1
|
Chen M, Almeida SO, Sayre JW, Karlsberg RP, Packard RRS. Distal-vessel fractional flow reserve by computed tomography to monitor epicardial coronary artery disease. Eur Heart J Cardiovasc Imaging 2024; 25:163-172. [PMID: 37708371 PMCID: PMC11032197 DOI: 10.1093/ehjci/jead229] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/26/2023] [Accepted: 09/08/2023] [Indexed: 09/16/2023] Open
Abstract
AIMS Coronary computed tomography angiography (CTA) and fractional flow reserve by computed tomography (FFR-CT) are increasingly utilized to characterize coronary artery disease (CAD). We evaluated the feasibility of distal-vessel FFR-CT as an integrated measure of epicardial CAD that can be followed serially, assessed the CTA parameters that correlate with distal-vessel FFR-CT, and determined the combination of clinical and CTA parameters that best predict distal-vessel FFR-CT and distal-vessel FFR-CT changes. METHODS AND RESULTS Patients (n = 71) who underwent serial CTA scans at ≥2 years interval (median = 5.2 years) over a 14-year period were included in this retrospective study. Coronary arteries were analysed blindly using artificial intelligence-enabled quantitative coronary CTA. Two investigators jointly determined the anatomic location and corresponding distal-vessel FFR-CT values at CT1 and CT2. A total of 45.3% had no significant change, 27.8% an improvement, and 26.9% a worsening in distal-vessel FFR-CT at CT2. Stepwise multiple logistic regression analysis identified a four-parameter model consisting of stenosis diameter ratio, lumen volume, low density plaque volume, and age, that best predicted distal-vessel FFR-CT ≤ 0.80 with an area under the curve (AUC) = 0.820 at CT1 and AUC = 0.799 at CT2. Improvement of distal-vessel FFR-CT was captured by a decrease in high-risk plaque and increases in lumen volume and remodelling index (AUC = 0.865), whereas increases in stenosis diameter ratio, medium density calcified plaque volume, and total cholesterol presaged worsening of distal-vessel FFR-CT (AUC = 0.707). CONCLUSION Distal-vessel FFR-CT permits the integrative assessment of epicardial atherosclerotic plaque burden in a vessel-specific manner and can be followed serially to determine changes in global CAD.
Collapse
Affiliation(s)
- Michael Chen
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, 10833 Le Conte Ave., CHS Building Room 43-268, Los Angeles, CA 90095, USA
| | - Shone O Almeida
- Cardiovascular Research Foundation of Southern California, Beverly Hills, CA, USA
| | - James W Sayre
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Ronald P Karlsberg
- Cardiovascular Research Foundation of Southern California, Beverly Hills, CA, USA
- Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - René R Sevag Packard
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, 10833 Le Conte Ave., CHS Building Room 43-268, Los Angeles, CA 90095, USA
- Cardiovascular Research Foundation of Southern California, Beverly Hills, CA, USA
- Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
- Veterans Affairs West Los Angeles Medical Center, Los Angeles, CA, USA
- Department of Physiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA
- Molecular Biology Institute, University of California, Los Angeles, CA, USA
- California NanoSystems Institute, University of California, Los Angeles, CA, USA
| |
Collapse
|
2
|
Almeida SO, Winchester DE, Blankstein R, Shaw LJ, Ferencik M, Arbab-Zadeh A, Choi AD. Expanding appropriate use of cardiac CT in chronic coronary disease: Key insights from the 2023 update. J Cardiovasc Comput Tomogr 2023; 17:465-469. [PMID: 37923579 DOI: 10.1016/j.jcct.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Shone O Almeida
- Division of Cardiovascular Sciences, University of South Florida, Tampa, FL, USA
| | - David E Winchester
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida and Malcom Randall VA Medical Center, Gainesville, FL, USA
| | - Ron Blankstein
- Cardiovascular Division (Department of Medicine) and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Leslee J Shaw
- Blavatnik Family Women's Research Institute, Icahn School of Medicine at Mount Sinai Medical Center, New York, NY, USA
| | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health and Sciences University, Portland, OR, USA
| | - Armin Arbab-Zadeh
- Division of Cardiology, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Andrew D Choi
- Division of Cardiology, Department of Radiology, The George Washington University School of Medicine, Washington, DC, USA.
| |
Collapse
|
3
|
Cho GW, Almeida SO, Gang ES, Elad Y, Duncan R, Budoff MJ, Karlsberg RP. Performance and Integration of Smartphone Wireless ECG Monitoring into the Enterprise Electronic Health Record: First Clinical Experience. Clin Med Insights Case Rep 2022; 15:11795476211069194. [PMID: 35095284 PMCID: PMC8796093 DOI: 10.1177/11795476211069194] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 11/24/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: Patient initiated, remote cardiac monitoring has proved to be a significant advance in the diagnosis and management of arrhythmias. Further improvements in ease of use and access to results will further improve health outcomes and cost-effectiveness. Here we describe a proof-of-concept evaluation to assess the feasibility of successfully implementing a cloud-based management system using KardiaPro (KP) for remote electrocardiogram (ECG) monitoring to interface into EPIC, an enterprise electronic health record (EHR) system. Methods: The KP management system was embedded using hypertext markup language (HTML) code directly into the EHR. Encrypted credentials and patient data were bundled with an application programming interface key allowing linkage of remote monitoring from patients’ smartphones. During the time of implementation, a total of 322 patients and 32 179 ECGs were recorded. Results: The KP-EHR interface provided full functionality, allowing detection, interpretation and documentation of atrial fibrillation (AF), flutter events, ventricular tachycardia, and complete heart block. Our study focused on KP’s detection of AF, and 16.7% of tracings were classified as probable AF with only 2.3% of tracings not analyzed by the KP algorithm because of tracings that were too noisy or truncated. Enhanced management was facilitated with clinical information immediately accessible. Blinded physician ECG review validated the KP proprietary algorithm interpretation and ECGs. Conclusions: Direct integration of KP into EHR was successful and practical. It allows for historical, point of care and immediate retrieval of remote ambulatory monitoring data and documentation into the electronic health record. KP EHR integration warrants further study as it has the potential to improve cost-effectiveness and clinical diagnostic value, leading to improvements in delivery of patient care.
Collapse
Affiliation(s)
- Geoffrey W Cho
- Cardiovascular Research Foundation of Southern California, Beverly Hills, CA, USA
- UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Shone O Almeida
- Cardiovascular Research Foundation of Southern California, Beverly Hills, CA, USA
- LA Biomedical Research Institute, Los Angeles, CA, USA
| | - Eli S Gang
- Cardiovascular Research Foundation of Southern California, Beverly Hills, CA, USA
- Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Yaron Elad
- Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
- Division of Informatics, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ray Duncan
- Division of Informatics, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Matthew J Budoff
- Cardiovascular Research Foundation of Southern California, Beverly Hills, CA, USA
- LA Biomedical Research Institute, Los Angeles, CA, USA
| | - Ronald P Karlsberg
- Cardiovascular Research Foundation of Southern California, Beverly Hills, CA, USA
- Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| |
Collapse
|
4
|
Almeida SO, Ram RJ, Kinninger A, Budoff MJ. Effect of 5-lipoxygenase inhibitor, VIA-2291 (Atreleuton), on epicardial fat volume in patients with recent acute coronary syndrome. J Cardiovasc Comput Tomogr 2020; 14:343-348. [DOI: 10.1016/j.jcct.2019.12.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 12/21/2019] [Accepted: 12/24/2019] [Indexed: 12/01/2022]
|
5
|
Almeida SO, Ahmed NM, Karlsberg RP. Left Main Coronary Artery Thrombus Diagnosed and Managed With Coronary Computed Tomography Angiography and Fractional Flow Reserve Derived From Computed Tomography. Clin Med Insights Cardiol 2019; 13:1179546819894592. [PMID: 31853209 PMCID: PMC6906343 DOI: 10.1177/1179546819894592] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 11/18/2019] [Indexed: 11/27/2022]
Abstract
Left main coronary artery thrombus (LMCA-T) is a rare disease state and diagnosed
with invasive coronary angiography (ICA). We present a case of LMCA-T diagnosed
with coronary computed tomography angiography (CTA) and treated without ICA in a
patient who presented to a hospital in the middle of war zone in Erbil, Iraqi
Kurdistan. Coronary CTA performed 1 month later demonstrated resolution of the
thrombus. Fractional flow reserve computed from computed tomography (FFR-CT;
HeartFlow, Redwood City, CA) performed retrospectively confirmed that the clot
was not hemodynamically significant at the time of diagnosis. This case
demonstrates the diagnostic capabilities of coronary CTA and FFR-CT when ICA is
not readily available.
Collapse
Affiliation(s)
- Shone O Almeida
- Cardiovascular Research Foundation of Southern California, Beverly Hills, CA, USA
| | - Nasih M Ahmed
- Cardiology and CT Department, Surgical Specialty Hospital, Erbil, Iraqi Kurdistan
| | - Ronald P Karlsberg
- Cardiovascular Research Foundation of Southern California, Beverly Hills, CA, USA.,Cedars Sinai Heart Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
6
|
Almeida SO, Honoris L, Defranco A, Port S, Li D, Nasir K, Kronmal R, Barr RG, Budoff M. Reliability of CAC Scoring on Nongated Compared With Gated Cardiac CT Scans From MESA. JACC Cardiovasc Imaging 2019; 13:177-178. [PMID: 31542523 DOI: 10.1016/j.jcmg.2019.08.007] [Citation(s) in RCA: 1] [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] [Received: 05/09/2019] [Revised: 08/01/2019] [Accepted: 08/07/2019] [Indexed: 10/26/2022]
|
7
|
Shafter AM, Almeida SO, Syed U, Shaikh K, Budoff MJ. Anomalous coronary sinus communication to the left atrium. J Cardiol Cases 2019; 20:122-124. [PMID: 31969939 DOI: 10.1016/j.jccase.2019.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 04/10/2019] [Revised: 05/18/2019] [Accepted: 06/19/2019] [Indexed: 12/18/2022] Open
Abstract
This report highlights an unusual anatomical finding with serious implications in clinical cardiac care. We present a case of a fistula or bridging vein originating from the left atrium (LA) and inserting into the coronary sinus (CS) which courses posteriorly to the right atrium and inserts near the superior vena cava, essentially serving as a left to right shunt in a 64-year-old woman presenting with chest pain. The coronary venous system serves as a vital access point in the placement of cardiac pacemakers and defibrillators. Coronary sinus anomalies are rare and often occur in isolation or in association with other vascular anomalies. The described conduit serves as a functional interatrial shunt, though likely with minimal hemodynamic significance given the low pressure state of the left and right atria. This case highlights the importance of understanding the coronary venous anatomy and its variations in terms of anatomic course, valves, diameter, angulation, relationship to coronary arteries. <Learning objective: Coronary CT angiography can provide detailed anatomical information for diagnosis and treatment of anomalous coronary sinus communication to the left atrium. Coronary sinus ablation may be necessary in atrial fibrillation refractory to pulmonary venous isolation. An important differential diagnosis to this anomaly is unroofed CS. Anomalous coronary sinus communication to the left atrium demonstrates anomalous bridging vein indirectly communicating the CS to the LA. However, unroofed CS demonstrates a direct CS to LA communication through a wall defect; the CS is usually enlarged.>.
Collapse
Affiliation(s)
- Ahmed M Shafter
- Los Angeles Biomedical Research Institute, Division of Cardiology, Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Shone O Almeida
- Los Angeles Biomedical Research Institute, Division of Cardiology, Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Usman Syed
- Los Angeles Biomedical Research Institute, Division of Cardiology, Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Kashif Shaikh
- Los Angeles Biomedical Research Institute, Division of Cardiology, Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Matthew J Budoff
- Los Angeles Biomedical Research Institute, Division of Cardiology, Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
| |
Collapse
|
8
|
Abstract
Lipid lowering therapy has been the mainstay of cardiovascular risk reduction and prevention. Statin drugs have been shown to reduce serum cholesterol along with significant reduction in morbidity and mortality of cardiovascular disease. Whether these benefits are purely through lipid lowering or pleiotropic (cholesterol independent) effects has yet to be fully understood. Advances in cardiac imaging, from intravascular ultrasound to multi-detector coronary computed tomography angiography, have furthered our understanding of statin's effect on atherosclerotic plaque. Notably, statins play a role in plaque regression with reduction in lipid content. These drugs further stabilize atherosclerotic plaque with thickened fibrous caps and macrocalcification that serves to stabilize atheromas.
Collapse
Affiliation(s)
- Shone O Almeida
- Los Angeles Biomedical Institute, 1124W Carson St, Torrance, CA 90502, USA.
| | - Matthew Budoff
- Los Angeles Biomedical Institute, 1124W Carson St, Torrance, CA 90502, USA
| |
Collapse
|
9
|
Abstract
Stem cell regenerative therapies hold promise for treating diseases across the spectrum of medicine. While significant progress has been made in the preclinical stages, the clinical application of cardiac cell therapy is limited by technical challenges. Certain methods of cell delivery, such as intramyocardial injection, carry a higher rate of arrhythmias. Other potential contributors to the arrhythmogenicity of cell transplantation include reentrant pathways caused by heterogeneity in conduction velocities between graft and host as well as graft automaticity. In this article, the arrhythmogenic potential of cell delivery to the heart is discussed.
Collapse
Affiliation(s)
- Shone O Almeida
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, 100 UCLA Medical Plaza, Suite 630 East, Los Angeles, CA 90095, USA
| | - Rhys J Skelton
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, 100 UCLA Medical Plaza, Suite 630 East, Los Angeles, CA 90095, USA; Murdoch Children's Research Institute, The Royal Children's Hospital, Cardiac Development, 50 Flemington Road, Parkville, Victoria 3052, Australia
| | - Sasikanth Adigopula
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, 100 UCLA Medical Plaza, Suite 630 East, Los Angeles, CA 90095, USA
| | - Reza Ardehali
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, 100 UCLA Medical Plaza, Suite 630 East, Los Angeles, CA 90095, USA; Eli and Edyth Broad Stem Cell Research Center, University of California, 675 Charles E Young Drive South, MRL Room 3780, Los Angeles, CA 90095, USA.
| |
Collapse
|