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Vogelgesang F, Coenen MH, Schueler S, Schlattmann P, Dewey M. An exemplary reanalysis of coronary computed tomography angiography diagnostic meta-analyses shows insufficient data sharing and incorrect sensitivity and specificity estimates. J Clin Epidemiol 2024; 170:111306. [PMID: 38428541 DOI: 10.1016/j.jclinepi.2024.111306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVES To systematically evaluate the reproducibility of primary data and, the reproducibility and correctness of pooled sensitivity and specificity estimates reported in a sample of diagnostic meta-analyses. STUDY DESIGN AND SETTING We conducted an exemplary systematic review of diagnostic meta-analyses comparing coronary computed tomography angiography to invasive coronary angiography in patients with suspected coronary artery disease. The objectives were to assess 1) the reproducibility of contingency tables, 2) the reproducibility of pooled sensitivity and specificity, and 3) differences to reported results when applying a recommended bivariate binomial model for pooling sensitivity and specificity. Therefore, we reproduced the contingency tables and recalculated sensitivity and specificity by utilizing both the pooling method of each meta-analysis and a bivariate binomial model. We used linear trends to assess the improvement of these objectives over time. RESULTS We identified 38 diagnostic meta-analyses, each including on average 19 primary studies (range: 3 to 89 studies; total: 715-including duplicates) with an average of approximately 1800 patients per meta-analysis (range: 118 to 7516 patients). For 31 meta-analyses (82%, 95% CI: 65%, 91%), the contingency tables were reproducible; however, only 15 published them. Using the pooling method of each meta-analysis, we obtained comparable recalculated sensitivities/specificities for 28 meta-analyses (74% [57%, 86%]). Only 11 meta-analyses pooled sensitivity/specificity using a bivariate binomial model (29% [16%, 46%]). When all meta-analyses were pooled with this model, published sensitivities/specificities were confirmed for 19 of 38 meta-analyses (50% [34%, 66%]). There was only marginal improvement in data availability and application of recommended pooling methods over time. CONCLUSION Data sharing should become standard practice along with the use of appropriate pooling methods. Journal publication requirements may play a key role in enhancing the quality of scientific reporting and methodological standards which may lead to more reliable and consistent outcomes. The ability to reproduce sensitivity and specificity estimates in diagnostic imaging meta-analyses is dependent on the availability of contingency tables and the explicit reporting of pooling methods and software used.
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Affiliation(s)
- Felicitas Vogelgesang
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Maria H Coenen
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Sabine Schueler
- 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; Berlin Institute of Health and Berlin University Alliance, Berlin, Germany.
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2
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Dalebout EM, Hirsch A, Kluin J, Galema TW, Roos-Hesselink JW, Budde RP. Computed Tomography in Infectious Endocarditis. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101292. [PMID: 39131217 PMCID: PMC11308100 DOI: 10.1016/j.jscai.2023.101292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 12/22/2023] [Accepted: 12/26/2023] [Indexed: 08/13/2024]
Abstract
Imaging is one of the cornerstones in diagnosis and management of infective endocarditis, underlined by recent guidelines. Echocardiography is the first-line imaging technique, however, computed tomography (CT) has a class I recommendation in native and prosthetic valve endocarditis to detect valvular lesions in case of possible endocarditis and to detect paravalvular and periprosthetic complications in case of inconclusive echocardiography. Echocardiography has a higher diagnostic accuracy than CT in detecting valvular lesions, but not for diagnosing paravalvular lesions where CT is superior. Additionally, CT is useful and recommended by guidelines to detect extracardiac manifestations of endocarditis and in planning surgical treatment including assessment of the coronary arteries. The advent of photon-counting CT and its improved spatial resolution and spectral imaging is expected to expand the role of CT in the diagnosis of infective endocarditis. In this review, we provide an overview of the current role of CT in infective endocarditis focusing on image acquisition, image reconstruction, interpretation, and diagnostic accuracy.
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Affiliation(s)
- Eefje M. Dalebout
- Department of Cardiology, Cardiovascular Institute, Thorax Center, Erasmus MC, Rotterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
- Department of Cardiothoracic Surgery, Thorax Center, Erasmus MC, Rotterdam, the Netherlands
| | - Alexander Hirsch
- Department of Cardiology, Cardiovascular Institute, Thorax Center, Erasmus MC, Rotterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Jolanda Kluin
- Department of Cardiothoracic Surgery, Thorax Center, Erasmus MC, Rotterdam, the Netherlands
| | - Tjebbe W. Galema
- Department of Cardiology, Cardiovascular Institute, Thorax Center, Erasmus MC, Rotterdam, the Netherlands
| | - Jolien W. Roos-Hesselink
- Department of Cardiology, Cardiovascular Institute, Thorax Center, Erasmus MC, Rotterdam, the Netherlands
| | - Ricardo P.J. Budde
- Department of Cardiology, Cardiovascular Institute, Thorax Center, Erasmus MC, Rotterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
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3
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Zhang Y, Liu Z, Cheng Y, Li Z, Wang Z, Peng L, Li J, Shuai T. New Whole-Heart motion correction algorithm enables diagnostic CT of aortic valve and coronary arteries in systolic phase for transcatheter aortic valve implantation candidates. Eur J Radiol 2023; 168:111141. [PMID: 37832197 DOI: 10.1016/j.ejrad.2023.111141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/13/2023] [Accepted: 10/05/2023] [Indexed: 10/15/2023]
Abstract
OBJECTIVES To investigate the ability of new generation snapshot freeze (NGSSF) algorithm in improving diagnostic image quality of both aortic valve and coronary arteries for transcatheter aortic valve implantation (TAVI) candidates in TAVI planning CT. METHODS Sixty-four TAVI candidates underwent TAVI planning CT were enrolled. Scans from coronary CT angiography were reconstructed at 20%, 30%, 40%, and 75% R-R cardiac phases with NGSSF and standard (STD) algorithm. In each phase, following parameters were compared: aortic valve measurements and their reproducibility; image quality of aortic valve and coronary arteries. The diagnostic accuracies of TAVI planning CT for coronary artery stenosis in 30% R-R phase with NGSSF and STD algorithms were calculated in 47out of 64 patients with invasive coronary angiography as reference standard. RESULTS For subjective image quality evaluation, the excellent rate for aortic valve improved from 25.0% to 93.8% and the interpretable rate for coronary arteries increased from 20.3% to 95.3% in the 30% phase images with NGSSF compared with images with STD. For the detection of > 50% coronary artery stenosis, the 30% phase images with NGSSF provided a sensitivity of 90%, specificity of 81.48%, negative predictive value of 91.7%, and positive predictive value of 78.3% on a per-patient basis; While images with STD, had a corresponding results of 95.0%, 33.33%, 90.0%, and 51.4%, respectively. CONCLUSIONS NGSSF significantly improves image quality for both aortic valve and coronary arteries compared with STD for TAVI patients of all heart rates. NGSSF enables the accurate measurement for aortic valve and satisfactory diagnostic performance for coronary arteries stenosis in the same systolic phase for TAVI planning.
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Affiliation(s)
- Yu Zhang
- Department of Radiology, West China Hospital, Sichuan University, China
| | - Zixuan Liu
- Department of Radiology, West China Hospital, Sichuan University, China
| | - Yong Cheng
- Department of Radiology, West China Hospital, Sichuan University, China
| | - Zhenlin Li
- Department of Radiology, West China Hospital, Sichuan University, China
| | - Ziwei Wang
- Department of Radiology, West China Hospital, Sichuan University, China
| | - Liqing Peng
- Department of Radiology, West China Hospital, Sichuan University, China
| | | | - Tao Shuai
- Department of Radiology, West China Hospital, Sichuan University, China.
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4
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Incremental Utility of 3D Printing to Guide the Surgical Management of Apical Aneurysm. JACC Case Rep 2022; 4:1056-1059. [PMID: 36062049 PMCID: PMC9434645 DOI: 10.1016/j.jaccas.2022.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 11/23/2022]
Abstract
A 24-year-old man presented with a nonischemic cardiomyopathy of unknown etiology, apical aneurysm, and a secondary mitral regurgitation. Computer tomography–derived 3-dimensional model of the patient’s heart was an essential step in guiding the surgical management for an optimal outcome. (Level of Difficulty: Advanced.)
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5
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Hughes D, Linchangco R, Reyaldeen R, Xu B. Expanding utility of cardiac computed tomography in infective endocarditis: A contemporary review. World J Radiol 2022; 14:180-193. [PMID: 36160630 PMCID: PMC9350612 DOI: 10.4329/wjr.v14.i7.180] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 06/26/2022] [Accepted: 07/06/2022] [Indexed: 02/06/2023] Open
Abstract
There is increasing evidence on the utility of cardiac computed tomography (CCT) in infective endocarditis (IE) to investigate the valvular pathology, the extra-cardiac manifestations of IE and pre-operative planning. CCT can assist in the diagnosis of perivalvular complications, such as pseudoaneurysms and abscesses, and can help identify embolic events to the lungs or systemic vasculature. CCT has also been shown to be beneficial in the pre-operative planning of patients by delineating the coronary artery anatomy and the major cardiovascular structures in relation to the sternum. Finally, hybrid nuclear/computed tomography techniques have been shown to increase the diagnostic accuracy in prosthetic valve endocarditis. This manuscript aims to provide a contemporary update of the existing evidence base for the use of CCT in IE.
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Affiliation(s)
- Diarmaid Hughes
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Richard Linchangco
- Section of Cardiovascular Imaging, Imaging Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Reza Reyaldeen
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, United States
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6
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van den Boogert TPW, Claessen BEPM, Boekholdt SM, Leiner T, Vliegenthart R, Schuiling SF, Timmer JR, Bekkers SCAM, Voskuil M, Siebelink HJ, van Es W, Lamb HJ, Prokop M, Damman P, Stoker J, Willems HC, Henriques JP, Planken RN. The impact and challenges of implementing CTCA according to the 2019 ESC guidelines on chronic coronary syndromes: a survey and projection of CTCA services in the Netherlands. Insights Imaging 2021; 12:186. [PMID: 34921633 PMCID: PMC8684565 DOI: 10.1186/s13244-021-01122-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 11/02/2021] [Indexed: 11/10/2022] Open
Abstract
Background The 2019 ESC-guidelines on chronic coronary syndromes (ESC-CCS) recommend computed tomographic coronary angiography (CTCA) or non-invasive functional imaging instead of exercise ECG as initial test to diagnose obstructive coronary artery disease. Since impact and challenges of these guidelines are unknown, we studied the current utilisation of CTCA-services, status of CTCA-protocols and modeled the expected impact of these guidelines in the Netherlands. Methods and results A survey on current practice and CTCA utilisation was disseminated to every Dutch hospital organisation providing outpatient cardiology care and modeled the required CTCA capacity for implementation of the ESC guideline, based on these national figures and expert consensus. Survey response rate was 100% (68/68 hospital organisations). In 2019, 63 hospital organisations provided CTCA-services (93%), CTCA was performed on 99 CTCA-capable CT-scanners, and 37,283 CTCA-examinations were performed. Between the hospital organisations, we found substantial variation considering CTCA indications, CTCA equipment and acquisition and reporting standards. To fully implement the new ESC guideline, our model suggests that 70,000 additional CTCA-examinations would have to be performed in the Netherlands. Conclusions Despite high national CTCA-services coverage in the Netherlands, a substantial increase in CTCA capacity is expected to be able to implement the 2019 ESC-CCS recommendations on the use of CTCA. Furthermore, the results of this survey highlight the importance to address variations in image acquisition and to standardise the interpretation and reporting of CTCA, as well as to establish interdisciplinary collaboration and organisational alignment.
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Affiliation(s)
- T P W van den Boogert
- Heart centre, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - B E P M Claessen
- Heart centre, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - S M Boekholdt
- Heart centre, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - T Leiner
- Department of Radiology, Utrecht University Medical centre, Utrecht, The Netherlands
| | - R Vliegenthart
- Department of Radiology, University Medical centre Groningen, Groningen, The Netherlands
| | - S F Schuiling
- Zorgevaluatie en Gepast Gebruik, Diemen, The Netherlands
| | - J R Timmer
- Departments of Cardiology, Isala, Zwolle, The Netherlands
| | - S C A M Bekkers
- Department of Cardiology, Maastricht University Medical centre, Maastricht, The Netherlands
| | - M Voskuil
- Department of Cardiology, Utrecht University Medical centre, Utrecht, The Netherlands
| | - H J Siebelink
- Department of Cardiology, Leiden University Medical centre, Leiden, The Netherlands
| | - W van Es
- Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - H J Lamb
- Department of Radiology, Leiden University Medical centre, Leiden, The Netherlands
| | - M Prokop
- Department of Radiology, Nuclear Medicine, and Anatomy, Radboud University Medical centre, Nijmegen, The Netherlands
| | - P Damman
- Department of Cardiology, Radboud University Medical centre, Nijmegen, The Netherlands
| | - J Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - H C Willems
- Division of Geriatrics, Department of Internal Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - J P Henriques
- Heart centre, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - R N Planken
- Department of Radiology and Nuclear Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. .,Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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7
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Pavone N, Burzotta F, Bruno P, Spalletta C, Farina P, Cammertoni F, Nesta M, Chiariello GA, Grandinetti M, De Belvis AG, Marzetti E, Angeletti C, Pasquini A, Mazza A, Iafrancesco M, Trani C, Lombardo A, Massetti M. Heart Valve Critical Pathway and Heart Valve Clinic: Novel Benchmarks for Modern Management of Valvular Heart Disease. Crit Pathw Cardiol 2021; 20:126-133. [PMID: 33813534 DOI: 10.1097/hpc.0000000000000260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The growing burden of valvular heart disease in Western countries represents a challenge for the daily clinical practice, especially in the light of the ever-increasing number of therapeutic options. The Euro Heart Survey showed that, among elderly subjects with severe, symptomatic valve dysfunction, surgery is denied for 33% of patients with aortic stenosis and for 50% of patients with mitral regurgitation. Current management (from diagnosis to follow-up) is often fragmented in multiple-sometimes unnecessary-steps. Such a "patchy" approach may translate into a suboptimal management, especially in the geriatric population. New healthcare models exist that can coordinate care, reduce fragmentation, limit costs and, ultimately, improve outcomes: the clinical pathways.
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Affiliation(s)
- Natalia Pavone
- From the Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Francesco Burzotta
- From the Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
- Università Cattolica del Sacro Cuore, Roma, Italia
| | - Piergiorgio Bruno
- From the Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
- Università Cattolica del Sacro Cuore, Roma, Italia
| | - Claudio Spalletta
- From the Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Piero Farina
- From the Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Federico Cammertoni
- From the Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Marialisa Nesta
- From the Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | | | - Maria Grandinetti
- From the Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Antonio G De Belvis
- From the Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
- Università Cattolica del Sacro Cuore, Roma, Italia
| | - Emanuele Marzetti
- From the Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
- Università Cattolica del Sacro Cuore, Roma, Italia
| | - Carmen Angeletti
- From the Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Annalisa Pasquini
- From the Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Andrea Mazza
- From the Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Mauro Iafrancesco
- From the Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Carlo Trani
- From the Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
- Università Cattolica del Sacro Cuore, Roma, Italia
| | - Antonella Lombardo
- From the Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
- Università Cattolica del Sacro Cuore, Roma, Italia
| | - Massimo Massetti
- From the Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
- Università Cattolica del Sacro Cuore, Roma, Italia
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8
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Khurrami L, Møller JE, Lindholt JS, Urbonaviciene G, Steffensen FH, Lambrechtsen J, Karon M, Frost L, Busk M, Egstrup K, Fredgart MH, Diederichsen ACP. Cross-sectional study of aortic valve calcification and cardiovascular risk factors in older Danish men. Heart 2021; 107:1536-1543. [PMID: 34376488 DOI: 10.1136/heartjnl-2021-319023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 06/27/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Aortic valve calcification (AVC) and coronary artery calcification (CAC) are predictors of cardiovascular disease (CVD), presumably sharing risk factors. Our objectives were to determine the prevalence and extent of AVC in a large population of men aged 60-74 years and to assess the association between AVC and cardiovascular risk factors including CAC and biomarkers. METHODS Participants from the DANish CArdioVAscular Screening and intervention trial (DANCAVAS) with AVC and CAC scores and without previous valve replacement were included in the study. Calcification scores were calculated on non-contrast CT scans. Cardiovascular risk factors were self-reported, measured or both, and further explored using descriptive and regression analysis for AVC association. RESULTS 14 073 men aged 60-74 years were included. The AVC scores ranged from 0 to 9067 AU, with a median AVC of 6 AU (IQR 0-82). In 8156 individuals (58.0%), the AVC score was >0 and 215 (1.5%) had an AVC score ≥1200. In the regression analysis, all cardiovascular risk factors were associated with AVC; however, after inclusion of CAC ≥400, only age (ratio of expected counts (REC) 1.07 (95% CI 1.06 to 1.09)), hypertension (REC 1.24 (95% CI 1.09 to 1.41)), obesity (REC 1.34 (95% CI 1.20 to 1.50)), known CVD (REC 1.16 (95% CI 1.03 to 1.31)) and serum phosphate (REC 2.25 (95% CI 1.66 to 3.10) remained significantly associated, while smoking, diabetes, hyperlipidaemia, estimated glomerular filtration rate and serum calcium were not. CONCLUSIONS AVC was prevalent in the general population of men aged 60-74 years and was significantly associated with all modifiable cardiovascular risk factors, but only selectively after adjustment for CAC ≥400 AU. TRIAL REGISTRATION NUMBER NCT03946410 and ISRCTN12157806.
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Affiliation(s)
- Lida Khurrami
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Odense University Hospital, Odense, Denmark.,Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jes Sanddal Lindholt
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark.,Cardiovascular Centre of Excellence (CAVAC), Odense, Denmark.,University of Southern Denmark, Odense, Denmark
| | | | | | - Jess Lambrechtsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Marek Karon
- Department of Medicine, Nykøbing Falster Hospital, Region Zealand, Denmark
| | - Lars Frost
- Department of Cardiology, Regional Hospital of Central Jutland, Silkeborg, Denmark
| | - Martin Busk
- Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark
| | - Kenneth Egstrup
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Axel Cosmus Pyndt Diederichsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark.,Cardiovascular Centre of Excellence (CAVAC), Odense, Denmark.,University of Southern Denmark, Odense, Denmark
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9
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Image quality and diagnostic performance evaluation in transcatheter aortic valve implantation candidates with atrial fibrillation using a whole-heart coverage CT scanner. Eur Radiol 2021; 32:1034-1043. [PMID: 34338842 DOI: 10.1007/s00330-021-08187-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/09/2021] [Accepted: 06/29/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate the image quality and diagnostic performance for obstructive coronary artery disease of transcatheter aortic valve implantation (TAVI) patients with atrial fibrillation (AF) during TAVI planning CT using a whole-heart coverage CT scanner. METHODS Eighty-eight consecutive TAVI candidates with AF (50 men, 74 ± 6 years) who underwent both TAVI planning CT and invasive coronary catheter angiography (ICA) were retrospectively analyzed. With ICA results as the reference standard, the accuracy of TAVI planning CT for lesion detection on a per-vessel and per-patient level was calculated. Meanwhile, image quality, contrast volume, and effective dose (ED) were evaluated. A 5-point visual scale (1-5) was used to assess the subjective image quality. The CT value and signal-to-noise ratio were measured for the left main coronary artery (LM), left anterior descending (LAD), left circumflex (LCX), and right coronary arteries (RCA). RESULTS The ED for CCTA was 3.25 ± 1.39 mSv and contrast volume was 58.14 ± 12.34 mL. A total of 1371 (1371/1408 = 97.4%) segments with diameter > 1.5 mm were analyzed. For the subjective evaluation, the mean score was 3.99 ± 0.96 for overall image quality. The mean CT values in LM, RCA, LCX, and LAD were all above 400 HU. For the detection of > 50% stenosis, TAVI planning CT provided on the per-vessel and per-patient basis 97.06% and 100% in sensitivity, 96.23% and 89.06% in specificity, 99.7% and 100% in negative predictive value, and 73.3% and 77.4% in positive predictive value, respectively. CONCLUSION TAVI planning CT with whole-heart coverage demonstrates good CCTA image quality and a high sensitivity and NPV in excluding obstructive CAD in TAVI candidates with AF. KEY POINTS • Transcatheter aortic valve implantation planning (TAVI) CT with whole-heart coverage enables good image quality of CCTA in TAVI candidates with atrial fibrillation. • Obstructive coronary artery disease may be excluded with high accuracy in transcatheter aortic valve implantation (TAVI) candidates with atrial fibrillation with the usage of whole-heart coverage TAVI planning CT.
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10
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Coronary computed tomography versus coronary angiography for preoperative coronary assessment before valve surgery. Egypt Heart J 2021; 73:63. [PMID: 34224049 PMCID: PMC8257824 DOI: 10.1186/s43044-021-00180-7] [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: 04/24/2021] [Accepted: 06/05/2021] [Indexed: 11/30/2022] Open
Abstract
Background Conventional coronary angiography (CAG) is currently the gold standard technique for the assessment of coronary arteries prior to cardiac valve surgery. Although CAG is a relatively safe procedure, however, it is still an invasive procedure, and it has potential hazards and complications. Coronary computed tomography angiography (CCTA) is a non-invasive technique that has emerged robustly as an excellent and attractive tool for delineating coronary anatomy. Therefore, we sought to evaluate the accuracy of CCTA when compared with the gold standard CAG in the evaluation of coronary arteries before valve surgery. We screened 111 consecutive patients with VHD undergoing a routine cardiac catheterization for preoperative evaluation of CAD. Fifty patients were eligible and underwent both CAG and CCTA. Significant coronary stenosis was defined as a luminal diameter decrease of ≥ 50%. Additionally, ectasia, calcifications, and congenital coronary anomalies were analyzed. Also, we compared both techniques regarding radiation dose, contrast volume, and complications. Non-evaluable segments were excluded from all levels of analysis. Sixty-one patients were excluded from the study due to various reasons. Results Among the 50 patients of the study population, 27 (54%) were males. The prevalence of significant CAD in the study population was 19.6% according to the patient-based analysis, and CAG could have been avoided in 80.4% of patients with a true-negative CCTA result. Diagnostic accuracy of CCTA for detection of significant stenosis was evaluated regarding sensitivity and specificity, positive predictive value, negative predictive value, and overall accuracy of CCTA, which was 87.5%, 99.6%,87.5%, 99.6%, and 99.2%, respectively, for segmental-based analysis; 86%, 100%, 100%, 99%, and 99%, respectively, for vessel-based analysis; and 77.8%,100%,100%, 94.9%, and 95.7%, respectively, for patient-based analysis. Fewer rates of complications were encountered with CCTA. Additional information obtained like calcifications and congenital anomalies was diagnosed better with CCTA than CAG. Conclusion Owing mainly to its high negative predictive value, a well-performed CCTA exam is an excellent method to rule out coronary artery disease, specially in patients who are not at high risk of atherosclerosis.
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Narula J, Chandrashekhar Y, Ahmadi A, Abbara S, Berman DS, Blankstein R, Leipsic J, Newby D, Nicol ED, Nieman K, Shaw L, Villines TC, Williams M, Hecht HS. SCCT 2021 Expert Consensus Document on Coronary Computed Tomographic Angiography: A Report of the Society of Cardiovascular Computed Tomography. J Cardiovasc Comput Tomogr 2021; 15:192-217. [PMID: 33303384 PMCID: PMC8713482 DOI: 10.1016/j.jcct.2020.11.001] [Citation(s) in RCA: 155] [Impact Index Per Article: 51.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Jagat Narula
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Y Chandrashekhar
- University of Minnesota and VA Medical Center, Minneapolis, MN, USA
| | - Amir Ahmadi
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Suhny Abbara
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Ron Blankstein
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | | | - David Newby
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - Edward D Nicol
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | | | - Leslee Shaw
- New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Todd C Villines
- University of Virginia Health System, Charlottesville, VA, USA
| | - Michelle Williams
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - Harvey S Hecht
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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12
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Procopio A, Radico F, Alexandre J, Mapelli M, Archilletti F, Acasandrei C, Fulgenzi F, Ghebru Y, Faggiano P, Mairesse GH, Gallina S, Agostoni P, De Caterina R, Zimarino M. ST-segment/heart rate hysteresis improves the exercise testing accuracy for coronary artery detection in asymptomatic patients with severe aortic stenosis. J Cardiovasc Med (Hagerstown) 2021; 22:323-325. [PMID: 33633050 DOI: 10.2459/jcm.0000000000001081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Antonio Procopio
- Institute of Cardiology and Center of Excellence on Aging - 'G. d'Annunzio' University - Chieti, Italy
| | - Francesco Radico
- Institute of Cardiology and Center of Excellence on Aging - 'G. d'Annunzio' University - Chieti, Italy
| | - Joachim Alexandre
- Normandie Univ, Unicaen, CHU de Caen Normandie, Department of Pharmacology, EA 4650, Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, Caen, France
| | - Massimo Mapelli
- Cardiology Center Monzino, IRCCS
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Federico Archilletti
- Institute of Cardiology and Center of Excellence on Aging - 'G. d'Annunzio' University - Chieti, Italy
| | | | - Fabio Fulgenzi
- Institute of Cardiology and Center of Excellence on Aging - 'G. d'Annunzio' University - Chieti, Italy
| | - Yacob Ghebru
- Institute of Cardiology and Center of Excellence on Aging - 'G. d'Annunzio' University - Chieti, Italy
| | - Pompilio Faggiano
- Department of Cardiology, Spedali Civili and University of Brescia - Brescia
| | | | - Sabina Gallina
- Institute of Cardiology and Center of Excellence on Aging - 'G. d'Annunzio' University - Chieti, Italy
| | - Piergiuseppe Agostoni
- Cardiology Center Monzino, IRCCS
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | | | - Marco Zimarino
- Institute of Cardiology and Center of Excellence on Aging - 'G. d'Annunzio' University - Chieti, Italy
- Interventional Cath Lab, ASL 2 Abruzzo, Chieti, Italy
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Impact of Coronary Artery Disease and Percutaneous Coronary Intervention on Transcatheter Aortic Valve Implantation. J Interv Cardiol 2021; 2021:6672400. [PMID: 33824628 PMCID: PMC8016584 DOI: 10.1155/2021/6672400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/07/2021] [Accepted: 03/16/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction The prevalence of coronary artery disease (CAD) detected in preoperative work-up for transcatheter aortic valve implantation (TAVI) is high. Instead, the management of a concomitant CAD remains unclear. We evaluate the impact of CAD and percutaneous coronary intervention (PCI) on TAVI procedures. Materials and Methods A retrospective study was conducted on 1336 consecutive patients who underwent TAVI in Toulouse University Hospital, Rangueil, France. The studied population was divided into 2 groups: CAD-TAVI group and No CAD-TAVI group. Then, the CAD-TAVI group was segregated into 2 subgroups: PCI-TAVI group and No PCI-TAVI group. In-hospital adverse clinical outcomes were assessed in each group. Results Pre-TAVI work-up revealed significant CAD in 36% of 1030 patients eligible for inclusion in the study. The overall prevalence of in-hospital death, stroke, major or life-threatening bleeding, minor bleeding, major vascular complications, minor vascular complications, pacemaker implantation, and acute kidney injury was 2.7%, 2.4%, 2.8%, 3.6%, 3.9%, 7.5%, 12.5%, and 2.7%, respectively. Among the studied population, 55% were admitted to the cardiac care unit. No significant statistical difference was observed between groups. Discussion. CAD-TAVI population was not more likely to develop in-hospital adverse clinical outcomes post-TAVI procedure compared to others. Also, no significant difference regarding in-hospital death was observed. In parallel, performing PCI prior to TAVI did not increase the risk of in-hospital death and complications. The difference in terms of the distribution of antithrombotic regimen may explain the higher prevalence of bleeding events in the PCI-TAVI group. Conclusion This study provides direct clinical relevance useful in daily practice. No negative impact has been attributed to the presence of a concomitant CAD and/or preoperative PCI on the TAVI hospitalization period.
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Perpetua EM, Guibone KA, Keegan PA, Palmer R, Speight MK, Jagnic K, Michaels J, Nguyen RA, Pickett ES, Ramsey D, Schnell SJ, Wong SC, Reisman M. Best Practice Recommendations for Optimizing Care in Structural Heart Programs: Planning Efficient and Resource Leveraging Systems (PEARLS). STRUCTURAL HEART 2021; 5:168-179. [PMID: 35378800 PMCID: PMC8968322 DOI: 10.1080/24748706.2021.1877858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/11/2021] [Accepted: 09/26/2021] [Indexed: 11/24/2022]
Abstract
The COVID19 pandemic brought unprecedented disruption to healthcare. Staggering morbidity, mortality, and economic losses prompted the review and refinement of care for structural heart disease (SHD). To mitigate negative impacts in the face of crisis or capacity constraints, this paper offers best practice recommendations for Planning Efficient and Resource Leveraging Systems (PEARLS) in structural heart programs. A systematic assessment is recommended for hospital capacity, Heart Team roles and functions, and patient and procedural risks associated with increased resource utilization. Strategies, tactics, and pathways are provided for the delivery of patient-centered, efficient and resource-leveraging care from referral to follow-up. Through the optimal use of capacity and resources, paired with dynamic triage, forecasting, and surveillance, Heart Teams may aspire to plan and implement an optimized system of care for SHD. Abbreviations: AS: aortic stenosis; ASD: atrioseptal defect; COVID19: Coronavirus disease 19; LAAO: left atrial appendage occlusion; MI: myocardial infarction; MR: mitral regurgitation; PFO: patent foramen ovale; PVL: paravalvular leak; SHD: structural heart disease; SAVR: surgical aortic valve replacement; SDM: shared decision-making; TAVR: transcatheter aortic valve replacement; TMVr: transcatheter mitral valve repair; TMVR: transcatheter mitral valve replacement; TEE: transesophageal echocardiography; TTE: transthoracic echocardiography.
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15
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Izumi C, Eishi K, Ashihara K, Arita T, Otsuji Y, Kunihara T, Komiya T, Shibata T, Seo Y, Daimon M, Takanashi S, Tanaka H, Nakatani S, Ninami H, Nishi H, Hayashida K, Yaku H, Yamaguchi J, Yamamoto K, Watanabe H, Abe Y, Amaki M, Amano M, Obase K, Tabata M, Miura T, Miyake M, Murata M, Watanabe N, Akasaka T, Okita Y, Kimura T, Sawa Y, Yoshida K. JCS/JSCS/JATS/JSVS 2020 Guidelines on the Management of Valvular Heart Disease. Circ J 2020; 84:2037-2119. [DOI: 10.1253/circj.cj-20-0135] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kiyoyuki Eishi
- Division of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Kyomi Ashihara
- Department of Cardiology, Tokyo Women’s Medical University Hospital
| | - Takeshi Arita
- Division of Cardiovascular Medicine Heart & Neuro-Vascular Center, Fukuoka Wajiro
| | - Yutaka Otsuji
- Department of Cardiology, Hospital of University of Occupational and Environmental Health
| | - Takashi Kunihara
- Department of Cardiac Surgery, The Jikei University School of Medicine
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka City University Postgraduate of Medicine
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Masao Daimon
- Department of Clinical Laboratory/Cardiology, The University of Tokyo Hospital
| | | | | | - Satoshi Nakatani
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | - Hiroshi Ninami
- Department of Cardiac Surgery, Tokyo Women’s Medical University
| | - Hiroyuki Nishi
- Department of Cardiovascular Surgery, Osaka General Medical Center
| | | | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | | | - Kazuhiro Yamamoto
- Division of Cardiovascular Medicine, Endocrinology and Metabolism, Faculty of Medicine, Tottori University
| | | | - Yukio Abe
- Department of Cardiology, Osaka City General Hospital
| | - Makoto Amaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Masashi Amano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kikuko Obase
- Division of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center
| | - Takashi Miura
- Division of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | | | - Mitsushige Murata
- Department of Laboratory Medicine, Tokai University Hachioji Hospital
| | - Nozomi Watanabe
- Department of Cardiology, Miyazaki Medical Association Hospital
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Yutaka Okita
- Department of Cardiovascular Surgery, Takatsuki Hospital
| | - Takeshi Kimura
- Department of Cardiology, Kyoto University Graduate School of Medicine
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Kiyoshi Yoshida
- Department of Cardiology, Sakakibara Heart Institute of Okayama
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16
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Hasselbalch RB, Pries-Heje MM, Kjølhede Holle SL, Engstrøm T, Heitmann M, Pedersen F, Schou M, Mickley H, Elming H, Steffensen R, Koeber L, Iversen K. Coronary risk of patients with valvular heart disease: prospective validation of CT-Valve Score. Open Heart 2020; 7:openhrt-2020-001380. [PMID: 33020259 PMCID: PMC7537465 DOI: 10.1136/openhrt-2020-001380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/18/2020] [Accepted: 09/02/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To prospectively validate the CT-Valve score, a new risk score designed to identify patients with valvular heart disease at a low risk of coronary artery disease (CAD) who could benefit from multislice CT (MSCT) first instead of coronary angiography (CAG). METHODS This was a prospective cohort study of patients referred for valve surgery in the Capital Region of Denmark and Odense University Hospital from the 1 February 2015 to the 1 February 2017. MSCT was implemented for patients with a CT-Valve score ≤7 at the referring physician's discretion. Patients with a history of CAD or chronic kidney disease were excluded. The primary outcome was the proportion of patients needing reevaluation with CAG after MSCT and risk of CAD among the patients determined to be low to intermediate risk. RESULTS In total, 1149 patients were included. The median score was 9 (IQR 3) and 339 (30%) had a score ≤7. MSCT was used for 117 patients. Of these 29 (25%) were reevaluated and 9 (7.7%) had CAD. Of the 222 patients with a score ≤7 that did not receive an MSCT, 14 (6%) had significant CAD. The estimated total cost of evaluation among patients with a score ≤7 before implementation was €132 093 compared with €79 073 after, a 40% reduction. Similarly, estimated total radiation before and after was 608 mSv and 362 mSv, a 41% reduction. Follow-up at a median of 32 months (18-48) showed no ischaemic events for patients receiving only MSCT. CONCLUSION The CT-Valve score is a valid method for determining risk of CAD among patients with valvular heart disease. Using a score ≤7 as a cut-off for the use of MSCT is safe and cost-effective.
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Affiliation(s)
- Rasmus Bo Hasselbalch
- Department of Cardiology, Herlev Hospital, Herlev, Denmark .,Department of Emergency Medicine, Herlev Hospital, Herlev, Denmark
| | | | | | - Thomas Engstrøm
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Merete Heitmann
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Frants Pedersen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev Hospital, Herlev, Denmark.,Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Hans Mickley
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Hanne Elming
- Department of Cardiology, Roskilde Hospital, Roskilde, Sjaelland, Denmark
| | - Rolf Steffensen
- Department of Cardiology, Nephrology and Endocrinology, Nordsjaellands Hospital, Hilleroed, Denmark
| | - Lars Koeber
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kasper Iversen
- Department of Cardiology, Herlev Hospital, Herlev, Denmark.,Department of Emergency Medicine, Herlev Hospital, Herlev, Denmark
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17
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Botta L, Amodio C, Pagano V, Di Marco L, Leone A, Loforte A, Martin-Suarez S, Savini C, Pacini D. AVR in patients with anomalous course of the circumflex artery without prosthetic downsizing. J Card Surg 2020; 35:3125-3127. [PMID: 32741015 DOI: 10.1111/jocs.14927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
An anomalous origin of the left circumflex coronary artery that arises as a side branch of the right coronary artery and encircles the aortic annulus is usually an incidental finding. However, in patients undergoing aortic valve/root procedures, its existence can significantly complicate the surgical treatment. We report our operative strategy with three different prostheses without valve downsizing.
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Affiliation(s)
- Luca Botta
- Cardio-Thoraco-Vascular Department, Cardiac-Surgery Unit, S. Orsola Hospital, Bologna, Italy
| | - Ciro Amodio
- Cardio-Thoraco-Vascular Department, Cardiac-Surgery Unit, S. Orsola Hospital, Bologna, Italy
| | - Vincenzo Pagano
- Cardio-Thoraco-Vascular Department, Cardiac-Surgery Unit, S. Orsola Hospital, Bologna, Italy
| | - Luca Di Marco
- Cardio-Thoraco-Vascular Department, Cardiac-Surgery Unit, S. Orsola Hospital, Bologna, Italy
| | - Alessandro Leone
- Cardio-Thoraco-Vascular Department, Cardiac-Surgery Unit, S. Orsola Hospital, Bologna, Italy
| | - Antonio Loforte
- Cardio-Thoraco-Vascular Department, Cardiac-Surgery Unit, S. Orsola Hospital, Bologna, Italy
| | - Sofia Martin-Suarez
- Cardio-Thoraco-Vascular Department, Cardiac-Surgery Unit, S. Orsola Hospital, Bologna, Italy
| | - Carlo Savini
- Cardio-Thoraco-Vascular Department, Cardiac-Surgery Unit, S. Orsola Hospital, Bologna, Italy
| | - Davide Pacini
- Cardio-Thoraco-Vascular Department, Cardiac-Surgery Unit, S. Orsola Hospital, Bologna, Italy
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Horgan SJ, Mediratta A, Gillam LD. Cardiovascular Imaging in Infective Endocarditis: A Multimodality Approach. Circ Cardiovasc Imaging 2020; 13:e008956. [PMID: 32683888 DOI: 10.1161/circimaging.120.008956] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Multimodality imaging plays a pivotal role in the evaluation and management of infective endocarditis (IE)-a condition with high morbidity and mortality. The diagnosis of IE is primarily based on the modified Duke criteria with echocardiography as the first-line imaging modality. Both transthoracic and transesophageal echocardiography delineate vegetation location and size, assess for paravalvular extension of infection, and have the added advantage of defining the hemodynamic effects of valvular or device infection. Native and prosthetic valve IE, infections relating to cardiac implantable electronic devices, and indwelling catheters are effectively evaluated with echocardiography. However, complementary imaging is occasionally required when there remains diagnostic uncertainty following transesophageal echocardiography. Multidetector computed tomography and nuclear imaging techniques such as positron emission tomography and white blood cell scintigraphy have been shown to reduce the rate of misdiagnosed IE particularly in the setting of prosthetic valve endocarditis, paravalvular extension of infection, and cardiac implantable electronic devices. In this review, we describe a modern approach to cardiac imaging in native and prosthetic valve endocarditis, as well as cardiac implantable electronic devices including pacing devices and left ventricular assist devices. Current guidelines addressing the role of multimodality imaging in IE are discussed. The utility of imaging in the assessment of local and distant endocarditis complications such as pericardial sequelae, myocarditis, and embolic events is also addressed.
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Affiliation(s)
- Stephen J Horgan
- Gagnon Cardiovascular Institute, Morristown Medical Center/Atlantic Health System, NJ
| | - Anuj Mediratta
- Gagnon Cardiovascular Institute, Morristown Medical Center/Atlantic Health System, NJ
| | - Linda D Gillam
- Gagnon Cardiovascular Institute, Morristown Medical Center/Atlantic Health System, NJ
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Matta A, Moussallem N. Coronary artery disease is associated with valvular heart disease, but could it Be a predictive factor? Indian Heart J 2019; 71:284-287. [PMID: 31543203 PMCID: PMC6796620 DOI: 10.1016/j.ihj.2019.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/29/2019] [Accepted: 07/02/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This study was conducted to evaluate the prevalence of significant coronary artery disease (CAD) in patients with severe valvular heart disease (VHD) and the association between these two cardiac entities. Our research aims to introduce the theory of a possible causal relationship. METHODS A retrospective study was conducted on 1308 consecutive patients who underwent surgery for severe VHD in the cardiovascular department of Notre-Dame de Secours University Hospital (NDSUH) between December 2000 and December 2016. According to transthoracic echocardiography, patients were divided into 4 groups: patients with severe aortic stenosis (AS), patients with severe aortic regurgitation (AR), patients with severe mitral stenosis (MS), and patients with severe mitral regurgitation (MR). Preoperative coronary angiographies were reviewed for the presence or the absence of significant CAD (≥50% luminal stenosis). Chi-square test and 2 × 2 tables were used. RESULTS Of the 1308 patients with severe VHD, 1002 patients had isolated aortic valve disease, 240 patients had isolated mitral valve disease, and 66 patients had combined aortomitral valve disease. CAD was detected in 27.75% of all patients with severe VHD, in 32% of patients with isolated aortic valve disease, and in 15% of patients with isolated mitral valve disease. Statistical analysis showed a higher prevalence in patients with severe aortic valve stenosis and a significant relationship between CAD and aortic valve disease, mainly severe AS (p < 0.0001). CONCLUSION The prevalence of CAD in patients with VHD is 27.75%, and it correlates significantly with aortic valve disease, in particular with severe AS. Future large studies are needed to evaluate the possible causal relationship.
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Affiliation(s)
- Anthony Matta
- Faculty of Medicine, Holy Spirit University of Kaslik, Kaslik, Lebanon.
| | - Nicolas Moussallem
- Faculty of Medicine, Holy Spirit University of Kaslik, Kaslik, Lebanon; Past President of Lebanese Society of Cardiology; Fellow of European Society of Cardiology and American College of Cardiology
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20
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Malahfji M, Mahmarian JJ. Imaging to Stratify Coronary Artery Disease Risk in Asymptomatic Patients with Diabetes. Methodist Debakey Cardiovasc J 2019; 14:266-272. [PMID: 30788012 DOI: 10.14797/mdcj-14-4-266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Coronary artery disease (CAD) is the leading cause of morbidity and mortality in patients with diabetes mellitus. Patients with diabetes have a higher prevalence of CAD and a larger magnitude of ischemia, and they are more likely to have silent myocardial ischemia and myocardial infarction. However, recent large cohort studies demonstrate that diabetic patients are not a homogenous group with similar high risk for cardiac events. In fact, more than 30% of asymptomatic diabetic patients do not have evidence of coronary atherosclerosis and have a very low annual cardiac event rate. Accordingly, there has been a recent paradigm shift as to whether the detection of subclinical coronary atherosclerosis through imaging can best guide therapeutic decision making. This review discusses the role of various cardiac imaging techniques for stratifying cardiovascular risk and optimizing therapy in asymptomatic diabetic patients.
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Alzahrani T, Tashkandi A, Sarkar A, Smuclovisky C, Earls JP, Choi AD. Practical Clinical Application of Cardiac Computed Tomography‐Derived Fractional Flow Reserve. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2019. [DOI: 10.15212/cvia.2019.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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22
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van den Boogert T, Claessen B, Robbers-Visser D, Henriques J, Planken N. Complementary role of cardiac computed tomography angiography in the diagnosis of prosthetic aortic valve endocarditis and septic coronary embolism - a case report. J Radiol Case Rep 2019; 13:9-14. [PMID: 31565167 PMCID: PMC6743864 DOI: 10.3941/jrcr.v13i2.3464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A 73-year old man presented with a posterolateral ST-elevated myocardial infarction 9 months after biological aortic valve replacement for aortic valve stenosis. Invasive coronary angiography showed a filling defect across the left main coronary artery bifurcation extending into the left anterior descending artery and the ramus circumflex. Transthoracic echocardiography revealed a thickened prosthesis leaflet with signs of slight stenosis. Cardiac computed tomography angiography showed a mass on the left coronary cusp of the valve prosthesis, suggestive for vegetation or thrombus. The scan also revealed central luminal filling defects, indicative for thrombus or septic emboli. Blood cultures proved positive for Propionibacterium acnes, therefore the patient was treated for prosthetic valve endocarditis. Computed tomography angiography offers high diagnostic accuracy for detecting infective endocarditis and renders complementary information about valvular anatomy, coronary artery disease and the extension of infections.
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Affiliation(s)
- Thomas van den Boogert
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Bimmer Claessen
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - José Henriques
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Nils Planken
- Department of Radiology and nuclear medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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24
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Doenst T, Diab M, Sponholz C, Bauer M, Färber G. The Opportunities and Limitations of Minimally Invasive Cardiac Surgery. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 114:777-784. [PMID: 29229038 DOI: 10.3238/arztebl.2017.0777] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 04/05/2017] [Accepted: 09/13/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Over the past two decades, minimally invasive techniques for classic heart valve surgery and isolated bypass surgery have been developed that enable access to the heart via partial sternotomy for most aortic valve procedures and via sternotomy-free mini-thoracotomy for other procedures. METHODS We review the current evidence on minimally invasive cardiac surgery on the basis of pertinent randomized studies and database studies retrieved by a selective search in the MEDLINE and PubMed Central databases, as well as by the Google Scholar search engine. RESULTS A PubMed search employing the search term "minimally invasive cardiac surgery" yielded nearly 10 000 hits, among which there were 7 prospective, randomized, controlled trials (RCTs) on aortic valve replacement, with a total of 477 patients, and 3 RCTs on mitral valve surgery, with a total of 340 patients. Only limited reports of specified centers are currently available for multiple valvular procedures and multiple coronary artery bypass procedures. The RCTs reveal that the minimally invasive techniques are associated with fewer wound infections and faster mobilization, without any difference in survival. Minimally invasive procedures are technically demanding and have certain anatomical prerequisites, such as appropriate coronary morphology for multiple bypass operations and the position of the aorta in the chest for sternotomy-free aortic valve procedures. The articles reviewed here were presumably affected by selection bias, in that patients in the published studies were preselected, and there may have been negative studies that were not published at all. CONCLUSION Specialized surgeons and centers can now carry out many cardiac valvular and bypass operations via minithoracotomy rather than sternotomy. According to current evidence, these minimally invasive techniques yield results that are at least as good as classic open-heart surgery.
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Affiliation(s)
- Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller Universität Jena; Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Friedrich-Schiller Universität Jena
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van den Boogert TPW, Vendrik J, Claessen BEPM, Baan J, Beijk MA, Limpens J, Boekholdt SAM, Hoek R, Planken RN, Henriques JP. CTCA for detection of significant coronary artery disease in routine TAVI work-up : A systematic review and meta-analysis. Neth Heart J 2018; 26:591-599. [PMID: 30178209 PMCID: PMC6288031 DOI: 10.1007/s12471-018-1149-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has evolved to standard treatment of severe aortic stenosis in patients with an intermediate to high surgical risk. Computed tomography coronary angiography (CTCA) could partially replace invasive coronary angiography to diagnose significant coronary artery disease in the work-up for TAVI. A literature search was performed in MEDLINE and EMBASE for papers comparing CTCA and coronary angiography in TAVI candidates. The primary endpoint was the diagnostic accuracy of CTCA, compared to coronary angiography, for detection of significant (>50% diameter stenosis) coronary artery disease, measured as sensitivity, specificity, positive—(PPV) and negative predictive value (NPV). Seven studies were included, with a cumulative sample size of 1,275 patients. The patient-based pooled sensitivity, specificity, PPV and NPV were 95, 65, 71 and 94% respectively. Quality assessment revealed excellent and good quality in terms of applicability and risk of bias respectively, with the main concern being patient selection. In conclusion, on the basis of a significance cut-off value of 50% diameter stenosis, CTCA provides acceptable diagnostic accuracy for the exclusion of coronary artery disease in patients referred for TAVI. Using the routinely performed preoperative computed tomography scans as a gatekeeper for coronary angiography could decrease additional coronary angiographies by 37% in this high-risk and fragile population.
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Affiliation(s)
- T P W van den Boogert
- Heart Centre, Academic Medical Centre, part of the Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - J Vendrik
- Heart Centre, Academic Medical Centre, part of the Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - B E P M Claessen
- Heart Centre, Academic Medical Centre, part of the Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - J Baan
- Heart Centre, Academic Medical Centre, part of the Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - M A Beijk
- Heart Centre, Academic Medical Centre, part of the Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - J Limpens
- Medical Library, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - S A M Boekholdt
- Heart Centre, Academic Medical Centre, part of the Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - R Hoek
- Heart Centre, Academic Medical Centre, part of the Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - R N Planken
- Department of Radiology and Nuclear Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - J P Henriques
- Heart Centre, Academic Medical Centre, part of the Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands.
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Chaikriangkrai K, Jhun HY, Shantha GPS, Abdulhak AB, Tandon R, Alqasrawi M, Klappa A, Pancholy S, Deshmukh A, Bhama J, Sigurdsson G. Diagnostic Accuracy of Coronary Computed Tomography Before Aortic Valve Replacement: Systematic Review and Meta-Analysis. J Thorac Imaging 2018; 33:207-216. [PMID: 29389809 DOI: 10.1097/rti.0000000000000322] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE In aortic stenosis patients referred for surgical and transcatheter aortic valve replacement (AVR), the evidence of diagnostic accuracy of coronary computed tomography angiography (CCTA) has been limited. The objective of this study was to investigate the diagnostic accuracy of CCTA for significant coronary artery disease (CAD) in patients referred for AVR using invasive coronary angiography (ICA) as the gold standard. MATERIALS AND METHODS We searched databases for all diagnostic studies of CCTA in patients referred for AVR, which reported diagnostic testing characteristics on patient-based analysis required to pool summary sensitivity, specificity, positive-likelihood ratio, and negative-likelihood ratio. Significant CAD in both CCTA and ICA was defined by >50% stenosis in any coronary artery, coronary stent, or bypass graft. RESULTS Thirteen studies evaluated 1498 patients (mean age, 74 y; 47% men; 76% transcatheter AVR). The pooled prevalence of significant stenosis determined by ICA was 43%. Hierarchical summary receiver-operating characteristic analysis demonstrated a summary area under curve of 0.96. The pooled sensitivity, specificity, and positive-likelihood and negative-likelihood ratios of CCTA in identifying significant stenosis determined by ICA were 95%, 79%, 4.48, and 0.06, respectively. In subgroup analysis, the diagnostic profiles of CCTA were comparable between surgical and transcatheter AVR. CONCLUSIONS Despite the higher prevalence of significant CAD in patients with aortic stenosis than with other valvular heart diseases, our meta-analysis has shown that CCTA has a suitable diagnostic accuracy profile as a gatekeeper test for ICA. Our study illustrates a need for further study of the potential role of CCTA in preoperative planning for AVR.
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Affiliation(s)
| | - Hye Yeon Jhun
- Department of Medicine, University of Kansas Medical Center, Kansas City, KS
| | | | - Aref Bin Abdulhak
- Heart and Vascular Center, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Rudhir Tandon
- Heart and Vascular Center, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Musab Alqasrawi
- Heart and Vascular Center, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Anthony Klappa
- Heart and Vascular Center, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Samir Pancholy
- The Wright Center for Graduate Medical Education, Scranton, PA
| | | | - Jay Bhama
- Heart and Vascular Center, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Gardar Sigurdsson
- Heart and Vascular Center, University of Iowa Hospitals and Clinics, Iowa City, IA
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Roura G, Gomez-Lara J, Fuentes Castillo L, Ferreiro JL, Romaguera R, Teruel L, Gracida Blancas M, Carreño E, Gomez-Hospital JA, Cequier A. Long-term prognostic impact of non-invasive follow-up with computed tomography angiography in patients with left main coronary artery stenting. Minerva Cardioangiol 2018; 66:528-535. [PMID: 29687696 DOI: 10.23736/s0026-4725.18.04567-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Left main coronary artery (LMCA) stenting is an evolving technique. Whether follow-up computed tomography angiography (CTA) might have clinical impact in these patients is controversial. The aim of present study is to compare clinical outcomes of patients with LMCA stenting followed with CTA versus patients with conventional clinical follow-up. METHODS From 2003 to 2014 all consecutive patients with unprotected LMCA stenosis treated with single DES implantation were prospectively included. Since 2009 all patients underwent CTA at 6-month after LMCA stenting. Therefore, the non-CTA group included all patients treated from 2003 to 2009 and the CTA group included patients treated from 2009 to 2014. Patients with 6-month cardiac events, renal dysfunction or atrial fibrillation were excluded. All patients underwent at least 2-year clinical follow-up. The primary endpoint was a composite of cardiac death, nonfatal myocardial infarction, and LMCA revascularization. RESULTS A total of 236 patients were included (119 in the non-CTA and 117 in the CTA group). Nine event-free patients presented with in-stent restenosis as assessed by CTA at 6 months; 5 had angiographic confirmation and were revascularized. At 2 years, the primary end-point was observed in 15.1% and 7.3% of patients of the non-CTA and CTA groups, respectively (P=0.07). All-cause mortality was higher in the non-CTA group (8.4% vs. 2.6%; P=0.05). Euroscore and CTA were found independent predictors of the primary end-point in the multivariate analysis. CONCLUSIONS Elective 6-month CTA after LMCA stenting is associated with better outcomes compared to conventional clinical follow-up.
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Affiliation(s)
- Gerard Roura
- Unit of Interventional Cardiology, Heart Disease Institute, IDIBELL - Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain -
| | - Josep Gomez-Lara
- Unit of Interventional Cardiology, Heart Disease Institute, IDIBELL - Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | - Lara Fuentes Castillo
- Unit of Interventional Cardiology, Heart Disease Institute, IDIBELL - Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | - José L Ferreiro
- Unit of Interventional Cardiology, Heart Disease Institute, IDIBELL - Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | - Rafael Romaguera
- Unit of Interventional Cardiology, Heart Disease Institute, IDIBELL - Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | - Luis Teruel
- Unit of Interventional Cardiology, Heart Disease Institute, IDIBELL - Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | - Montserrat Gracida Blancas
- Unit of Interventional Cardiology, Heart Disease Institute, IDIBELL - Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | - Elena Carreño
- Department of Radiology, IDIBELL - Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | - Joan A Gomez-Hospital
- Unit of Interventional Cardiology, Heart Disease Institute, IDIBELL - Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | - Angel Cequier
- Unit of Interventional Cardiology, Heart Disease Institute, IDIBELL - Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain
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Coronary computed tomography angiography: Star of the show or supporting act? J Thorac Cardiovasc Surg 2018; 155:1432-1433. [DOI: 10.1016/j.jtcvs.2017.12.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 12/18/2017] [Indexed: 11/21/2022]
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29
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Lee W, Kim JB, Yang DH, Kim C, Kim J, Ju MH, Kim HJ, Kang JW, Jung SH, Kim YH, Choo SJ, Lee CW, Chung CH, Lee JW, Lim TH. Comparative effectiveness of coronary screening in heart valve surgery: Computed tomography versus conventional coronary angiography. J Thorac Cardiovasc Surg 2018; 155:1423-1431.e3. [DOI: 10.1016/j.jtcvs.2017.10.128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 10/02/2017] [Accepted: 10/27/2017] [Indexed: 12/30/2022]
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Cazelli JG, Camargo GC, Kruczan DD, Weksler C, Felipe AR, Gottlieb I. Prevalence and Prediction of Obstructive Coronary Artery Disease in Patients Undergoing Primary Heart Valve Surgery. Arq Bras Cardiol 2017; 109:348-356. [PMID: 28977048 PMCID: PMC5644215 DOI: 10.5935/abc.20170135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 06/13/2017] [Indexed: 11/20/2022] Open
Abstract
Background The prevalence of coronary artery disease (CAD) in valvular patients is
similar to that of the general population, with the usual association with
traditional risk factors. Nevertheless, the search for obstructive CAD is
more aggressive in the preoperative period of patients with valvular heart
disease, resulting in the indication of invasive coronary angiography (ICA)
to almost all adult patients, because it is believed that coronary artery
bypass surgery should be associated with valve replacement. Objectives To evaluate the prevalence of obstructive CAD and factors associated with it
in adult candidates for primary heart valve surgery between 2001 and 2014 at
the National Institute of Cardiology (INC) and, thus, derive and validate a
predictive obstructive CAD score. Methods Cross-sectional study evaluating 2898 patients with indication for heart
surgery of any etiology. Of those, 712 patients, who had valvular heart
disease and underwent ICA in the 12 months prior to surgery, were included.
The P value < 0.05 was adopted as statistical significance. Results The prevalence of obstructive CAD was 20%. A predictive model of obstructive
CAD was created from multivariate logistic regression, using the variables
age, chest pain, family history of CAD, systemic arterial hypertension,
diabetes mellitus, dyslipidemia, smoking, and male gender. The model showed
excellent correlation and calibration (R² = 0.98), as well as excellent
accuracy (ROC of 0.848; 95%CI: 0.817-0.879) and validation (ROC of 0.877;
95%CI: 0.830 - 0.923) in different valve populations. Conclusions Obstructive CAD can be estimated from clinical data of adult candidates for
valve repair surgery, using a simple, accurate and validated score, easy to
apply in clinical practice, which may contribute to changes in the
preoperative strategy of acquired heart valve surgery in patients with a
lower probability of obstructive disease.
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Affiliation(s)
| | | | - Dany David Kruczan
- Instituto Estadual de Cardiologia Aloysio de Castro, Rio de Janeiro, RJ, Brazil
| | - Clara Weksler
- Instituto Nacional de Cardiologia, Rio de Janeiro, RJ, Brazil
| | | | - Ilan Gottlieb
- Instituto Nacional de Cardiologia, Rio de Janeiro, RJ, Brazil
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Abstract
Cardiac computed tomography angiography (CCTA) is a noninvasive imaging technique that has been rapidly adopted into clinical practice. Over the past decade, technological advances have improved CCTA accuracy, and there is an increasing amount of data supporting its prognostic value in the assessment of coronary artery disease. Recently, "appropriate use criteria" has been used as a tool to minimize inappropriate testing and reduce patient exposure to unnecessary risk and inconclusive studies. This review will summarize the appropriate uses of CCTA in patients before and after cardiac surgery. Although the most common indication for CCTA is assessment of patency of native coronary arteries, other potential perioperative uses (eg, assessment of congenital heart disease, valvular heart disease, pericardial disease, myocardial disease, cardiac anatomy, bypass grafts, aortic disease, and cardiac masses) will be reviewed.
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32
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Feasibility of a single-beat prospective ECG-gated cardiac CT for comprehensive evaluation of aortic valve disease using a 256-detector row wide-volume CT scanner: an initial experience. Int J Cardiovasc Imaging 2017; 34:293-300. [DOI: 10.1007/s10554-017-1223-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/31/2017] [Indexed: 12/14/2022]
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33
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Reply to “Letter to the Editor Preoperative evaluation of coronary artery fistula using dual-source computed tomography”. Int J Cardiol 2017; 234:118. [DOI: 10.1016/j.ijcard.2016.12.135] [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: 11/23/2022]
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Dewey M, Schlattmann P. Investigating Patients for CAD Before Cardiac Valve Surgery: Is CT Angiography Enough? JACC Cardiovasc Imaging 2016; 9:1071-1073. [PMID: 27344414 DOI: 10.1016/j.jcmg.2015.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 11/12/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Marc Dewey
- Department of Radiology, Charité Universitätsmedizin, Berlin, Germany.
| | - Peter Schlattmann
- Institute of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
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