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Li Y, Yang Z, Yin P, Gao X, Li L, Zhao Q, Zhen Y, Wang Y, Liu C. Quantitative analysis of abdominal aortic blood flow by 99mTc-DTPA renal scintigraphy in patients with heart failure. Ann Nucl Med 2024; 38:418-427. [PMID: 38466548 DOI: 10.1007/s12149-024-01912-w] [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: 09/25/2023] [Accepted: 02/05/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVE This study aimed to explore the characteristics of abdominal aortic blood flow in patients with heart failure (HF) using 99mTc-diethylenetriaminepentaacetic acid (DTPA) renal scintigraphy. We investigated the ability of renal scintigraphy to measure the cardiopulmonary transit time and assessed whether the time-to-peak of the abdominal aorta (TTPa) can distinguish between individuals with and without HF. METHODS We conducted a retrospective study that included 304 and 37 patients with and without HF (controls), respectively. All participants underwent 99mTc-DTPA renal scintigraphy. The time to peak from the abdominal aorta's first-pass time-activity curve was noted and compared between the groups. The diagnostic significance of TTPa for HF was ascertained through receiver operating characteristic (ROC) analysis and logistic regression. Factors influencing the TTPa were assessed using ordered logistic regression. RESULTS The HF group displayed a significantly prolonged TTPa than controls (18.5 [14, 27] s vs. 11 [11, 13] s). Among the HF categories, HF with reduced ejection fraction (HFrEF) exhibited the longest TTPa compared with HF with mildly reduced (HFmrEF) and preserved EF (HFpEF) (25 [17, 36.5] s vs. 17 [15, 23] s vs. 15 [11, 17] s) (P < 0.001). The ROC analysis had an area under the curve of 0.831, which underscored TTPa's independent diagnostic relevance for HF. The diagnostic precision was enhanced as left ventricular ejection fraction (LVEF) declined and HF worsened. Independent factors for TTPa included the left atrium diameter, LVEF, right atrium diameter, velocity of tricuspid regurgitation, and moderate to severe aortic regurgitation. CONCLUSIONS Based on 99mTc-DTPA renal scintigraphy, TTPa may be used as a straightforward and non-invasive tool that can effectively distinguish patients with and without HF.
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Affiliation(s)
- Yue Li
- Heart Failure Center, The First Hospital of Hebei Medical University, Hebei Medical University, 89 Donggang Road, Shijiazhuang, 050031, Hebei, China
- Department of Cardiology, The Second Hospital of Hebei Medical University, 215 Heping Road, Shijiazhuang, 050000, Hebei, China
- Cardiovascular Research Center of Hebei Medical University, Shijiazhuang, 050000, Hebei, China
| | - Zhiqiang Yang
- Heart Failure Center, The First Hospital of Hebei Medical University, Hebei Medical University, 89 Donggang Road, Shijiazhuang, 050031, Hebei, China
| | - Pei Yin
- Division of Nuclear Medicine, The First Hospital of Hebei Medical University, Shijiazhuang, 050031, Hebei, China
| | - Xian Gao
- Health Institute of The First Hospital of Hebei Medical University, Shijiazhuang, 050031, Hebei, China
| | - Lizhuo Li
- Heart Failure Center, The First Hospital of Hebei Medical University, Hebei Medical University, 89 Donggang Road, Shijiazhuang, 050031, Hebei, China
| | - Qingzhen Zhao
- Heart Failure Center, The First Hospital of Hebei Medical University, Hebei Medical University, 89 Donggang Road, Shijiazhuang, 050031, Hebei, China
| | - Yuzhi Zhen
- Heart Failure Center, The First Hospital of Hebei Medical University, Hebei Medical University, 89 Donggang Road, Shijiazhuang, 050031, Hebei, China
| | - Yu Wang
- Heart Failure Center, The First Hospital of Hebei Medical University, Hebei Medical University, 89 Donggang Road, Shijiazhuang, 050031, Hebei, China
| | - Chao Liu
- Heart Failure Center, The First Hospital of Hebei Medical University, Hebei Medical University, 89 Donggang Road, Shijiazhuang, 050031, Hebei, China.
- Cardiovascular Research Center of Hebei Medical University, Shijiazhuang, 050000, Hebei, China.
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Kaproth-Joslin K, Hobbs S, Rajiah P, Chaturvedi A, Chaturvedi A. Optimizing low contrast volume thoracic CT angiography: From the basics to the advanced. J Clin Imaging Sci 2022; 12:41. [PMID: 36128360 PMCID: PMC9479554 DOI: 10.25259/jcis_51_2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 06/30/2022] [Indexed: 11/04/2022] Open
Abstract
Contrast-enhanced CT angiography (CTA) is a widely used, noninvasive imaging technique for evaluating cardiovascular structures. Contrast-induced nephrotoxicity is a concern in renal disease; however, the true nephrotoxic potential of iodinated contrast media (CM) is unknown. If a renal impaired patient requires CTA, it is important to protect the kidneys from further harm by reducing total iodinated CM volume while still obtaining diagnostic quality imaging. These same reduced volume CM techniques can also be applied to nonrenal impaired patients in times of CM shortage. This educational review discusses several modifications to CTA that can be adapted to both conventional 64-slice and the newer generation CT scanners which enable subsecond acquisition with a reduced CM volume technique. Such modifications include hardware and software adjustments and changes to both the volume and flow rate of administered CM, with the goal to reduce the dose of CM without compromising diagnostic yield.
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Affiliation(s)
| | - Susan Hobbs
- Department of Imaging Sciences, University of Rochester, Rochester, New York, United States
| | - Prabhakar Rajiah
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States
| | - Apeksha Chaturvedi
- Department of Imaging Sciences, University of Rochester, Rochester, New York, United States
| | - Abhishek Chaturvedi
- Department of Imaging Sciences, University of Rochester, Rochester, New York, United States
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Gonska B, Buckert D, Mörike J, Scharnbeck D, Kersten J, Cuspidi C, Rottbauer W, Tadic M. Imaging Challenges in Patients with Severe Aortic Stenosis and Heart Failure: Did We Find a Way Out of the Labyrinth? J Clin Med 2022; 11:jcm11020317. [PMID: 35054012 PMCID: PMC8777924 DOI: 10.3390/jcm11020317] [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: 11/30/2021] [Revised: 12/22/2021] [Accepted: 01/05/2022] [Indexed: 11/16/2022] Open
Abstract
Aortic stenosis (AS) is the most frequent degenerative valvular disease in developed countries. Its incidence has been constantly rising due to population aging. The diagnosis of AS was considered straightforward for a very long time. High gradients and reduced aortic valve area were considered as "sine qua non" in diagnosis of AS until a growing body of evidence showed that patients with low gradients could also have severe AS with the same or even worse outcome. This completely changed the paradigm of AS diagnosis and involved large numbers of parameters that had never been used in the evaluation of AS severity. Low gradient AS patients may present with heart failure (HF) with preserved or reduced left ventricular ejection fraction (LVEF), associated with changes in cardiac output and flow across the aortic valve. These patients with low-flow low-gradient or paradoxical low-flow low-gradient AS are particularly challenging to diagnose, and cardiac output and flow across the aortic valve have become the most relevant parameters in evaluation of AS, besides gradients and aortic valve area. The introduction of other imaging modalities in the diagnosis of AS significantly improved our knowledge about cardiac mechanics, tissue characterization of myocardium, calcium and inflammation burden of the aortic valve, and their impact on severity, progression and prognosis of AS, not only in symptomatic but also in asymptomatic patients. However, a variety of novel parameters also brought uncertainty regarding the clinical relevance of these indices, as well as the necessity for their validation in everyday practice. The aim of this review is to summarize the prevalence of HF in patients with severe AS and elaborate on the diagnostic challenges and advantages of comprehensive multimodality cardiac imaging to identify the patients that may benefit from surgical or transcatheter aortic valve replacement, as well as parameters that may help during follow-up.
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Affiliation(s)
- Birgid Gonska
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany; (B.G.); (D.B.); (J.M.); (D.S.); (J.K.); (W.R.)
| | - Dominik Buckert
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany; (B.G.); (D.B.); (J.M.); (D.S.); (J.K.); (W.R.)
| | - Johannes Mörike
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany; (B.G.); (D.B.); (J.M.); (D.S.); (J.K.); (W.R.)
| | - Dominik Scharnbeck
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany; (B.G.); (D.B.); (J.M.); (D.S.); (J.K.); (W.R.)
| | - Johannes Kersten
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany; (B.G.); (D.B.); (J.M.); (D.S.); (J.K.); (W.R.)
| | - Cesare Cuspidi
- Department for Internal Medicine, University of Milan-Bicocca, 20126 Milan, Italy;
| | - Wolfang Rottbauer
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany; (B.G.); (D.B.); (J.M.); (D.S.); (J.K.); (W.R.)
| | - Marijana Tadic
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany; (B.G.); (D.B.); (J.M.); (D.S.); (J.K.); (W.R.)
- Correspondence: ; Tel.: +49-176-3236-0011
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Zhu M, Fan X, Liu W, Shen J, Chen W, Xu Y, Yu X. Artificial Intelligence-Based Echocardiographic Left Atrial Volume Measurement with Pulmonary Vein Comparison. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:1336762. [PMID: 34912531 PMCID: PMC8668302 DOI: 10.1155/2021/1336762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/03/2021] [Accepted: 11/05/2021] [Indexed: 11/17/2022]
Abstract
This paper combines echocardiographic signal processing and artificial intelligence technology to propose a deep neural network model adapted to echocardiographic signals to achieve left atrial volume measurement and automatic assessment of pulmonary veins efficiently and quickly. Based on the echocardiographic signal generation mechanism and detection method, an experimental scheme for the echocardiographic signal acquisition was designed. The echocardiographic signal data of healthy subjects were measured in four different experimental states, and a database of left atrial volume measurements and pulmonary veins was constructed. Combining the correspondence between ECG signals and echocardiographic signals in the time domain, a series of preprocessing such as denoising, feature point localization, and segmentation of the cardiac cycle was realized by wavelet transform and threshold method to complete the data collection. This paper proposes a comparative model based on artificial intelligence, adapts to the characteristics of one-dimensional time-series echocardiographic signals, automatically extracts the deep features of echocardiographic signals, effectively reduces the subjective influence of manual feature selection, and realizes the automatic classification and evaluation of human left atrial volume measurement and pulmonary veins under different states. The experimental results show that the proposed BP neural network model has good adaptability and classification performance in the tasks of LV volume measurement and pulmonary vein automatic classification evaluation and achieves an average test accuracy of over 96.58%. The average root-mean-square error percentage of signal compression is only 0.65% by extracting the coding features of the original echocardiographic signal through the convolutional autoencoder, which completes the signal compression with low loss. Comparing the training time and classification accuracy of the LSTM network with the original signal and encoded features, the experimental results show that the AI model can greatly reduce the model training time cost and achieve an average accuracy of 97.97% in the test set and increase the real-time performance of the left atrial volume measurement and pulmonary vein evaluation as well as the security of the data transmission process, which is very important for the comparison of left atrial volume measurement and pulmonary vein. It is of great practical importance to compare left atrial volume measurements with pulmonary veins.
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Affiliation(s)
- Mengyun Zhu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Ximin Fan
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Weijing Liu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Jianying Shen
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Wei Chen
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Xuejing Yu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
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van den Boogert TPW, Lopes RR, Lobe NHJ, Verwest TA, Stoker J, Henriques JP, Marquering HA, Planken RN. Patient-tailored Contrast Delivery Protocols for Computed Tomography Coronary Angiography: Lower Contrast Dose and Better Image Quality. J Thorac Imaging 2021; 36:353-359. [PMID: 34269752 DOI: 10.1097/rti.0000000000000593] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The first objective of this study was to evaluate the efficacy of a patient-tailored contrast delivery protocol for coronary computed tomography angiography (CTCA), in terms of diagnostic coronary attenuation and total iodine load (TIL), by adjusting the iodine delivery rate (IDR) via dilution for body weight and tube voltage (kV), as compared with a protocol with a fixed bolus of contrast in a clinical setting. The secondary objective was to assess the association between the test-bolus data and luminal attenuation in CTCA. MATERIALS AND METHODS Patients who underwent CTCA with fixed IDR contrast delivery (cohort 1) or with IDR adjusted for body weight and kV settings (70 to 120 kV) (cohort 2) were included, and compared for intravascular luminal attenuation and TIL. The association between intravascular luminal attenuation and test-bolus scan data was investigated with linear regression. RESULTS In cohort 1 (176 patients), the mean luminal attenuation differed markedly between kV categories, whereas in cohort 2 (154 patients), there were no marked differences. The mean TIL reduced significantly (20.1±1.2 g in cohort 1, 17.7±3.0 g in cohort 2, P<0.001). The peak height of the test-bolus scan was independently associated with luminal attenuation in the ascending aorta, with a 0.58 HU increase per HU peak-height increase (SE=0.18, P<0.001). CONCLUSION Clinical implementation of a patient-tailored contrast delivery protocol for CTCA, adjusted for body weight and kV, improves luminal attenuation and significantly reduces the TIL. The peak height of the test-bolus scan is associated with luminal attenuation in the ascending aorta in the CTCA scan.
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Affiliation(s)
| | | | - Nick H J Lobe
- Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences
| | - Tim A Verwest
- Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | | | - Henk A Marquering
- Biomedical Engineering and Physics
- Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences
| | - R Nils Planken
- Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences
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