1
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Nguyen ET, Green CR, Adams SJ, Bishop H, Gleeton G, Hague CJ, Hanneman K, Harris S, Strzelczyk J, Dennie C. CAR and CSTR Cardiac Computed Tomography (CT) Practice Guidelines: Part 2-Non-Coronary Imaging. Can Assoc Radiol J 2024; 75:502-517. [PMID: 38486374 DOI: 10.1177/08465371241233228] [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: 08/02/2024] Open
Abstract
The cardiac computed tomography (CT) practice guidelines provide an updated review of the technological improvements since the publication of the first Canadian Association of Radiologists (CAR) cardiac CT practice guidelines in 2009. An overview of the current evidence supporting the use of cardiac CT in the most common clinical scenarios, standards of practice to optimize patient preparation and safety as well as image quality are described. Coronary CT angiography (CCTA) is the focus of Part I. In Part II, an overview of cardiac CT for non-coronary indications that include valvular and pericardial imaging, tumour and mass evaluation, pulmonary vein imaging, and imaging of congenital heart disease for diagnosis and treatment monitoring are discussed. The guidelines are intended to be relevant for community hospitals and large academic centres with established cardiac CT imaging programs.
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Affiliation(s)
- Elsie T Nguyen
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | | | - Scott J Adams
- Department of Medical Imaging, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Helen Bishop
- Division of Cardiology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Guylaine Gleeton
- Department of Radiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec City, QC, Canada
| | - Cameron J Hague
- Department of Diagnostic Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Kate Hanneman
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Scott Harris
- Department of Radiology, Memorial University, St. John's, NL, Canada
| | - Jacek Strzelczyk
- Department of Radiology, University of Manitoba, Winnipeg, MB, Canada
| | - Carole Dennie
- Department of Radiology, Radiation Oncology and Medical Physics, University of Ottawa, Ottawa, ON, Canada
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2
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Devesa A, Rashed E, Moss N, Robson PM, Pyzik R, Roldan J, Taimur S, Rana MM, Ashley K, Young A, Patel G, Mahmood K, Mitter SS, Lala A, Barghash M, Fox A, Correa A, Pirlamarla P, Contreras J, Parikh A, Mancini D, Jacobi A, Ghesani N, Gavane SC, Ghesani M, Itagaki S, Anyanwu A, Fayad ZA, Trivieri MG. 18F-FDG PET/CT in left ventricular assist device infections: In-depth characterization and clinical implications. J Heart Lung Transplant 2024; 43:529-538. [PMID: 37951322 DOI: 10.1016/j.healun.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 10/09/2023] [Accepted: 11/06/2023] [Indexed: 11/13/2023] Open
Abstract
BACKGROUND Previous retrospective studies suggest a good diagnostic performance of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET)/computed tomography (CT) in left ventricular assist device (LVAD) infections. Our aim was to prospectively evaluate the role of PET/CT in the characterization and impact on clinical management of LVAD infections. METHODS A total of 40 patients (aged 58 [53-62] years) with suspected LVAD infection and 5 controls (aged 69 [64-71] years) underwent 18F-FDG-PET/CT. Four LVAD components were evaluated: exit site and subcutaneous driveline (peripheral), pump pocket, and outflow graft. The location with maximal uptake was considered the presumed site of infection. Infection was confirmed by positive culture (exit site or blood) and/or surgical findings. RESULTS Visual uptake was present in 40 patients (100%) in the infection group vs 4 (80%) control subjects. For each individual component, the presence of uptake was more frequent in the infection than in the control group. The location of maximal uptake was most frequently the pump pocket (48%) in the infection group and the peripheral components (75%) in the control group. Maximum standard uptake values (SUVmax) were higher in the infection than in the control group: SUVmax (average all components): 6.9 (5.1-8.5) vs 3.8 (3.7-4.3), p = 0.002; SUVmax (location of maximal uptake): 10.6 ± 4.0 vs 5.4 ± 1.9, p = 0.01. Pump pocket infections were more frequent in patients with bacteremia than without bacteremia (79% vs 31%, p = 0.011). Pseudomonas (32%) and methicillin-susceptible Staphylococcus aureus (29%) were the most frequent pathogens and were associated with pump pocket infections, while Staphylococcus epidermis (11%) was associated with peripheral infections. PET/CT affected the clinical management of 83% of patients with infection, resulting in surgical debridement (8%), pump exchange (13%), and upgrade in the transplant listing status (10%), leading to 8% of urgent transplants. CONCLUSIONS 18F-FDG-PET/CT enables the diagnosis and characterization of the extent of LVAD infections, which can significantly affect the clinical management of these patients.
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Affiliation(s)
- Ana Devesa
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Mount Sinai Fuster Heart Hospital, New York, New York; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Eman Rashed
- Mount Sinai Fuster Heart Hospital, New York, New York
| | - Noah Moss
- Mount Sinai Fuster Heart Hospital, New York, New York
| | - Philip M Robson
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Renata Pyzik
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Julie Roldan
- Mount Sinai Fuster Heart Hospital, New York, New York
| | - Sarah Taimur
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Meenakshi M Rana
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kimberly Ashley
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anna Young
- Mount Sinai Fuster Heart Hospital, New York, New York
| | - Gopi Patel
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kiran Mahmood
- Mount Sinai Fuster Heart Hospital, New York, New York
| | | | - Anuradha Lala
- Mount Sinai Fuster Heart Hospital, New York, New York
| | - Maya Barghash
- Mount Sinai Fuster Heart Hospital, New York, New York
| | - Arieh Fox
- Mount Sinai Fuster Heart Hospital, New York, New York
| | - Ashish Correa
- Mount Sinai Fuster Heart Hospital, New York, New York
| | | | | | - Aditya Parikh
- Mount Sinai Fuster Heart Hospital, New York, New York
| | - Donna Mancini
- Mount Sinai Fuster Heart Hospital, New York, New York
| | - Adam Jacobi
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nasrin Ghesani
- Division of Nuclear Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Somali C Gavane
- Division of Nuclear Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Munir Ghesani
- Division of Nuclear Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Shinobu Itagaki
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anelechi Anyanwu
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Zahi A Fayad
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Maria Giovanna Trivieri
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Mount Sinai Fuster Heart Hospital, New York, New York.
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3
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Pergola V, Cameli M, Mattesi G, Mushtaq S, D’Andrea A, Guaricci AI, Pastore MC, Amato F, Dellino CM, Motta R, Perazzolo Marra M, Dellegrottaglie S, Pedrinelli R, Iliceto S, Nodari S, Perrone Filardi P, Pontone G. Multimodality Imaging in Advanced Heart Failure for Diagnosis, Management and Follow-Up: A Comprehensive Review. J Clin Med 2023; 12:7641. [PMID: 38137711 PMCID: PMC10743799 DOI: 10.3390/jcm12247641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/02/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Advanced heart failure (AHF) presents a complex landscape with challenges spanning diagnosis, management, and patient outcomes. In response, the integration of multimodality imaging techniques has emerged as a pivotal approach. This comprehensive review delves into the profound significance of these imaging strategies within AHF scenarios. Multimodality imaging, encompassing echocardiography, cardiac magnetic resonance imaging (CMR), nuclear imaging and cardiac computed tomography (CCT), stands as a cornerstone in the care of patients with both short- and long-term mechanical support devices. These techniques facilitate precise device selection, placement, and vigilant monitoring, ensuring patient safety and optimal device functionality. In the context of orthotopic cardiac transplant (OTC), the role of multimodality imaging remains indispensable. Echocardiography offers invaluable insights into allograft function and potential complications. Advanced methods, like speckle tracking echocardiography (STE), empower the detection of acute cell rejection. Nuclear imaging, CMR and CCT further enhance diagnostic precision, especially concerning allograft rejection and cardiac allograft vasculopathy. This comprehensive imaging approach goes beyond diagnosis, shaping treatment strategies and risk assessment. By harmonizing diverse imaging modalities, clinicians gain a panoramic understanding of each patient's unique condition, facilitating well-informed decisions. The aim is to highlight the novelty and unique aspects of recently published papers in the field. Thus, this review underscores the irreplaceable role of multimodality imaging in elevating patient outcomes, refining treatment precision, and propelling advancements in the evolving landscape of advanced heart failure management.
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Affiliation(s)
- Valeria Pergola
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35128 Padova, Italy; (G.M.); (F.A.); (M.P.M.); (S.I.)
| | - Matteo Cameli
- Department of Cardiovascular Diseases, University of Sienna, 53100 Siena, Italy; (M.C.); (M.C.P.)
| | - Giulia Mattesi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35128 Padova, Italy; (G.M.); (F.A.); (M.P.M.); (S.I.)
| | - Saima Mushtaq
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (S.M.); (C.M.D.); (G.P.)
| | | | - Andrea Igoren Guaricci
- University Cardiology Unit, Interdisciplinary Department of Medicine, Policlinic University Hospital, 70121 Bari, Italy;
| | - Maria Concetta Pastore
- Department of Cardiovascular Diseases, University of Sienna, 53100 Siena, Italy; (M.C.); (M.C.P.)
| | - Filippo Amato
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35128 Padova, Italy; (G.M.); (F.A.); (M.P.M.); (S.I.)
| | - Carlo Maria Dellino
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (S.M.); (C.M.D.); (G.P.)
| | - Raffaella Motta
- Unit of Radiology, Department of Medicine, Medical School, University of Padua, 35122 Padua, Italy;
| | - Martina Perazzolo Marra
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35128 Padova, Italy; (G.M.); (F.A.); (M.P.M.); (S.I.)
| | - Santo Dellegrottaglie
- Division of Cardiology, Ospedale Medico-Chirurgico Accreditato Villa dei Fiori, 80011 Acerra, Italy;
| | - Roberto Pedrinelli
- Cardiac, Thoracic and Vascular Department, University of Pisa, 56126 Pisa, Italy;
| | - Sabino Iliceto
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35128 Padova, Italy; (G.M.); (F.A.); (M.P.M.); (S.I.)
| | - Savina Nodari
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Institute of Cardiology, University of Brescia, 25123 Brescia, Italy;
| | - Pasquale Perrone Filardi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80138 Naples, Italy;
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (S.M.); (C.M.D.); (G.P.)
- Department of Biomedical, Surgical and Sciences, University of Milan, 20122 Milan, Italy
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4
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Zaloznik Djordjevic J, Özkan T, Göncz E, Ksela J, Möckel M, Strnad M. Common Complications and Cardiopulmonary Resuscitation in Patients with Left Ventricular Assist Devices: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1981. [PMID: 38004030 PMCID: PMC10672734 DOI: 10.3390/medicina59111981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 10/28/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023]
Abstract
Heart failure remains a major global burden regarding patients' morbidity and mortality and health system organization, logistics, and costs. Despite continual advances in pharmacological and resynchronization device therapy, it is currently well accepted that heart transplantation and mechanical circulatory support represent a cornerstone in the management of advanced forms of this disease, with the latter becoming an increasingly accepted treatment modality due to the ongoing shortage of available donor hearts in an ever-increasing pool of patients. Mechanical circulatory support strategies have seen tremendous advances in recent years, especially in terms of pump technology improvements, indication for use, surgical techniques for device implantation, exchange and explantation, and postoperative patient management, but not in the field of treatment of critically ill patients and those undergoing cardiac arrest. This contemporary review aims to summarize the collected knowledge of this topic with an emphasis on complications in patients with left ventricular assist devices, their treatment, and establishing a clear-cut algorithm and the latest recommendations regarding out-of-hospital or emergency department management of cardiac arrest in this patient population.
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Affiliation(s)
| | - Timur Özkan
- Department of Emergency and Acute Medicine, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Eva Göncz
- Department of Emergency and Acute Medicine, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Jus Ksela
- Department of Cardiovascular Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Martin Möckel
- Department of Emergency and Acute Medicine, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Matej Strnad
- Department of Emergency Medicine, University Medical Centre Maribor, 2000 Maribor, Slovenia
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5
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Gu Z, Ong CW, Mi Y, Seetharaman A, Ling RR, Ramanathan K, Leo HL. The Impact of Left Ventricular Assist Device Outflow Graft Positioning on Aortic Hemodynamics: Improving Flow Dynamics to Mitigate Aortic Insufficiency. Biomimetics (Basel) 2023; 8:465. [PMID: 37887596 PMCID: PMC10604423 DOI: 10.3390/biomimetics8060465] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/27/2023] [Accepted: 09/20/2023] [Indexed: 10/28/2023] Open
Abstract
Heart failure is a global health concern with significant implications for healthcare systems. Left ventricular assist devices (LVADs) provide mechanical support for patients with severe heart failure. However, the placement of the LVAD outflow graft within the aorta has substantial implications for hemodynamics and can lead to aortic insufficiency during long-term support. This study employs computational fluid dynamics (CFD) simulations to investigate the impact of different LVAD outflow graft locations on aortic hemodynamics. The introduction of valve morphology within the aorta geometry allows for a more detailed analysis of hemodynamics at the aortic root. The results demonstrate that the formation of vortex rings and subsequent vortices during the high-velocity jet flow from the graft interacted with the aortic wall. Time-averaged wall shear stress (TAWSS) and oscillatory shear index (OSI) indicate that modification of the outflow graft location changes mechanical states within the aortic wall and aortic valve. Among the studied geometric factors, both the height and inclination angle of the LVAD outflow graft are important in controlling retrograde flow to the aortic root, while the azimuthal angle primarily determines the rotational direction of blood flow in the aortic arch. Thus, precise positioning of the LVAD outflow graft emerges as a critical factor in optimizing patient outcomes by improving the hemodynamic environment.
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Affiliation(s)
- Zhuohan Gu
- Department of Biomedical Engineering, National University of Singapore, Singapore 119077, Singapore; (Z.G.); (A.S.)
| | - Chi Wei Ong
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore 639798, Singapore
| | - Yongzhen Mi
- Institute of High Performance Computing (IHPC), Agency for Science, Technology and Research (A*STAR), Singapore 138632, Singapore;
| | - Ashwin Seetharaman
- Department of Biomedical Engineering, National University of Singapore, Singapore 119077, Singapore; (Z.G.); (A.S.)
| | - Ryan Ruiyang Ling
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore (K.R.)
| | - Kollengode Ramanathan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore (K.R.)
- Cardiothoracic Intensive Care Unit, National University Heart Centre Singapore, National Univeristy Health System, Singapore 119228, Singapore
| | - Hwa Liang Leo
- Department of Biomedical Engineering, National University of Singapore, Singapore 119077, Singapore; (Z.G.); (A.S.)
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6
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Wilson SI, Ingram KE, Oh A, Moreno MR, Kassi M. The role of innovative modeling and imaging techniques in improving outcomes in patients with LVAD. Front Cardiovasc Med 2023; 10:1248300. [PMID: 37692033 PMCID: PMC10484111 DOI: 10.3389/fcvm.2023.1248300] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023] Open
Abstract
Heart failure remains a significant cause of mortality in the United States and around the world. While organ transplantation is acknowledged as the gold standard treatment for end stage heart failure, supply is limited, and many patients are treated with left ventricular assist devices (LVADs). LVADs extend and improve patients' lives, but they are not without their own complications, particularly the hemocompatibility related adverse events (HRAE) including stroke, bleeding and pump thrombosis. Mainstream imaging techniques currently in use to assess appropriate device function and troubleshoot complications, such as echocardiography and cardiac computed tomography, provide some insight but do not provide a holistic understanding of pump induced flow alterations that leads to HRAEs. In contrast, there are technologies restricted to the benchtop-such as computational fluid dynamics and mock circulatory loops paired with methods like particle image velocimetry-that can assess flow metrics but have not been optimized for clinical care. In this review, we outline the potential role and current limitations of converging available technologies to produce novel imaging techniques, and the potential utility in evaluating hemodynamic flow to determine whether LVAD patients may be at higher risk of HRAEs. This addition to diagnostic and monitoring capabilities could improve prevention and treatment of LVAD-induced complications in heart failure patients.
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Affiliation(s)
- Shannon I. Wilson
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, United States
| | - Katelyn E. Ingram
- DeBakey Heart and Vascular- Heart Center Research, Houston Methodist Research Institute, Houston, TX, United States
| | - Albert Oh
- School of Engineering Medicine, Texas A&M University, Houston, TX, United States
| | - Michael R. Moreno
- J. Mike Walker ‘66 Department of Mechanical Engineering, Texas A&M University, College Station, TX, United States
| | - Mahwash Kassi
- Cardiology, DeBakey Heart and Vascular, Houston Methodist Hospital, Houston, TX, United States
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7
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Shields A, Setlur Nagesh SV, Rajagopal K, Bednarek DR, Rudin S, Chivukula VK. Application of 1,000 fps High-Speed Angiography to In-Vitro Hemodynamic Evaluation of Left Ventricular Assist Device Outflow Graft Configurations. ASAIO J 2023; 69:756-765. [PMID: 37140988 PMCID: PMC10524133 DOI: 10.1097/mat.0000000000001948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
Left ventricular assist device (LVAD)-induced hemodynamics are characterized by fast-moving flow with large variations in velocity, making quantitative assessments difficult with existing imaging methods. This study demonstrates the ability of 1,000 fps high-speed angiography (HSA) to quantify the effect of the surgical implantation angle of a LVAD outflow graft on the hemodynamics within the ascending aorta in vitro . High-speed angiography was performed on patient-derived, three-dimensional-printed optically opaque aortic models using a nonsoluble contrast media, ethiodol, as a flow tracer. Outflow graft configuration angles of 45° and 90° with respect to the central aortic axis were considered. Projected velocity distributions were calculated from the high-speed experimental sequences using two methods: a physics-based optical flow algorithm and tracking of radio-opaque particles. Particle trajectories were also used to evaluate accumulated shear stress. Results were then compared with computational fluid dynamics (CFD) simulations to confirm the results of the high-speed imaging method. Flow patterns derived from HSA coincided with the impingement regions and recirculation zones formed in the aortic root as seen in the CFD for both graft configurations. Compared with the 45° graft, the 90° configuration resulted in 81% higher two-dimensional-projected velocities (over 100 cm/s) along the contralateral wall of the aorta. Both graft configurations suggest elevated accumulated shear stresses along individual trajectories. Compared with CFD simulations, HSA successfully characterized the fast-moving flow and hemodynamics in each LVAD graft configuration in vitro , demonstrating the potential utility of this technology as a quantitative imaging modality.
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Affiliation(s)
- Allison Shields
- Medical Physics Program, University at Buffalo, Buffalo,
New York, USA
- Canon Stroke and Vascular Research Center, University at
Buffalo, Buffalo, New York, USA
| | - Swetadri Vasan Setlur Nagesh
- Medical Physics Program, University at Buffalo, Buffalo,
New York, USA
- Canon Stroke and Vascular Research Center, University at
Buffalo, Buffalo, New York, USA
| | - Keshava Rajagopal
- Division of Cardiac Surgery, Department of Surgery, Sidney
Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania,
USA
| | - Daniel R. Bednarek
- Medical Physics Program, University at Buffalo, Buffalo,
New York, USA
- Canon Stroke and Vascular Research Center, University at
Buffalo, Buffalo, New York, USA
| | - Stephen Rudin
- Medical Physics Program, University at Buffalo, Buffalo,
New York, USA
- Canon Stroke and Vascular Research Center, University at
Buffalo, Buffalo, New York, USA
| | - Venkat Keshav Chivukula
- Department of Biomedical Engineering, Florida Institute of
Technology, Melbourne, Florida, USA
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8
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Velangi PS, Agdamag AC, Nijjar PS, Pogatchnik B, Nijjar PS. Update on CT Imaging of Left Ventricular Assist Devices and Associated Complications. CURRENT CARDIOVASCULAR IMAGING REPORTS 2022. [DOI: 10.1007/s12410-022-09570-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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9
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Hoegger MJ, Ludwig DR, Zulfiqar M, Raptis DA, Shetty AS. Enhancing the interpretation of unenhanced abdominopelvic CT. Curr Probl Diagn Radiol 2022; 51:787-797. [DOI: 10.1067/j.cpradiol.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/05/2022] [Indexed: 11/22/2022]
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10
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Dilsizian V, Budde RPJ, Chen W, Mankad SV, Lindner JR, Nieman K. Best Practices for Imaging Cardiac Device-Related Infections and Endocarditis: A JACC: Cardiovascular Imaging Expert Panel Statement. JACC Cardiovasc Imaging 2021; 15:891-911. [PMID: 34922877 DOI: 10.1016/j.jcmg.2021.09.029] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/01/2021] [Accepted: 09/13/2021] [Indexed: 12/13/2022]
Abstract
The diagnosis of cardiac device infection and, more importantly, accurate localization of the infection site, such as defibrillator pocket, pacemaker lead, along the peripheral driveline or central portion of the left ventricular assist device, prosthetic valve ring abscesses, and perivalvular extensions, remain clinically challenging. Although transthoracic and transesophageal echocardiography are the first-line imaging tests in suspected endocarditis and for assessing hemodynamic complications, recent studies suggest that cardiac computed tomography (CT) or CT angiography and functional imaging with 18F-fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) with CT (FDG PET/CT) may have an incremental role in technically limited or inconclusive cases on echocardiography. One of the key benefits of FDG PET/CT is in its detection of inflammatory cells early in the infection process, before morphological damages ensue. However, there are many unanswered questions in the literature. In this document, we provide consensus on best practices among the various imaging studies, which includes the detection of cardiac device infection, differentiation of infection from inflammation, image-guided patient management, and detailed recommendations on patient preparation, image acquisition, processing, interpretation, and standardized reporting.
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Affiliation(s)
- Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Wengen Chen
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Sunil V Mankad
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonathan R Lindner
- Knight Cardiovascular Institute and the Oregon National Primate Research Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Koen Nieman
- Department of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
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11
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Venkateswaran R, Dimarakis I. A tale of two grafts. Perfusion 2020; 36:643-644. [PMID: 32930055 DOI: 10.1177/0267659120957179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rajamiyer Venkateswaran
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Wythenshawe Hospital, Manchester, UK.,Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Ioannis Dimarakis
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Wythenshawe Hospital, Manchester, UK.,Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
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12
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CT Imaging of Left Ventricular Assist Devices and Associated Complications. CURRENT CARDIOVASCULAR IMAGING REPORTS 2020. [DOI: 10.1007/s12410-020-09546-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ten Hove D, Treglia G, Slart RHJA, Damman K, Wouthuyzen-Bakker M, Postma DF, Gheysens O, Borra RJH, Mecozzi G, van Geel PP, Sinha B, Glaudemans AWJM. The value of 18F-FDG PET/CT for the diagnosis of device-related infections in patients with a left ventricular assist device: a systematic review and meta-analysis. Eur J Nucl Med Mol Imaging 2020; 48:241-253. [PMID: 32594196 PMCID: PMC7835315 DOI: 10.1007/s00259-020-04930-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/14/2020] [Indexed: 12/18/2022]
Abstract
Background Left ventricular assist devices (LVADs) are increasingly used for the treatment of advanced heart failure. LVADs improve quality of life and decrease mortality, but the driveline carries substantial risk for major infections. These device-related LVAD and driveline infections are difficult to diagnose with conventional imaging. We reviewed and analysed the current literature on the additive value of 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography (FDG-PET/CT) imaging for the diagnosis of LVAD-related infections.” Materials/methods We performed a systematic literature review using several databases from their inception until the 31st of December, 2019. Studies investigating the diagnostic performance of FDG-PET/CT in patients with suspected LVAD infection were retrieved. After a bias risk assessment using QUADAS-2, a study-aggregate meta-analysis was performed on a per examination-based analysis. Results A total of 10 studies were included in the systematic review, eight of which were also eligible for study-aggregate meta-analysis. For the meta-analysis, a total of 256 FDG-PET/CT scans, examining pump/pocket and/or driveline infection, were acquired in 230 patients. Pooled sensitivity of FDG-PET/CT was 0.95 (95% confidence interval (CI) 0.89–0.97) and pooled specificity was 0.91 (95% CI 0.54–0.99) for the diagnosis of device-related infection. For pump/pocket infection, sensitivity and specificity of FDG-PET/CT were 0.97 (95%CI 0.69–1.00) and 0.93 (95%CI 0.64–0.99), respectively. For driveline infection, sensitivity and specificity were 0.96 (95%CI 0.88–0.99) and 0.99 (95%CI 0.13–1.00) respectively. Significant heterogeneity existed across studies for specificity, mostly caused by differences in scan procedures. Predefined criteria for suspicion of LVAD and/or driveline infection were lacking in all included studies. Conclusions FDG-PET/CT is a valuable tool for assessment of device-related infection in LVAD patients, with high sensitivity and high, albeit variable, specificity. Standardization of FDG-PET/CT procedures and criteria for suspected device-related LVAD infections are needed for consistent reporting of FDG-PET/CT scans. Electronic supplementary material The online version of this article (10.1007/s00259-020-04930-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- D Ten Hove
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands. .,Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - G Treglia
- Clinic of Nuclear Medicine and PET/CT Centre, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona and Lugano, Switzerland.,Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Health Technology Assessment Unit, Academic Education, Research and Innovation Area, Ente Ospedaliero Cantonale, Via Lugano 4F, CH-6500, Bellinzona, Switzerland
| | - R H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands.,Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, Enschede, the Netherlands
| | - K Damman
- University of Groningen, Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M Wouthuyzen-Bakker
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - D F Postma
- Department of Internal Medicine and infectious diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - O Gheysens
- Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - R J H Borra
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands.,Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - G Mecozzi
- Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - P P van Geel
- University of Groningen, Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - B Sinha
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
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Expanding Use of New Technology Creates New Challenges in Preventing and Managing Infections: a Review of Diagnostic and Management Considerations for Infections Among Patients with Long-Term Invasive Devices for Advanced Heart Failure. Curr Infect Dis Rep 2020. [DOI: 10.1007/s11908-020-00724-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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15
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Rao VN, Fudim M, Griffin A, Rymer JA, Jones WS, Koweek LM, Smith TP, Marin D, DeVore AD. Lawn Mower Versus Left Ventricular Assist Device. JACC Case Rep 2020; 2:406-410. [PMID: 34317252 PMCID: PMC8311724 DOI: 10.1016/j.jaccas.2019.12.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/13/2019] [Accepted: 12/18/2019] [Indexed: 11/27/2022]
Abstract
A 77-year-old man with history of ischemic cardiomyopathy and left ventricular assist device (LVAD) presented with abdominal pain after a lawn mower accident. Examination and imaging revealed a displaced LVAD driveline and a pericardial hematoma secondary to traumatic coronary artery injury. The patient was treated with coronary artery coil embolization. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Vishal N. Rao
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
- Address for correspondence: Dr. Vishal N. Rao, Division of Cardiology, Duke University Hospital, 2301 Erwin Road, DUMC 3845, Durham, North Carolina 27710.
| | - Marat Fudim
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Andrew Griffin
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Jennifer A. Rymer
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - W. Schuyler Jones
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Lynne M.H. Koweek
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Tony P. Smith
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Daniele Marin
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Adam D. DeVore
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
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Kligerman S, Horowitz M, Jacobs K, Weihe E. Imaging of Cardiac Support Devices. Radiol Clin North Am 2019; 58:151-165. [PMID: 31731898 DOI: 10.1016/j.rcl.2019.08.012] [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: 02/07/2023]
Abstract
Patients hospitalized in the intensive care unit (ICU) often have multiple support lines and devices that need routine imaging evaluation by radiologists. In patients with cardiogenic shock or depressed cardiac function, mechanical circulation support devices are used in combination with medical therapies to improve patient outcomes and sometimes can stabilize patients for surgical intervention. This article discusses some of the more commonly encountered mechanical circulation devices seen in ICU patients, including intra-aortic balloon pumps, Impella devices, extracorporeal membrane oxygenation cannulas, and ventricular assist devices. Normal appearance and commonly encountered device-related complications that can be diagnosed on imaging are reviewed.
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Affiliation(s)
- Seth Kligerman
- Cardiothoracic Radiology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.
| | - Michael Horowitz
- Cardiothoracic Radiology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Kathleen Jacobs
- Cardiothoracic Radiology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Elizabeth Weihe
- Cardiothoracic Radiology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
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17
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Expanding the Scope of Multimodality Imaging in Durable Mechanical Circulatory Support. JACC Cardiovasc Imaging 2019; 13:1069-1081. [PMID: 31542528 DOI: 10.1016/j.jcmg.2019.05.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 05/13/2019] [Accepted: 05/24/2019] [Indexed: 01/01/2023]
Abstract
An increasing number of patients transition to advanced-stage heart failure refractory to medical therapy. Left ventricular assist systems (LVAS) provide a bridge to candidates awaiting heart transplantation and extended device durability allows permanent implantation referred to as destination therapy. Noninvasive imaging plays a pivotal role in the optimal management of patients implanted with durable mechanical circulatory support (MCS) devices. Several advances require an updated perspective of multi-modality imaging in contemporary LVAS management. First, there has been substantial evolution of devices such as the introduction of the fully magnetically levitated HeartMate 3 pump (Abbott, Abbott Park, Illinois). Second, imaging beyond the device, of the peripheral system, is increasingly recognized as clinically relevant. Third, U.S. Food and Drug Administration recalls have called attention to LVAS complications beyond pump thrombosis that are amenable to imaging-based diagnosis. Fourth, there is increased availability of multimodality imaging, such as computed tomography and positron emission tomography, at many centers across the world. In this review, the authors provide a practical and contemporary approach to multi-modality imaging of current-generation durable MCS devices. As the use of LVAS and other novel MCS devices increases globally, it is critical for clinicians caring for LVAS patients to understand the roles of various imaging modalities in patient evaluation and management.
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Sarv P, Pankaj W, Michelle S, Shawn S. Typical but uncommon computed tomography angiographic appearance of left ventricular assist device: Awareness is key! Eur J Radiol Open 2019; 6:132-135. [PMID: 30989090 PMCID: PMC6447749 DOI: 10.1016/j.ejro.2019.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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20
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Mehra MR, Salerno C, Naka Y, Uriel N, Cleveland JC, Horstmanshof D, Goldstein DJ. A tale of the twist in the outflow graft: An analysis from the MOMENTUM 3 trial. J Heart Lung Transplant 2018; 37:1281-1284. [PMID: 30245150 DOI: 10.1016/j.healun.2018.08.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 08/20/2018] [Indexed: 11/21/2022] Open
Affiliation(s)
- Mandeep R Mehra
- Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts.
| | - Christopher Salerno
- Department of Cardiothoracic Surgery, St. Vincent Heart Center, Indianapolis, Indiana
| | - Yoshifumi Naka
- Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, New York
| | - Nir Uriel
- Section of Cardiology, The University of Chicago School of Medicine and Medical Center, Chicago, Illinois
| | - Joseph C Cleveland
- Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Douglas Horstmanshof
- Division of Cardiology, Integris Baptist Medical Center, Oklahoma City, Oklahoma
| | - Daniel J Goldstein
- Department of Cardiothoracic Surgery, Montefiore Einstein Center for Heart and Vascular Care, Bronx, New York
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