1
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Adamu YM, Umar AB, Muhammad AR, Mijinyawa MS, Ismail A. Aberrant right coronary artery in an elderly Nigerian with recent dyspnoea detected on coronary CT angiogram. Radiol Case Rep 2024; 19:2621-2624. [PMID: 38645958 PMCID: PMC11026724 DOI: 10.1016/j.radcr.2024.03.047] [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] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/08/2024] [Accepted: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
An anomalous origin of the right coronary artery has been documented in up to 0.92% of the general population, which is more common than an anomalous origin of the left coronary artery. We present a case of an elderly hypertensive man who developed mild dyspnoea on exertion for 3 months with associated retro-sternal pain as well as occasional palpitation which all tend to subside at rest. An electrocardiogram showed evidence of left atrial enlargement. A coronary computed tomographic angiogram was acquired with a 160-slice scanner which revealed the right coronary artery to originate from the left aortic sinus with a retro-aortic pattern of anatomical course. Vascular wall calcifications were noted with multilevel luminal narrowing on the left anterior descending however distal opacification was adequate. Our case further depicts the reason for keeping in mind anatomical variations while evaluating cardiac pathologies even among Black Africans.
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Affiliation(s)
| | | | | | | | - Anas Ismail
- Department of Radiology, Bayero University, Kano, Nigeria
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2
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Suk J, de Haan P, Lippe P, Brune C, Wolterink JM. Mesh neural networks for SE(3)-equivariant hemodynamics estimation on the artery wall. Comput Biol Med 2024; 173:108328. [PMID: 38552282 DOI: 10.1016/j.compbiomed.2024.108328] [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] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 01/29/2024] [Accepted: 03/17/2024] [Indexed: 04/17/2024]
Abstract
Computational fluid dynamics (CFD) is a valuable asset for patient-specific cardiovascular-disease diagnosis and prognosis, but its high computational demands hamper its adoption in practice. Machine-learning methods that estimate blood flow in individual patients could accelerate or replace CFD simulation to overcome these limitations. In this work, we consider the estimation of vector-valued quantities on the wall of three-dimensional geometric artery models. We employ group-equivariant graph convolution in an end-to-end SE(3)-equivariant neural network that operates directly on triangular surface meshes and makes efficient use of training data. We run experiments on a large dataset of synthetic coronary arteries and find that our method estimates directional wall shear stress (WSS) with an approximation error of 7.6% and normalised mean absolute error (NMAE) of 0.4% while up to two orders of magnitude faster than CFD. Furthermore, we show that our method is powerful enough to accurately predict transient, vector-valued WSS over the cardiac cycle while conditioned on a range of different inflow boundary conditions. These results demonstrate the potential of our proposed method as a plugin replacement for CFD in the personalised prediction of hemodynamic vector and scalar fields.
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Affiliation(s)
- Julian Suk
- Department of Applied Mathematics & Technical Medical Center, University of Twente, Enschede, 7522 NB, The Netherlands.
| | - Pim de Haan
- Qualcomm AI Research, Qualcomm Technologies Netherlands B.V., Nijmegen, 6546 AS, The Netherlands; QUVA Lab, University of Amsterdam, Amsterdam, 1012 WX, The Netherlands
| | - Phillip Lippe
- QUVA Lab, University of Amsterdam, Amsterdam, 1012 WX, The Netherlands
| | - Christoph Brune
- Department of Applied Mathematics & Technical Medical Center, University of Twente, Enschede, 7522 NB, The Netherlands
| | - Jelmer M Wolterink
- Department of Applied Mathematics & Technical Medical Center, University of Twente, Enschede, 7522 NB, The Netherlands
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3
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Arderiu G, Bejar MT, Civit-Urgell A, Peña E, Badimon L. Crosstalk of human coronary perivascular adipose-derived stem cells with vascular cells: role of tissue factor. Basic Res Cardiol 2024; 119:291-307. [PMID: 38430261 DOI: 10.1007/s00395-024-01037-1] [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: 10/03/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 03/03/2024]
Abstract
The coronary perivascular adipose tissue (cPVAT) has been associated to the burden of cardiovascular risk factors and to the underlying vessel atherosclerotic plaque severity. Although the "outside to inside" hypothesis of PVAT-derived-adipokine regulation of vessel function is currently accepted, whether the resident mesenchymal stem cells (ASCs) in PVAT have a regulatory role on the underlying vascular arterial smooth muscle cells (VSMCs) is not known. Here, we investigated the interactions between resident PVAT-ASCs and VSMCs. ASCs were obtained from PVAT overlying the left anterior descending (LAD) coronary artery of hearts removed at heart transplant operations. PVAT was obtained both from patients with non-ischemic and ischemic heart disease as the cause of heart transplant. ASCs were isolated from PVAT, phenotypically characterized by flow cytometry, functionally tested for proliferation, and differentiation. Crosstalk between ASCs and VSMCs was investigated by co-culture studies. ASCs were detected in the adventitia of the LAD-PVAT showing differentiation capacity and angiogenic potential. ASCs obtained from PVAT of non-ischemic and ischemic hearts showed different tissue factor (TF) expression levels, different VSMCs recruitment capacity through the axis ERK1/2-ETS1 signaling and different angiogenic potential. Induced upregulation of TF in ASCs isolated from ischemic PVAT rescued their angiogenic capacity in subcutaneously implanted plugs in mice, whereas silencing TF in ASCs decreased the proangiogenic capacity of non-ischemic ASCs. The results indicate for the first time a novel mechanism of regulation of VSMCs by PVAT-ASCs in angiogenesis, mediated by TF expression in ASCs. Regulation of TF in ASCs may become a therapeutic intervention to increase cardiac protection.
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Affiliation(s)
- Gemma Arderiu
- Cardiovascular-Program, Institut de Recerca Sant Pau, IIB-Sant Pau, Carrer Sant Quintí, 77-79, 08041, Barcelona, Spain.
- Ciber CV, Instituto Carlos III, Madrid, Spain.
| | - Maria Teresa Bejar
- Cardiovascular-Program, Institut de Recerca Sant Pau, IIB-Sant Pau, Carrer Sant Quintí, 77-79, 08041, Barcelona, Spain
- Wellcome-MRC Cambridge Stem Cell Institute, University of Cambridge, Puddicombe Way, Cambridge, CB2 0AW, UK
| | - Anna Civit-Urgell
- Cardiovascular-Program, Institut de Recerca Sant Pau, IIB-Sant Pau, Carrer Sant Quintí, 77-79, 08041, Barcelona, Spain
- Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona (UB), Barcelona, Spain
| | - Esther Peña
- Cardiovascular-Program, Institut de Recerca Sant Pau, IIB-Sant Pau, Carrer Sant Quintí, 77-79, 08041, Barcelona, Spain
- Ciber CV, Instituto Carlos III, Madrid, Spain
| | - Lina Badimon
- Cardiovascular-Program, Institut de Recerca Sant Pau, IIB-Sant Pau, Carrer Sant Quintí, 77-79, 08041, Barcelona, Spain
- Ciber CV, Instituto Carlos III, Madrid, Spain
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4
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Pascaner AF, Rosato A, Fantazzini A, Vincenzi E, Basso C, Secchi F, Lo Rito M, Conti M. Automatic 3D Segmentation and Identification of Anomalous Aortic Origin of the Coronary Arteries Combining Multi-view 2D Convolutional Neural Networks. J Imaging Inform Med 2024; 37:884-891. [PMID: 38343261 PMCID: PMC11031525 DOI: 10.1007/s10278-023-00950-6] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/18/2023] [Accepted: 10/29/2023] [Indexed: 04/20/2024]
Abstract
This work aimed to automatically segment and classify the coronary arteries with either normal or anomalous origin from the aorta (AAOCA) using convolutional neural networks (CNNs), seeking to enhance and fasten clinician diagnosis. We implemented three single-view 2D Attention U-Nets with 3D view integration and trained them to automatically segment the aortic root and coronary arteries of 124 computed tomography angiographies (CTAs), with normal coronaries or AAOCA. Furthermore, we automatically classified the segmented geometries as normal or AAOCA using a decision tree model. For CTAs in the test set (n = 13), we obtained median Dice score coefficients of 0.95 and 0.84 for the aortic root and the coronary arteries, respectively. Moreover, the classification between normal and AAOCA showed excellent performance with accuracy, precision, and recall all equal to 1 in the test set. We developed a deep learning-based method to automatically segment and classify normal coronary and AAOCA. Our results represent a step towards an automatic screening and risk profiling of patients with AAOCA, based on CTA.
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Affiliation(s)
- Ariel Fernando Pascaner
- Department of Civil Engineering and Architecture, University of Pavia, Via Adolfo Ferrata 3, 27100, Pavia, Italy
| | - Antonio Rosato
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, Piazza Edmondo Malan 2, 20097, San Donato Milanese, Italy
| | - Alice Fantazzini
- Camelot Biomedical Systems S.r.l., Via Al Ponte Reale 2/20, 16124, Genoa, Italy
| | - Elena Vincenzi
- Camelot Biomedical Systems S.r.l., Via Al Ponte Reale 2/20, 16124, Genoa, Italy
| | - Curzio Basso
- Camelot Biomedical Systems S.r.l., Via Al Ponte Reale 2/20, 16124, Genoa, Italy
| | - Francesco Secchi
- Unit of Radiology, IRCCS Policlinico San Donato, Piazza Edmondo Malan 2, 20097, San Donato Milanese, Italy
| | - Mauro Lo Rito
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, Piazza Edmondo Malan 2, 20097, San Donato Milanese, Italy
| | - Michele Conti
- Department of Civil Engineering and Architecture, University of Pavia, Via Adolfo Ferrata 3, 27100, Pavia, Italy.
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5
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Torta E, Griffo B, Caridi GCA, De Nisco G, Chiastra C, Morbiducci U, Gallo D. Smartphone-based particle tracking velocimetry for the in vitro assessment of coronary flows. Med Eng Phys 2024; 126:104144. [PMID: 38621846 DOI: 10.1016/j.medengphy.2024.104144] [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] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 02/05/2024] [Accepted: 03/09/2024] [Indexed: 04/17/2024]
Abstract
The present study adopts a smartphone-based approach for the experimental characterization of coronary flows. Technically, Particle Tracking Velocimetry (PTV) measurements were performed using a smartphone camera and a low-power continuous wave laser in realistic healthy and stenosed phantoms of left anterior descending artery with inflow Reynolds numbers approximately ranging from 20 to 200. A Lagrangian-Eulerian mapping was performed to convert Lagrangian PTV velocity data to a Eulerian grid. Eulerian velocity and vorticity data obtained from smartphone-based PTV measurements were compared with Particle Image Velocimetry (PIV) measurements performed with a smartphone-based setup and with a conventional setup based on a high-power double-pulsed laser and a CMOS camera. Smartphone-based PTV and PIV velocity flow fields substantially agreed with conventional PIV measurements, with the former characterized by lower average percentage differences than the latter. Discrepancies emerged at high flow regimes, especially at the stenosis throat, due to particle image blur generated by smartphone camera shutter speed and image acquisition frequency. In conclusion, the present findings demonstrate the feasibility of PTV measurements using a smartphone camera and a low-power light source for the in vitro characterization of cardiovascular flows for research, industrial and educational purposes, with advantages in terms of costs, safety and usability.
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Affiliation(s)
- Elena Torta
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Bianca Griffo
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | | | - Giuseppe De Nisco
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Claudio Chiastra
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Umberto Morbiducci
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Diego Gallo
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy.
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Mehier B, Mahmoudi K, Veugeois A, Masri A, Amabile N, Giudice CD, Paul JF. Diagnostic performance of deep learning to exclude coronary stenosis on CT angiography in TAVI patients. Int J Cardiovasc Imaging 2024:10.1007/s10554-024-03063-5. [PMID: 38461472 DOI: 10.1007/s10554-024-03063-5] [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] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 02/03/2024] [Indexed: 03/12/2024]
Abstract
We evaluated the diagnostic performance of a deep-learning model (DLM) (CorEx®, Spimed-AI, Paris, France) designed to automatically detect > 50% coronary stenosis on coronary computed tomography angiography (CCTA) images. We studied inter-observer variability as an additional aim. CCTA images obtained before transcatheter aortic valve implantation (TAVI) were assessed by two radiologists and the DLM, and the results were compared to those of invasive coronary angiography (ICA) used as the reference standard. 165 consecutive patients underwent both CCTA and ICA as part of their TAVI work-up. We excluded the 42 (25.5%) patients with a history of stenting or bypass grafting and the 23 (13.9%) patients with low-quality images. We retrospectively subjected the CCTA images from the remaining 100 patients to evaluation by the DLM and compared the DLM and ICA results. All 25 patients with > 50% stenosis by ICA also had > 50% stenosis by DLM evaluation of CCTA: thus, the DLM had 100% sensitivity and 100% negative predictive value. False-positive DLM results were common, yielding a positive predictive value of only 39% (95% CI, 27-51%). Two radiologists with 3 and 25 years' experience, respectively, performed similarly to the DLM in evaluating the CCTA images; thus, accuracy did not differ significantly between each reader and the DLM (p = 0.625 and p = 0.375, respectively). The DLM had 100% negative predictive value for > 50% stenosis and performed similarly to experienced radiologists. This tool may hold promise for identifying the up to one-third of patients who do not require ICA before TAVI.
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Affiliation(s)
- Benjamin Mehier
- Department of Radiology, Cardiac Imaging, Institut Mutualiste Montsouris, 75014, Paris, France.
| | - Khalil Mahmoudi
- Interventional Cardiology Department, Institut Mutualiste Montsouris, 75014, Paris, France
| | - Aurélie Veugeois
- Interventional Cardiology Department, Institut Mutualiste Montsouris, 75014, Paris, France
| | - Alaa Masri
- Interventional Cardiology Department, Institut Mutualiste Montsouris, 75014, Paris, France
| | - Nicolas Amabile
- Interventional Cardiology Department, Institut Mutualiste Montsouris, 75014, Paris, France
| | - Costantino Del Giudice
- Radiology and Interventional Radiology Department, Cardiac Imaging, Institut Mutualiste Montsouris, 75014, Paris, France
| | - Jean-François Paul
- Department of Radiology, Cardiac Imaging, Institut Mutualiste Montsouris, Spimed-AI, 75014, Paris, France
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7
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Chen X, Mumme RP, Corrigan KL, Mukai-Sasaki Y, Koutroumpakis E, Palaskas NL, Nguyen CM, Zhao Y, Huang K, Yu C, Xu T, Daniel A, Balter PA, Zhang X, Niedzielski JS, Shete SS, Deswal A, Court LE, Liao Z, Yang J. Deep learning-based automatic segmentation of cardiac substructures for lung cancers. Radiother Oncol 2024; 191:110061. [PMID: 38122850 DOI: 10.1016/j.radonc.2023.110061] [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] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/09/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE Accurate and comprehensive segmentation of cardiac substructures is crucial for minimizing the risk of radiation-induced heart disease in lung cancer radiotherapy. We sought to develop and validate deep learning-based auto-segmentation models for cardiac substructures. MATERIALS AND METHODS Nineteen cardiac substructures (whole heart, 4 heart chambers, 6 great vessels, 4 valves, and 4 coronary arteries) in 100 patients treated for non-small cell lung cancer were manually delineated by two radiation oncologists. The valves and coronary arteries were delineated as planning risk volumes. An nnU-Net auto-segmentation model was trained, validated, and tested on this dataset with a split ratio of 75:5:20. The auto-segmented contours were evaluated by comparing them with manually drawn contours in terms of Dice similarity coefficient (DSC) and dose metrics extracted from clinical plans. An independent dataset of 42 patients was used for subjective evaluation of the auto-segmentation model by 4 physicians. RESULTS The average DSCs were 0.95 (+/- 0.01) for the whole heart, 0.91 (+/- 0.02) for 4 chambers, 0.86 (+/- 0.09) for 6 great vessels, 0.81 (+/- 0.09) for 4 valves, and 0.60 (+/- 0.14) for 4 coronary arteries. The average absolute errors in mean/max doses to all substructures were 1.04 (+/- 1.99) Gy and 2.20 (+/- 4.37) Gy. The subjective evaluation revealed that 94% of the auto-segmented contours were clinically acceptable. CONCLUSION We demonstrated the effectiveness of our nnU-Net model for delineating cardiac substructures, including coronary arteries. Our results indicate that this model has promise for studies regarding radiation dose to cardiac substructures.
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Affiliation(s)
- Xinru Chen
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, United States
| | - Raymond P Mumme
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Kelsey L Corrigan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Yuki Mukai-Sasaki
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States; Advanced Medical Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Efstratios Koutroumpakis
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Nicolas L Palaskas
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Callistus M Nguyen
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Yao Zhao
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, United States
| | - Kai Huang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, United States
| | - Cenji Yu
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, United States
| | - Ting Xu
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Aji Daniel
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Peter A Balter
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, United States
| | - Xiaodong Zhang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, United States
| | - Joshua S Niedzielski
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, United States
| | - Sanjay S Shete
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, United States; Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Anita Deswal
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Laurence E Court
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, United States
| | - Zhongxing Liao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Jinzhong Yang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, United States.
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Olloni A, Lorenzen EL, Jeppesen SS, Diederichsen A, Finnegan R, Hoffmann L, Kristiansen C, Knap M, Milo MLH, Møller DS, Pøhl M, Persson G, Sand HMB, Sarup N, Thing RS, Brink C, Schytte T. An open source auto-segmentation algorithm for delineating heart and substructures - Development and validation within a multicenter lung cancer cohort. Radiother Oncol 2024; 191:110065. [PMID: 38122851 DOI: 10.1016/j.radonc.2023.110065] [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] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/27/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND AND PURPOSE Irradiation of the heart in thoracic cancers raises toxicity concerns. For accurate dose estimation, automated heart and substructure segmentation is potentially useful. In this study, a hybrid automatic segmentation is developed. The accuracy of delineation and dose predictions were evaluated, testing the method's potential within heart toxicity studies. MATERIALS AND METHODS The hybrid segmentation method delineated the heart, four chambers, three large vessels, and the coronary arteries. The method consisted of a nnU-net heart segmentation and partly atlas- and model-based segmentation of the substructures. The nnU-net training and atlas segmentation was based on lung cancer patients and was validated against a national consensus dataset of 12 patients with breast cancer. The accuracy of dose predictions between manual and auto-segmented heart and substructures was evaluated by transferring the dose distribution of 240 previously treated lung cancer patients to the consensus data set. RESULTS The hybrid auto-segmentation method performed well with a heart dice similarity coefficient (DSC) of 0.95, with no statistically significant difference between the automatic and manual delineations. The DSC for the chambers varied from 0.78-0.86 for the automatic segmentation and was comparable with the inter-observer variability. Most importantly, the automatic segmentation was as precise as the clinical experts in predicting the dose distribution to the heart and all substructures. CONCLUSION The hybrid segmentation method performed well in delineating the heart and substructures. The prediction of dose by the automatic segmentation was aligned with the manual delineations, enabling measurement of heart and substructure dose in large cohorts. The delineation algorithm will be available for download.
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Affiliation(s)
- Agon Olloni
- Department of Oncology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Denmark.
| | - Ebbe Laugaard Lorenzen
- Department of Clinical Research, University of Southern Denmark, Denmark; Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Denmark
| | - Stefan Starup Jeppesen
- Department of Oncology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Denmark
| | - Axel Diederichsen
- Department of Clinical Research, University of Southern Denmark, Denmark; Department of Cardiology, Odense University Hospital, Denmark
| | - Robert Finnegan
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Lone Hoffmann
- Department of Oncology, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Denmark
| | - Charlotte Kristiansen
- Department of Oncology, Vejle Hospital University Hospital of Southern Denmark, Denmark
| | - Marianne Knap
- Department of Oncology, Aarhus University Hospital, Denmark
| | | | - Ditte Sloth Møller
- Department of Oncology, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Denmark
| | - Mette Pøhl
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Gitte Persson
- Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte, Denmark; Department of Clinical Medicine, Copenhagen University, Denmark
| | - Hella M B Sand
- Department of Oncology, Aalborg University Hospital, Denmark
| | - Nis Sarup
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Denmark
| | - Rune Slot Thing
- Department of Oncology, Vejle Hospital University Hospital of Southern Denmark, Denmark
| | - Carsten Brink
- Department of Clinical Research, University of Southern Denmark, Denmark; Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Denmark
| | - Tine Schytte
- Department of Oncology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark
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9
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Woon CK, Omar E, Siew SF, Nawawi HM, Kasim NAM, Chainchel Singh MK. The effect of post-mortem computed tomography angiography (PMCTA) on biomarkers of coronary artery disease. J Forensic Leg Med 2024; 102:102654. [PMID: 38310784 DOI: 10.1016/j.jflm.2024.102654] [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] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/17/2024] [Accepted: 01/30/2024] [Indexed: 02/06/2024]
Abstract
Coronary atherosclerosis is due to build-up of plaque within the coronary arteries. Post-mortem computed tomography (PMCT) allows non or minimally invasive visualization of abnormalities prior to an autopsy, however PMCT-angiography (PMCTA) greatly enhances relevant findings, especially in viewing the cardiovascular system which is important in the diagnosis of coronary atherosclerosis. Contrast media used in PMCTA however has been reported to cause distortion of tissue which may interfere with post-mortem investigation outcomes. A cross sectional study to investigate the effect of PMCTA on tissue biomarkers in coronary arteries was performed involving cases brought in dead to the Institute and Accident and Emergency Unit. Sixty-three autopsy cases were included in this study, whereby 18 cases underwent PMCT while 45 cases underwent PMCTA. The subjects subsequently had a conventional autopsy where coronary artery sections were collected for standard histological examination and immunohistochemistry examination for endothelial inflammatory (CD36), prothrombogenic (TPA) and plaque stability (MMP-9) markers. The subjects consisted of 55 males and 8 females with a mean age ±SD of 49 ± 18.11 years. There were no significant differences in the coronary artery endothelial expression of CD36, MMP-9 and TPA between PMCT and PMCTA subjects. PMCTA does not alter CD36, TPA and MMP-9 markers supporting the safe use of PMCTA in post-mortem examinations.
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Affiliation(s)
- Choy Ker Woon
- Department of Anatomy, Faculty of Medicine, Universiti Teknologi MARA, Jalan Hospital 47000, Sungai Buloh, Selangor, Malaysia; Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - Effat Omar
- Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia; Department of Pathology, Faculty of Medicine, Universiti Teknologi MARA, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - Sheue Feng Siew
- National Institute of Forensic Medicine (IPFN), Hospital Kuala Lumpur, Ministry of Health Malaysia, Jalan Pahang, 50586, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Hapizah M Nawawi
- Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia; Department of Pathology, Faculty of Medicine, Universiti Teknologi MARA, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - Noor Alicezah M Kasim
- Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia; Department of Pathology, Faculty of Medicine, Universiti Teknologi MARA, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - Mansharan Kaur Chainchel Singh
- Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia; National Institute of Forensic Medicine (IPFN), Hospital Kuala Lumpur, Ministry of Health Malaysia, Jalan Pahang, 50586, Wilayah Persekutuan Kuala Lumpur, Malaysia; Department of Radiology, Hospital Al-Sultan Abdullah, Universiti Teknologi MARA, 42300, Bandar Puncak Alam, Selangor, Malaysia.
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Brahim O, Mahjoub Y, Boussaid M, Limem H, Aissaoui A. Fibromuscular dysplasia of the coronary arteries: An unusual case of sudden death and review of the literature. J Forensic Leg Med 2024; 102:102633. [PMID: 38241822 DOI: 10.1016/j.jflm.2023.102633] [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] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 01/21/2024]
Abstract
Fibromuscular dysplasia of the coronary is an uncommon coronary defect with a range of pathological alterations and unpredictable clinical description that can cause sudden death. We present an autopsy case of sudden cardiac death due to a rupture of a coronary artery aneurysm in a 59-year-old woman. Postmortem autopsy revealed two huge saccular aneurysms located at the right coronary artery, one of which was ruptured leading to a fatal hemopericardium. Histopathological examination revealed coronary artery fibromuscular dysplasia with fibromyxoid dissociation of the media causing saccular aneurysms. The involvement of coronary arteries in fibromuscular dysplasia with aneurysmal features has been rarely reported in the literature and is most likely an underdiagnosed finding. Due to the little number of published studies, the etiology is not fully understood and data on pathogenesis, risk factors, manifestation, disease course, and mortality are still unclear, which is a gap that needs to be filled in order to avoid under-diagnosis of the disease. Our case report aimed to discuss the mechanisms of sudden death attributed to coronary fibromuscular dysplasia.
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Affiliation(s)
- Oumeima Brahim
- Department of Legal Medicine, Taher Sfar Teaching Hospital, 5100, Mahdia, Tunisia; Faculty of Medicine of Monastir, University of Monastir, Tunisia; Laboratory of Technology and Medical Imaging " LR12ES06, Tunisia.
| | - Yosra Mahjoub
- Department of Legal Medicine, Taher Sfar Teaching Hospital, 5100, Mahdia, Tunisia; Faculty of Medicine of Monastir, University of Monastir, Tunisia; Laboratory of Technology and Medical Imaging " LR12ES06, Tunisia.
| | - Marwa Boussaid
- Department of Legal Medicine, Taher Sfar Teaching Hospital, 5100, Mahdia, Tunisia; Faculty of Medicine of Monastir, University of Monastir, Tunisia; Laboratory of Technology and Medical Imaging " LR12ES06, Tunisia.
| | - Hiba Limem
- Department of Legal Medicine, Taher Sfar Teaching Hospital, 5100, Mahdia, Tunisia; Faculty of Medicine of Monastir, University of Monastir, Tunisia; Laboratory of Technology and Medical Imaging " LR12ES06, Tunisia.
| | - Abir Aissaoui
- Department of Legal Medicine, Taher Sfar Teaching Hospital, 5100, Mahdia, Tunisia; Faculty of Medicine of Monastir, University of Monastir, Tunisia; Laboratory of Technology and Medical Imaging " LR12ES06, Tunisia.
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11
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Rojas-Granados A, Pérez-Campos E, Sanchez-Sanchez M, Chávez MAM, Pérez-Campos-Mayoral L, Ángeles-Castellanos M. Prevalence of myocardial bridges in the Mexican population: A morphometric and histological analysis. Morphologie 2023; 108:100760. [PMID: 38157748 DOI: 10.1016/j.morpho.2023.100760] [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] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/15/2023] [Accepted: 12/16/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Myocardial bridge (MB) is described as an abnormal band of myocardium covering a variable portion of any coronary artery. METHODS The current study explores the presence of MB throughout the coronary arterial system and provides a morphometric description through instrumented dissection of a sample of 100 human hearts. The study shows a higher prevalence of MB in the Mexican population than in previous reports. RESULTS In the total sample (n=100), MB was identified in 96% of it. A total of 421 MBs were observed, with a mean of 4.38mm (±0.28) per dissected heart. The most frequently affected vessel is the anterior interventricular artery where a total of 52 MBs were found, of the total sample studied. DISCUSSION The high prevalence of MB among Mexican patients could be the result of a genetic association for this population or the neoformation of MB after birth due to lifestyle-associated factors. Further studies are required to better understand the high prevalence of MB among Mexican subjects.
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Affiliation(s)
- A Rojas-Granados
- Departamento de Anatomia, Facultad de Medicina. Universidad Nacional Autónoma de México, México, Mexico
| | - E Pérez-Campos
- Tecnológico Nacional de México/IT, Oaxaca, Oaxaca City, Mexico
| | - M Sanchez-Sanchez
- Posgrado Facultad de Odontologia, Universidad Autónoma Benito Juárez de Oaxaca, Oaxaca, Mexico
| | - M A M Chávez
- Facultad de Medicina y Cirugia, Universidad Autónoma Benito Juárez de Oaxaca, Oaxaca, Mexico
| | - L Pérez-Campos-Mayoral
- Facultad de Medicina y Cirugia, Universidad Autónoma Benito Juárez de Oaxaca, Oaxaca, Mexico
| | - M Ángeles-Castellanos
- Departamento de Anatomia, Facultad de Medicina. Universidad Nacional Autónoma de México, México, Mexico; Departamento de Innovacion en Material Biologico Humano, Facultad de Medicina, Universidad Nacional Autonoma de Mexico, México, Mexico.
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12
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Ma R, van Assen M, Sidorenkov G, Ties D, Jan Pelgrim G, Stillman A, de Cecco C, van der Harst P, Vliegenthart R. Relationships of pericoronary and epicardial fat measurements in male and female patients with and without coronary artery disease. Eur J Radiol 2023; 169:111154. [PMID: 37944331 DOI: 10.1016/j.ejrad.2023.111154] [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] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/06/2023] [Accepted: 10/16/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Although pericoronary adipose tissue (PCAT) is a component of the epicardial adipose tissue (EAT) depot, they may have different associations to coronary artery disease (CAD). We explored relationships between pericoronary adipose tissue mean attenuation (PCATMA) and EAT measurements in coronary CT angiography (CCTA) in patients with and without CAD. MATERIAL AND METHODS CCTA scans of 185 non-CAD and 81 CAD patients (86.4% >50% stenosis) were included and retrospectively analyzed. PCATMA and EAT density/volume were measured and analyzed by sex, including associations with age, risk factors and tube voltage using linear regression models. RESULTS In non-CAD and CAD, mean PCATMA and EAT volume were higher in men than in women (non-CAD: -92.5 ± 10.6HU vs -96.2 ± 8.4HU, and 174.4 ± 69.1 cm3 vs 124.1 ± 57.3 cm3; CAD: -92.2 ± 9.0HU vs -97.4 ± 9.7HU, and 193.6 ± 62.5 cm3 vs 148.5 ± 50.5 cm3 (p < 0.05)). EAT density was slightly lower in men than women in non-CAD (-96.4 ± 6.3HU vs -94.4 ± 5.5HU (p < 0.05)), and similar in CAD (-98.2 ± 5.2HU vs 98.2 ± 6.4HU). There was strong correlation between PCATMA and EAT density (non-CAD: r = 0.725, p < 0.001, CAD: r = 0.686, p < 0.001) but no correlation between PCATMA and EAT volume (non-CAD: r = 0.018, p = 0.81, CAD: r = -0.055, p = 0.63). A weak inverse association was found between EAT density and EAT volume (non-CAD: r = -0.244, p < 0.001, CAD: r = -0.263, p = 0.02). In linear regression models, EAT density was significantly associated with PCATMA in both non-CAD and CAD patients independent of risk factors and tube voltage. CONCLUSION In CAD and non-CAD patients, EAT density, but not EAT volume, showed significant associations with PCATMA. Compared to women, men had higher PCATMA and EAT volume independently of disease status, but similar or slightly lower EAT density. Differences in trends and relations of PCATMA and EAT by sex could indicate that personalized interpretation and thresholding is needed.
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Affiliation(s)
- Runlei Ma
- University of Groningen, University Medical Center Groningen, Department of Radiology, the Netherlands; Affiliated Hospital of Nanjing University of Chinese Medicine, Department of Radiology, China; Jiangsu Province Hospital of Chinese Medicine, Department of Radiology, China
| | - Marly van Assen
- Emory University, School of Medicine, Department of Radiology and Imaging Sciences, Atlanta, GA, USA
| | - Grigory Sidorenkov
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, the Netherlands
| | - Daan Ties
- University of Groningen, University Medical Center Groningen, Department of Cardiology, the Netherlands
| | - Gert Jan Pelgrim
- University of Groningen, University Medical Center Groningen, Department of Radiology, the Netherlands
| | - Arthur Stillman
- Emory University, School of Medicine, Department of Radiology and Imaging Sciences, Atlanta, GA, USA
| | - Carlo de Cecco
- Emory University, School of Medicine, Department of Radiology and Imaging Sciences, Atlanta, GA, USA
| | - Pim van der Harst
- University of Groningen, University Medical Center Groningen, Department of Cardiology, the Netherlands; University Medical Center Utrecht, Department of Cardiology, Division of Heart and Lungs, the Netherlands
| | - Rozemarijn Vliegenthart
- University of Groningen, University Medical Center Groningen, Department of Radiology, the Netherlands.
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Martin R, Segars P, Samei E, Miró J, Duong L. Unsupervised synthesis of realistic coronary artery X-ray angiogram. Int J Comput Assist Radiol Surg 2023; 18:2329-2338. [PMID: 37336801 PMCID: PMC10786317 DOI: 10.1007/s11548-023-02982-3] [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] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 06/01/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE Medical image analysis suffers from a sparsity of annotated data necessary in learning-based models. Cardiorespiratory simulators have been developed to counter the lack of data. However, the resulting data often lack realism. Hence, the proposed method aims to synthesize realistic and fully customizable angiograms of coronary arteries for the training of learning-based biomedical tasks, for cardiologists performing interventions, and for cardiologist trainees. METHODS 3D models of coronary arteries are generated with a fully customizable realistic cardiorespiratory simulator. The transfer of X-ray angiography style to simulator-generated images is performed using a new vessel-specific adaptation of the CycleGAN model. The CycleGAN model is paired with a vesselness-based loss function that is designed as a vessel-specific structural integrity constraint. RESULTS Validation is performed both on the style and on the preservation of the shape of the arteries of the images. The results show a PSNR of 14.125, an SSIM of 0.898, and an overlapping of 89.5% using the Dice coefficient. CONCLUSION We proposed a novel fluoroscopy-based style transfer method for the enhancement of the realism of simulated coronary artery angiograms. The results show that the proposed model is capable of accurately transferring the style of X-ray angiograms to the simulations while keeping the integrity of the structures of interest (i.e., the topology of the coronary arteries).
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Affiliation(s)
- Rémi Martin
- Department of Software and Information Technology Engineering, École de Technologie Supérieure, 1100 Notre-Dame, Montréal, QC, H3C 1K3, Canada.
| | - Paul Segars
- Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University Medical Center, 2424 Erwin Road, Durham, NC, 27705, USA
| | - Ehsan Samei
- Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University Medical Center, 2424 Erwin Road, Durham, NC, 27705, USA
| | - Joaquim Miró
- Department of Pediatrics, CHU Sainte-Justine, 3175 Chem. de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - Luc Duong
- Department of Software and Information Technology Engineering, École de Technologie Supérieure, 1100 Notre-Dame, Montréal, QC, H3C 1K3, Canada
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Yang H, Ning Y. "Hand as foot" figural teaching method in coronary arteries. Asian J Surg 2023; 46:4947-4948. [PMID: 37596229 DOI: 10.1016/j.asjsur.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/01/2023] [Indexed: 08/20/2023] Open
Affiliation(s)
- Huailu Yang
- Department of Emergency, The Affiliated Hospital of Inner Mongolia Medical University, Tongdao North Street, Hohhot, 010050, China
| | - Yuzhen Ning
- Department of Emergency, The Affiliated Hospital of Inner Mongolia Medical University, Tongdao North Street, Hohhot, 010050, China.
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Usman M, Qureshi HZ, Zahid K, Bukhari SN. Role of coronary arteries in patients with Acute Coronary Syndrome. Pak J Med Sci 2023; 39:1717-1719. [PMID: 37936760 PMCID: PMC10626102 DOI: 10.12669/pjms.39.6.7173] [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] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 06/20/2023] [Accepted: 07/16/2023] [Indexed: 11/09/2023] Open
Abstract
Objective To assess the role of coronary arteries in acute coronary syndrome patients who have survived sudden cardiac arrest. Method A cross-sectional study was conducted in Department of Cardiology at Chaudhary Pervaiz Elahi Institute of Cardiology, Multan from 1st May 2021 to 1st October 2021. A total of 203 patients who were diagnosed with sudden cardiac arrest were included as subjects of the study. Baseline data of all patients including age, sex, body mass index, history of smoking, diabetes and hypertension was noted. Coronary angiography was performed in all patients within five days after admission in hospital due to SCA. Results The average age of patients was 52.61±11.09 years. There were 140 (68.97%) male and 63 (31.03%) female patients. There were 131 (64.53%) patients with STEMI and 72 (35.47%) patients with Non-STEMI. LMCAD were diagnosed in 29 (14.29%) patients, RCA in 88 (43.35%) patients, LAD in 174 (85.71%) Patients and LCX in 41 (20.20%) patients. Conclusion LAD has the most involvement among the coronary arteries (85.71%) in patients with sudden cardiac arrest.
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Affiliation(s)
- Muhammad Usman
- Dr. Muhammad Usman, MBBS, FCPSI, MO, Department of Cardiology, Ch. Pervaiz Elahi Institute of Cardiology Multan, Multan - Pakistan
| | - Hareem Zahra Qureshi
- Dr. Hareem Zahra Qureshi, MBBS, FCPSI, MO, Department of Cardiology, Ch. Pervaiz Elahi Institute of Cardiology Multan, Multan - Pakistan
| | - Kiran Zahid
- Dr. Kiran Zahid, MBBS, FCPSI, WMO, Department of Cardiology, Ch. Pervaiz Elahi Institute of Cardiology Multan, Multan - Pakistan
| | - Syed Naseem Bukhari
- Dr. Syed Naseem Bukhari, MBBS, FCPS, Assistant Professor, Department of Cardiology, Ch. Pervaiz Elahi Institute of Cardiology Multan, Multan - Pakistan
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Moon SH, Kim JW, Yang JH, Kang DH, Kim SH, Jung JJ, Ahn JH, Park SE, Jeon KN, Byun JH. Predicting severe proximal left anterior descending coronary artery stenosis using proximal left anterior descending coronary artery tortuosity and the angle between the left main and anterior descending coronary arteries: a retrospective cross-sectional study. Quant Imaging Med Surg 2023; 13:7459-7466. [PMID: 37969625 PMCID: PMC10644144 DOI: 10.21037/qims-23-518] [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] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/17/2023] [Indexed: 11/17/2023]
Abstract
Background Coronary bifurcation angles influence plaque initiation in the coronary artery, and changes in blood flow caused by tortuosity in the coronary arteries can reduce blood pressure distal to the tortuous portion of the coronary artery, leading to myocardial ischemia. We aimed to describe two factors (coronary artery tortuosity and bifurcation angle) as one descriptor for the evaluation of proximal left anterior descending coronary artery (LAD) disease. Methods We reviewed the medical records of 133 consecutive patients who underwent computed tomography angiography (CTA) for angina symptoms between November 2019 and January 2020. The patients were divided into two groups according to the presence of significant LAD stenosis on CTA (defined as LAD stenosis >50%). The straight length of the vessel was measured using the central luminal line of the flow path, and, calculated using proprietary algorithms in TeraRecon software. We used three-dimensional volume rendering and two-dimensional axial images to measure the left main coronary artery (LM)-LAD angles. Results In the univariate analysis, there were significant differences in the linear distance between the endpoints of the 20 mm actual curve of the LAD (d20), cosine value for LM-LAD angle (cosθ) <0.8, age, presence of hypertension or diabetes, and number of pack years [hazard ratio (HR): 2.70, 8.04, 1.05, 3.70, 2.82, and 1.04; P=0.029, P<0.001, P=0.020, P=0.024, P=0.021, and P=0.002, respectively]. However, in the multivariate analysis, the cosθ multiplied by d20 (d20*cosθ) <15.5, presence of hypertension and number of pack years (HR: 11.36, 4.54, and 1.04; P<0.001, P=0.019, and P=0.003, respectively) were predictors of significant proximal LAD stenosis. Conclusions As the tortuosity and LM-LAD angle increased (d20 and cosθ decreased, respectively), the chance of proximal LAD lesions formation increased. d20*cosθ might be useful as a predictor of proximal LAD stenosis.
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Affiliation(s)
- Seong Ho Moon
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jong Woo Kim
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jun Ho Yang
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Dong Hoon Kang
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Sung Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jae Jun Jung
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jong Hwa Ahn
- Department of Cardiology, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Sung Eun Park
- Department of Radiology, Gyeongsang National University College of Medicine, Changwon, Republic of Korea
| | - Kyung Nyeo Jeon
- Department of Radiology, Gyeongsang National University College of Medicine, Changwon, Republic of Korea
| | - Joung Hun Byun
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
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Xu B, Wang L, Yang J, Yang B, Xu L, Chen Y, Zheng D. Multi-constraint point set registration with redundant point removal for the registration of coronary arteries. Comput Biol Med 2023; 165:107438. [PMID: 37688990 DOI: 10.1016/j.compbiomed.2023.107438] [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] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/06/2023] [Accepted: 08/29/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Coronary artery disease (CAD) is the leading cause of death worldwide. The registration of the coronary artery at different phases can help radiologists explore the motion patterns of the coronary artery and assist in the diagnosis of CAD. However, there is no automatic and easy-to-execute method to solve the missing data problem that occurs at the endpoints of the coronary artery tree. This paper proposed a non-rigid multi-constraint point set registration with redundant point removal (MPSR-RPR) algorithm to tackle this challenge. METHODS Firstly, the MPSR-RPR algorithm roughly registered two coronary artery point sets with the pre-set smoothness regularization parameter and Gaussian filter width value. The moving coherent, local feature, and the corresponding relationship between bifurcation point pairs were exploited as the constraints. Next, the spatial geometry information of the coronary artery was utilized to automatically recognize the vessel endpoints and to delete the redundant points of the coronary artery. Finally, the algorithm continued carrying out the multi-constraint registration with another group of the pre-set parameters to improve the alignment performance. RESULTS The experimental results demonstrated that the MPSR-RPR algorithm achieved a significantly lower mean value of the modified Hausdorff distance (MHD) compared to the other state-of-the-art methods for addressing the serious missing data in the left and right coronary arteries. CONCLUSION This study demonstrated the effectiveness of the proposed algorithm in aligning coronary arteries, providing significant value in assisting in the diagnosis of coronary artery and myocardial lesions.
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Affiliation(s)
- Bu Xu
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, 110169, China
| | - Lu Wang
- School of Computer Science and Engineering, Northeastern University, Shenyang, 110169, China
| | - Jinzhong Yang
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, 110169, China
| | - Benqiang Yang
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, 110169, China; Department of Radiology, General Hospital of North Theater Command, Shenyang, 110016, China
| | - Lisheng Xu
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, 110169, China; Key Laboratory of Medical Image Computing, Ministry of Education, Shenyang, 110169, China; Engineering Research Center of Medical Imaging and Intelligent Analysis, Ministry of Education, Shenyang, 110169, China.
| | - Yang Chen
- School of Computer Science and Engineering, Southeast University, Nanjing, 210096, China
| | - Dingchang Zheng
- Research Centre of Intelligent Healthcare, Coventry University, Coventry, CV1 5RW, United Kingdom
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Uzdavinyte Gateliene E, Cesnaite G, Sadauskiene E, Barysiene J. Late diagnosis of Kawasaki disease with major cardiovascular complications: a case report. Eur Heart J Case Rep 2023; 7:ytad486. [PMID: 37908547 PMCID: PMC10613633 DOI: 10.1093/ehjcr/ytad486] [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] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 09/15/2023] [Accepted: 10/02/2023] [Indexed: 11/02/2023]
Abstract
Background Kawasaki disease (KD) is an acute systemic vasculitis syndrome, mostly targeting children under 5 years old. If untreated, coronary artery abnormalities develop to approximately one out of four patients who suffered from KD. As KD might be easily missed in childhood, managing cardiovascular complications might become a real challenge at an advanced age. Case summary A 25-year-old woman was presented to a skying resort hospital with discomfort in chest, shortness of breath, cold sweat, and dizziness after skiing. Based on increased troponin level and ECG findings, the specialists diagnosed myocarditis and initiated treatment with non-steroidal anti-inflammatory drugs. After the symptoms recurred in half a year, there was a need for further clarification of the diagnosis of myocarditis. The patient received a comprehensive cardiac imaging evaluation at Vilnius University Santaros Clinic to differentiate the cause of the recurrent chest pains. Coronary artery computed tomography revealed presence of aneurysm with wall calcification in left anterior descending artery S6-10 mm in diameter and aneurysm of circumflex artery S11-7 mm in diameter as well as occlusion of calcified right coronary artery. After taking a detailed medical history, a presumption about a former case of KD has been made. Discussion Coronary artery aneurysm is a cardiovascular sequelae of KD if it is left untreated. Due to atypical presentation, it might be overlooked, while the key of successful KD management is an early diagnosis and therapy.
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Affiliation(s)
- Egle Uzdavinyte Gateliene
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Santariskiu Str. 2, 08410 Vilnius, Lithuania
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M.K. Ciurlionio Str. 21, 03101 Vilnius, Lithuania
| | - Guste Cesnaite
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M.K. Ciurlionio Str. 21, 03101 Vilnius, Lithuania
| | - Egle Sadauskiene
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Santariskiu Str. 2, 08410 Vilnius, Lithuania
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M.K. Ciurlionio Str. 21, 03101 Vilnius, Lithuania
| | - Jurate Barysiene
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Santariskiu Str. 2, 08410 Vilnius, Lithuania
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M.K. Ciurlionio Str. 21, 03101 Vilnius, Lithuania
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Östgren CJ, Otten J, Festin K, Angerås O, Bergström G, Cederlund K, Engström G, Eriksson MJ, Eriksson M, Fall T, Gummesson A, Hagström E, Hellman U, James SK, Jernberg T, Kihlberg J, Kylhammar D, Markstad H, Nilsson P, Persson A, Persson M, Pirazzi C, Renklint R, Rosengren A, Söderberg S, Sundström J. Prevalence of atherosclerosis in individuals with prediabetes and diabetes compared to normoglycaemic individuals-a Swedish population-based study. Cardiovasc Diabetol 2023; 22:261. [PMID: 37759237 PMCID: PMC10537533 DOI: 10.1186/s12933-023-01982-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 03/03/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Patients with type 2 diabetes have an increased risk of death and cardiovascular events and people with diabetes or prediabetes have been found to have increased atherosclerotic burden in the coronary and carotid arteries. This study will estimate the cross-sectional prevalence of atherosclerosis in the coronary and carotid arteries in individuals with prediabetes and diabetes, compared with normoglycaemic individuals in a large population-based cohort. METHODS The 30,154 study participants, 50-64 years, were categorized according to their fasting glycaemic status or self-reported data as normoglycaemic, prediabetes, and previously undetected or known diabetes. Prevalence of affected coronary artery segments, severity of stenosis and coronary artery calcium score (CACS) were determined by coronary computed tomography angiography. Total atherosclerotic burden was assessed in the 11 clinically most relevant segments using the Segment Involvement Score and as the presence of any coronary atherosclerosis. The presence of atherosclerotic plaque in the carotid arteries was determined by ultrasound examination. RESULTS Study participants with prediabetes (n = 4804, 16.0%) or diabetes (n = 2282, 7.6%) had greater coronary artery plaque burden, more coronary stenosis and higher CACS than normoglycaemic participants (all, p < 0.01). Among male participants with diabetes 35.3% had CACS ≥ 100 compared to 16.1% among normoglycaemic participants. For women, the corresponding figures were 8.9% vs 6.1%. The prevalence of atherosclerosis in the coronary arteries was higher in participants with previously undetected diabetes than prediabetes, but lower than in patients with known diabetes. The prevalence of any plaque in the carotid arteries was higher in participants with prediabetes or diabetes than in normoglycaemic participants. CONCLUSIONS In this large population-based cohort of currently asymptomatic people, the atherosclerotic burden in the coronary and carotid arteries increased with increasing degree of dysglycaemia. The finding that the atherosclerotic burden in the coronary arteries in the undetected diabetes category was midway between the prediabetes category and patients with known diabetes may have implications for screening strategies and tailored prevention interventions for people with dysglycaemia in the future.
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Affiliation(s)
- Carl Johan Östgren
- Department of Health, Medicine and Caring Sciences, Centre of Medical Image Science and Visualization (CMIV), Linköping University, 581 83, Linköping, SE, Sweden.
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Julia Otten
- Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden
| | - Karin Festin
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Oskar Angerås
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Göran Bergström
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kerstin Cederlund
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Maria J Eriksson
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Eriksson
- Medicine Unit Endocrinology, Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm, Sweden
- Unit of Endocrinology, Department of Medicine, Karolinska Institute at Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Tove Fall
- Department of Medical Sciences, Molecular Epidemiology, Uppsala University, Uppsala, Sweden
| | - Anders Gummesson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Genetics and Genomics, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Emil Hagström
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Urban Hellman
- Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden
| | - Stefan K James
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Johan Kihlberg
- Department of Health, Medicine and Caring Sciences, Centre of Medical Image Science and Visualization (CMIV), Linköping University, 581 83, Linköping, SE, Sweden
- Department of Radiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - David Kylhammar
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences and Department of Clinical Physiology, Linköping University, Linköping, Sweden
| | - Hanna Markstad
- Center for Medical Imaging and Physiology, Skåne University Hospital and Lund University, Lund, Sweden
- Experimental Cardiovascular Research, Clinical Research Center, Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Peter Nilsson
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
- Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Anders Persson
- Department of Health, Medicine and Caring Sciences, Centre of Medical Image Science and Visualization (CMIV), Linköping University, 581 83, Linköping, SE, Sweden
- Department of Radiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Sciences, Huddinge University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Margaretha Persson
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
- Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Carlo Pirazzi
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Rebecka Renklint
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, Geriatrics and Emergency Medicine, Sahlgrenska University Hospital Östra Hospital, Gothenburg, Sweden
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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Tian D, Sun Y, Guo JJ, Zhao SH, Lu HF, Chen YY, Ge MY, Zeng MS, Jin H. 3.0 T unenhanced Dixon water-fat separation whole-heart coronary magnetic resonance angiography: compressed-sensing sensitivity encoding imaging versus conventional 2D sensitivity encoding imaging. Int J Cardiovasc Imaging 2023; 39:1775-1784. [PMID: 37428247 DOI: 10.1007/s10554-023-02878-y] [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] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 05/16/2023] [Indexed: 07/11/2023]
Abstract
This study was aimed to investigate 3.0 T unenhanced Dixon water-fat whole-heart CMRA (coronary magnetic resonance angiography) using compressed-sensing sensitivity encoding (CS-SENSE) and conventional sensitivity encoding (SENSE) in vitro and in vivo. The key parameters of CS-SENSE and conventional 1D/2D SENSE were compared in vitro phantom study. In vivo study, fifty patients with suspected coronary artery disease (CAD) completed unenhanced Dixon water-fat whole-heart CMRA at 3.0 T using both CS-SENSE and conventional 2D SENSE methods. We compared mean acquisition time, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and the diagnostic accuracy between two techniques. In vitro study, CS-SENSE achieved better effectiveness between higher SNR/CNR and shorter scan times using the appropriate acceleration factor compared with conventional 2D SENSE. In vivo study, CS-SENSE CMRA had better performance than 2D SENSE in terms of the mean acquisition time, SNR and CNR (7.4 ± 3.2 min vs. 8.3 ± 3.4 min, P = 0.001; SNR: 115.5 ± 35.4 vs. 103.3 ± 32.2; CNR: 101.1 ± 33.2 vs. 90.6 ± 30.1, P < 0.001 for both). The diagnostic accuracy between CS-SENSE and 2D SENSE had no significant difference on a patient-based analysis (sensitivity: 97.3% vs. 91.9%; specificity: 76.9% vs. 61.5%; accuracy: 92.0% vs. 84.0%; P > 0.05 for each). Unenhanced CS-SENSE Dixon water-fat separation whole-heart CMRA at 3.0 T can improve the SNR and CNR, shorten the acquisition time while providing equally satisfactory image quality and diagnostic accuracy compared with 2D SENSE CMRA.
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Affiliation(s)
- Di Tian
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, No. 180 Fenglin Rd, Shanghai, 200032, China
| | - Yi Sun
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, No. 180 Fenglin Rd, Shanghai, 200032, China
| | - Jia-Jun Guo
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, No. 180 Fenglin Rd, Shanghai, 200032, China
| | - Shi-Hai Zhao
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, No. 180 Fenglin Rd, Shanghai, 200032, China
| | - Hong-Fei Lu
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, No. 180 Fenglin Rd, Shanghai, 200032, China
| | - Yin-Yin Chen
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, No. 180 Fenglin Rd, Shanghai, 200032, China
| | - Mei-Ying Ge
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, No. 180 Fenglin Rd, Shanghai, 200032, China.
| | - Meng-Su Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, No. 180 Fenglin Rd, Shanghai, 200032, China
| | - Hang Jin
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, No. 180 Fenglin Rd, Shanghai, 200032, China.
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21
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Pinos D, Griffith J, Emrich T, Schoepf UJ, O'Doherty J, Zsarnoczay E, Fink N, Vecsey-Nagy M, Suranyi P, Tesche C, Aquino GJ, Varga-Szemes A, Brandt V. Intra-individual comparison of image quality of the coronary arteries between photon-counting detector and energy-integrating detector CT systems. Eur J Radiol 2023; 166:111008. [PMID: 37542817 DOI: 10.1016/j.ejrad.2023.111008] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 07/23/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE To intra-individually compare the objective and subjective image quality of coronary computed tomography angiography (CCTA) between photon-counting detector CT (PCD-CT) and energy-integrating detector CT (EID-CT). METHOD Consecutive patients undergoing clinically indicated CCTA on an EID-CT system were prospectively enrolled for a research CCTA performed on a PCD-CT system within 30 days. Polychromatic images were reconstructed for both EID- and PCD-CT, while virtual monoenergetic images (VMI) were generated at 40, 45, 50, 55, 60 and 70 keV for PCD-CT. Two blinded readers calculated contrast-to-noise ratio (CNR) for each major coronary artery and rated image noise, vessel attenuation, vessel sharpness, and overall quality on a 1-5 Likert scale. Patients were then stratified by body mass index (BMI) [high (>30 kg/m2) vs low (<30 kg/m2)] for subgroup analysis. RESULTS A total of 20 patients (67.5 ± 9.0 years, 75% male) were included in the study. Compared with EID-CT, coronary artery CNR values from PCD-CT monoenergetic and polychromatic reconstructions were all significantly higher than CNR values from EID-CT, with incrementally greater differences in obese subjects (all p < 0.008). Subjective image noise and sharpness were also significantly higher for all VMI reconstructions compared to EID-CT (all p < 0.008). All subjective scores were significantly higher for 55, 60, and 70 keV PCD-CT than EID-CT values (all p < 0.05). CONCLUSIONS The improved objective and subjective image quality of PCD-CT compared to EID-CT may provide better visualization of the coronary arteries for a wide array of patients, especially those with a high BMI.
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Affiliation(s)
- Daniel Pinos
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina (25 Courtenay Dr, Charleston, SC, 29425, USA)
| | - Joseph Griffith
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina (25 Courtenay Dr, Charleston, SC, 29425, USA)
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina (25 Courtenay Dr, Charleston, SC, 29425, USA); Department of Diagnostic and Interventional Radiology, University Medical Center Mainz (1 Langenbeckstraße, 55131 Mainz, Germany); German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany (1 Langenbeckstraße, 55131 Mainz, Germany)
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina (25 Courtenay Dr, Charleston, SC, 29425, USA).
| | - Jim O'Doherty
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina (25 Courtenay Dr, Charleston, SC, 29425, USA); Siemens Medical Solutions USA (40 Liberty Boulevard, 19355 Malvern, PA, USA)
| | - Emese Zsarnoczay
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina (25 Courtenay Dr, Charleston, SC, 29425, USA); Medical Imaging Center, Semmelweis University (Korányi Sándor utca 2, Budapest, 1083, Hungary)
| | - Nicola Fink
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina (25 Courtenay Dr, Charleston, SC, 29425, USA); Department of Radiology, University Hospital Munich, LMU Munich, Munich, Germany (15 Marchioninistr., 81377 München, Germany)
| | - Milan Vecsey-Nagy
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina (25 Courtenay Dr, Charleston, SC, 29425, USA); MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Center, Semmelweis University (18 Hataror ut, 1122 Budapest, Hungary)
| | - Pal Suranyi
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina (25 Courtenay Dr, Charleston, SC, 29425, USA)
| | - Christian Tesche
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina (25 Courtenay Dr, Charleston, SC, 29425, USA); Department of Cardiology, Clinic Augustinum Munich (16 Wolkerweg, 81375 München, Germany); Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University (Lazarettstraße 36, 80636 München, Germany)
| | - Gilberto J Aquino
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina (25 Courtenay Dr, Charleston, SC, 29425, USA)
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina (25 Courtenay Dr, Charleston, SC, 29425, USA)
| | - Verena Brandt
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina (25 Courtenay Dr, Charleston, SC, 29425, USA); Department of Cardiology and Angiology, Robert-Bosch-Hospital (Auerbachstraße 110, 70376 Stuttgart, Germany)
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22
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Ismail A, Lawal Y, Isyaku K, Garba I, Ismail JA, Tabari AM, Umar MS. Burden, Severity and Characteristic Pattern of Coronary Artery Disease using 160-Slice Computed Tomographic Angiography: Earliest Report from Northern Nigeria. West Afr J Med 2023; 40:779-785. [PMID: 37638969] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
BACKGROUND Coronary computed tomography angiography (CCTA) allows for non-invasive visualization of the coronary arteries which is promising in diagnosing coronary artery disease. OBJECTIVES To determine the prevalence, morphology, anatomic distribution pattern and correlates of CAD in our environment. METHODS This cross-sectional study was conducted on the first cohort of patients referred for CCTA in our hospital. The patients were examined with 160-slice Toshiba® CT scanner. Their demographic data, relevant clinical information as well as the findings on CCTA were extracted and documented. The data were analysed using the R programming software version 4.0.4. RESULTS Out of a total of 153 patients who presented for CCTA within the study period, 133 (84.7%) were eligible for analysis. Their age ranged from 22-78 years with a mean ± SD of 55.8 ± 11.7 years. A total of 33 (24.8%) had normal CCTA, while 100 (75.2%) had either stenosis or total occlusion. There was a significantly higher (p-value of 0.00001) calcium score among those with stenosis compared to those with normal CCTA. The severity of the stenotic lesion was associated with the calcium score. The logistic regression analyses showed a statistically significant (P = 0.0415, OR = 1.0569, 97.5% CI =1.078152-1.123240) association between age and the presence of coronary stenosis. In addition, most of the stenotic lesions were in the left anterior descending artery (LAD). CONCLUSION Majority of the patients had coronary artery disease of variable severity and the LAD was the most involved artery. There was no significant association between sex and severity of the disease; however, old age and higher number of lesions were associated with severe disease.
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Affiliation(s)
- A Ismail
- Department of Radiology, Bayero University, Kano State, Nigeria
| | - Y Lawal
- Department of Radiology, Bayero University, Kano State, Nigeria
| | - K Isyaku
- Department of Radiology, Bayero University, Kano State, Nigeria
| | - I Garba
- Department of Medical Radiography, Bayero University, Kano State, Nigeria
| | - J A Ismail
- Cardiothoracic Unit, Department of Surgery, Bayero University, Kano State, Nigeria
| | - A M Tabari
- Department of Radiology, Barau Dikko Teaching Hospital, Kaduna State, Nigeria
| | - M S Umar
- Cardiology Unit, Department of Internal Medicine, Bayero University, Kano State, Nigeria
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23
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Gómez-Torres FA, Cortés-Machado LS, Ballesteros-Acuña LE. Comparison of coronary arteries morphometry and distribution in bovines with humans and other animal species. Open Vet J 2023; 13:955-964. [PMID: 37701666 PMCID: PMC10495096 DOI: 10.5455/ovj.2023.v13.i8.1] [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] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/08/2023] [Indexed: 09/14/2023] Open
Abstract
Background The left coronary artery (LCA) in the bovines is more developed than the right. Aim The objective of the study is to describe the bovine coronary system from a morphological point of view, including the morphometry and its distribution. Methods Arciform suture with 2.0 silk was applied around the sinus orifice and coronary ostium and a number 14 catheter was installed, to perfuse semi-synthetic polyester resin, consisting of a mixture of 85% GP40L palatal with 15% styrene with red color mineral. Results The average weight of 28 bovine hearts used in our study was 1.534.1 kg. The right coronary artery had a proximal caliber of 5 +/- 0.9 mm. The LCA caliber and length were 9.4 +/- 1.2 and 18.3 +/- 4.8 mm, respectively. This artery was divided into two branches in 85.7% of the cases and trifurcated in 14.3%. The paraconal interventricular branch (PIB) ended more frequently in the apex (46.4%), and its proximal caliber was 6.4 +/- 1.4 mm. The left circumflex branch ended in 82.1% in the subsinusal interventricular sulcus, and its proximal caliber was 5.9 +/- 1.2 mm. The proximal calibers of the PIB and the left circumflex branch did not present statistically significant differences (p = 0.137). The sinoatrial branch presented a dual origin (right and LCA) in 46.4% of the cases and a single origin from the LCA in 53.6% of the samples. In the evaluated hearts, left coronary dominance was observed in most cases (96.4%). Their presence of anastomosis between the branches of the coronary arteries was observed in 57.1% of cases. Conclusion The presence of a myocardial bridge was found in six hearts (21.4%). In bovines, a high percentage of anastomosis was found, a protective factor in obstruction of the coronary arterial branches.
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Affiliation(s)
- Fabián A. Gómez-Torres
- Department of Basic Sciences, School of Medicine, Universidad Industrial de Santander, Bucaramanga, Colombia
| | - Luz S. Cortés-Machado
- Veterinary Medicine Faculty, Universidad Cooperativa de Colombia, Bucaramanga, Colombia
| | - Luis E. Ballesteros-Acuña
- Department of Basic Sciences, School of Medicine, Universidad Industrial de Santander, Bucaramanga, Colombia
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Faure ME, Budde RP, van den Bosch AE, Wilschut JM, ten Cate T, Duijnhouwer AL, Roos-Hesselink JW, Hirsch A. Percutaneous pulmonary valve implantation: Pre- and post-procedural RVOT and coronary artery relationship assessed by CT. Int J Cardiol Heart Vasc 2023; 47:101224. [PMID: 37252194 PMCID: PMC10209805 DOI: 10.1016/j.ijcha.2023.101224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/08/2023] [Accepted: 05/12/2023] [Indexed: 05/31/2023]
Affiliation(s)
- Marguerite E. Faure
- Dep. of Radiology and Nuclear Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Dep. of Radiology, AZ Monica, Antwerp, Belgium
| | - Ricardo P.J. Budde
- Dep. of Radiology and Nuclear Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Dep. of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Annemien E. van den Bosch
- Dep. of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, the Netherlands
| | - Jeroen M. Wilschut
- Dep. of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Tim ten Cate
- Dep. of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Jolien W. Roos-Hesselink
- Dep. of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, the Netherlands
| | - Alexander Hirsch
- Dep. of Radiology and Nuclear Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Dep. of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands
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25
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Javed S, Mei Y, Zhang Y, Liu C, Liu S. Multi-slice CT analysis of the length of left main coronary artery: its relation to sex, age, diameter and branching pattern of left main coronary artery, and coronary dominance. Surg Radiol Anat 2023:10.1007/s00276-023-03193-w. [PMID: 37402958 DOI: 10.1007/s00276-023-03193-w] [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] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/26/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE The objective of this research was to analyze and correlate the length of the left main coronary artery (LMCA) with significant clinical parameters using multi-slice CT (MSCT). MATERIALS AND METHODS 1500 patients (851 males and 649 females; mean age 57.38 ± 11.03 [SD]; age range: 5-85 years) who underwent MSCT scans from September 2020 to March 2022 were retrospectively included. The data were applied to generate three-dimensional (3D) simulations of a coronary tree using the syngo.via post-processing workstation. The reconstructed images were then interpreted, and the collected data were subjected to statistical analysis. RESULTS The results showed 1206 (80.4%) cases with medium LMCA, 133 (8.9%) with long LMCA, and 161 (10.7%) with short LMCA. The average diameter of LMCA at its midpoint was 4.69 ± 0.74 mm. The most frequent type of division of LMCA was bifurcation in 1076 (71.7%) cases; in 424 (28.3%) cases, the LMCA was divided into three or more branches. The dominance was right in 1339 (89.3%), left in 78 (5.2%), and co-dominant in 83 (5.5%) cases. There was a positive correlation between the length and branching patterns of LMCA, χ2 = 113.993, P = 0.000 (< 0.05). Other variables like age, sex, diameter of LMCA, and coronary dominance did not show any significant correlation. CONCLUSION This study has demonstrated a significant association between the length and the branching pattern of LMCA, which may be essential in diagnosing and treating coronary artery patients.
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Affiliation(s)
- Saeed Javed
- Research Center for Sectional and Imaging Anatomy, Shandong Key Laboratory of Digital Human and Clinical Anatomy, Department of Anatomy and Neurobiology, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
| | - Yixuan Mei
- Research Center for Sectional and Imaging Anatomy, Shandong Key Laboratory of Digital Human and Clinical Anatomy, Department of Anatomy and Neurobiology, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Department of Medical Imaging, Dongying People's Hospital, Dongying, 257091, China
| | - Yi Zhang
- Department of Medical Imaging, Shandong Provincial Hospital, Shandong First Medical University, Jinan, 250021, Shandong, China
- Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan, 250014, Shandong, China
| | - Cheng Liu
- Department of Medical Imaging, Shandong Provincial Hospital, Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Shuwei Liu
- Research Center for Sectional and Imaging Anatomy, Shandong Key Laboratory of Digital Human and Clinical Anatomy, Department of Anatomy and Neurobiology, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.
- Shandong University School of Medicine, 44#, Wenhua Xi Road, Jinan, 250012, Shandong, China.
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26
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González-Campo L, Vicente-Bártulos A, Gaetano-Gil A, Estelles-Lerga P, Pecharromán-de Las Heras I, Zamora J. Coronary computed tomography in emergencies: The importance of the radiologist's experience. Radiologia (Engl Ed) 2023; 65:298-306. [PMID: 37516483 DOI: 10.1016/j.rxeng.2023.07.002] [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] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/19/2021] [Indexed: 07/31/2023]
Abstract
INTRODUCTION Incorporating coronary computed tomography angiography (CTA) in the hospital workup for suspected acute coronary syndrome requires appropriate skills for interpreting this imaging test. Radiologists' skills can affect the interobserver agreement in evaluating these studies. OBJECTIVE To determine the interobserver agreement according to radiologists' experience in the interpretation of coronary CTA studies done in patients who present at the emergency department with acute chest pain and low-to-intermediate probability of acute coronary syndrome. MATERIALS AND METHODS We studied the interobserver agreement in the urgent evaluation of coronary CTA studies in which CAD-RADS was used to register the findings. We created pairs of observers among a total of 8 assessors (4 attending radiologists and 4 radiology residents). We used the kappa coefficient to estimate the overall concordance and the concordance between subgroups according to their experience. RESULTS The agreement was substantial between experienced radiologists and residents (k=0.627; 95%CI: 0.436-0.826) as well as between all the pairs of observers (k=0.661; 95%CI: 0.506-0.823) for all the CAD-RADS together. The degree of agreement within the group of experienced radiologists was greater than that within the group of residents in all the analyses. The agreement was excellent for the overall CAD-RADS (k=0.950; 95% CI: 0.896-1) and for CAD-RADS ≥ 4 (k=1); the agreement was lower for CAD-RADS ≥ 3 (k=0.754; 95% CI: 0.246-1.255). The agreement for the residents for these categories was k=0.623, k=0.596, and k=0.473, respectively. CONCLUSION The agreement among attending radiologists regarding the assessment of urgent coronary CTA studies is excellent. The agreement is lower when residents are paired with attending radiologists. These findings should be taken into consideration when implementing coronary CTA in emergency departments and in the organisation of radiological staff for interpreting and reporting this imaging test.
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Affiliation(s)
- L González-Campo
- Servicio de Radiodiagnóstico, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - A Vicente-Bártulos
- Servicio de Radiodiagnóstico, Hospital Universitario Ramón y Cajal, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - A Gaetano-Gil
- Unidad de Bioestadística Clínica, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain
| | | | | | - J Zamora
- Unidad de Bioestadística Clínica, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; Institute of Applied Research, University of Birmingham, United Kingdom
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Fries B, Johnson V, Schneider N, Dörr O, Chasan R, Mathew S, Hamm CW, Schmitt J. Electroanatomic visualization of coronary arteries: a case series to elicit safety, feasibility, and diagnostic value in complex ablation procedures. Europace 2023; 25:1339-1344. [PMID: 36607137 PMCID: PMC10105871 DOI: 10.1093/europace/euac258] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 11/23/2022] [Indexed: 01/07/2023] Open
Abstract
AIMS The goal of this case series was to evaluate the feasibility, safety, and advantages of a wire-based approach for the live visualization of coronary arteries (CAs) in an electroanatomic mapping (EAM) system and to assess its diagnostic information. METHODS AND RESULTS For this single-centre case series, we included procedures in which close proximity of a possible ablation site to any epicardial vessel was suspected. An uncoated-tip guidewire was introduced into the relevant CAs after exclusion of critical CA stenosis by coronary angiography. By connecting this wire to the EAM system using a clip and pin connection, mapping and live visualization of the wire tip is possible, as well as the assessment of the local electrograms within the respective CAs. Procedural wire insertion and intracoronary mapping was performed by EP specialists and was assisted to judge the relevance of CA disease by an interventional cardiologist. A total of nine procedures in nine patients were included in this case series, four ventricular tachycardia ablation procedures and five procedures for the ablation of premature ventricular contractions. The left CAs were mapped in eight cases and the right CA was mapped in one case. In two cases, epicardial mapping was combined with visualization of the right or left CAs. There were no complications attributed to coronary wiring and mapping in this case. CONCLUSION We demonstrated the feasibility and safety of CA visualization and integration in an EAM. The live visualization of the CAs added valuable information without the need for preprocedural planning or the purchase of separate software. Electroanatomic visualization was achieved intraprocedurally in a safe and straightforward manner, adding critical diagnostic information without excessive costs or risks.
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Affiliation(s)
- Bastian Fries
- Department of Cardiology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392 Giessen, Germany
| | - Victoria Johnson
- Department of Cardiology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392 Giessen, Germany
| | - Nikita Schneider
- Department of Cardiology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392 Giessen, Germany
| | - Oliver Dörr
- Department of Cardiology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392 Giessen, Germany
| | - Ritvan Chasan
- Department of Cardiology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392 Giessen, Germany
| | - Shibu Mathew
- Department of Cardiology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392 Giessen, Germany
| | - Christian W Hamm
- Department of Cardiology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392 Giessen, Germany
| | - Joern Schmitt
- Department of Cardiology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392 Giessen, Germany
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Etter D, Warnock G, Koszarski F, Niemann T, Mikail N, Bengs S, Buechel RR, Kaufmann P, Gebhard C, Rossi A. Towards universal comparability of pericoronary adipose tissue attenuation: a coronary computed tomography angiography phantom study. Eur Radiol 2023; 33:2324-2330. [PMID: 36472700 PMCID: PMC10017558 DOI: 10.1007/s00330-022-09274-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 10/03/2022] [Accepted: 10/24/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Different computed tomography (CT) scanners, variations in acquisition protocols, and technical parameters employed for image reconstruction may introduce bias in the analysis of pericoronary adipose tissue (PCAT) attenuation derived from coronary computed tomography angiography (CCTA). Therefore, the aim of this study was to establish the effect of tube voltage, measured as kilovoltage peak (kVp), and iterative reconstruction on PCAT mean attenuation (PCATMA). METHODS Twelve healthy ex vivo porcine hearts were injected with iodine-enriched agar-agar to allow for ex vivo CCTA imaging on a 256-slice CT and a dual-source CT system. Images were acquired at tube voltages of 80, 100, 120, and 140 kVp and reconstructed by using both filtered back projection and iterative reconstruction algorithms. PCATMA was measured semi-automatically on CCTA images in the proximal segment of coronary arteries. RESULTS The tube voltage showed a significant effect on PCATMA measurements on both the 256-slice CT scanner (p < 0.001) and the dual-source CT system (p = 0.013), resulting in higher attenuation values with increasing tube voltage. Similarly, the use of iterative reconstructions was associated with a significant increase of PCATMA (256-slice CT: p < 0.001 and dual-source CT: p = 0.014). Averaged conversion factors to correct PCATMA measurements for tube voltage other than 120 kVp were 1.267, 1.080 and 0.947 for 80, 100, and 140 kVp, respectively. CONCLUSION PCATMA values are significantly affected by acquisition and reconstruction parameters. The same tube voltage and reconstruction type are recommended when PCAT attenuation is used in multicenter and longitudinal studies. KEY POINTS • The tube voltage used for CCTA acquisition affects pericoronary adipose tissue attenuation, resulting in higher attenuation values of fat with increasing tube voltage. • Conversion factors for pericoronary adipose tissue attenuation values could be used to adjust for differences in attenuation between scans performed at different tube voltages. • In longitudinal CCTA studies employing pericoronary adipose tissue attenuation as imaging endpoint, it is recommended to maintain tube voltage and image reconstruction type constant across serial scans.
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Affiliation(s)
- Dominik Etter
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, 8952, Schlieren, Switzerland
| | - Geoff Warnock
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, 8952, Schlieren, Switzerland
| | - Frederic Koszarski
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Tilo Niemann
- Department of Radiology, Kantonsspital Baden, 5400, Baden, Switzerland
| | - Nidaa Mikail
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, 8952, Schlieren, Switzerland
| | - Susan Bengs
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, 8952, Schlieren, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Philipp Kaufmann
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Cathérine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, 8952, Schlieren, Switzerland
| | - Alexia Rossi
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
- Center for Molecular Cardiology, University of Zurich, 8952, Schlieren, Switzerland.
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Kang HW, Ahn WJ, Jeong JH, Suh YJ, Yang DH, Choi H, Hwang SH, Yong HS, Oh YW, Kang EY, Kim C. Evaluation of fully automated commercial software for Agatston calcium scoring on non-ECG-gated low-dose chest CT with different slice thickness. Eur Radiol 2023; 33:1973-81. [PMID: 36152039 DOI: 10.1007/s00330-022-09143-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/09/2022] [Accepted: 09/01/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate commercial deep learning-based software for fully automated coronary artery calcium (CAC) scoring on non-electrocardiogram (ECG)-gated low-dose CT (LDCT) with different slice thicknesses compared with manual ECG-gated calcium-scoring CT (CSCT). METHODS This retrospective study included 567 patients who underwent both LDCT and CSCT. All LDCT images were reconstructed with a 2.5-mm slice thickness (LDCT2.5-mm), and 453 LDCT scans were reconstructed with a 1.0-mm slice thickness (LDCT1.0-mm). Automated CAC scoring was performed on CSCT (CSCTauto), LDCT1.0-mm, and LDCT2.5-mm images. The reliability of CSCTauto, LDCT1.0-mm, and LDCT2.5-mm was compared with manual CSCT scoring (CSCTmanual) using intraclass correlation coefficients (ICCs) and Bland-Altman analysis. Agreement, in CAC severity category, was analyzed using weighted kappa statistics. Diagnostic performance at various Agatston score cutoffs was also calculated. RESULTS CSCTauto, LDCT1.0-mm, and LDCT2.5-mm demonstrated excellent agreement with CSCTmanual (ICC [95% confidence interval, CI]: 1.000 [1.000, 1.000], 0.937 [0.917, 0.952], and 0.955 [0.946, 0.963], respectively). The mean difference with 95% limits of agreement was lower with LDCT1.0-mm than with LDCT2.5-mm (19.94 [95% CI, -244.0, 283.9] vs. 45.26 [-248.2, 338.7]). Regarding CAC severity, LDCT1.0-mm achieved almost perfect agreement, and LDCT2.5-mm achieved substantial agreement (kappa [95% CI]: 0.809 [0.776, 0.838], 0.776 [0.740, 0.809], respectively). Diagnostic performance for detecting Agatston score ≥ 400 was also higher with LDCT1.0-mm than with LDCT2.5-mm (F1 score, 0.929 vs. 0.855). CONCLUSIONS Fully automated CAC-scoring software with both CSCT and LDCT yielded excellent reliability and agreement with CSCTmanual. LDCT1.0-mm yielded more accurate Agatston scoring than LDCT2.5-mm using fully automated commercial software. KEY POINTS • Total Agatston scores and all vessels of CSCTauto, LDCT1.0-mm, and LDCT2.5-mm demonstrated excellent agreement with CSCTmanual (all ICC > 0.85). • The diagnostic performance for detecting all Agatston score cutoffs was better with LDCT1.0-mm than with LDCT2.5-mm. • This automated software yielded a lower degree of underestimation compared with methods described in previous studies, and the degree of underestimation was lower with LDCT1.0-mm than with LDCT2.5-mm.
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Michaud K, Jacobsen C, Basso C, Banner J, Blokker BM, de Boer HH, Dedouit F, O'Donnell C, Giordano C, Magnin V, Grabherr S, Suvarna SK, Wozniak K, Parsons S, van der Wal AC. Application of postmortem imaging modalities in cases of sudden death due to cardiovascular diseases-current achievements and limitations from a pathology perspective : Endorsed by the Association for European Cardiovascular Pathology and by the International Society of Forensic Radiology and Imaging. Virchows Arch 2023; 482:385-406. [PMID: 36565335 PMCID: PMC9931788 DOI: 10.1007/s00428-022-03458-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 12/25/2022]
Abstract
Postmortem imaging (PMI) is increasingly used in postmortem practice and is considered a potential alternative to a conventional autopsy, particularly in case of sudden cardiac deaths (SCD). In 2017, the Association for European Cardiovascular Pathology (AECVP) published guidelines on how to perform an autopsy in such cases, which is still considered the gold standard, but the diagnostic value of PMI herein was not analyzed in detail. At present, significant progress has been made in the PMI diagnosis of acute ischemic heart disease, the most important cause of SCD, while the introduction of postmortem CT angiography (PMCTA) has improved the visualization of several parameters of coronary artery pathology that can support a diagnosis of SCD. Postmortem magnetic resonance (PMMR) allows the detection of acute myocardial injury-related edema. However, PMI has limitations when compared to clinical imaging, which severely impacts the postmortem diagnosis of myocardial injuries (ischemic versus non-ischemic), the age-dating of coronary occlusion (acute versus old), other potentially SCD-related cardiac lesions (e.g., the distinctive morphologies of cardiomyopathies), aortic diseases underlying dissection or rupture, or pulmonary embolism. In these instances, PMI cannot replace a histopathological examination for a final diagnosis. Emerging minimally invasive techniques at PMI such as image-guided biopsies of the myocardium or the aorta, provide promising results that warrant further investigations. The rapid developments in the field of postmortem imaging imply that the diagnosis of sudden death due to cardiovascular diseases will soon require detailed knowledge of both postmortem radiology and of pathology.
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Affiliation(s)
- Katarzyna Michaud
- University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Christina Jacobsen
- Section of Forensic Pathology, Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Cristina Basso
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Jytte Banner
- Section of Forensic Pathology, Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Hans H de Boer
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, Monash University, Melbourne, Australia
| | - Fabrice Dedouit
- GRAVIT, Groupe de Recherche en Autopsie Virtuelle et Imagerie Thanatologique, Forensic Department, University Hospital, Rangueil, Toulouse, France
| | - Chris O'Donnell
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, Monash University, Melbourne, Australia
| | - Carla Giordano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Virginie Magnin
- University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Silke Grabherr
- University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - S Kim Suvarna
- Department of Histopathology, Northern General Hospital, The University of Sheffield, Sheffield, UK
| | - Krzysztof Wozniak
- Department of Forensic Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Sarah Parsons
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, Monash University, Melbourne, Australia
| | - Allard C van der Wal
- Department of Pathology, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands.
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Das N, Hill R, Trivedi M, Kenkre TS, Alsaied T, Feingold B, Harris TH, Christopher AB. Longitudinal Assessment of Cardiac Function Following Multisystem Inflammatory Syndrome in Children Associated with COVID-19. Pediatr Cardiol 2023; 44:607-17. [PMID: 35864203 DOI: 10.1007/s00246-022-02972-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/07/2022] [Indexed: 12/04/2022]
Abstract
Multisystem inflammatory syndrome in children (MIS-C) after COVID-19 is commonly associated with cardiac involvement. Studies found myocardial dysfunction, as measured by decreased ejection fraction and abnormal strain, to be common early in illness. However, there is limited data on longitudinal cardiac outcomes. We aim to describe the evolution of cardiac findings in pediatric MIS-C from acute illness through at least 2-month follow-up. A retrospective single-center review of 36 patients admitted with MIS-C from April 2020 through September 2021 was performed. Echocardiographic data including cardiac function and global longitudinal strain (GLS) were analyzed at initial presentation, discharge, 2-4-week follow-up, and at least 2-month follow-up. Patients with mild and severe disease, normal and abnormal left ventricular ejection fraction (LVEF), and normal and abnormal GLS at presentation were compared. On presentation, 42% of patients with MIS-C had decreased LVEF < 55%. In patients in whom GLS was obtained (N = 18), 44% were abnormal (GLS < |- 18|%). Of patients with normal LVEF, 22% had abnormal GLS. There were no significant differences in troponin or brain natriuretic peptide between those with normal and abnormal LVEF. In most MIS-C patients with initial LVEF < 55% (90%), LVEF normalized upon discharge. At 2-month follow-up, all patients had normal LVEF with 21% having persistently abnormal GLS. Myocardial systolic dysfunction and abnormal deformation were common findings in MIS-C at presentation. While EF often normalized by 2 months, persistently abnormal GLS was more common, suggesting ongoing subclinical dysfunction. Our study offers an optimistic outlook for recovery in patients with MIS-C and carditis, however ongoing investigation for longitudinal effects is warranted.
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Lind L, Markstad H, Ahlström H, Angerås O, Brandberg J, Brunström M, Engström G, Engvall JE, Eriksson MJ, Eriksson M, Gottsäter A, Hagström E, Krachler B, Lampa E, Mannila M, Nilsson PM, Nyström FH, Persson A, Redfors B, Sandström A, Themudo R, Völz S, Ärnlöv J, Östgren CJ, Bergström G. Obesity is associated with coronary artery stenosis independently of metabolic risk factors: The population-based SCAPIS study. Atherosclerosis 2022; 362:1-10. [PMID: 36356325 DOI: 10.1016/j.atherosclerosis.2022.10.007] [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: 04/01/2022] [Revised: 10/03/2022] [Accepted: 10/13/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Previous studies reported divergent results on whether metabolically healthy obesity is associated with increased coronary artery calcium and carotid plaques. We investigated this in a cross-sectional fashion in a large, well-defined, middle-aged population using coronary CT angiography (CCTA) and carotid ultrasound. METHODS In the SCAPIS study (50-65 years, 51% female), CCTA and carotid artery ultrasound were performed in 23,674 individuals without clinical atherosclerotic disease. These subjects were divided into six groups according to BMI (normal weight, overweight, obese) and the presence of metabolic syndrome (MetS) according to the NCEP consensus criteria. RESULTS The severity of coronary artery stenosis was increased in individuals with obesity without MetS compared to normal-weight individuals without MetS (OR 1.47, 95%CI 1.34-1.62; p < 0.0001), even after adjusting for non-HDL-cholesterol and several lifestyle factors. Such difference was not observed for the presence of carotid artery plaques (OR 0.94, 95%CI 0.87-1.02; p = 0.11). Obese or overweight individuals without any MetS criteria (except the waist criterion) showed significantly more pronounced stenosis in the coronary arteries as compared to the normal-weight individuals, while one criterion was needed to show increased plaque prevalence in the carotid arteries. High blood pressure was the most important single criterion for increased atherosclerosis in this respect. CONCLUSIONS Individuals with obesity without MetS showed increased severity of coronary artery stenosis, but no increased occurrence of carotid artery plaques compared to normal-weight individuals without MetS, further emphasizing that obesity is not a benign condition even in the absence of MetS.
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Affiliation(s)
- Lars Lind
- Department of Medical Sciences, Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
| | - Hanna Markstad
- Center for Medical Imaging and Physiology, Skåne University Hospital Lund University, Lund, Sweden; Experimental Cardiovascular Research, Clinical Research Center, Clinical Sciences, Lund University, Malmö, Sweden
| | - Håkan Ahlström
- Department of Surgical Sciences, Section of Radiology, Uppsala University, Uppsala, Sweden
| | - Oskar Angerås
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - John Brandberg
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mattias Brunström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden
| | - Jan E Engvall
- CMIV, Centre of Medical Image Science and Visualization, Linköping University, Linköping, Sweden; Department of Clinical Physiology, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Maria J Eriksson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Anders Gottsäter
- Department of Medicine, Skåne University Hospital Malmö, Lund University, Lund, Sweden
| | - Emil Hagström
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Benno Krachler
- Department of Public Health and Clinical Medicine, Sustainable Health, Umeå University, Umeå, Sweden
| | - Erik Lampa
- Department of Medical Sciences, Clinical Epidemiology, Uppsala University, Uppsala, Sweden
| | - Maria Mannila
- Heart and Vascular Theme, Department of Cardiology and Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Peter M Nilsson
- Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden
| | - Fredrik H Nyström
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anders Persson
- CMIV, Centre of Medical Image Science and Visualization, Linköping University, Linköping, Sweden; Department of Radiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Björn Redfors
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Anette Sandström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Raquel Themudo
- Radiology Department, Karolinska University Hospital, Huddinge, Stockholm, Sweden; Division of Medical Imaging and Technology, Department of Clinical Sciences, Intervention and Technology at Karolinska Institutet, Stockholm, Sweden
| | - Sebastian Völz
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Johan Ärnlöv
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden; School of Health and Social Studies, Dalarna University, Falun, Sweden
| | - Carl Johan Östgren
- CMIV, Centre of Medical Image Science and Visualization, Linköping University, Linköping, Sweden; Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Göran Bergström
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Malone LJ, Browne LP, Morgan GJ, Lovell MA, Campbell DN, Jaggers JJ, Leahy RA, Mitchell MB, Mong DA, Weinman JP, Zablah JE, Stone ML. Computed Tomographic Angiography Provides Reliable Coronary Artery Evaluation in Infants With Pulmonary Atresia Intact Ventricular Septum. Semin Thorac Cardiovasc Surg 2022:S1043-0679(22)00255-6. [PMID: 36244628 DOI: 10.1053/j.semtcvs.2022.10.003] [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] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Abstract
Evaluate the use of coronary CTA as an initial assessment for determining Right Ventricle Dependent Coronary Circulation (RVDCC) in neonates with Pulmonary Atresia with Intact Ventricular Septum (PA IVS). Retrospective review of cases with coronary CTA and compare with available catheter angiography, pathology, surgical reports, and outcomes from Mar 2015 to May 2022. In our cohort of 16 patients, 3 were positive for RVDCC, confirmed by pathologic evaluation, and there was concordance for presence or absence of RVDCC with catheter angiography in 5 patients (4 negatives for RVDCC, 1 positive). Clinical follow up for the 8 patients that underwent RV decompression had no clinical evidence of myocardial ischemia. Our findings suggest that coronary CTA is reliable as first-line imaging for determination of RVDCC in neonates with PA IVS. These findings, if supported by further prospective study, may reserve invasive coronary angiography for cases with diagnostic uncertainty or at the time of necessary transcatheter interventions.
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Affiliation(s)
- LaDonna J Malone
- Department of Radiology, Children's Hospital of Colorado, University of Colorado Aurora, Colorado.
| | - Lorna P Browne
- Department of Radiology, Children's Hospital of Colorado, University of Colorado Aurora, Colorado
| | - Gareth J Morgan
- Department of Cardiology, Children's Hospital of Colorado, University of Colorado Aurora, Colorado
| | - Mark A Lovell
- Department of Pathology, Children's Hospital of Colorado, University of Colorado Aurora, Colorado
| | - David N Campbell
- Department of Cardiothoracic Surgery, Children's Hospital of Colorado, University of Colorado Aurora, Colorado
| | - James J Jaggers
- Department of Cardiothoracic Surgery, Children's Hospital of Colorado, University of Colorado Aurora, Colorado
| | - Ryan A Leahy
- Department of Cardiology, Children's Hospital of Colorado, University of Colorado Aurora, Colorado
| | - Max B Mitchell
- Department of Cardiothoracic Surgery, Children's Hospital of Colorado, University of Colorado Aurora, Colorado
| | - David A Mong
- Department of Radiology, Children's Hospital of Colorado, University of Colorado Aurora, Colorado
| | - Jason P Weinman
- Department of Radiology, Children's Hospital of Colorado, University of Colorado Aurora, Colorado
| | - Jenny E Zablah
- Department of Cardiology, Children's Hospital of Colorado, University of Colorado Aurora, Colorado
| | - Matthew L Stone
- Department of Cardiothoracic Surgery, Children's Hospital of Colorado, University of Colorado Aurora, Colorado
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Beauchamp DN, Ramaciotti C, Brown P, Thankavel PP. Coronary Artery Origins Pattern in Pediatric Patients with Right-Left Fusion Bicuspid Aortic Valve. Pediatr Cardiol 2022; 43:1229-1238. [PMID: 35187607 DOI: 10.1007/s00246-022-02843-x] [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: 11/29/2021] [Accepted: 02/03/2022] [Indexed: 11/26/2022]
Abstract
Bicuspid aortic valve (BAV) is a common congenital heart defect associated with coronary artery (CA) variants, including higher incidence of left CA dominance and shorter left main CA length. We observed by transthoracic echocardiography that left and right CA origins appear closer together in pediatric patients with right-left fusion (R/L) BAV compared to patients with trileaflet aortic valves. We sought to objectively confirm this observation. A retrospective review of pediatric echocardiograms with R/L BAV at a single institution (12/2010-11/2018) was performed. The 'coronary angle' was defined as the angle between the left and right coronary artery origins in the parasternal short axis view relative to the center of the aortic valve orifice. Values were compared to age-matched controls. Patients with inadequate images, anomalous coronary origins, or predefined significant congenital heart defects were excluded. We compared 191 R/L BAV patients (64% male) to 136 controls (57% male). Coronary angle was significantly more acute in R/L BAV than in controls (117.9° ± 16.7° vs 139.0° ± 10.1°, p < 0.0001). This was independent of age and gender. The difference persisted when BAV patients with abnormal aortic annulus/root diameters were removed from analysis (119.5° ± 15.1° vs 139.0° ± 10.1°, p < 0.0001). CA origins are closer together in R/L BAV independent of age, gender, or annulus/root size. This new anatomical description may aid in the diagnosis of subtle ('forme fruste') R/L BAV, assist in interventional planning, and improve understanding of the relationship between BAV and CA development.
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Affiliation(s)
- Daniel N Beauchamp
- University of Texas Southwestern Medical School, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
- Pediatric Residency Program, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
| | - Claudio Ramaciotti
- Division of Pediatric Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
- Children's Health, 1935 Medical District Dr, Dallas, TX, 75235, USA
| | - Paul Brown
- Children's Health, 1935 Medical District Dr, Dallas, TX, 75235, USA
- Medical City Children's Cardiology Specialists, 7777 Forest Ln, Ste A337, Dallas, TX, 75230, USA
| | - Poonam P Thankavel
- Division of Pediatric Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
- Children's Health, 1935 Medical District Dr, Dallas, TX, 75235, USA
- Medical City Children's Cardiology Specialists, 7777 Forest Ln, Ste A337, Dallas, TX, 75230, USA
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35
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Watkins KJ, Zampi JD, Lowery R, Yu S, Owens ST, Romano JC, Schumacher KR. Native Aortic Root Thrombosis in Single-Ventricle Patients with Native-to-Neoaortic Anastomoses. Pediatr Cardiol 2022; 43:1247-50. [PMID: 35181799 DOI: 10.1007/s00246-022-02845-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 02/04/2022] [Indexed: 10/19/2022]
Abstract
In single-ventricle patients with native-to-neoaortic anastomoses, the native aortic root serves as a conduit to the coronary arteries. Thrombosis of the native aortic root has been described only in small, limited reports. We described our center's experience with this rare adverse event. All single-ventricle patients who underwent native-to-neoaortic anastomosis from 2002 to 2017 were compiled from institutional databases. Chart review identified cases of native aortic root thrombosis. Of 467 patients, there were 9 (2%) cases of native aortic root thrombosis; all had hypoplastic left heart syndrome. Timing of thrombosis varied and occurred following each stage of single-ventricle palliation. For treatment, 8 patients received systemic anticoagulation and one patient did not receive any treatment. One patient also underwent percutaneous thrombectomy. Three patients (33.3%) died during the follow-up period. Among survivors, 4/6 had right ventricular systolic function that was mildly depressed or worse at a median follow-up of 8.3 years (interquartile range 1.3-10.8). Native aortic root thrombosis is a rare complication occurring at various stages of single-ventricle palliation. In this series, 6 of 9 patients (66.6%) survived; however, ventricular function was often compromised. No risk factors were identified to focus preventative therapies.
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36
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Lu H, Guo J, Zhao S, Yang S, Ma J, Ge M, Chen Y, Zeng M, Jin H. Assessment of Non-contrast-enhanced Dixon Water-fat Separation Compressed Sensing Whole-heart Coronary MR Angiography at 3.0 T: A Single-center Experience. Acad Radiol 2022; 29 Suppl 4:S82-90. [PMID: 34127363 DOI: 10.1016/j.acra.2021.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/08/2021] [Accepted: 05/11/2021] [Indexed: 11/23/2022]
Abstract
RATIONALE AND OBJECTIVES The clinical utility of Dixon water-fat separation coronary MR angiography (CMRA) with compressed sensing (CS) reconstruction has not been determined in a patient population. This study was designed to evaluate the performance of 3.0 T non-contrast-enhanced Dixon water-fat separation CS whole-heart CMRA sequence in vitro and in vivo. MATERIALS AND METHODS In vitro phantom MRI, we compared key parameters of the SENSE and CS images. And in this prospective in vivo study, from November 2019 to October 2020, 94 participants were recruited for 3.0 T non-contrast-enhanced Dixon water-fat separation CS whole-heart CMRA. The accuracy of CMRA for detecting a ≥ 50% reduction in diameter was determined using X-ray coronary angiography (CA) as the reference method. RESULTS Compared with SENSE, CS with an appropriate acceleration factor offers both higher SNR/CNR (p < 0.05) and a shortened acquisition. Fifty-eight patients successfully completed the CMRA and CA. The sensitivity, specificity, positive predictive values, negative predictive values, and accuracy of 3.0 T non-contrast-enhanced Dixon water-fat separation CS whole-heart CMRA according to a patient-based analysis were 96.4%, 66.7%, 73.0%, 95.2% and 81.0%, respectively. The area under the receiver-operator characteristic (ROC) curve (AUC) of 3.0 T non-contrast-enhanced Dixon water-fat separation CS whole-heart CMRA for detecting significant coronary artery stenosis is 0.908, 0.895, and 0.904 in patient-, vessel-, and segment-based analyses respectively. CONCLUSION 3.0 T non-contrast-enhanced Dixon water-fat separation whole-heart CMRA using appropriate CS is a promising noninvasive and radiation-free technique to detect clinically significant coronary stenosis on patients with suspected CAD.
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Abstract
Atherosclerosis is a chronic inflammatory disorder that is the underlying cause of most cardiovascular disease. Resident cells of the artery wall and cells of the immune system participate in atherogenesis. This process is influenced by plasma lipoproteins, genetics, and the hemodynamics of the blood flow in the artery. A variety of animal models have been used to study the pathophysiology and mechanisms that contribute to atherosclerotic lesion formation. No model is ideal as each has its own advantages and limitations with respect to manipulation of the atherogenic process and modeling human atherosclerosis and lipoprotein profile. In this chapter we will discuss pig and mouse models of experimental atherosclerosis. The similarity of pig lipoprotein metabolism and the pathophysiology of the lesions in these animals with that of humans is a major advantage. While a few genetically engineered pig models have been generated, the ease of genetic manipulation in mice and the relatively short time frame for the development of atherosclerosis has made them the most extensively used model. Newer approaches to induce hypercholesterolemia in mice have been developed that do not require germline modifications. These approaches will facilitate studies on atherogenic mechanisms.
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38
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Martínez-Cano CA, Aguilar-Arias A, Arango-Rivas AM, Baena-Gómez C. “Malignant” origin of the left coronary artery, case report. Arch Cardiol Mex 2022; 92:143-146. [PMID: 34010269 PMCID: PMC8771044 DOI: 10.24875/acm.20000437] [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] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
El origen anómalo de las arterias coronarias (OAAC) es muy infrecuente, sin embargo, su diagnóstico ha ido en aumento por el incremento en el uso de la angiotomografía coronaria por tomografía dentro del algoritmo del paciente con sospecha de enfermedad coronaria. Presentamos el caso de un paciente con dolor torácico crónico agudizado en quien se diagnosticó un OAAC de la coronaria izquierda con curso interarterial «maligno», que fue llevado a cirugía, con mejoría completa de síntomas y en calidad de vida.
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Affiliation(s)
- Carlos A Martínez-Cano
- Servicio de Cardiología Clínica CardioVID, Universidad Pontificia Bolivariana, Medellín, Antioquia, Colombia
| | | | - Ana M Arango-Rivas
- Servicio de Medicina Interna, Universidad Pontificia Bolivariana, Medellín, Antioquia, Colombia
| | - Catalina Baena-Gómez
- Servicio de Medicina, Universidad Pontificia Bolivariana, Medellín, Antioquia, Colombia
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Abstract
Imaging the coronary arteries of children, with their faster heart rates, small vessel size and common inability to lie still or breath-hold, has been a major challenge. With numerous advances in technology, CT examinations can now be performed quickly, often with children free-breathing and with much lower radiation doses than previously. This has led to increased use in children. Care must be taken with technique and choice of electrocardiogram (ECG)-gating technique to obtain adequate imaging for a diagnosis while keeping radiation dose as low as reasonably achievable (ALARA). In this paper, we discuss techniques and tips for CT imaging of the coronary arteries in children, including use of dual-source- and ultrawide-detector CT scanners.
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Affiliation(s)
- LaDonna J Malone
- Department of Radiology, University of Colorado, Aurora, CO, USA.
- Department of Radiology, Children's Hospital of Colorado, 13123 E. 16th Ave., B125, Aurora, CO, 80045, USA.
| | - Cara E Morin
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Lorna P Browne
- Department of Radiology, University of Colorado, Aurora, CO, USA
- Department of Radiology, Children's Hospital of Colorado, 13123 E. 16th Ave., B125, Aurora, CO, 80045, USA
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40
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Wentzel JJ, Papafaklis MI, Antoniadis AP, Takahashi S, Cefalo NV, Cormier M, Saito S, Coskun AU, Stone PH. Sex-related differences in plaque characteristics and endothelial shear stress related plaque-progression in human coronary arteries. Atherosclerosis 2021; 342:9-18. [PMID: 34999306 DOI: 10.1016/j.atherosclerosis.2021.12.013] [Citation(s) in RCA: 6] [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: 09/03/2021] [Revised: 12/08/2021] [Accepted: 12/23/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Clinical atherosclerosis manifestations are different in women compared to men. Since endothelial shear stress (ESS) is known to play a critical role in coronary atherosclerosis development, we investigated differences in anatomical characteristics and endothelial shear stress (ESS)-related plaque growth in human coronary arteries in men compared to women. METHODS 1183 coronary arteries (male/female: 944/239) from the PREDICTION study were studied for differences in artery/plaque and ESS characteristics, and ESS-related plaque progression (6-10 months follow-up) among men and women and after stratification for age. All characteristics were derived from IVUS-based vascular profiling and reported per 3 mm-segments (13,030 3-mm-segments (male/female: 10,465/2,565)). RESULTS Coronary arteries and plaques were significantly smaller in females compared to males; but no important differences were observed in plaque burden, ESS and rate of plaque progression. Change in plaque burden was inversely related to ESS (p<0.001) with no difference between women versus men (β: -0.62 ± 0.13 vs -0.68 ± 0.05, p=0.62). However, stratification for age demonstrated that ESS-related plaque growth was more marked in young women compared to men (<55 years, β: -2.02 ± 0.61 vs -0.33 ± 0.10, p=0.007), reducing in magnitude over the age-categories up till 75 years. CONCLUSIONS Coronary artery and plaque size are smaller in women compared to men, but ESS and ESS- related plaque progression were similar. Sex-related differences in ESS-related plaque growth were evident after stratification for age. These observations suggest that although the fundamental processes of atherosclerosis progression are similar in men versus women, plaque progression may be influenced by age within gender.
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Affiliation(s)
- Jolanda J Wentzel
- Biomedical Engineering, Department of Cardiology, ErasmusMC, University Medical Center Rotterdam, the Netherlands.
| | | | - Antonios P Antoniadis
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Saeko Takahashi
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Nicholas V Cefalo
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michelle Cormier
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Shigeru Saito
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Ahmet U Coskun
- Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA
| | - Peter H Stone
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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41
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Haligheri G, Patel CR, Komarlu R. Prenatal Delineation of Coronary Anatomy in Dextro-Transposition of Great Arteries. J Cardiovasc Echogr 2021; 31:171-174. [PMID: 34900553 PMCID: PMC8603768 DOI: 10.4103/jcecho.jcecho_34_21] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/24/2021] [Accepted: 07/12/2021] [Indexed: 11/04/2022] Open
Abstract
Background Dextro-transposition of the great arteries (D-TGA) is the second-most common cyanotic congenital heart disease with variable coronary artery anatomy. The arterial switch procedure has revolutionized outcomes for this defect, with coronary anatomy being a key determinant of both short- and long-term outcomes following surgical repair. The assessment of coronary anatomy is usually undertaken in the postnatal period by transthoracic echocardiography, with assessment prenatally not being well studied. We sought to assess the feasibility of delineating the coronary arteries on fetal echocardiograms in a small cohort of patients followed prenatally. Methods This was a retrospective review of fetuses with D-TGA from 2008 to 2018. Patients with prenatal diagnosis of D-TGA were reviewed for the assessment of coronary artery anatomy. Details of coronary artery anatomy diagnosed prenatally were compared with postnatal transthoracic echocardiograms and intraoperative findings. Results Thirty-four fetuses with findings of D-TGA on prenatal echocardiograms were reviewed. 14/34 fetuses had attempted delineation of coronary artery anatomy, with average gestational age of 28 weeks (range 23-31 weeks) at the time of diagnosis. Two-dimensional and color Doppler imaging of the coronary arteries on both short and long axis images were performed, with complete delineation being possible in ~ 86% of fetuses. These findings were confirmed postnatally. Conclusions Fetuses with D-TGA can have variable coronary artery anatomy which drives postnatal outcomes. Our study describes a cohort of patients with D-TGA wherein coronary artery anatomy was assessed. We demonstrate that coronary artery evaluation is feasible prenatally with optimal imaging techniques, being more successful after 25 weeks' gestation. The potential knowledge of dangerous variants can help with referral to centers of excellence for appropriate postnatal management and facilitate prenatal care accordingly.
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Affiliation(s)
- Geetha Haligheri
- Department of Pediatric Cardiology, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Missouri, OH, US
| | - Chandrakant R Patel
- Department of Pediatric Cardiology, Akron Children's Hospital, Akron, OH, US
| | - Rukmini Komarlu
- Department of Pediatric Cardiology, Cleveland Clinic Children's Hospital, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, OH, US
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42
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Moshfegh H, Tajeddini F, Pakravan HA, Mahzoon M, Azadi Yazdi E, Bazrafshan Drissi H. A validated reduced-order dynamic model of nitric oxide regulation in coronary arteries. Comput Biol Med 2021; 139:104958. [PMID: 34717232 DOI: 10.1016/j.compbiomed.2021.104958] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 09/30/2021] [Accepted: 10/16/2021] [Indexed: 01/15/2023]
Abstract
Nitric Oxide (NO) provides myocardial oxygen demands of the heart during exercise and cardiac pacing and also prevents cardiovascular diseases such as atherosclerosis and platelet adhesion and aggregation. However, the direct in vivo measurement of NO in coronary arteries is still challenging. To address this matter, a mathematical model of dynamic changes of calcium and NO concentration in the coronary artery was developed for the first time. The model is able to simulate the effect of NO release in coronary arteries and its impact on the hemodynamics of the coronary arterial tree and also to investigate the vasodilation effects of arteries during cardiac pacing. For these purposes, flow rate, time-averaged wall shear stress, dilation percent, NO concentration, and Calcium (Ca2+) concentration within coronary arteries were obtained. In addition, the impact of hematocrit on the flow rate of the coronary artery was studied. It was seen that the behavior of flow rate, wall shear stress, and Ca2+ is biphasic, but the behavior of NO concentration and the dilation percent is triphasic. Also, by increasing the Hematocrit, the blood flow reduces slightly. The results were compared with several experimental measurements to validate the model qualitatively and quantitatively. It was observed that the presented model is well capable of predicting the behavior of arteries after releasing NO during cardiac pacing. Such a study would be a valuable tool to understand the mechanisms underlying vessel damage, and thereby to offer insights for the prevention or treatment of cardiovascular diseases.
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43
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Sliman H, Sharoni E, Adawi S, Leviner DB, Karkabi B, Zissman K, Zafrir B. Pericardial constriction with calcified cystic mass compressing the right ventricle and right coronary artery. J Cardiol Cases 2021; 24:118-121. [PMID: 34466174 DOI: 10.1016/j.jccase.2021.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/06/2021] [Revised: 02/05/2021] [Accepted: 02/16/2021] [Indexed: 11/27/2022] Open
Abstract
Constrictive pericarditis is characterized by fibrosis and calcification of the pericardium that progressively impair the diastolic filling of the heart, causing heart failure. Uncommonly, pericardial constriction may be localized leading to a focal cystic mass formation that may compress nearby cardiac structures. We describe a unique case of a patient presenting with right heart failure due to idiopathic calcific constrictive pericarditis that was associated with a large pericardial cystic mass compressing the right ventricular free wall. This led to reduced cardiac output and possibly severe focal stenosis of the proximal right coronary artery that was resolved after pericardiectomy, the only definitive treatment for chronic progressive constrictive pericarditis. <Learning objective: Constrictive calcified pericarditis with localized cystic mass formation may lead to focal compression of nearby cardiac structures, causing right heart failure with cirrhosis-like symptoms and reduced cardiac output. Uncommonly, epicardial coronary obstruction is encountered, which may be reversible after pericardiectomy. Multi-modality imaging is often necessary to establish diagnosis, especially when unexplained heart failure exists.>.
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Affiliation(s)
- Hussein Sliman
- Department of Cardiology, Lady Davis Carmel Medical Center, 7 Michal St., Haifa 3436212, Israel.,Faculty of Medicine, Technion, Israel Institute of Medicine, Haifa, Israel
| | - Erez Sharoni
- Faculty of Medicine, Technion, Israel Institute of Medicine, Haifa, Israel.,Department of Cardio-thoracic Surgery, Carmel Medical Center, Haifa, Israel
| | - Salim Adawi
- Department of Cardiology, Lady Davis Carmel Medical Center, 7 Michal St., Haifa 3436212, Israel.,Faculty of Medicine, Technion, Israel Institute of Medicine, Haifa, Israel
| | - Dror B Leviner
- Faculty of Medicine, Technion, Israel Institute of Medicine, Haifa, Israel.,Department of Cardio-thoracic Surgery, Carmel Medical Center, Haifa, Israel
| | - Basheer Karkabi
- Department of Cardiology, Lady Davis Carmel Medical Center, 7 Michal St., Haifa 3436212, Israel.,Faculty of Medicine, Technion, Israel Institute of Medicine, Haifa, Israel
| | - Keren Zissman
- Department of Cardiology, Lady Davis Carmel Medical Center, 7 Michal St., Haifa 3436212, Israel.,Faculty of Medicine, Technion, Israel Institute of Medicine, Haifa, Israel
| | - Barak Zafrir
- Department of Cardiology, Lady Davis Carmel Medical Center, 7 Michal St., Haifa 3436212, Israel.,Faculty of Medicine, Technion, Israel Institute of Medicine, Haifa, Israel
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44
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van Zandwijk JK, Tuncay V, Vliegenthart R, Pelgrim GJ, Slump CH, Oudkerk M, van Ooijen PMA. Assessment of Dynamic Change of Coronary Artery Geometry and Its Relationship to Coronary Artery Disease, Based on Coronary CT Angiography. J Digit Imaging 2021; 33:480-489. [PMID: 31745678 PMCID: PMC7165136 DOI: 10.1007/s10278-019-00300-5] [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] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
To investigate the relationship between dynamic changes of coronary artery geometry and coronary artery disease (CAD) using computed tomography (CT). Seventy-one patients underwent coronary CT angiography with retrospective electrocardiographic gating. End-systolic (ES) and end-diastolic (ED) phases were automatically determined by dedicated software. Centerlines were extracted for the right and left coronary artery. Differences between ES and ED curvature and tortuosity were determined. Associations of change in geometrical parameters with plaque types and degree of stenosis were investigated using linear mixed models. The differences in number of inflection points were analyzed using Wilcoxon signed-rank tests. Tests were done on artery and segment level. One hundred thirty-seven arteries (64.3%) and 456 (71.4%) segments were included. Curvature was significantly higher in ES than in ED phase for arteries (p = 0.002) and segments (p < 0.001). The difference was significant only at segment level for tortuosity (p = 0.005). Number of inflection points was significantly higher in ES phase on both artery and segment level (p < 0.001). No significant relationships were found between degree of stenosis and plaque types and dynamic change in geometrical parameters. Non-invasive imaging by cardiac CT can quantify change in geometrical parameters of the coronary arteries during the cardiac cycle. Dynamic change of vessel geometry through the cardiac cycle was not found to be related to the presence of CAD.
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Affiliation(s)
- Jordy K van Zandwijk
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Volkan Tuncay
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rozemarijn Vliegenthart
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Radiology, University Medical Center Groningen, University of Groningen, PO Box 30001, NL-9700 RB, Groningen, The Netherlands
| | - Gert Jan Pelgrim
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Radiology, University Medical Center Groningen, University of Groningen, PO Box 30001, NL-9700 RB, Groningen, The Netherlands
| | - Cornelis H Slump
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Matthijs Oudkerk
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Peter M A van Ooijen
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. .,Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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45
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Razek AAKA, Fahmy D. Coronary artery disease imaging reporting and data system (CAD-RADS): what radiologists need to know? Emerg Radiol 2021; 28:1185-203. [PMID: 34387783 DOI: 10.1007/s10140-021-01973-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/16/2021] [Indexed: 11/09/2022]
Abstract
The aim of this work is to review Coronary Artery Disease Imaging Reporting and Data System (CAD-RADS) that was designed to standardize reporting language and improve the communication of data among radiologists and clinicians. Stenotic lesions are graded into 5 grades ranging from 0 (no stenosis) to 5 (total occlusion), where the highest grade represents the final score. The expert consensus platform has added 4 special modifiers (non-diagnostic, stent, graft, and vulnerability) to aid patient management through linking these scores with decision algorithm and treatment plan. Adherence to standard imaging protocol; knowledge of normal, variant, and anomalous anatomy; and skillful evaluation of stenosis are important for proper utilization of this reporting system. Lastly, radiologists should be aware of the inherited benefits, limitations, and common pitfalls of this classification system.
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46
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Fayssal I, Moukalled F. A fast algebraic approach for noninvasive prediction of fractional flow reserve in coronary arteries. Comput Methods Biomech Biomed Engin 2021; 24:1761-1793. [PMID: 34304648 DOI: 10.1080/10255842.2021.1918122] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The fractional flow reserve (FFR) index is an important clinical indicator for characterizing coronary artery disease (CAD) functional significance, allowing cardiologists to decide whether intervention is required or not. Noninvasive techniques for calculating FFR are still incompletely resolved and rely heavily on time consuming numerical methods, which may hinder their clinical translation. This paper reports on the development of two fast and noninvasive methods for predicting FFR in diseased coronary arteries. The new methods are derived from physical principles and account for patient-specific physiological parameters that can be noninvasively measured. The developed algebraic equations calculate FFR without performing any tedious numerical simulations, making them attractive for clinical applications. The performance of the methods is assessed by comparing their predictions with measurements and with results obtained by full three-dimensional numerical simulations on healthy and diseased idealized coronary arteries and actual anatomical branches. Results generated by the new methodology are within 5% of measurements and in very good agreement with values obtained numerically.
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Affiliation(s)
- Iyad Fayssal
- Mechanical and Mechatronics Engineering Department, Rafik Hariri University, P.O.Box: 10 - Damour, Chouf Meshref, Lebanon
| | - Fadl Moukalled
- Mechanical Engineering Department, American University of Beirut, Riad El-Solh, Beirut, Lebanon
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47
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Xin Y, Zhang J, Fan Y, Wang C. Serum free fatty acids are associated with severe coronary artery calcification, especially in diabetes: a retrospective study. BMC Cardiovasc Disord 2021; 21:343. [PMID: 34266394 PMCID: PMC8281587 DOI: 10.1186/s12872-021-02152-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 07/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background Serum free fatty acid (FFA) concentrations are associated with coronary heart disease and diabetes mellitus (DM). Few studies focused on the relationship between serum FFA levels and coronary artery calcification (CAC). Methods This was a retrospective, single-centered study recruiting patients underwent FFA quantification, coronary angiography and intravascular ultrasound (IVUS). CAC severity was assessed with the maximum calcific angle (arc) of the calcified plaque scanned by IVUS. Patients with an arc ≥ 180° were classified into the severe CAC (SCAC) group, and those with an arc < 180° were classified into the non-SCAC group. Clinical characteristics, serum indices were compared between 2 groups. Logistic regression, receiver operating characteristic (ROC) curves and area under the curves (AUC) were performed. Results Totally, 426 patients with coronary artery disease were consecutively included. Serum FFA levels were significantly higher in the SCAC group than non-SCAC group (6.62 ± 2.17 vs. 5.13 ± 1.73 mmol/dl, p < 0.001). Logistic regression revealed that serum FFAs were independently associated with SCAC after adjusting for confounding factors in the whole cohort (OR 1.414, CI 1.237–1.617, p < 0.001), the non-DM group (OR 1.273, CI 1.087–1.492, p = 0.003) and the DM group (OR 1.939, CI 1.388–2.710, p < 0.001). ROC analysis revealed a serum FFA AUC of 0.695 (CI 0.641–0.750, p < 0.001) in the whole population. The diagnostic predictability was augmented (AUC = 0.775, CI 0.690–0.859, p < 0.001) in the DM group and decreased (AUC = 0.649, CI 0.580–0.718, p < 0.001) in the non-DM group. Conclusions Serum FFA levels were independently associated with SCAC, and could have some predictive capacity for SCAC. The association was strongest in the DM group. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02152-w.
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Affiliation(s)
- Yangxun Xin
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junfeng Zhang
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuqi Fan
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Changqian Wang
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Koyanagi H, Tsutsumi Y, Tokuda Y, Tanaka A, Endo M, Furukawa Y, Abe S. Computed tomography imaging using split-bolus contrast injection with volume scan of aortic root and heart for preoperative evaluation of transcatheter aortic valve implantation. Heart Vessels 2021; 37:132-141. [PMID: 34236462 DOI: 10.1007/s00380-021-01899-8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 07/02/2021] [Indexed: 11/24/2022]
Abstract
The purpose of this study was to investigate using split-bolus contrast injection (SPBI) with volume scanning of the heart and aortic root with helical scanning of the access route, compared to single bolus contrast injection (SI) with variable helical pitch scanning (VHP) of the heart and aortic root and access route in a preoperative evaluation before transcatheter aortic valve implantation (TAVI). Thirty-five patients who underwent preoperative CT before TAVI using SPBI (contrast media: 24.5 mgI /kg/s, injected for 12 s for heart scan and then injected for 8 s for access route) were examined. Electrocardiogram (ECG) gated scans of the heart were performed by volume scan, after a period of time, non-gated helical scans of the aorto-iliac were performed (SPBI method). For comparison, 40 patients who had a single bolus injection (26.5 mg I/kg/s, injected for period of the scan time plus 3 s) and a VHP scan (SI method) before the SPBI method was performed were included in the study. The image qualities of the coronary arteries, aortic root, and access route (aorta-iliac), as well as radiation and iodine doses, were assessed. In visual assessment, image quality of coronary artery was significantly better with the SPBI method (grade; excellent: 57.1% in SPBI vs. 24.3% in SI, p = 0.03). There was no significant difference in image quality of the aortic root by visual assessment. The signal-to-noise (SNR) and contrast-to-noise ratio (CNR) of coronary and aortic root were not significantly different between the two methods. The access route showed significantly higher SNR (45.7 ± 11.5 vs. 34.3 ± 9.8, p < 0.001) and CNR (36.0 ± 9.7 vs. 28.0 ± 8.8, p < 0.001) for the SPBI method. The SPBI method compared to SI method reduced iodine dose by 10% and radiation dose by 45%. Preoperative CT imaging before TAVI using SPBI with volume scan is useful and can reduce iodine and radiation doses.
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Affiliation(s)
- Hitomi Koyanagi
- Department of Radiological Technology, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan.
| | - Yoshinori Tsutsumi
- Department of Radiological Technology, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Yoshiyuki Tokuda
- Department of Cardiac Surgery, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Maki Endo
- Department of Radiological Technology, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Yasushi Furukawa
- Department of Radiological Technology, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Shinji Abe
- Department of Radiological Technology, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
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Duran SR, Huffaker T, Dixon B, Gooty V, Abou Zahr R, Arar Y, Greer JS, Butts RJ, Hussain MT. Feasibility and safety of quantitative adenosine stress perfusion cardiac magnetic resonance imaging in pediatric heart transplant patients with and without coronary allograft vasculopathy. Pediatr Radiol 2021; 51:1311-1321. [PMID: 33791838 DOI: 10.1007/s00247-021-04977-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 02/05/2020] [Revised: 11/11/2020] [Accepted: 01/21/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pediatric heart transplant patients require cardiac catheterization to monitor for coronary allograft vasculopathy. Cardiac catheterization has no safe and consistent method for measuring microvascular disease. Stress perfusion cardiac magnetic resonance imaging (MRI) assessing microvascular disease has been performed in adults. OBJECTIVE To investigate the feasibility and safety of performing cardiac MRI with quantitative adenosine stress perfusion testing in pediatric heart transplant patients with and without coronary allograft vasculopathy. MATERIALS AND METHODS All pediatric heart transplant patients with coronary vasculopathy at our institution were asked to participate. Age- and gender-matched pediatric heart transplant patients without vasculopathy were recruited for comparison. Patients underwent cardiac MRI with adenosine stress perfusion testing. RESULTS Sixteen pediatric heart transplant patients, ages 6-22 years, underwent testing. Nine patients had vasculopathy by angiography. No heart block or other complications occurred during the study. The myocardial perfusion reserve for patients with vasculopathy showed no significant difference with comparison patients (median: 1.43 vs. 1.48; P=0.49). Values for both groups were lower than expected values based on previous adult studies. The patients were also analyzed for time after transplant and the number of rejection episodes. Patients within 6 years of transplantation had a nonsignificant trend toward a higher myocardial perfusion reserve (median: 1.57) versus patients with older transplants (median: 1.47; P=0.46). Intra- and interobserver reproducibility were 97% and 92%, respectively. CONCLUSION Myocardial perfusion reserve is a safe and feasible method for estimating myocardial perfusion in pediatric heart transplant patients. There is no reliable way to monitor microvascular disease in pediatric patients. This method shows potential and deserves investigation in a larger cohort.
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Affiliation(s)
- Silvestre R Duran
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA. .,Division of Pediatric Cardiology, Children's Medical Center Dallas, Dallas, TX, USA. .,Division of Pediatric Cardiology, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH, USA.
| | - Tyler Huffaker
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - Bryant Dixon
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - Vasu Gooty
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA.,Division of Pediatric Cardiology, Children's Medical Center Dallas, Dallas, TX, USA
| | - Riad Abou Zahr
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA.,Division of Pediatric Cardiology, Children's Medical Center Dallas, Dallas, TX, USA
| | - Yousef Arar
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA.,Division of Pediatric Cardiology, Children's Medical Center Dallas, Dallas, TX, USA
| | - Joshua S Greer
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - Ryan J Butts
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA.,Division of Pediatric Cardiology, Children's Medical Center Dallas, Dallas, TX, USA
| | - Mohammad T Hussain
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA.,Division of Pediatric Cardiology, Children's Medical Center Dallas, Dallas, TX, USA
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Rios-Navarro C, Daghbouche-Rubio N, Gavara J, de Dios E, Perez N, Vila JM, Chorro FJ, Ruiz-Sauri A, Bodi V. Ischemia-reperfusion injury to coronary arteries: Comprehensive microscopic study after reperfused myocardial infarction. Ann Anat 2021; 238:151785. [PMID: 34144157 DOI: 10.1016/j.aanat.2021.151785] [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] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Coronary arteries supply oxygen and nutrients to the heart. We evaluated the dynamics of microscopic damage throughout the ischemia-reperfusion process in the wall of coronary arteries following myocardial infarction (MI). METHODS In a swine model of reperfused MI, animals were divided into one control and four MI groups: 90-min ischemia without reperfusion, or followed by one minute, one week or one month reperfusion. Left anterior descending (LAD; infarct-related artery) and control right coronary arteries (RCA) were isolated. Taking the balloon inflation region as a reference, we isolated the proximal and distal LAD areas, performing histological staining and immunohistochemistry. RESULTS Although mild changes in tunica intima were observed during ischemia, an almost complete absence of endothelium, and abnormal breaks in the internal elastic layer were found post-revascularization. In tunica media, increased thickness was observed soon after reperfusion, whereas larger thickness, disorganized muscle cell distribution and edema were found one week after reperfusion. This damage was more pronounced in distal rather than proximal LAD, whereas no changes were detected in RCA. In the tunica adventitia, vasa vasorum density decayed during ischemia in both LAD regions, but was restored after one month. Leukocyte adhesion to the artery was observed post-revascularization, developing into a massive presence in the three layers one week post-reperfusion. CONCLUSIONS Ischemia-reperfusion can itself induce damage in the wall of the epicardial coronary artery, becoming more pronounced in the region distal to balloon inflation. Exploring these abnormalities will provide insight into the pathophysiology of coronary circulation and MI.
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Affiliation(s)
| | | | - Jose Gavara
- INCLIVA Health Research Institute, Valencia, Spain
| | - Elena de Dios
- Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red - Cardiovascular, Spain
| | - Nerea Perez
- INCLIVA Health Research Institute, Valencia, Spain
| | - Jose M Vila
- INCLIVA Health Research Institute, Valencia, Spain; Department of Physiology, School of Medicine, University of Valencia, Valencia, Spain
| | - Francisco J Chorro
- INCLIVA Health Research Institute, Valencia, Spain; Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red - Cardiovascular, Spain; Cardiology Department, Hospital Clinico Universitario, Valencia, Spain
| | - Amparo Ruiz-Sauri
- INCLIVA Health Research Institute, Valencia, Spain; Department of Pathology, School of Medicine, University of Valencia, Valencia, Spain.
| | - Vicente Bodi
- INCLIVA Health Research Institute, Valencia, Spain; Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red - Cardiovascular, Spain; Cardiology Department, Hospital Clinico Universitario, Valencia, Spain.
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