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Papolos A, Fan E, Wagle RR, Foster E, Boyle AJ, Yeghiazarians Y, MacGregor JS, Grossman W, Schiller NB, Ganz P, Tison GH. Echocardiographic determination of pulmonary arterial capacitance. Int J Cardiovasc Imaging 2019; 35:1581-1586. [PMID: 30968263 DOI: 10.1007/s10554-019-01595-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 11/29/2018] [Accepted: 04/01/2019] [Indexed: 12/30/2022]
Abstract
A growing body of evidence has demonstrated that pulmonary arterial capacitance (PAC) is the strongest hemodynamic predictor of clinical outcomes across a wide spectrum of cardiovascular disease, including pulmonary hypertension and heart failure. We hypothesized that a ratio of right ventricular stroke volume (RVOT VTI) to the associated peak arterial systolic pressure (PASP) could function as a reliable non-invasive surrogate for PAC. We performed a prospective study of patients undergoing simultaneous transthoracic echocardiography and right heart catheterization (RHC) for various clinical indications. Measurements of the RVOT VTI/PASP ratio from echocardiographic measurements were compared against PAC calculated from RHC measurements. Correlation coefficients and Bland-Altman analysis compared the RVOT VTI/PASP ratio with PAC. Forty-five subjects were enrolled, 38% were female and mean age was 54 years (SD 13 years). The reason for referral to RHC was most commonly post-heart transplant surveillance (40%), followed by heart failure (22%), and pulmonary hypertension (18%). Pre-capillary pulmonary hypertension was present in 18%, isolated post-capillary pulmonary hypertension was present in 13%, and combined pre-and post-capillary pulmonary hypertension was present in 29%. The RVOT VTI/PASP ratio was obtainable in the majority of patients (78%), and Pearson's correlation demonstrated moderately-strong association between PAC and the RVOT VTI/PASP ratio, r = 0.75 (P < 0.001). Bland-Altman analysis demonstrated good agreement between measurements without suggestion of systematic bias and a mean difference in standardized units of - 0.133. In a diverse population of patients and hemodynamic profiles, we validated that the ratio of RVOT VTI/PASP to be a reliably-obtained non-invasive marker associated with PAC.
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Affiliation(s)
- Alexander Papolos
- Division of Cardiology, University of California, San Francisco, 555 Mission Bay Blvd South, Box 3120, San Francisco, CA, 94158, USA
| | - Eugene Fan
- Division of Cardiology, University of California, San Francisco, 555 Mission Bay Blvd South, Box 3120, San Francisco, CA, 94158, USA
| | | | - Elyse Foster
- Division of Cardiology, University of California, San Francisco, 555 Mission Bay Blvd South, Box 3120, San Francisco, CA, 94158, USA
| | - Andrew J Boyle
- Division of Cardiology, The University of Newcastle, Callaghan, Australia
| | - Yerem Yeghiazarians
- Division of Cardiology, University of California, San Francisco, 555 Mission Bay Blvd South, Box 3120, San Francisco, CA, 94158, USA
| | - John S MacGregor
- Division of Cardiology, University of California, San Francisco, 555 Mission Bay Blvd South, Box 3120, San Francisco, CA, 94158, USA
| | - William Grossman
- Division of Cardiology, University of California, San Francisco, 555 Mission Bay Blvd South, Box 3120, San Francisco, CA, 94158, USA
| | - Nelson B Schiller
- Division of Cardiology, University of California, San Francisco, 555 Mission Bay Blvd South, Box 3120, San Francisco, CA, 94158, USA
| | - Peter Ganz
- Division of Cardiology, University of California, San Francisco, 555 Mission Bay Blvd South, Box 3120, San Francisco, CA, 94158, USA
| | - Geoffrey H Tison
- Division of Cardiology, University of California, San Francisco, 555 Mission Bay Blvd South, Box 3120, San Francisco, CA, 94158, USA.
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Ahmed FZ, James J, Cunnington C, Motwani M, Fullwood C, Hooper J, Burns P, Qamruddin A, Al-Bahrani G, Armstrong I, Tout D, Clarke B, Sandoe JAT, Arumugam P, Mamas MA, Zaidi AM. Early diagnosis of cardiac implantable electronic device generator pocket infection using ¹⁸F-FDG-PET/CT. Eur Heart J Cardiovasc Imaging 2015; 16:521-30. [PMID: 25651856 PMCID: PMC4407104 DOI: 10.1093/ehjci/jeu295] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 11/25/2014] [Indexed: 01/07/2023] Open
Abstract
AIMS To examine the utility of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) in the early diagnosis of cardiac implantable electronic device (CIED) generator pocket infection. METHODS AND RESULTS A total of 86 patients with CIEDs were evaluated with (18)F-FDG PET/CT imaging: 46 with suspected generator pocket infection and 40 without any history of infection. (18)F-FDG activity in the region of the generator pocket was expressed as a semi-quantitative ratio (SQR)-defined as the maximum count rate around the CIED divided by the mean count rate between normal right and left lung parenchyma. All patients underwent standard clinical management, independent of the PET/CT result. Patients with suspected generator pocket infection that required CIED extraction (n = 32) had significantly higher (18)F-FDG activity compared with those that did not (n = 14), and compared with controls (n = 40) [SQR: 4.80 (3.18-7.05) vs. 1.40 (0.88-1.73) vs. 1.10 (0.98-1.40), respectively; P < 0.001]. On receiver operator characteristic analysis, SQR had a high diagnostic accuracy (area under curve = 0.98) for the early identification of patients with confirmed infection (i.e. those ultimately needing extraction)-with an optimal SQR cut-off value of >2.0 (sensitivity = 97%; specificity = 98%). CONCLUSION This study highlights the potential benefits of evaluating patients with suspected CIED generator pocket infection using (18)F-FDG PET/CT. In this study, (18)F-FDG PET/CT had a high diagnostic accuracy in the early diagnosis of CIED generator pocket infection, even where initial clinical signs were underwhelming.
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Affiliation(s)
- Fozia Zahir Ahmed
- Cardiovascular Institute, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK Department of Cardiology, Manchester Heart Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Jacqueline James
- Department of Nuclear Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Colin Cunnington
- Department of Cardiology, Manchester Heart Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Manish Motwani
- Department of Cardiology, Manchester Heart Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Catherine Fullwood
- Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK Department of Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK
| | - Jacquelyn Hooper
- Department of Cardiology, Manchester Heart Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Phillipa Burns
- Department of Microbiology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Ahmed Qamruddin
- Department of Microbiology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Ghada Al-Bahrani
- Department of Nuclear Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Ian Armstrong
- Department of Nuclear Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Deborah Tout
- Department of Nuclear Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Bernard Clarke
- Cardiovascular Institute, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK Department of Cardiology, Manchester Heart Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Jonathan A T Sandoe
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, and University of Leeds, Leeds, UK
| | - Parthiban Arumugam
- Department of Nuclear Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Mamas A Mamas
- Cardiovascular Institute, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK Department of Cardiology, Manchester Heart Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Amir M Zaidi
- Department of Cardiology, Manchester Heart Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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Maleki M, Mozaffari K, Givtaj N, Tatina A, Bahadorian B. Metastatic osteosarcoma and heart: a rare involvement in an unusual cardiac location. Heart Asia 2013; 5:120-1. [PMID: 27326101 DOI: 10.1136/heartasia-2013-010342] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Majid Maleki
- Department of Echocardiography , Shahid Rajaei Cardiovascular Medical Center , Tehran , Iran
| | - Kambiz Mozaffari
- Department of Pathology , Shahid Rajaei Cardiovascular Medical Center, Tehran university of medical sciences , Tehran , Iran
| | - Nader Givtaj
- Department of Surgery , Shahid Rajaei Cardiovascular Medical Center, Tehran university of medical sciences, Tehran , Iran
| | - Alireza Tatina
- Department of Cardiology , Shahid Rajaei Cardiovascular Medical Center, Tehran university of medical sciences , Tehran , Iran
| | - Behdad Bahadorian
- Department of Cardiology , Shahid Rajaei Cardiovascular Medical Center, Tehran university of medical sciences , Tehran , Iran
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Chacko Y, Haladyn JK, Smith DM, Lim R. Compliance charts to guide non-complex small artery stenting: validation by quantitative coronary angiography. Heart Asia 2013; 5:76-9. [PMID: 27326085 DOI: 10.1136/heartasia-2013-010312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 05/05/2013] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine whether stent sizing derived from manufacturers' compliance charts provides a reasonable in vivo estimate of final minimum lumen diameter (MLD) when compared with quantitative coronary angiography (QCA). DESIGN Single-centre measurement comparison study. SETTING Tertiary referral university hospital. PATIENTS Fifty cases receiving a single stent for non-complex de novo stenosis were randomly selected from the percutaneous coronary intervention database of our high-volume centre. Restenosis, stent thrombosis, bifurcational disease, rotablation, left main or graft stenting, intravascular ultrasound or kissing balloon inflations were exclusion criteria. MAIN OUTCOME MEASURES Equality and limits of agreement (LOA) between compliance chart and QCA measurements of final MLD, especially focusing on patients with small stents<3 mm. The paired t test and Bland-Altman plots were used to compare measurements. RESULTS There was no significant difference between compliance chart-derived and QCA final MLD (n=50; mean -0.034 mm, SD 0.35, 95% CI -0.132 to +0.064; p=0.49), with reasonable Bland-Altman LOA between the two methods of assessing final MLD in the overall group (LOA -0.72 to +0.66 mm), as well as in the group of particular interest with Derived final MLD <3 mm (n=30; mean 0.019 mm, SD 0.27, 95% CI -0.082 to +0.119; p=0.71; LOA -0.52 to +0.56 mm). CONCLUSIONS Compliance charts provide an acceptable estimate of final MLD and are a reasonable guide to sizing during non-complex stenting, especially in small vessels <3 mm.
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Affiliation(s)
- Yohan Chacko
- Department of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Department of Cardiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - J Kimberly Haladyn
- Department of Medicine , The University of Queensland , Brisbane, Queensland , Australia
| | - Debbie M Smith
- Department of Cardiology , Princess Alexandra Hospital , Brisbane, Queensland , Australia
| | - Richard Lim
- Department of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Department of Cardiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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