1
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Krebs-Demmer L, Ronit A, Sigvardsen PE, Lebech AM, Gerstoft J, Knudsen AD, Fuchs A, Kühl JT, Nordestgaard BG, Kofoed KF, Nielsen SD. Cardiac chamber volumes and left ventricular mass in people living with HIV and matched uninfected controls. HIV Med 2020; 21:625-634. [PMID: 32902086 DOI: 10.1111/hiv.12916] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES People living with HIV (PLWH) have increased risk of cardiovascular diseases compared with uninfected populations. We assessed structural cardiac abnormalities and their associated risk factors in well-treated PLWH and uninfected controls using multidetector computed tomography (MDCT). METHODS People living with HIV and age- and sex-matched uninfected controls underwent MDCT to determine left atrial volume (LAV), left ventricular diastolic volume (LVDV), right ventricular diastolic volume (RVDV) and left ventricular mass (LVM). All outcomes were indexed to body surface area (BSA) (LAVi, LVDVi, RVDVi and LVMi). RESULTS A total of 592 PLWH and 1184 uninfected controls were included in the study. PLWH had smaller mean (SD) LAVi [40 (8) vs. 41 (9) mL/m2 ; P = 0.002] and LVDVi [61 (13) vs. 65 (14) mL/m2 ; P < 0.001] but larger RVDVi [89 (18) vs. 86 (17) mL/m2 ; P < 0.001] than uninfected controls. HIV was independently associated with 7 mL (95% CI: -10 to -3) smaller LVDV, and with 12 mL (95% CI: 8-16) larger RVDV, and 4 g (95% CI: 1-6) larger LVM after adjustment for cardiovascular risk factors and BSA. Large RVDV in PLWH was not associated with obstructive lung function. CONCLUSIONS HIV was independently associated with smaller LVDV and larger RVDV and LVM. Alterations in cardiac chamber volumes in PLWH were mainly minor. The clinical impact of these findings is uncertain, but it seems unlikely that alterations in cardiac chamber volumes explain the increased burden of cardiovascular disease previously observed in PLWH.
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Affiliation(s)
- L Krebs-Demmer
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - A Ronit
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - P E Sigvardsen
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - A-M Lebech
- Department of Infectious Diseases, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - J Gerstoft
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - A D Knudsen
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - A Fuchs
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - J T Kühl
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - B G Nordestgaard
- The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - K F Kofoed
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Radiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - S D Nielsen
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Sami SM, Elfawal SK, Abdelgawad MS, Zidan MA, Zaki AM, Mowaki AF. MDCT in the study of left ventricular function compared with MRI in patients with myocardial ischemia. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2017.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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3
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Huang M, Wei R, Wang Y, Su T, Li Q, Yang X, Chen X. Protective effect of glucagon-like peptide-1 agents on reperfusion injury for acute myocardial infarction: a meta-analysis of randomized controlled trials. Ann Med 2017; 49:552-561. [PMID: 28286967 DOI: 10.1080/07853890.2017.1306653] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND The cardioprotective properties of glucagon-like peptide-1 (GLP-1) receptor agonists in acute myocardial infarction (AMI) patients against reperfusion injury remain unclear. We performed a meta-analysis to assess their role in the acute phase of AMI. METHODS AND RESULTS Randomized controlled trials (RCTs) comparing GLP-1 agents with placebo in AMI patients undergoing percutaneous coronary intervention were identified by searching PubMed, Embase and Cochrane libraries. Six RCTs with 800 patients were included in the meta-analysis. Compared with placebo, GLP-1 agents improved left ventricular ejection fraction (LVEF) by 2.46 [95% confidence interval (CI): 0.23-4.70%] and reduced the infarct size in grams as well as in percentage of the area at risk [weighted mean difference (WMD) - 5.29, 95% CI: -10.39 to -0.19; WMD -0.08, 95% CI: -0.12 to -0.04, respectively]. The incidence of cardiovascular events appeared to be lower with GLP-1 therapy, but the statistical significance was not reached [relative risk (RR): 0.78; 95% CI: 0.58-1.06]. In terms of safety evaluation, GLP-1 treatment increased the risk of gastrointestinal adverse events (RR: 5.50, 95% CI: 2.85-10.60). CONCLUSIONS Our analysis shows that in patients with AMI undergoing PCI, GLP-1 treatment is associated with improved LVEF and reduced infarct size.
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Affiliation(s)
- Mengjie Huang
- a Department of Nephrology , Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research , Beijing , P.R. China
| | - Ribao Wei
- a Department of Nephrology , Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research , Beijing , P.R. China
| | - Yang Wang
- a Department of Nephrology , Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research , Beijing , P.R. China
| | - Tingyu Su
- a Department of Nephrology , Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research , Beijing , P.R. China
| | - Qingping Li
- a Department of Nephrology , Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research , Beijing , P.R. China
| | - Xi Yang
- a Department of Nephrology , Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research , Beijing , P.R. China
| | - Xiangmei Chen
- a Department of Nephrology , Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research , Beijing , P.R. China
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4
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Naoum C, Blanke P, Cavalcante JL, Leipsic J. Cardiac Computed Tomography and Magnetic Resonance Imaging in the Evaluation of Mitral and Tricuspid Valve Disease. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005331. [DOI: 10.1161/circimaging.116.005331] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Transcatheter interventions to treat mitral and tricuspid valve disease are becoming increasingly available because of the growing number of elderly patients with significant comorbidities or high operative risk. Thorough clinical and imaging evaluation in these patients is essential. The latter involves both characterization of the mechanism and severity of valvular disease as well as determining the hemodynamic consequences and extent of ventricular remodeling, which is an important predictor of future outcomes. Moreover, an assessment of the suitability and risk of complications associated with device-specific therapies is also an important component of the preprocedural evaluation in this cohort. Although echocardiography including 2-dimensional and 3-dimensional methods has an important role in the initial assessment and procedural guidance, cross-sectional imaging, including both computed tomographic imagning and cardiac magnetic resonance imaging, is increasingly being integrated into the evaluation of mitral and tricuspid valve disease. In this review, we discuss the role of cross-sectional imaging in mitral and tricuspid valve disease, primarily valvular regurgitation assessment, with an emphasis on the preprocedural evaluation and implications for transcatheter interventions.
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Affiliation(s)
- Christopher Naoum
- From the Department of Cardiology, Concord Hospital, University of Sydney, Australia (C.N.); Department of Radiology and Division of Cardiology, Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, Canada (P.B., J.L.); and Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, PA (J.L.C.)
| | - Philipp Blanke
- From the Department of Cardiology, Concord Hospital, University of Sydney, Australia (C.N.); Department of Radiology and Division of Cardiology, Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, Canada (P.B., J.L.); and Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, PA (J.L.C.)
| | - João L. Cavalcante
- From the Department of Cardiology, Concord Hospital, University of Sydney, Australia (C.N.); Department of Radiology and Division of Cardiology, Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, Canada (P.B., J.L.); and Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, PA (J.L.C.)
| | - Jonathon Leipsic
- From the Department of Cardiology, Concord Hospital, University of Sydney, Australia (C.N.); Department of Radiology and Division of Cardiology, Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, Canada (P.B., J.L.); and Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, PA (J.L.C.)
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5
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Scollan KF, Stieger-Vanegas SM, Sisson DD. Assessment of left ventricular volume and function in healthy dogs by use of one-, two-, and three-dimensional echocardiography versus multidetector computed tomography. Am J Vet Res 2016; 77:1211-1219. [DOI: 10.2460/ajvr.77.11.1211] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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6
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Thériault-Lauzier P, Mylotte D, Dorfmeister M, Spaziano M, Andalib A, Mamane S, Chetrit M, Blanke P, Cecere R, Buithieu J, Martucci G, Tchetche D, Modine T, van Mieghem N, Lange R, Windecker S, Bilodeau L, Leipsic J, Piazza N. Quantitative multi-slice computed tomography assessment of the mitral valvular complex for transcatheter mitral valve interventions part 1: systematic measurement methodology and inter-observer variability. EUROINTERVENTION 2016; 12:e1011-e1020. [DOI: 10.4244/eijy15m11_09] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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7
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Kaniewska M, Schuetz GM, Willun S, Schlattmann P, Dewey M. Noninvasive evaluation of global and regional left ventricular function using computed tomography and magnetic resonance imaging: a meta-analysis. Eur Radiol 2016; 27:1640-1659. [DOI: 10.1007/s00330-016-4513-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 05/02/2016] [Accepted: 07/18/2016] [Indexed: 01/06/2023]
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8
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Cho JY, Sun JS, Sur YK, Park JS, Kang DK. Relationship between left ventricular mass and coronary artery disease in young adults: a single-center study using cardiac computed tomography. Int J Cardiovasc Imaging 2015; 31 Suppl 2:187-96. [DOI: 10.1007/s10554-015-0772-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 09/15/2015] [Indexed: 12/31/2022]
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9
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Kim YJ, Yong HS, Kim SM, Kim JA, Yang DH, Hong YJ. Korean guidelines for the appropriate use of cardiac CT. Korean J Radiol 2015; 16:251-85. [PMID: 25741189 PMCID: PMC4347263 DOI: 10.3348/kjr.2015.16.2.251] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 01/03/2015] [Indexed: 01/07/2023] Open
Abstract
The development of cardiac CT has provided a non-invasive alternative to echocardiography, exercise electrocardiogram, and invasive angiography and cardiac CT continues to develop at an exponential speed even now. The appropriate use of cardiac CT may lead to improvements in the medical performances of physicians and can reduce medical costs which eventually contribute to better public health. However, until now, there has been no guideline regarding the appropriate use of cardiac CT in Korea. We intend to provide guidelines for the appropriate use of cardiac CT in heart diseases based on scientific data. The purpose of this guideline is to assist clinicians and other health professionals in the use of cardiac CT for diagnosis and treatment of heart diseases, especially in patients at high risk or suspected of heart disease.
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Affiliation(s)
- Young Jin Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Hwan Seok Yong
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 152-703, Korea
| | - Sung Mok Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
| | - Jeong A Kim
- Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang 411-706, Korea
| | - Dong Hyun Yang
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Yoo Jin Hong
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea
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Thériault-Lauzier P, Spaziano M, Vaquerizo B, Buithieu J, Martucci G, Piazza N. Computed Tomography for Structural Heart Disease and Interventions. Interv Cardiol 2015; 10:149-154. [PMID: 29588693 DOI: 10.15420/icr.2015.10.03.149] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Transcatheter cardiac interventions are a fast evolving field. The past decade has seen the development of transcatheter aortic valve replacement, transcatheter mitral valve repair and replacement, septal defect closure devices and left atrial appendage closure devices for thromboprophylaxis. More than ever, medical imaging is taking a central role in the care of patients with structural heart disease. In this review article we outline the use of MSCT as a tool for diagnosis of structural heart interventions, as well as patient selection, pre-procedural planning, device sizing and post-procedural assessment. We focus on procedures targeting the aortic valve, the mitral valve, the inter-atrial septum and the left atrial appendage.
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Affiliation(s)
| | - Marco Spaziano
- McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Jean Buithieu
- McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Nicolo Piazza
- McGill University Health Centre, Montreal, Quebec, Canada.,German Heart Centre Munich, Munich, Germany
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11
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Sharma A, Einstein AJ, Vallakati A, Arbab-Zadeh A, Mukherjee D, Lichstein E. Meta-analysis of global left ventricular function comparing multidetector computed tomography with cardiac magnetic resonance imaging. Am J Cardiol 2014; 113:731-8. [PMID: 24355312 DOI: 10.1016/j.amjcard.2013.11.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 11/06/2013] [Accepted: 11/06/2013] [Indexed: 11/17/2022]
Abstract
We compare the diagnostic accuracy of multidetector row computed tomography (MDCT) to cardiac magnetic resonance imaging (CMR) for evaluating global left ventricular function. We systematically searched PubMed, CINAHL, Cochrane CENTRAL, Scopus, and the Web of Science databases for studies published between 1966 to January 2013 that compared left ventricle (LV) volumes, ejection fraction (EF) and LV mass measured by MDCT and CMR. We performed meta-analyses and used random-effects model with inverse variance weighting test to determine the overall bias and limits of agreement of LV end-diastolic volume, end-systolic volume, stroke volume, and EF measured by MDCT and CMR. Furthermore, subgroup analyses were performed to compare 16-slice and 64-slice MDCT with CMR. Two study authors independently reviewed the 90 articles originally identified and selected 27 studies (n = 831) for analysis. Excellent correlation and a linear relation were seen between MDCT and CMR for LV end-diastolic volume (r = 0.93; p <0.001), LV end-systolic volume (r = 0.95; p <0.001), LV stroke volume (r = 0.85; p <0.001), LV ejection fraction (r = 0.93; p <0.001), and LV mass (r = 0.86; p <0.001). Subgroup analyses showed strong positive correlations for both 16- and 64-slice MDCT. In conclusion, although not the first-line test for LV function assessment in most patients, when appropriate, retrospectively gated MDCT provides an accurate and valid assessment of LV function compared with CMR.
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Affiliation(s)
- Abhishek Sharma
- Department of Medicine, Maimonides Medical Center, Brooklyn, New York.
| | - Andrew J Einstein
- Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Ajay Vallakati
- Division of Cardiology, University of Kansas Medical Center, Kansas City, Kansas
| | - Armin Arbab-Zadeh
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Edgar Lichstein
- Department of Medicine, Maimonides Medical Center, Brooklyn, New York
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12
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Guo YK, Yang ZG, Shao H, Deng W, Ning G, Dong ZH. Right ventricular dysfunction and dilatation in patients with mitral regurgitation: Analysis using ECG-gated multidetector row computed tomography. Int J Cardiol 2013; 167:1585-90. [DOI: 10.1016/j.ijcard.2012.04.104] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Revised: 03/29/2012] [Accepted: 04/15/2012] [Indexed: 11/29/2022]
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13
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Greupner J, Zimmermann E, Grohmann A, Dübel HP, Althoff TF, Althoff T, Borges AC, Rutsch W, Schlattmann P, Hamm B, Dewey M. Head-to-head comparison of left ventricular function assessment with 64-row computed tomography, biplane left cineventriculography, and both 2- and 3-dimensional transthoracic echocardiography: comparison with magnetic resonance imaging as the reference standard. J Am Coll Cardiol 2012; 59:1897-907. [PMID: 22595410 DOI: 10.1016/j.jacc.2012.01.046] [Citation(s) in RCA: 134] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 12/27/2011] [Accepted: 01/17/2012] [Indexed: 01/28/2023]
Abstract
OBJECTIVES This study was designed to compare the accuracy of 64-row contrast computed tomography (CT), invasive cineventriculography (CVG), 2-dimensional echocardiography (2D Echo), and 3-dimensional echocardiography (3D Echo) for left ventricular (LV) function assessment with magnetic resonance imaging (MRI). BACKGROUND Cardiac function is an important determinant of therapy and is a major predictor for long-term survival in patients with coronary artery disease. A number of methods are available for assessment of function, but there are limited data on the comparison between these multiple methods in the same patients. METHODS A total of 36 patients prospectively underwent 64-row CT, CVG, 2D Echo, 3D Echo, and MRI (as the reference standard). Global and regional LV wall motion and ejection fraction (EF) were measured. In addition, assessment of interobserver agreement was performed. RESULTS For the global EF, Bland-Altman analysis showed significantly higher agreement between CT and MRI (p < 0.005, 95% confidence interval: ±14.2%) than for CVG (±20.2%) and 3D Echo (±21.2%). Only CVG (59.5 ± 13.9%, p = 0.03) significantly overestimated EF in comparison with MRI (55.6 ± 16.0%). CT showed significantly better agreement for stroke volume than 2D Echo, 3D Echo, and CVG. In comparison with MRI, CVG-but not CT-significantly overestimated the end-diastolic volume (p < 0.001), whereas 2D Echo and 3D Echo significantly underestimated the EDV (p < 0.05). There was no significant difference in diagnostic accuracy (range: 76% to 88%) for regional LV function assessment between the 4 methods when compared with MRI. Interobserver agreement for EF showed high intraclass correlation for 64-row CT, MRI, 2D Echo, and 3D Echo (intraclass correlation coefficient >0.8), whereas agreement was lower for CVG (intraclass correlation coefficient = 0.58). CONCLUSIONS 64-row CT may be more accurate than CVG, 2D Echo, and 3D Echo in comparison with MRI as the reference standard for assessment of global LV function.
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14
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Quantitative assessment of pure aortic valve regurgitation with dual-source CT. Clin Radiol 2012; 67:643-8. [DOI: 10.1016/j.crad.2011.07.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 06/19/2011] [Accepted: 07/05/2011] [Indexed: 11/18/2022]
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Fernandez-Friera L, Garcia-Alvarez A, Guzman G, Garcia MJ. Coronary CT and the coronary calcium score, the future of ED risk stratification? Curr Cardiol Rev 2012; 8:86-97. [PMID: 22708911 PMCID: PMC3406277 DOI: 10.2174/157340312801784989] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 08/17/2011] [Accepted: 09/01/2011] [Indexed: 01/07/2023] Open
Abstract
Accurate and efficient evaluation of acute chest pain remains clinically challenging because traditional diagnostic modalities have many limitations. Recent improvement in non-invasive imaging technologies could potentially improve both diagnostic efficiency and clinical outcomes of patients with acute chest pain while reducing unnecessary hospitalizations. However, there is still controversy regarding much of the evidence for these technologies. This article reviews the role of coronary artery calcium score and the coronary computed tomography in the assessment of individual coronary risk and their usefulness in the emergency department in facilitating appropriate disposition decisions. The evidence base and clinical applications for both techniques are also described, together with cost- effectiveness and radiation exposure considerations.
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Affiliation(s)
- Leticia Fernandez-Friera
- Departamento de Cardiologia, Hospital Universitario Marqués de Valdecilla, Santander. Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid. Spain
| | - Ana Garcia-Alvarez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid. Spain
- Thorax Institute Cardiology Department, Hospital Clinic, Barcelona, Spain
| | - Gabriela Guzman
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid. Spain
- Hospital La Paz, Madrid. Spain
| | - Mario J Garcia
- Montefiore Heart Center-Albert Einstein School of Medicine. New York
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16
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Asferg C, Usinger L, Kristensen TS, Abdulla J. Accuracy of multi-slice computed tomography for measurement of left ventricular ejection fraction compared with cardiac magnetic resonance imaging and two-dimensional transthoracic echocardiography: a systematic review and meta-analysis. Eur J Radiol 2012; 81:e757-62. [PMID: 22381439 DOI: 10.1016/j.ejrad.2012.02.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2011] [Revised: 01/30/2012] [Accepted: 02/02/2012] [Indexed: 01/28/2023]
Abstract
BACKGROUND Multi-slice computed tomography (MSCT) allows non-invasive assessment of the coronary arteries and simultaneously can provide measurement of left ventricular ejection fraction (LVEF). The accuracy of newer MSCT generations (64-slice or more) for assessment of LVEF compared with magnetic resonance imaging (MRI) and two-dimensional transthoracic echocardiography (TTE) has not been evaluated in a meta-analysis. PURPOSE To evaluate, via a systematic literature review and meta-analysis, whether MSCT can assess LVEF with high accuracy compared with MRI and TTE. METHODS Electronic databases and reference lists for relevant published studies were searched. Twenty-seven eligible studies provided mean LVEF% with its standard deviation (SD) measured by MSCT versus MRI and TTE. Meta-analysis of weighted mean difference (WMD) and Bland-Altman method were used to quantify the mean difference and agreement between MSCT compared with MRI and TTE. RESULTS The results of combining 12 studies showed no significant difference in LVEF% between MSCT and MRI with a WMD of -0.11 (-1.48, 1.26, 95% CI), p=0.88. Bland-Altman analysis showed excellent agreement between MSCT and MRI with a bias of 0.0 (-3.7, 3.7 ± 1.96SD) with 95% CI. The results of combining 15 studies showed no significant difference in LVEF between MSCT versus TTE measurements with a WMD of 0.19 (-1.13 to 1.50; 95% CI), p=0.87. Bland-Altman analysis showed excellent agreement between MSCT and TTE with a bias of 0.3 (-4.7, 5.7 ± 1.96SD) with 95% CI. CONCLUSION The newer MSCT generations can provide accurate LVEF measurement compared to MRI and TTE. MSCT represents a valid technique for the combined evaluation of LVEF and coronary artery disease.
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Affiliation(s)
- Camilla Asferg
- Department of Medicine M2, Division of Cardiology, Copenhagen University Hospital, Nordre Ringvej 57, 2600 Glostrup, Denmark.
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Truong QA, Toepker M, Mahabadi AA, Bamberg F, Rogers IS, Blankstein R, Brady TJ, Nagurney JT, Hoffmann U. Relation of left ventricular mass and concentric remodeling to extent of coronary artery disease by computed tomography in patients without left ventricular hypertrophy: ROMICAT study. J Hypertens 2009; 27:2472-82. [PMID: 19696685 PMCID: PMC2875785 DOI: 10.1097/hjh.0b013e328331054a] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Cardiac computed tomography allows for simultaneous assessment of left ventricular mass (LVM) and coronary artery disease (CAD). We aimed to determine whether LVM, LVM index (LVMi), and the left ventricular geometric pattern of concentric remodeling are associated with the extent of CAD in patients without left ventricular hypertrophy. METHODS In 348 patients from the Rule Out Myocardial Infarction Using Computer Assisted Tomography trial, 64-slice computed tomography was performed and LVM measured at end-diastole. We used three LVM indexation criteria to obtain three cohorts: LVM indexed to body surface area by echocardiography (n = 337) and computed tomography criteria (n = 325), and by height (n = 326). The cohorts were subdivided into concentric remodeling and normal geometry. Extent of coronary plaque was classified based on a 17-segment model, treated as a continuous variable, and stratified into three groups: zero segment, one to four segments, and more than four segments. RESULTS Patients with more than four segments of coronary plaque had higher LVM (Delta12.8-15.1 g) and LVMi (Delta4.0-5.5 g/m and Delta2.2 g/m) than those without CAD (all P < or = 0.03). After multivariable adjustment, LVM and LVMi remained independent predictors of extent of coronary plaque, with 0.27-0.29 segments more plaque per 20 g increase of LVM (all P = 0.02), 0.32-0.34 segments more plaque per 10 g/m increase of LVMi (both P = 0.02), and 0.80 segments more plaque per 10 g/m increase of LVMi (P = 0.008). Concentric remodeling patients had 1.1-1.3 segments more plaque than those with normal geometry (all P < or = 0.05). Patients with more than four segments of plaque had two-fold increase in odds (all P < or = 0.05) of having concentric remodeling as compared with those without CAD. CONCLUSION Increased LVM, LVMi, and concentric remodeling are associated with a greater degree of coronary plaque burden in patients without left ventricular hypertrophy. These findings could provide an indication to intensify medical therapy in patients with subclinical CAD and hypertension.
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Affiliation(s)
- Quynh A Truong
- Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
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