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D'Angelo T, Mastrodicasa D, Lanzafame LRM, Yel I, Koch V, Gruenewald LD, Sharma SP, Ascenti V, Micari A, Blandino A, Vogl TJ, Mazziotti S, Budde RPJ, Booz C. Optimization of window settings for coronary arteries assessment using spectral CT-derived virtual monoenergetic imaging. LA RADIOLOGIA MEDICA 2024; 129:999-1007. [PMID: 38935247 PMCID: PMC11252218 DOI: 10.1007/s11547-024-01835-6] [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: 10/01/2023] [Accepted: 06/19/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE To determine the optimal window setting for virtual monoenergetic images (VMI) reconstructed from dual-layer spectral coronary computed tomography angiography (DE-CCTA) datasets. MATERIAL AND METHODS 50 patients (30 males; mean age 61.1 ± 12.4 years who underwent DE-CCTA from May 2021 to June 2022 for suspected coronary artery disease, were retrospectively included. Image quality assessment was performed on conventional images and VMI reconstructions at 70 and 40 keV. Objective image quality was assessed using contrast-to-noise ratio (CNR). Two independent observers manually identified the best window settings (B-W/L) for VMI 70 and VMI 40 visualization. B-W/L were then normalized with aortic attenuation using linear regression analysis to obtain the optimized W/L (O-W/L) settings. Additionally, subjective image quality was evaluated using a 5-point Likert scale, and vessel diameters were measured to examine any potential impact of different W/L settings. RESULTS VMI 40 demonstrated higher CNR values compared to conventional and VMI 70. B-W/L settings identified were 1180/280 HU for VMI 70 and 3290/900 HU for VMI 40. Subsequent linear regression analysis yielded O-W/L settings of 1155/270 HU for VMI 70 and 3230/880 HU for VMI 40. VMI 40 O-W/L received the highest scores for each parameter compared to conventional (all p < 0.0027). Using O-W/L settings for VMI 70 and VMI 40 did not result in significant differences in vessel measurements compared to conventional images. CONCLUSION Optimization of VMI requires adjustments in W/L settings. Our results recommend W/L settings of 1155/270 HU for VMI 70 and 3230/880 HU for VMI 40.
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Affiliation(s)
- Tommaso D'Angelo
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital "Policlinico G. Martino", Via Consolare Valeria 1, 98100, Messina, Italy.
- Department of Radiology and Nuclear Medicine, Erasmus MC, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
| | - Domenico Mastrodicasa
- Department of Radiology, Stanford University School of Medicine, 453 Quarry Rd, MC 5659, Palo Alto, CA 94304-5659, USA
| | - Ludovica R M Lanzafame
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital "Policlinico G. Martino", Via Consolare Valeria 1, 98100, Messina, Italy
| | - Ibrahim Yel
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Vitali Koch
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Leon D Gruenewald
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Simran P Sharma
- Department of Radiology and Nuclear Medicine, Erasmus MC, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Velio Ascenti
- Department of Radiology, Policlinico Universitario Ospedale Maggiore, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Antonino Micari
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital "Policlinico G. Martino", Via Consolare Valeria 1, 98100, Messina, Italy
| | - Alfredo Blandino
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital "Policlinico G. Martino", Via Consolare Valeria 1, 98100, Messina, Italy
| | - Thomas J Vogl
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Silvio Mazziotti
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital "Policlinico G. Martino", Via Consolare Valeria 1, 98100, Messina, Italy
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus MC, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Christian Booz
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
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Scalia IG, Gheyath B, Tamarappoo BK, Moudgil R, Otton J, Pereyra M, Narayanasamy H, Larsen C, Herrmann J, Arsanjani R, Ayoub C. Chemotherapy Related Cardiotoxicity Evaluation-A Contemporary Review with a Focus on Cardiac Imaging. J Clin Med 2024; 13:3714. [PMID: 38999280 PMCID: PMC11242267 DOI: 10.3390/jcm13133714] [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: 06/20/2024] [Accepted: 06/21/2024] [Indexed: 07/14/2024] Open
Abstract
The long-term survivorship of patients diagnosed with cancer has improved due to accelerated detection and rapidly evolving cancer treatment strategies. As such, the evaluation and management of cancer therapy related complications has become increasingly important, including cardiovascular complications. These have been captured under the umbrella term "cardiotoxicity" and include left ventricular dysfunction and heart failure, acute coronary syndromes, valvular abnormalities, pericardial disease, arrhythmia, myocarditis, and vascular complications. These complications add to the burden of cardiovascular disease (CVD) or are risk factors patients with cancer treatment are presenting with. Of note, both pre- and newly developing CVD is of prognostic significance, not only from a cardiovascular perspective but also overall, potentially impacting the level of cancer therapy that is possible. Currently, there are varying recommendations and practices regarding CVD risk assessment and mitigating strategies throughout the cancer continuum. This article provides an overview on this topic, in particular, the role of cardiac imaging in the care of the patient with cancer. Furthermore, it summarizes the current evidence on the spectrum, prevention, and management of chemotherapy-related adverse cardiac effects.
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Affiliation(s)
- Isabel G. Scalia
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA; (I.G.S.)
| | - Bashaer Gheyath
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Balaji K. Tamarappoo
- Division of Cardiology, Banner University Medical Center, The University of Arizona College of Medicine, Phoenix, AZ 85004, USA
| | - Rohit Moudgil
- Department of Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - James Otton
- Clinical School, St. Vincent’s Hospital, UNSW, Sydney, NSW 2010, Australia
| | - Milagros Pereyra
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA; (I.G.S.)
| | - Hema Narayanasamy
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA; (I.G.S.)
| | - Carolyn Larsen
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA; (I.G.S.)
| | - Joerg Herrmann
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Reza Arsanjani
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA; (I.G.S.)
| | - Chadi Ayoub
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA; (I.G.S.)
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3
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Oikonomou EK, Aminorroaya A, Dhingra LS, Partridge C, Velazquez EJ, Desai NR, Krumholz HM, Miller EJ, Khera R. Real-world evaluation of an algorithmic machine-learning-guided testing approach in stable chest pain: a multinational, multicohort study. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2024; 5:303-313. [PMID: 38774380 PMCID: PMC11104476 DOI: 10.1093/ehjdh/ztae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/13/2024] [Accepted: 03/20/2024] [Indexed: 05/24/2024]
Abstract
Aims An algorithmic strategy for anatomical vs. functional testing in suspected coronary artery disease (CAD) (Anatomical vs. Stress teSting decIsion Support Tool; ASSIST) is associated with better outcomes than random selection. However, in the real world, this decision is rarely random. We explored the agreement between a provider-driven vs. simulated algorithmic approach to cardiac testing and its association with outcomes across multinational cohorts. Methods and results In two cohorts of functional vs. anatomical testing in a US hospital health system [Yale; 2013-2023; n = 130 196 (97.0%) vs. n = 4020 (3.0%), respectively], and the UK Biobank [n = 3320 (85.1%) vs. n = 581 (14.9%), respectively], we examined outcomes stratified by agreement between the real-world and ASSIST-recommended strategies. Younger age, female sex, Black race, and diabetes history were independently associated with lower odds of ASSIST-aligned testing. Over a median of 4.9 (interquartile range [IQR]: 2.4-7.1) and 5.4 (IQR: 2.6-8.8) years, referral to the ASSIST-recommended strategy was associated with a lower risk of acute myocardial infarction or death (hazard ratioadjusted: 0.81, 95% confidence interval [CI] 0.77-0.85, P < 0.001 and 0.74 [95% CI 0.60-0.90], P = 0.003, respectively), an effect that remained significant across years, test types, and risk profiles. In post hoc analyses of anatomical-first testing in the Prospective Multicentre Imaging Study for Evaluation of Chest Pain (PROMISE) trial, alignment with ASSIST was independently associated with a 17% and 30% higher risk of detecting CAD in any vessel or the left main artery/proximal left anterior descending coronary artery, respectively. Conclusion In cohorts where historical practices largely favour functional testing, alignment with an algorithmic approach to cardiac testing defined by ASSIST was associated with a lower risk of adverse outcomes. This highlights the potential utility of a data-driven approach in the diagnostic management of CAD.
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Affiliation(s)
- Evangelos K Oikonomou
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, PO Box 208017, New Haven, 06520-8017 CT, USA
| | - Arya Aminorroaya
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, PO Box 208017, New Haven, 06520-8017 CT, USA
| | - Lovedeep S Dhingra
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, PO Box 208017, New Haven, 06520-8017 CT, USA
| | - Caitlin Partridge
- Yale Center for Clinical Investigation, 2 Church Street South, New Haven, 06519 CT, USA
| | - Eric J Velazquez
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, PO Box 208017, New Haven, 06520-8017 CT, USA
| | - Nihar R Desai
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, PO Box 208017, New Haven, 06520-8017 CT, USA
| | - Harlan M Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, PO Box 208017, New Haven, 06520-8017 CT, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 195 Church Street 5th Floor, New Haven, 06510 CT, USA
| | - Edward J Miller
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, PO Box 208017, New Haven, 06520-8017 CT, USA
| | - Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, PO Box 208017, New Haven, 06520-8017 CT, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 195 Church Street 5th Floor, New Haven, 06510 CT, USA
- Section of Biomedical Informatics and Data Science, Yale School of Medicine, 100 College Street, New Haven, 06511 CT, USA
- Section of Health Informatics, Department of Biostatistics, Yale School of Public Health, 60 College Street, New Haven, 06510 CT, USA
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Scarpa Matuck BR, Akino N, Bakhshi H, Cox C, Ebrahimihoor E, Ishida M, Lemos PA, Lima JAC, Matheson MB, Orii M, Ostovaneh A, Ostovaneh MR, Schuijf JD, Szarf G, Trost JC, Yoshioka K, Arbab-Zadeh A. Ultra-high-resolution CT vs. invasive angiography for detecting hemodynamically significant coronary artery disease: Rationale and methods of the CORE-PRECISION multicenter study. J Cardiovasc Comput Tomogr 2024:S1934-5925(24)00107-2. [PMID: 38702271 DOI: 10.1016/j.jcct.2024.04.012] [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: 03/12/2024] [Revised: 04/18/2024] [Accepted: 04/22/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Direct coronary arterial evaluation via computed tomography (CT) angiography is the most accurate noninvasive test for the diagnosis of coronary artery disease (CAD). However, diagnostic accuracy is limited in the setting of severe coronary calcification or stents. Ultra-high-resolution CT (UHR-CT) may overcome this limitation, but no rigorous study has tested this hypothesis. METHODS The CORE-PRECISION is an international, multicenter, prospective diagnostic accuracy study testing the non-inferiority of UHR-CT compared to invasive coronary angiography (ICA) for identifying patients with hemodynamically significant CAD. The study will enroll 150 patients with history of CAD, defined as prior documentation of lumen obstruction, stenting, or a calcium score ≥400, who will undergo UHR-CT before clinically prompted ICA. Assessment of hemodynamically significant CAD by UHR-CT and ICA will follow clinical standards. The reference standard will be the quantitative flow ratio (QFR) with <0.8 defined as abnormal. All data will be analyzed in independent core laboratories. RESULTS The primary outcome will be the comparative diagnostic accuracy of UHR-CT vs. ICA for detecting hemodynamically significant CAD on a patient level. Secondary analyses will focus on vessel level diagnostic accuracy, quantitative stenosis analysis, automated contour detection, in-depth plaque analysis, and others. CONCLUSION CORE-PRECISION aims to investigate if UHR-CT is non-inferior to ICA for detecting hemodynamically significant CAD in high-risk patients, including those with severe coronary calcification or stents. We anticipate this study to provide valuable insights into the utility of UHR-CT in this challenging population and for its potential to establish a new standard for CAD assessment.
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Affiliation(s)
- Bruna R Scarpa Matuck
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Naruomi Akino
- Canon Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Hooman Bakhshi
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christopher Cox
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Elnaz Ebrahimihoor
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Masaru Ishida
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, Yahaba, Japan
| | - Pedro A Lemos
- Department of Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Joao A C Lima
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew B Matheson
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Makoto Orii
- Department of Radiology, Iwate Medical University, Yahaba, Japan
| | - Aysa Ostovaneh
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mohammad R Ostovaneh
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Gilberto Szarf
- Department of Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Jeffrey C Trost
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Armin Arbab-Zadeh
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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5
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Pergola V, Cameli M, Mattesi G, Mushtaq S, D’Andrea A, Guaricci AI, Pastore MC, Amato F, Dellino CM, Motta R, Perazzolo Marra M, Dellegrottaglie S, Pedrinelli R, Iliceto S, Nodari S, Perrone Filardi P, Pontone G. Multimodality Imaging in Advanced Heart Failure for Diagnosis, Management and Follow-Up: A Comprehensive Review. J Clin Med 2023; 12:7641. [PMID: 38137711 PMCID: PMC10743799 DOI: 10.3390/jcm12247641] [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: 11/06/2023] [Revised: 12/02/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Advanced heart failure (AHF) presents a complex landscape with challenges spanning diagnosis, management, and patient outcomes. In response, the integration of multimodality imaging techniques has emerged as a pivotal approach. This comprehensive review delves into the profound significance of these imaging strategies within AHF scenarios. Multimodality imaging, encompassing echocardiography, cardiac magnetic resonance imaging (CMR), nuclear imaging and cardiac computed tomography (CCT), stands as a cornerstone in the care of patients with both short- and long-term mechanical support devices. These techniques facilitate precise device selection, placement, and vigilant monitoring, ensuring patient safety and optimal device functionality. In the context of orthotopic cardiac transplant (OTC), the role of multimodality imaging remains indispensable. Echocardiography offers invaluable insights into allograft function and potential complications. Advanced methods, like speckle tracking echocardiography (STE), empower the detection of acute cell rejection. Nuclear imaging, CMR and CCT further enhance diagnostic precision, especially concerning allograft rejection and cardiac allograft vasculopathy. This comprehensive imaging approach goes beyond diagnosis, shaping treatment strategies and risk assessment. By harmonizing diverse imaging modalities, clinicians gain a panoramic understanding of each patient's unique condition, facilitating well-informed decisions. The aim is to highlight the novelty and unique aspects of recently published papers in the field. Thus, this review underscores the irreplaceable role of multimodality imaging in elevating patient outcomes, refining treatment precision, and propelling advancements in the evolving landscape of advanced heart failure management.
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Affiliation(s)
- Valeria Pergola
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35128 Padova, Italy; (G.M.); (F.A.); (M.P.M.); (S.I.)
| | - Matteo Cameli
- Department of Cardiovascular Diseases, University of Sienna, 53100 Siena, Italy; (M.C.); (M.C.P.)
| | - Giulia Mattesi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35128 Padova, Italy; (G.M.); (F.A.); (M.P.M.); (S.I.)
| | - Saima Mushtaq
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (S.M.); (C.M.D.); (G.P.)
| | | | - Andrea Igoren Guaricci
- University Cardiology Unit, Interdisciplinary Department of Medicine, Policlinic University Hospital, 70121 Bari, Italy;
| | - Maria Concetta Pastore
- Department of Cardiovascular Diseases, University of Sienna, 53100 Siena, Italy; (M.C.); (M.C.P.)
| | - Filippo Amato
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35128 Padova, Italy; (G.M.); (F.A.); (M.P.M.); (S.I.)
| | - Carlo Maria Dellino
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (S.M.); (C.M.D.); (G.P.)
| | - Raffaella Motta
- Unit of Radiology, Department of Medicine, Medical School, University of Padua, 35122 Padua, Italy;
| | - Martina Perazzolo Marra
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35128 Padova, Italy; (G.M.); (F.A.); (M.P.M.); (S.I.)
| | - Santo Dellegrottaglie
- Division of Cardiology, Ospedale Medico-Chirurgico Accreditato Villa dei Fiori, 80011 Acerra, Italy;
| | - Roberto Pedrinelli
- Cardiac, Thoracic and Vascular Department, University of Pisa, 56126 Pisa, Italy;
| | - Sabino Iliceto
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35128 Padova, Italy; (G.M.); (F.A.); (M.P.M.); (S.I.)
| | - Savina Nodari
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Institute of Cardiology, University of Brescia, 25123 Brescia, Italy;
| | - Pasquale Perrone Filardi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80138 Naples, Italy;
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (S.M.); (C.M.D.); (G.P.)
- Department of Biomedical, Surgical and Sciences, University of Milan, 20122 Milan, Italy
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Mushtaq S, Gigante C, Conte E, Capovilla TM, Sonck J, Tanzilli A, Barbato E, Monizzi G, Belmonte M, De Bruyne B, Bartorelli AL, Schillaci M, Marchetti D, Carerj ML, Pontone G, Collet C, Andreini D. Preoperative angiography-derived fractional flow reserve may predict coronary artery bypass grafting occlusion and disease progression. J Cardiovasc Med (Hagerstown) 2023; 24:651-658. [PMID: 37605957 DOI: 10.2459/jcm.0000000000001509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
BACKGROUND Graft occlusion after coronary artery bypass grafting (CABG) has been associated with competitive flow of native coronary arteries. OBJECTIVES To assess with coronary computed tomography angiography (CCTA) graft occlusion and coronary artery disease (CAD) progression of native vessels after CABG and their relationship with angiography-derived vessel fractional flow reserve (vFFR) performed before surgery. METHODS Between 2006 and 2018, serial vFFR analyses were obtained before CABG in each major native coronary vessel from two institutions. All patients underwent follow-up CCTA. RESULTS In 171 consecutive patients, serial preoperative angiograms were suitable for vFFR analysis of 298 grafted and 59 nongrafted vessels. Median time between CABG and CCTA was 2.1 years. Preoperative vFFR was assessed in 131 left anterior descending artery (LAD), 132 left circumflex artery (LCX) and 94 right coronary aretry (RCA) and was less than 0.80 in 255 of 298 bypassed vessels. Graft occlusion was observed at CCTA in 28 of 298 grafts. The median preoperative vFFR value of native coronaries was higher in occluded compared with patent grafts (0.75 vs. 0.60, P < 0.001) and was associated with graft. The best vFFR cut-off to predict graft occlusion was 0.67. Progression of CAD was higher in grafted than in nongrafted vessels (89.6 vs. 47.5%, P < 0.001). Pre-CABG vFFR predicted disease progression of grafted native vessels (AUC = 0.83). CONCLUSION Preoperative vFFR derived from invasive coronary angiography was able to predict graft occlusion and CAD progression of grafted coronary arteries.
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Affiliation(s)
| | | | | | | | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples
| | | | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples
| | | | | | | | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences
| | - Matteo Schillaci
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- University of Milan, Milan
| | - Davide Marchetti
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- University of Milan, Milan
| | - Maria Ludovica Carerj
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Diagnostic and Interventional Radiology Unit, Department of Biomedical Sciences and Morphological and Functional Imaging, 'G. Martino' University Hospital Messina, Messina
| | - Gianluca Pontone
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences
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7
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Gibarti C, Murín P, Huňavý M, Koribský R, Urban L, Studenčan M, Gál P. Adenosine vs. regadenoson for stress induction in dynamic CT perfusion scan of the myocardium: A single‑center retrospective comparison. Exp Ther Med 2023; 25:192. [PMID: 37020529 PMCID: PMC10068412 DOI: 10.3892/etm.2023.11891] [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: 09/21/2022] [Accepted: 01/27/2023] [Indexed: 03/18/2023] Open
Abstract
Cardiac computed tomography (CT) angiography offers several approaches to determine the hemodynamic severity of coronary artery obstruction. Dynamic myocardial perfusion is based on serial CT imaging of contrast flow into the myocardium and calculation of absolute myocardial perfusion rates. East-Slovak Institute of Cardiovascular Diseases has been the first center in Slovakia intensively using this modern technique to increase the quality level of non-invasive diagnosis of symptomatic patients with a low to moderate pre-test probability of ischemic heart disease. The present study included 46 patients with a mean age of 64 years (33 men and 13 women). Prior to the CT study, myocardial stress was pharmacologically (adenosine, n=15 and regadenoson, n=31) induced by vasodilatation of the coronary arteries. Hemodynamic parameters (myocardial blood flow) were evaluated in all patients following successful CT perfusion without complications, allergic reaction or other severe side effects. The present study revealed that regadenoson increased the heart rate following infusion with a higher magnitude compared with adenosine. Moreover, the effect of regadenoson was independent of patient's body mass index and was associated with a lower incidence of mild adverse effects. The present study provided further clinical evidence for a more wider use of regadenoson over adenosine.
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Affiliation(s)
- Claudia Gibarti
- Department of Radiology, East-Slovak Institute of Cardiovascular Diseases, Inc., 040 11 Košice, Slovakia
| | - Pavol Murín
- Department of First Department of Cardiology, East-Slovak Institute of Cardiovascular Diseases, Inc., 040 11 Košice, Slovakia
| | - Mikuláš Huňavý
- Department of First Department of Cardiology, East-Slovak Institute of Cardiovascular Diseases, Inc., 040 11 Košice, Slovakia
| | - Roman Koribský
- Department of Radiology, East-Slovak Institute of Cardiovascular Diseases, Inc., 040 11 Košice, Slovakia
| | - Lukáš Urban
- Department of Biomedical Research, East-Slovak Institute of Cardiovascular Diseases, Inc., 040 11 Košice, Slovakia
- Department of Pharmacology, Faculty of Medicine, Pavol Jozef Šafárik University, 040 11 Košice, Slovakia
| | - Martin Studenčan
- Department of Radiology, East-Slovak Institute of Cardiovascular Diseases, Inc., 040 11 Košice, Slovakia
| | - Peter Gál
- Department of Biomedical Research, East-Slovak Institute of Cardiovascular Diseases, Inc., 040 11 Košice, Slovakia
- Department of Pharmacology, Faculty of Medicine, Pavol Jozef Šafárik University, 040 11 Košice, Slovakia
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Yoshihara S. Evaluation of causal heart diseases in cardioembolic stroke by cardiac computed tomography. World J Radiol 2023; 15:98-117. [PMID: 37181820 PMCID: PMC10167814 DOI: 10.4329/wjr.v15.i4.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/08/2023] [Accepted: 03/30/2023] [Indexed: 04/26/2023] Open
Abstract
Cardioembolic stroke is a potentially devastating condition and tends to have a poor prognosis compared with other ischemic stroke subtypes. Therefore, it is important for proper therapeutic management to identify a cardiac source of embolism in stroke patients. Cardiac computed tomography (CCT) can detect the detailed visualization of various cardiac pathologies in the cardiac chambers, interatrial and interventricular septum, valves, and myocardium with few motion artifacts and few dead angles. Multiphase reconstruction images of the entire cardiac cycle make it possible to demonstrate cardiac structures in a dynamic manner. Consequently, CCT has the ability to provide high-quality information about causal heart disease in cardioembolic stroke. In addition, CCT can simultaneously evaluate obstructive coronary artery disease, which may be helpful in surgical planning in patients who need urgent surgery, such as cardiac tumors or infective endocarditis. This review will introduce the potential clinical applications of CCT in an ischemic stroke population, with a focus on diagnosing cardioembolic sources using CCT.
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Affiliation(s)
- Shu Yoshihara
- Department of Diagnostic Radiology, Iwata City Hospital, Iwata 438-8550, Shizuoka, Japan
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Geering L, Sartoretti T, Mergen V, Cundari G, Rusek S, Civaia F, Rossi P, Wildberger JE, Templin C, Manka R, Eberhard M, Alkadhi H. First in-vivo coronary stent imaging with clinical ultra high resolution photon-counting CT. J Cardiovasc Comput Tomogr 2023:S1934-5925(23)00085-0. [PMID: 36898952 DOI: 10.1016/j.jcct.2023.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Coronary stent imaging remains limited with conventional CT. In this patient study we evaluated the quality of coronary stent imaging and determined the optimal reconstruction settings for ultra-high-resolution (UHR) coronary CT angiography (cCTA) with clinical photon-counting-detector CT (PCD-CT). METHODS In this retrospective dual-center study, 22 patients with 36 coronary stents who underwent UHR cCTA with PCD-CT were included. Images with a slice thickness of 0.6mm and Bv40 kernel and UHR images at a slice thickness of 0.2mm with kernels of eight sharpness levels (Bv40, Bv44, Bv56, Bv60, Bv64, Bv72, Bv80, and Bv89) and adapted matrix-sizes and field-of-views were reconstructed. Image noise, contrast-to-noise-ratio (CNR), in-stent diameters, and differences of in-stent attenuation compared with adjacent segments were measured. Stent strut sharpness was quantified using data derived from line profiles. Subjective in-stent lumen visualization was rated by two blinded, independent readers. In-vitro stent diameters were taken as reference standard. RESULTS At increasing kernel sharpness, CNR decreased, in-stent diameter increased (1.8 ± 0.5mm for 0.6mm/Bv40 to 2.5 ± 0.5mm for 0.2mm/Bv89), and stent strut sharpness increased. Differences of in-stent attenuation decreased from 0.6mm/Bv40 to 0.2 mm/Bv60-Bv80 kernels, being not different from zero for the latter kernels (p > 0.05). Percentage (absolute) differences of measured to in-vitro diameters decreased from 40.1 ± 11.1% (1.2 ± 0.4mm) for 0.6mm/Bv40 to 16.6 ± 8% (0.5 ± 0.3mm) for 0.2mm/Bv89. There were no associations between stent angulation and in-stent diameter or attenuation differences (p > 0.05). Qualitative scores increased from suboptimal/good for 0.6mm/Bv40 to very good/excellent for 0.2mm/Bv64 and 0.2mm/Bv72. CONCLUSION UHR cCTA with clinical PCD-CT enables excellent in-vivo coronary stent lumen visualization.
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Affiliation(s)
- Ladina Geering
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thomas Sartoretti
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, the Netherlands; Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Victor Mergen
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Giulia Cundari
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, Italy
| | | | | | | | - Joachim E Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, the Netherlands; Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Robert Manka
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Matthias Eberhard
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Institute of Radiology, Spitäler Fmi AG, Spital Interlaken, Unterseen, Switzerland
| | - Hatem Alkadhi
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
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Tran-Nguyen N, Yan AT, Fremes S, Triverio P, Jimenez-Juan L. Abnormal Wall Shear Stress Area is Correlated to Coronary Artery Bypass Graft Remodeling 1 Year After Surgery. Ann Biomed Eng 2023:10.1007/s10439-023-03167-4. [PMID: 36871052 DOI: 10.1007/s10439-023-03167-4] [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: 11/17/2022] [Accepted: 02/12/2023] [Indexed: 03/06/2023]
Abstract
Coronary artery bypass graft surgery is a common intervention for coronary artery disease; however, it suffers from graft failure, and the underlying mechanisms are not fully understood. To better understand the relation between graft hemodynamics and surgical outcomes, we performed computational fluid dynamics simulations with deformable vessel walls in 10 study participants (24 bypass grafts) based on CT and 4D flow MRI one month after surgery to quantify lumen diameter, wall shear stress (WSS), and related hemodynamic measures. A second CT acquisition was performed one year after surgery to quantify lumen remodeling. Compared to venous grafts, left internal mammary artery grafts experienced lower abnormal WSS (< 1 Pa) area one month after surgery (13.8 vs. 70.1%, p = 0.001) and less inward lumen remodeling one year after surgery (- 2.4% vs. - 16.1%, p = 0.027). Abnormal WSS area one month post surgery correlated with percent change in graft lumen diameter one year post surgery (p = 0.030). This study shows for the first time prospectively a correlation between abnormal WSS area one month post surgery and graft lumen remodeling 1 year post surgery, suggesting that shear-related mechanisms may play a role in post-operative graft remodeling and might help explain differences in failure rates between arterial and venous grafts.
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Affiliation(s)
- Nhien Tran-Nguyen
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada.
| | - Andrew T Yan
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
- St. Michael's Hospital, Toronto, ON, Canada
| | - Stephen Fremes
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Sunnybrook Research Institute, Toronto, ON, Canada
| | - Piero Triverio
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Department of Electrical and Computer Engineering, University of Toronto, Toronto, ON, Canada
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada
| | - Laura Jimenez-Juan
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
- St. Michael's Hospital, Toronto, ON, Canada
- Sunnybrook Research Institute, Toronto, ON, Canada
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11
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Intravenous Contrast Material for Cardiac Computed Tomography: Results From the Open-label Multicenter, Multivendor Italian Registry of Contrast Material Use in Cardiac Computed Tomography. J Thorac Imaging 2023; 38:128-135. [PMID: 36821381 DOI: 10.1097/rti.0000000000000644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The Italian Registry of Contrast Material use in Cardiac Computed Tomography (iRCM-CCT) is a multicenter, multivendor, observational study on the use of contrast media (CM) in patients undergoing cardiac computed tomography (CCT). The aim of iRCM-CCT is to assess image quality and safety profile of intravenous CM compounds. MATERIALS AND METHODS iRCM-CCT enrolled 1842 consecutive patients undergoing CCT (≥50 per site) at 20 cluster sites with the indication of suspected coronary artery disease. Demographic characteristics, CCT, and CM protocols, clinical indications, safety markers, radiation dose reports, qualitative (ie, poor vascular enhancement) and quantitative (ie, HU attenuation values) image parameters were recorded. A centralized coordinating center collected and assessed all image parameters. RESULTS The cohort included 891 men and 951 women (age: 63±14 y, body mass index: 26±4 kg/m2) studied with ≥64 detector rows computed tomography scanners and different iodinated intravenous CM protocols and compounds (iodixanol, iopamidol, iohexol, iobitridol, iopromide, and iomeprol). The following vascular attenuation was reported: 504±147 HU in the aorta, 451±146 HU in the right coronary artery, 474±146 HU in the left main, 451±146 HU in the left anterior descending artery, and 441±149 HU in the circumflex artery. In 4% of cases the image quality was not satisfactory due to poor enhancement. The following adverse reactions to CM were recorded: 6 (0.3%) extravasations and 17 (0.9%) reactions (11 mild, 4 moderate, 2 severe). CONCLUSIONS In a multicenter registry on CM use during CCT the prevalence of CM-related adverse reactions was very low. The appropriate use of CM is a major determinant of image quality.
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Lee SH, Hong D, Dai N, Shin D, Choi KH, Kim SM, Kim HK, Jeon KH, Ha SJ, Lee KY, Park TK, Yang JH, Song YB, Hahn JY, Choi SH, Choe YH, Gwon HC, Ge J, Lee JM. Anatomic and Hemodynamic Plaque Characteristics for Subsequent Coronary Events. Front Cardiovasc Med 2022; 9:871450. [PMID: 35677691 PMCID: PMC9167998 DOI: 10.3389/fcvm.2022.871450] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesWhile coronary computed tomography angiography (CCTA) enables the evaluation of anatomic and hemodynamic plaque characteristics of coronary artery disease (CAD), the clinical roles of these characteristics are not clear. We sought to evaluate the prognostic implications of CCTA-derived anatomic and hemodynamic plaque characteristics in the prediction of subsequent coronary events.MethodsThe study cohort consisted of 158 patients who underwent CCTA with suspected CAD within 6–36 months before percutaneous coronary intervention (PCI) for acute myocardial infarction (MI) or unstable angina and age-/sex-matched 62 patients without PCI as the control group. Preexisting high-risk plaque characteristics (HRPCs: low attenuation plaque, positive remodeling, napkin-ring sign, spotty calcification, minimal luminal area <4 mm2, or plaque burden ≥70%) and hemodynamic parameters (per-vessel fractional flow reserve [FFRCT], per-lesion ΔFFRCT, and percent ischemic myocardial mass) were analyzed from prior CCTA. The primary outcome was a subsequent coronary event, which was defined as a composite of vessel-specific MI or revascularization for unstable angina. The prognostic impact of clinical risk factors, HRPCs, and hemodynamic parameters were compared between vessels with (160 vessels) and without subsequent coronary events (329 vessels).ResultsVessels with a subsequent coronary event had higher number of HRPCs (2.6 ± 1.4 vs. 2.3 ± 1.4, P = 0.012), lower FFRCT (0.76 ± 0.13 vs. 0.82 ± 0.11, P < 0.001), higher ΔFFRCT (0.14 ± 0.12 vs. 0.09 ± 0.08, P < 0.001), and higher percent ischemic myocardial mass (29.0 ± 18.5 vs. 26.0 ± 18.4, P = 0.022) than those without a subsequent coronary event. Compared with clinical risk factors, HRPCs and hemodynamic parameters showed higher discriminant abilities for subsequent coronary events with ΔFFRCT being the most powerful predictor. HRPCs showed additive discriminant ability to clinical risk factors (c-index 0.620 vs. 0.558, P = 0.027), and hemodynamic parameters further increased discriminant ability (c-index 0.698 vs. 0.620, P = 0.001) and reclassification abilities (NRI 0.460, IDI 0.061, P < 0.001 for all) for subsequent coronary events. Among vessels with negative FFRCT (>0.80), adding HRPCs into clinical risk factors significantly increased discriminant and reclassification abilities for subsequent coronary events (c-index 0.687 vs. 0.576, P = 0.005; NRI 0.412, P = 0.002; IDI 0.064, P = 0.001) but not for vessels with positive FFRCT (≤0.80).ConclusionIn predicting subsequent coronary events, both HRPCs and hemodynamic parameters by CCTA allow better prediction of subsequent coronary events than clinical risk factors. HRPCs provide more incremental predictability than clinical risk factors alone among vessels with negative FFRCT but not among vessels with positive FFRCT.Clinical Trial RegistrationPreDiction and Validation of Clinical CoursE of Coronary Artery DiSease With CT-Derived Non-INvasive HemodYnamic Phenotyping and Plaque Characterization (DESTINY Study), NCT04794868.
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Affiliation(s)
- Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - David Hong
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Neng Dai
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Doosup Shin
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | - Ki Hong Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sung Mok Kim
- Department of Radiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyun Kuk Kim
- Department of Internal Medicine and Cardiovascular Center, Chosun University Hospital, University of Chosun College of Medicine, Gwangju, South Korea
| | - Ki-Hyun Jeon
- Division of Cardiovascular Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sang Jin Ha
- Division of Cardiology, Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, South Korea
| | - Kwan Yong Lee
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young Bin Song
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yeon Hyeon Choe
- Department of Radiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- *Correspondence: Joo Myung Lee ;
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Carrabba N, Pontone G, 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, Francone M, Esposito A. Appropriateness criteria for the use of cardiac computed tomography, SIC-SIRM part 2: acute chest pain evaluation; stent and coronary artery bypass graft patency evaluation; planning of coronary revascularization and transcatheter valve procedures; cardiomyopathies, electrophysiological applications, cardiac masses, cardio-oncology and pericardial diseases evaluation. J Cardiovasc Med (Hagerstown) 2022; 23:290-303. [PMID: 35486680 DOI: 10.2459/jcm.0000000000001303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In the past 20 years, cardiac computed tomography (CCT) has become a pivotal technique for the noninvasive diagnostic workup of coronary and cardiac diseases. Continuous technical and methodological improvements, combined with fast growing scientific evidence, have progressively expanded the clinical role of CCT. Randomized clinical trials documented the value of CCT in increasing the cost-effectiveness of the management of patients with acute chest pain presenting in the emergency department, also during the pandemic. Beyond the evaluation of stents and surgical graft patency, the anatomical and functional coronary imaging have the potential to guide treatment decision-making and planning for complex left main and three-vessel coronary disease. Furthermore, there has been an increasing demand to use CCT for preinterventional planning in minimally invasive procedures, such as transcatheter valve implantation and mitral valve repair. Yet, the use of CCT as a roadmap for tailored electrophysiological procedures has gained increasing importance to assure maximum success. In the meantime, innovations and advanced postprocessing tools have generated new potential applications of CCT from the simple coronary anatomy to the complete assessment of structural, functional and pathophysiological biomarkers of cardiac disease. 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 Cardiology (SIC) and the Italian Society of Medical and Interventional Radiology (SIRM), represents the second of two consensus documents collecting the expert opinion of cardiologists and radiologists about current appropriate use of CCT.
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Affiliation(s)
- Nazario Carrabba
- Department of Cardiothoracovascular Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence
| | | | - Daniele Andreini
- Centro Cardiologico Monzino IRCCS.,Department of Clinical Sciences and Community Health, University of Milan, Milan
| | - Vitaliano Buffa
- Department of Radiology, Azienda Ospedaliera San Camillo Forlanini, Rome
| | | | - Iacopo Carbone
- Department of Radiological, Oncological and Pathological Sciences, 'Sapienza' University of Rome, Rome
| | - Alberto Clemente
- Department of Radiology, CNR (National Council of Research)/Tuscany Region 'Gabriele Monasterio' Foundation (FTGM), Massa
| | - Andrea Igoren Guaricci
- University Cardiology Unit, Cardiothoracic Department, Policlinic University Hospital, Bari
| | | | - Ciro Indolfi
- Department of Medical and Surgical Sciences, Magna Grecia University, Catanzaro
| | - Ludovico La Grutta
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties-ProMISE, University of Palermo
| | - Guido Ligabue
- Department of Medical and Surgical Sciences, Modena and Raggio Emilia University.,Radiology Department, AOU of Modena, Modena
| | - Carlo Liguori
- Radiology Unit, Ospedale del Mare -A.S.L Na1- Centro, Naples
| | - Giuseppe Mercuro
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari
| | | | - Danilo Neglia
- Cardiovascular Department, CNR (National Council of Research)/Tuscany Region 'Gabriele Monasterio' Foundation (FTGM), Pisa
| | - Anna Palmisano
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS Ospedale San Raffaele.,Vita-Salute San Raffaele University, Milan
| | - Roberto Sciagrà
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence
| | - 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.,Vita-Salute San Raffaele University, Milan
| | - Marco Francone
- Department of Radiological, Oncological and Pathological Sciences, 'Sapienza' University of Rome, Rome
| | - Antonio Esposito
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS Ospedale San Raffaele.,Vita-Salute San Raffaele University, Milan
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Wieske V, Walther M, Dubourg B, Alkadhi H, Nørgaard BL, Meijs MFL, Diederichsen ACP, Wan YL, Mickley H, Nikolaou K, Shabestari AA, Halvorsen BA, Martuscelli E, Sun K, Herzog BA, Marcus RP, Leschka S, Garcia MJ, Ovrehus KA, Knuuti J, Mendoza-Rodriguez V, Bettencourt N, Muraglia S, Buechel RR, Kaufmann PA, Zimmermann E, Tardif JC, Budoff MJ, Schlattmann P, Dewey M. Computed tomography angiography versus Agatston score for diagnosis of coronary artery disease in patients with stable chest pain: individual patient data meta-analysis of the international COME-CCT Consortium. Eur Radiol 2022; 32:5233-5245. [PMID: 35267094 PMCID: PMC9279219 DOI: 10.1007/s00330-022-08619-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/05/2022] [Accepted: 01/28/2022] [Indexed: 11/29/2022]
Abstract
Objectives There is conflicting evidence about the comparative diagnostic accuracy of the Agatston score versus computed tomography angiography (CTA) in patients with suspected obstructive coronary artery disease (CAD). Purpose To determine whether CTA is superior to the Agatston score in the diagnosis of CAD. Methods In total 2452 patients with stable chest pain and a clinical indication for invasive coronary angiography (ICA) for suspected CAD were included by the Collaborative Meta-analysis of Cardiac CT (COME-CCT) Consortium. An Agatston score of > 400 was considered positive, and obstructive CAD defined as at least 50% coronary diameter stenosis on ICA was used as the reference standard. Results Obstructive CAD was diagnosed in 44.9% of patients (1100/2452). The median Agatston score was 74. Diagnostic accuracy of CTA for the detection of obstructive CAD (81.1%, 95% confidence interval [CI]: 77.5 to 84.1%) was significantly higher than that of the Agatston score (68.8%, 95% CI: 64.2 to 73.1%, p < 0.001). Among patients with an Agatston score of zero, 17% (101/600) had obstructive CAD. Diagnostic accuracy of CTA was not significantly different in patients with low to intermediate (1 to < 100, 100–400) versus moderate to high Agatston scores (401–1000, > 1000). Conclusions Results in our international cohort show CTA to have significantly higher diagnostic accuracy than the Agatston score in patients with stable chest pain, suspected CAD, and a clinical indication for ICA. Diagnostic performance of CTA is not affected by a higher Agatston score while an Agatston score of zero does not reliably exclude obstructive CAD. Key Points • CTA showed significantly higher diagnostic accuracy (81.1%, 95% confidence interval [CI]: 77.5 to 84.1%) for diagnosis of coronary artery disease when compared to the Agatston score (68.8%, 95% CI: 64.2 to 73.1%, p < 0.001). • Diagnostic performance of CTA was not affected by increased amount of calcium and was not significantly different in patients with low to intermediate (1 to <100, 100–400) versus moderate to high Agatston scores (401–1000, > 1000). • Seventeen percent of patients with an Agatston score of zero showed obstructive coronary artery disease by invasive angiography showing absence of coronary artery calcium cannot reliably exclude coronary artery disease. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-022-08619-4.
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Affiliation(s)
- Viktoria Wieske
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Mario Walther
- Department of Fundamental Sciences, Jena University of Applied Sciences, Jena, Germany
| | - Benjamin Dubourg
- Cardiac Imaging Unit, Department of Radiology, Rouen University Hospital, Rouen, France
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Bjarne L Nørgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Matthijs F L Meijs
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, Netherlands
| | | | - Yung-Liang Wan
- Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Chang Gung Memorial Hospital at Linkou, Taoyaun City, Taiwan
| | - Hans Mickley
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | - Abbas A Shabestari
- Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Eugenio Martuscelli
- Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Kai Sun
- Department of Radiology, Baotou Central Hospital, Baotou, Inner Mongolia Province, China
| | | | - Roy P Marcus
- Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Sebastian Leschka
- Department of Radiology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Mario J Garcia
- Department of Cardiology, Montefiore, University Hospital for the Albert Einstein College of Medicine, New York, NY, USA
| | | | - Juhani Knuuti
- Turku University Hospital and University of Turku, Turku, Finland
| | | | - Nuno Bettencourt
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | | | - Ronny R Buechel
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Elke Zimmermann
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | | | | | - Peter Schlattmann
- Institute of Medical Statistics, Computer Sciences and Data Science, University Hospital of Friedrich Schiller University Jena, Jena, Germany
| | - Marc Dewey
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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15
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Zeng Y, Geng D, Zhang J. Noise-optimized virtual monoenergetic imaging technology of the third-generation dual-source computed tomography and its clinical applications. Quant Imaging Med Surg 2021; 11:4627-4643. [PMID: 34737929 DOI: 10.21037/qims-20-1196] [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: 10/24/2020] [Accepted: 06/02/2021] [Indexed: 02/05/2023]
Abstract
The third-generation dual-source computed tomography (DSCT) is among the most advanced imaging methods. It employs noise-optimized virtual monoenergetic imaging (VMI+) technology. It uses the frequency-split method to extract high-contrast image information from low-energy images and low-noise information from images reconstructed at an optimal energy level, combining them to obtain the final image with improved quality. This review is the first to summarize the results of clinical studies that primarily and recently evaluated the VMI+ technique based on tumor, blood vessel, and other lesion classification. We aim to assist radiologists in quickly selecting the appropriate energy level when performing image reconstruction for superior image quality in clinical work and providing several ideas for future scientific research of the VMI+ technique. Presently, VMI+ reconstruction is mostly used for images of various tumors or blood vessels, including coronary plaques, coronary stents, deep vein thromboses, pulmonary embolisms (PEs), active arterial hemorrhages, and endoleaks after endovascular aneurysm repair. In addition, VMI+ has been used for imaging children's heads, liver lesions, pancreatic lacerations, and reducing metal artifacts. Regarding the reconstruction at the optimal energy level, the VMI+ technique yielded a higher image quality than the pre-optimized virtual monoenergetic imaging (VMI) technique and single-energy CT. Moreover, either low concentrations of contrast medium or low iodine injection rates can be applied before VMI+ reconstruction at a low-energy level to reduce contrast agent-related kidney injury risk. After reconstructing an image at the optimal energy level, both the image's window width and level can also be adjusted to improve the image effect's reach and diagnosis suitability. To improve image quality and lesion-imaging clarity and reduce the use of contrast agents, VMI+ reconstruction technology has been applied clinically, in which the selection of energy level is the key to the whole reconstruction process. Our review summarizes these optimal levels for radiologists' reference and suggests new ideas for the direction of future VMI+ research.
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Affiliation(s)
- Yanwei Zeng
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China.,Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China.,Center for Shanghai Intelligent Imaging for Critical Brain Diseases Engineering and Technology Research, Shanghai, China
| | - Daoying Geng
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China.,Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China.,Center for Shanghai Intelligent Imaging for Critical Brain Diseases Engineering and Technology Research, Shanghai, China
| | - Jun Zhang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China.,Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China.,Center for Shanghai Intelligent Imaging for Critical Brain Diseases Engineering and Technology Research, Shanghai, China
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16
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Tridandapani S, Banait-Deshmane S, Aziz MU, Bhatti P, Singh SP. Coronary computed tomographic angiography: A review of the techniques, protocols, pitfalls, and radiation dose. J Med Imaging Radiat Sci 2021; 52:S1-S11. [PMID: 34565701 DOI: 10.1016/j.jmir.2021.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/13/2021] [Accepted: 08/28/2021] [Indexed: 11/26/2022]
Abstract
Coronary computed tomographic angiography (CCTA) is a viable alternative to catheter coronary angiography for several clinical indications, chiefly because it is fast and non-invasive. For effective clinical use of CCTA, various technical and patient factors should be considered. In this brief review article, we discuss the indication and contraindications for CCTA, technical requirements for CCTA including radiation dose, patient preparation principles, image post-processing, and pitfalls and artifacts of CCTA.
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Affiliation(s)
- Srini Tridandapani
- Department of Radiology, University of Alabama, Birmingham, AL, USA; School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA.
| | | | | | - Pamela Bhatti
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Satinder P Singh
- Department of Radiology, University of Alabama, Birmingham, AL, USA
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17
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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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18
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Vasilakis GM, Lakhani DA, Adelanwa A, Hogg JP, Kim C. Atypical imaging presentation of a massive intracavitary cardiac thrombus: A case report and brief review of the literature. Radiol Case Rep 2021; 16:2847-2852. [PMID: 34401011 PMCID: PMC8350016 DOI: 10.1016/j.radcr.2021.06.089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 01/08/2023] Open
Abstract
Intracavitary cardiac thrombi, uncommonly found in the right chambers, have been shown to form secondary to endocardial and myocardial diseases. The differential diagnosis for an intracavitary cardiac mass is broad, including primary cardiac tumors, cardiac metastases, anatomic variants, vegetations, and thrombi. Here we present a unique case with a large calcified intracavitary cardiac thrombus in a 26-year-old woman with obesity, immune thrombocytopenic purpura, and a new diagnosis of systemic lupus erythematosus. Initial imaging presentation in this case masqueraded as a tumor, delaying the true diagnosis. A combination of cardiac imaging techniques, including transthoracic and transesophageal echocardiograms, cardiac CT, and cardiac MRI were required to correctly diagnose this calcified bland thrombus.
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Affiliation(s)
- Georgia M Vasilakis
- School of Medicine, West Virginia University School of Medicine, WV, 26506, USA
| | - Dhairya A Lakhani
- Department of Radiology, West Virginia University, Morgantown, WV, 26506, USA
| | - Ayodele Adelanwa
- Department of Pathology, West Virginia University, Morgantown, WV, 26506, USA
| | - Jeffery P Hogg
- Department of Radiology, West Virginia University, Morgantown, WV, 26506, USA
| | - Cathy Kim
- Department of Radiology, West Virginia University, Morgantown, WV, 26506, USA.,Section of Cardiothoracic Imaging, Department of Radiology, West Virginia University, Morgantown, WV, 26506, USA
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19
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Sieren MM, Maintz D, Gutberlet M, Krombach GA, Bamberg F, Hunold P, Lehmkuhl L, Fischbach K, Reinartz S, Antoch G, Barkhausen J, Sandstede J, Völker M, Naehle C. Current Status of Cardiovascular Imaging in Germany: Structured Data from the National Certification Program, ESCR Registry, and Survey among Radiologists. ROFO-FORTSCHR RONTG 2021; 194:181-191. [PMID: 34384112 DOI: 10.1055/a-1554-9236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE In the light of the increasing importance of cardiovascular cross-sectional imaging in current guidelines, the goal of this study is to provide a comprehensive overview of cardiovascular imaging (CVI) offered by radiological institutions across Germany. MATERIALS AND METHODS Data were extracted from the national certification program database of the German Roentgen Society (DRG) from 2015-2021. A nationwide online survey among radiology institutes (university hospitals, non-university hospitals, and private practices) was conducted for 2019, and data was extracted from the European Society of Cardiovascular Radiology (ESCR) registry. The data collection's key points included the number of centers and individuals certified for CVI, the number of cardiac CT and MRI examinations performed, the reporting habits, and the participation in the ESCR registry. RESULTS 71 centers and 1278 persons, both with a substantial increase since 2015, were registered and certified by the DRG to perform CVI. According to the survey, a total of 69,286 CT and 64,281 MRI examinations were performed annually. Data from the survey and the ESCR registry indicated that reporting was mostly done solely by radiologists or, to a lesser degree, in joint consensus meetings with non-radiologists. The overall participation rate in the ESCR registry was 48 % among the survey's participants. CONCLUSION This comprehensive analysis demonstrates that high-quality CVI by radiologists is available nationwide. The current challenges are to provide the best medical and technical quality of CVI by radiology for patient care and to ensure economic sustainability in the German health care system to accommodate the predicted substantial need for CVI in the future. KEY POINTS · High-quality advanced CVI service by radiologists is available nationwide.. · Highly qualified specialist knowledge is widely represented from university to private practices.. · Certification programs successfully contribute to the dissemination & deepening of CVI expertise.. · The ESCR registry is an established international tool for the documentation of CVI.. CITATION FORMAT · Sieren M, Maintz D, Gutberlet M et al. Current Status of Cardiovascular Imaging in Germany: Structured Data from the National Certification Program, ESCR Registry, and Survey among Radiologists. Fortschr Röntgenstr 2021; DOI: 10.1055/a-1554-9236.
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Affiliation(s)
- Malte Maria Sieren
- Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - David Maintz
- Department for Interventional and Diagnostic Radiology, University Hospital Cologne, Germany
| | - Matthias Gutberlet
- Department for Diagnostic and Interventional Radiology, Heart Center Leipzig - University Leipzig, Germany.,Steering Committee Chair MRCT-Registry of the ESCR, ESCR, Vienna, Austria
| | - Gabriele Anja Krombach
- Department of Diagnostic and Interventional Radiology, University-Hospital Gießen, Germany
| | - Fabian Bamberg
- Department for Diagnostic and Interventional Radiology, University Hospital Freiburg, Germany
| | - Peter Hunold
- n/a, FOKUS Radiologie & Nuklearmedizin, Göttingen, Germany
| | - Lukas Lehmkuhl
- Department for Diagnostic and Interventional Radiology, RHÖN Clinic, Campus Bad Neustadt, Germany
| | - Katharina Fischbach
- Diagnostische Radiologie, Otto-von-Guericke-Universität, Magdeburg, Germany.,Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Otto von Guericke University, Magdeburg, Germany
| | - Sebastian Reinartz
- Department for Diagnostic and Interventional Radiology, University Hospital Aachen, Germany
| | - Gerald Antoch
- Department for Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University Düsseldorf, University Hospital Düsseldorf, Germany
| | - Jörg Barkhausen
- Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - Jörn Sandstede
- Hamburg Wördemanns Weg, Radiologische Allianz, Hamburg, Germany.,Berufsverband der deutschen Radiologen e.V. (BDR), Munich, Germany
| | - Martin Völker
- Bereich Wissenschaft, Nachwuchsförderung, Zertifizierung, German Roentgen Society "Deutsche Röntgengesellschaft", Berlin, Germany
| | - Claas Naehle
- Department for Interventional and Diagnostic Radiology, University Hospital Cologne, Germany
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20
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Coronary CT Angiography Guided Medical Therapy in Subclinical Atherosclerosis. J Clin Med 2021; 10:jcm10040625. [PMID: 33562179 PMCID: PMC7914610 DOI: 10.3390/jcm10040625] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 12/11/2022] Open
Abstract
The goals of primary prevention in coronary atherosclerosis are to avoid sudden cardiac death, myocardial infarction or the need for revascularization procedures. Successful prevention will rely on accurate identification, effective therapy and monitoring of those at risk. Identification and potential monitoring can be achieved using cardiac computed tomography (CT). Cardiac CT can determine coronary artery calcification (CAC), a useful surrogate of coronary atherosclerosis burden. Cardiac CT can also assess coronary CT angiography (CCTA). CCTA can identify arterial lumen narrowing and highlight mural atherosclerosis hitherto hidden from other anatomical approaches. Herein we consider the role of CCTA and CAC-scoring in subclinical atherosclerosis. We explore the use of these modalities in screening and discuss data that has used CCTA for guiding primary prevention. We examine therapeutic trials using CCTA to determine the effects of plaque-modifying therapies. Finally, we address the role of CCTA and CAC to guide therapy as defined in current primary prevention documents. CCTA has emerged as an essential tool in the detection and management of clinical coronary artery disease. To date, its role in subclinical atherosclerosis is less well defined, yet with modern CT scanners and continued pharmacotherapy development, CCTA is likely to achieve a more prominent place in the primary prevention of coronary atherosclerosis.
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21
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Potential Application of Cardiac Computed Tomography for Early Detection of Coronary Atherosclerosis: From Calcium Score to Advanced Atherosclerosis Analysis. J Clin Med 2021; 10:jcm10030521. [PMID: 33535691 PMCID: PMC7867151 DOI: 10.3390/jcm10030521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/14/2021] [Accepted: 01/21/2021] [Indexed: 12/16/2022] Open
Abstract
In the present article, an overview of advanced analysis of coronary atherosclerosis by coronary computed tomography angiography (CCTA) is provided, focusing on the potential application of this technique in a primary prevention setting. Coronary artery calcium score (CACS) has a well-demonstrated prognostic value even in a primary prevention setting; however, fibro-fatty, high-risk coronary plaque may be missed by this tool. On the contrary, even if not recommended for primary prevention in the general population, CCTA may enable early high-risk atherosclerosis detection, and specific subgroups of patients may benefit from its application. However, further studies are needed to determine the possible use of CCTA in a primary prevention setting.
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22
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The Role of Cardiac Computed Tomography in Valve Disease and Valve Intervention Planning. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-020-00879-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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23
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Zhang N, Yang G, Zhang W, Wang W, Zhou Z, Zhang H, Xu L, Chen Y. Fully automatic framework for comprehensive coronary artery calcium scores analysis on non-contrast cardiac-gated CT scan: Total and vessel-specific quantifications. Eur J Radiol 2021; 134:109420. [PMID: 33302029 PMCID: PMC7814341 DOI: 10.1016/j.ejrad.2020.109420] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/27/2020] [Accepted: 11/14/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To develop a fully automatic multiview shape constraint framework for comprehensive coronary artery calcium scores (CACS) quantification via deep learning on nonenhanced cardiac CT images. METHODS In this retrospective single-centre study, a multi-task deep learning framework was proposed to detect and quantify coronary artery calcification from CT images collected between October 2018 and March 2019. A total of 232 non-contrast cardiac-gated CT scans were retrieved and studied (80 % for model training and 20 % for testing). CACS results of testing datasets (n = 46), including Agatston score, calcium volume score, calcium mass score, were calculated fully automatically and manually at total and vessel-specific levels, respectively. RESULTS No significant differences were found in CACS quantification obtained using automatic or manual methods at total and vessel-specific levels (Agatston score: automatic 535.3 vs. manual 542.0, P = 0.993; calcium volume score: automatic 454.2 vs. manual 460.6, P = 0.990; calcium mass score: automatic 128.9 vs. manual 129.5, P = 0.992). Compared to the ground truth, the number of calcified vessels can be accurate recognized automatically (total: automatic 107 vs. manual 102, P = 0.125; left main artery: automatic 15 vs. manual 14, P = 1.000 ; left ascending artery: automatic 37 vs. manual 37, P = 1.000; left circumflex artery: automatic 22 vs. manual 20, P = 0.625; right coronary artery: automatic 33 vs. manual 31, P = 0.500). At the patient's level, there was no statistic difference existed in the classification of Agatston scoring (P = 0.317) and the number of calcified vessels (P = 0.102) between the automatic and manual results. CONCLUSIONS The proposed framework can achieve reliable and comprehensive quantification for the CACS, including the calcified extent and distribution indicators at both total and vessel-specific levels.
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Affiliation(s)
- Nan Zhang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 2(nd) Anzhen Road, Chaoyang District, Beijing, China
| | - Guang Yang
- Cardiovascular Research Centre, Royal Brompton Hospital, SW3 6NP, London, UK; National Heart and Lung Institute, Imperial College London, London, SW7 2AZ, UK
| | - Weiwei Zhang
- School of Biomedical Engineering, Sun Yat-Sen University, China
| | - Wenjing Wang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 2(nd) Anzhen Road, Chaoyang District, Beijing, China
| | - Zhen Zhou
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 2(nd) Anzhen Road, Chaoyang District, Beijing, China
| | - Heye Zhang
- School of Biomedical Engineering, Sun Yat-Sen University, China
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 2(nd) Anzhen Road, Chaoyang District, Beijing, China.
| | - Yundai Chen
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
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24
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Gul M, Sheikh M, Chaudhry A, Gerges L, Al Halabi H, Feldman E, Chaudhry A. Role of cardiac nuclear stress perfusion exam after computed tomographic coronary angiogram for evaluation of obstructive coronary artery disease in patients with chest pain. J Thorac Dis 2020; 12:5067-5077. [PMID: 33145083 PMCID: PMC7578483 DOI: 10.21037/jtd-2019-pitd-12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Clinical workup for chest pain varies among institutions. Acute coronary syndrome (ACS) is the primary diagnosis to rule out in the differential diagnosis, due to its associated mortality and morbidity. Although studies have demonstrated efficacy of coronary computed tomographic angiography (CCTA) in diagnosis obstructive coronary artery disease (CAD), there is limited evidence in the clinical value of performing cardiac nuclear stress perfusion imaging [myocardial perfusion imaging (MPI)] exam in patients with chest pain after undergoing CCTA. We aim to evaluate clinical value of follow-up nuclear cardiac MPI in patients with chest pain who have undergone recent CCTA. Methods A total of 1,000 patients were evaluated in this IRB approved retrospective study who presented with symptoms of ACS. Patients who had elevated troponin or abnormal electrocardiogram (ECG) findings at initial presentation or prior to cardiac nuclear MPI were excluded from the study. All patients who underwent 64- or 320-detector row ECG-gated CCTA as well as a follow-up nuclear MPI. Patients who had diagnostics studies limited by artifact [e.g., suboptimal intravenous (IV) contrast bolus in CCTA, motion artifact on CCTA or MPI, etc.] were excluded. Results One hundred patients met the inclusion criteria. Patient demographics include average age 64.3 [32–89] years, 59 male, 41 females. Ninety-five/100 patients had at least one vessel with 50–70% coronary artery diameter stenosis measured on CCTA. There were no focal perfusion abnormalities identified on cardiac nuclear MPI in patients with less than 70% stenosis diagnosed on CCTA. Five percent of patients were identified with coronary arterial narrowing greater than 70% on CCTA and all 5 of these patients have evidence of abnormal cardiac nuclear stress test (perfusion abnormalities, chest pain, abnormal ECG). Conclusions In low-to-intermediate risk patients with chest pain and evidence of non-critical coronary artery stenosis (i.e., less than 70% stenosis) diagnosed on CCTA, a follow-up cardiac nuclear perfusion imaging is of limited value.
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Affiliation(s)
- Maryam Gul
- Precision Rheumatology, Anaheim, CA, USA
| | - Mubashir Sheikh
- Department of Diagnostic and Interventional Radiology, City of Hope National Medical Center, Duarte, CA, USA
| | - Abbas Chaudhry
- Department of Diagnostic and Interventional Radiology, City of Hope National Medical Center, Duarte, CA, USA
| | - Luke Gerges
- Department of Diagnostic and Interventional Radiology, City of Hope National Medical Center, Duarte, CA, USA
| | - Hadi Al Halabi
- Department of Diagnostic and Interventional Radiology, City of Hope National Medical Center, Duarte, CA, USA
| | - Eric Feldman
- Department of Diagnostic and Interventional Radiology, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Ammar Chaudhry
- Department of Diagnostic and Interventional Radiology, Stony Brook University Medical Center, Stony Brook, NY, USA
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25
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Garcia AM, Assunção-Jr AN, Dantas-Jr RN, Parga JR, Ganem F. Stent evaluation by coronary computed tomography angiography: a comparison between Iopamidol-370 and Ioversol-320 hypo-osmolar iodine concentration contrasts. Br J Radiol 2020; 93:20200078. [PMID: 32816561 DOI: 10.1259/bjr.20200078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Qualitative and quantitative image analysis between Iopamidol-370 and Ioversol-320 in stents´ evaluation by coronary computed tomography angiography (CTA). METHODS Sixty-five patients with low-risk stable angina undergoing stent follow-up with coronary CTA were assigned to Iopamidol I-370 (n = 33) or Ioversol I-320 (n = 32) in this prospective, double-blind, non-inferiority, randomized trial. Stent lumen image quality was graded by 5-point Likert Scale. Lumen mean attenuation was measured at native coronary segments: pre-stent, post-stent, distal segments and at coronary plaques. Lumen attenuation increase (LAI) ratio was calculated for all stents. Heart rate (HR) variation, premature heart beats (PHB), heat sensation (HS), blooming and beam hardening were also assessed. RESULTS Image quality was similar between groups, with no significant difference (Likert score 4.48 ± 0.75 vs 4.54 ± 0.65, p = 0.5). There were similarities in LAI ratio between I-370 and I-320 (0.39 ± 0.42 vs 0.48 ± 0.44 HU, p = 0.08). Regarding lumen mean attenuation at native coronary segments, a significant difference was observed, with I-320 presenting lower values, including contrast mean attenuation in distal segments. After statistical multivariate analysis, three variables correlated with stent image quality: 1) stent diameter, 2) HR variation and 3) stent lumen LAI ratio. CONCLUSIONS There was no significant difference between Iopamidol-370 mgI ml-1 and Ioversol-320 mgI ml-1 contrasts regarding overall stent lumen image quality, which was mainly influenced by stent diameter, HR and LAI ratio.Advances in knowledge:Coronary CTA allows adequate stents' visualization and image quality is influenced by stent diameter, HR variation and LAI ratio.Stents' image quality showed no difference between different concentration contrasts (I-370 vs. I-320); however, higher concentration contrasts may provide an improved overall visualization, especially regarding coronary distal segments.
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26
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Takaoka H, Uehara M, Saito Y, Ota J, Iida Y, Takahashi M, Sano K, Komuro I, Kobayashi Y. Improved Diagnostic Performance of New-generation 320-slice Computed Tomography with Forward-projected Model-based Iterative Reconstruction SoluTion for the Assessment of Late Enhancement in Left Ventricular Myocardium. Intern Med 2020; 59:2095-2103. [PMID: 32493851 PMCID: PMC7516322 DOI: 10.2169/internalmedicine.4561-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective Forward-projected Model-based Iterative Reconstruction SoluTion (FIRST) is a novel reconstruction method. We investigated the improvement in the diagnostic performance for the detection of abnormal late enhancement (LE) in left ventricular myocardium (LVM) using a new-generation 320-slice computed tomography (CT) device with FIRST. Methods This is a retrospective study that included 100 adult patients who underwent cardiac CT including a late phase scan and magnetic resonance imaging (MRI) within 3 months. The first 50 consecutive patients (first-generation group) underwent first-generation 320-slice CT without FIRST, and the next 50 consecutive patients (second-generation group) underwent second-generation 320-slice CT with FIRST. We compared the diagnostic performance of the first- and second-generation 320-slice CT with FIRST with MRI as a reference standard to detect LE in LVM. Results In the patient-based analysis, the sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of detection of LE on CT were 79%, 90%, 92%, 76%, and 84%, respectively, in the first-generation group and 97%, 84%, 91%, 94%, and 92%, respectively, in the second-generation group. The sensitivity was significantly higher in the second-generation group than in the first-generation group (p=0.049). In the segment-based analysis, the sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of detection of LE on CT were 69%, 96%, 83%, 92%, and 90%, respectively, in the first-generation group and 87%, 94%, 84%, 95%, and 92%, respectively, in the second-generation group. The sensitivity and negative predictive value were significantly higher in the second-generation group than in the first-generation group (p<0.001 and p=0.016). The contrast-noise ratio was significantly higher in the second-generation group than in the first-generation group (5.6±1.7 vs. 2.8±1.1, p<0.001), and the radiation dose for the assessment of LE on CT was significantly higher in the first-generation group than in the second-generation group (4.7±2.7 mSv vs. 2.3±0.1 mSv, p<0.001). Conclusion The diagnostic performance for the detection of LE in LVM significantly improved with the use of second-generation 320-slice CT and FIRST.
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Affiliation(s)
- Hiroyuki Takaoka
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
| | - Masae Uehara
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Japan
| | - Yuichi Saito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
| | - Joji Ota
- Department of Radiology, Chiba University Hospital, Japan
| | - Yasunori Iida
- Department of Cardiovascular Surgery, Saiseikai Yokohamashi Tobu Hospital, Japan
| | - Manami Takahashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
| | - Koichi Sano
- Department of Cardiovascular Medicine, Eastern Chiba Medical Center, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
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Foldyna B, Udelson JE, Karády J, Banerji D, Lu MT, Mayrhofer T, Bittner DO, Meyersohn NM, Emami H, Genders TSS, Fordyce CB, Ferencik M, Douglas PS, Hoffmann U. Pretest probability for patients with suspected obstructive coronary artery disease: re-evaluating Diamond-Forrester for the contemporary era and clinical implications: insights from the PROMISE trial. Eur Heart J Cardiovasc Imaging 2020; 20:574-581. [PMID: 30520944 DOI: 10.1093/ehjci/jey182] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 10/31/2018] [Indexed: 11/13/2022] Open
Abstract
AIMS To update pretest probabilities (PTP) for obstructive coronary artery disease (CAD ≥ 50%) across age, sex, and clinical symptom strata, using coronary computed tomography angiography (CTA) in a large contemporary population of patients with stable chest pain referred to non-invasive testing. METHODS AND RESULTS We included patients enrolled in the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) trial and randomized to CTA. Exclusively level III-certified readers, blinded to demographic and clinical data, assessed the prevalence of CAD ≥ 50% in a central core lab. After comparing the recent European Society of Cardiology-Diamond and Forrester PTP (ESC-DF) with the actual observed prevalence of CAD ≥ 50%, we created a new PTP set by replacing the ESC-DF PTP with the observed prevalence of CAD ≥ 50% across strata of age, sex, and type of angina. In 4415 patients (48.3% men; 60.5 ± 8.2 years; 78% atypical angina; 11% typical angina; 11% non-anginal chest pain), the observed prevalence of CAD ≥ 50% was 13.9%, only one-third of the average ESC-DF PTP (40.6; P < 0.001 for difference). The PTP in the new set ranged 2-48% and were consistently lower than the ESC-DF PTP across all age, sex, and angina type categories. Initially, 4284/4415 (97%) patients were classified as intermediate-probability by the ESC-DF (PTP 15-85%); using the PROMISE-PTP, 50.2% of these patients were reclassified to the low PTP category (PTP < 15%). CONCLUSION The ESC-DF PTP overestimate vastly the actual prevalence of CAD ≥ 50%. A new set of PTP, derived from results of non-invasive testing, may substantially reduce the need for non-invasive tests in stable chest pain.
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Affiliation(s)
- Borek Foldyna
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, USA
| | - James E Udelson
- Tufts University School of Medicine and the Cardiovascular Center, Tufts Medical Center, 800 Washington Street North, Boston, MA, USA
| | - Júlia Karády
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, USA.,Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, Hungary
| | - Dahlia Banerji
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, USA
| | - Michael T Lu
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, USA
| | - Thomas Mayrhofer
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, USA.,School of Business Studies, Stralsund University of Applied Sciences, Zur Schwedenschanze 15, Stralsund, Germany
| | - Daniel O Bittner
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, USA.,Department of Cardiology, Friedrich-Alexander University Erlangen-Nürnberg, University Hospital Erlangen, Maximilianspl. 2, Erlangen, Germany
| | - Nandini M Meyersohn
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, USA
| | - Hamed Emami
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, USA
| | - Tessa S S Genders
- Duke Clinical Research Institute, Duke University School of Medicine, 2400 Pratt Street, Durham, NC, USA
| | - Christopher B Fordyce
- Division of Cardiology, University of British Columbia, 2775 Laurel Street, Vancouver, BC, Canada
| | - Maros Ferencik
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, USA.,Knight Cardiovascular Institute, Oregon Health and Science University, 3181 S.W. Sam Jackson Park Road, Portland, OR, USA
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, 2400 Pratt Street, Durham, NC, USA
| | - Udo Hoffmann
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, USA
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Ngam PI, Ong CC, Chai P, Wong SS, Liang CR, Teo LLS. Computed tomography coronary angiography - past, present and future. Singapore Med J 2020; 61:109-115. [PMID: 32488269 DOI: 10.11622/smedj.2020028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Computed tomography coronary angiography (CTCA) is a robust and reliable non-invasive alternative imaging modality to invasive coronary angiography, which is the reference standard in evaluating the degree of coronary artery stenosis. CTCA has high negative predictive value and can confidently exclude significant coronary artery disease (CAD) in low to intermediate risk patients. Over the years, substantial effort has been made to reduce the radiation dose and increase the cost efficiency of CTCA. In this review, we present the evolution of computed tomography scanners in the context of coronary artery imaging as well as its clinical applications and limitations. We also highlight the future directions of CTCA as a one-stop non-invasive imaging modality for anatomic and functional assessment of CAD.
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Affiliation(s)
- Pei Ing Ngam
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Ching Ching Ong
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Ping Chai
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Siong Sung Wong
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Chong Ri Liang
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Lynette Li San Teo
- Department of Diagnostic Imaging, National University Hospital, Singapore
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Diekhoff T, Kainberger F, Oleaga L, Dewey M, Zimmermann E. Effectiveness of the clinical decision support tool ESR eGUIDE for teaching medical students the appropriate selection of imaging tests: randomized cross-over evaluation. Eur Radiol 2020; 30:5684-5689. [PMID: 32435929 PMCID: PMC7476994 DOI: 10.1007/s00330-020-06942-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/17/2020] [Accepted: 05/07/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate ESR eGUIDE-the European Society of Radiology (ESR) e-Learning tool for appropriate use of diagnostic imaging modalities-for learning purposes in different clinical scenarios. METHODS This anonymized evaluation was performed after approval of ESR Education on Demand leadership. Forty clinical scenarios were developed in which at least one imaging modality was clinically most appropriate, and the scenarios were divided into sets 1 and 2. These sets were provided to medical students randomly assigned to group A or B to select the most appropriate imaging test for each scenario. Statistical comparisons were made within and across groups. RESULTS Overall, 40 medical students participated, and 31 medical students (78%) answered both sets. The number of correctly chosen imaging methods per set in these 31 paired samples was significantly higher when answered with versus without use of ESR eGUIDE (13.7 ± 2.6 questions vs. 12.1 ± 3.2, p = 0.012). Among the students in group A, who first answered set 1 without ESR eGUIDE (11.1 ± 3.2), there was significant improvement when set 2 was answered with ESR eGUIDE (14.3 ± 2.5, p = 0.013). The number of correct answers in group B did not drop when set 2 was answered without ESR eGUIDE (12.4 ± 2.6) after having answered set 1 first with ESR eGUIDE (13.0 ± 2.7, p = 0.66). CONCLUSION The clinical decision support tool ESR eGUIDE is suitable for training medical students in choosing the best radiological imaging modality in typical scenarios, and its use in teaching radiology can thus be recommended. KEY POINTS • ESR eGUIDE improved the number of appropriately selected imaging modalities among medical students. • This improvement was also seen in the group of students which first selected imaging tests without ESR eGUIDE. • In the student group which used ESR eGUIDE first, appropriate selection remained stable even without the teaching tool.
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Affiliation(s)
- Torsten Diekhoff
- Department of Radiology, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universitat Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Franz Kainberger
- Department of Radiology, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universitat Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Laura Oleaga
- Department of Radiology, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universitat Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Marc Dewey
- Department of Radiology, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universitat Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Elke Zimmermann
- Department of Radiology, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universitat Berlin, Charitéplatz 1, 10117, Berlin, Germany
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Coronary computed tomography angiography using model-based iterative reconstruction algorithms in the detection of significant coronary stenosis: how the plaque type influences the diagnostic performance. Pol J Radiol 2019; 84:e522-e529. [PMID: 32082450 PMCID: PMC7016499 DOI: 10.5114/pjr.2019.91259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 11/04/2019] [Indexed: 01/14/2023] Open
Abstract
Purpose To evaluate the ability of coronary computed tomography angiography (CCTA) with model-based iterative reconstruction (MBIR) algorithm in detecting significant coronary artery stenosis compared with invasive coronary angiography (ICA). Material and methods We retrospectively identified 55 patients who underwent CCTA using the MBIR algorithm with evidence of at least one significant stenosis (≥ 50%) and an ICA within three months. Patients were stratified based on calcium score; stenoses were classified by type and by coronary segment involved. Dose-length-product was compared with the literature data obtained with previous reconstruction algorithms. Coronary artery stenosis was estimated on ICAs based on a qualitative method. Results CCTA data were confirmed by ICA in 89% of subjects, and in 73% and 94% of patients with CS < 400 and ≥ 400, respectively. ICA confirmed 81% of calcific stenoses, 91% of mixed, and 67% of soft plaques. Both the dose exposure of patients with prospective acquisition (34) and the exposure of the whole population were significantly lower than the standard of reference (p < 0.001 and p = 0.007). Conclusions CCTA with MBIR is valuable in detecting significant coronary artery stenosis with a solid reduction of radiation dose. Diagnostic performance was influenced by plaque composition, being lower compared with ICA for patients with lower CAC score and soft plaques; the visualisation of an intraluminal hypodensity could cause false positives, particularly in D1 and MO segments.
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Balbi M, Dapoto A, Brambilla P, Senni M, Sironi S. Incidental cardiac aspergillomas in an immunocompromised woman. Radiol Case Rep 2019; 15:120-124. [PMID: 31798758 PMCID: PMC6883306 DOI: 10.1016/j.radcr.2019.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 09/09/2019] [Accepted: 10/14/2019] [Indexed: 10/26/2022] Open
Abstract
We report a case of 3 autopsy proven incidental cardiac aspergillomas, a rare and yet deadly manifestation caused by Aspergillus. A 48-year-old Caucasian woman affected by a large B-cell lymphoma was referred to our institute for a whole-body fluorine-18 fluorodeoxyglucose positron emission tomography/contrast-enhanced computed tomography restaging examination, which demonstrated 3 intracardiac masses. The patient was hospitalized, and both a transthoracic echocardiogram and a cardiac magnetic resonance imaging examination were performed. None of the imaging modalities provided a definitive diagnosis. A positive serum galactomannan assay allowed for the initiation of antifungal therapy, but, nevertheless, the patient died a few days later. This case highlights the need to consider cardiac aspergilloma in the differential diagnosis of cardiac masses, especially in immunocompromised patients. Though noninvasive imaging modalities and cardiac magnetic resonance imaging, in particular, help determine the nature of a cardiac lesion, cardiac aspergilloma shows no distinctive radiological features. A high degree of clinical suspicion is therefore key to achieving a timely diagnosis. Histopathological examination with microbiological confirmation remains the diagnostic gold standard.
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Affiliation(s)
- Maurizio Balbi
- University of Milano-Bicocca, School of Medicine and Surgery, Via Cadore 48, 20900 Monza, Italy.,Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
| | - Annarita Dapoto
- University of Milano-Bicocca, School of Medicine and Surgery, Via Cadore 48, 20900 Monza, Italy.,Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
| | - Paolo Brambilla
- Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
| | - Michele Senni
- Department of Cardiology, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
| | - Sandro Sironi
- University of Milano-Bicocca, School of Medicine and Surgery, Via Cadore 48, 20900 Monza, Italy.,Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
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Abstract
Intracardiac masses are classified as neoplastic or non-neoplastic. Prognosis varies based on the diagnosis of the mass since treatment options differ greatly. As novel imaging techniques emerge, a multimodality approach to the evaluation of intracardiac masses becomes an important part of non-invasive evaluation prior to potential surgical planning or oncological treatment. The purpose of this article is to compare the available imaging modalities-echocardiography, cardiovascular magnetic resonance, cardiac computed tomography, nuclear imaging, and emerging novel hybrid imaging techniques for future clinical applications-and to review the characteristic features seen on those modalities for the most common intracardiac masses.
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Computed Tomography in Heart Failure. CURRENT CARDIOVASCULAR IMAGING REPORTS 2019. [DOI: 10.1007/s12410-019-9512-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Emerging Role of Coronary Computed Tomography Angiography in Lipid-Lowering Therapy: a Bridge to Image-Guided Personalized Medicine. Curr Cardiol Rep 2019; 21:72. [DOI: 10.1007/s11886-019-1170-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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35
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Screening for Early Lung Cancer, Chronic Obstructive Pulmonary Disease, and Cardiovascular Disease (the Big-3) Using Low-dose Chest Computed Tomography. J Thorac Imaging 2019; 34:160-169. [DOI: 10.1097/rti.0000000000000379] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Ghanem AM, Matta JR, Elgarf R, Hamimi A, Muniyappa R, Ishaq H, Hadigan C, McConnell MV, Gharib AM, Abd-Elmoniem KZ. Sexual Dimorphism of Coronary Artery Disease in a Low- and Intermediate-Risk Asymptomatic Population: Association with Coronary Vessel Wall Thickness at MRI in Women. Radiol Cardiothorac Imaging 2019; 1:e180007. [PMID: 32076665 DOI: 10.1148/ryct.2019180007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/25/2019] [Accepted: 02/15/2019] [Indexed: 01/07/2023]
Abstract
Purpose To demonstrate the association between coronary vessel wall thickness (VWT) measured at MRI and coronary artery disease (CAD) risk in asymptomatic groups at low and intermediate risk on the basis of Framingham score. Materials and Methods A total of 131 asymptomatic adults were prospectively enrolled. All participants underwent CT angiography for scoring CAD, and coronary VWT was measured at 3.0-T MRI. Nonlinear single and multivariable regression analyses with consideration for interaction with sex were performed to investigate the association of traditional atherosclerotic risk factors and VWT with CT angiography-based CAD scores. Results The analysis included 62 women and 62 men with low or intermediate Framingham score of less than 20%. Age (mean age, 45.0 years ± 14.5 [standard deviation]) and body mass index were not different between the groups. Age, sex, and VWT were individually significantly associated with all CT angiography-based CAD scores (P < .05). Additionally, sex was a significant effect modifier of the associations with all CAD scores. In men, age was the only statistically significant independent risk factor of CAD; in women, VWT was the only statistically significant independent surrogate associated with increased CAD scores (P < .05). Conclusion In asymptomatic women, VWT MRI was the primary independent surrogate of CAD, whereas age was the strongest risk factor in men. This study suggests that VWT may be used as a CAD surrogate in women at low or intermediate risk of CAD. Further longitudinal studies are required to determine the potential implication and use of this MRI technique for the preventative management of CAD in women.© RSNA, 2019.
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Affiliation(s)
- Ahmed M Ghanem
- Biomedical and Metabolic Imaging Branch (A.M.G., J.R.M., R.E., A.H., H.I., A.M.G., K.Z.A.) and Diabetes, Endocrinology, and Obesity Branch, Clinical Endocrinology Section (R.M.), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Building 10, Room 3-5340, MSC 1263, 10 Center Drive, Bethesda, MD 20892; Laboratory of Immunoregulation, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md (C.H.); Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, Calif (M.V.M.); and Cardiovascular Health Innovations, Verily Life Sciences/Alphabet, South San Francisco, Calif (M.V.M.)
| | - Jatin Raj Matta
- Biomedical and Metabolic Imaging Branch (A.M.G., J.R.M., R.E., A.H., H.I., A.M.G., K.Z.A.) and Diabetes, Endocrinology, and Obesity Branch, Clinical Endocrinology Section (R.M.), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Building 10, Room 3-5340, MSC 1263, 10 Center Drive, Bethesda, MD 20892; Laboratory of Immunoregulation, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md (C.H.); Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, Calif (M.V.M.); and Cardiovascular Health Innovations, Verily Life Sciences/Alphabet, South San Francisco, Calif (M.V.M.)
| | - Reham Elgarf
- Biomedical and Metabolic Imaging Branch (A.M.G., J.R.M., R.E., A.H., H.I., A.M.G., K.Z.A.) and Diabetes, Endocrinology, and Obesity Branch, Clinical Endocrinology Section (R.M.), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Building 10, Room 3-5340, MSC 1263, 10 Center Drive, Bethesda, MD 20892; Laboratory of Immunoregulation, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md (C.H.); Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, Calif (M.V.M.); and Cardiovascular Health Innovations, Verily Life Sciences/Alphabet, South San Francisco, Calif (M.V.M.)
| | - Ahmed Hamimi
- Biomedical and Metabolic Imaging Branch (A.M.G., J.R.M., R.E., A.H., H.I., A.M.G., K.Z.A.) and Diabetes, Endocrinology, and Obesity Branch, Clinical Endocrinology Section (R.M.), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Building 10, Room 3-5340, MSC 1263, 10 Center Drive, Bethesda, MD 20892; Laboratory of Immunoregulation, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md (C.H.); Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, Calif (M.V.M.); and Cardiovascular Health Innovations, Verily Life Sciences/Alphabet, South San Francisco, Calif (M.V.M.)
| | - Ranganath Muniyappa
- Biomedical and Metabolic Imaging Branch (A.M.G., J.R.M., R.E., A.H., H.I., A.M.G., K.Z.A.) and Diabetes, Endocrinology, and Obesity Branch, Clinical Endocrinology Section (R.M.), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Building 10, Room 3-5340, MSC 1263, 10 Center Drive, Bethesda, MD 20892; Laboratory of Immunoregulation, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md (C.H.); Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, Calif (M.V.M.); and Cardiovascular Health Innovations, Verily Life Sciences/Alphabet, South San Francisco, Calif (M.V.M.)
| | - Hadjira Ishaq
- Biomedical and Metabolic Imaging Branch (A.M.G., J.R.M., R.E., A.H., H.I., A.M.G., K.Z.A.) and Diabetes, Endocrinology, and Obesity Branch, Clinical Endocrinology Section (R.M.), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Building 10, Room 3-5340, MSC 1263, 10 Center Drive, Bethesda, MD 20892; Laboratory of Immunoregulation, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md (C.H.); Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, Calif (M.V.M.); and Cardiovascular Health Innovations, Verily Life Sciences/Alphabet, South San Francisco, Calif (M.V.M.)
| | - Colleen Hadigan
- Biomedical and Metabolic Imaging Branch (A.M.G., J.R.M., R.E., A.H., H.I., A.M.G., K.Z.A.) and Diabetes, Endocrinology, and Obesity Branch, Clinical Endocrinology Section (R.M.), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Building 10, Room 3-5340, MSC 1263, 10 Center Drive, Bethesda, MD 20892; Laboratory of Immunoregulation, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md (C.H.); Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, Calif (M.V.M.); and Cardiovascular Health Innovations, Verily Life Sciences/Alphabet, South San Francisco, Calif (M.V.M.)
| | - Michael V McConnell
- Biomedical and Metabolic Imaging Branch (A.M.G., J.R.M., R.E., A.H., H.I., A.M.G., K.Z.A.) and Diabetes, Endocrinology, and Obesity Branch, Clinical Endocrinology Section (R.M.), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Building 10, Room 3-5340, MSC 1263, 10 Center Drive, Bethesda, MD 20892; Laboratory of Immunoregulation, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md (C.H.); Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, Calif (M.V.M.); and Cardiovascular Health Innovations, Verily Life Sciences/Alphabet, South San Francisco, Calif (M.V.M.)
| | - Ahmed M Gharib
- Biomedical and Metabolic Imaging Branch (A.M.G., J.R.M., R.E., A.H., H.I., A.M.G., K.Z.A.) and Diabetes, Endocrinology, and Obesity Branch, Clinical Endocrinology Section (R.M.), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Building 10, Room 3-5340, MSC 1263, 10 Center Drive, Bethesda, MD 20892; Laboratory of Immunoregulation, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md (C.H.); Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, Calif (M.V.M.); and Cardiovascular Health Innovations, Verily Life Sciences/Alphabet, South San Francisco, Calif (M.V.M.)
| | - Khaled Z Abd-Elmoniem
- Biomedical and Metabolic Imaging Branch (A.M.G., J.R.M., R.E., A.H., H.I., A.M.G., K.Z.A.) and Diabetes, Endocrinology, and Obesity Branch, Clinical Endocrinology Section (R.M.), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Building 10, Room 3-5340, MSC 1263, 10 Center Drive, Bethesda, MD 20892; Laboratory of Immunoregulation, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md (C.H.); Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, Calif (M.V.M.); and Cardiovascular Health Innovations, Verily Life Sciences/Alphabet, South San Francisco, Calif (M.V.M.)
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Sagone A, Iacopino S, Pieragnoli P, Arena G, Verlato R, Molon G, Rovaris G, Curnis A, Rauhe W, Lunati M, Senatore G, Landolina M, Allocca G, De Servi S, Tondo C. Cryoballoon ablation of atrial fibrillation is effectively feasible without previous imaging of pulmonary vein anatomy: insights from the 1STOP project. J Interv Card Electrophysiol 2019; 55:267-275. [PMID: 30607667 DOI: 10.1007/s10840-018-0500-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/17/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Pulmonary vein isolation by cryoablation (PVI-C) is a standard therapy for the treatment of atrial fibrillation (AF); however, PVI-C can become a challenging procedure due to the anatomy of the left atrium and pulmonary veins (PVs). Importantly, the utility of imaging before the procedure is still unknown regarding the long-term clinical outcomes following PVI-C. The aim of the analysis is to evaluate the impact of imaging before PVI-C on procedural data and AF recurrence. METHODS Patients with paroxysmal AF underwent an index PVI-C. Data were collected prospectively in the framework of 1STOP ClinicalService® project. Patients were divided into two groups according to the utilization of pre-procedural imaging of PV anatomy (via CT or MRI) or the non-usage of pre-procedural imaging. RESULTS Out of 912 patients, 461 (50.5%) were evaluated with CT or MRI before the PVI-C and denoted as the imaging group. Accordingly, 451 (49.5%) patients had no pre-procedural imaging and were categorized as the no imaging group. Patient baseline characteristics were comparable between the two cohorts, but the ablation centers that comprised the imaging group had fewer PVI-C cases per year than the no imaging group (p < 0.001). The procedure, fluoroscopy, and left atrial dwell times were significantly shorter in the no imaging cohort (p < 0.001). The rates of complications were significantly greater in the imaging group compared to the no imaging group (6.9% vs. 2.7%; p = 0.003); this difference was attributed to differences in transient diaphragmatic paralysis. The 12-month freedom from AF was 76.2% in the imaging group and 80.0% in the no imaging group (p = 0.390). CONCLUSIONS In our analysis, PVI-C was effective regardless of the availability of imaging data on PV anatomy.
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Affiliation(s)
- A Sagone
- Policlinico IRCCS Multimedica Sesto San Giovanni, Via Milanese, 300, 20099, Sesto San Giovanni, MI, Italy.
| | - S Iacopino
- Maria Cecilia Hospital, GVM Care & Research Group, Cotignola, Italy
| | | | - G Arena
- Nuovo Ospedale delle Apuane, Massa, Italy
| | - R Verlato
- ULSS 6 Euganea, Camposampiero, Italy
| | - G Molon
- IRCCS Sacro Cuore Don Calabria Don Calabria, Negrar, Italy
| | | | - A Curnis
- Azienda Ospedaliera Spedali Civili, Brescia, Italy
| | - W Rauhe
- Ospedale Centrale di Bolzano, Bolzano, Italy
| | - M Lunati
- A De Gasperis' CardioCenter, ASST GOM Niguarda, Milan, Italy
| | - G Senatore
- Presidio Ospedaliero Riunito, Ciriè, Italy
| | - M Landolina
- Department of Cardiology, Ospedale Maggiore, Crema, Italy
| | - G Allocca
- Santa Maria dei Battuti, Conegliano, Italy
| | - S De Servi
- Policlinico IRCCS Multimedica Sesto San Giovanni, Via Milanese, 300, 20099, Sesto San Giovanni, MI, Italy
| | - C Tondo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS Milan Azienda, Milan, Italy
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Symons R, De Bruecker Y, Roosen J, Van Camp L, Cork TE, Kappler S, Ulzheimer S, Sandfort V, Bluemke DA, Pourmorteza A. Quarter-millimeter spectral coronary stent imaging with photon-counting CT: Initial experience. J Cardiovasc Comput Tomogr 2018; 12:509-515. [PMID: 30509378 DOI: 10.1016/j.jcct.2018.10.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 08/12/2018] [Accepted: 10/09/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To evaluate the performance and clinical feasibility of 0.25 mm resolution mode of a dual-energy photon-counting detector (PCD) computed tomography (CT) system for coronary stent imaging and to compare the results to state-of-the-art dual-energy energy-integrating detector (EID) CT. MATERIALS AND METHODS Coronary stents with different diameters (2.0-4.0 mm) were examined inside a coronary artery phantom consisting of plastic tubes filled with iodine-based and gadolinium-based contrast material diluted to approximate clinical concentrations (n = 18). EID images were acquired using 2nd and 3rd generation dual-source CT systems (SOMATOM Flash and SOMATOM Force, Siemens Healthcare) at 0.60 mm (defined as standard-resolution (SR)) isotropic voxel size. Radiation-dose matched PCD images were acquired using a human prototype PCD system (Siemens Healthcare) at 0.50 mm (SR) and 0.25 mm (HR) imaging modes. Images were reconstructed using optimized convolution kernels. RESULTS Dual-energy HR PCD images significantly better stent lumen visualization (median: 69.5%, IQR: 61.2-78.9%) over dual-energy EID, and standard-resolution PCD images (median: 53.2-57.4%, all P < 0.01). HR PCD acquisitions reconstructed at SR image voxel size showed 25.3% lower image noise compared to SR PCD acquisitions (P < 0.001). High-resolution iodine and gadolinium maps, as well as virtual monoenergetic images, were calculated from the PCD data and enabled estimation of contrast agent concentration in the lumen without interference from the coronary stent. CONCLUSION HR spectral PCD imaging significantly improves coronary stent lumen visibility over dual-energy EID. When the PCD-HR data was reconstructed into standard voxel sizes (0.5 mm isotropic) the image noise decreased by 25% compared to SR acquisition of PCD. Both dual-energy systems were consistent in estimating contrast agent concentrations.
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Affiliation(s)
- Rolf Symons
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA; Department of Imaging & Pathology, University Hospitals Leuven, Leuven, Belgium
| | | | - John Roosen
- Department of Cardiology, Imelda Hospital, Bonheiden, Belgium
| | - Laurent Van Camp
- Department of Imaging & Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Tyler E Cork
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA; Departments of Radiological Sciences and Bioengineering, University of California, Los Angeles, CA, USA
| | | | | | - Veit Sandfort
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - David A Bluemke
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA; Department of Radiology, University of Wisconsin Madison, Madison, WI, USA
| | - Amir Pourmorteza
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA; Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA.
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Extracardiac findings on coronary computed tomography angiography in patients without significant coronary artery disease. Eur Radiol 2018; 29:1714-1723. [PMID: 30255246 DOI: 10.1007/s00330-018-5688-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/09/2018] [Accepted: 07/30/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To analyse extracardiac findings in patients without significant coronary artery disease (CAD) in general and in symptomatic patients in particular. METHODS We searched the Radiology Information System database for coronary computed tomography angiographies (CTA) performed from 2000-2014 and retrospectively enrolled 3,898 patients without significant CAD (coronary stenosis < 50%) in CTA. In 2,330 symptomatic patients, we analysed the spectrum of extracardiac findings and identified pathologies potentially explaining chest pain. Finally, we investigated variables affecting the number of extracardiac findings detected in CTA. RESULTS Overall extracardiac findings were found in 1,177 patients (30.2%; 95%CI, 28.8-31.7%). 94 patients (2.4%; 95%CI, 2.0-2.9%) had extracardiac findings with a recommendation for follow-up, sixteen patients (0.4%; 95%CI, 0.3-0.7%) had incidental urgent, and another three patients (0.1%; 95%CI, 0.1-0.2%) had incidental malignant extracardiac findings. 185 of 2,330 symptomatic patients (7.9%; 95%CI, 6.9-9.1%) revealed extracardiac findings potentially explaining chest pain after exclusion of significant CAD. The number of extracardiac findings increased significantly with patient age (p < 0.001) and the cumulative experience of the CT reader (p < 0.001). CONCLUSION 30.2% of patients undergoing CTA for exclusion of CAD had ECF, and 7.9% of symptomatic patients without significant CAD on their examination had findings that could potentially explain their symptoms. KEY POINTS • Of patients undergoing CTA, 2.8% have relevant incidental extracardiac findings. • CTA could identify the differential diagnosis of chest pain when excluding significant CAD. • Patient age and reader's professional experience influence the number of detected ECFs.
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Oikonomou EK, Marwan M, Desai MY, Mancio J, Alashi A, Hutt Centeno E, Thomas S, Herdman L, Kotanidis CP, Thomas KE, Griffin BP, Flamm SD, Antonopoulos AS, Shirodaria C, Sabharwal N, Deanfield J, Neubauer S, Hopewell JC, Channon KM, Achenbach S, Antoniades C. Non-invasive detection of coronary inflammation using computed tomography and prediction of residual cardiovascular risk (the CRISP CT study): a post-hoc analysis of prospective outcome data. Lancet 2018; 392:929-939. [PMID: 30170852 PMCID: PMC6137540 DOI: 10.1016/s0140-6736(18)31114-0] [Citation(s) in RCA: 562] [Impact Index Per Article: 93.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 04/29/2018] [Accepted: 05/10/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Coronary artery inflammation inhibits adipogenesis in adjacent perivascular fat. A novel imaging biomarker-the perivascular fat attenuation index (FAI)-captures coronary inflammation by mapping spatial changes of perivascular fat attenuation on coronary computed tomography angiography (CTA). However, the ability of the perivascular FAI to predict clinical outcomes is unknown. METHODS In the Cardiovascular RISk Prediction using Computed Tomography (CRISP-CT) study, we did a post-hoc analysis of outcome data gathered prospectively from two independent cohorts of consecutive patients undergoing coronary CTA in Erlangen, Germany (derivation cohort) and Cleveland, OH, USA (validation cohort). Perivascular fat attenuation mapping was done around the three major coronary arteries-the proximal right coronary artery, the left anterior descending artery, and the left circumflex artery. We assessed the prognostic value of perivascular fat attenuation mapping for all-cause and cardiac mortality in Cox regression models, adjusted for age, sex, cardiovascular risk factors, tube voltage, modified Duke coronary artery disease index, and number of coronary CTA-derived high-risk plaque features. FINDINGS Between 2005 and 2009, 1872 participants in the derivation cohort underwent coronary CTA (median age 62 years [range 17-89]). Between 2008 and 2016, 2040 patients in the validation cohort had coronary CTA (median age 53 years [range 19-87]). Median follow-up was 72 months (range 51-109) in the derivation cohort and 54 months (range 4-105) in the validation cohort. In both cohorts, high perivascular FAI values around the proximal right coronary artery and left anterior descending artery (but not around the left circumflex artery) were predictive of all-cause and cardiac mortality and correlated strongly with each other. Therefore, the perivascular FAI measured around the right coronary artery was used as a representative biomarker of global coronary inflammation (for prediction of cardiac mortality, hazard ratio [HR] 2·15, 95% CI 1·33-3·48; p=0·0017 in the derivation cohort, and 2·06, 1·50-2·83; p<0·0001 in the validation cohort). The optimum cutoff for the perivascular FAI, above which there is a steep increase in cardiac mortality, was ascertained as -70·1 Hounsfield units (HU) or higher in the derivation cohort (HR 9·04, 95% CI 3·35-24·40; p<0·0001 for cardiac mortality; 2·55, 1·65-3·92; p<0·0001 for all-cause mortality). This cutoff was confirmed in the validation cohort (HR 5·62, 95% CI 2·90-10·88; p<0·0001 for cardiac mortality; 3·69, 2·26-6·02; p<0·0001 for all-cause mortality). Perivascular FAI improved risk discrimination in both cohorts, leading to significant reclassification for all-cause and cardiac mortality. INTERPRETATION The perivascular FAI enhances cardiac risk prediction and restratification over and above current state-of-the-art assessment in coronary CTA by providing a quantitative measure of coronary inflammation. High perivascular FAI values (cutoff ≥-70·1 HU) are an indicator of increased cardiac mortality and, therefore, could guide early targeted primary prevention and intensive secondary prevention in patients. FUNDING British Heart Foundation, and the National Institute of Health Research Oxford Biomedical Research Centre.
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Affiliation(s)
- Evangelos K Oikonomou
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Mohamed Marwan
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Milind Y Desai
- Cleveland Clinic Heart and Vascular Institute, Cleveland, OH, USA
| | - Jennifer Mancio
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Alaa Alashi
- Cleveland Clinic Heart and Vascular Institute, Cleveland, OH, USA
| | | | - Sheena Thomas
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Laura Herdman
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Christos P Kotanidis
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Katharine E Thomas
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Brian P Griffin
- Cleveland Clinic Heart and Vascular Institute, Cleveland, OH, USA
| | - Scott D Flamm
- Cleveland Clinic Heart and Vascular Institute, Cleveland, OH, USA
| | - Alexios S Antonopoulos
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Cheerag Shirodaria
- Cardiology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Caristo Diagnostics, Oxford, UK
| | - Nikant Sabharwal
- Cardiology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - John Deanfield
- University College London Institute of Cardiovascular Science, London, UK
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK; Oxford Centre of Research Excellence, British Heart Foundation, Oxford, UK; Oxford Biomedical Research Centre, National Institute of Health Research, Oxford, UK
| | - Jemma C Hopewell
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Keith M Channon
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK; Oxford Centre of Research Excellence, British Heart Foundation, Oxford, UK; Oxford Biomedical Research Centre, National Institute of Health Research, Oxford, UK
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Charalambos Antoniades
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK; Oxford Centre of Research Excellence, British Heart Foundation, Oxford, UK; Oxford Biomedical Research Centre, National Institute of Health Research, Oxford, UK.
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Ouellette ML, Löffler AI, Beller GA, Workman VK, Holland E, Bourque JM. Clinical Characteristics, Sex Differences, and Outcomes in Patients With Normal or Near-Normal Coronary Arteries, Non-Obstructive or Obstructive Coronary Artery Disease. J Am Heart Assoc 2018; 7:JAHA.117.007965. [PMID: 29720503 PMCID: PMC6015317 DOI: 10.1161/jaha.117.007965] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Normal or near‐normal coronary arteries (NNCAs) or nonobstructive coronary artery disease (CAD) are found on invasive coronary angiography in ≈55% of patients. Some attribute this to frequent referral of low‐risk patients. We sought to identify the referral indications, pretest risk, key clinical characteristics, sex, and outcomes in patients with NNCAs and nonobstructive CAD versus obstructive CAD on nonemergent invasive coronary angiography. Methods and Results Over 24 months, 925 consecutive patients were classified as having NNCAs (≤20% stenosis), nonobstructive CAD (21–49% stenosis), or obstructive CAD (≥50% stenosis). Outcomes included cardiac death, nonfatal myocardial infarction, and late revasclarization. NNCAs were found in 285 patients (31.0%), nonobstructive CAD in 125 (13.5%), and obstructive CAD in 513 (55.5%). NNCAs or nonobstructive CAD was found in 40.5% with stress ischemia, 27.9% after a non‐ST‐elevation myocardial infarction, and in 55.5% with stable or unstable angina. More women than men (53.5% versus 37.2%; P<0.001) had NNCAs or nonobstructive CAD across all referral indications. Pretest risk was high and ICA appropriate in 75.5% and 99.2% of patients, respectively. Annual rates of cardiac death or nonfatal myocardial infarction were 1.0%, 1.1%, and 6.7%, respectively, for patients with NNCAs, nonobstructive CAD, and obstructive CAD (P<0.001). No sex differences in outcomes were observed with either NNCAs, nonobstructive CAD, or obstructive CAD (P=0.84). Conclusions Many (44.5%) patients undergoing nonemergent invasive coronary angiography have NNCAs or nonobstructive CAD despite high pretest risk, including ischemia and troponin elevation. Although women had more NNCAs or nonobstructive CAD, there were no differences in event rates by sex. Patients with NNCAs and nonobstructive CAD had very low event rates.
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Affiliation(s)
- Michelle L Ouellette
- Cardiovascular Division and the Cardiovascular Imaging Center, Department of Medicine, University of Virginia Health System, Charlottesville, VA
| | - Adrián I Löffler
- Cardiovascular Division and the Cardiovascular Imaging Center, Department of Medicine, University of Virginia Health System, Charlottesville, VA
| | - George A Beller
- Cardiovascular Division and the Cardiovascular Imaging Center, Department of Medicine, University of Virginia Health System, Charlottesville, VA
| | - Virginia K Workman
- Cardiovascular Division and the Cardiovascular Imaging Center, Department of Medicine, University of Virginia Health System, Charlottesville, VA
| | - Eric Holland
- Cardiovascular Division and the Cardiovascular Imaging Center, Department of Medicine, University of Virginia Health System, Charlottesville, VA
| | - Jamieson M Bourque
- Cardiovascular Division and the Cardiovascular Imaging Center, Department of Medicine, University of Virginia Health System, Charlottesville, VA
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Hirata K, Utsunomiya D, Kidoh M, Funama Y, Oda S, Yuki H, Nagayama Y, Iyama Y, Nakaura T, Sakabe D, Tsujita K, Yamashita Y. Tradeoff between noise reduction and inartificial visualization in a model-based iterative reconstruction algorithm on coronary computed tomography angiography. Medicine (Baltimore) 2018; 97:e10810. [PMID: 29768380 PMCID: PMC5976325 DOI: 10.1097/md.0000000000010810] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
We aimed to evaluate the image quality performance of coronary CT angiography (CTA) under the different settings of forward-projected model-based iterative reconstruction solutions (FIRST).Thirty patients undergoing coronary CTA were included. Each image was reconstructed using filtered back projection (FBP), adaptive iterative dose reduction 3D (AIDR-3D), and 2 model-based iterative reconstructions including FIRST-body and FIRST-cardiac sharp (CS). CT number and noise were measured in the coronary vessels and plaque. Subjective image-quality scores were obtained for noise and structure visibility.In the objective image analysis, FIRST-body produced the significantly highest contrast-to-noise ratio. Regarding subjective image quality, FIRST-CS had the highest score for structure visibility, although the image noise score was inferior to that of FIRST-body.In conclusion, FIRST provides significant improvements in objective and subjective image quality compared with FBP and AIDR-3D. FIRST-body effectively reduces image noise, but the structure visibility with FIRST-CS was superior to FIRST-body.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Kenichi Tsujita
- Cardiovascular Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto-shi, Kumamoto, Japan
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The Correlation of Dyslipidemia with the Extent of Coronary Artery Disease in the Multiethnic Study of Atherosclerosis. J Lipids 2018; 2018:5607349. [PMID: 29785308 PMCID: PMC5892234 DOI: 10.1155/2018/5607349] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 01/21/2018] [Accepted: 02/20/2018] [Indexed: 11/17/2022] Open
Abstract
Background The extent of coronary artery calcium (CAC) improves cardiovascular disease (CVD) risk prediction. The association between common dyslipidemias (combined hyperlipidemia, simple hypercholesterolemia, metabolic Syndrome (MetS), isolated low high-density lipoprotein cholesterol, and isolated hypertriglyceridemia) compared with normolipidemia and the risk of multivessel CAC is underinvestigated. Objectives To determine whether there is an association between common dyslipidemias compared with normolipidemia, and the extent of coronary artery involvement among MESA participants who were free of clinical cardiovascular disease at baseline. Methods In a cross-sectional analysis, 4,917 MESA participants were classified into six groups defined by specific LDL-c, HDL-c, or triglyceride cutoff points. Multivessel CAC was defined as involvement of at least 2 coronary arteries. Multivariate Poisson regression analysis evaluated the association of each group with multivessel CAC after adjusting for CVD risk factors. Results Unadjusted analysis showed that all groups except hypertriglyceridemia had statistically significant prevalence ratios of having multivessel CAC as compared to the normolipidemia group. The same groups maintained statistical significance prevalence ratios with multivariate analysis adjusting for other risk factors including Agatston CAC score [combined hyperlipidemia 1.41 (1.06-1.87), hypercholesterolemia 1.55 (1.26-1.92), MetS 1.28 (1.09-1.51), and low HDL-c 1.20 (1.02-1.40)]. Conclusion Combined hyperlipidemia, simple hypercholesterolemia, MetS, and low HDL-c were associated with multivessel coronary artery disease independent of CVD risk factors and CAC score. These findings may lay the groundwork for further analysis of the underlying mechanisms in the observed relationship, as well as for the development of clinical strategies for primary prevention.
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Arendt CT, Tischendorf P, Wichmann JL, Messerli M, Jörg L, Ehl N, Gohmann RF, Wildermuth S, Vogl TJ, Bauer RW. Using coronary CT angiography for guiding invasive coronary angiography: potential role to reduce intraprocedural radiation exposure. Eur Radiol 2018; 28:2756-2762. [PMID: 29417250 DOI: 10.1007/s00330-018-5317-2] [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: 08/17/2017] [Revised: 12/29/2017] [Accepted: 01/09/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVES We investigated the potential reduction of patient exposure during invasive coronary angiography (ICA) if the procedure had only been directed to the vessel with at least one ≥ 50% stenosis as described in the CT report. METHODS Dose reports of 61 patients referred to ICA because of at least one ≥ 50% stenosis on coronary CT angiography (CCTA) were included. Dose-area product (DAP) was documented separately for left (LCA) and right coronary arteries (RCA) by summing up the single DAP for each angiographic projection. The study population was subdivided as follows: coronary intervention of LCA (group 1) or RCA (group 2) only, or of both vessels (group 3), or further bypass grafting (group 4), or no further intervention (group 5). RESULTS 57.4% of the study population could have benefitted from reduced exposure if catheterization had been directly guided to the vessel of interest as described on CCTA. Mean relative DAP reductions were as follows: group 1 (n = 18), 11.2%; group 2 (n = 2), 40.3%; group 3 (n = 10), 0%; group 4 (n = 3), 0%; group 5 (n = 28), 28.8%. CONCLUSIONS Directing ICA to the vessel with stenosis as described on CCTA would reduce intraprocedural patient exposure substantially, especially for patients with single-vessel stenosis. KEY POINTS • Patients with CAD can benefit from decreased radiation exposure during coronary angiography. • ICA should be directed solely to significant stenoses as described on CCTA. • Severely calcified plaques remain a limitation of CCTA leading to unnecessary ICA referrals.
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Affiliation(s)
- Christophe T Arendt
- Institute for Diagnostic and Interventional Radiology, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Patricia Tischendorf
- Institute for Diagnostic and Interventional Radiology, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Julian L Wichmann
- Institute for Diagnostic and Interventional Radiology, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Michael Messerli
- Clinic for Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.,Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zürich, Switzerland
| | - Lucas Jörg
- Clinic for Cardiology, Medical Department I, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Niklas Ehl
- Clinic for Cardiology, Medical Department I, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Robin F Gohmann
- Clinic for Diagnostic and Interventional Radiology, RWTH University Hospital Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Simon Wildermuth
- Clinic for Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Thomas J Vogl
- Institute for Diagnostic and Interventional Radiology, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Ralf W Bauer
- RNS Gemeinschaftspraxis GbR, Private Radiology and Radiation Therapy Group, Alte Schmelze 20, 65201, Wiesbaden, Germany.
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Masoudkabir F, Vasheghani-Farahani A, Hakki E, Poorhosseini H, Sadeghian S, Abbasi SH, Bahmanyar S, Kassaian SE. Novel Scoring System for Prediction of Cardiac Syndrome X in Women with Typical Angina and a Positive Exercise Tolerance Test. Tex Heart Inst J 2018; 45:5-10. [PMID: 29556144 DOI: 10.14503/thij-16-5906] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A major diagnostic challenge for cardiologists is to distinguish cardiac syndrome X (CSX) from obstructive coronary artery disease in women with typical angina and a positive exercise tolerance test (ETT). We performed this study to develop a scoring system that more accurately predicts CSX in this patient population. Data on 976 women with typical angina and a positive ETT who underwent coronary angiography at our center were randomly divided into derivation and validation datasets. We developed a backward stepwise logistic regression model that predicted the presence of CSX, and a scoring system was derived from it. The derivation dataset (809 patients) was calibrated by uing a Hosmer-Lemeshow goodness-of-fit test (8 degrees of freedom; χ2=12.9; P=0.115), and the area under the curve was 0.758. The validation dataset (167 patients) was calibrated in the same way (8 degrees of freedom; χ2=9.0; P=0.339), and the area under the curve was 0.782. Independent predictors of CSX were age <55 years; negative histories of smoking, diabetes mellitus, hyperlipidemia, hypertension, or familial premature coronary artery disease; and highly positive ETTs. A total score >9.5 was the optimal cutoff point for differentiating CSX from obstructive coronary artery disease. Our proposed scoring system is a simple, objective, and accurate system for distinguishing CSX from obstructive coronary artery disease in women with typical angina and positive ETTs. It may help determine which of these patients need invasive coronary angiograms or noninvasive tests like computed tomographic coronary angiography.
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Kim J, Kang JW, Kim K, Choi SI, Chun EJ, Kim YG, Kim WY, Seo DW, Shin J, Lee H, Jin KN, Ahn S, Hwang SS, Kim KP, Jeong RB, Ha SO, Choi B, Yoon CH, Suh JW, Kim HL, Kim JK, Jang S, Seo JS. SEALONE (Safety and Efficacy of Coronary Computed Tomography Angiography with Low Dose in Patients Visiting Emergency Room) trial: study protocol for a randomized controlled trial. Clin Exp Emerg Med 2018; 4:208-213. [PMID: 29306269 PMCID: PMC5758626 DOI: 10.15441/ceem.17.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 09/20/2017] [Accepted: 09/20/2017] [Indexed: 11/29/2022] Open
Abstract
Objective Chest pain is one of the most common complaints in the emergency department (ED). Cardiac computed tomography angiography (CCTA) is a frequently used tool for the early triage of patients with low- to intermediate-risk acute chest pain. We present a study protocol for a multicenter prospective randomized controlled clinical trial testing the hypothesis that a low-dose CCTA protocol using prospective electrocardiogram (ECG)-triggering and limited-scan range can provide sufficient diagnostic safety for early triage of patients with acute chest pain. Methods The trial will include 681 younger adult (aged 20 to 55) patients visiting EDs of three academic hospitals for acute chest pain or equivalent symptoms who require further evaluation to rule out acute coronary syndrome. Participants will be randomly allocated to either low-dose or conventional CCTA protocol at a 2:1 ratio. The low-dose group will undergo CCTA with prospective ECG-triggering and restricted scan range from sub-carina to heart base. The conventional protocol group will undergo CCTA with retrospective ECG-gating covering the entire chest. Patient disposition is determined based on computed tomography findings and clinical progression and all patients are followed for a month. The primary objective is to prove that the chance of experiencing any hard event within 30 days after a negative low-dose CCTA is less than 1%. The secondary objectives are comparisons of the amount of radiation exposure, ED length of stay and overall cost. Results and Conclusion Our low-dose protocol is readily applicable to current multi-detector computed tomography devices. If this study proves its safety and efficacy, dose-reduction without purchasing of expensive newer devices would be possible.
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Affiliation(s)
- Joonghee Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joon-Won Kang
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyuseok Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang Il Choi
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun Ju Chun
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yeo Goon Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Won Young Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Woo Seo
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jonghwan Shin
- Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Huijai Lee
- Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Kwang-Nam Jin
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Soyeon Ahn
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seung Sik Hwang
- Department of Preventive Medicine, Seoul National University School of Public Health, Seoul, Korea
| | - Kwang Pyo Kim
- Department of Nuclear Engineering, Kyung Hee University, Suwon, Korea
| | - Ru-Bi Jeong
- Department of Emergency Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Sang Ook Ha
- Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Byungho Choi
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang-Hwan Yoon
- Department of Cardiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung-Won Suh
- Department of Cardiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hack-Lyoung Kim
- Department of Cardiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Ju Kyoung Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sujin Jang
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji Seon Seo
- Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
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Noguchi T, Nakao K, Asaumi Y, Morita Y, Otsuka F, Kataoka Y, Hosoda H, Miura H, Fukuda T, Yasuda S. Noninvasive Coronary Plaque Imaging. J Atheroscler Thromb 2017; 25:281-293. [PMID: 29225326 PMCID: PMC5906180 DOI: 10.5551/jat.rv17019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Early identification of high-risk or vulnerable atherosclerotic plaques prone to rupture and performing preemptive therapy prior to catastrophic cardiovascular events are optimal goals of plaque imaging. Despite the advances in imaging modalities to identify vulnerable characteristics, the predictive value of the imaging techniques in the clinical setting is still developing. In this regard, reliable and high-sensitive imaging modalities identifying vulnerable plaque characters that may lead to future cardiovascular events will be useful. In this review article, we describe a current non-invasive plaque imaging technique to identify high-risk coronary plaque features.
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Affiliation(s)
- Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kazuhiro Nakao
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yasuhide Asaumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoshiaki Morita
- Department of Radiology, National Cerebral and Cardiovascular Center
| | - Fumiyuki Otsuka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yu Kataoka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hayato Hosoda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hiroyuki Miura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Tetsuya Fukuda
- Department of Radiology, National Cerebral and Cardiovascular Center
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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Abstract
OPINION STATEMENT Coronary CT angiography (CTA) is a highly accurate test for the diagnosis of coronary artery disease (CAD), with its use guided by numerous contemporary appropriate use criteria and clinical guidelines. Unique among non-invasive tests for CAD, coronary CTA provides direct visualization of coronary atherosclerosis for the assessment of angiographic stenosis, as well as validated measures of plaque vulnerability. Long-term studies now clearly demonstrate that the absence of CAD on coronary CTA identifies a patient that is at very low risk for future cardiovascular events. Conversely, the presence, location, and severity of CAD as measured on coronary CTA provide powerful prognostic information that is superior to traditional risk factors and other clinical variables. Observational studies and data obtained from clinical trials suggest that the anatomic information derived from coronary CTA significantly increases the utilization of statins and aspirin. Furthermore, these changes are associated with reductions in the risk for mortality, revascularizations, and incident myocardial infarctions among subjects with coronary atherosclerosis. As a result, current societal consensus statements have attempted to standardize coronary CTA reporting, to include incorporation of vulnerable plaque features and recommendations on the use of preventive therapies, such as statins, so to more consistently link important prognostic findings on coronary CTA to appropriate preventive and therapeutic interventions. Automated measures of total coronary plaque volume, machine learning, and CT-derived fractional flow reserve may further refine the prognostic accuracy of coronary CTA. Herein, we summarize recently published literature that reports the long-term (≥ 5 years of follow-up) prognostic usefulness of coronary CTA.
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Lim JW, Lee H, Her K, Park HW, Shin KE. Myocardial CT perfusion imaging for pre- and postoperative evaluation of myocardial ischemia in a patient with myocardial bridging: A case report. Medicine (Baltimore) 2017; 96:e8277. [PMID: 29049223 PMCID: PMC5662389 DOI: 10.1097/md.0000000000008277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Although myocardial bridging (MB) is usually considered as benign, initial medical therapy and following surgical treatment in drug-refractory cases has been widely accepted for managing symptomatic MB. Before the patient proceeds to percutaneous or surgical intervention, however, the presence of objective ischemia in the corresponding myocardial territory should be documented. PATIENT CONCERN AND INTERVENTION We herein report a 43-year-old male complaining of chest pain in whom cardiac CT with myocardial perfusion (cCTP) showed an MB of left anterior descending artery (LAD) with preoperative perfusion defect in corresponding myocardium and normalization of perfusion after supra-arterial myotomy. DIAGNOSIS Myocardial bridging-induced ischemia. LESSONS This case illustrates the potential utility of cCTP for the simultaneous assessment of MB and its hemodynamic significance for treatment planning and post-therapeutic evaluation although further research is needed to establish the clinical usefulness of this technique.
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Affiliation(s)
| | - Heon Lee
- Division of Cardiovascular and Thoracic Imaging, Department of Radiology
| | - Keun Her
- Department of Thoracic and Cardiovascular Surgery
| | - Hyun Woo Park
- Department of Cardiology, Soonchunhyang University Hospital, Bucheon, Republic of Korea
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Abstract
Cardiac computed tomography (CT) is increasingly used in the evaluation of cardiomyopathies, particularly in patients who are not able to undergo other non-invasive imaging tests such as magnetic resonance imaging (MRI) due to the presence of MRI-incompatible pacemakers/defibrillators or other contraindications or due to extensive artifacts from indwelling metallic devices. Advances in scanner technology enable acquisition of CT images with high spatial resolution, good temporal resolution, wide field of view and multi-planar reconstruction capabilities. CT is useful in cardiomyopathies in several ways, particularly in the evaluation of coronary arteries, characterization of cardiomyopathy phenotype, quantification of cardiac volumes and function, treatment-planning, and post-treatment evaluation. In this article, we review the imaging techniques and specific applications of CT in the evaluation of cardiomyopathies.
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Affiliation(s)
- Kevin Kalisz
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Prabhakar Rajiah
- Cardiothoracic Imaging, Radiology Department, UT Southwestern Medical Center, Dallas, Texas, USA
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