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Xiong QF, Fu XR, Ku LZ, Zhou D, Guo SP, Zhang WS. Diagnostic performance of coronary computed tomography angiography stenosis score for coronary stenosis. BMC Med Imaging 2024; 24:39. [PMID: 38336622 PMCID: PMC10854174 DOI: 10.1186/s12880-024-01213-8] [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: 10/09/2023] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Coronary computed tomography angiography stenosis score (CCTA-SS) is a proposed diagnosis score that considers the plaque characteristics, myocardial function, and the diameter reduction rate of the lesions. This study aimed to evaluate the diagnostic performance of the CCTA-SS in seeking coronary artery disease (CAD). METHODS The 228 patients with suspected CAD who underwent CCTA and invasive coronary angiography (ICA) procedures were under examination. The diagnostic performance was evaluated with the receiver operating curve (ROC) for CCTA-SS in detecting CAD (defined as a diameter reduction of ≥ 50%) and severe CAD (defined as a diameter reduction of ≥ 70%). RESULTS The area under ROC (AUC) of CCTA-SS was 0.909 (95% CI: 0.864-0.943), which was significantly higher than that of CCTA (AUC: 0.826; 95% CI: 0.771-0.873; P = 0.0352) in diagnosing of CAD with a threshold of 50%. The optimal cutoff point of CCTA-SS was 51% with a sensitivity of 90.66%, specificity of 95.65%, positive predictive value of 98.80%, negative predictive value of 72.13%, and accuracy of 91.67%, whereas the optimal cutoff point of CCTA was 55%, and the corresponding values were 87.36%, 93.48%, 98.15%, 65.15%, and 88.60%, respectively. With a threshold of 70%, the performance of CCTA-SS with an AUC of 0.927 (95% CI: 0.885-0.957) was significantly higher than that of CCTA with an AUC of 0.521 (95% CI: 0.454-0.587) (P < 0.0001). CONCLUSIONS CCTA-SS significantly improved the diagnostic accuracy of coronary stenosis, including CAD and severe CAD, compared with CCTA.
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Affiliation(s)
- Qing-Feng Xiong
- Hainan Enhance International Medical Center, Boao, China.
- Wuhan Asia Heart Hospital of Wuhan University of Science and Technology, Wuhan, China.
| | - Xiao-Rong Fu
- Wuchang Hospital of Wuhan University of Science and Technology, Wuhan, China
| | - Lei-Zhi Ku
- Wuhan Asia Heart Hospital of Wuhan University of Science and Technology, Wuhan, China
| | - Di Zhou
- Wuhan Asia Heart Hospital of Wuhan University of Science and Technology, Wuhan, China
| | - Sheng-Peng Guo
- Wuhan Asia Heart Hospital of Wuhan University of Science and Technology, Wuhan, China
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Seitz P, Krieghoff C, Gottschling S, Lücke C, Abdel-Wahab M, Holzhey D, Gohmann RF, Gutberlet M. Pre-procedural high-pitch coronary CT angiography assessment of patients undergoing transcatheter aortic valve implantation (TAVI) without patient-specific adjustment: analysis of diagnostic performance. Clin Radiol 2021; 76:862.e29-862.e36. [PMID: 34261598 DOI: 10.1016/j.crad.2021.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/15/2021] [Indexed: 11/20/2022]
Abstract
AIM To evaluate the ability to assess the coronary arteries using pre-procedural computed tomography (CT; high-pitch mode) in patients referred for transcatheter aortic valve implantation (TAVI). METHODS AND MATERIALS CT and invasive coronary angiography (ICA) were performed pre-TAVI in 100 patients (46 women; 79 ± 5.9 years). CT was performed in prospectively ECG-triggered high-pitch mode after intravenous administration of 70 ml iodinated contrast medium. Image quality was assessed using a four-point scale (graded 0-3). Significant coronary artery stenosis (≥50% diameter) was graded as either present or absent by one observer and in one-third of patients by two observers independently. ICA was the standard of reference. Results were reported per segment and per patient. RESULTS Twenty-two percent of patients had known coronary artery disease (CAD). In two cases, a coronary anomaly was detected. Diagnostic image quality (grade 1-3) was achieved in 30.3% of segments. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 75%, 80.5%, 16%, and 98.5%, respectively. Significant coronary stenosis could be ruled out completely in all segments in three patients. The interrater agreement per patient was excellent (kappa = 1). CONCLUSION Relevant coronary findings can frequently be observed in high-pitch TAVI-planning CT. Despite the limitations of the technique and in patients referred to pre-TAVI evaluation (rapid heart rate, coronary calcifications, etc.), a valid evaluation of coronary arteries is possible in a considerable proportion of segments with a high NPV; however, few studies were completely free of motion artefacts to dependably exclude CAD using this technique in this challenging group of patients.
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Affiliation(s)
- P Seitz
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany.
| | - C Krieghoff
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany
| | - S Gottschling
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany
| | - C Lücke
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany
| | - M Abdel-Wahab
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany; Leipzig Heart Institute, Russenstraße 69a, 04289, Leipzig, Germany
| | - D Holzhey
- Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany
| | - R F Gohmann
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany; Medical Faculty, University of Leipzig, Liebigstraße 27, 04103, Leipzig, Germany
| | - M Gutberlet
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany; Leipzig Heart Institute, Russenstraße 69a, 04289, Leipzig, Germany; Medical Faculty, University of Leipzig, Liebigstraße 27, 04103, Leipzig, Germany
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Liang CR, Ong CC, Chai P, Teo LLS. Comparison of radiation dose, contrast enhancement and image quality of prospective ECG-Gated CT coronary angiography: Single versus dual source CT. Radiography (Lond) 2021; 27:831-839. [PMID: 33581989 DOI: 10.1016/j.radi.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 01/09/2021] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The updated National Institute of Clinical Excellence (NICE) guidelines of 2017 state that new generation cardiac CT scanners (Aquilion ONE, Brilliance iCT, Discovery CT750 HD and Somatom Definition Flash) are recommended as an option for first-line imaging of the coronary arteries in people with suspected stable coronary artery disease (with an estimated likelihood of coronary artery disease of 10-29%) in whom imaging with earlier generation CT scanners is difficult. New generation cardiac CT scanners are also recommended as an option for first-line evaluation of disease progression, to establish need for revascularisation in people with known coronary artery disease in whom imaging with earlier generation CT scanners is difficult. CT scanning might not be necessary in situations in which immediate revascularisation is being considered. The European Society of Cardiology 2019 clinical practice guidelines recommend non-invasive functional imaging for myocardial ischaemia or coronary CT angiography (CTA) as the initial test to diagnose CAD in symptomatic patients in whom obstructive CAD cannot be excluded by clinical assessment alone. Given increased computed tomography coronary angiogram (CTCA) utilisation, radiation dose, contrast enhancement and image quality of prospective ECG-gated CTCA between 256-slice single-source and 192x2-slice dual-source CT scanners were retrospectively evaluated. METHODS Prospectively gated CTCA data from 63 patients on a 256-slice CT (group A) and 71 patients on a 192x2-slice dual source CT (group B) from January to December 2016 were retrospectively evaluated respectively. Scanner-reported dose length product values were used with a conversion factor (k = 0.014 mSv/mGy x cm) to estimate effective dose. Contrast enhancement was assessed with mean CT attenuation at selected regions of interest on axial coronary images. Image quality of the coronary arteries was assessed by a 4-point grading score (1 = non-diagnostic, 4 = excellent image quality). RESULTS The radiation doses in group B were significantly lower than group A (3.68 + 2.13 mSv versus 4.81 + 1.56 mSv, p < 0.001). There were no significant differences in contrast enhancement in the left coronary artery, proximal right coronary artery and left ventricular wall for both groups. Vessel image quality scores for group B were higher than group A (right coronary artery (RCA): 3.2 + 0.7 versus 2.4 + 0.7, p < 0.001; left anterior descending (LAD) artery: 3.0 + 0.8 vs 2.5 + 0.6, p < 0.001; left circumflex (LCx) artery: 3.3 + 0.7 vs 2.6 + 0.6, p < 0.001). Coronary artery contour scores for group B were significantly higher than group A (RCA: 3.2 + 0.8 versus 2.3 + 0.7, p < 0.001; LAD: 3.0 + 0.7 versus 2.4 + 0.6, p < 0.001; LCx: 3.3 + 0.6 versus 2.5 + 0.6, p < 0.001). CONCLUSION Prospective ECG-gated CTCA performed on 192x2-slice CT results in better image quality and lower radiation dose than 256-slice CT. There were no significant differences in contrast enhancement in left main coronary artery (LMCA), proximal RCA and left ventricular wall in both groups. IMPLICATIONS FOR PRACTICE In institutions with both 256-slice and 192x2-slice CT scanners, we recommend that CTCAs be preferentially performed using the 192x2-slice CT scanner.
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Affiliation(s)
- C R Liang
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - C C Ong
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - P Chai
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - L L S Teo
- Department of Diagnostic Imaging, National University Hospital, Singapore.
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Kaufmann R, Rezar R, Strohmer B, Wernly B, Lichtenauer M, Hitzl W, Meissnitzer M, Hergan K, Granitz M. Left Atrial Ejection Fraction Assessed by Prior Cardiac CT Predicts Recurrence of Atrial Fibrillation after Pulmonary Vein Isolation. J Clin Med 2021; 10:jcm10040752. [PMID: 33668541 PMCID: PMC7918780 DOI: 10.3390/jcm10040752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/06/2021] [Accepted: 02/10/2021] [Indexed: 12/03/2022] Open
Abstract
Assuming that atrial fibrillation (AF) is associated with left atrial remodeling and dysfunction, we hypothesize that left atrial and left atrial appendage ejection fractions (LAEF and LAAEF) are useful and may be more sensitive outcome predictors of pulmonary vein isolation (PVI). Fifty patients who underwent PVI at our institution with available pre-interventional cardiac computed tomography (CT) for procedure planning were included in this retrospective study. The patients were separated into two groups by recurrence and non-recurrence of AF and subgroups of paroxysmal and persistent AF. Semiautomatic volumetric analysis of the left atrium was used to calculate morphological and functional parameters and optimal cut-offs were calculated using the Youden index. LAEF (accuracy 94%, sensitivity 67%) and LAAEF (accuracy 90%, sensitivity 67%) were significantly reduced in patients with AF recurrence (16% vs. 36%, p = 0.00002; 16% vs. 42%, p = 0.000002), and in the subgroup analysis, the functional parameters were independent from AF type (paroxysmal and persistent). With a cut-off of <23% for both LAEF and LAAEF (area under the curve (AUC) 0.94, 95%CI 0.84–0.99 and AUC 0.96, 95%CI 0.86–0.99, respectively), AF recurrence occurred in 77.8%, within a mean follow-up period of 229 days. In conclusion, left atrial function on prior cardiac CT offers useful parameters for predicting AF recurrence after PVI.
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Affiliation(s)
- Reinhard Kaufmann
- Department of Radiology, University Hospital Salzburg, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.M.); (K.H.); (M.G.)
- Correspondence:
| | - Richard Rezar
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (R.R.); (B.S.); (B.W.); (M.L.)
| | - Bernhard Strohmer
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (R.R.); (B.S.); (B.W.); (M.L.)
| | - Bernhard Wernly
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (R.R.); (B.S.); (B.W.); (M.L.)
| | - Michael Lichtenauer
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (R.R.); (B.S.); (B.W.); (M.L.)
| | - Wolfgang Hitzl
- Research Office (Biostatistics), Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria;
| | - Matthias Meissnitzer
- Department of Radiology, University Hospital Salzburg, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.M.); (K.H.); (M.G.)
| | - Klaus Hergan
- Department of Radiology, University Hospital Salzburg, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.M.); (K.H.); (M.G.)
| | - Marcel Granitz
- Department of Radiology, University Hospital Salzburg, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.M.); (K.H.); (M.G.)
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Branch KR, Hira R, Brusen R, Maynard C, Kudenchuk PJ, Petek BJ, Strote J, Sayre MR, Gatewood M, Carlbom D, Counts C, Probstfield JL, Gunn M. Diagnostic accuracy of early computed tomographic coronary angiography to detect coronary artery disease after out-of-hospital circulatory arrest. Resuscitation 2020; 153:243-250. [PMID: 32422241 DOI: 10.1016/j.resuscitation.2020.04.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/14/2020] [Accepted: 04/23/2020] [Indexed: 12/23/2022]
Abstract
AIM To test the diagnostic accuracy of ECG-gated coronary computed tomography angiography (CCTA) to detect coronary artery disease (CAD) among survivors of out-of-hospital circulatory arrest (OHCA). METHODS We prospectively studied head-to-pelvis computed tomography (CT) scanning (<6 h from hospital arrival) in OHCA survivors. This sub-study tested the primary outcome of CCTA diagnostic accuracy to identify obstructive CAD (≥50% stenosis) compared to clinically-ordered invasive coronary angiography. Patients were not optimized with beta receptor blockade or nitroglycerin. Secondary analyses included CCTA accuracy for CAD in major coronary arteries, obstructive disease at ≥70% stenosis threshold, and where non-evaluable CCTA segments were considered either obstructive or non-obstructive. RESULTS Of the 104 enrolled OHCA survivors, 28 (27%) received both CT and invasive angiography in this sub study. All CCTA studies were evaluable although 49/346 (14%) individual coronary segments were unevaluable, primarily due to being too small to evaluate (65%). Patient-level diagnostic accuracy for the ≥50% stenosis threshold was high at 0.93 (95% CI 0.77-0.98) with a specificity of 1.0 (95% CI 0.8-1.0), sensitivity of 0.85 (95%CI 0.58-0.96), negative predictive value of 0.88 (95% CI 0.66-0.97) and positive predictive value of 1.0 (0.74-1.0). When non-evaluable segments were considered obstructive, the sensitivity rose to 0.92 (95% CI 0.67-0.99) with lower specificity of 0.27 (95% CI 0.11-0.52). CONCLUSION Early CCTA of OHCA survivors has high diagnostic accuracy to detect obstructive coronary artery disease. However, the number of non-diagnostic coronary segments is high suggesting further CCTA refinement is needed, such as the pre-CCTA use of nitroglycerin. CLINICAL TRIAL REGISTRATION NCT03111043 https://clinicaltrials.gov/ct2/show/record/NCT03111043.
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Affiliation(s)
- Kelley R Branch
- University of Washington, Cardiology, Seattle, WA, United States.
| | - Ravi Hira
- Harborview Medical Center, Cardiology, Seattle, United States
| | - Robin Brusen
- University of Washington, Cardiology, Seattle, WA, United States
| | - Charles Maynard
- Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, United States
| | | | - Bradley J Petek
- Massachusetts General Hospital, Internal Medicine, Boston, MA, United States
| | - Jared Strote
- University of Washington, Emergency Medicine, Seattle, United States
| | - Michael R Sayre
- University of Washington, Emergency Medicine, Seattle, United States
| | - Medley Gatewood
- University of Washington, Emergency Medicine, Seattle, United States
| | - David Carlbom
- Harborview Medical Center, Pulmonary Critical Care and Sleep Medicine, Seattle, United States
| | - Catherine Counts
- Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, United States
| | | | - Martin Gunn
- Harborview Medical Center, Radiology, Seattle, United States
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Richards CE, Obaid DR. Low-Dose Radiation Advances in Coronary Computed Tomography Angiography in the Diagnosis of Coronary Artery Disease. Curr Cardiol Rev 2019; 15:304-315. [PMID: 30806322 PMCID: PMC8142354 DOI: 10.2174/1573403x15666190222163737] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 12/24/2018] [Accepted: 12/26/2018] [Indexed: 01/16/2023] Open
Abstract
Background
Coronary computed tomography angiography (CCTA) is now widely used in the diagnosis of coronary artery disease since it is a rapid, minimally invasive test with a diagnostic accuracy comparable to coronary angiography. However, to meet demands for increasing spatial and temporal resolution, higher x-ray radiation doses are required to circumvent the resulting increase in image noise. Exposure to high doses of ionizing radiation with CT imaging is a major health concern due to the potential risk of radiation-associated malignancy. Given its increasing use, a number of dose saving algorithms have been implemented to CCTA to minimize radiation exposure to “as low as reasonably achievable (ALARA)” without compromising diagnostic image quality. Objective
The purpose of this review is to outline the most recent advances and current status of dose saving techniques in CCTA. Method
PubMed, Medline, EMBASE and Scholar databases were searched to identify feasibility studies, clinical trials, and technology guidelines on the technical advances in CT scanner hardware and reconstruction software. Results
Sub-millisievert (mSv) radiation doses have been reported for CCTA due to a combination of strategies such as prospective electrocardiogram-gating, high-pitch helical acquisition, tube current modulation, tube voltage reduction, heart rate reduction, and the most recent novel adaptive iterative reconstruction algorithms. Conclusion
Advances in radiation dose reduction without loss of image quality justify the use of CCTA as a non-invasive alternative to coronary catheterization in the diagnosis of coronary artery disease.
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Affiliation(s)
- Caryl E Richards
- Department of Cardiology, Morriston Hospital, Heol Maes Eglwys, Morriston, Swansea, SA6 6NL, United Kingdom
| | - Daniel R Obaid
- Department of Cardiology, Morriston Hospital, Heol Maes Eglwys, Morriston, Swansea, SA6 6NL, United Kingdom.,Swansea University Medical School, Swansea University, Grove Building, Singleton Park, Sketty, Swansea SA2 8PP, United Kingdom
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Zhang M, Wan L, Liu K, Wu W, Li H, Wang Y, Lu B, Wang H. Aortic roots assessment by an automated three-dimensional transesophageal echocardiography: an intra-individual comparison. Int J Cardiovasc Imaging 2019; 35:2029-2036. [PMID: 31297671 DOI: 10.1007/s10554-019-01664-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 07/03/2019] [Indexed: 01/01/2023]
Abstract
To evaluate the accuracy, reproducibility, and transcatheter heart valve (THV) sizing efficiency of an automated 3-dimensional transesophageal echocardiographic (3D-TEE) post-processing software in the assessments of aortic roots, intra-individually compared with multidetector computed tomography (MDCT). We prospectively studied 67 patients with normal aortic roots. We measured diameters of aortic annulus (AA), sinus of Valsalva (SOV), and sino-tubular junction (STJ) by full-automated and semi-automated methods using 3D-TEE datasets, then compared them to corresponding transthoracic echocardiography and MDCT values. THV sizes were chosen based on echocardiography and MDCT measurements according to recommended criterion. Taking MDCT planimetered diameters as reference, the full-automated (r: 0.4745-0.8792) and semi-automated (r: 0.6647-0.8805) 3D-TEE measurements were linearly correlated (p < 0.0001). The average differences between semi-automated or full-automated measurements and reference were 0.3 mm or 1.3 mm for AA, - 1.9 mm or - 0.5 mm for SOV, and - 0.1 mm or 1.9 mm for STJ, respectively. The intra-class correlation coefficients of semi-automated method were 0.79-0.96 (intra-observer) and 0.75-0.92 (inter-observer). THV sizing by semi-automated measurements using echocardiographic criteria was larger than that by MDCT measurements using MDCT criteria (p < 0.0001) but equivalent (p > 0.05) if both using MDCT standards. The new automated 3D-TEE software allows modeling and quantifying aortic roots with high reproducibility. Measurements by the semi-automated method closely approximate and well correlate with the corresponding MDCT, thus THV sizing by this modeled 3D-TEE measurements should adopt recommended MDCT criteria but not echocardiographic criteria. The full-automated 3D-TEE segmentations are yet immature. (Semi-automated assessMent of Aortic Roots by Three-dimensional transEsophageal echocaRdiography [SMARTER], NCT02724709).
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Affiliation(s)
- Minghui Zhang
- Department of Echocardiography, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, 167 Beilishi Road, Beijing, 100037, China
| | - Linyuan Wan
- Department of Echocardiography, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, 167 Beilishi Road, Beijing, 100037, China
| | - Kun Liu
- Department of Radiologic Imaging, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, 167 Beilishi Road, Beijing, 100037, China
| | - Weichun Wu
- Department of Echocardiography, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, 167 Beilishi Road, Beijing, 100037, China
| | - Hui Li
- Department of Echocardiography, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, 167 Beilishi Road, Beijing, 100037, China
| | - Yuan Wang
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, 167 Beilishi Road, Beijing, 100037, China
| | - Bin Lu
- Department of Radiologic Imaging, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, 167 Beilishi Road, Beijing, 100037, China
| | - Hao Wang
- Department of Echocardiography, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, 167 Beilishi Road, Beijing, 100037, China.
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Nedoma J, Fajkus M, Martinek R, Nazeran H. Vital Sign Monitoring and Cardiac Triggering at 1.5 Tesla: A Practical Solution by an MR-Ballistocardiography Fiber-Optic Sensor. SENSORS (BASEL, SWITZERLAND) 2019; 19:E470. [PMID: 30682784 PMCID: PMC6386836 DOI: 10.3390/s19030470] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/11/2019] [Accepted: 01/21/2019] [Indexed: 12/21/2022]
Abstract
This article presents a solution for continuous monitoring of both respiratory rate (RR) and heart rate (HR) inside Magnetic Resonance Imaging (MRI) environments by a novel ballistocardiography (BCG) fiber-optic sensor. We designed and created a sensor based on the Fiber Bragg Grating (FBG) probe encapsulated inside fiberglass (fiberglass is a composite material made up of glass fiber, fabric, and cured synthetic resin). Due to this, the encapsulation sensor is characterized by very small dimensions (30 × 10 × 0.8 mm) and low weight (2 g). We present original results of real MRI measurements (conventionally most used 1.5 T MR scanner) involving ten volunteers (six men and four women) by performing conventional electrocardiography (ECG) to measure the HR and using a Pneumatic Respiratory Transducer (PRT) for RR monitoring. The acquired sensor data were compared against real measurements using the objective Bland⁻Altman method, and the functionality of the sensor was validated (95.36% of the sensed values were within the ±1.96 SD range for the RR determination and 95.13% of the values were within the ±1.96 SD range for the HR determination) by this means. The accuracy of this sensor was further characterized by a relative error below 5% (4.64% for RR and 4.87% for HR measurements). The tests carried out in an MRI environment demonstrated that the presence of the FBG sensor in the MRI scanner does not affect the quality of this imaging modality. The results also confirmed the possibility of using the sensor for cardiac triggering at 1.5 T (for synchronization and gating of cardiovascular magnetic resonance) and for cardiac triggering when a Diffusion Weighted Imaging (DWI) is used.
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Affiliation(s)
- Jan Nedoma
- Department of Telecommunications, Faculty of Electrical Engineering and Computer Science, VSB-Technical University of Ostrava, 17 Listopadu 15, 70833 Ostrava, Czech Republic.
| | - Marcel Fajkus
- Department of Telecommunications, Faculty of Electrical Engineering and Computer Science, VSB-Technical University of Ostrava, 17 Listopadu 15, 70833 Ostrava, Czech Republic.
| | - Radek Martinek
- Department of Cybernetics and Biomedical Engineering, Faculty of Electrical Engineering and Computer Science, VSB-Technical University of Ostrava, 17 Listopadu 15, 70833 Ostrava, Czech Republic.
| | - Homer Nazeran
- Department of Metallurgical, Materials and Biomedical Engineering, University of Texas El Paso, 500 W University Ave, El Paso, TX 79968, USA.
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Korosoglou G, Marwan M, Giusca S, Schmermund A, Schneider S, Bruder O, Hausleiter J, Schroeder S, Leber A, Limbourg T, Gitsioudis G, Rixe J, Zahn R, Katus HA, Achenbach S, Senges J. Influence of irregular heart rhythm on radiation exposure, image quality and diagnostic impact of cardiac computed tomography angiography in 4,339 patients. Data from the German Cardiac Computed Tomography Registry. J Cardiovasc Comput Tomogr 2017; 12:34-41. [PMID: 29195843 DOI: 10.1016/j.jcct.2017.11.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 10/22/2017] [Accepted: 11/16/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND Coronary computed tomography angiography (coronary CTA) provides non-invasive evaluation of the coronary arteries with high precision for the detection of significant coronary artery disease (CAD). AIM To investigate whether irregular heart rhythm including atrial fibrillation and premature beats during data acquisition influences (i) radiation and contrast media exposure, (ii) number of non-evaluable coronary segments and (iii) diagnostic impact of coronary CTA. METHODS Twelve tertiary care centers with ≥64 slice CT scanners and ≥5 years of experience with cardiovascular imaging participated in this registry. Between 2009 and 2014, 4339 examinations were analysed in patients who underwent clinically indicated coronary CTA for suspected CAD. Clinical and epidemiologic data were gathered from all patients. In addition, clinical presentation, heart rate and rhythm during the scan, Agatston score, radiation and contrast media exposure and the diagnostic impact of coronary CTA were systematically analysed. RESULTS Of 4339 patients in total, 260 (6.0%) had irregular heart rhythm, whereas the remaining 4079 (94.0%) had stable sinus rhythm. Patients with irregular heart rhythm were older (63.2 ± 12.5yrs versus 58.6 ± 11.4yrs. p < 0.001), exhibited a higher rate of pathologic stress tests before CTA (37.1% versus 26.1%, p < 0.01) and higher heart rates during CTA compared to those with sinus rhythm (62.5 ± 11.6bpm versus 58.9 ± 8.5bpm, p < 0.001). Both contrast media exposure and radiation exposure were significantly higher in patients with irregular heart rhythm (90 mL (95%CI = 80-110 mL) versus 80 mL (95%CI = 70-90 mL) and 6.2 mSv (95%CI = 2.5-11.7) versus 3.3 mSv (95%CI = 1.7-6.9), p < 0.001 for both). Coronary CTA excluded significant CAD less frequently in patients with irregular heart rhythm (32.9% versus 44.8%, p < 0.001). This was attributed to the higher rate of examinations with at least one non-diagnostic coronary segment in patients with irregular heart rhythm (10.8% versus 4.6%, p < 0.001). Subsequent invasive angiography could be avoided in 47.2% of patients with irregular heart rhythm compared to 52.9% of patients with sinus rhythm (p = NS), whereas downstream stress testing was recommended in 3.2% of patients with irregular heart rhythm versus 4.0% of patients with sinus rhythm (p = NS). CONCLUSION A significant number of patients scheduled for coronary CTA have irregular heart rhythm in a real-world clinical setting. In such patients, heart rate during coronary CTA is higher, possibly resulting in (i) higher radiation and contrast agent exposure and (ii) more frequent coronary CTA examinations with at least one non-diagnostic coronary artery segment. However, this does not seem to lead to increased downstream stress testing or subsequent invasive procedures.
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Affiliation(s)
- Grigorios Korosoglou
- Department of Cardiology and Vascular Medicine, GRN Hospital Weinheim, Weinheim, Germany..
| | - Mohamed Marwan
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nuernberg, Erlangen, Germany
| | - Sorin Giusca
- Department of Cardiology and Vascular Medicine, GRN Hospital Weinheim, Weinheim, Germany
| | - Axel Schmermund
- Cardiovascular Center Bethanien (CCB), Frankfurt Am Main, Germany
| | | | | | - Jörg Hausleiter
- Department of Cardiology, Ludwig-Maximilian's University, Munich, Germany
| | - Stephen Schroeder
- Department of Cardiology and Pneumology, Alb Fils Clinics, Geislingen, Germany
| | | | - Tobias Limbourg
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - Gitsios Gitsioudis
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nuernberg, Erlangen, Germany
| | - Johannes Rixe
- Department of Cardiology, University of Giessen, Giessen, Germany
| | - Ralf Zahn
- Department of Cardiology, Ludwigshafen, Germany
| | - Hugo A Katus
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nuernberg, Erlangen, Germany
| | - Jochen Senges
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
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10
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Hinzpeter R, Wagner MW, Wurnig MC, Seifert B, Manka R, Alkadhi H. Texture analysis of acute myocardial infarction with CT: First experience study. PLoS One 2017; 12:e0186876. [PMID: 29095833 PMCID: PMC5667797 DOI: 10.1371/journal.pone.0186876] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 10/09/2017] [Indexed: 11/25/2022] Open
Abstract
Objective To investigate the feasibility and accuracy of texture analysis to distinguish through objective and quantitative image information between healthy and infarcted myocardium with computed tomography (CT). Materials and methods Twenty patients (5 females; mean age 56±10years) with proven acute myocardial infarction (MI) and 20 patients (8 females; mean age 42±15years) with no cardiac abnormalities (hereafter termed controls) underwent contrast-enhanced cardiac CT. Short axis CT images of the left ventricle (LV) were reconstructed at the slice thicknesses 1mm, 2mm, and 5mm. Two independent, blinded readers segmented the LV in controls and patients. Texture analysis was performed yielding first-level features based on the histogram (variance, skewness, kurtosis, entropy), second-level features based on the gray-level co-occurrence matrix (GLCM) (contrast, correlation, energy and homogeneity), and third-level features based on the gray-level run-length matrix (GLRLM). Results Inter-and intrareader agreement was good to excellent for all histogram (intraclass correlation coefficient (ICC):0.70–0.93) and for all GLCM features (ICC:0.66–0.99), and was variable for the GLRLM features (ICC:-0.12–0.99). Univariate analysis showed significant differences between patients and controls for 2/4 histogram features, 3/4 GLCM and for 6/11 GLRLM features and all assessed slice thicknesses (all,p<0.05). In a multivariate logistic regression model, the single best variable from each level, determined by ROC analysis, was included stepwise. The best model included kurtosis (OR 0.08, 95%CI:0.01–0.65,P = 0.018) and short run high gray-level emphasis (SRHGE, OR 0.97, 95%CI:0.94–0.99,P = 0.007), with an area-under-the-curve (AUC) of 0.90 (95%CI:0.80–0.99). The best results for kurtosis and SRHGE (AUC = 0.78) were obtained at a 5mm slice thickness. A cut-off value of 14.4 for kurtosis+0.013*SRHGE predicted acute MI with a sensitivity of 95% (specificity 55%). Conclusion Our study illustrates the feasibility of texture analysis for distinguishing healthy from acutely infarcted myocardium with cardiac CT using objective, quantitative features, with most reproducible and accurate results at a short axis slice thickness of 5mm.
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Affiliation(s)
- Ricarda Hinzpeter
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Matthias W Wagner
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Moritz C Wurnig
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Burkhardt Seifert
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Robert Manka
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Cardiology, University Heart Center Zurich, University of Zurich, Zurich, Switzerland.,Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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11
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Wang Y, Kang W, Wang X, Chen M, Qin Q, Guo M, Ge Z. Functional Role and Mechanism of microRNA-28b in Atrial Myocyte in a Persistent Atrial Fibrillation Rat Model. Med Sci Monit 2016; 22:3073-8. [PMID: 27574952 PMCID: PMC5008747 DOI: 10.12659/msm.896780] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background Persistent atrial fibrillation has been indicated to be related with microRNA-28b. However, the exact role of microRNA-28b in persistent atrial fibrillation needs to be further elucidated. Therefore, this study aimed to establish a rat model of persistent atrial fibrillation to investigate the level of microRNA-28b in atrial myocytes and to explore the molecular mechanism involved. Material/Methods A persistent atrial fibrillation model was established in rats by using chronic rapid atrial pacing induction. The size of the heart was measured by ultrasonic method. The expression of microRNA-28b in left atrial myocytes was quantified by RT-PCR. Cardiomyocytes were isolated and cultured to detect cell proliferation and apoptosis by MTT and flow cytometry, respectively. The specific inhibitor of ERK signaling pathway, PD98059, was used to further illustrate the role of ERK signaling pathway in the modulation of cardiomyocytes in persistent atrial fibrillation. Results MicroRNA-28b was up-regulated in the experimental rat model with persistent atrial fibrillation. The proliferation of cardiomyocytes was significantly inhibited with potentiated apoptosis. Blockage of the ERK pathway suppressed the microRNA-28b expression and inhibited cell apoptosis. Conclusions microRNA-28b-induced growth inhibition and cell apoptosis of atrial myocytes was observed in the rat model with persistent atrial fibrillation, via activation of the ERK signaling pathway.
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Affiliation(s)
- Yongbin Wang
- Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland)
| | - Weiqiang Kang
- Department of Cardiology, Qingdao Municipal hospital, Qingdao, Shandong, China (mainland)
| | - Xu Wang
- Department of Emergency Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Meina Chen
- Department of Emergency Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Qiaoji Qin
- Department of Emergency Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Minglei Guo
- Department of Emergency Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Zhiming Ge
- Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland)
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12
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Eid M, De Cecco CN, Schoepf UJ, Mangold S, Tesche C, Varga-Szemes A, Suranyi P, Stalcup S, Ball BD, Caruso D. The Role of MRI and CT in the Diagnosis of Atherosclerosis in an Aging Population. CURRENT RADIOLOGY REPORTS 2016. [DOI: 10.1007/s40134-016-0141-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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