1
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Engele LJ, González-Fernández V, Mulder BJM, Ruperti-Repilado FJ, Abia RL, van der Vlist K, Buendía F, Rueda J, Gabriel H, Schrutka L, Bouchardy J, Schwerzmann M, Possner M, Greutmann M, Gallego P, Ladouceur M, Jongbloed MRM, Tobler D, Dos L, Bouma BJ. Decreased clinical performance in TGA-ASO patients after RVOT interventions; a multicenter European collaboration. Int J Cardiol 2024:132027. [PMID: 38583591 DOI: 10.1016/j.ijcard.2024.132027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 03/13/2024] [Accepted: 04/04/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND In patients with transposition of the great arteries and an arterial switch operation (TGA-ASO) right ventricular outflow tract (RVOT) obstruction is a common complication requiring one or more RVOT interventions. OBJECTIVES We aimed to assess cardiopulmonary exercise capacity and right ventricular function in patients stratified for type of RVOT intervention. METHODS TGA-ASO patients (≥16 years) were stratified by type of RVOT intervention. The following outcome parameters were included: predicted (%) peak oxygen uptake (peak VO2), tricuspid annular plane systolic excursion (TAPSE), tricuspid Lateral Annular Systolic Velocity (TV S'), right ventricle (RV)-arterial coupling (defined as TAPSE/RV systolic pressure ratio), and N-terminal proBNP (NT-proBNP). RESULTS 447 TGA patients with a mean age of 25.0 (interquartile range (IQR) 21-29) years were included. Patients without previous RVOT intervention (n = 338, 76%) had a significantly higher predicted peak VO2 (78.0 ± 17.4%) compared to patients with single approach catheter-based RVOT intervention (73.7 ± 12.7%), single approach surgical RVOT intervention (73.8 ± 28.1%), and patients with multiple approach RVOT intervention (66.2 ± 14.0%, p = 0.021). RV-arterial coupling was found to be significantly lower in patients with prior catheter-based and/or surgical RVOT intervention compared to patients without any RVOT intervention (p = 0.029). CONCLUSIONS TGA patients after a successful arterial switch repair have a decreased exercise capacity. A considerable amount of TGA patients with either catheter or surgical RVOT intervention perform significantly worse compared to patients without RVOT interventions.
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Affiliation(s)
- Leo J Engele
- CAHAL, Center for Congenital Heart Disease Amsterdam-Leiden, location Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Víctor González-Fernández
- Hospital Universitari Vall d'Hebron, CIBERCV and European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD Heart), Barcelona, Spain
| | - Barbara J M Mulder
- CAHAL, Center for Congenital Heart Disease Amsterdam-Leiden, location Amsterdam University Medical Center, Amsterdam, the Netherlands
| | | | - Raquel Ladrón Abia
- Hospital Universitario Virgen del Rocio and European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD Heart), Seville, Spain
| | - Kim van der Vlist
- CAHAL, Center for Congenital Heart Disease Amsterdam-Leiden, location Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Francisco Buendía
- Hospital Universitari i Politècnic La Fe and CIBERCV, València, Spain
| | - Joaquin Rueda
- Hospital Universitari i Politècnic La Fe and CIBERCV, València, Spain
| | | | | | - Judith Bouchardy
- University Hospital Lausanne, Switzerland; University Hospital of Geneva, Switzerland
| | - Markus Schwerzmann
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mathias Possner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Pastora Gallego
- Hospital Universitario Virgen del Rocio and European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD Heart), Seville, Spain
| | - Magalie Ladouceur
- Hôpital Européen Georges Pompidou, AP-HP, Paris Cité University, Centre de Recherche Cardiovasculaire de Paris, INSERM U970, Paris, France
| | - Monique R M Jongbloed
- CAHAL, Center for Congenital Heart Disease Amsterdam-Leiden, location Leiden University Medical Center, Department of Cardiology and Anatomy & Embryology, Leiden, the Netherlands
| | - Daniel Tobler
- University Hospital, University of Basel, Switzerland
| | - Laura Dos
- Hospital Universitari Vall d'Hebron, CIBERCV and European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD Heart), Barcelona, Spain
| | - Berto J Bouma
- CAHAL, Center for Congenital Heart Disease Amsterdam-Leiden, location Amsterdam University Medical Center, Amsterdam, the Netherlands.
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2
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Bütikofer S, Greutmann-Yantiri M, Gubler C, Reiner C, Alkadhi H, Pfammatter T, Puippe G, Santos Lopes B, Possner M, Bonassin F, Meier L, Babic D, Attenhofer Jost C, Jüngst C, Müllhaupt B, Bernsmeier C, Schwerzmann M, Tobler D, Lenggenhager D, Marques Maggio E, Greutmann M. Determinants of Advanced Liver Fibrosis in Adult Patients After Fontan Palliation: Usefulness of Ultrasound Transient Elastography. Can J Cardiol 2023; 39:1338-1345. [PMID: 37116790 DOI: 10.1016/j.cjca.2023.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Fontan-associated liver disease is an increasing concern. Our aim was to assess prevalence and predictors of advanced liver fibrosis with a specific focus on utility of liver stiffness measurement by ultrasound transient elastography. METHODS A total of 97 adult Fontan patients (55% male, median age: 23.1 years, interquartile range [IQR]: 18.7-30.6); 92 (95%) were evaluated with transient elastography, and 50 (52%) underwent transjugular liver biopsy. Advanced liver fibrosis was defined as congestive hepatic fibrosis score 3 or 4. RESULTS Only 4 patients (4%) had liver stiffness values < 10 kilopascal (kPa). Liver-stiffness measurements correlated weakly with peak oxygen uptake on exercise testing and Fontan pressure but not with Model for End-Stage Liver Disease excluding INR (MELD-XI) score or spleen size. Serial follow-up liver stiffness measurements in 73 clinically stable patients showed large variability among individual patients. Advanced liver fibrosis was present in 35 of 50 (70%) patients on liver biopsy and was associated to MELD-XI-Score ≥ 11 and splenomegaly but not to liver-stiffness measurements. Advanced liver fibrosis was not associated with patient age or time since Fontan operation but with younger age at completion of Fontan (3.7 years, IQR: 2.3-6.3 vs 6.8 years; IQR: 3.5-12.1; P = 0.037). CONCLUSIONS In our cohort, advanced liver fibrosis was present in the majority of adult Fontan patients. Liver stiffness as measured by transient elastography was not associated with the degree of liver fibrosis. Because of its high variability on serial measurements, it seems not to be useful for clinical decision making. The unexpected finding that younger age at completion of Fontan was associated with advanced liver fibrosis merits further evaluation.
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Affiliation(s)
- Simon Bütikofer
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Mehtap Greutmann-Yantiri
- University Heart Centre Zurich, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christoph Gubler
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Cecilia Reiner
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Hatem Alkadhi
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thomas Pfammatter
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Gilbert Puippe
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Bruno Santos Lopes
- University Heart Centre Zurich, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Mathias Possner
- University Heart Centre Zurich, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Francesca Bonassin
- University Heart Centre Zurich, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Lukas Meier
- University Heart Centre Zurich, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Daniela Babic
- University Heart Centre Zurich, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christine Attenhofer Jost
- University Heart Centre Zurich, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christoph Jüngst
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Beat Müllhaupt
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Christine Bernsmeier
- Department of Gastroenterology and Hepatology, University Hospital Basel, Basel, Switzerland
| | - Markus Schwerzmann
- Center for Congenital Heart Disease, University Hospital Inselspital, University of Bern, Bern, Switzerland
| | - Daniel Tobler
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Daniela Lenggenhager
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Ewerton Marques Maggio
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Matthias Greutmann
- University Heart Centre Zurich, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
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3
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Greutmann M, Tobler D, Engel R, Heg D, Mueller C, Frenk A, Gabriel H, Rutz T, Buechel RR, Willhelm M, Trachsel L, Freese M, Ruperti-Repilado FJ, Valsangiacomo Buechel E, Beitzke D, Haaf P, Wustmann K, Schwitz F, Possner M, Schwitter J, Bouchardy J, Schwerzmann M. Effect of phosphodiesterase-5 inhibition on SystEmic Right VEntricular size and function. A multicentre, double-blind, randomized, placebo-controlled trial: SERVE. Eur J Heart Fail 2023; 25:1105-1114. [PMID: 37264734 DOI: 10.1002/ejhf.2924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/11/2023] [Accepted: 05/24/2023] [Indexed: 06/03/2023] Open
Abstract
AIMS In adults with congenital heart disease and systemic right ventricles, progressive right ventricular systolic dysfunction is common and is associated with adverse outcomes. Our aim was to assess the impact of the phosphodiesterase-5-inhibitor tadalafil on right ventricular systolic function. METHODS AND RESULTS This was a double-blind, randomized, placebo-controlled, multicentre superiority trial (NCT03049540) involving 100 adults with systemic right ventricles (33 women, mean age: 40.7 ± 10.7 years), comparing tadalafil 20 mg once daily versus placebo (1:1 ratio). The primary endpoint was the change in right ventricular end-systolic volume after 3 years of therapy. Secondary endpoints were changes in right ventricular ejection fraction, exercise capacity and N-terminal pro-B-type natriuretic peptide concentration. Primary endpoint assessment by intention to treat analysis at 3 years of follow-up was possible in 83 patients (42 patients in the tadalafil group and 41 patients in the placebo group). No significant changes over time in right ventricular end-systolic volumes were observed in the tadalafil and the placebo group, and no significant differences between treatment groups (3.4 ml, 95% confidence interval -4.3 to 11.0, p = 0.39). No significant changes over time were observed for the pre-specified secondary endpoints for the entire study population, without differences between the tadalafil and the placebo group. CONCLUSIONS In this trial in adults with systemic right ventricles, right ventricular systolic function, exercise capacity and neuro-hormonal activation remained stable over a 3-year follow-up period. No significant treatment effect of tadalafil was observed. Further research is needed to find effective treatment for improvement of ventricular function in adults with systemic right ventricles.
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Affiliation(s)
- Matthias Greutmann
- University Heart Center, Department of cardiology, University of Zurich, Zürich, Switzerland
| | - Daniel Tobler
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Reto Engel
- Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Dik Heg
- CTU Bern, University of Bern, Bern, Switzerland
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - André Frenk
- Department of Cardiology, Center for Congenital Heart Disease, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Harald Gabriel
- Department of Cardiology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Tobias Rutz
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Cardiac MR Center of the University Hospital Lausanne and CMR Corelab (swissCVIcorelab, CHUV), Lausanne, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Matthias Willhelm
- University Clinic of Cardiology, Preventive Cardiology and Sports Medicine, Inselspital, University Hospital, University of Bern, Bern, Switzerland
| | - Lukas Trachsel
- University Clinic of Cardiology, Preventive Cardiology and Sports Medicine, Inselspital, University Hospital, University of Bern, Bern, Switzerland
| | - Michael Freese
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | | | | | - Dietrich Beitzke
- Department of Biomedical Imaging and Image-Guided Therapy, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Philip Haaf
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Kerstin Wustmann
- Cardiac MR Center of the University Hospital Lausanne and CMR Corelab (swissCVIcorelab, CHUV), Lausanne, Switzerland
| | - Fabienne Schwitz
- Department of Cardiology, Center for Congenital Heart Disease, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mathias Possner
- University Heart Center, Department of cardiology, University of Zurich, Zürich, Switzerland
| | - Juerg Schwitter
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Cardiac MR Center of the University Hospital Lausanne and CMR Corelab (swissCVIcorelab, CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine, Lausanne University (UniL), Lausanne, Switzerland
| | - Judith Bouchardy
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Division of Cardiology, Hôpitaux Universitaires de Genève (HUG), Genève, Switzerland
| | - Markus Schwerzmann
- Department of Cardiology, Center for Congenital Heart Disease, Bern University Hospital, University of Bern, Bern, Switzerland
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
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4
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Van den Eynde J, Possner M, Alahdab F, Veldtman G, Goldstein BH, Rathod RH, Hoskoppal AK, Saraf A, Feingold B, Alsaied T. Thromboprophylaxis in Patients With Fontan Circulation. J Am Coll Cardiol 2023; 81:374-389. [PMID: 36697138 PMCID: PMC11040452 DOI: 10.1016/j.jacc.2022.10.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND The optimal strategy for thromboprophylaxis in patients with a Fontan circulation is unknown. OBJECTIVES The aim of this study was to compare the efficacy and safety of aspirin, warfarin, and nonvitamin K oral anticoagulants (NOACs) in a network meta-analysis. METHODS Relevant studies published by February 2022 were included. The primary efficacy outcome was thromboembolic events; major bleeding was a secondary safety outcome. Frequentist network meta-analyses were conducted to estimate the incidence rate ratios (IRRs) of both outcomes. Ranking of treatments was performed based on probability (P) score. RESULTS A total of 21 studies were included (26,546 patient-years). When compared with no thromboprophylaxis, NOAC (IRR: 0.11; 95% CI: 0.03-0.40), warfarin (IRR: 0.23; 95% CI: 0.14-0.37), and aspirin (IRR: 0.24; 95% CI: 0.15-0.39) were all associated with significantly lower rates of thromboembolic events. However, the network meta-analysis revealed no significant differences in the rates of major bleeding (NOAC: IRR: 1.45 [95% CI: 0.28-7.43]; warfarin: IRR: 1.38 [95% CI: 0.41-4.69]; and aspirin: IRR: 0.72 [95% CI: 0.20-2.58]). Rankings, which simultaneously analyze competing interventions, suggested that NOACs have the highest P score to prevent thromboembolic events (P score 0.921), followed by warfarin (P score 0.582), aspirin (P score 0.498), and no thromboprophylaxis (P score 0.001). Aspirin tended to have the most favorable overall profile. CONCLUSIONS Aspirin, warfarin, and NOAC are associated with lower risk of thromboembolic events. Recognizing the limited number of patients and heterogeneity of studies using NOACs, the results support the safety and efficacy of NOACs in patients with a Fontan circulation.
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Affiliation(s)
- Jef Van den Eynde
- Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, Maryland, USA; Department of Cardiovascular Diseases, University Hospitals Leuven and Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium. https://twitter.com/JefVandenEynde
| | - Mathias Possner
- Cardiology Department, Cantonal Hospital St Gallen, St Gallen, Switzerland; University Heart Center Zurich, Department of Cardiology, University of Zurich, Zurich, Switzerland. https://twitter.com/m_possner
| | - Fares Alahdab
- Houston Methodist Research Institute, Houston Methodist Hospital, Houston, Texas, USA
| | - Gruschen Veldtman
- Scottish Adult Congenital Cardiac Service, Golden Jubilee Hospital, Glasgow, Scotland, United Kingdom
| | - Bryan H Goldstein
- The Heart and Vascular Institute, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Rahul H Rathod
- Department of Cardiology, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Arvind K Hoskoppal
- The Heart and Vascular Institute, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Anita Saraf
- The Heart and Vascular Institute, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Brian Feingold
- The Heart and Vascular Institute, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Tarek Alsaied
- The Heart and Vascular Institute, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
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5
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Schmiady MO, Possner M, Horisberger T, Ouda A. Intracardiac bone cement embolism resulting in ventricular perforation: an unusual cause of sudden chest pain. Interdiscip Cardiovasc Thorac Surg 2023; 36:6976701. [PMID: 36802249 PMCID: PMC9931077 DOI: 10.1093/icvts/ivac292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 12/13/2022] [Indexed: 01/10/2023]
Abstract
Leakage of bone cement is a known complication after percutaneous kyphoplasty. In rare cases, bone cement can reach the venous system and cause life-threatening embolism. We present the case of a 73-year-old male, who was admitted to our hospital with new-onset chest pain and dyspnoea. He had a history of percutaneous kyphoplasty. Multimodal imaging showed intracardiac cement embolism in the right ventricle with penetration of the interventricular septum and perforation of the apex. The bone cement was successfully removed during open cardiac surgery.
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Affiliation(s)
- Martin O Schmiady
- Corresponding author. Clinic for Cardiac Surgery, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland. Tel: +41-44-255-95-82; fax: +41-44-255-44-67; e-mail: (M.O. Schmiady)
| | - Mathias Possner
- Department of Cardiology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Thomas Horisberger
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Ahmed Ouda
- Clinic for Cardiac Surgery, University Heart Center, University Hospital Zurich, Zurich, Switzerland
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6
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Possner M, Bonassin Tempesta F, Santos Lopes B, Meier L, Babic D, Attenhofer Jost C, Greutmann M. Lymphopenia and immunoglobulin deficiency in adult patients with a Fontan circulation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Patients with a functionally univentricular heart and a Fontan palliation are prone to a wide range of extra-cardiac complications. Lymphopenia and immunoglobulin deficiency are insufficiently characterized in this population.
Purpose
The aim of this study was to analyze prevalence and associations of lymphopenia and immunoglobulin deficiency in a cohort of adult Fontan patients.
Methods
Ninety-five consecutive patients with a Fontan circulation that were seen at our institution between 2011 and 2021 were screened. Laboratory results and clinical characteristics were extracted from the patient's charts.
Results
Fifty-five patients (47% male) underwent evaluation of lymphocyte and/or immunoglobulin subpopulations at a mean age of 28.9±9.7 years. Baseline characteristics are depicted in the Table. Seven patients (7/55, 12.7%) had immunoglobulin G (IgG) levels below the lower limit of normal (i.e. <7.0 g/l). Patients with IgG deficiency had a higher prevalence of protein-losing enteropathy (43% versus 4%, p=0.001). Fifteen patients (15/52, 28.8%) had lymphocyte counts below the lower limit of normal (i.e. <850/μl). Lymphocyte counts and lymphocyte subpopulations were comparable in groups with and without protein-losing enteropathy. There was a moderately positive correlation between absolute lymphocyte counts and IgG levels (r=0.301, p=0.032). In a subgroup of 24 patients that underwent liver biopsy, there was no difference in terms of absolute lymphocyte counts and immunoglobulin subpopulations in patients with a low (i.e. 1–2) and high (i.e. 3–4) congestive hepatic fibrosis score.
Conclusion
IgG deficiency is present in 13% of patients with a Fontan circulation and seems to be associated with the presence of protein-losing enteropathy. Lymphopenia is more common and occurs in a quarter of all patients with a Fontan circulation; however, its etiology is likely more complex and multifactorial.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Possner
- University Heart Center, Cardiology , Zurich , Switzerland
| | | | - B Santos Lopes
- University Heart Center, Cardiology , Zurich , Switzerland
| | - L Meier
- University Heart Center, Cardiology , Zurich , Switzerland
| | - D Babic
- University Heart Center, Cardiology , Zurich , Switzerland
| | | | - M Greutmann
- University Heart Center, Cardiology , Zurich , Switzerland
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7
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Katz DA, Peck D, Lubert AM, Possner M, Zafar F, Trout AT, Palermo JJ, Anwar N, Dillman JR, Powell AW, Xanthakos SA, Opotowsky AR, Veldtman G, Alsaied T. Hepatic Steatosis in Patients With Single Ventricle and a Fontan Circulation. J Am Heart Assoc 2021; 10:e019942. [PMID: 33880928 PMCID: PMC8200742 DOI: 10.1161/jaha.120.019942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Hepatic steatosis, caused by nonalcoholic fatty liver disease, is a leading cause of chronic liver disease. The interplay between hepatic steatosis and the development of liver disease following the Fontan procedure is not well understood. This study examined the prevalence and associations of hepatic steatosis in patients with a Fontan circulation. Methods and Results This was a single‐center retrospective study of 95 patients with a Fontan circulation with liver magnetic resonance imaging performed between 2012 and 2019. The average age at magnetic resonance imaging was 21.5±8.5 years. The percent liver fat signal was determined using magnetic resonance chemical shift‐encoded proton density fat fraction imaging. Hepatic steatosis was defined as liver fat ≥5% and was present in 10.5% of the cohort. The presence of hepatic steatosis was associated with higher body mass index (29±4 versus 24±6 kg/m2, P=0.006), a higher frequency of obesity (50% versus 12%, P=0.015), lower high‐density lipoprotein cholesterol (35±9 versus 43±14 mg/dL, P=0.050), and greater subcutaneous fat thickness (2.6±0.7 versus 1.8±1.0 cm, P=0.043). There was no association between hepatic steatosis and cardiovascular imaging or hemodynamic variables from cardiac catheterization. Conclusions Risk factors for hepatic steatosis in patients with Fontan circulation include obesity and dyslipidemia, similar to what is seen in the general population. Fontan hemodynamics were not associated with hepatic steatosis.
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Affiliation(s)
- David A Katz
- Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH.,The Heart Institute Cincinnati Children's Hospital Medical Center Cincinnati OH
| | - Daniel Peck
- Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH.,The Heart Institute Cincinnati Children's Hospital Medical Center Cincinnati OH
| | - Adam M Lubert
- Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH.,The Heart Institute Cincinnati Children's Hospital Medical Center Cincinnati OH
| | - Mathias Possner
- Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH.,The Heart Institute Cincinnati Children's Hospital Medical Center Cincinnati OH
| | - Faizeen Zafar
- Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH
| | - Andrew T Trout
- Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH.,Department of Radiology Cincinnati Children's Hospital Medical Center Cincinnati OH.,Department of Radiology University of Cincinnati College of Medicine Cincinnati OH
| | - Joseph J Palermo
- Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH.,Department of Gastroenterology Cincinnati Children's Hospital Medical Center Cincinnati OH
| | - Nadeem Anwar
- Department of Gastroenterology University of Cincinnati Cincinnati OH
| | - Jonathan R Dillman
- Department of Radiology Cincinnati Children's Hospital Medical Center Cincinnati OH.,Department of Radiology University of Cincinnati College of Medicine Cincinnati OH
| | - Adam W Powell
- Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH.,The Heart Institute Cincinnati Children's Hospital Medical Center Cincinnati OH
| | - Stavra A Xanthakos
- Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH.,Department of Gastroenterology Cincinnati Children's Hospital Medical Center Cincinnati OH
| | - Alexander R Opotowsky
- Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH.,The Heart Institute Cincinnati Children's Hospital Medical Center Cincinnati OH
| | - Gruschen Veldtman
- King Faisal Specialist Hospital and Research Centre Riyadh Saudi Arabia
| | - Tarek Alsaied
- Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH.,The Heart Institute Cincinnati Children's Hospital Medical Center Cincinnati OH
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8
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Possner M, Gordon-Walker T, Egbe AC, Poterucha JT, Warnes CA, Connolly HM, Ginde S, Clift P, Kogon B, Book WM, Walker N, Wagenaar LJ, Moe T, Oechslin E, Kay WA, Norris M, Dillman JR, Trout AT, Anwar N, Hoskoppal A, Broering DC, Bzeizi K, Veldtman G. Hepatocellular carcinoma and the Fontan circulation: Clinical presentation and outcomes. Int J Cardiol 2020; 322:142-148. [PMID: 32828959 DOI: 10.1016/j.ijcard.2020.08.057] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/16/2020] [Accepted: 08/17/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Fontan-associated liver disease (FALD) is universal in patients with a Fontan circulation. Hepatocellular carcinoma (HCC) is one of its severe expressions, and, though rare, frequently fatal. The purpose of this study was to describe the clinical presentation, risk factors, and outcomes of HCC in patients with a Fontan circulation. METHODS A multicenter case series of Fontan patients with a diagnosis of HCC formed the basis of this study. The case series was extended by published cases and case reports. Clinical presentation, tumor characteristics, laboratory and hemodynamic findings as well as treatment types and outcomes, were described. RESULTS Fifty-four Fontan patients (50% female) with a diagnosis of HCC were included. Mean age at HCC diagnosis was 30 ± 9.4 years and mean duration from Fontan surgery to HCC diagnosis was 21.6 ± 7.4 years. Median HCC size at the time of diagnosis was 4 cm with a range of 1 to 22 cm. The tumor was located in the right hepatic lobe in 65% of the patients. Fifty-one percent had liver cirrhosis at the time of HCC diagnosis. Fifty percent of the patients had no symptoms related to HCC and alpha-fetoprotein was normal in 26% of the cases. Twenty-six patients (48%) died during a median follow-up duration of 10.6 (range 1-50) months. CONCLUSIONS HCC in Fontan patients occurs at a young age with a 1-year survival rate of only 50%. Meticulous liver surveillance is crucial to detect small tumors in the early stage.
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Affiliation(s)
- Mathias Possner
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Timothy Gordon-Walker
- Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom; The University of Edinburgh, Edinburgh, United Kingdom
| | - Alexander C Egbe
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Carole A Warnes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Heidi M Connolly
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Salil Ginde
- Division of Pediatric Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Paul Clift
- Department of Cardiology, New Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Brian Kogon
- Department of Cardiothoracic Surgery, Children's Healthcare of Atlanta, Egleston, Emory University, Atlanta, GA, USA
| | - Wendy M Book
- Division of Cardiology, Department of Medicine, Emory University Department of Medicine, Atlanta, GA, USA
| | - Niki Walker
- Scottish Adult Congenital Cardiac Service, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Lodewijk J Wagenaar
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente Hospital, Enschede, the Netherlands
| | - Tabitha Moe
- Division of Cardiology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Erwin Oechslin
- Toronto Congenital Cardiac Centre for Adults, University Health Network / Peter Munk Cardiac Centre, and University of Toronto, Toronto, Ontario, Canada
| | - W Aaron Kay
- Section of Pediatric Cardiology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA; Krannert Institute of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Mark Norris
- Division of Pediatric Cardiology, University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Nadeem Anwar
- Division of Gastroenterology, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Arvind Hoskoppal
- Department of Pediatrics, University of Utah and Intermountain Healthcare, Salt Lake City, UT, USA
| | - Dieter C Broering
- Department of Liver Transplantation, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Khalid Bzeizi
- Adult Congenital Heart Disease, Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Gruschen Veldtman
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Adult Congenital Heart Disease, Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
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9
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Tseng SY, Siddiqui S, Di Maria MV, Hill GD, Lubert AM, Kutty S, Opotowsky AR, Possner M, Morales DLS, Quintessenza JA, Alsaied T. Atrioventricular Valve Regurgitation in Single Ventricle Heart Disease: A Common Problem Associated With Progressive Deterioration and Mortality. J Am Heart Assoc 2020; 9:e015737. [PMID: 32419552 PMCID: PMC7429008 DOI: 10.1161/jaha.119.015737] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The Fontan procedure has provided patients with single ventricle physiology extended survival into adulthood and in many cases has improved their quality of life. Atrioventricular valve regurgitation (AVVR) is common in single ventricle patients and is associated with increased risk of mortality. AVVR is more common in patients with a systemic tricuspid or common atrioventricular valve but is generally progressive irrespective of underlying valve morphology. AVVR can be attributable to diverse structural and functional abnormalities at multiple levels of the valvar apparatus, as well as ventricular dysfunction and dilation. Multiple imaging modalities including recent advances in 3‐dimensional echocardiography and cross‐sectional imaging have been used to further understand AVVR. Surgery to address AVVR must be tailored to the underlying mechanism and the timing of surgical repair should be chosen carefully. In this review, we discuss the etiologies, treatment options, surgical timing, and outcomes of valve repair or replacement for AVVR in patients with single ventricle congenital heart disease, with a focus on those with a Fontan circulation as AVVR is associated with increased risk for Fontan failure and mortality. In‐depth understanding of the current literature will help guide clinicians in their approach and management of AVVR in this population.
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Affiliation(s)
- Stephanie Y Tseng
- Department of Pediatrics The Heart Institute Cincinnati Children's Hospital Medical Center University of Cincinnati College of Medicine Cincinnati OH
| | - Saira Siddiqui
- Department of Pediatrics The Heart Institute Cincinnati Children's Hospital Medical Center University of Cincinnati College of Medicine Cincinnati OH
| | - Michael V Di Maria
- Department of Pediatrics Heart Institute Children's Hospital Colorado University of Colorado School of Medicine Aurora CO
| | - Garick D Hill
- Department of Pediatrics The Heart Institute Cincinnati Children's Hospital Medical Center University of Cincinnati College of Medicine Cincinnati OH
| | - Adam M Lubert
- Department of Pediatrics The Heart Institute Cincinnati Children's Hospital Medical Center University of Cincinnati College of Medicine Cincinnati OH
| | - Shelby Kutty
- Taussig Heart Center The Johns Hopkins Hospital Baltimore MD
| | - Alexander R Opotowsky
- Department of Pediatrics The Heart Institute Cincinnati Children's Hospital Medical Center University of Cincinnati College of Medicine Cincinnati OH.,Department of Cardiology Boston Children's Hospital Boston MA USA
| | - Mathias Possner
- Division of Cardiology Department of Medicine University of Washington School of Medicine Seattle WA USA
| | - David L S Morales
- Department of Pediatrics The Heart Institute Cincinnati Children's Hospital Medical Center University of Cincinnati College of Medicine Cincinnati OH
| | - James A Quintessenza
- Department of Pediatrics The Heart Institute Cincinnati Children's Hospital Medical Center University of Cincinnati College of Medicine Cincinnati OH
| | - Tarek Alsaied
- Department of Pediatrics The Heart Institute Cincinnati Children's Hospital Medical Center University of Cincinnati College of Medicine Cincinnati OH
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10
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Vandenplas Y, Carnielli VP, Ksiazyk J, Luna MS, Migacheva N, Mosselmans JM, Picaud JC, Possner M, Singhal A, Wabitsch M. Factors affecting early-life intestinal microbiota development. Nutrition 2020; 78:110812. [PMID: 32464473 DOI: 10.1016/j.nut.2020.110812] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/18/2020] [Accepted: 03/01/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This paper reviews the published evidence on early-life intestinal microbiota development, as well as the different factors influencing its development before, at, and after birth. A literature search was done using PubMed, Cochrane and EMBASE databases. A growing body of evidence indicates that the intrauterine environment is not sterile as once presumed, but that maternal-fetal transmission of microbiota occurs during pregnancy. The consecutive order of bacteria with which the gastrointestinal tract is colonized will influence the outcome of community assembly and the ecological success of individual colonizers. The genetic background of the infant may also strongly influence microbial colonization of the gastrointestinal tract. The composition and development of infant gut microbiota can be influenced by many prenatal factors, such as maternal diet, obesity, smoking status, and use of antibiotic agents during pregnancy. Mode of delivery is generally accepted as a major factor determining the initial colonization. Breast milk stimulates the most balanced microbiome development for the infant, mainly because of its high content of unique oligosaccharides. Feeding is another important factor to determine intestinal colonization. Compared with breastfed infants, formula-fed infants have an increased richness of species. Initial clinical studies show that infant formulas supplemented with specific human milk oligosaccharides (HMOs) -2´-fucosyllactose alone or in combination with lacto-n-neotetraose are structurally identical to those in breast milk. HMOs increase the proportion of infants with a high bifidobacterial-dominated gut microbiota typical of that observed in breastfed infants, lead to plasma immune marker profiles similar to those of breast-fed infants and to lower morbidity and antibiotics use. Further clinical studies with the same, others or more HMOs are needed to confirm these clinical effects. A growing number of studies have reported on how the composition and development of the microbiota during early life will affect risk factors related to health up to and during adulthood. If exclusive breastfeeding is not possible, the composition of infant formula should be adapted to stimulate the development of a bifidobacterial-dominated gut microbiota typical of that observed in breastfed infants. The main components in breast milk that stimulate the growth of specific bifidobacteria are HMOs.
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Affiliation(s)
- Yvan Vandenplas
- KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
| | - V P Carnielli
- Neonatal Pediatrics, Polytechnic University of Marche, Ancona, Italy
| | - J Ksiazyk
- The Children's Memorial Health Institute, Department of Pediatrics, Nutrition and Metabolic Diseases, Warsaw, Poland
| | - M Sanchez Luna
- Neonatology Division, Complutense University. Research Institute University Hospital Gregorio Marañón, Madrid, Spain
| | - N Migacheva
- Department of Pediatrics, Samara State Medical University, Samara, Russia
| | | | - J C Picaud
- Neonatology, Croix-Rousse Hospital, Lyon and CarMen Unit, Claude Bernard University, Lyon, France
| | - M Possner
- Nestlé Nutrition Institute, Frankfurt am Main, Germany
| | - A Singhal
- Childhood Nutrition Research Centre, Great Ormond Street, UCL, Institute of Child Health, London, United Kingdom
| | - M Wabitsch
- Ulm University Hospital, Department of Pediatrics and Adolescent Medicine, Division of Pediatric Endocrinology and Diabetes, Centre for Hormonal Disorders in Children and Adolescents, Ulm, Germany
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11
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Zafar F, Possner M, Trout AT, Lorts A, Palermo JJ, Szugye C, Dillman JR, Veldtman GR, Opotowsky A, Lubert A, Alsaied T. RADIOLOGIC FINDINGS SUGGESTIVE OF PORTAL HYPERTENSION MAY IDENTIFY PATIENTS AT RISK FOR FONTAN FAILURE. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31232-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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12
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Morcos M, Feller J, Possner M, Chen M, Corson M, Verrier E, Krieger E. ANOMOLOUS LEFT CORONARY ARTERY OFF PULMONARY ARTERY PRESENTING AS DECOMPENSATED HEART FAILURE IN AN ADULT. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)33129-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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13
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Possner M, Buechel RR, Vontobel J, Mikulicic F, Gräni C, Benz DC, Clerc OF, Fuchs TA, Tobler D, Stambach D, Greutmann M, Kaufmann PA. Myocardial blood flow and cardiac sympathetic innervation in young adults late after arterial switch operation for transposition of the great arteries. Int J Cardiol 2020; 299:110-115. [DOI: 10.1016/j.ijcard.2019.07.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/03/2019] [Accepted: 07/11/2019] [Indexed: 11/24/2022]
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14
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Alsaied T, Possner M, Lubert AM, Trout AT, Szugye C, Palermo JJ, Lorts A, Goldstein BH, Veldtman GR, Anwar N, Dillman JR. Relation of Magnetic Resonance Elastography to Fontan Failure and Portal Hypertension. Am J Cardiol 2019; 124:1454-1459. [PMID: 31474329 DOI: 10.1016/j.amjcard.2019.07.052] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 07/24/2019] [Accepted: 07/25/2019] [Indexed: 12/11/2022]
Abstract
Fontan associated liver disease is associated with morbidity and mortality in palliated single-ventricle congenital heart disease patients. Magnetic resonance elastography (MRE) provides a quantitative assessment of liver stiffness in Fontan patients. We hypothesized that MRE liver stiffness correlates with liver enzymes, hemodynamics, portal hypertension, and Fontan failure (FF). All adult Fontan patients who had MRE between 2011 and 2018 were included. Radiologic portal hypertension was defined as splenomegaly, ascites, and/or varices. FF was defined as death, transplantation, or heart failure symptoms requiring escalation of diuretics. Seventy patients with a median age of 24.7 years and a median follow-up from MRE of 3.9 years were included. The median liver stiffness was 4.3 kPa (interquartile range [IQR]: 3.8 to 5.0 kPa). There was a weak, positive correlation between liver stiffness and Fontan pathway pressure (r = 0.34, p = 0.03). There was a moderate negative correlation of liver stiffness with ventricular ejection fraction (r = -0.52, p = 0.03). Liver stiffness was weakly positively correlated with liver transaminases and gamma glutamyl transferase. Patients with portal hypertension had higher liver stiffness compared to patients without (5.2 ± 1.3 vs 4.2 ± 0.8 kPa, p = 0.03). At MRE or during follow-up, 13 patients (19%) met definition of FF and had significantly higher liver stiffness compared to patients without FF (5.1 [IQR: 4.3 to 6.3] vs 4.2 [IQR: 3.7 to 4.7] kPa, p = 0.01). Liver stiffness above 4.5 kPa differentiated FF with a sensitivity of 77% and specificity of 77%. In conclusion, elevated MRE-derived liver stiffness is associated with worse hemodynamics, liver enzymes and clinical outcomes in Fontan patients. This measure may serve as a global imaging biomarker of Fontan health.
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Affiliation(s)
- Tarek Alsaied
- Cincinnati Children's Hospital Heart Institute, Department of Pediatrics, University of Cincinnati College of Medicine Cincinnati, Ohio.
| | - Mathias Possner
- Cincinnati Children's Hospital Heart Institute, Department of Pediatrics, University of Cincinnati College of Medicine Cincinnati, Ohio
| | - Adam M Lubert
- Cincinnati Children's Hospital Heart Institute, Department of Pediatrics, University of Cincinnati College of Medicine Cincinnati, Ohio
| | - Andrew T Trout
- Cincinnati Children's Hospital Medical Center, Department of Radiology, University of Cincinnati College of Medicine Cincinnati, Ohio
| | - Cassandra Szugye
- Cincinnati Children's Hospital Heart Institute, Department of Pediatrics, University of Cincinnati College of Medicine Cincinnati, Ohio
| | - Joseph J Palermo
- Cincinnati Children's Hospital Medical Center, Division of Gastroenterology, Department of Pediatrics, University of Cincinnati College of Medicine Cincinnati, Ohio
| | - Angela Lorts
- Cincinnati Children's Hospital Heart Institute, Department of Pediatrics, University of Cincinnati College of Medicine Cincinnati, Ohio
| | - Bryan H Goldstein
- Cincinnati Children's Hospital Heart Institute, Department of Pediatrics, University of Cincinnati College of Medicine Cincinnati, Ohio
| | - Gruschen R Veldtman
- Cincinnati Children's Hospital Heart Institute, Department of Pediatrics, University of Cincinnati College of Medicine Cincinnati, Ohio; Adult Congenital Heart Disease, Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Nadeem Anwar
- University of Cincinnati Medical Center, Division of Gastroenterology, Department of Medicine, University of Cincinnati College of Medicine Cincinnati, Ohio
| | - Johnathan R Dillman
- Cincinnati Children's Hospital Medical Center, Department of Radiology, University of Cincinnati College of Medicine Cincinnati, Ohio
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15
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Haider A, Possner M, Messerli M, Bengs S, Osto E, Maredziak M, Portmann A, Fiechter M, Giannopoulos AA, Treyer V, Gaisl T, von Felten E, Patriki D, Benz DC, Fuchs TA, Gräni C, Pazhenkottil AP, Buechel RR, Kaufmann PA, Gebhard C. Quantification of intrathoracic fat adds prognostic value in women undergoing myocardial perfusion imaging. Int J Cardiol 2019; 292:258-264. [PMID: 31178224 DOI: 10.1016/j.ijcard.2019.04.092] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/16/2019] [Accepted: 04/29/2019] [Indexed: 01/12/2023]
Abstract
AIM Amongst patients with coronary artery disease (CAD), women experience relatively worse outcomes as compared to men. Evidence to date has failed to explore unique female imaging targets as major determinants of cardiovascular risk. We sought to assess the prognostic value of epicardial (EFV) and intrathoracic fat volume (IFV) quantification in women and men with suspected and known CAD. METHODS AND RESULTS Intrathoracic fat volume and EFV were calculated from non-contrast CT and analyzed in a propensity-matched cohort of 190 patients (95 women, mean age 62.5 ± 11.3 years) undergoing myocardial perfusion imaging (MPI) and coronary computed tomography angiography (CCTA) for evaluation of CAD. IFV and EFV were significantly lower in women as compared to men (198.2 ± 78.4 vs 293.2 ± 114.7 cm3 and 105.6 ± 48.9 vs 135.8 ± 60.9 cm3, p < 0.001) and showed a strong association with coronary artery calcium score (CACS) and obstructive CAD in women (p < 0.05), but not in men. Fat volumes were not related to abnormal MPI in either population (p = NS). During a median follow-up of 2.8 years, high IFV was associated with reduced event free survival (log rank = 0.019 vs low IFV) in women, but not in men. Accordingly, a multivariate Cox regression model adjusted for cardiovascular risk factors, CACS, CCTA, and MPI findings selected IFV as a significant predictor of major adverse cardiovascular events (MACE) in women (HR 1.32, 95%CI 1.18-1.55, p = 0.001). CONCLUSION Quantification of IFV provides incremental prognostic value for MACE in women, beyond that provided by traditional risk factors and imaging findings.
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Affiliation(s)
- Ahmed Haider
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland; Center for Molecular Cardiology, University of Zurich, Switzerland
| | - Mathias Possner
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Susan Bengs
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland; Center for Molecular Cardiology, University of Zurich, Switzerland
| | - Elena Osto
- Center for Molecular Cardiology, University of Zurich, Switzerland; Laboratory of Translational Nutrition Biology, ETH, Zurich, Switzerland; University Heart Center, Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Monika Maredziak
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland; Center for Molecular Cardiology, University of Zurich, Switzerland
| | - Angela Portmann
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland; Center for Molecular Cardiology, University of Zurich, Switzerland
| | - Michael Fiechter
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland; Center for Molecular Cardiology, University of Zurich, Switzerland
| | | | - Valerie Treyer
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Gaisl
- Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Elia von Felten
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Dimitri Patriki
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Dominik C Benz
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Tobias A Fuchs
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Christoph Gräni
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Catherine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland; Center for Molecular Cardiology, University of Zurich, Switzerland.
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16
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Benz DC, Gräni C, Ferro P, Neumeier L, Messerli M, Possner M, Clerc OF, Gebhard C, Gaemperli O, Pazhenkottil AP, Kaufmann PA, Buechel RR. Corrected coronary opacification decrease from coronary computed tomography angiography: Validation with quantitative 13N-ammonia positron emission tomography. J Nucl Cardiol 2019; 26:561-568. [PMID: 28685251 DOI: 10.1007/s12350-017-0980-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 06/07/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND To assess the functional relevance of a coronary artery stenosis, corrected coronary opacification (CCO) decrease derived from coronary computed tomography angiography (CCTA) has been proposed. The present study aims at validating CCO decrease with quantitative 13N-ammonia positron emission tomography (PET) myocardial perfusion imaging (MPI). METHODS AND RESULTS This retrospective study consists of 39 patients who underwent hybrid CCTA/PET-MPI. From CCTA, attenuation in the coronary lumen was measured before and after a stenosis and corrected to the aorta to calculate CCO and its decrease. Relative flow reserve (RFR) was calculated by dividing the stress myocardial blood flow (MBF) of a vessel territory subtended by a stenotic coronary by the stress MBF of the reference territories without stenoses. RFR was abnormal in 11 vessel territories (27%). CCO decrease yielded a sensitivity, specificity, negative predictive value, positive predictive value, and accuracy for prediction of an abnormal RFR of 73%, 70%, 88%, 47%, and 70%, respectively. CONCLUSIONS CCTA-derived CCO decrease has moderate diagnostic accuracy to predict an abnormal RFR in PET-MPI. However, its high negative predictive value to rule out functional relevance of a given lesion may confer clinical implications in the diagnostic work-up of patients with a coronary stenosis.
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Affiliation(s)
- Dominik C Benz
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Christoph Gräni
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Paola Ferro
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Luis Neumeier
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Mathias Possner
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Olivier F Clerc
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Catherine Gebhard
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Oliver Gaemperli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
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17
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Benz DC, Fuchs TA, Gräni C, Studer Bruengger AA, Clerc OF, Mikulicic F, Messerli M, Stehli J, Possner M, Pazhenkottil AP, Gaemperli O, Kaufmann PA, Buechel RR. Head-to-head comparison of adaptive statistical and model-based iterative reconstruction algorithms for submillisievert coronary CT angiography. Eur Heart J Cardiovasc Imaging 2019; 19:193-198. [PMID: 28200212 DOI: 10.1093/ehjci/jex008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 01/16/2017] [Indexed: 01/04/2023] Open
Abstract
Aims Iterative reconstruction (IR) algorithms allow for a significant reduction in radiation dose of coronary computed tomography angiography (CCTA). We performed a head-to-head comparison of adaptive statistical IR (ASiR) and model-based IR (MBIR) algorithms to assess their impact on quantitative image parameters and diagnostic accuracy for submillisievert CCTA. Methods and results CCTA datasets of 91 patients were reconstructed using filtered back projection (FBP), increasing contributions of ASiR (20, 40, 60, 80, and 100%), and MBIR. Signal and noise were measured in the aortic root to calculate signal-to-noise ratio (SNR). In a subgroup of 36 patients, diagnostic accuracy of ASiR 40%, ASiR 100%, and MBIR for diagnosis of coronary artery disease (CAD) was compared with invasive coronary angiography. Median radiation dose was 0.21 mSv for CCTA. While increasing levels of ASiR gradually reduced image noise compared with FBP (up to - 48%, P < 0.001), MBIR provided largest noise reduction (-79% compared with FBP) outperforming ASiR (-59% compared with ASiR 100%; P < 0.001). Increased noise and lower SNR with ASiR 40% and ASiR 100% resulted in substantially lower diagnostic accuracy to detect CAD as diagnosed by invasive coronary angiography compared with MBIR: sensitivity and specificity were 100 and 37%, 100 and 57%, and 100 and 74% for ASiR 40%, ASiR 100%, and MBIR, respectively. Conclusion MBIR offers substantial noise reduction with increased SNR, paving the way for implementation of submillisievert CCTA protocols in clinical routine. In contrast, inferior noise reduction by ASiR negatively affects diagnostic accuracy of submillisievert CCTA for CAD detection.
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Affiliation(s)
- Dominik C Benz
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | - Tobias A Fuchs
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | - Christoph Gräni
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | - Annina A Studer Bruengger
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | - Olivier F Clerc
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | - Fran Mikulicic
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | - Julia Stehli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | - Mathias Possner
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | - Oliver Gaemperli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
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Possner M, Santos Lopes B, Bonassin Tempesta F, Attenhofer Jost C, Greutmann M. P4525The fate of the pulmonary root after Fontan palliation. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Benz DC, Gräni C, Hirt Moch B, Mikulicic F, Vontobel J, Fuchs TA, Stehli J, Clerc OF, Possner M, Pazhenkottil AP, Gaemperli O, Buechel RR, Kaufmann PA. A low-dose and an ultra-low-dose contrast agent protocol for coronary CT angiography in a clinical setting: quantitative and qualitative comparison to a standard dose protocol. Br J Radiol 2017; 90:20160933. [PMID: 28406318 DOI: 10.1259/bjr.20160933] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the impact of a low-dose (LD) and an ultra-LD (ULD) contrast protocol for coronary CT angiography on qualitative and quantitative image parameters in a clinical setting. METHODS We scanned 120 consecutive patients with a 256-slice CT scanner applying a LD (60 patients, 35-55 ml) or ULD (60 patients, 25-45 ml) contrast protocol adapted to the body mass index. Visually assessed image quality and attenuation measured in each coronary segment were retrospectively compared in 20 consecutive patients scanned with a normal-dose (ND, 40-105 ml) contrast protocol. RESULTS Visually assessed image quality did not differ significantly among protocols. By contrast, attenuation obtained from the ULD protocol (median contrast volume 35 ml) differed significantly from the LD (median 45 ml) and ND (median 70 ml) protocols in the coronary segments (316 ± 52 vs 363 ± 60 and 359 ± 52 HU, p < 0.001). Attenuation did not differ significantly between the LD and ND protocol. The proportion of patients with inadequate coronary vessel attenuation was significantly higher (p < 0.001) in the ULD protocol (37%) than in the ND (5%) and LD (10%) protocols but did not differ significantly between the ND and LD protocols. CONCLUSION In a clinical setting, a LD contrast protocol with a median volume of 45 ml is feasible for the latest generation 256-slice coronary CT angiography as it yields attenuation comparable to a ND protocol. By contrast, the implementation of an ULD protocol remains challenging. Advances in knowledge: Although not perceived by the naked eye, an ULD contrast protocol in a clinical setting yields attenuation below a threshold for diagnostic image quality.
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Affiliation(s)
- Dominik C Benz
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Christoph Gräni
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Beatrice Hirt Moch
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Fran Mikulicic
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Jan Vontobel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Tobias A Fuchs
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Julia Stehli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Olivier F Clerc
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Mathias Possner
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Oliver Gaemperli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
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Benz DC, Mikulicic F, Gräni C, Moret D, Possner M, Clerc OF, Studer Bruengger AA, Gaemperli O, Buechel RR, Pazhenkottil AP, Kaufmann PA. Long-term outcome prediction by functional parameters derived from coronary computed tomography angiography. Int J Cardiol 2017; 243:533-537. [PMID: 28592383 DOI: 10.1016/j.ijcard.2017.05.083] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 04/28/2017] [Accepted: 05/17/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Estimation of hemodynamic relevance of a coronary stenosis from coronary computed angiography (CCTA) has raised substantial interest. Recently, the corrected coronary opacification (CCO) decrease and the transluminal attenuation gradient (TAG) have been suggested as faster alternatives to the FFRCT. The aim of the study was to evaluate whether the diagnostic accuracy of CCO decrease and TAG translates into an added prognostic value in patients evaluated for coronary artery disease (CAD). METHODS This retrospective study consists of 162 consecutive patients referred for evaluation of known or suspected CAD by CCTA. CCO decrease was defined as difference of mean luminal coronary attenuation normalized to aorta attenuation proximal-distal of a stenosis. To calculate TAG, mean attenuation was measured at 5-mm intervals from the ostium to a distal segment with a minimal cross-sectional area of 2.0mm2. Death, myocardial infarction, unstable angina requiring hospitalization, and coronary revascularization were defined as major adverse cardiac events (MACE). Multivariate analysis included covariates age, sex, ≥3 cardiovascular risk factors and stenosis severity. RESULTS Follow-up was completed in 154 patients, CAD was found in 72. During median follow-up of 6.1years (interquartile range, 5.8-6.9years), 55 patients experienced a MACE. Among CAD patients, the presence of an abnormal CCO decrease (p<0.05) but not TAG (p=0.894) was associated with a worse MACE-free survival. In multivariate analysis, CCO decrease was an independent predictor of MACE (HR, 2.27; 95% CI, 1.14-4.52; p=0.02) while TAG was not predictive (p=0.895). CONCLUSION In CAD patients, CCO decrease adds long-term prognostic value over clinical characteristics and stenosis severity while TAG does not.
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Affiliation(s)
- Dominik C Benz
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Fran Mikulicic
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Christoph Gräni
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Dominic Moret
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Mathias Possner
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Olivier F Clerc
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Annina A Studer Bruengger
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Oliver Gaemperli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland.
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Gräni C, Benz DC, Steffen DA, Clerc OF, Schmied C, Possner M, Vontobel J, Mikulicic F, Gebhard C, Pazhenkottil AP, Gaemperli O, Hurwitz S, Kaufmann PA, Buechel RR. Outcome in middle-aged individuals with anomalous origin of the coronary artery from the opposite sinus: a matched cohort study. Eur Heart J 2017; 38:2009-2016. [DOI: 10.1093/eurheartj/ehx046] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 01/24/2017] [Indexed: 01/09/2023] Open
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Gräni C, Benz DC, Schmied C, Vontobel J, Mikulicic F, Possner M, Clerc OF, Stehli J, Fuchs TA, Pazhenkottil AP, Gaemperli O, Buechel RR, Kaufmann PA. Hybrid CCTA/SPECT myocardial perfusion imaging findings in patients with anomalous origin of coronary arteries from the opposite sinus and suspected concomitant coronary artery disease. J Nucl Cardiol 2017; 24:226-234. [PMID: 26711099 DOI: 10.1007/s12350-015-0342-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 11/05/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Anomalous coronary arteries originating from the opposite sinus of Valsalva (ACAOS) are associated with adverse cardiac events. Discrimination between ACAOS and coronary artery disease (CAD)-related perfusion defects may be difficult. The aim of the present study was to investigate the value of hybrid coronary computed tomography angiography (CCTA)/SPECT-MPI in patients with ACAOS and possible concomitant CAD. METHODS We retrospectively identified 46 patients (mean age 56 ± 12 years) with ACAOS revealed by CCTA who underwent additional SPECT-MPI. ACAOS with an interarterial course were classified as malignant, whereas all other variants were considered benign. CCTA/SPECT-MPI hybrid imaging findings (ischemia or scar) were analyzed according to the territory subtended by an anomalous vessel or a stenotic coronary artery. RESULTS Twenty-six (57%) patients presented with malignant ACAOS. Myocardial ischemia or scar was found only in patients who had concomitant obstructive CAD in the vessel matching the perfusion defect as evidenced by hybrid CCTA/SPECT imaging. CONCLUSION Hybrid CCTA/SPECT-MPI represents a valuable non-invasive tool to discriminate the impact of ACAOS from concomitant CAD on myocardial ischemia. Our results suggest that in a middle-aged population myocardial ischemia due to ACAOS per se may be exceedingly rare and is more likely attributable to concomitant CAD.
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Affiliation(s)
- Christoph Gräni
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Dominik C Benz
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Christian Schmied
- Department of Cardiology, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Jan Vontobel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Fran Mikulicic
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Mathias Possner
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Olivier F Clerc
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Julia Stehli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Tobias A Fuchs
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Oliver Gaemperli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
- Department of Cardiology, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
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Possner M, Vontobel J, Nguyen-Kim TDL, Zindel C, Holy EW, Stämpfli SF, Zuber M, Kaufmann PA, Nietlispach F, Maisano F, Niemann M, Tanner FC. Prognostic value of aortic regurgitation after TAVI in patients with chronic kidney disease. Int J Cardiol 2016; 221:180-7. [DOI: 10.1016/j.ijcard.2016.06.145] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/11/2016] [Accepted: 06/24/2016] [Indexed: 11/15/2022]
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Gräni C, Benz DC, Possner M, Clerc OF, Mikulicic F, Vontobel J, Stehli J, Fuchs TA, Pazhenkottil AP, Gaemperli O, Kaufmann PA, Buechel RR. Fused cardiac hybrid imaging with coronary computed tomography angiography and positron emission tomography in patients with complex coronary artery anomalies. CONGENIT HEART DIS 2016; 12:49-57. [PMID: 27539240 DOI: 10.1111/chd.12402] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 07/01/2016] [Accepted: 07/15/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To provide data on the value of fused cardiac hybrid imaging with coronary computed tomography angiography (CCTA) and positron emission tomography myocardial perfusion imaging (PET-MPI) in patients with complex coronary artery anomalies (CCAA). DESIGN/SETTING This is a retrospective, single-center study. PATIENTS Seven consecutive patients with CCAA (mean 57 ± 7 y, 86% were male) who underwent clinically indicated hybrid CCTA/PET-MPI between 2005 and 2015 in our clinic were included. The findings from both modalities and fused cardiac hybrid imaging were evaluated in these patients. RESULTS Out of the seven patients with CCAA, two patients had Bland-White-Garland anomaly, two patients showed a coronary artery fistula, two patients showed a "single right," and one patient showed a "single left" coronary artery. Semiquantitative fused hybrid CCTA/PET-MPI depicted inferolateral scar matching the territory of a nonanomalous vessel with significant concomitant coronary artery disease (CAD) in one patient only. In contrast, analysis of quantitative myocardial blood flow (MBF) as assessed by fused hybrid CCTA/PET-MPI revealed abnormally reduced flow capacities in the territories subtended by the anomalous vessels in 4 patients. CONCLUSIONS In this case series of middle-aged patients with CCAA, perfusion defects as assessed by semiquantitative PET-MPI were rare and attributable to concomitant CAD rather than to the anomalous vessel itself. By contrast, impaired MBF as assessed by quantitative hybrid CCTA/PET-MPI was revealed in the majority of patients in the vessel territories subtended by the anomalous coronary artery itself. Fused hybrid CCTA/PET-MPI incorporating information on morphology and on semiquantitative and quantitative myocardial perfusions may provide added value for the management of patients with CCAA.
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Affiliation(s)
- Christoph Gräni
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Dominik C Benz
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Mathias Possner
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Olivier F Clerc
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Fran Mikulicic
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Jan Vontobel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Julia Stehli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Tobias A Fuchs
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Oliver Gaemperli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
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Benz DC, Gräni C, Hirt Moch B, Mikulicic F, Vontobel J, Fuchs TA, Stehli J, Clerc OF, Possner M, Pazhenkottil AP, Gaemperli O, Buechel RR, Kaufmann PA. Minimized Radiation and Contrast Agent Exposure for Coronary Computed Tomography Angiography: First Clinical Experience on a Latest Generation 256-slice Scanner. Acad Radiol 2016; 23:1008-14. [PMID: 27174030 DOI: 10.1016/j.acra.2016.03.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 03/03/2016] [Accepted: 03/05/2016] [Indexed: 12/29/2022]
Abstract
RATIONALE AND OBJECTIVES The aim of the study was to evaluate the impact of the latest coronary computed tomography angiography (CCTA) techniques allowing a radiation- and contrast-sparing protocol on image quality in unselected patients referred for exclusion of suspected coronary artery disease (CAD). MATERIALS AND METHODS This prospective study was approved by the local ethics committee, and all patients provided written informed consent. Between March and June 2015, 89 consecutive patients (61% male; mean age 55 ± 11 years) referred for exclusion of CAD by 256-slice CCTA using prospective electrocardiogram triggering were included. Tube voltage (80-120 kVp), tube current (180-310 mA) as well contrast agent volume (25-45 mL) and flow rate (3.5-5 mL/s) were adapted to body mass index. Signal intensity was measured by placing a region of interest in the aortic root, the left main artery, and the proximal right coronary artery. Image noise was measured in the aortic root. Two independent blinded readers semi-quantitatively assessed the image quality regarding motion, noise, and contrast on a 4-point scale. RESULTS Median contrast agent volume and median effective radiation dose were 35 mL (interquartile range, 30-40 mL) and 0.5 mSv (interquartile range, 0.4-0.6 mSv), respectively. Mean attenuation in the aortic root was 412 ± 89 Hounsfield units. Diagnostic image quality was obtained in 1050 of 1067 (98.4%) coronary segments and, on an intention-to-diagnosis basis, in 85 of 89 (95.5%) patients. Below a cut-off heart rate of 67 beats/min, only 1 of 974 (0.1%) coronary segments was nondiagnostic. CONCLUSION A radiation- and contrast-sparing protocol for CCTA on a latest generation 256-slice computed tomography scanner yields diagnostic image quality in patients referred for CAD exclusion in daily clinical routine.
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Attinger-Toller A, Maisano F, Senn O, Taramasso M, Shakir S, Possner M, Gloekler S, Windecker S, Stortecky S, Lüscher TF, Meier B, Nietlispach F. “One-Stop Shop”. JACC Cardiovasc Interv 2016; 9:1487-95. [DOI: 10.1016/j.jcin.2016.04.038] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/25/2016] [Accepted: 04/26/2016] [Indexed: 12/12/2022]
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Gräni C, Benz DC, Schmied C, Vontobel J, Possner M, Clerc OF, Mikulicic F, Stehli J, Fuchs TA, Pazhenkottil AP, Gaemperli O, Kaufmann PA, Buechel RR. Prevalence and characteristics of coronary artery anomalies detected by coronary computed tomography angiography in 5 634 consecutive patients in a single centre in Switzerland. Swiss Med Wkly 2016; 146:w14294. [PMID: 27124568 DOI: 10.4414/smw.2016.14294] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
STUDY PRINCIPLES Coronary computed tomography angiography (CCTA) allows three-dimensional visualisation of the origin, course and ending of the coronary vessels with high spatial resolution, yielding an accurate depiction of coronary artery anomalies (CAAs). This study sought to determine the prevalence, incidence and characteristics of CAAs detected with CCTA in a single centre in Switzerland. METHODS CAAs were retrospectively identified in 5 634 consecutive patients referred for CCTA between March 2007 and July 2015. Single coronary arteries, Bland-White-Garland syndrome, anomalous coronary arteries originating from the opposite site of the sinus of Valsalva (ACAOS) with an interarterial course and coronary artery fistulas were classified as potentially malignant CAAs. RESULTS We identified 145 patients with CAAs, resulting in an overall prevalence of 2.6% and cumulative incidence of 2.1% in all patients referred for CCTA in the observation period. Forty-nine (33.8%) patients showed malignant CAAs including 1 (0.7%) patient with Bland-White-Garland syndrome, 7 (4.8%) with single coronary arteries, 36 (24.8%) with ACAOS and an interarterial course, and 5 (3.5%) with coronary artery fistulas. The remaining 96 (66.2%) patients were classified as having benign variants. CONCLUSIONS The prevalence of CAA detected by CCTA is not negligible. Because of its noninvasive nature, relatively low cost and low radiation exposure, a further increase in the utilisation of CCTA may be expected, which may consequently be paralleled by an increasing absolute number of incidentally detected CAAs. Hence, awareness of the main issues and possible management strategies regarding CAAs is of importance for every treating physician.
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Affiliation(s)
- Christoph Gräni
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Switzerland
| | - Dominik C Benz
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Switzerland
| | | | - Jan Vontobel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Switzerland
| | - Mathias Possner
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Switzerland
| | - Olivier F Clerc
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Switzerland
| | - Fran Mikulicic
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Switzerland
| | - Julia Stehli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Switzerland
| | - Tobias A Fuchs
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Switzerland
| | - Oliver Gaemperli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Switzerland; Department of Cardiology, University Hospital Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Switzerland
| | - Ronny Ralf Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Switzerland
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Gräni C, Benz D, Clerc O, Schmied C, Steffen D, Mikulicic F, Vontobel J, Possner M, Pazhenkottil A, Gaemperli O, Kaufmann P, Buechel R. OUTCOME IN MIDDLE-AGED INDIVIDUALS WITH ANOMALOUS CORONARY ARTERIES ORIGINATING FROM THE OPPOSITE SINUS: A CASE CONTROL STUDY. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30982-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Benz DC, Gräni C, Hirt-Moch B, Mikulicic F, Vontobel J, Fuchs T, Stehli J, Clerc O, Possner M, Pazhenkottil A, Gaemperli O, Buechel R, Kaufmann P. A RADIATION- AND CONTRAST-SPARING PROTOCOL FOR CORONARY COMPUTED TOMOGRAPHY ANGIOGRAPHY: FIRST CLINICAL EXPERIENCE ON A LATEST-GENERATION 256-SLICE SCANNER. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)31740-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Clerc OF, Fuchs TA, Possner M, Vontobel J, Mikulicic F, Stehli J, Liga R, Benz DC, Gräni C, Pazhenkottil AP, Gaemperli O, Buechel RR, Kaufmann PA. Real-time respiratory triggered SPECT myocardial perfusion imaging using CZT technology: impact of respiratory phase matching between SPECT and low-dose CT for attenuation correction. Eur Heart J Cardiovasc Imaging 2016; 18:31-38. [DOI: 10.1093/ehjci/jew031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 02/04/2016] [Indexed: 01/10/2023] Open
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Stehli J, Clerc OF, Fuchs TA, Possner M, Gräni C, Benz DC, Buechel RR, Kaufmann PA. Impact of monochromatic coronary computed tomography angiography from single-source dual-energy CT on coronary stenosis quantification. J Cardiovasc Comput Tomogr 2016; 10:135-40. [DOI: 10.1016/j.jcct.2015.12.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 12/14/2015] [Indexed: 11/29/2022]
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Vontobel J, Possner M, Schütz P, Müller B, Taramasso M, Binder RK, Haueis S, Attinger-Toller A, Maisano F, Nietlispach F. Early safety outcome following transcatheter aortic valve implantation: is the amount of contrast media used a matter of concern? Swiss Med Wkly 2015; 145:w14238. [PMID: 26709491 DOI: 10.4414/smw.2015.14238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
QUESTIONS UNDER STUDY The study objective was to evaluate the impact of the amount of contrast medium used for transcatheter aortic valve implantation (TAVI) on short-term outcome. Patients undergoing TAVI are exposed to repeat contrast medium application both for preprocedural screening and during the TAVI procedure itself. Whether the amount of contrast media is associated with worse outcome is unclear. METHODS A total of 257 patients were included (median age 82.7 years) and divided into two groups with preserved and reduced kidney function (glomerular filtration rate <60 ml/min/1.73 m2), respectively. Total volume of contrast media administered during and within 5 days prior to TAVI was analysed. A combined early safety endpoint at 30 days was evaluated. RESULTS The early safety endpoint was reached by 31 patients and acute kidney injury occurred in 22 patients. The median total volume of contrast media administered was 144 ml (interquartile range 81-225 ml). The amount of contrast did not independently predict the early safety endpoint in the overall population (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.56 to 1.53, p = 0.774) and in subgroups with preserved and reduced kidney function. Change in creatinine was an independent strong predictor of the early safety endpoint in the overall population (OR 18.13, 95% CI 4.70 to 69.99, p <0.001), as well as in subgroups with preserved and reduced kidney function. The amount of contrast did not predict a change in creatinine within 72 hours following TAVI (r = 0.02, 95% CI -0.02 to 0.07, p = 0.368). CONCLUSION Decreased kidney function after TAVI influences outcome. When rather small amounts of contrast media are used for screening and the TAVI procedure itself, the amount of contrast media seems not to be an independent predictor of outcome, further suggesting that decreased kidney function after TAVI is multifactorial.
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Affiliation(s)
- Jan Vontobel
- Department of Cardiology, University Heart Centre, Zurich, Switzerland
| | - Mathias Possner
- Department of Cardiology, University Heart Centre, Zurich, Switzerland
| | - Philipp Schütz
- Department of Endocrinology, Diabetology and Metabolism, Medical University Hospital Aarau, Switzerland
| | - Beat Müller
- Department of Endocrinology, Diabetology and Metabolism, Medical University Hospital Aarau, Switzerland
| | | | - Roland K Binder
- Department of Cardiology, University Heart Centre, Zurich, Switzerland
| | - Sabine Haueis
- Department of Cardiology, University Heart Centre, Zurich, Switzerland
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Lagan J, Rio P, Barone-Rochette G, Limeres Freire J, Abreu A, Clerc OF, Iriart X, Van Den Hoven AT, Meah M, Hasleton J, Mcshane J, Trent R, Abreu A, Santos V, Santa-Clara H, Oliveira L, Martins Oliveira M, Silva Cunha P, Moura Branco L, Mota Carmo M, Cruz Ferreira R, Zoreka FZ, Calizzano A, Vautrin E, Quesada JL, Broisat A, Riou L, Baguet JP, Fagret D, Ghezzi C, Rodriguez J, Oristrell G, Quiroga X, Pizzi N, Perez-Rodon J, Galve E, Aguade S, Santa Clara H, Santos V, Oliveira L, Oliveira M, Rio P, Cunha P, Portugal G, Ferreira R, Mota Carmo M, Kaufmann BP, Possner M, Liga R, Vontobel J, Mikulicic F, Graeni C, Benz DC, Kaufmann PA, Buechel RR, Selmi W, Jalal Z, Thambo JB, Saru-Chelu RG, Duijnhouwer AL, Van Hagen IM, Roos-Hesselink JW. Rapid Fire Abstract session: usefulness of CT and radionuclide imaging in different clinical scenarios378Improving the cost-effectiveness of chest pain investigations using single photon emission computed tomography379Is autonomic nervous dysfunction severity associated to less benefit from cardiac resynchronization therapy?380Validation of stress Thallium-201/Rest Technetium-99m sequential dual isotope high-speed myocardial perfusion imaging against fractional flow reserve for the detection of the extent of ischemia.381Nuclear imaging to predict adverse events in heart failure patients382Autonomic nervous system modulation in patients with heart failure and resynchronization after high intensity interval training383Long-term prediction of cardiac events using low-dose coronary ct angiography with prospective triggering384Left atrial appendage sizing for percutaneous occlusion with Amplatzer cardiac plug: a multimodality imaging approach385Evaluation of PAPVR using cardiac CT or MR imaging in patients with Turner syndrome. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Clerc OF, Lima Da Silva G, Jobbe Duval A, Santoro C, Possner M, Liga R, Fuchs TA, Dougoud S, Stehli J, Vontobel J, Mikulicic F, Kaufmann PA, Gaemperli O, Almeida AMG, David C, Francisco AR, Guimaraes T, Placido R, Menezes M, Pinto FJ, Rimbert A, Cueff C, Lecointe S, Hagege AA, Levine R, Merot J, Le Marec H, Schott JJ, Le Tourneau T, Lembo M, Esposito R, Cocozza S, Ilardi F, Arpino G, De Placido S, De Simone G, Trimarco B, Galderisi M. Young Investigator Award session – Clinical Science442Left bundle branch block and coronary artery disease in coronary ct angiography443Focal myocardial fibrosis and abnormal left ventricular strain in patients with sarcoidosis without clinical evidence of cardiac disease444Arhgap24, a first gene for fibro elastic deficiency mitral valve prolapse? A phenotypic study445Advantage of using ASE/EACVI criteria for detection of subclinical cardiotoxicity in breast cancer patients undergoing anthracycline and trastuzumab therapy. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Possner M, Liga R, Gaisl T, Vontobel J, Clerc OF, Mikulicic F, Benz DC, Gräni C, Stehli J, Fuchs TA, Dey D, Pazhenkottil AP, Herzog BA, Gaemperli O, Buechel RR, Kaufmann PA. Quantification of epicardial and intrathoracic fat volume does not provide an added prognostic value as an adjunct to coronary artery calcium score and myocardial perfusion single-photon emission computed tomography. Eur Heart J Cardiovasc Imaging 2015; 17:885-91. [PMID: 26341295 DOI: 10.1093/ehjci/jev209] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 08/02/2015] [Indexed: 11/14/2022] Open
Abstract
AIMS To compare the predictive value of epicardial and intrathoracic fat volume (EFV, IFV), coronary artery calcium (CAC) score, and single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) for major adverse cardiac events (MACE). METHODS AND RESULTS Follow-up was obtained in 275 patients with known or suspected coronary artery disease (CAD), who underwent SPECT-MPI including non-contrast cardiac computed tomography (CT) for attenuation correction to evaluate ischaemic heart disease and in whom EFV, IFV, and CAC score were calculated from non-contrast CT. Associations between fat volume, traditional cardiovascular risk factors, CAC score, and SPECT-MPI results were assessed and MACE predictors identified by Cox proportional hazard regression and global χ(2) statistics. After a median follow-up of 2.9 years, MACE were recorded in 38 patients. In univariate Cox regression analysis, EFV and IFV were predictors of MACE (P = 0.013 and P = 0.004, respectively). In multivariate analysis, EFV and IFV provided incremental predictive value beyond traditional cardiovascular risk factors (P < 0.05 and P < 0.01). However, after adjustment for CAC score and SPECT-MPI results, EFV and IFV fell short of statistical significance as independent outcome predictors. CONCLUSION Quantification of EFV and IFV is associated with MACE and may improve risk stratification beyond traditional cardiovascular risk factors. However, once CAC score and/or SPECT-MPI results are known, EFV and IFV do not provide any added clinically relevant prognostic value. Further studies may identify the subpopulation with the largest relative merit of EFV and IFV as an adjunct to SPECT-MPI and CAC score.
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Affiliation(s)
- Mathias Possner
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Riccardo Liga
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Thomas Gaisl
- Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Jan Vontobel
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Olivier F Clerc
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Fran Mikulicic
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Dominik C Benz
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Christoph Gräni
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Julia Stehli
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Tobias A Fuchs
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Damini Dey
- Department of Biomedical Sciences, Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Bernhard A Herzog
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Oliver Gaemperli
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
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Clerc OF, Possner M, Maire R, Liga R, Fuchs TA, Stehli J, Vontobel J, Mikulicic F, Gräni C, Benz DC, Lüscher TF, Herzog BA, Buechel RR, Kaufmann PA, Gaemperli O. Association of left bundle branch block with obstructive coronary artery disease on coronary CT angiography: a case-control study. Eur Heart J Cardiovasc Imaging 2015; 17:765-71. [PMID: 26320169 DOI: 10.1093/ehjci/jev202] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 07/27/2015] [Indexed: 11/14/2022] Open
Abstract
AIMS Left bundle branch block (LBBB) is considered an unfavourable prognostic marker in patients with underlying heart disease. Testing for coronary artery disease (CAD) is often prompted by incidental LBBB finding, but published studies disagree about a significant association between LBBB and CAD. We therefore assessed the association of LBBB with previously unknown CAD in patients undergoing coronary computed tomography angiography (CCTA). METHODS AND RESULTS We enrolled 818 patients (mean age 57.2 ± 11.1 years, 106 patients with presumably new LBBB and 712 controls) without known CAD who underwent 64-slice CCTA. Image quality was assessed for each coronary segment. Comparison of obstructive CAD prevalence (defined as ≥50% stenosis) was performed using triple case-matching for pre-test probability (based on age, gender, and symptom typicality) in 101 LBBB patients and 303 matched controls with diagnostic quality in all segments. We found no difference in obstructive CAD prevalence between LBBB patients and matched controls (15 vs. 16%, P = 0.88). Similarly, there were no significant differences in cardiovascular risk factors (CVRF), stenosis severity, CAD extent, non-obstructive CAD, and vessel-based analysis between patient groups. Image quality was very high in LBBB patients and comparable to controls. On multivariate analysis, age, gender, typical angina, and CVRF, but not LBBB (P = 0.94), emerged as significant and independent predictors of obstructive CAD. CONCLUSION CAD prevalence is similar in LBBB patients at low-to-moderate pre-test probability compared with controls with similar CVRF matched for age, gender, and symptom typicality. CCTA is a useful imaging modality in LBBB patients, providing comparable image quality to non-LBBB controls.
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Affiliation(s)
- Olivier F Clerc
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland Department of Cardiology, University Hospital Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland
| | - Mathias Possner
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland
| | - René Maire
- Cardiological and Aviation Medicine Practice, Männedorf CH-8708, Switzerland
| | - Riccardo Liga
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland
| | - Tobias A Fuchs
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland
| | - Julia Stehli
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland Department of Cardiology, University Hospital Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland
| | - Jan Vontobel
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland
| | - Fran Mikulicic
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland
| | - Christoph Gräni
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland
| | - Dominik C Benz
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland
| | - Thomas F Lüscher
- Department of Cardiology, University Hospital Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland
| | - Bernhard A Herzog
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland
| | - Ronny R Buechel
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland
| | - Philipp A Kaufmann
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland
| | - Oliver Gaemperli
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland Department of Cardiology, University Hospital Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland
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Vontobel J, Liga R, Possner M, Clerc OF, Mikulicic F, Veit-Haibach P, Ter Voert EEGW, Fuchs TA, Stehli J, Pazhenkottil AP, Benz DC, Gräni C, Gaemperli O, Herzog B, Buechel RR, Kaufmann PA. MR-based attenuation correction for cardiac FDG PET on a hybrid PET/MRI scanner: comparison with standard CT attenuation correction. Eur J Nucl Med Mol Imaging 2015; 42:1574-80. [PMID: 26091704 DOI: 10.1007/s00259-015-3089-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 05/15/2015] [Indexed: 12/20/2022]
Abstract
PURPOSE The aim of this study was to evaluate the feasibility of attenuation correction (AC) for cardiac (18)F-labelled fluorodeoxyglucose (FDG) positron emission tomography (PET) using MR-based attenuation maps. METHODS We included 23 patients with no known cardiac history undergoing whole-body FDG PET/CT imaging for oncological indications on a PET/CT scanner using time-of-flight (TOF) and subsequent whole-body PET/MR imaging on an investigational hybrid PET/MRI scanner. Data sets from PET/MRI (with and without TOF) were reconstructed using MR AC and semi-quantitative segmental (20-segment model) myocardial tracer uptake (per cent of maximum) and compared to PET/CT which was reconstructed using CT AC and served as standard of reference. RESULTS Excellent correlations were found for regional uptake values between PET/CT and PET/MRI with TOF (n = 460 segments in 23 patients; r = 0.913; p < 0.0001) with narrow Bland-Altman limits of agreement (-8.5 to +12.6 %). Correlation coefficients were slightly lower between PET/CT and PET/MRI without TOF (n = 460 segments in 23 patients; r = 0.851; p < 0.0001) with broader Bland-Altman limits of agreement (-12.5 to +15.0 %). PET/MRI with and without TOF showed minimal underestimation of tracer uptake (-2.08 and -1.29 %, respectively), compared to PET/CT. CONCLUSION Relative myocardial FDG uptake obtained from MR-based attenuation corrected FDG PET is highly comparable to standard CT-based attenuation corrected FDG PET, suggesting interchangeability of both AC techniques.
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Affiliation(s)
- Jan Vontobel
- Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
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Gaisl T, Schlatzer C, Schwarz EI, Possner M, Stehli J, Sievi NA, Clarenbach CF, Dey D, Slomka PJ, Kaufmann PA, Kohler M. Coronary artery calcification, epicardial fat burden, and cardiovascular events in chronic obstructive pulmonary disease. PLoS One 2015; 10:e0126613. [PMID: 26011039 PMCID: PMC4444203 DOI: 10.1371/journal.pone.0126613] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 04/04/2015] [Indexed: 01/23/2023] Open
Abstract
RATIONALE Patients with chronic obstructive pulmonary disease (COPD) suffer from significantly more cardiovascular comorbidity and mortality than would be anticipated from conventional risk factors. The aim of this study was to determine whether COPD patients have a higher coronary artery calcium score (CACS) and epicardial fat burden, compared to control subjects, and their association with cardiovascular events. METHODS From a registry of 1906 patients 81 patients with clinically diagnosed COPD were one-to-one matched to 81 non-COPD control subjects with a smoking history, according to their age, sex, and the number of classic cardiovascular risk factors (arterial hypertension, diabetes mellitus, dyslipidemia, family history of premature coronary artery disease). CACS, epicardial fat, and subsequent major adverse cardiovascular events (MACE) during follow-up were compared between groups. RESULTS Patients with COPD (Global Initiative for Chronic Obstructive Lung Disease-classification I: 5%, II: 23%, III: 16% and IV: 56%) showed no difference in CACS (median difference 68 Agatston Units [95% confidence interval -176.5 to 192.5], p=0.899) or epicardial fat volume (mean difference -0.5 cm3 [95% confidence interval -20.9 to 21.9], p=0.961) compared with controls. After a median follow-up of 42.6 months a higher incidence of MACE was observed in COPD patients (RR=2.80, p=0.016) compared with controls. Cox proportional hazard regression identified cardiac ischemias and CACS as independent predictors for MACE. CONCLUSION COPD patients experienced a higher MACE incidence compared to controls despite no baseline differences in coronary calcification and epicardial fat burden. Other mechanisms such as undersupply of medication seem to account for an excess cardiovascular comorbidity in COPD patients.
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Affiliation(s)
- Thomas Gaisl
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | | | - Esther I. Schwarz
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Mathias Possner
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Julia Stehli
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Noriane A. Sievi
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | | | - Damini Dey
- Departments of Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Piotr J. Slomka
- Departments of Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Philipp A. Kaufmann
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Malcolm Kohler
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
- Zurich Centre for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
- Centre for Interdisciplinary Sleep Research, University of Zurich, Zurich, Switzerland
- * E-mail:
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Taniguchi Y, Takahashi Y, Toba T, Yamada S, Yokoi K, Kobayashi S, Okajima S, Shimane A, Kawai H, Yasaka Y, Smanio P, Oliveira MA, Machado L, Cestari P, Medeiros E, Fukuzawa S, Okino S, Ikeda A, Maekawa J, Ichikawa S, Kuroiwa N, Yamanaka K, Igarashi A, Inagaki M, Patel K, Mahan M, Ananthasubramaniam K, Mouden M, Yokota S, Ottervanger J, Knollema S, Timmer J, Jager P, Padron K, Peix A, Cabrera L, Pena Bofill V, Valera D, Rodriguez Nande L, Carrillo Hernandez R, Mena Esnard E, Fernandez Columbie Y, Bertella E, Baggiano A, Mushtaq S, Segurini C, Loguercio M, Conte E, Beltrama V, Petulla' M, Andreini D, Pontone G, Guzic Salobir B, Dolenc Novak M, Jug B, Kacjan B, Novak Z, Vrtovec M, Mushtaq S, Pontone G, Bertella E, Conte E, Segurini C, Volpato V, Baggiano A, Formenti A, Pepi M, Andreini D, Ajanovic R, Husic-Selimovic A, Zujovic-Ajanovic A, Mlynarski R, Mlynarska A, Golba K, Sosnowski M, Ameta D, Goyal M, Kumar D, Chandra S, Sethi R, Puri A, Dwivedi SK, Narain VS, Saran RK, Nekolla S, Rischpler C, Nicolosi S, Langwieser N, Dirschinger R, Laugwitz K, Schwaiger M, Goral JL, Napoli J, Forcada P, Zucchiatti N, Damico A, Damico A, Olivieri D, Lavorato M, Dubesarsky E, Montana O, Salgado C, Jimenez-Heffernan A, Ramos-Font C, Lopez-Martin J, Sanchez De Mora E, Lopez-Aguilar R, Manovel A, Martinez A, Rivera F, Soriano E, Maroz-Vadalazhskaya N, Trisvetova E, Vrublevskaya O, Abazid R, Kattea M, Saqqah H, Sayed S, Smettei O, Winther S, Svensson M, Birn H, Jorgensen H, Botker H, Ivarsen P, Bottcher M, Maaniitty T, Stenstrom I, Saraste A, Pikkarainen E, Uusitalo V, Ukkonen H, Kajander S, Bax J, Knuuti J, Choi T, Park H, Lee C, Lee J, Seo Y, Cho Y, Hwang E, Cho D, Sanchez Enrique C, Ferrera C, Olmos C, Jimenez - Ballve A, Perez - Castejon MJ, Fernandez C, Vivas D, Vilacosta I, Nagamachi S, Onizuka H, Nishii R, Mizutani Y, Kitamura K, Lo Presti M, Polizzi V, Pino P, Luzi G, Bellavia D, Fiorilli R, Madeo A, Malouf J, Buffa V, Musumeci F, Rosales S, Puente A, Zafrir N, Shochat T, Mats A, Solodky A, Kornowski R, Lorber A, Boemio A, Pellegrino T, Paolillo S, Piscopo V, Carotenuto R, Russo B, Pellegrino S, De Matteis G, Perrone-Filardi P, Cuocolo A, Piscopo V, Pellegrino T, Boemio A, Carotenuto R, Russo B, Pellegrino S, De Matteis G, Petretta M, Cuocolo A, Amirov N, Ibatullin M, Sadykov A A, Saifullina G, Ruano R, Diego Dominguez M, Rodriguez Gabella T, Diego Nieto A, Diaz Gonzalez L, Garcia-Talavera J, Sanchez Fernandez P, Leen A, Al Younis I, Zandbergen-Harlaar S, Verberne H, Gimelli A, Veltman C, Wolterbeek R, Bax J, Scholte A, Mooney D, Rosenblatt J, Dunn T, Vasaiwala S, Okuda K, Nakajima K, Nystrom K, Edenbrandt L, Matsuo S, Wakabayashi H, Hashimoto M, Kinuya S, Iric-Cupic V, Milanov S, Davidovic G, Zdravkovic V, Ashikaga K, Yoneyama K, Akashi Y, Shugushev Z, Maximkin D, Chepurnoy A, Volkova O, Baranovich V, Faibushevich A, El Tahlawi M, Elmurr A, Alzubaidi S, Sakrana A, Gouda M, El Tahlawi R, Sellem A, Melki S, Elajmi W, Hammami H, Okano M, Kato T, Kimura M, Funasako M, Nakane E, Miyamoto S, Izumi T, Haruna T, Inoko M, Massardo T, Swett E, Fernandez R, Vera V, Zhindon J, Fernandez R, Swett E, Vera V, Zhindon J, Alay R, Massardo T, Ohshima S, Nishio M, Kojima A, Tamai S, Kobayashi T, Murohara T, Burrell S, Van Rosendael A, Van Den Hoogen I, De Graaf M, Roelofs J, Kroft L, Bax J, Scholte A, Rjabceva I, Krumina G, Kalvelis A, Chanakhchyan F, Vakhromeeva M, Kankiya E, Koppes J, Knol R, Wondergem M, Van Der Ploeg T, Van Der Zant F, Lazarenko SV, Bruin VS, Pan XB, Declerck JM, Van Der Zant FM, Knol RJJ, Juarez-Orozco LE, Alexanderson E, Slart R, Tio R, Dierckx R, Zeebregts C, Boersma H, Hillege H, Martinez-Aguilar M, Jordan-Rios A, Christensen TE, Ahtarovski KA, Bang LE, Holmvang L, Soeholm H, Ghotbi AA, Andersson H, Ihlemann N, Kjaer A, Hasbak P, Gulya M, Lishmanov YB, Zavadovskii K, Lebedev D, Stahle M, Hellberg S, Liljenback H, Virta J, Metsala O, Yla-Herttuala S, Saukko P, Knuuti J, Saraste A, Roivainen A, Thackeray J, Wang Y, Bankstahl J, Wollert K, Bengel F, Saushkina Y, Evtushenko V, Minin S, Efimova I, Evtushenko A, Smishlyaev K, Lishmanov Y, Maslov L, Okuda K, Nakajima K, Kirihara Y, Sugino S, Matsuo S, Taki J, Hashimoto M, Kinuya S, Ahmadian A, Berman J, Govender P, Ruberg F, Miller E, Piriou N, Pallardy A, Valette F, Cahouch Z, Mathieu C, Warin-Fresse K, Gueffet J, Serfaty J, Trochu J, Kraeber-Bodere F, Van Dijk J, Mouden M, Ottervanger J, Van Dalen J, Jager P, Zafrir N, Ofrk H, Vaturi M, Shochat T, Hassid Y, Belzer D, Sagie A, Kornowski R, Kaminek M, Metelkova I, Budikova M, Koranda P, Henzlova L, Sovova E, Kincl V, Drozdova A, Jordan M, Shahid F, Teoh Y, Thamen R, Hara N, Onoguchi M, Hojyo O, Kawaguchi Y, Murai M, Udaka F, Matsuzawa Y, Bulugahapitiya DS, Avison M, Martin J, Liu YH, Wu J, Liu C, Sinusas A, Daou D, Sabbah R, Bouladhour H, Coaguila C, Aguade-Bruix S, Pizzi M, Romero-Farina G, Candell-Riera J, Castell-Conesa J, Patchett N, Sverdlov A, Miller E, Daou D, Sabbah R, Bouladhour H, Coaguila C, Smettei O, Abazid R, Boulaamayl El Fatemi S, Sallam L, Snipelisky D, Park J, Ray J, Shapiro B, Kostkiewicz M, Szot W, Holcman K, Lesniak-Sobelga A, Podolec P, Clerc O, Possner M, Liga R, Vontobel J, Mikulicic F, Graeni C, Benz D, Herzog B, Gaemperli O, Kaufmann P. Poster Session 1: Sunday 3 May 2015, 08:30-18:00 * Room: Poster Area. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bouyoucef SE, Uusitalo V, Kamperidis V, De Graaf M, Maaniitty T, Stenstrom I, Broersen A, Scholte A, Saraste A, Bax J, Knuuti J, Furuhashi T, Moroi M, Awaya T, Masai H, Minakawa M, Kunimasa T, Fukuda H, Sugi K, Berezin A, Kremzer A, Clerc O, Kaufmann B, Possner M, Liga R, Vontobel J, Mikulicic F, Graeni C, Benz D, Kaufmann P, Buechel R, Ferreira M, Cunha M, Albuquerque A, Ramos D, Costa G, Lima J, Pego M, Peix A, Cisneros L, Cabrera L, Padron K, Rodriguez L, Heres F, Carrillo R, Mena E, Fernandez Y, Huizing E, Van Dijk J, Van Dalen J, Timmer J, Ottervanger J, Slump C, Jager P, Venuraju S, Jeevarethinam A, Yerramasu A, Atwal S, Mehta V, Lahiri A, Arjonilla Lopez A, Calero Rueda MJ, Gallardo G, Fernandez-Cuadrado J, Hernandez Aceituno D, Sanchez Hernandez J, Yoshida H, Mizukami A, Matsumura A, Smettei O, Abazid R, Sayed S, Mlynarska A, Mlynarski R, Golba K, Sosnowski M, Winther S, Svensson M, Jorgensen H, Bouchelouche K, Gormsen L, Holm N, Botker H, Ivarsen P, Bottcher M, Cortes CM, Aramayo G E, Daicz M, Casuscelli J, Alaguibe E, Neira Sepulveda A, Cerda M, Ganum G, Embon M, Vigne J, Enilorac B, Lebasnier A, Valancogne L, Peyronnet D, Manrique A, Agostini D, Menendez D, Rajpal S, Kocherla C, Acharya M, Reddy P, Sazonova I, Ilushenkova Y, Batalov R, Rogovskaya Y, Lishmanov Y, Popov S, Varlamova N, Prado Diaz S, Jimenez Rubio C, Gemma D, Refoyo Salicio E, Valbuena Lopez S, Moreno Yanguela M, Torres M, Fernandez-Velilla M, Lopez-Sendon J, Guzman Martinez G, Puente A, Rosales S, Martinez C, Cabada M, Melendez G, Ferreira R, Gonzaga A, Santos J, Vijayan S, Smith S, Smith M, Muthusamy R, Takeishi Y, Oikawa M, Goral JL, Napoli J, Montana O, Damico A, Quiroz M, Damico A, Forcada P, Schmidberg J, Zucchiatti N, Olivieri D, Jeevarethinam A, Venuraju S, Dumo A, Ruano S, Rakhit R, Davar J, Nair D, Cohen M, Darko D, Lahiri A, Yokota S, Ottervanger J, Maas A, Mouden M, Timmer J, Knollema S, Jager P, Sanja Mazic S, Lazovic B, Marina Djelic M, Jelena Suzic Lazic J, Tijana Acimovic T, Milica Deleva M, Vesnina Z, Zafrir N, Bental T, Mats I, Solodky A, Gutstein A, Hasid Y, Belzer D, Kornowski R, Ben Said R, Ben Mansour N, Ibn Haj Amor H, Chourabi C, Hagui A, Fehri W, Hawala H, Shugushev Z, Patrikeev A, Maximkin D, Chepurnoy A, Kallianpur V, Mambetov A, Dokshokov G, Teresinska A, Wozniak O, Maciag A, Wnuk J, Dabrowski A, Czerwiec A, Jezierski J, Biernacka K, Robinson J, Prosser J, Cheung G, Allan S, Mcmaster G, Reid S, Tarbuck A, Martin W, Queiroz R, Falcao A, Giorgi M, Imada R, Nogueira S, Chalela W, Kalil Filho R, Meneghetti W, Matveev V, Bubyenov A, Podzolkov V, Shugushev Z, Maximkin D, Chepurnoy A, Baranovich V, Faibushevich A, Kolzhecova Y, Volkova O, Kallianpur V, Peix A, Cabrera L, Padron K, Rodriguez L, Fernandez J, Lopez G, Mena E, Fernandez Y, Dondi M, Paez D, Butcher C, Reyes E, Al-Housni M, Green R, Santiago H, Ghiotto F, Hinton-Taylor S, Pottle A, Mason M, Underwood S, Casans Tormo I, Diaz-Exposito R, Plancha-Burguera E, Elsaban K, Alsakhri H, Yoshinaga K, Ochi N, Tomiyama Y, Katoh C, Inoue M, Nishida M, Suzuki E, Manabe O, Ito Y, Tamaki N, Tahilyani A, Jafary F, Ho Hee Hwa H, Ozdemir S, Kirilmaz B, Barutcu A, Tan Y, Celik F, Sakgoz S, Cabada Gamboa M, Puente Barragan A, Morales Vitorino N, Medina Servin M, Hindorf C, Akil S, Hedeer F, Jogi J, Engblom H, Martire V, Pis Diez E, Martire M, Portillo D, Hoff C, Balche A, Majgaard J, Tolbod L, Harms H, Bouchelouche K, Soerensen J, Froekiaer J, Gormsen L, Nudi F, Neri G, Procaccini E, Pinto A, Vetere M, Biondi-Zoccai G, Falcao A, Chalela W, Giorgi M, Imada R, Soares J, Do Val R, Oliveira M, Kalil Filho R, Meneghetti J, Tekabe Y, Anthony T, Li Q, Schmidt A, Johnson L, Groenman M, Tarkia M, Kakela M, Halonen P, Kiviniemi T, Pietila M, Yla-Herttuala S, Knuuti J, Roivainen A, Saraste A, Nekolla S, Swirzek S, Higuchi T, Reder S, Schachoff S, Bschorner M, Laitinen I, Robinson S, Yousefi B, Schwaiger M, Kero T, Lindsjo L, Antoni G, Westermark P, Carlson K, Wikstrom G, Sorensen J, Lubberink M, Rouzet F, Cognet T, Guedj K, Morvan M, El Shoukr F, Louedec L, Choqueux C, Nicoletti A, Le Guludec D, Jimenez-Heffernan A, Munoz-Beamud F, Sanchez De Mora E, Borrachero C, Salgado C, Ramos-Font C, Lopez-Martin J, Hidalgo M, Lopez-Aguilar R, Soriano E, Okizaki A, Nakayama M, Ishitoya S, Sato J, Takahashi K, Burchert I, Caobelli F, Wollenweber T, Nierada M, Fulsche J, Dieckmann C, Bengel F, Shuaib S, Mahlum D, Port S, Gemma D, Refoyo E, Cuesta E, Guzman G, Lopez T, Valbuena S, Fernandez-Velilla M, Del Prado S, Moreno M, Lopez-Sendon J, Harbinson M, Donnelly L, Einstein AJ, Johnson LL, Deluca AJ, Kontak AC, Groves DW, Stant J, Pozniakoff T, Cheng B, Rabbani LE, Bokhari S, Caobelli F, Schuetze C, Nierada M, Fulsche J, Dieckmann C, Bengel F, Aguade-Bruix S, Pizzi M, Romero-Farina G, Terricabras M, Villasboas D, Castell-Conesa J, Candell-Riera J, Brunner S, Gross L, Todica A, Lehner S, Di Palo A, Niccoli Asabella A, Magarelli C, Notaristefano A, Ferrari C, Rubini G, Sellem A, Melki S, Elajmi W, Hammami H, Ziadi M, Montero J, Ameriso J, Villavicencio R, Benito Gonzalez TF, Mayorga Bajo A, Gutierrez Caro R, Rodriguez Santamarta M, Alvarez Roy L, Martinez Paz E, Barinaga Martin C, Martin Fernandez J, Alonso Rodriguez D, Iglesias Garriz I, Gemma D, Refoyo E, Cuesta E, Guzman G, Valbuena S, Rosillo S, Del Prado S, Torres M, Moreno M, Lopez-Sendon J, Taleb S, Cherkaoui Salhi G, Regbaoui Y, Ait Idir M, Guensi A, Puente A, Rosales S, Martinez C, Cabada M, Benito Gonzalez TF, Mayorga Bajo A, Gutierrez Caro R, Rodriguez Santamarta M, Alvarez Roy L, Martinez Paz E, Martin Lopez CE, Castano Ruiz M, Martin Fernandez J, Iglesias Garriz I. Poster Session 2: Monday 4 May 2015, 08:00-18:00 * Room: Poster Area. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Stehli J, Fuchs TA, Singer A, Bull S, Clerc OF, Possner M, Gaemperli O, Buechel RR, Kaufmann PA. First experience with single-source, dual-energy CCTA for monochromatic stent imaging. Eur Heart J Cardiovasc Imaging 2014; 16:507-12. [DOI: 10.1093/ehjci/jeu282] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 11/11/2014] [Indexed: 01/08/2023] Open
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