (MI). MR imaging is useful in establishing the diagnosis of acute MI, particularly in patients who present with symptoms of MI but outside the diagnostic time frame of altered cardiac enzyme levels or with clinical features of acute MI but without an angiographic culprit lesion. MR imaging is valuable in establishing a diagnosis of chronic MI and distinguishing this condition from nonischemic cardiomyopathies, mainly through use of delayed-enhancement patterns. MR imaging also provides clinicians with several prognostic indicators that enable risk stratification, such as scar burden, microvascular obstruction, hemorrhage, and peri-infarct ischemia. The extent and transmurality of scar burden have been shown to have independent and incremental prognostic power over a range of left ventricular function. The extent of scarring at MR imaging is an important predictor of successful outcome after revascularization procedures, and extensive scarring in the lateral wall indicates poor outcome after cardiac resynchronization therapy. Scar size at MR imaging is also a useful surrogate end point in clinical trials. Finally, MR imaging can be used to detect complications of MI, such as aneurysms, pericarditis, ventricular septal defect, thrombus, and mitral regurgitation. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.335125722/-/DC1.
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Affiliation(s)
- Prabhakar Rajiah
- Cardiothoracic Imaging Section, University Hospitals of Cleveland, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Lancellotti P, Nkomo VT, Badano LP, Bergler-Klein J, Bogaert J, Davin L, Cosyns B, Coucke P, Dulgheru R, Edvardsen T, Gaemperli O, Galderisi M, Griffin B, Heidenreich PA, Nieman K, Plana JC, Port SC, Scherrer-Crosbie M, Schwartz RG, Sebag IA, Voigt JU, Wann S, Yang PC. Expert consensus for multi-modality imaging evaluation of cardiovascular complications of radiotherapy in adults: a report from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging 2014; 14:721-40. [PMID: 23847385 DOI: 10.1093/ehjci/jet123] [Citation(s) in RCA: 210] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Cardiac toxicity is one of the most concerning side effects of anti-cancer therapy. The gain in life expectancy obtained with anti-cancer therapy can be compromised by increased morbidity and mortality associated with its cardiac complications. While radiosensitivity of the heart was initially recognized only in the early 1970s, the heart is regarded in the current era as one of the most critical dose-limiting organs in radiotherapy. Several clinical studies have identified adverse clinical consequences of radiation-induced heart disease (RIHD) on the outcome of long-term cancer survivors. A comprehensive review of potential cardiac complications related to radiotherapy is warranted. An evidence-based review of several imaging approaches used to detect, evaluate, and monitor RIHD is discussed. Recommendations for the early identification and monitoring of cardiovascular complications of radiotherapy by cardiac imaging are also proposed.
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Affiliation(s)
- Patrizio Lancellotti
- Department of Cardiology, GIGA Cardiovascular Sciences, Heart Valve Clinic, University of Liège Hospital, CHU du Sart-Tilman, Liège 4000, Belgium.
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81
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Wichmann JL, Arbaciauskaite R, Kerl JM, Frellesen C, Bodelle B, Lehnert T, Monsefi N, Vogl TJ, Bauer RW. Evaluation of monoenergetic late iodine enhancement dual-energy computed tomography for imaging of chronic myocardial infarction. Eur Radiol 2014; 24:1211-8. [DOI: 10.1007/s00330-014-3126-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 02/06/2014] [Accepted: 02/12/2014] [Indexed: 11/30/2022]
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82
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Suncion VY, Ghersin E, Fishman JE, Zambrano JP, Karantalis V, Mandel N, Nelson KH, Gerstenblith G, DiFede Velazquez DL, Breton E, Sitammagari K, Schulman IH, Taldone SN, Williams AR, Sanina C, Johnston PV, Brinker J, Altman P, Mushtaq M, Trachtenberg B, Mendizabal AM, Tracy M, Da Silva J, McNiece IK, Lardo AC, George RT, Hare JM, Heldman AW. Does transendocardial injection of mesenchymal stem cells improve myocardial function locally or globally?: An analysis from the Percutaneous Stem Cell Injection Delivery Effects on Neomyogenesis (POSEIDON) randomized trial. Circ Res 2014; 114:1292-301. [PMID: 24449819 DOI: 10.1161/circresaha.114.302854] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
RATIONALE Transendocardial stem cell injection (TESI) with mesenchymal stem cells improves remodeling in chronic ischemic cardiomyopathy, but the effect of the injection site remains unknown. OBJECTIVE To address whether TESI exerts its effects at the site of injection only or also in remote areas, we hypothesized that segmental myocardial scar and segmental ejection fraction improve to a greater extent in injected than in noninjected segments. METHODS AND RESULTS Biplane ventriculographic and endocardial tracings were recorded. TESI was guided to 10 sites in infarct-border zones. Sites were mapped according to the 17-myocardial segment model. As a result, 510 segments were analyzed in 30 patients before and 13 months after TESI. Segmental early enhancement defect (a measure of scar size) was reduced by TESI in both injected (-43.7 ± 4.4%; n=95; P<0.01) and noninjected segments (-25.1 ± 7.8%; n=148; P<0.001; between-group comparison P<0.05). Conversely, segmental ejection fraction (a measure of contractile performance) improved in injected scar segments (19.9 ± 3.3-26.3 ± 3.5%; P=0.003) but not in noninjected scar segments (21.3 ± 2.6-23.5 ± 3.2%; P=0.20; between-group comparison P<0.05). Furthermore, segmental ejection fraction in injected scar segments improved to a greater degree in patients with baseline segmental ejection fraction <20% (12.1 ± 1.2-19.9 ± 2.7%; n=18; P=0.003), versus <20% (31.7 ± 3.4-35.5 ± 3.3%; n=12; P=0.33, between-group comparison P<0.0001). CONCLUSIONS These findings illustrate a dichotomy in regional responses to TESI. Although scar size reduction was evident in all scar segments, scar size reduction and ventricular functional responses preferentially occurred at the sites of TESI versus non-TESI sites. Furthermore, improvement was greatest when segmental left ventricular dysfunction was severe.
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Affiliation(s)
- Viky Y Suncion
- From The Interdisciplinary Stem Cell Institute (V.Y.S., J.P.Z., V.K., N.M., D.L.D.V., K.S., I.H.S., S.N.T., A.R.W., C.S., J.D.S., I.K.M., J.M.H., A.W.H.), Departments of Medicine (J.P.Z., K.H.N., I.H.S., M.M., B.T., M.T., J.M.H., A.W.H.), and Radiology (E.G., J.E.F.), University of Miami Miller School of Medicine, FL; Cardiovascular Division, The Johns Hopkins University School of Medicine, Baltimore, MD (G.G., E.B., P.V.J., J.B., A.C.L., R.T.G.); Division of Cell Therapy, EMMES Corporation, Rockville, MD (A.M.M.); and Biocardia Inc, San Carlos, CA (P.A.). I.K.M is currently affiliated with the Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, TX. J.P.Z. is currently affiliated with Jackson South Community Hospital, Miami, FL. M.T. is currently affiliated with Rush University Medical Center, Chicago, IL
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83
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van Werkhoven JM, Schuijf JD, Bax JJ. Myocardial perfusion imaging to assess ischemia using multislice computed tomography. Expert Rev Cardiovasc Ther 2014; 7:49-56. [DOI: 10.1586/14779072.7.1.49] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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84
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Weininger M, Renker M, Rowe GW, Abro JA, Costello P, Schoepf UJ. Integrative computed tomographic imaging of coronary artery disease. Expert Rev Cardiovasc Ther 2014; 9:27-43. [DOI: 10.1586/erc.10.166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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85
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Lancellotti P, Nkomo VT, Badano LP, Bergler-Klein J, Bergler J, Bogaert J, Davin L, Cosyns B, Coucke P, Dulgheru R, Edvardsen T, Gaemperli O, Galderisi M, Griffin B, Heidenreich PA, Nieman K, Plana JC, Port SC, Scherrer-Crosbie M, Schwartz RG, Sebag IA, Voigt JU, Wann S, Yang PC. Expert consensus for multi-modality imaging evaluation of cardiovascular complications of radiotherapy in adults: a report from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. J Am Soc Echocardiogr 2013; 26:1013-32. [PMID: 23998694 DOI: 10.1016/j.echo.2013.07.005] [Citation(s) in RCA: 162] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Cardiac toxicity is one of the most concerning side effects of anti-cancer therapy. The gain in life expectancy obtained with anti-cancer therapy can be compromised by increased morbidity and mortality associated with its cardiac complications. While radiosensitivity of the heart was initially recognized only in the early 1970s, the heart is regarded in the current era as one of the most critical dose-limiting organs in radiotherapy. Several clinical studies have identified adverse clinical consequences of radiation-induced heart disease (RIHD) on the outcome of long-term cancer survivors. A comprehensive review of potential cardiac complications related to radiotherapy is warranted. An evidence-based review of several imaging approaches used to detect, evaluate, and monitor RIHD is discussed. Recommendations for the early identification and monitoring of cardiovascular complications of radiotherapy by cardiac imaging are also proposed.
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Affiliation(s)
- Patrizio Lancellotti
- Department of Cardiology, GIGA Cardiovascular Sciences, Heart Valve Clinic, University of Liège Hospital, CHU du Sart-Tilman, Liège 4000, Belgium.
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86
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Moy AJ, Lo PC, Choi B. High-resolution visualization of mouse cardiac microvasculature using optical histology. BIOMEDICAL OPTICS EXPRESS 2013; 5:69-77. [PMID: 24466477 PMCID: PMC3891346 DOI: 10.1364/boe.5.000069] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 10/04/2013] [Accepted: 11/15/2013] [Indexed: 05/09/2023]
Abstract
Cardiovascular disease typically is associated with dysfunction of the coronary vasculature and microvasculature. The study of cardiovascular disease typically involves imaging of the large coronary vessels and quantification of cardiac blood perfusion. These methods, however, are not well suited for imaging of the cardiac microvasculature. We used the optical histology method, which combines chemical optical clearing and optical imaging, to create high-resolution, wide-field maps of the cardiac microvasculature in ventral slices of mouse heart. We have demonstrated the ability of the optical histology method to enable wide-field visualization of the cardiac microvasculature in high-resolution and anticipate that optical histology may have significant impact in studying cardiovascular disease.
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87
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Schwarz F, Hinkel R, Baloch E, Marcus RP, Hildebrandt K, Sandner TA, Kupatt C, Hoffmann V, Wintersperger BJ, Reiser MF, Theisen D, Nikolaou K, Bamberg F. Myocardial CT perfusion imaging in a large animal model: comparison of dynamic versus single-phase acquisitions. JACC Cardiovasc Imaging 2013; 6:1229-38. [PMID: 24269264 DOI: 10.1016/j.jcmg.2013.05.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 05/02/2013] [Accepted: 05/23/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study sought to compare dynamic versus single-phase high-pitch computed tomography (CT) acquisitions for the assessment of myocardial perfusion in a porcine model with adjustable degrees of coronary stenosis. BACKGROUND The incremental value of the 2 different approaches to CT-based myocardial perfusion imaging remains unclear. METHODS Country pigs received stent implantation in the left anterior descending coronary artery, in which an adjustable narrowing (50% and 75% stenoses) was created using a balloon catheter. All animals underwent CT-based rest and adenosine-stress myocardial perfusion imaging using dynamic and single-phase high-pitch acquisitions at both degrees of stenosis. Fluorescent microspheres served as a reference standard for myocardial blood flow. Segmental CT-based myocardial blood flow (MBFCT) was derived from dynamic acquisitions. Segmental single-phase enhancement (SPE) was recorded from high-pitch, single-phase examinations. MBFCT and SPE were compared between post-stenotic and reference segments, and receiver-operating characteristic curve analysis was performed. RESULTS Among 6 animals (28 ± 2 kg), there were significant differences of MBFCT and SPE between post-stenotic and reference segments for all acquisitions at 75% stenosis. By contrast, although for 50% stenosis at rest, MBFCT was lower in post-stenotic than in reference segments (0.65 ± 0.10 ml/g/min vs. 0.75 ± 0.16 ml/g/min, p < 0.05), there was no difference for SPE (128 ± 27 Hounsfield units vs. 137 ± 35 Hounsfield units, p = 0.17), which also did not significantly change under adenosine stress. In receiver-operating characteristic curve analyses, segmental MBFCT showed significantly better performance for ischemia prediction at 75% stenosis and stress (area under the curve: 0.99 vs. 0.89, p < 0.05) as well as for 50% stenosis, regardless of adenosine administration (area under the curve: 0.74 vs. 0.57 and 0.88 vs. 0.61, respectively, both p < 0.05). CONCLUSIONS At higher degrees of coronary stenosis, both MBFCT and SPE permit an accurate prediction of segmental myocardial hypoperfusion. However, accuracy of MBFCT is higher than that of SPE at 50% stenosis and can be increased by adenosine stress at both degrees of stenosis.
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Affiliation(s)
- Florian Schwarz
- Department of Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany
| | - Rabea Hinkel
- Department of Cardiology, Ludwig-Maximilians-University, Munich, Germany
| | - Elisabeth Baloch
- Department of Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany
| | - Roy P Marcus
- Department of Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany
| | - Kristof Hildebrandt
- Department of Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany
| | - Torleif A Sandner
- Department of Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany
| | - Christian Kupatt
- Department of Cardiology, Ludwig-Maximilians-University, Munich, Germany
| | - Verena Hoffmann
- Department of Biostatistics, Ludwig-Maximilians-University, Munich, Germany
| | - Bernd J Wintersperger
- Department of Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany; Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Maximilian F Reiser
- Department of Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany; DZHK (German Center for Cardiovascular Research) and Munich Heart Alliance, Munich, Germany
| | - Daniel Theisen
- Department of Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany; DZHK (German Center for Cardiovascular Research) and Munich Heart Alliance, Munich, Germany
| | - Konstantin Nikolaou
- Department of Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany; DZHK (German Center for Cardiovascular Research) and Munich Heart Alliance, Munich, Germany
| | - Fabian Bamberg
- Department of Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany; DZHK (German Center for Cardiovascular Research) and Munich Heart Alliance, Munich, Germany.
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Abstract
Left ventricular (LV) dysfunction caused by ischemia secondary to coronary artery disease results not only from cardiac myocyte death but also from stunning and hibernation, which are potentially reversible phenomena. Myocardial viability testing is often used in patients with ischemic cardiomyopathy to predict recovery of contractile function after revascularization. Although several observational studies have supported the use of viability testing, the Surgical Treatment for Ischemic Heart failure (STICH) viability substudy challenged its role in clinical decision-making, as viability testing in this study did not predict differential outcomes based on treatment type, and there was a trend toward increased survival in patients with no viability who underwent revascularization. However, the results of the STICH trial have caused controversy because of limitations in study design and implementation. Randomized controlled trials using high-resolution modalities such as positron emission tomography or delayed hyperenhancement cardiac magnetic resonance are needed to determine the incremental benefits that revascularization may afford based on myocardial viability.
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89
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Assessment of microembolization associated with revascularization in acute myocardial infarction: MDCT cardiac perfusion and function study. Int J Cardiovasc Imaging 2013; 29:1861-9. [DOI: 10.1007/s10554-013-0273-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 08/03/2013] [Indexed: 11/25/2022]
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90
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Qu XK, Fang WY, Ye JD, Guan SF, Li RG, Xu YJ, Shen Y, Zhang M, Liu H. Utility of 64-MSCT in assessing acute non-reperfused myocardial infarct size. J Geriatr Cardiol 2013; 10:247-52. [PMID: 24133512 PMCID: PMC3796698 DOI: 10.3969/j.issn.1671-5411.2013.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Revised: 06/16/2013] [Accepted: 08/24/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate the utility of multi-slice computed tomography (MSCT) in assessing acute non-reperfused myocardial infarct size. METHODS Seven domestic pigs (mean weight 17.3 ± 1.9 kg) underwent ligation of the distal left anterior descending artery to establish a model of acute myocardial infarction (MI). MSCT and triphenyltetrazolium chloride (TTC) staining were performed two hours later. The following data were acquired and analyzed: MI volume (%), CT values of the infarcted region, left ventricular cavity and normal cardiac tissue at various scanning time-points (1, 5, 10, 15, 20 min after contrast injection). RESULTS Using MSCT, the overall MI volume showed a time-dependent decrease, with a reduction of 28.87% after 20 min. The greatest reduction occurred at the 5 min time-point. In TTC staining, MI volume was 9.87% ± 2.44%. When MI size, as determined by MSCT, was compared with that by TTC staining in Bland-Altman plots, there was a better agreement at 5, 10, and 15 min time-points at 1 and 20 min. CONCLUSIONS The study indicates that double-phase scanning examination using MSCT is a useful tool to assess MI size, and the optimal late-phase scanning time-point set within 5-15 min of contrast injection.
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Affiliation(s)
- Xin-Kai Qu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
| | - Wei-Yi Fang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
| | - Jian-Ding Ye
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
| | - Shao-Feng Guan
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
| | - Ruo-Gu Li
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
| | - Ying-Jia Xu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
| | - Yan Shen
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
| | - Min Zhang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
| | - Hua Liu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
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91
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Dwivedi G, Al-Shehri H, deKemp RA, Ali I, Alghamdi AA, Klein R, Scullion A, Ruddy TD, Beanlands RS, Chow BJ. Scar imaging using multislice computed tomography versus metabolic imaging by F-18 FDG positron emission tomography: A pilot study. Int J Cardiol 2013; 168:739-45. [DOI: 10.1016/j.ijcard.2012.09.218] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 09/24/2012] [Accepted: 09/29/2012] [Indexed: 11/26/2022]
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92
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Srichai MB, Chandarana H, Donnino R, Lim IIP, Leidecker C, Babb J, Jacobs JE. Diagnostic accuracy of cardiac computed tomography angiography for myocardial infarction. World J Radiol 2013; 5:295-303. [PMID: 24003355 PMCID: PMC3758497 DOI: 10.4329/wjr.v5.i8.295] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 06/13/2013] [Accepted: 07/18/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate diagnostic accuracy of high, low and mixed voltage dual energy computed tomography (DECT) for detection of prior myocardial infarction (MI).
METHODS: Twenty-four consecutive patients (88% male, mean age 65 ± 11 years old) with clinically documented prior MI (> 6 mo) were prospectively recruited to undergo late phase DECT for characterization of their MI. Computed tomography (CT) examinations were performed using a dual source CT system (64-slice Definition or 128-slice Definition FLASH, Siemens Healthcare) with initial first pass and 10 min late phase image acquisitions. Using the 17-segment model, regional systolic function was analyzed using first pass CT as normal or abnormal (hypokinetic, akinetic, dyskinetic). Regions with abnormal systolic function were identified as infarct segments. Late phase DE scans were reconstructed into: 140 kVp, 100 kVp, mixed (120 kVp) images and iodine-only datasets. Using the same 17-segment model, each dataset was evaluated for possible (grade 2) or definite (grade 3) late phase myocardial enhancement abnormalities. Logistic regression for correlated data was used to compare reconstructions in terms of the accuracy for detecting infarct segments using late myocardial hyperenhancement scores.
RESULTS: All patients reported prior history of documented myocardial infarction, with most occurring more than 5 years prior (n = 18; 75% of cohort). Fifty-five of 408 (13%) segments demonstrated abnormal wall motion and were classified as infarct. The remaining 353 segments were classified as non-infarcted segments. A total of 1692 segments were analyzed for late phase enhancement abnormalities, with 91 (5.5%) segments not interpretable due to artifact. Combined grades 2 and 3 compared to grade 3 only enhancement abnormalities demonstrated significantly higher sensitivity and similar specificity for detection of infarct segments for all reconstructions evaluated. Evaluation of different voltage acquisitions demonstrated the highest diagnostic performance for the 100 kVp reconstruction which had higher diagnostic accuracy (87%; 95%CI: 80%-90%), sensitivity (86%-93%; 95%CI: 54%-78%) and specificity (90%; 95%CI: 86%-93%) compared to the other reconstructions. For sensitivity, there were significant differences noted between 100 kVp vs 140 kVp (P < 0.0005), 100 kVp vs mixed (P < 0.0001), and 100 kVp vs iodine only (P < 0.005) using combined grade 2 and grade 3 perfusion abnormalities. For specificity, there were significant differences noted between 100 kVp vs 140 kVp (P < 0.005), and 100 kVp vs mixed (P < 0.01) using combined grades 2 and 3 perfusion abnormalities.
CONCLUSION: Low voltage acquisition CT, 100 kVp in this study, demonstrates superior diagnostic performance when compared to higher and mixed voltage acquisitions for detection of prior MI.
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93
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Bengel FM, George RT, Schuleri KH, Lardo AC, Wollert KC. Image-guided therapies for myocardial repair: concepts and practical implementation. Eur Heart J Cardiovasc Imaging 2013; 14:741-51. [PMID: 23720377 DOI: 10.1093/ehjci/jet038] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Cell- and molecule-based therapeutic strategies to support wound healing and regeneration after myocardial infarction (MI) are under development. These emerging therapies aim at sustained preservation of ventricular function by enhancing tissue repair after myocardial ischaemia and reperfusion. Such therapies will benefit from guidance with regard to timing, regional targeting, suitable candidate selection, and effectiveness monitoring. Such guidance is effectively obtained by non-invasive tomographic imaging. Infarct size, tissue characteristics, muscle mass, and chamber geometry can be determined by magnetic resonance imaging and computed tomography. Radionuclide imaging can be used for the tracking of therapeutic agents and for the interrogation of molecular mechanisms such as inflammation, angiogenesis, and extracellular matrix activation. This review article portrays the hypothesis that an integrated approach with an early implementation of structural and molecular tomographic imaging in the development of novel therapies will provide a framework for achieving the goal of improved tissue repair after MI.
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Affiliation(s)
- Frank M Bengel
- Department of Nuclear Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany.
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94
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Shiozaki AA, Senra T, Arteaga E, Martinelli Filho M, Pita CG, Ávila LFR, Parga Filho JR, Mady C, Kalil-Filho R, Bluemke DA, Rochitte CE. Myocardial fibrosis detected by cardiac CT predicts ventricular fibrillation/ventricular tachycardia events in patients with hypertrophic cardiomyopathy. J Cardiovasc Comput Tomogr 2013; 7:173-81. [PMID: 23849490 DOI: 10.1016/j.jcct.2013.04.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 04/21/2013] [Accepted: 04/23/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Myocardial fibrosis (MF) occurs in up to 80% of subjects with asymptomatic or mildly symptomatic hypertrophic cardiomyopathy (HCM) and can constitute an arrhythmogenic substrate for re-entrant, life-threatening ventricular arrhythmias in predisposed persons. OBJECTIVE The aim was to investigate whether MF detected by delayed enhancement cardiac CT is predictive of ventricular tachycardia (VT) and fibrillation (VF) that require appropriate therapy by an implantable cardioverter defibrillator (ICD) in patients with HCM. METHODS Twenty-six patients with HCM with previously (for at least 1 year) implanted ICD underwent MF evaluation by cardiac CT. MF was quantified by myocardial delayed enhanced cardiac CT. Data on ICD firing were recorded every 3 months after ICD implantation. Risk factors for sudden cardiac death in patients with HCM were evaluated in all patients. RESULTS MF was present in 25 of 26 patients (96%) with mean fibrosis mass of 20.5 ± 15.8 g. Patients with appropriate ICD shocks for VF/VT had significantly greater MF mass than patients without (29.10 ± 19.13 g vs 13.57 ± 8.31 g; P = .01). For a MF mass of at least 18 g, sensitivity and specificity for appropriate ICD firing were 73% (95% CI, 49%-88%) and 71% (95% CI, 56%-81%), respectively. Kaplan-Meier curves indicated a significantly greater VF/VT event rate in patients with MF mass ≥18 g than in patients with MF <18 g (P = .02). In the Cox regression analysis, the amount of MF was independently associated with VF/VT in ICD-stored electrograms. CONCLUSION The mass of MF detected by cardiac CT in patients with HCM at high risk of sudden death was associated with appropriate ICD firings.
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Affiliation(s)
- Afonso Akio Shiozaki
- Cardiovascular Magnetic Resonance and Computed Tomography Sector, Heart Institute, InCor, University of São Paulo Medical School, São Paulo, Brazil
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Amanieu C, Sanchez I, Arion S, Bonnefoy E, Revel D, Douek P, Boussel L. Acute myocardial infarction: early CT aspects of myocardial microcirculation obstruction after percutaneous coronary intervention. Eur Radiol 2013; 23:2405-12. [PMID: 23652846 DOI: 10.1007/s00330-013-2853-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 02/28/2013] [Accepted: 03/01/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the capabilities of delayed enhanced multidetector CT (DE-MDCT), performed immediately after percutaneous coronary intervention (PCI), in predicting myocardial microvascular obstruction (MVO) formation assessed by delayed enhanced MRI (DE-MRI). METHODS Thirty-two patients presenting with a primary acute myocardial infarction, successfully recanalised by PCI, underwent a DE-MDCT immediately after PCI and a DE-MRI within 1 week. The left ventricle was split into 64 subsegments, rated as "healthy", "infarcted" or "MVO" on DE-MRI. Their mean density was measured on DE-MDCT and calculated relative to the patient's mean healthy myocardium density. Hypoenhanced DE-MDCT subsegments, termed "CT early MVO", were also recorded. Sensitivity and specificity of DE-MDCT for MRI-assessed "MVO" subsegments detection was calculated for mean CT relative density (threshold determined from a ROC analysis), "CT early MVO" and both. RESULTS Mean CT relative density was higher in MRI-assessed "MVO" than in "infarcted" and "healthy" subsegments (1.82 ± 0.46, 1.43 ± 0.36 and 1.0 ± 0.13 respectively; P < 0.001) leading to a sensitivity and specificity of 94.3 % and 89.2 % for a cutoff of 1.36. Sensitivity and specificity were respectively 16.9 % and 99.8 % for "CT early MVO" and 95.3 % and 89.3 % when considering the two patterns. CONCLUSION DE-MDCT, performed immediately after PCI, allows for an accurate prediction of MVO formation. KEY POINTS • Myocardial microvascular obstruction (MVO) is an important prognostic sequel following myocardial infarction. • MVO can be accurately predicted by multidector CT (MDCT). • Both hypo- and hyperenhanced myocardial areas can be analysed by MDCT. • MDCT may become a useful prognostic tool for acute MI outcome.
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Affiliation(s)
- Charles Amanieu
- Department of Radiology, Louis Pradel Hospital, CREATIS, CNRS UMR 5220, INSERM U1044, Lyon, France
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96
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Ruggieri VG, Haigron P, Wang Q, Esneault S, Madeleine R, Heautot JF, Leguerrier A, Verhoye JP. CT-scan images preprocessing and segmentation to improve bioprosthesis leaflets morphological analysis. Med Hypotheses 2013; 81:86-93. [PMID: 23618610 DOI: 10.1016/j.mehy.2013.03.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 02/25/2013] [Accepted: 03/24/2013] [Indexed: 11/24/2022]
Abstract
The visualization of bioprosthesis leaflet morphology might help to better understand the underlying mechanism of dysfunction in degenerated aortic bioprosthesis. Because today such visualization of bioprosthesis leaflet morphology is intricate to impossible with other imaging techniques, we hypothesized that the processing of multi-detector CT images would allow better visualization of the prosthetic valve leaflets after biological aortic valve replacement. The purpose of our study was to prospectively evaluate patients with a degenerated aortic bioprosthesis, waiting for reoperation, by using 64-slice CT to evaluate prosthetic leaflets morphology. A semi-automatic segmentation of pre-operative tomodensitometric images was conducted, using 2 different implementations of the region growing algorithm. Here we report all segmentation steps (selection of the region of interest, filtering, segmentation). Studied degenerated aortic bioprostheses were represented by two Carpentier-Edwards Supra Annular Valve (porcine leaflets), one Edwards Perimount (pericardial leaflets) and one Medtronic Mosaic (porcine leaflets). Both segmentation methods (Isotropic Region Growing and Stick Region Growing) allowed a semi-automatic segmentation with 3D reconstruction of all bioprosthetic components (stent, leaflets, degeneration/calcifications). Explanted bioprosthesis CT images were also processed and used as reference. Segmentation results were compared by means of quantitative criteria. Semi-automatic segmentation using region growing algorithm seems to provide an interesting approach for the morphological characterization of degenerated aortic bioprostheses. We believe that in the next future CT scan images segmentation may play an important role to better understand the mechanism of dysfunction in failing aortic bioprostheses. Moreover, bioprostheses 3D reconstructions could be integrated into preoperative planning tools to optimize valve-in-valve procedure.
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Affiliation(s)
- V G Ruggieri
- Department of Cardiovascular and Thoracic Surgery, University Hospital, INSERM U1099 Rennes University, Rennes, France.
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97
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Peng J, Zhang LJ, Schoepf UJ, Gibbs KP, Ji HS, Yang GF, Zhu H, Lu GM. Acute myocardial infarct detection with dual energy CT: correlation with single photon emission computed tomography myocardial scintigraphy in a canine model. Acta Radiol 2013; 54:259-66. [PMID: 23543148 DOI: 10.1258/ar.2012.120104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Dual-energy CT (DECT) has been used to detect myocardial infarct. However, few comparable studies with histopathological findings as gold standard have been published. PURPOSE To investigate the accuracy of DECT iodine maps for detecting acute myocardial infarction compared with single photon emission computed tomography (SPECT) in a canine model using histopathological findings as the reference standard. MATERIAL AND METHODS A model of myocardial ischemia was created by ligating the left anterior descending (LAD) coronary artery after thoracotomy in six dogs, while another three dogs undergoing thoracotomy without LAD ligature served as a control group. Contrast-enhanced DECT scans of the heart were performed, followed by resting 99mTc-MIBI SPECT myocardial perfusion imaging in all nine dogs before and 3 h after the procedure. Triphenyltetrazolium chloride (TTC) staining was performed and analyzed. In the short axis of the left ventricle, the wall surface was divided into 17 segments, which were assessed for infarcted myocardium on conventional CT from average-weighted data, DECT myocardial iodine maps, conventional CT plus DECT, SPECT, and histopathology. Inter-observer and inter-modality agreement for conventional CT, DECT myocardial iodine maps, and SPECT were calculated. CT value of infracted and non-infracted areas was measured. RESULTS With the histopathological results as the reference standard, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 75.0% (30/40), 92.0% (104/113), 76.9% (30/39), 91.2% (104/114), 87.6% (134/153) for conventional CT, 85.0% (34/40), 84.1% (95/113), 65.4% (34/52), 94.1% (95/101), 84.3% (129/153) for DECT myocardial iodine maps; 87.5% (35/40), 92.9% (105/113), 81.4% (35/43), 95.5% (105/110), 91.5% (140/153) for conventional CT plus DECT; 82.5% (33/40), 90.3% (102/113), 75.0% (33/44), and 93.6% (102/109), 88.2% (135/153) for SPECT, respectively. Excellent inter-observer agreement (Kappa value >0.8) and good inter-modality agreement (Kappa value >0.6) for each modality were found. CT values of infarcted myocardium (26 ± 22 HU, 36 ± 33 HU, 34 ± 16 HU) were lower than those of non-infarcted myocardium (115 ± 16 HU, 121 ± 28 HU, 123 ± 11 HU) on images of 140 kVp, 80 kVp, and average-weighted 120 kVp images (all P < 0.05). CONCLUSION With histopathology as the reference standard, DECT myocardial iodine maps can detect acute myocardial infarction with diagnostic accuracy comparable to resting SPECT myocardial perfusion imaging in a canine model. DECT plus conventional CT had a potential to improve the detection of acute myocardial infarction.
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Affiliation(s)
- Jin Peng
- Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu, China
- Department of Medical Imaging, Chenggong Hospital, Xiamen University, Xiamen, Fujian, China
| | - Long Jiang Zhang
- Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu, China
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Kevin P Gibbs
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Heng Shan Ji
- Department of Nuclear Medicine, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu, China
| | - Gui Fen Yang
- Department of Nuclear Medicine, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu, China
| | - Hong Zhu
- Department of Nuclear Medicine, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu, China
| | - Guang Ming Lu
- Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu, China
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Daubert JC, Saxon L, Adamson PB, Auricchio A, Berger RD, Beshai JF, Breithard O, Brignole M, Cleland J, DeLurgio DB, Dickstein K, Exner DV, Gold M, Grimm RA, Hayes DL, Israel C, Leclercq C, Linde C, Lindenfeld J, Merkely B, Mont L, Murgatroyd F, Prinzen F, Saba SF, Shinbane JS, Singh J, Tang AS, Vardas PE, Wilkoff BL, Zamorano JL, Anand I, Blomström-Lundqvist C, Boehmer JP, Calkins H, Cazeau S, Delgado V, Estes NAM, Haines D, Kusumoto F, Leyva P, Ruschitzka F, Stevenson LW, Torp-Pedersen CT. 2012 EHRA/HRS expert consensus statement on cardiac resynchronization therapy in heart failure: implant and follow-up recommendations and management. Europace 2013; 14:1236-86. [PMID: 22930717 DOI: 10.1093/europace/eus222] [Citation(s) in RCA: 201] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Ruggieri V, Wang Q, Esneault S, Madeleine R, Luo L, Leguerrier A, Verhoye JP, Haigron P. Analysis of degenerated aortic valve bioprosthesis by segmentation of preoperative CT images. Ing Rech Biomed 2012. [DOI: 10.1016/j.irbm.2012.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kakouros N, Rybicki FJ, Mitsouras D, Miller JM. Coronary pressure-derived fractional flow reserve in the assessment of coronary artery stenoses. Eur Radiol 2012. [PMID: 23179519 DOI: 10.1007/s00330-012-2670-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Catheter-based angiography is the reference-standard to establish coronary anatomy. While routinely employed clinically, lumen assessment correlates poorly with physiological measures of ischaemia. Moreover, functional studies to identify and localise ischaemia before elective angiography are often not available. This article reviews fractional flow reserve (FFR) and its role in guiding patient management for patients with a potentially haemodynamic significant coronary lesion. METHODS This review discusses the theory, evidence, indications, and limitations of FFR. Also included are emerging non-invasive imaging FFR surrogates currently under evaluation for accuracy with respect to standard FFR. RESULTS Coronary pressure-derived fractional flow reserve (FFR) rapidly assesses the haemodynamic significance of individual coronary artery lesions and can readily be performed in the catheterisation laboratory. The use of FFR has been shown to effectively guide coronary revascularization procedures leading to improved patient outcomes. CONCLUSIONS FFR is an invaluable modality in guiding coronary disease treatment decisions. It is safe, cost-effective and leads to improved patient outcomes. Non-invasive imaging modalities to assess the physiologic significance of CAD are currently being developed and evaluated.
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Affiliation(s)
- Nikolaos Kakouros
- Division of Cardiology, Johns Hopkins Hospital and Johns Hopkins University, 600 N. Wolfe Street, Blalock 536, Baltimore, MD 21287, USA
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