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Pasurka M, Statescu A, von Knebel Doeberitz P, Kubach J, Dally F, Gravius S, Betsch M. Incidental findings are frequent in shoulder CT and MRI scans and increase with age. J Orthop 2024; 56:161-166. [PMID: 38882230 PMCID: PMC11169079 DOI: 10.1016/j.jor.2024.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 05/26/2024] [Indexed: 06/18/2024] Open
Abstract
Objectives CT and MRI scans of the shoulder can lead to the identification of incidental findings (IF), which can have a major impact on the further treatment of the patient. The aim of this retrospective study was to record the prevalence of IF, incidentalomas (IT) and malignant IT for CT and MRI examinations of the shoulder and to investigate the effect of patient characteristics on the statistical occurrence of IF, IT and malignant IT. Materials and methods A total of 903 shoulder examinations (415 CT, 488 MRI) were retrospectively analyzed for the presence of IF, subsequently categorized (harmless IF, IT requiring clarification, malignant IT) and analyzed regarding patient characteristics. The statistical analysis was carried out using independent t- and chi-square tests. A significance level of p < 0.05 was set. Results Among the 903 patients evaluated (436 female, 467 male), 153 (16.9%) patients experienced IF (harmless IF: 101 (11.2%) patients, IT: 94 (10.4%), malignant IT: 4 (0.4%). The average age of the patients without IF and IT was significantly lower compared to the patients with IF and IT (p < 0.001). While IF occurred in 31.1% of the CT, IF was only detected in 4.9% of the MRI (p < 0.001). Conclusion IF have a high prevalence (16.9%), especially in CT examinations of the shoulder, which increases with age. The exact detection and initiation of appropriate therapy is of great clinical importance, as early detection of life-threatening diseases enables more effective treatment and a potential gain in health and lifespan.
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Affiliation(s)
- Mario Pasurka
- Department of Trauma Surgery and Orthopaedics, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, 91054, Erlangen, Germany
| | - Adrian Statescu
- Department of Orthopaedic and Trauma Surgery, University Medical Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, 68167, Mannheim, Germany
| | - Philipp von Knebel Doeberitz
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, 68167, Mannheim, Germany
| | - Joshua Kubach
- Department of Trauma Surgery and Orthopaedics, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, 91054, Erlangen, Germany
| | - Franz Dally
- Department of Orthopaedic and Trauma Surgery, University Medical Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, 68167, Mannheim, Germany
| | - Sascha Gravius
- Department of Orthopaedic and Trauma Surgery, University Medical Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, 68167, Mannheim, Germany
| | - Marcel Betsch
- Department of Trauma Surgery and Orthopaedics, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, 91054, Erlangen, Germany
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2
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Tobe A, Tanaka A, Tokuda Y, Miki Y, Furusawa K, Akita S, Fujii T, Tsutsumi Y, Ishii H, Iwano S, Naganawa S, Usui A, Murohara T. Incidental findings on computed tomography for preoperative assessment before transcatheter aortic valve implantation in Japanese patients. Heart Vessels 2021; 36:1911-1922. [PMID: 34081162 DOI: 10.1007/s00380-021-01875-2] [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: 03/01/2021] [Accepted: 05/14/2021] [Indexed: 10/21/2022]
Abstract
Extra-cardiovascular incidental findings (IFs) on preoperative computed tomography (CT) are frequently observed in transcatheter aortic valve implantation (TAVI) candidates. However, the backgrounds of TAVI candidates and comorbidities differ based on the race and/or country, and data on IFs in a specific population are not always applicable to another. The aim of this study was to assess the prevalence, type, and clinical impact of IFs in Japanese TAVI candidates. This was a retrospective, single-center, observational study. CT reports of 257 TAVI candidates were reviewed, and IFs were classified as (a) insignificant: findings that did not require further investigation, treatment, or follow-up; (b) intermediate: findings that needed to be followed up or were considered for further investigation but did not affect the planning of TAVI; and (c) significant: findings that required further investigation immediately or affected the planning of TAVI. At least one IF was found in 254 patients (98.8%). Insignificant, intermediate, and significant IFs were found in 253 (98.4%), 153 (59.5%), and 34 (13.2%) patients, respectively. Newly indicated significant IFs were found in 19 patients (7.4%). In 2 patients (0.8%), TAVI was canceled because of significant IFs. In patients who consequently underwent TAVI, the presence of significant IFs was not associated with the duration from CT performance to TAVI [28 (19-40) days vs. 27 (19-43) days, p = 0.74] and all-cause mortality during the median follow-up period of 413 (223-805) days (p = 0.44). Almost all Japanese TAVI candidates had at least one IF, and the prevalence of significant IFs was not negligible. Although the presence of significant IFs was not associated with mid-term mortality, appropriate management of IFs was considered important.
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Affiliation(s)
- Akihiro Tobe
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Yoshiyuki Tokuda
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yusuke Miki
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenji Furusawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sho Akita
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Taro Fujii
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshinori Tsutsumi
- Department of Radiological Technology, Nagoya University Hospital, Nagoya, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Cardiology, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Shingo Iwano
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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3
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Frattini S, Troise G, Fucci C, Pressman GS, Faggiano P. Aortic valve stenosis and cancer: a common and complex association. Expert Rev Cardiovasc Ther 2021; 19:289-299. [PMID: 33688784 DOI: 10.1080/14779072.2021.1902306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction. The prevalence of aortic valve stenosis (AS) and malignancy are both high, especially in elderly people and in developed countries. These two conditions frequently coexist and share the same risk factors as atherosclerotic disease.Area covered. The progression of calcified AS may be accelerated by both cardiovascular risk factors and cancer treatments, such as radiotherapy. The standard treatment for symptomatic severe AS is surgical aortic valve replacement; however, in cancer patients, transcatheter implantation may be preferred as they are often at high-risk for cardiac surgery. In patients with AS and cancer, physicians may face difficult treatment decisions.To date, there is limited information on the impact of malignancy on outcomes in patients with severe AS; hence, there is no established treatment policy.Expert Opinion. Treating clinicians must integrate complex information about the severity of valve disease and expected cardiac outcomes with information regarding the cancer prognosis and the need for specific treatment, including surgery. Other comorbidities, age and frailty also contribute to decision-making about whether, when, and how to perform aortic valve replacement.
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Affiliation(s)
| | - Giovanni Troise
- Cardiac Surgery Division, Fondazione Poliambulanza, Brescia, Italy
| | - Carlo Fucci
- Cardiac Surgery Division, Spedali Civili, Brescia, Italy
| | - Gregg S Pressman
- Einstein Medical Center, Heart and Vascular Institute, Philadelphia, Pennsylvania, US
| | - Pompilio Faggiano
- , University of Brescia and Fondazione Poliambulanza, Brescia, Italy
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4
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Ghotra AS, Monlezun DJ, Boone D, Jacob R, Poosti K, Loghin C, Garcia-Sayan E, Johnson S, Zhao Y, Balan P, Nguyen TC, Estrera A, Gregoric ID, Loyalka P, Kar B, Smalling RW, Dhoble A. Outcomes of Patients Undergoing Transcatheter Aortic Valve Implantation With Incidentally Discovered Masses on Computed Tomography. Am J Cardiol 2020; 132:114-118. [PMID: 32798041 DOI: 10.1016/j.amjcard.2020.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 12/16/2022]
Abstract
Routine preprocedural chest and abdomen computed tomography is done prior to transcatheter aortic valve implantation (TAVI), which, in turn, have led to the discovery of radiographic potentially malignant incidental masses (pMIM). It is largely unknown whether pMIM impact the outcomes of patients undergoing TAVI. In this retrospective cohort study from a single center, 1,081 patients underwent TAVI from 2012 to 2016, who had available computed tomographies, survived the index hospitalization, and also had 1 year follow-up data for review. Machine learning (backward propagation neural network)-augmented multivariable regression for mortality by pMIM was conducted. In this cohort of 1,081 patients, the mean age was 79.1 (± 9.0), 48.8% were females, 16.8% had a history of prior malignancy, and 21.1% had pMIM. One-year mortality for the entire cohort was 12.6%. The most common prior malignancies were prostate, breast, and lymphoma and the most common pMIM were present in the lung, kidneys, and thyroid. In a fully adjusted regression analysis, neither prior malignancy nor pMIM increased mortality odds. However, having both was associated with a higher 1-year mortality (odds ratio 4.02, 95% confidence interval 1.50 to 10.73, p = 0.006). In conclusion, presence of pMIM alone was not associated with an increased 1-year mortality among patients undergoing TAVI. However, the presence of pMIM and a history of prior malignancy was associated with a significant increase in 1-year mortality.
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5
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Rositzka M, Hoffmann KT, Meyer HJ, Surov A. Incidental findings on CT angiography of the head and neck in stroke patients. Evaluation of frequency and detection rate. Clin Neurol Neurosurg 2020; 193:105783. [PMID: 32203706 DOI: 10.1016/j.clineuro.2020.105783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/26/2020] [Accepted: 03/13/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE A comprehensive CT algorithm in suspected ischemic stroke consists of a native CT scan, CT perfusion imaging of the brain and a CT angiography from the aortic arch to the vertex. Besides core findings of the brain and targeted vessels, various other findings may be identified. We analyzed a large patient sample and estimated the frequency of incidental findings (IFs) and whether these findings were correctly mentioned in the radiological reports. PATIENTS AND METHODS In the time period between 01/16 and 02/19 the radiological database of one hospital containing 1625 patients admitted for stroke suspicion were retrospectively evaluated. In total 1175 patients with ischemic stroke CTs were included. IFs were classified according to Lumbreras et al. for their clinical relevance. The primary radiological report was used to classify, whether the finding was reported initially or not. RESULTS Overall, 1988 IFs were identified in 1175 patients (mean 1.7 findings per patient). The most frequent finding were thyroid incidentalomas with n = 461 (23.2 % of all findings), followed by signs of mucosal swelling and/or opacification of the nasal sinus (n = 391, 19.7 %). Regarding clinical relevance, 181 findings were of major relevance (9.1 % of all findings), 902 were of moderate relevance (45.4 %) and 905 were of minor relevance (45.5 %). Overall, 772 findings (38.8 %) were not reported and 1216 (61.2 %) were sufficiently reported by the radiologist. CONCLUSION The present study corroborates that incidental findings are frequent in patients undergoing ischemic stroke CT, which are about half of moderate and major relevance. About 40 % of these findings were not mentioned in the primary radiology report, including findings of high clinical relevance. The radiologist should be aware of these findings.
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Affiliation(s)
- Markus Rositzka
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Liebigstr. 20, 04103, Germany.
| | - Karl-Titus Hoffmann
- Department of Neuroradiology, University of Leipzig, Leipzig, Liebigstr. 20, 04103, Germany.
| | - Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Liebigstr. 20, 04103, Germany.
| | - Alexey Surov
- Department of Diagnostic and Interventional Radiology, University of Magdeburg, Magdeburg, Leipziger Str 44, 39120 Magdeburg, Germany.
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6
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Hinton J, Gough S, Ahmed H, Gabara L, Rawlins J, Calver A, Shah BN, Rakhit D, Shambrook J, Harden S, Peebles C, Abbas A, Curzen N. Frequency and impact of incidental findings on computed tomography during work-up for transcatheter aortic valve implantation: single centre experience and review of the literature. Br J Radiol 2019; 92:20190344. [PMID: 31359789 DOI: 10.1259/bjr.20190344] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To assess the frequency and impact of incidental findings (IF) on CT during work-up for transcatheter aortic valve intervention (TAVI). METHODS A consecutive cohort of patients referred for consideration of TAVI who underwent a CT scan between 2009 and 2018 were studied retrospectively. CT reports were reviewed for the presence of IFs and categorised based upon their clinical significance: (a) insignificant-findings that did not require specific treatment or follow-up; (b) intermediate-findings that did not impact on the decision-making process but required follow-up; (c) significant-findings that either required urgent investigation or meant that TAVI was clinically inappropriate. RESULTS A total of 652 patients were included, whose median age was 82 years. One or more insignificant IF was found in 95.6% of patients. Intermediate IFs were documented in 5.4%. 91 (14%) patients had at least one significant IF. These included possible malignancy in 67 (74%). The ultimate decision to offer aortic valve intervention was only changed by the presence of an IF in 3.5% of cases. CONCLUSION Clinically significant IFs are detected in more than 1 in 10 of patients undergoing CT as part of a TAVI work-up, although just over half of these patients still receive aortic valve intervention. ADVANCES IN KNOWLEDGE This study is the largest UK cohort, which, when combined with a review of existing literature, provides a clear picture of the frequency and clinical impact of IFs found at CT for TAVI assessment.
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Affiliation(s)
- Jonathan Hinton
- Coronary Research Group, University Hospital Southampton NHS Foundation Trust, England.,Faculty of Medicine, University of Southampton, England
| | - Sam Gough
- Coronary Research Group, University Hospital Southampton NHS Foundation Trust, England
| | - Hanad Ahmed
- Coronary Research Group, University Hospital Southampton NHS Foundation Trust, England
| | - Lavinia Gabara
- Coronary Research Group, University Hospital Southampton NHS Foundation Trust, England
| | - John Rawlins
- Coronary Research Group, University Hospital Southampton NHS Foundation Trust, England
| | - Alison Calver
- Coronary Research Group, University Hospital Southampton NHS Foundation Trust, England
| | - Benoy N Shah
- Coronary Research Group, University Hospital Southampton NHS Foundation Trust, England
| | - Dhrubo Rakhit
- Coronary Research Group, University Hospital Southampton NHS Foundation Trust, England
| | - James Shambrook
- Cardiothoracic Radiology, University Hospital Southampton NHS Foundation Trust, England
| | - Stephen Harden
- Cardiothoracic Radiology, University Hospital Southampton NHS Foundation Trust, England
| | - Charles Peebles
- Cardiothoracic Radiology, University Hospital Southampton NHS Foundation Trust, England
| | - Ausami Abbas
- Cardiothoracic Radiology, University Hospital Southampton NHS Foundation Trust, England
| | - Nick Curzen
- Coronary Research Group, University Hospital Southampton NHS Foundation Trust, England.,Faculty of Medicine, University of Southampton, England
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7
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Incidental Findings Diagnosed during Preprocedural Evaluation of TAVR. Cardiol Res Pract 2019; 2019:7478608. [PMID: 31061731 PMCID: PMC6466941 DOI: 10.1155/2019/7478608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 03/12/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Transcatheter aortic valve replacement is an important therapeutic option for aortic stenosis (AS) patients who have high surgical risk. TAVR is a complex procedure. Proper preparation of the patient is of significant importance for the final success and affects the morbidity and mortality of the TAVR directly. Pre-TAVR computed tomography is one of the corner stones of these preparation steps, and many patients get some incidental diagnoses. Materials and Methods In this trial, we have investigated 155 patients who had underwent TAVR between February 2013 and March 2017 at Hacettepe University Adult Hospital Cardiology Clinic. Results Total number of incidental diagnoses was 541, and 451 of them were the first diagnoses. Total number of cardiovascular findings and noncardiovascular findings was 369 and 172, respectively. The most common cardiovascular finding is atherosclerotic heart disease (139, 89.6%). The most common noncardiovascular finding is pulmonary nodule (41, 26.4%). 143 of 155 patients had at least one incidental diagnosis after the reassessment, and 33 different diagnoses were identified with computed tomography. The mean STS-PROM was 8.38% (range 2.8% to 23%), and the mean STS-PROM was calculated 9.4% (range 3.6% to 23%) after the reassessment of computed tomography. Conclusion Preprocedural evaluation is one of the most important steps in TAVR. Computed tomography imaging provides extensive information, not only for procedure planning. Our findings emphasize that computed tomography has a crucial role for the preprocedural evaluation of TAVR candidates.
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8
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Kay FU, Canan A, Abbara S. Common Incidental Findings on Cardiac CT: a Systematic Review. CURRENT CARDIOVASCULAR IMAGING REPORTS 2019. [DOI: 10.1007/s12410-019-9494-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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9
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Ha FJ, Tham JLM, Paleri S, Wright C, Yap KK, Adams HS, Whitbourn RJ, Palmer SC. Outcomes of incidental findings on multi-detector computed tomography for transcatheter aortic valve implantation assessment: A single-centre study and review of the literature. J Med Imaging Radiat Oncol 2019; 63:446-453. [PMID: 30874377 DOI: 10.1111/1754-9485.12872] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 02/17/2019] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Patients with severe aortic stenosis (AS) require multi-detector computed tomography (MDCT) when considered for transcatheter aortic valve implantation (TAVI). Incidental findings on MDCT are common given the age group and region imaged. Our aim was to evaluate the frequency and outcome of incidental findings (IF) identified on MDCT and the impact on survival. METHODS This single-centre analysis retrospectively reviewed severe AS patients who underwent MDCT during TAVI workup. MDCT reports were reviewed for any IF and defined into three categories: IF of no relevant clinical significance (IF-NoCS), IF of non-immediate clinical significance (IF-NICS) and IF of immediate clinical significance (IF-ICS). Demographics, follow-up of IF and survival were calculated from MDCT date. RESULTS Two hundred and sixty-five patients underwent MDCT for TAVI suitability (mean age 83 ± 6 years, 52% male). The majority proceeded to TAVI (65%). Renal lesions (25%) and lung nodules (18%) were the most common IF. Fifty-nine patients (22%) had IF-NICS; 39% (23/59) were benign, 59% were not further investigated and one patient had suspected lung cancer. Six patients (2.3%) had IF-ICS and all were diagnosed with lung cancer. During a median follow-up of 272 days, there was no survival difference between patients with IF-ICS or IF-NICS versus patients without IF or IF-NoCS in the overall cohort (P = 0.44) or in TAVI patients (P = 0.88). CONCLUSION Incidental findings on MDCT are common with one-quarter having IF-ICS or IF-NCIS. Most patients with IF-NICS did not undergo further investigation. Standardized reporting of MDCT may assist in clarifying the need for further investigation which will in turn influence decision and timing to proceed with TAVI.
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Affiliation(s)
- Francis J Ha
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Jodie Li Mei Tham
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Sarang Paleri
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Christine Wright
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Kelvin K Yap
- Medical Imaging Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Heath Sl Adams
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Faculty of Health Science, University of Tasmania, Hobart, Tasmania, Australia
| | - Robert J Whitbourn
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Sonny C Palmer
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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10
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Abstract
Improvements in imaging techniques have led to an expansion in the number of cross-sectional cardiac studies being performed. This means that incidental non-cardiac findings (INCF) identified on cardiac imaging have become an important clinical concern. The majority of INCF are not clinically significant. However, some INCF will require follow-up or changes in management. Differentiating clinically significant from non-significant INCF can be challenging, particularly given the breadth of potential findings and the range of organ systems involved. Following up INCF also has economic implications. Recent changes to the lung nodule follow-up guidelines will reduce the cost of following up incidental lung nodules. In this manuscript, we discuss the common and important INCF which may be identified in cardiovascular imaging and explore potential implications of these findings.
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11
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Patel A, Mahendran K, Collins M, Abdelaziz M, Khogali S, Luckraz H. Incidental abnormal CT scan findings during transcatheter aortic valve implantation assessment: incidence and implications. Open Heart 2018; 5:e000855. [PMID: 30228909 PMCID: PMC6135460 DOI: 10.1136/openhrt-2018-000855] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/05/2018] [Accepted: 07/24/2018] [Indexed: 11/07/2022] Open
Abstract
Objectives The aim of this retrospective series is to describe the prevalence and clinical significance of the incidental findings found during pre–transcatheter aortic valve implantation (TAVI) work-up and to ascertain the clinical course of such patients. Methods Consecutive patients undergoing TAVI from 2013 to 2015 where a TAVI CT assessment was performed (n=138) were included in the study. All incidental findings that were not expected from the patient’s history were discussed at the TAVI multidisciplinary meeting in order to ascertain the clinical significance of said findings and whether they would alter the proposed course of treatment. Mortality data were determined by careful retrospective case note and follow-up appointment analysis. Results Seventy-eight patients (57%) were found to have incidental findings on pre-TAVI CT scan. The majority of patients had benign pathology with high incidence in particular of diverticular disease, pleural effusions, gallstones, hiatus hernia and degenerative spinal disease. Vascular pathology such as superior mesenteric, renal and iliac artery stenoses and abdominal aortic aneurysm was detected in seven patients. In terms of long-term mortality data, we found no significant difference between those with incidental findings and those without (p=0.48). Survival as assessed by Kaplan-Meier analysis showed no significant difference between those with and without incidental abnormal CT scan findings (p=0.98). Conclusions Incidental findings with potential for malignancy are common in an elderly, comorbid population. Ultimately, clinical correlation and prognosis must be swiftly ascertained in order to streamline the patients down the appropriate management pathway while avoiding unnecessary delay for treatment of their aortic stenosis.
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Affiliation(s)
- Akshay Patel
- Department of Cardiothoracic Surgery, Heart and Lung Centre, New Cross Hospital, Wolverhampton, UK
| | - Kajan Mahendran
- Department of Cardiothoracic Surgery, Heart and Lung Centre, New Cross Hospital, Wolverhampton, UK
| | - Michael Collins
- Department of Radiology, Heart and Lung Centre, New Cross Hospital, Wolverhampton, UK
| | - Mahmoud Abdelaziz
- Department of Cardiothoracic Surgery, Heart and Lung Centre, New Cross Hospital, Wolverhampton, UK
| | - Saib Khogali
- Department of Cardiology, Heart and Lung Centre, New Cross Hospital, Wolverhampton, UK
| | - Heyman Luckraz
- Department of Cardiothoracic Surgery, Heart Centre, American Hospital Dubai, Dubai, United Arab Emirates
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12
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Multidetector computed tomography evaluation of candidates for transcatheter aortic valve implantation. RADIOLOGIA 2018. [DOI: 10.1016/j.rxeng.2017.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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13
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Guillén Subirán ME, Ros Mendoza LH, Angulo Herviás E, Yagüe Romeo D, Núñez Motilva ME. Multidetector computed tomography evaluation of candidates for transcatheter aortic valve implantation. RADIOLOGIA 2017; 60:24-38. [PMID: 29032806 DOI: 10.1016/j.rx.2017.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/01/2017] [Accepted: 08/05/2017] [Indexed: 10/18/2022]
Abstract
In transcatheter aortic valve implantation (TAVI), a biologic valve mounted in a stent is implanted without removing the native valve. This procedure was first done in humans by Alain Cribier in 2002 and was included in clinical guidelines after the multicenter PARTNER (Placement of AoRtic TraNscathetER) randomized clinical trial, which showed that TAVI obtained better outcomes than conservative medical treatment and is an alternative to surgery in patients with high surgical risk. Candidates for TAVI must be assessed to determine whether the procedure is feasible, because TAVI is not ideal for all patients who are considered inoperable. Multidetector computed tomography plays an important role in the anatomic evaluation of candidates and in guiding the procedure in those who are finally selected.
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Affiliation(s)
- M E Guillén Subirán
- Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, España.
| | - L H Ros Mendoza
- Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, España
| | - E Angulo Herviás
- Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, España
| | - D Yagüe Romeo
- Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, España
| | - M E Núñez Motilva
- Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, España
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14
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van Kesteren F, Wiegerinck EMA, van Mourik MS, Vis MM, Koch KT, Piek JJ, Stoker J, Tijssen JG, Baan J, Planken RN. Impact of Potentially Malignant Incidental Findings by Computed Tomographic Angiography on Long-Term Survival After Transcatheter Aortic Valve Implantation. Am J Cardiol 2017; 120:994-1001. [PMID: 28774429 DOI: 10.1016/j.amjcard.2017.06.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/26/2017] [Accepted: 06/15/2017] [Indexed: 12/17/2022]
Abstract
Computed tomography angiography (CTA) in workup for transcatheter aortic valve implantation (TAVI) frequently reveals potentially malignant incidental findings. Most incidental findings provoke discussions on their influence. We aimed to analyze if these findings were a predictor of long-term survival after TAVI. In a single-center retrospective analysis, all consecutive patients with pre-TAVI CTA were included (years 2009 to 2014). Patients were divided by presence or absence of incidental findings. We analyzed up to 5 years of all-cause, non-cardiovascular and cardiovascular mortality for all 553 patients who underwent TAVI; 113 had a potentially malignant incidental finding (20.4%). At 5 years, all-cause mortality risk was 64.5% in patients with versus 49.1% in patients without a finding (hazard ratio [HR] 1.70, 95% confidence interval [CI] 1.25 to 2.31). After adjustment, the findings remained an independent predictor of all-cause (adjusted HR 1.46, 95% CI 1.07 to 1.99) and non-cardiovascular mortality (adjusted subdistribution HR 1.84, 95% CI 1.06 to 3.20), but not of cardiovascular mortality. In conclusion, the presence of potentially malignant incidental findings on CTA is an independent predictor of long-term all-cause and noncardiovascular mortality but not of cardiovascular mortality.
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Affiliation(s)
- Floortje van Kesteren
- Heart Center, Academic Medical Center, University of Amsterdam, The Netherlands; Department of Radiology, Academic Medical Center, University of Amsterdam, The Netherlands
| | | | | | - M Marije Vis
- Heart Center, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Karel T Koch
- Heart Center, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Jan J Piek
- Heart Center, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Jaap Stoker
- Heart Center, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Jan G Tijssen
- Heart Center, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Jan Baan
- Heart Center, Academic Medical Center, University of Amsterdam, The Netherlands
| | - R Nils Planken
- Department of Radiology, Academic Medical Center, University of Amsterdam, The Netherlands.
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15
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Kakefuda Y, Hayashida K, Yamada Y, Yashima F, Inohara T, Yanagisawa R, Tanaka M, Arai T, Kawakami T, Maekawa Y, Tsuruta H, Itabashi Y, Murata M, Sano M, Okamoto K, Yoshitake A, Shimizu H, Jinzaki M, Fukuda K. Impact of Subclinical Vascular Complications Detected by Systematic Postprocedural Multidetector Computed Tomography After Transcatheter Aortic Valve Implantation Using Balloon-Expandable Edwards SAPIEN XT Heart Valve. Am J Cardiol 2017; 119:1100-1105. [PMID: 28162223 DOI: 10.1016/j.amjcard.2016.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 12/15/2016] [Accepted: 12/15/2016] [Indexed: 12/20/2022]
Abstract
Complications after transcatheter aortic valve implantation (TAVI) remain an important issue. This study aimed to evaluate the impact of systematic postprocedural multidetector computed tomography (MDCT) to detect subclinical complications after TAVI. From October 2013 to August 2015, a total of 135 patients who underwent transfemoral TAVI (n = 116) or transapical TAVI (n = 19) with Sapien XT and MDCT preprocedure and postprocedure were enrolled. Postprocedural MDCT findings were compared with the preprocedural MDCT findings. Cardiovascular complications were observed in 25.9% of patients, including 6 cases (4.5%) with major complications. Of those, clinically apparent major complications were reported in 2 cases including rupture of the sinus of Valsalva and iliac rupture. The complications in the remaining 4 cases (3.0%) included aortic dissection, aortic intramural hematoma, and left ventricular apical pseudoaneurysm, which were totally asymptomatic and only detected by MDCT. The apical pseudoaneurysm required surgical repair. Minor complications were observed in 21.5% of patients, 50% of which were subclinical. Only 1 case with femoral pseudoaneurysm required an additional procedure. Noncardiovascular findings were detected in 27.4% of patients; the most frequent were pleural effusions and atelectasis, which were predominantly observed in those treated through a transapical approach. Contrast-induced acute kidney injury after postprocedural MDCT was reported in 1 patient whose clinical course was complicated by sepsis. In conclusion, postprocedural MDCT was useful in detecting important subclinical complications that may affect the clinical course without deterioration of renal function.
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Affiliation(s)
- Yuki Kakefuda
- Department of Cardiology, Keio University School of Medicine, Japan; Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Japan.
| | - Yoshitake Yamada
- Department of Diagnostic Radiology, Keio University School of Medicine, Japan
| | - Fumiaki Yashima
- Department of Cardiology, Keio University School of Medicine, Japan
| | - Taku Inohara
- Department of Cardiology, Keio University School of Medicine, Japan
| | - Ryo Yanagisawa
- Department of Cardiology, Keio University School of Medicine, Japan
| | - Makoto Tanaka
- Department of Cardiology, Keio University School of Medicine, Japan
| | - Takahide Arai
- Department of Cardiology, Keio University School of Medicine, Japan
| | - Takashi Kawakami
- Department of Cardiology, Keio University School of Medicine, Japan
| | - Yuichiro Maekawa
- Department of Cardiology, Keio University School of Medicine, Japan
| | - Hikaru Tsuruta
- Department of Cardiology, Keio University School of Medicine, Japan
| | - Yuji Itabashi
- Department of Cardiology, Keio University School of Medicine, Japan
| | | | - Motoaki Sano
- Department of Cardiology, Keio University School of Medicine, Japan
| | - Kazuma Okamoto
- Department of Cardiovascular Surgery, Keio University School of Medicine, Japan
| | - Akihiro Yoshitake
- Department of Cardiovascular Surgery, Keio University School of Medicine, Japan
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery, Keio University School of Medicine, Japan
| | - Masahiro Jinzaki
- Department of Diagnostic Radiology, Keio University School of Medicine, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Japan
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16
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Fathala A, Bin Saeedan M, Zulfiqar A, Al Sergani H. Non-Cardiovascular Computed Tomography Incidental Findings in Patients Who Underwent Transaortic Valve Implantation Procedure. Cardiol Res 2017; 8:13-19. [PMID: 28275420 PMCID: PMC5340520 DOI: 10.14740/cr445w] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2017] [Indexed: 12/29/2022] Open
Abstract
Background Transcatheter aortic valve implantation (TAVI) is a new treatment option for patients with severe aortic stenosis. Pre-TAVI procedure workup includes computed tomography angiography (CTA) of the heart and aorta from aortic annulus to the iliofemoral arteries. Frequently, there are a number of incidental non-cardiac findings (INCFs) in pre-TAVI CTA. However, the frequency and clinical significance of these INCFs are unknown. The aim of our study was to investigate the prevalence of INCFs and their clinical significance. Methods This was a retrospective review of 67 patients who underwent dedicated pre-TAVI CTA from 2010 till 2015. Non-cardiovascular INCFs were classified according to their clinical significance into three categories. The first category includes findings that may require urgent treatment. The second category includes findings that need further follow-up. The third category includes incidental findings that require no further follow-up or recommendation. Results The total number of patients was 67, and the mean age was 73 ± 8 years. All patients had INCFs and the total number was 248. Of the patients, 69% had chest findings, 85% had abdominal findings, and 33% had musculoskeletal findings. Results based on categorical classification were as follows: 9%, 25%, and 66% of these 248 findings belong to the first category, the second category, and the third category, respectively. Conclusion Non-cardiovascular INCFs are common in pre-TAVI CTA presumably due to increased age of such specific population. These findings have variable clinical significance and some of them might require acute treatment or additional evaluation, and should be managed properly taking into consideration patient’s life expectancy and comorbidities.
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Affiliation(s)
- Ahmed Fathala
- Department of Radiology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Mnahi Bin Saeedan
- Department of Radiology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Ali Zulfiqar
- King Faisal Heart Institute, Riyadh, Saudi Arabia
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17
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Thoracic Incidental Findings in Preoperative Computed Tomography Evaluation for Transcatheter Aortic Valve Implantation (TAVI). J Thorac Imaging 2017; 31:183-8. [PMID: 27082418 DOI: 10.1097/rti.0000000000000208] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Many older patients with aortic stenosis are excluded from surgical intervention due to multiple comorbidities. For these patients, transcatheter aortic valve implantation (TAVI) is a viable treatment alternative. Cardiothoracic computed tomography (CT) provides detailed anatomic assessment of the aortic root structures for patient selection, preprocedural planning, and intraoperative decision-making; however, nonaortic incidental findings are frequently detected. The prevalence and clinical significance of these findings have not been well described. MATERIALS AND METHODS This retrospective study examined incidental findings in 209 consecutive patients (96 women and 113 men; mean age, 70 y) with aortic stenosis undergoing preoperative cardiothoracic CT evaluation for TAVI during a 3-year period. Incidental findings were recorded, and medical records were reviewed for follow-up diagnostic examinations. RESULTS Incidental findings, both significant and nonsignificant, were observed in 85.6% of patients (179/209). Noncalcified pulmonary nodules were the most common incidental finding occurring in 59/209 (28.2%) patients, followed by pleural effusion and emphysema both of which occurred in 34/209 (16.3%) patients, respectively. CONCLUSIONS Cardiothoracic CT obtained for evaluation before TAVI has a high frequency of incidental findings.
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18
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Schramm D, Justus A, Bach AG, Surov A. Incidental findings in the skeletal musculature on computed tomography. Br J Radiol 2016; 90:20160727. [PMID: 27936890 DOI: 10.1259/bjr.20160727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The purpose of this study was to analyze intramuscular incidental findings identified on CT in a large patient cohort. METHODS In the time period from 2010 to 2015, a total of 44,794 patients with several diagnoses were investigated by CT. Only those patients who underwent body CT including the neck, thorax, abdomen and pelvic regions after the i.v. application of a contrast medium were involved in the study. There were 4085 patients. On further analysis, only patients with intramuscular findings (IFs) incidentally detected on CT were included. Osseous or soft-tissue lesions with invasion into the musculature were excluded from the study. Patients with known or clinically suspicious muscle disorders were also excluded. Overall, 639 (15.64% of the 4085 analyzed cases) patients, 253 females and 386 males, with mean age 72.43 ± 12.02 years, were identified. Collected data were evaluated by means of descriptive statistics. RESULTS In the 639 patients, 917 IFs were identified. More often, several benign disorders were diagnosed (n = 803, 87.6%). There were hernias (33.5%), atrophy of different muscles (22%), lipomas (21%), intramuscular calcifications (8.7%), bursitis (1.2%) and intramuscular bleeding (1.1%). Malignant IFs (n = 114, 12.4%) included intramuscular metastases (11.9%) and lymphomas (0.6%). Most frequently, the identified IFs were localized in the abdominal wall musculature, paravertebral and gluteal muscles. In 657 cases (71.6% of all IFs), the identified muscle findings were not diagnosed by the radiologist who initially assessed the investigation. CONCLUSION CT can detect different incidental disorders within the skeletal musculature. Most of them were benign. However, malignant lesions can also occur. Therefore, skeletal muscles should be carefully evaluated on CT performed for other reasons. Advances in knowledge: IFs occur in 15.6% of CT investigations. Benign findings represent 87.6% and malignant lesions can be identified in 12.4%.
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Affiliation(s)
- Dominik Schramm
- Department of Radiology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Annkathrin Justus
- Department of Radiology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Andreas G Bach
- Department of Radiology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Alexey Surov
- Department of Radiology, Martin Luther University Halle-Wittenberg, Halle, Germany
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19
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CT imaging before transcatheter aortic valve implantation (TAVI) using variable helical pitch scanning and its diagnostic performance for coronary artery disease. Eur Radiol 2016; 27:1963-1970. [DOI: 10.1007/s00330-016-4547-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 08/01/2016] [Accepted: 08/08/2016] [Indexed: 10/21/2022]
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20
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CT before transcatheter aortic valve replacement: Value of venous phase imaging for detection and interpretation of findings with impact on the TAVR procedure. J Cardiovasc Comput Tomogr 2015; 9:422-7. [DOI: 10.1016/j.jcct.2015.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 03/08/2015] [Accepted: 03/17/2015] [Indexed: 12/21/2022]
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