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Napoli G, Mushtaq S, Basile P, Carella MC, De Feo D, Latorre MD, Baggiano A, Ciccone MM, Pontone G, Guaricci AI. Beyond Stress Ischemia: Unveiling the Multifaceted Nature of Coronary Vulnerable Plaques Using Cardiac Computed Tomography. J Clin Med 2024; 13:4277. [PMID: 39064316 PMCID: PMC11278082 DOI: 10.3390/jcm13144277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/04/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
Historically, cardiovascular prevention has been predominantly focused on stress-induced ischemia, but recent trials have challenged this paradigm, highlighting the emerging role of vulnerable, non-flow-limiting coronary plaques, leading to a shift towards integrating plaque morphology with functional data into risk prediction models. Coronary computed tomography angiography (CCTA) represents a high-resolution, low-risk, and largely available non-invasive modality for the precise delineation of plaque composition, morphology, and inflammatory activity, further enhancing our ability to stratify high-risk plaque and predict adverse cardiovascular outcomes. Coronary artery calcium (CAC) scoring, derived from CCTA, has emerged as a promising tool for predicting future cardiovascular events in asymptomatic individuals, demonstrating incremental prognostic value beyond traditional cardiovascular risk factors in terms of myocardial infarction, stroke, and all-cause mortality. Additionally, CCTA-derived information on adverse plaque characteristics, geometric characteristics, and hemodynamic forces provides valuable insights into plaque vulnerability and seems promising in guiding revascularization strategies. Additionally, non-invasive assessments of epicardial and pericoronary adipose tissue (PCAT) further refine risk stratification, adding prognostic significance to coronary artery disease (CAD), correlating with plaque development, vulnerability, and rupture. Moreover, CT imaging not only aids in risk stratification but is now emerging as a screening tool able to monitor CAD progression and treatment efficacy over time. Thus, the integration of CAC scoring and PCAT evaluation into risk stratification algorithms, as well as the identification of high-risk plaque morphology and adverse geometric and hemodynamic characteristics, holds promising results for guiding personalized preventive interventions, helping physicians in identifying high-risk individuals earlier, tailoring lifestyle and pharmacological interventions, and improving clinical outcomes in their patients.
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Affiliation(s)
- Gianluigi Napoli
- University Cardiologic Unit, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Polyclinic University Hospital, 70124 Bari, Italy; (G.N.); (P.B.); (M.C.C.); (D.D.F.); (M.D.L.); (M.M.C.)
| | - Saima Mushtaq
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (S.M.); (A.B.); (G.P.)
| | - Paolo Basile
- University Cardiologic Unit, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Polyclinic University Hospital, 70124 Bari, Italy; (G.N.); (P.B.); (M.C.C.); (D.D.F.); (M.D.L.); (M.M.C.)
| | - Maria Cristina Carella
- University Cardiologic Unit, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Polyclinic University Hospital, 70124 Bari, Italy; (G.N.); (P.B.); (M.C.C.); (D.D.F.); (M.D.L.); (M.M.C.)
| | - Daniele De Feo
- University Cardiologic Unit, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Polyclinic University Hospital, 70124 Bari, Italy; (G.N.); (P.B.); (M.C.C.); (D.D.F.); (M.D.L.); (M.M.C.)
| | - Michele Davide Latorre
- University Cardiologic Unit, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Polyclinic University Hospital, 70124 Bari, Italy; (G.N.); (P.B.); (M.C.C.); (D.D.F.); (M.D.L.); (M.M.C.)
| | - Andrea Baggiano
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (S.M.); (A.B.); (G.P.)
| | - Marco Matteo Ciccone
- University Cardiologic Unit, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Polyclinic University Hospital, 70124 Bari, Italy; (G.N.); (P.B.); (M.C.C.); (D.D.F.); (M.D.L.); (M.M.C.)
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (S.M.); (A.B.); (G.P.)
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
| | - Andrea Igoren Guaricci
- University Cardiologic Unit, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Polyclinic University Hospital, 70124 Bari, Italy; (G.N.); (P.B.); (M.C.C.); (D.D.F.); (M.D.L.); (M.M.C.)
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Liu S, Huang L, Gui S, Pang X, Liu J, Li X, Wang Y, He W, Zhang X, Peng L. Optimizing coronary CT angiography quality with motion-compensated reconstruction for second-generation dual-layer spectral detector CT. Eur Radiol 2024:10.1007/s00330-024-10908-z. [PMID: 38987398 DOI: 10.1007/s00330-024-10908-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/25/2024] [Accepted: 05/07/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVES To investigate the effect of motion-compensated reconstruction (MCR) algorithm on improving the image quality of coronary computed tomography angiography (CCTA) using second-generation dual-layer spectral detector computed tomography (DLCT), and to evaluate the influence of heart rate (HR) on the motion-correction efficacy of this algorithm. MATERIALS AND METHODS We retrospectively enrolled 127 patients who underwent CCTA for suspected coronary artery disease using second-generation DLCT. We divided the patients into two subgroups according to their average HR during scanning: the "HR < 75 bpm" group and the "HR ≥ 75 bpm" group. All images were reconstructed by the standard (STD) algorithm and MCR algorithm. Subjective image quality (4-point Likert scale), interpretability, and objective image quality between the STD and MCR in the whole population and within each subgroup were compared. RESULTS MCR showed significantly higher Likert scores and interpretability than STD on the per-segment (3.58 ± 0.69 vs. 2.82 ± 0.93, 98.4% vs. 91.9%), per-vessel (3.12 ± 0.81 vs. 2.12 ± 0.74, 96.3% vs. 78.7%) and per-patient (2.57 ± 0.76 vs. 1.62 ± 0.55, 90.6% vs. 59.1%) levels (all p < 0.001). In the analysis of HR subgroups on a per-vessel basis of interpretability, significant differences were observed only in the right coronary artery in the low HR group, whereas significant differences were noted in three major coronary arteries in the high HR group. For objective image quality assessment, MCR significantly improved the SNR (13.22 ± 4.06 vs. 12.72 ± 4.06) and the contrast-to-noise ratio (15.84 ± 4.82 vs. 15.39 ± 4.38) compared to STD (both p < 0.001). CONCLUSION MCR significantly improves the subjective image quality, interpretability, and objective image quality of CCTA, especially in patients with higher HRs. CLINICAL RELEVANCE STATEMENT The motion-compensated reconstruction algorithm of the second-generation dual-layer spectral detector computed tomography is helpful in improving the image quality of coronary computed tomography angiography in clinical practice, especially in patients with higher heart rates. KEY POINTS Motion artifacts from cardiac movement affect the quality and interpretability of coronary computed tomography angiography (CCTA). This motion-compensated reconstruction (MCR) algorithm significantly improves the image quality of CCTA in clinical practice. Image quality improvement by using MCR was more significant in the high heart rate group.
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Affiliation(s)
- Shengmei Liu
- Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
- Department of Radiology, Sichuan Taikang Hospital, Chengdu, 610041, Sichuan, China
| | - Linyan Huang
- Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Shen Gui
- Department of Clinical Science, Philips Healthcare, Shanghai, China
| | - Xueting Pang
- Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Jing Liu
- Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Xue Li
- Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Yinqiu Wang
- Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Wenzhang He
- Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Xiaodi Zhang
- Department of Clinical Science, Philips Healthcare, Shanghai, China
| | - Liqing Peng
- Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China.
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Lisi C, Moser LJ, Mergen V, Flohr T, Eberhard M, Alkadhi H. Increasing the rate of datasets amenable to CT FFR and quantitative plaque analysis: Value of software for reducing stair-step artifacts demonstrated in photon-counting detector CT. Eur J Radiol Open 2024; 12:100574. [PMID: 38882632 PMCID: PMC11179571 DOI: 10.1016/j.ejro.2024.100574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 05/25/2024] [Accepted: 05/28/2024] [Indexed: 06/18/2024] Open
Abstract
Purpose To determine the value of an algorithm for reducing stair-step artifacts for advanced coronary analyses in sequential mode coronary CT angiography (CCTA). Methods Forty patients undergoing sequential mode photon-counting detector CCTA with at least one stair-step artifact were included. Twenty patients (14 males; mean age 57±17years) with 45 segments showing stair-step artifacts and without atherosclerosis were included for CTFFR analysis. Twenty patients (20 males; mean age 74±13years) with 22 segments showing stair-step artifacts crossing an atherosclerotic plaque were included for quantitative plaque analysis. Artifacts were graded, and CTFFR and quantitative coronary plaque analyses were performed in standard reconstructions and in those reconstructed with a software (entitled ZeeFree) for artifact reduction. Results Stair-step artifacts were significantly reduced in ZeeFree compared to standard reconstructions (p<0.05). In standard reconstructions, CTFFR was not feasible in 3/45 (7 %) segments but was feasible in all ZeeFree reconstructions. In 9/45 (20 %) segments without atherosclerosis, the ZeeFree algorithm led to a change of CTFFR values from pathologic in standard to physiologic values in ZeeFree reconstructions. In one segment (1/22, 5 %), quantitative plaque analysis was not feasible in standard but only in ZeeFree reconstruction. The mean overall plaque volume (111±60 mm3), the calcific (77±47 mm3), fibrotic (31±28 mm3), and lipidic (4±3 mm3) plaque components were higher in standard than in ZeeFree reconstructions (overall 75±50 mm3, p<0.001; calcific 51±42 mm3, p<0.001; fibrotic 22±19 mm3, p<0.05; lipidic 3±3 mm3, p=0.055). Conclusion Despite the lack of reference standard modalities for CTFFR and coronary plaque analysis, initial evidence indicates that an algorithm for reducing stair-step artifacts in sequential mode CCTA increases the rate and quality of datasets amenable to advanced coronary artery analysis, hereby potentially improving patient management.
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Affiliation(s)
- Costanza Lisi
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Lukas J Moser
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Victor Mergen
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thomas Flohr
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Matthias Eberhard
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Hatem Alkadhi
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Gerbasi A, Dagliati A, Albi G, Chiesa M, Andreini D, Baggiano A, Mushtaq S, Pontone G, Bellazzi R, Colombo G. CAD-RADS scoring of coronary CT angiography with Multi-Axis Vision Transformer: A clinically-inspired deep learning pipeline. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 244:107989. [PMID: 38141455 DOI: 10.1016/j.cmpb.2023.107989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 11/10/2023] [Accepted: 12/17/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND AND OBJECTIVE The standard non-invasive imaging technique used to assess the severity and extent of Coronary Artery Disease (CAD) is Coronary Computed Tomography Angiography (CCTA). However, manual grading of each patient's CCTA according to the CAD-Reporting and Data System (CAD-RADS) scoring is time-consuming and operator-dependent, especially in borderline cases. This work proposes a fully automated, and visually explainable, deep learning pipeline to be used as a decision support system for the CAD screening procedure. The pipeline performs two classification tasks: firstly, identifying patients who require further clinical investigations and secondly, classifying patients into subgroups based on the degree of stenosis, according to commonly used CAD-RADS thresholds. METHODS The pipeline pre-processes multiplanar projections of the coronary arteries, extracted from the original CCTAs, and classifies them using a fine-tuned Multi-Axis Vision Transformer architecture. With the aim of emulating the current clinical practice, the model is trained to assign a per-patient score by stacking the bi-dimensional longitudinal cross-sections of the three main coronary arteries along channel dimension. Furthermore, it generates visually interpretable maps to assess the reliability of the predictions. RESULTS When run on a database of 1873 three-channel images of 253 patients collected at the Monzino Cardiology Center in Milan, the pipeline obtained an AUC of 0.87 and 0.93 for the two classification tasks, respectively. CONCLUSION According to our knowledge, this is the first model trained to assign CAD-RADS scores learning solely from patient scores and not requiring finer imaging annotation steps that are not part of the clinical routine.
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Affiliation(s)
- Alessia Gerbasi
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Via Ferrata 5, Pavia, Italy.
| | - Arianna Dagliati
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Via Ferrata 5, Pavia, Italy
| | - Giuseppe Albi
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Via Ferrata 5, Pavia, Italy
| | | | - Daniele Andreini
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Andrea Baggiano
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | - Gianluca Pontone
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Riccardo Bellazzi
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Via Ferrata 5, Pavia, Italy; IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Pavia, Italy
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Degtiarova G, Mikulicic F, Vontobel J, Garefa C, Keller LS, Boehm R, Ciancone D, Gebhard C, Pazhenkottil AP, Kaufmann PA, Buechel RR. Post-hoc motion correction for coronary computed tomography angiography without additional radiation dose - Improved image quality and interpretability for “free”. IMAGING 2022. [DOI: 10.1556/1647.2022.00060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
AbstractObjectiveTo evaluate the impact of a motion-correction (MC) algorithm, applicable post-hoc and not dependent on extended padding, on the image quality and interpretability of coronary computed tomography angiography (CCTA).MethodsNinety consecutive patients undergoing CCTA on a latest-generation 256-slice CT device were prospectively included. CCTA was performed with prospective electrocardiogram-triggering and the shortest possible acquisition window (without padding) at 75% of the R-R-interval. All datasets were reconstructed without and with MC of the coronaries. The latter exploits the minimal padding inherent in cardiac CT scans with this device due to data acquisition also during the short time interval needed for the tube to reach target currents and voltage (“free” multiphase). Two blinded readers independently assessed image quality on a 4-point Likert scale for all segments.ResultsA total of 1,030 coronary segments were evaluated. Application of MC both with automatic and manual coronary centerline tracking resulted in a significant improvement in image quality as compared to the standard reconstruction without MC (mean Likert score 3.67 [3.50;3.81] vs 3.58 [3.40;3.73], P = 0.005, and 3.7 [3.55;3.82] vs 3.58 [3.40;3.73], P < 0.001, respectively). Furthermore, MC significantly reduced the proportion of non-evaluable segments and patients with at least one non-evaluable coronary segment from 2% to as low as 0.3%, and from 14% to as low as 3%. Reduction of motion artifacts was predominantly observed in the right coronary artery.ConclusionsA post-hoc device-specific MC algorithm improves image quality and interpretability of prospectively electrocardiogram-triggered CCTA and reduces the proportion of non-evaluable scans without any additional radiation dose exposure.
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Affiliation(s)
- Ganna Degtiarova
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Zurich, Switzerland
| | - Fran Mikulicic
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Zurich, Switzerland
| | - Jan Vontobel
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Zurich, Switzerland
| | - Chrysoula Garefa
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Zurich, Switzerland
| | - Lukas S. Keller
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Zurich, Switzerland
| | - Reto Boehm
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Zurich, Switzerland
| | - Domenico Ciancone
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Zurich, Switzerland
| | - Catherine Gebhard
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Zurich, Switzerland
| | - Aju P. Pazhenkottil
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Zurich, Switzerland
| | - Philipp A. Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Zurich, Switzerland
| | - Ronny R. Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Zurich, Switzerland
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Argentiero A, Muscogiuri G, Rabbat MG, Martini C, Soldato N, Basile P, Baggiano A, Mushtaq S, Fusini L, Mancini ME, Gaibazzi N, Santobuono VE, Sironi S, Pontone G, Guaricci AI. The Applications of Artificial Intelligence in Cardiovascular Magnetic Resonance-A Comprehensive Review. J Clin Med 2022; 11:jcm11102866. [PMID: 35628992 PMCID: PMC9147423 DOI: 10.3390/jcm11102866] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 12/11/2022] Open
Abstract
Cardiovascular disease remains an integral field on which new research in both the biomedical and technological fields is based, as it remains the leading cause of mortality and morbidity worldwide. However, despite the progress of cardiac imaging techniques, the heart remains a challenging organ to study. Artificial intelligence (AI) has emerged as one of the major innovations in the field of diagnostic imaging, with a dramatic impact on cardiovascular magnetic resonance imaging (CMR). AI will be increasingly present in the medical world, with strong potential for greater diagnostic efficiency and accuracy. Regarding the use of AI in image acquisition and reconstruction, the main role was to reduce the time of image acquisition and analysis, one of the biggest challenges concerning magnetic resonance; moreover, it has been seen to play a role in the automatic correction of artifacts. The use of these techniques in image segmentation has allowed automatic and accurate quantification of the volumes and masses of the left and right ventricles, with occasional need for manual correction. Furthermore, AI can be a useful tool to directly help the clinician in the diagnosis and derivation of prognostic information of cardiovascular diseases. This review addresses the applications and future prospects of AI in CMR imaging, from image acquisition and reconstruction to image segmentation, tissue characterization, diagnostic evaluation, and prognostication.
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Affiliation(s)
- Adriana Argentiero
- University Cardiology Unit, Cardio-Thoracic Department, Policlinic University Hospital, 70121 Bari, Italy; (A.A.); (N.S.); (P.B.); (V.E.S.)
| | - Giuseppe Muscogiuri
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy; (G.M.); (S.S.)
- Department of Radiology, IRCCS Istituto Auxologico Italiano, San Luca Hospital, 20149 Milan, Italy
| | - Mark G. Rabbat
- Division of Cardiology, Loyola University of Chicago, Chicago, IL 60660, USA;
| | - Chiara Martini
- Radiologic Sciences, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy;
| | - Nicolò Soldato
- University Cardiology Unit, Cardio-Thoracic Department, Policlinic University Hospital, 70121 Bari, Italy; (A.A.); (N.S.); (P.B.); (V.E.S.)
| | - Paolo Basile
- University Cardiology Unit, Cardio-Thoracic Department, Policlinic University Hospital, 70121 Bari, Italy; (A.A.); (N.S.); (P.B.); (V.E.S.)
| | - Andrea Baggiano
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (S.M.); (L.F.); (M.E.M.); (G.P.)
| | - Saima Mushtaq
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (S.M.); (L.F.); (M.E.M.); (G.P.)
| | - Laura Fusini
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (S.M.); (L.F.); (M.E.M.); (G.P.)
| | - Maria Elisabetta Mancini
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (S.M.); (L.F.); (M.E.M.); (G.P.)
| | - Nicola Gaibazzi
- Department of Cardiology, Azienda Ospedaliero-Universitaria, 43126 Parma, Italy;
| | - Vincenzo Ezio Santobuono
- University Cardiology Unit, Cardio-Thoracic Department, Policlinic University Hospital, 70121 Bari, Italy; (A.A.); (N.S.); (P.B.); (V.E.S.)
| | - Sandro Sironi
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy; (G.M.); (S.S.)
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
| | - Gianluca Pontone
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (A.B.); (S.M.); (L.F.); (M.E.M.); (G.P.)
| | - Andrea Igoren Guaricci
- University Cardiology Unit, Cardio-Thoracic Department, Policlinic University Hospital, 70121 Bari, Italy; (A.A.); (N.S.); (P.B.); (V.E.S.)
- Department of Emergency and Organ Transplantation, University of Bari, 70121 Bari, Italy
- Correspondence:
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Gaibazzi N, Tuttolomondo D, Guaricci AI, De Marco F, Pontone G. Stress-echocardiography or coronary computed tomography in suspected chronic coronary syndrome after the 2019 European Guidelines? A practical guide. J Cardiovasc Med (Hagerstown) 2022; 23:12-21. [PMID: 34366402 DOI: 10.2459/jcm.0000000000001235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Stress-echocardiography can rightly be considered one of the champions of cardiac functional imaging, thanks to its real-time imaging, high temporal resolution, high safety and very low cost. When stress-echocardiography is performed at top technical quality, hence taking advantage of ultrasound contrast media for endocardial border delineation at least for suboptimal cases, subjectivity is minimized, and with the routine use of coronary flow reserve measurement (left anterior descending coronary artery, stress/rest ratio reduced or normal, i.e. <>2.0) diagnostic sensitivity is strengthened. The true competitor of any type of functional imaging, stress-echocardiography included, is nowadays coronary computed tomography angiography, which is instead a diagnostic method directly, noninvasively assessing coronary anatomy, apparently the holy grail for any cardiologist. The new 2019 Guidelines on chronic coronary syndrome of the European Society of Cardiology change the existing landscape and clinical practice, while they probably cannot clarify which type of test, functional or anatomic, should be first chosen in different clinical scenarios of suspected chronic coronary syndrome. We review the existing data and the authors' personal view in order to assess how functional stress-echocardiography compares with coronary computed tomography angiography regarding three main aspects: diagnosis of coronary artery disease, guidance of therapy (coronary revascularization versus medical therapy) and risk stratification.
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Affiliation(s)
| | | | | | - Federico De Marco
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese
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Lebedev S, Fournié E, Maier J, Stierstorfer K, Kachelrieß M. Motion compensation for aortic valves using partial angle CT reconstructions motion compensation of cardiac valve CT. Med Phys 2021; 49:1495-1506. [PMID: 34822186 DOI: 10.1002/mp.15379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 09/28/2021] [Accepted: 11/02/2021] [Indexed: 11/07/2022] Open
Abstract
PURPOSE A motion compensation method that is aimed at correcting motion artifacts of cardiac valves is proposed. The primary focus is the aortic valve. METHODS The method is based around partial angle reconstructions and a cost function including the image entropy. A motion model is applied to approximate the cardiac motion in the temporal and spatial domain. Based on characteristic values for velocities and strain during cardiac motion, penalties for the velocity and spatial derivatives are introduced to maintain anatomically realistic motion vector fields and avoid distortions. The model addresses global elastic deformation, but not the finer and more complicated motion of the valve leaflets. RESULTS The method is verified based on clinical data. Image quality was improved for most artifact impaired reconstructions. An image quality study with Likert scoring of the motion artifact severity on a scale from 1 (highest image quality) to 5 (lowest image quality/extreme artifact presence) was performed. The biggest improvements after applying motion compensation were achieved for strongly artifact impaired initial images scoring 4 and 5, resulting in an average change of the scores by -0.59 ± 0.06 and -1.33 ± 0.03, respectively. In case of artifact free images, a chance to introduce blurring was observed and their average score was raised by 0.42 ± 0.03. CONCLUSION Motion artifacts were consistently removed and image quality improved.
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Affiliation(s)
- Sergej Lebedev
- X-Ray Imaging and Computed Tomography, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Siemens Healthineers, Forchheim, Germany
- Department of Physics and Astronomy, University of Heidelberg, Heidelberg, Germany
| | | | - Joscha Maier
- X-Ray Imaging and Computed Tomography, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Marc Kachelrieß
- X-Ray Imaging and Computed Tomography, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Medical Faculty, University of Heidelberg, Heidelberg, Germany
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Ben Zekry S, Sreedharan S, Han D, Sellers S, Ahmadi AA, Blanke P, Hadamitzky M, Kim YJ, Conte E, Andreini D, Pontone G, Budoff MJ, Gottlieb I, Lee BK, Chun EJ, Cademartiri F, Maffei E, Marques H, Shin S, Choi JH, Virmani R, Samady H, Stone PH, Berman DS, Narula J, Shaw LJ, Bax JJ, Leipsic J, Chang HJ. Comparison of coronary atherosclerotic plaque progression in East Asians and Caucasians by serial coronary computed tomographic angiography: A PARADIGM substudy. J Cardiovasc Comput Tomogr 2021; 16:222-229. [PMID: 34736879 DOI: 10.1016/j.jcct.2021.09.012] [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: 08/17/2021] [Accepted: 09/28/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To investigate potential differences in plaque progression (PP) between in East Asians and Caucasians as well as to determine clinical predictors of PP in East Asians. BACKGROUND Studies have demonstrated differences in cardiovascular risk factors as well as plaque burden and progression across different ethnic groups. METHODS The study comprised 955 East Asians (age 60.4 ± 9.3 years, 50.9% males) and 279 Caucasians (age 60.4 ± 8.6 years, 74.5% males) who underwent two serial coronary computed tomography angiography (CCTA) studies over a period of at least 24 months. Patients were enrolled and analyzed from the PARADIGM (Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography IMaging) registry. After propensity-score matching, plaque composition and progression were compared between East Asian and Caucasian patients. Within East Asians, the plaque progression group (defined as plaque volume at follow-up CCTA minus plaque volume at baseline CCTA> 0) was compared to the no PP group to determine clinical predictors for PP in East Asians. RESULTS In the matched cohort, baseline volumes of total plaque as well as all plaque subtypes were comparable. There was a trend towards increased annualized plaque progression among East Asians compared to Caucasians (18.3 ± 24.7 mm3/year vs 16.6 mm3/year, p = 0.054). Among East Asians, 736 (77%) had PP. East Asians with PP had more clinical risk factors and higher plaque burden at baseline (normalized total plaque volume of144.9 ± 233.3 mm3 vs 36.6 ± 84.2 mm3 for PP and no PP, respectively, p < 0.001). Multivariate logistic regression analysis showed that baseline normalized plaque volume (OR: 1.10, CI: 1.10-1.30, p < 0.001), age (OR: 1.02, CI: 1.00-1.04, p = 0.023) and body mass index (OR: 2.24, CI: 1.01-1.13, p = 0.024) were all predictors of PP in East Asians. Clinical events, driven mainly by percutaneous coronary intervention, were higher among the PP group with a total of 124 (16.8%) events compared to 22 (10.0%) in the no PP group (p = 0.014). CONCLUSION East Asians and Caucasians had comparable plaque composition and progression. Among East Asians, the PP group had a higher baseline plaque burden which was associated with greater PP and increased clinical events.
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Affiliation(s)
- Sagit Ben Zekry
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada
| | - Subhashaan Sreedharan
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada
| | - Donghee Han
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Stephanie Sellers
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada
| | - Amir A Ahmadi
- Centre for Heart Lung Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada; Icahn School of Medicine at Mt. Sinai Hospital, New York, NY, USA
| | - Philipp Blanke
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Yong-Jin Kim
- Seoul National University Hospital, Seoul, South Korea
| | | | | | | | - Matthew J Budoff
- Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA, USA
| | - Ilan Gottlieb
- Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil
| | - Byoung Kwon Lee
- Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun Ju Chun
- Seoul National University Bundang Hospital, Bundang, South Korea
| | | | - Erica Maffei
- Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Sanghoon Shin
- National Health Insurance Service Ilsan Hospital, South Korea
| | | | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Habib Samady
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Peter H Stone
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel S Berman
- Department of Imaging, Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Jagat Narula
- Icahn School of Medicine at Mt. Sinai Hospital, New York, NY, USA; Zena and Michael A. Wiener Cardiovascular Institute, Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, New York, NY, USA
| | | | - Jeroen J Bax
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands
| | - Jonathon Leipsic
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada.
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Integrative Cardiovascular Imaging Center, Yonsei University College of Medicine, Seoul, South Korea
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Esposito A, Francone M, Andreini D, Buffa V, Cademartiri F, Carbone I, Clemente A, Guaricci AI, Guglielmo M, Indolfi C, La Grutta L, Ligabue G, Liguori C, Mercuro G, Mushtaq S, Neglia D, Palmisano A, Sciagrà R, Seitun S, Vignale D, Pontone G, Carrabba N. SIRM-SIC appropriateness criteria for the use of Cardiac Computed Tomography. Part 1: Congenital heart diseases, primary prevention, risk assessment before surgery, suspected CAD in symptomatic patients, plaque and epicardial adipose tissue characterization, and functional assessment of stenosis. LA RADIOLOGIA MEDICA 2021; 126:1236-1248. [PMID: 34160775 PMCID: PMC8370938 DOI: 10.1007/s11547-021-01378-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/20/2021] [Indexed: 12/23/2022]
Abstract
In the past 20 years, Cardiac Computed Tomography (CCT) has become a pivotal technique for the noninvasive diagnostic work-up of coronary and cardiac diseases. Continuous technical and methodological improvements, combined with fast growing scientific evidence, have progressively expanded the clinical role of CCT. Recent large multicenter randomized clinical trials documented the high prognostic value of CCT and its capability to increase the cost-effectiveness of the management of patients with suspected CAD. In the meantime, CCT, initially perceived as a simple non-invasive technique for studying coronary anatomy, has transformed into a multiparametric "one-stop-shop" approach able to investigate the heart in a comprehensive way, including functional, structural and pathophysiological biomarkers. In this complex and revolutionary scenario, it is urgently needed to provide an updated guide for the appropriate use of CCT in different clinical settings. This manuscript, endorsed by the Italian Society of Medical and Interventional Radiology (SIRM) and by the Italian Society of Cardiology (SIC), represents the first of two consensus documents collecting the expert opinion of Radiologists and Cardiologists about current appropriate use of CCT.
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Affiliation(s)
- Antonio Esposito
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
| | - Marco Francone
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Vitaliano Buffa
- Department of Radiology, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | | | - Iacopo Carbone
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | | | - Andrea Igoren Guaricci
- Cardiothoracic Department, University Cardiology Unit, Policlinic University Hospital, Bari, Italy
| | | | - Ciro Indolfi
- Department of Medical and Surgical Sciences, Magna Grecia University, Catanzaro, Italy
| | - Ludovico La Grutta
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties-ProMISE, University of Palermo, AOUP P. Giaccone, Palermo, Italy
| | - Guido Ligabue
- Department of Medical and Surgical Sciences, Modena and Reggio Emilia University, Modena, Italy
- Radiology Department, AOU of Modena, Modena, Italy
| | - Carlo Liguori
- Radiology Unit, Ospedale del Mare- A.S.LNa1-Centro, Naples, Italy
| | - Giuseppe Mercuro
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Danilo Neglia
- Cardiovascular Department, CNR (National Council of Research)/Tuscany Region 'Gabriele Monasterio' Foundation (FTGM), Pisa, Italy
| | - Anna Palmisano
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Roberto Sciagrà
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Sara Seitun
- Radiology Department, Ospedale Policlinico San Martino, IRCCS Per L'Oncologia E Le Neuroscienze, Genoa, Italy
| | - Davide Vignale
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | | | - Nazario Carrabba
- Cardiothoracovascular Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
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Serial coronary CT angiography-derived fractional flow reserve and plaque progression can predict long-term outcomes of coronary artery disease. Eur Radiol 2021; 31:7110-7120. [PMID: 33630163 DOI: 10.1007/s00330-021-07726-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/29/2020] [Accepted: 01/27/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate the utility of coronary CT angiography-derived fractional flow reserve (FFRCT) and plaque progression in patients undergoing serial coronary CT angiography for predicting major adverse cardiovascular events (MACE). METHODS This retrospective study evaluated patients suspected or known coronary artery disease who underwent serial coronary CT angiography examinations between January 2006 and December 2017 and followed up until June 2019. The primary endpoint was MACE, defined as acute coronary syndrome, rehospitalization due to progressive angina, percutaneous coronary intervention, or cardiac death. FFRCT and plaque parameters were analyzed on a per-vessel and per-patient basis. Univariable and multivariable COX regression analysis determined predictors of MACE. The prognostic value of FFRCT and plaque progression were assessed in nested models. RESULTS Two hundred eighty-four patients (median age, 61 years (interquartile range, 54-70); 202 males) were evaluated. MACE was observed in 45 patients (15.8%, 45/284). By Cox multivariable regression modeling, vessel-specific FFRCT ≤ 0.80 was associated with a 2.4-fold increased risk of MACE (HR (95% CI): 2.4 (1.3-4.4); p = 0.005) and plaque progression was associated with a 9-fold increased risk of MACE (HR (95% CI): 9 (3.5-23); p < 0.001) after adjusting for clinical and imaging risk factors. FFRCT and plaque progression improved the prediction of events over coronary artery calcium (CAC) score and high-risk plaques (HRP) in the receiver operating characteristics analysis (area under the curve: 0.70 to 0.86; p = 0.002). CONCLUSIONS Fractional flow reserve and plaque progression assessed by serial coronary CT angiography predicted the risk of future MACE. KEY POINTS • Vessel-specific CT angiography-derived fractional flow reserve (FFRCT) ≤ 0.80 and plaque progression improved the prediction of events over current risk factors. • Major adverse cardiovascular events (MACE) significantly increased with the presence of plaque progression at follow-up stratified by the FFRCT change group.
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Baessato F, Guglielmo M, Muscogiuri G, Baggiano A, Fusini L, Scafuri S, Babbaro M, Mollace R, Collevecchio A, Guaricci AI, Pontone G. Stress CMR in Known or Suspected CAD: Diagnostic and Prognostic Role. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6678029. [PMID: 33511208 PMCID: PMC7822671 DOI: 10.1155/2021/6678029] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/23/2020] [Accepted: 01/04/2021] [Indexed: 12/12/2022]
Abstract
The recently published 2019 guidelines on chronic coronary syndromes (CCS) focus on the need for noninvasive imaging modalities to accurately establish the diagnosis of coronary artery disease (CAD) and assess the risk of clinical scenario occurrence. Appropriate patient management should rely on controlling symptoms, improving prognosis, and guiding each therapeutic strategy as well as monitoring disease progress. Among the noninvasive imaging modalities, cardiovascular magnetic resonance (CMR) has gained broad acceptance in past years due to its unique features in providing a complete assessment of CAD through data on cardiac anatomy and function and myocardial viability, with high spatial and temporal resolution and without ionizing radiation. In detail, evaluation of the presence and extent of myocardial ischemia through stress CMR (S-CMR) has shown a high rule-in power in detecting functionally significant coronary artery stenosis in patients suspected of CCS. Moreover, S-CMR technique may add significant prognostic value, as demonstrated by different studies which have progressively evidenced the valuable power of this multiparametric imaging modality in predicting adverse cardiac events. The latest scientific progress supports a greater expansion of S-CMR with improvement of quantitative myocardial perfusion analysis, myocardial strain, and native mapping within the same examination. Although further study is warranted, these techniques, which are currently mostly restricted to the research field, are likely to become increasingly prevalent in the clinical setting with the scope of increasing accuracy in the selection of patients to be sent to invasive revascularization. This review investigates the diagnostic and prognostic role of S-CMR in the context of CAD, by analysing a strong, long-standing, scientific evidence together with an appraisal of new advanced techniques which may potentially enrich CAD management in the next future.
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Affiliation(s)
- Francesca Baessato
- Department of Cardiology, San Maurizio Regional Hospital, Bolzano, Italy
| | - Marco Guglielmo
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Giuseppe Muscogiuri
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Andrea Baggiano
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Laura Fusini
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Stefano Scafuri
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Mario Babbaro
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Rocco Mollace
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Ada Collevecchio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Andrea I. Guaricci
- Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy
| | - Gianluca Pontone
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
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Qian W, Liu W, Zhu Y, Wang J, Chen Y, Meng H, Chen L, Xu Y, Zhu X. Influence of heart rate and coronary artery calcification on image quality and diagnostic performance of coronary CT angiography: comparison between 96-row detector dual source CT and 256-row multidetector CT. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2021; 29:529-539. [PMID: 33749627 DOI: 10.3233/xst-210837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND CT-derived fractional flow reserve (FFRCT) and diagnostic accuracy rely on good image quality during coronary CT angiography (CCTA). OBJECTIVE To investigate whether heart rate (HR) and coronary artery calcium (CAC) score decrease image quality and diagnostic performance of two advanced CT scanners including 96-row detector dual source CT (DSCT) and 256-row multidetector CT (MDCT). METHODS First, 79 patients who underwent CCTA (42 with DSCT and 37 with MDCT) and invasive coronary angiography (ICA) are enrolled. Next, coronary segments with excellent image quality are evaluated and the percentage is calculated. Then, diagnostic accuracy in detecting significant diameter stenosis is presented with ICA as the reference standard. RESULTS Compared with the DSCT, the percentage of coronary segments with excellent image quality is lower (P = 0.010) while diagnostic accuracy on per-segment level is improved (P = 0.037) using MDCT. CAC score≥400 is the only independent factor influencing the percentage of coronary segments with excellent image quality [odds ratio (OR): DSCT, 3.096 and MDCT, 1.982] and segmental diagnostic accuracy (OR: DSCT, 2.630 and MDCT, 2.336) for both scanners. HR≥70 bpm (OR: 5.506) is the independent factor influencing the percentage of coronary segments with excellent image quality with MDCT. CONCLULSION During CCTA, CAC score≥400 still decreases the proportion of coronary segments with excellent image quality and diagnostic accuracy with advanced CT scanners. HR≥70 bpm is another factor causing image quality decreasing with MDCT.
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Affiliation(s)
- Wen Qian
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wangyan Liu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yinsu Zhu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jun Wang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yang Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Haoyu Meng
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Leilei Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yi Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaomei Zhu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Muscogiuri G, Van Assen M, Tesche C, De Cecco CN, Chiesa M, Scafuri S, Guglielmo M, Baggiano A, Fusini L, Guaricci AI, Rabbat MG, Pontone G. Artificial Intelligence in Coronary Computed Tomography Angiography: From Anatomy to Prognosis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:6649410. [PMID: 33381570 PMCID: PMC7762640 DOI: 10.1155/2020/6649410] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/30/2020] [Accepted: 12/09/2020] [Indexed: 12/20/2022]
Abstract
Cardiac computed tomography angiography (CCTA) is widely used as a diagnostic tool for evaluation of coronary artery disease (CAD). Despite the excellent capability to rule-out CAD, CCTA may overestimate the degree of stenosis; furthermore, CCTA analysis can be time consuming, often requiring advanced postprocessing techniques. In consideration of the most recent ESC guidelines on CAD management, which will likely increase CCTA volume over the next years, new tools are necessary to shorten reporting time and improve the accuracy for the detection of ischemia-inducing coronary lesions. The application of artificial intelligence (AI) may provide a helpful tool in CCTA, improving the evaluation and quantification of coronary stenosis, plaque characterization, and assessment of myocardial ischemia. Furthermore, in comparison with existing risk scores, machine-learning algorithms can better predict the outcome utilizing both imaging findings and clinical parameters. Medical AI is moving from the research field to daily clinical practice, and with the increasing number of CCTA examinations, AI will be extensively utilized in cardiac imaging. This review is aimed at illustrating the state of the art in AI-based CCTA applications and future clinical scenarios.
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Affiliation(s)
| | - Marly Van Assen
- Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Christian Tesche
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany
- Department of Internal Medicine, St. Johannes-Hospital, Dortmund, Germany
| | - Carlo N. De Cecco
- Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | | | - Stefano Scafuri
- Division of Interventional Structural Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | | | | | - Laura Fusini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Andrea I. Guaricci
- Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital “Policlinico Consorziale” of Bari, Bari, Italy
| | - Mark G. Rabbat
- Loyola University of Chicago, Chicago, IL, USA
- Edward Hines Jr. VA Hospital, Hines, IL, USA
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Kang EJ. Clinical Applications of Wide-Detector CT Scanners for Cardiothoracic Imaging: An Update. Korean J Radiol 2020; 20:1583-1596. [PMID: 31854147 PMCID: PMC6923215 DOI: 10.3348/kjr.2019.0327] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/23/2019] [Indexed: 12/21/2022] Open
Abstract
Technical developments in multidetector computed tomography (CT) have increased the number of detector rows on the z-axis, and 16-cm wide-area-coverage CT scanners have enabled volumetric scanning of the entire heart. Beyond coronary arterial imaging, such innovations offer several advantages during clinical imaging in the cardiothoracic area. The wide-detector CT scanner markedly reduces the image acquisition time to less than 1 second for coronary CT angiography, thereby decreasing the volume of contrast material and radiation dose required for the examination. It also eliminates stair-step artifacts, allowing robust improvements in myocardial function and perfusion imaging. Additionally, new imaging techniques for the cardiothoracic area, including subtraction imaging and free-breathing scans, have been developed and further improved by using the wide-detector CT scanner. This article investigates the technical developments in wide-detector CT scanners, summarizes their clinical applications in the cardiothoracic area, and provides a review of the recent literature.
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Affiliation(s)
- Eun Ju Kang
- Department of Radiology, College of Medicine, Dong-A University, Busan, Korea.
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17
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Muscogiuri G, Chiesa M, Trotta M, Gatti M, Palmisano V, Dell'Aversana S, Baessato F, Cavaliere A, Cicala G, Loffreno A, Rizzon G, Guglielmo M, Baggiano A, Fusini L, Saba L, Andreini D, Pepi M, Rabbat MG, Guaricci AI, De Cecco CN, Colombo G, Pontone G. Performance of a deep learning algorithm for the evaluation of CAD-RADS classification with CCTA. Atherosclerosis 2019; 294:25-32. [PMID: 31945615 DOI: 10.1016/j.atherosclerosis.2019.12.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/01/2019] [Accepted: 12/06/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Artificial intelligence (AI) is increasing its role in diagnosis of patients with suspicious coronary artery disease. The aim of this manuscript is to develop a deep convolutional neural network (CNN) to classify coronary computed tomography angiography (CCTA) in the correct Coronary Artery Disease Reporting and Data System (CAD-RADS) category. METHODS Two hundred eighty eight patients who underwent clinically indicated CCTA were included in this single-center retrospective study. The CCTAs were stratified by CAD-RADS scores by expert readers and considered as reference standard. A deep CNN was designed and tested on the CCTA dataset and compared to on-site reading. The deep CNN analyzed the diagnostic accuracy of the following three Models based on CAD-RADS classification: Model A (CAD-RADS 0 vs CAD-RADS 1-2 vs CAD-RADS 3,4,5), Model 1 (CAD-RADS 0 vs CAD-RADS>0), Model 2 (CAD-RADS 0-2 vs CAD-RADS 3-5). Time of analysis for both physicians and CNN were recorded. RESULTS Model A showed a sensitivity, specificity, negative predictive value, positive predictive value and accuracy of 47%, 74%, 77%, 46% and 60%, respectively. Model 1 showed a sensitivity, specificity, negative predictive value, positive predictive value and accuracy of 66%, 91%, 92%, 63%, 86%, respectively. Conversely, Model 2 demonstrated the following sensitivity, specificity, negative predictive value, positive predictive value and accuracy: 82%, 58%, 74%, 69%, 71%, respectively. Time of analysis was significantly lower using CNN as compared to on-site reading (530.5 ± 179.1 vs 104.3 ± 1.4 sec, p=0.01) CONCLUSIONS: Deep CNN yielded accurate automated classification of patients with CAD-RADS.
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Affiliation(s)
| | | | - Michela Trotta
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Marco Gatti
- Department of Surgical Sciences, Radiology Institute, University of Turin, Turin, Italy
| | - Vitanio Palmisano
- Department of Medical Imaging, University of Cagliari, Monserrato, Italy
| | - Serena Dell'Aversana
- Department of Advanced Biomedical Sciences, University of Naples "Federico II,", Naples, Italy
| | - Francesca Baessato
- Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Annachiara Cavaliere
- Department of Medicine, Institute of Radiology, University of Padova, Padua, Italy
| | - Gloria Cicala
- Section of Radiology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Giulia Rizzon
- Department of Medicine, Institute of Radiology, University of Padova, Padua, Italy
| | | | | | - Laura Fusini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Luca Saba
- Department of Medical Imaging, University of Cagliari, Monserrato, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Cardiovascular Sciences and Community Health, University of Milan, Italy
| | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Mark G Rabbat
- Loyola University of Chicago, Chicago, IL, USA; Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Andrea I Guaricci
- Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital "Policlinico Consorziale" of Bari, Bari, Italy
| | - Carlo N De Cecco
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
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Pontone G, De Cecco C, Baggiano A, Guaricci AI, Guglielmo M, Leiner T, Lima J, Maurovich-Horvat P, Muscogiuri G, Nance JW, Schoepf UJ. Design of CTP-PRO study (impact of stress Cardiac computed Tomography myocardial Perfusion on downstream resources and PROgnosis in patients with suspected or known coronary artery disease: A multicenter international study). Int J Cardiol 2019; 292:253-257. [DOI: 10.1016/j.ijcard.2019.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 11/25/2022]
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Improved visualization of the coronary arteries using motion correction during vasodilator stress CT myocardial perfusion imaging. Eur J Radiol 2019; 114:1-5. [PMID: 31005158 DOI: 10.1016/j.ejrad.2019.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/12/2019] [Accepted: 02/11/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Vasodilator stress computed tomography perfusion (sCTP) imaging is complementary to coronary CT angiography (CCTA), used to determine the hemodynamic significance of coronary artery disease. However, it requires a separate image acquisition due to motion artifacts caused by higher heart rates during stress, resulting in increased iodine contrast dose and radiation. We sought to determine whether a novel motion correction algorithm applied to stress images would improve the visualization of the coronary arteries to potentially allow CCTA + sCTP evaluation in a single scan. METHODS 28 patients referred for clinically indicated CCTA (iCT, Philips) underwent sCTP imaging (retrospective-gating with dose modulation; 100 kVp and 250 mA; 5.2 ± 4.3 mSv) after regadenoson (0.4 mg, Astellas). Stress images were reconstructed using standard filtered back-projection (FBP) and also processed to generate interaction-free coronary motion-compensated back-projection reconstructions (MCR). Each coronary artery from standard FBP and MCR images was viewed side-by-side by a reader blinded to the reconstruction technique, who graded severity of motion artifact by segment (scale 0-5, with 3 as the threshold for diagnostic quality) and to measure signal-to-noise and contrast-to-noise ratios (SNR, CNR). RESULTS Visualization scores were higher with MCR for all coronary segments, including 14/86 (16%) segments deemed as non-diagnostic on FBP images. SNR (7 ± 2) and CNR (15 ± 8) were unchanged by motion-correction (7 ± 3, p = 0.88 and 15 ± 5, p = 0.94, respectively). CONCLUSIONS MCR improves the visualization of coronary anatomy on sCTP images without degrading image characteristics. This algorithm is an important step towards the combined assessment of coronary anatomy and myocardial perfusion in a single scan, which will reduce study time, radiation exposure and contrast dose.
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Diagnostic accuracy of simultaneous evaluation of coronary arteries and myocardial perfusion with single stress cardiac computed tomography acquisition compared to invasive coronary angiography plus invasive fractional flow reserve. Int J Cardiol 2018; 273:263-268. [DOI: 10.1016/j.ijcard.2018.09.065] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 09/16/2018] [Accepted: 09/19/2018] [Indexed: 11/18/2022]
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Guaricci AI, Carrabba N, Aquaro GD, Rabbat MG, Gaemperli O, Bucciarelli Ducci C, Pontone G. Advanced imaging techniques (CT and MR): Gender-based diagnostic work-up in ischemic heart disease? Int J Cardiol 2018; 286:234-238. [PMID: 30459113 DOI: 10.1016/j.ijcard.2018.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/25/2018] [Accepted: 11/05/2018] [Indexed: 12/31/2022]
Abstract
It is ascertained that the epidemiology and social impact of ischemic heart disease is substantially different between the two genders. Moreover, there is substantial evidence that gender is able to modulate the clinical manifestation of most cardiac diseases, and specifically of coronary artery disease. Particularly, women present less angiographically significant coronary artery disease, smaller vessel lumen, and less plaque rupture occurrence as compared to men. On the contrary, manifestations as vasospasm, impaired vasodilatation at epicardial level, and microvascular dysfunction are more common in female. In clinical practice, it is important to know the gender-based aspects of clinical disease expression and how to diversify the diagnostic work-up. Cardiac Computed Tomography and Cardiac Magnetic Resonance are relatively new diagnostic imaging tools employed for studying both the cardiac structures and the pathophysiology of the cardiovascular system. In this paper, we aim to overview the non-invasive diagnostic role in a gender's dimension, mainly focusing on Cardiac Computed Tomography and Cardiac Magnetic Resonance in ischemic heart disease, and to understand whether the existing evidences support a different diagnostic work-up approach.
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Affiliation(s)
- Andrea Igoren Guaricci
- Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy
| | - Nazario Carrabba
- Cardiovascular and Thoracic Department of Careggi Hospital, Florence, Italy
| | - Giovanni Donato Aquaro
- U.O.C. Risonanza Magnetica per Immagini, Fondazione G. Monasterio CNR-Regione Toscana Pisa, Italy
| | - Mark G Rabbat
- Loyola University of Chicago, Chicago, IL, United States of America; Edward Hines Jr. VA Hospital, Hines, IL, United States of America
| | - Oliver Gaemperli
- University Heart Center, University Hospital Zurich, CH, Switzerland
| | - Chiara Bucciarelli Ducci
- Bristol NIHR Cardiovascular Biomedical Research Unit, Bristol Heart Institute, Bristol, United Kingdom
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Prognostic Value and Therapeutic Perspectives of Coronary CT Angiography: A Literature Review. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6528238. [PMID: 30306089 PMCID: PMC6165606 DOI: 10.1155/2018/6528238] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 08/01/2018] [Indexed: 12/16/2022]
Abstract
Coronary stenosis severity is both a powerful and a still debated predictor of prognosis in coronary artery disease. Coronary computed tomographic angiography (CCTA) has emerged as a noninvasive technique that enables anatomic visualization of coronary artery disease (CAD). CCTA with newer applications, plaque characterization and physiologic/functional evaluation, allows a comprehensive diagnostic and prognostic assessment of otherwise low-intermediate subjects for primary prevention. CCTA measures the overall plaque burden, differentiates plaque subtypes, and identifies high-risk plaque with good reproducibility. Research in this field may also advance towards an era of personalized risk prediction and individualized medical therapy. It has been demonstrated that statins may delay plaque progression and change some plaque features. The potential effects on plaque modifications induced by other medical therapies have also been investigated. Although it is not currently possible to recommend routinely serial scans to monitor the therapeutic efficacy of medical interventions, the plaque modulation, as a part of risk modification, appears a feasible strategy. In this review we summarize the current evidence regarding vulnerable plaque and effects of lipid lowering therapy on morphological features of CAD. We also discuss the potential ability of CCTA to characterize coronary atherosclerosis, stratify prognosis of asymptomatic subjects, and guide medical therapy.
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Impact of a New Adaptive Statistical Iterative Reconstruction (ASIR)-V Algorithm on Image Quality in Coronary Computed Tomography Angiography. Acad Radiol 2018; 25:1305-1313. [PMID: 29602723 DOI: 10.1016/j.acra.2018.02.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 01/28/2018] [Accepted: 02/03/2018] [Indexed: 11/22/2022]
Abstract
RATIONALE AND OBJECTIVES A new postprocessing algorithm named adaptive statistical iterative reconstruction (ASIR)-V has been recently introduced. The aim of this article was to analyze the impact of ASIR-V algorithm on signal, noise, and image quality of coronary computed tomography angiography. MATERIALS AND METHODS Fifty consecutive patients underwent clinically indicated coronary computed tomography angiography (Revolution CT; GE Healthcare, Milwaukee, WI). Images were reconstructed using filtered back projection and ASIR-V 0%, and a combination of filtered back projection and ASIR-V 20%-80% and ASIR-V 100%. Image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were calculated for left main coronary artery (LM), left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA) and were compared between the different postprocessing algorithms used. Similarly a four-point Likert image quality score of coronary segments was graded for each dataset and compared. A cutoff value of P < .05 was considered statistically significant. RESULTS Compared to ASIR-V 0%, ASIR-V 100% demonstrated a significant reduction of image noise in all coronaries (P < .01). Compared to ASIR-V 0%, SNR was significantly higher with ASIR-V 60% in LM (P < .01), LAD (P < .05), LCX (P < .05), and RCA (P < .01). Compared to ASIR-V 0%, CNR for ASIR-V ≥60% was significantly improved in LM (P < .01), LAD (P < .05), and RCA (P < .01), whereas LCX demonstrated a significant improvement with ASIR-V ≥80%. ASIR-V 60% had significantly better Likert image quality scores compared to ASIR-V 0% in segment-, vessel-, and patient-based analyses (P < .01). CONCLUSIONS Reconstruction with ASIR-V 60% provides the optimal balance between image noise, SNR, CNR, and image quality.
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Andreini D, Pontone G, Mushtaq S, Conte E, Guglielmo M, Mancini ME, Annoni A, Baggiano A, Formenti A, Montorsi P, Magatelli M, Di Odoardo L, Melotti E, Resta M, Muscogiuri G, Fiorentini C, Bartorelli AL, Pepi M. Diagnostic accuracy of coronary CT angiography performed in 100 consecutive patients with coronary stents using a whole-organ high-definition CT scanner. Int J Cardiol 2018; 274:382-387. [PMID: 30219253 DOI: 10.1016/j.ijcard.2018.09.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/31/2018] [Accepted: 09/03/2018] [Indexed: 11/15/2022]
Abstract
AIMS To evaluate image quality, interpretability, diagnostic accuracy and radiation exposure of coronary CT angiography (CCTA) performed with a new scanner equipped with 0.23-mm spatial resolution, new generation iterative reconstruction, 0.28-second gantry rotation time and intra-cycle motion-correction algorithm in consecutive patients with coronary stents, including those with high heart rate (HR) and atrial fibrillation (AF). MATERIALS AND METHODS We enrolled 100 consecutive patients (85 males, mean age 65 ± 10 years) with previous coronary stent implantation scheduled for clinically indicated non-emergent invasive coronary angiography (ICA). Image quality, coronary interpretability and diagnostic accuracy vs. ICA were evaluated and the effective dose (ED) was recorded. RESULTS Mean HR during the scan was 67 ± 13 bpm. Twenty-six patients had >65 bpm HR during scanning and 13 patients had AF. Overall, image quality was high (Likert = 3.2 ± 0.9). Stent interpretability was 95.8% (184/192 stents). Among 192 stented segments, CCTA correctly identified 22 out of 24 with >50% in-stent restenosis (ISR) (sensitivity 92%). In a stent-based analysis, specificity, positive and negative predictive values and diagnostic accuracy for ISR detection were 91%, 99%, 60% and 91%, respectively. In a patient-based analysis, CCTA diagnostic accuracy was 85%. Overall, mean ED of CCTA was 2.4 ± 1.2 mSv. CONCLUSIONS A whole-organ CT scanner was able to evaluate coronary stents with good diagnostic performance and low radiation exposure, also in presence of unfavorable HR and heart rhythm. TRANSLATIONAL ASPECT The present study is the first to evaluate the CCTA capability of detecting in-stent restenosis in consecutive patients, including those with high HR and AF, using a recent scanner generation that combines improved spatial and temporal resolution with wide coverage. Using the whole-organ high-definition CT scanner we obtained high quality images of coronary stents with good interpretability and diagnostic accuracy combined with low radiation exposure, even in patients with unfavorable HR or heart rhythm for CCTA evaluation.
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Affiliation(s)
- Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy.
| | | | | | | | | | | | | | | | | | - Piero Montorsi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Marco Magatelli
- Department of Clinical Cardiology, University of Brescia, Brescia, Italy
| | | | | | - Marta Resta
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | | | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
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Diagnostic Performance of a Novel Coronary CT Angiography Algorithm: Prospective Multicenter Validation of an Intracycle CT Motion Correction Algorithm for Diagnostic Accuracy. AJR Am J Roentgenol 2018; 210:1208-1215. [PMID: 29667891 DOI: 10.2214/ajr.17.18670] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Motion artifact can reduce the diagnostic accuracy of coronary CT angiography (CCTA) for coronary artery disease (CAD). The purpose of this study was to compare the diagnostic performance of an algorithm dedicated to correcting coronary motion artifact with the performance of standard reconstruction methods in a prospective international multicenter study. SUBJECTS AND METHODS Patients referred for clinically indicated invasive coronary angiography (ICA) for suspected CAD prospectively underwent an investigational CCTA examination free from heart rate-lowering medications before they underwent ICA. Blinded core laboratory interpretations of motion-corrected and standard reconstructions for obstructive CAD (≥ 50% stenosis) were compared with ICA findings. Segments unevaluable owing to artifact were considered obstructive. The primary endpoint was per-subject diagnostic accuracy of the intracycle motion correction algorithm for obstructive CAD found at ICA. RESULTS Among 230 patients who underwent CCTA with the motion correction algorithm and standard reconstruction, 92 (40.0%) had obstructive CAD on the basis of ICA findings. At a mean heart rate of 68.0 ± 11.7 beats/min, the motion correction algorithm reduced the number of nondiagnostic scans compared with standard reconstruction (20.4% vs 34.8%; p < 0.001). Diagnostic accuracy for obstructive CAD with the motion correction algorithm (62%; 95% CI, 56-68%) was not significantly different from that of standard reconstruction on a per-subject basis (59%; 95% CI, 53-66%; p = 0.28) but was superior on a per-vessel basis: 77% (95% CI, 74-80%) versus 72% (95% CI, 69-75%) (p = 0.02). The motion correction algorithm was superior in subgroups of patients with severely obstructive (≥ 70%) stenosis, heart rate ≥ 70 beats/min, and vessels in the atrioventricular groove. CONCLUSION The motion correction algorithm studied reduces artifacts and improves diagnostic performance for obstructive CAD on a per-vessel basis and in selected subgroups on a per-subject basis.
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Wen B, Xu L, Liang J, Fan Z, Sun Z. A Preliminary Study of Computed Tomography Coronary Angiography Within a Single Cardiac Cycle in Patients With Atrial Fibrillation Using 256-Row Detector Computed Tomography. J Comput Assist Tomogr 2018. [PMID: 29528910 DOI: 10.1097/rct.0000000000000683] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the image quality and radiation dose of computed tomography (CT) coronary angiography using a 256-row detector CT scanner in a single cardiac cycle in patients with atrial fibrillation (AF). METHODS Seventy consecutive patients (41 men and 29 women; age range was from 37 to 84 years, mean age was 61.7 ± 10.2 years; body mass index range was from 15.08 to 36.45 kg/m, mean body mass index was 25.9 ± 3.5 kg/m) with persistent or paroxysmal AF during acquisition, who were not receiving any medications for heart rate (HR) regulation, were imaged with a 256-row detector CT scanner (Revolution CT, GE healthcare). According to the HR or HR variability (HRV) the patients were divided into 4 groups: group A (HR, ≥75 bpm; n = 36), group B (HR, <75 bpm; n = 34), group C (HRV, ≥50 bpm; n = 26), and group D (HRV, <50 bpm; n = 44). The snapshot freeze algorithm reconstruction was used to reduce motion artifacts whenever necessary. Two experienced radiologists, who were blinded to the electrocardiograph and reconstruction information, independently graded the CT images in terms of visibility and artifacts with a 4-grade rating scale (1, excellent; 2, good; 3, poor; 4, insufficient) using the 18-segment model. Subjective image quality scores and effective dose (ED) were calculated and compared between these groups. RESULTS The HR during acquisition ranged from 47 to 222 bpm (88.24 ± 36.80 bpm). A total of 917 in 936 coronary artery segments were rated as diagnostically evaluable (98.2 ± 0.04%). There was no significant linear correlation between mean image quality and HR or HRV (P > 0.05). Snapshot freeze reconstruction technique was applied in 28 patients to reduce motion artifacts and thus showed image quality was improved from 93.2% to 98.4%. The ED was 3.05 ± 2.23 mSv (0.49-11.86 mSv) for all patients, and 3.76 ± 2.22 mSv (0.92-11.17 mSv), 2.30 ± 2.02 mSv (0.49-11.86 mSv), 3.89 ± 2.35 mSv (1.18-11.86 mSv), and 2.56 ± 2.03 mSv (0.49-11.17 mSv) for groups A, B, C, and D, respectively. There were significant differences in mean ED between groups A and B, as well as C and D (P <0.05). CONCLUSIONS This study shows that CT coronary angiography with use of a new 256-row detector CT in single cardiac cycle achieves diagnostic image quality but with lower radiation dose in patients with AF. Heart rate or HRV has no significant effect on image quality.
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Image Quality, Overall Evaluability, and Effective Radiation Dose of Coronary Computed Tomography Angiography With Prospective Electrocardiographic Triggering Plus Intracycle Motion Correction Algorithm in Patients With a Heart Rate Over 65 Beats Per Minute. J Thorac Imaging 2018; 33:225-231. [PMID: 29346192 DOI: 10.1097/rti.0000000000000320] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE Recently, a new intracycle motion correction algorithm (MCA) was introduced to reduce motion artifacts from heart rate (HR) in coronary computed tomography angiography (cCTA). The aim of the study was to evaluate the image quality, overall evaluability, and effective radiation dose (ED) of cCTA with prospective electrocardiographic (ECG) triggering plus MCA as compared with standard protocol with retrospective ECG triggering in patients with HR≥65 bpm. MATERIALS AND METHODS One hundred consecutive patients (67±10 y) scheduled for cCTA with 65<HR<80 bpm were retrospectively analyzed. The patients were assigned to 2 groups undergoing prospective (group 1) or retrospective (group 2) triggered cCTA. The study protocol was approved by the Institutional Ethics Committee and a written informed consent was obtained from all patients. Image noise, signal to noise ratio, contrast to noise ratio, Likert image quality score (score 1, nondiagnostic; score 2, adequate; score 3, good; score 4, excellent), overall image evaluability, and ED were measured and compared between the 2 groups. Both vessel-based and patient-based analyses were evaluated. Student test or Wilcoxon test were used to evaluate differences of continuous variables, whereas the χ test was used to study differences with regard to categorical data. A P-value <0.05 was considered statistically significant. RESULTS cCTA was successfully performed in all patients. In a segment-based model, group 1 compared with group 2 showed a lower rate of overall artifacts (67% vs. 83%; P<0.001) and motion artifacts (49% vs. 66%; P<0.001), resulting in a better Likert image quality score (2.83±1.03 vs. 2.37±1.02; P<0.01) and overall evaluability (85% vs. 75%; P<0.01). Group 1 showed a lower ED as compared with group 2 (3.1±1.9 vs. 11.9±3.3 mSv; P<0.01). CONCLUSION MCA and cCTA with prospective ECG-triggering acquisition in patients with high HR improves image quality and overall evaluability compared with cCTA with standard retrospective ECG triggering.
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Coronary Atherosclerosis Assessment by Coronary CT Angiography in Asymptomatic Diabetic Population: A Critical Systematic Review of the Literature and Future Perspectives. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8927281. [PMID: 29511691 PMCID: PMC5820580 DOI: 10.1155/2018/8927281] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 12/02/2017] [Indexed: 12/29/2022]
Abstract
The prognostic impact of diabetes mellitus (DM) on cardiovascular outcomes is well known. As a consequence of previous studies showing the high incidence of coronary artery disease (CAD) in diabetic patients and the relatively poor outcome compared to nondiabetic populations, DM is considered as CAD equivalent which means that diabetic patients are labeled as asymptomatic individuals at high cardiovascular risk. Lessons learned from the analysis of prognostic studies over the past decade have challenged this dogma and now support the idea that diabetic population is not uniformly distributed in the highest risk box. Detecting CAD in asymptomatic high risk individuals is controversial and, what is more, in patients with diabetes is challenging, and that is why the reliability of traditional cardiac stress tests for detecting myocardial ischemia is limited. Cardiac computed tomography angiography (CCTA) represents an emerging noninvasive technique able to explore the atherosclerotic involvement of the coronary arteries and, thus, to distinguish different risk categories tailoring this evaluation on each patient. The aim of the review is to provide a wide overview on the clinical meaning of CCTA in this field and to integrate the anatomical information with a reliable therapeutic approach.
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Impact of SSF on Diagnostic Performance of Coronary Computed Tomography Angiography Within 1 Heart Beat in Patients With High Heart Rate Using a 256-Row Detector Computed Tomography. J Comput Assist Tomogr 2018; 42:54-61. [DOI: 10.1097/rct.0000000000000641] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Suh YJ, Kim YJ, Kim JY, Chang S, Im DJ, Hong YJ, Choi BW. A whole-heart motion-correction algorithm: Effects on CT image quality and diagnostic accuracy of mechanical valve prosthesis abnormalities. J Cardiovasc Comput Tomogr 2017; 11:474-481. [PMID: 28966103 DOI: 10.1016/j.jcct.2017.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/16/2017] [Accepted: 09/19/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND We aimed to determine the effect of a whole-heart motion-correction algorithm (new-generation snapshot freeze, NG SSF) on the image quality of cardiac computed tomography (CT) images in patients with mechanical valve prostheses compared to standard images without motion correction and to compare the diagnostic accuracy of NG SSF and standard CT image sets for the detection of prosthetic valve abnormalities. METHODS A total of 20 patients with 32 mechanical valves who underwent wide-coverage detector cardiac CT with single-heartbeat acquisition were included. The CT image quality for subvalvular (below the prosthesis) and valvular regions (valve leaflets) of mechanical valves was assessed by two observers on a four-point scale (1 = poor, 2 = fair, 3 = good, and 4 = excellent). Paired t-tests or Wilcoxon signed rank tests were used to compare image quality scores and the number of diagnostic phases (image quality score≥3) between the standard image sets and NG SSF image sets. Diagnostic performance for detection of prosthetic valve abnormalities was compared between two image sets with the final diagnosis set by re-operation or clinical findings as the standard reference. RESULTS NG SSF image sets had better image quality scores than standard image sets for both valvular and subvalvular regions (P < 0.05 for both). The number of phases that were of diagnostic image quality per patient was significantly greater in the NG SSF image set than standard image set for both valvular and subvalvular regions (P < 0.0001). Diagnostic performance of NG SSF image sets for the detection of prosthetic abnormalities (20 pannus and two paravalvular leaks) was greater than that of standard image sets (P < 0.05). CONCLUSION Application of NG SSF can improve CT image quality and diagnostic accuracy in patients with mechanical valves compared to standard images.
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Affiliation(s)
- Young Joo Suh
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, South Korea
| | - Young Jin Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, South Korea.
| | - Jin Young Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, South Korea
| | - Suyon Chang
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, South Korea
| | - Dong Jin Im
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, South Korea
| | - Yoo Jin Hong
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, South Korea
| | - Byoung Wook Choi
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, South Korea
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Diagnostic performance of 256-row detector coronary CT angiography in patients with high heart rates within a single cardiac cycle: a preliminary study. Clin Radiol 2017; 72:694.e7-694.e14. [DOI: 10.1016/j.crad.2017.03.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 02/22/2017] [Accepted: 03/07/2017] [Indexed: 02/06/2023]
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Andreini D, Pontone G, Mushtaq S, Conte E, Perchinunno M, Guglielmo M, Volpato V, Annoni A, Baggiano A, Formenti A, Mancini ME, Beltrama V, Ditali V, Campari A, Fiorentini C, Bartorelli AL, Pepi M. Atrial Fibrillation: Diagnostic Accuracy of Coronary CT Angiography Performed with a Whole-Heart 230-µm Spatial Resolution CT Scanner. Radiology 2017; 284:676-684. [PMID: 28445682 DOI: 10.1148/radiol.2017161779] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Purpose To assess image quality, interpretability, diagnostic accuracy, and radiation exposure of a computed tomography (CT) scanner with 16-cm coverage and 230-µm spatial resolution at coronary artery evaluation in patients with atrial fibrillation (AF) by using invasive coronary angiography (ICA) as the reference method and to compare the results with those obtained in patients with sinus rhythm (SR). Materials and Methods Written informed consent and institutional ethics committee approval were obtained. Between March 2015 and February 2016, 166 consecutive patients were prospectively enrolled (83 with AF, 83 with SR). They underwent ICA and coronary CT angiography performed with a whole-heart CT scanner. Image quality, coronary segment interpretability, effective dose (ED), and diagnostic accuracy were assessed at CT angiography and were compared with those attained with ICA. Diagnostic performance of the groups was compared with the pairwise McNemar test. Results Mean heart rate during scanning was 83 beats per minute ± 21 (standard deviation) in the AF group and 63 beats per minute ± 14 in the SR group (P < .01). Coronary interpretability was 98.5% in the AF group and 98.4% in the SR group (P = .96). In a segment-based analysis, sensitivity and specificity in the detection of coronary stenosis of more than 50% compared with detection of ICA were 96.4% and 98.7%, respectively, in the chronic AF group (P = .98) and 95.6% and 98.1%, respectively, in the SR group (P = .32). In a patient-based analysis, sensitivity and specificity were 95.2% and 97.6%, respectively, in the chronic AF group (P = .95) and 97.8% and 94.7%, respectively, in the SR group (P = .93). Conclusion Whole-heart CT enables evaluation of coronary arteries with high image quality, low radiation exposure, and high diagnostic accuracy in patients with chronic AF, with a diagnostic performance similar to that in patients with SR. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Daniele Andreini
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Gianluca Pontone
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Saima Mushtaq
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Edoardo Conte
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Marco Perchinunno
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Marco Guglielmo
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Valentina Volpato
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Andrea Annoni
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Andrea Baggiano
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Alberto Formenti
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Maria Elisabetta Mancini
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Virginia Beltrama
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Valentina Ditali
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Alessandro Campari
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Cesare Fiorentini
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Antonio L Bartorelli
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
| | - Mauro Pepi
- From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.)
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Left atrium and pulmonary vein imaging using sub-millisiviert cardiac computed tomography: Impact on radiofrequency catheter ablation cumulative radiation exposure and outcome in atrial fibrillation patients. Int J Cardiol 2017; 228:805-811. [DOI: 10.1016/j.ijcard.2016.11.203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 11/06/2016] [Indexed: 01/08/2023]
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Lee SE, Chang HJ, Rizvi A, Hadamitzky M, Kim YJ, Conte E, Andreini D, Pontone G, Volpato V, Budoff MJ, Gottlieb I, Lee BK, Chun EJ, Cademartiri F, Maffei E, Marques H, Leipsic JA, Shin S, Choi JH, Chung N, Min JK. Rationale and design of the Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography IMaging (PARADIGM) registry: A comprehensive exploration of plaque progression and its impact on clinical outcomes from a multicenter serial coronary computed tomographic angiography study. Am Heart J 2016; 182:72-79. [PMID: 27914502 DOI: 10.1016/j.ahj.2016.09.003] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 09/17/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND The natural history of coronary artery disease (CAD) in patients with low-to-intermediate risk is not well characterized. Although earlier invasive serial studies have documented the progression of atherosclerotic burden, most were focused on high-risk patients only. The PARADIGM registry is a large, prospective, multinational dynamic observational registry of patients undergoing serial coronary computed tomographic angiography (CCTA). The primary aim of PARADIGM is to characterize the natural history of CAD in relation to clinical and laboratory data. DESIGN The PARADIGM registry (ClinicalTrials.govNCT02803411) comprises ≥2,000 consecutive patients across 9 cluster sites in 7 countries. PARADIGM sites were chosen on the basis of adequate CCTA volume, site CCTA proficiency, local demographic characteristics, and medical facilities to ensure a broad-based sample of patients. Patients referred for clinically indicated CCTA will be followed up and enrolled if they had a second CCTA scan. Patients will also be followed up beyond serial CCTA performance to identify adverse CAD events that include cardiac and noncardiac death, myocardial infarction, unstable angina, target vessel revascularization, and CAD-related hospitalization. SUMMARY The results derived from the PARADIGM registry are anticipated to add incremental insight into the changes in CCTA findings in accordance with the progression or regression of CAD that confer prognostic value beyond demographic and clinical characteristics.
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Affiliation(s)
- Sang-Eun Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Integrative Cardiovascular Imaging Center, Yonsei University Health System, Seoul, South Korea
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Integrative Cardiovascular Imaging Center, Yonsei University Health System, Seoul, South Korea.
| | - Asim Rizvi
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA
| | | | | | | | | | | | | | - Matthew J Budoff
- Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA, USA
| | - Ilan Gottlieb
- Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil
| | | | - Eun Ju Chun
- Seoul National University Bundang Hospital, South Korea
| | - Filippo Cademartiri
- Department of Radiology, Montréal Heart Institute/Université de Montréal, Montréal, Quebec, Canada
| | - Erica Maffei
- Department of Radiology, Montréal Heart Institute/Université de Montréal, Montréal, Quebec, Canada
| | | | - Jonathon A Leipsic
- Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Sanghoon Shin
- National Health Insurance Service Ilsan Hospital, South Korea
| | | | - Namsik Chung
- Division of Cardiology, Severance Cardiovascular Hospital, Integrative Cardiovascular Imaging Center, Yonsei University Health System, Seoul, South Korea
| | - James K Min
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA.
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