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Holte E, Podlesnikar T, Carvalho F, Demirkiran A, Manka R, Martínez GG, Michalski B, Pasquet Separovic A, Soliman-Aboumarie H, Shruti JS, Haugaa KH, Dweck MR. European Association of Cardiovascular Imaging survey on the evaluation of mitral regurgitation. Eur Heart J Cardiovasc Imaging 2024; 25:573-578. [PMID: 38387435 DOI: 10.1093/ehjci/jeae053] [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: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Abstract
AIMS To evaluate the diagnosis and imaging of patients with mitral regurgitation (MR) and the management in routine clinical practice across Europe, the European Association of Cardiovascular Imaging Scientific Initiatives Committee performed a survey across European centres. In particular, the routine use of echocardiography, advanced imaging modalities, heart valve clinics, and heart valve teams was explored. METHODS AND RESULTS A total of 61 responders, mainly from tertiary centres or university hospitals, from 26 different countries responded to the survey, which consisted of 22 questions. For most questions related to echocardiography and advanced imaging, the answers were relatively homogeneous and demonstrated good adherence to current recommendations. In particular, the centres used a multi-parametric echocardiographic approach and selected the effective regurgitant orifice and vena contracta width as their preferred assessments. 2D measurements are still the most widely used parameters to assess left ventricular structure; however, the majority use 3D trans-oesophageal echocardiography (TOE) to evaluate valve morphology in severe MR. The majority of centres reported the onsite availability and clinical use of ergometric stress echocardiography, cardiac computed tomography (CCT), and cardiac magnetic resonance (CMR) imaging. Heart valve clinics and heart valve teams were also widely prevalent. CONCLUSION Consistent with current guidelines, echocardiography (transthoracic echocardiography and TOE) remains the first-line and central imaging modality for the assessment of MR although the complementary use of 3D TOE, CCT, and CMR appears to be growing. Heart valve clinics and heart valve teams are now widely prevalent.
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Affiliation(s)
- Espen Holte
- Clinic of Cardiology, St. Olavs Hospital, Postboks 3250 Torgarden, Trondheim 7006, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology NTNU, Postboks 8905, Trondheim 7491, Norway
| | - Tomaž Podlesnikar
- University Medical Centre Maribor, Slovenia
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Fontes Carvalho
- Cardiovascular Research and Development Unit (UnIC), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ahmet Demirkiran
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands
- Department of Cardiology, Kocaeli Şehir Medical Center, Tavşantepe, İzmit/Kocaeli 41060, Türkiye
| | - Robert Manka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Gabriela Guzmán Martínez
- Department of Cardiology, Department of Medicine, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Błażej Michalski
- Department of Cardiology, Medical University of Lodz, Lodz, Poland
| | - Agnès Pasquet Separovic
- Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, IREC/CARD UCLouvain, Brussels B-1200, Belgium
| | - Hatem Soliman-Aboumarie
- Department of Cardiothoracic Critical Care, Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield Hospitals, London, UK
- School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, London, UK
| | - Joshi S Shruti
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Kristina H Haugaa
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Postboks 4950 Nydalen, Oslo 0424, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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Rinkel LA, Cramer ON, Özata ZB, Beemsterboer CFP, Guglielmi V, Nio SS, Bouma BJ, Boekholdt SM, Lobé NHJ, Beenen LFM, Marquering HA, Majoie CBLM, Roos YBWEM, van Randen A, Planken RN, Coutinho JM. Long-Term Clinical Implications of High-Risk Cardiac Computed Tomography Findings in Patients With Acute Ischemic Stroke. J Am Heart Assoc 2024:e033175. [PMID: 38639349 DOI: 10.1161/jaha.123.033175] [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: 10/29/2023] [Accepted: 01/26/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Cardiac computed tomography (CT) acquired during the initial acute stroke imaging protocol (acute cardiac CT) is increasingly used to screen for cardioembolism, but information on the long-term clinical implications of its findings is lacking. METHODS AND RESULTS We performed a prospective, single-center cohort study in which consecutive patients with ischemic stroke underwent ECG-gated acute cardiac CT and were followed up for 2 years. The primary outcome was functional outcome assessed using the modified Rankin Scale. Secondary outcomes were death and occurrence of major adverse cardiovascular events (composite of recurrent ischemic stroke, myocardial infarction, and cardiovascular death). We compared patients with and without a high-risk structural source of embolism on acute cardiac CT. Of 452 included patients, 55 (12.2%) had a high-risk source of embolism, predominantly cardiac thrombi (38 patients) and signs of endocarditis (8 patients). Follow-up at 2 years was complete for 430 (95.1%) patients. Patients with a high-risk source of embolism had a worse functional outcome (median modified Rankin Scale, 6 [IQR, 2-6] versus 2 [IQR, 1-5]; adjusted common odds ratio, 2.92 [95% CI, 1.62-5.25]), increased mortality rate (52.7% versus 23.7%; adjusted hazard ratio [HR], 3.28 [95% CI, 1.94-5.52]), and major adverse cardiovascular events (38.9% versus 17.5%; adjusted HR, 3.20 [95% CI, 1.80-5.69]). A high-risk source of embolism was not associated with recurrent ischemic stroke (11.1% versus 9.6%; adjusted HR, 1.30 [95% CI, 0.49-3.44]). CONCLUSIONS Structural high-risk sources of embolism on acute cardiac CT in patients with ischemic stroke were associated with poor long-term functional outcome and occurrence of major adverse cardiovascular events but not with recurrent stroke.
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Affiliation(s)
- Leon A Rinkel
- Department of Neurology, Amsterdam UMC Location University of Amsterdam Amsterdam The Netherlands
| | - Olivia N Cramer
- Department of Neurology, Amsterdam UMC Location University of Amsterdam Amsterdam The Netherlands
| | - Z Beyda Özata
- Department of Neurology, Amsterdam UMC Location University of Amsterdam Amsterdam The Netherlands
| | - Chiel F P Beemsterboer
- Department of Neurology, Amsterdam UMC Location University of Amsterdam Amsterdam The Netherlands
| | - Valeria Guglielmi
- Department of Neurology, Amsterdam UMC Location University of Amsterdam Amsterdam The Netherlands
| | - Shan Sui Nio
- Department of Neurology, Amsterdam UMC Location University of Amsterdam Amsterdam The Netherlands
| | - Berto J Bouma
- Department of Cardiology, Amsterdam UMC Location University of Amsterdam Amsterdam The Netherlands
| | - S Matthijs Boekholdt
- Department of Cardiology, Amsterdam UMC Location University of Amsterdam Amsterdam The Netherlands
| | - Nick H J Lobé
- Departments of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam Amsterdam The Netherlands
| | - Ludo F M Beenen
- Departments of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam Amsterdam The Netherlands
| | - Henk A Marquering
- Departments of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam Amsterdam The Netherlands
- Departments of Biomedical Engineering and Physics, Amsterdam UMC Location University of Amsterdam Amsterdam The Netherlands
| | - Charles B L M Majoie
- Departments of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam Amsterdam The Netherlands
| | - Yvo B W E M Roos
- Department of Neurology, Amsterdam UMC Location University of Amsterdam Amsterdam The Netherlands
| | - Adrienne van Randen
- Departments of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam Amsterdam The Netherlands
| | - R Nils Planken
- Departments of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam Amsterdam The Netherlands
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam UMC Location University of Amsterdam Amsterdam The Netherlands
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3
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Peters M, Tanel E, Marzlin N, Kroboth S, Kanani J, Bajwa TK, Allaqaband SQ, Johnson B, Weiss ES, Harland D, Jain R. Screening for Transcatheter Interventions by Echocardiography: A Comparison of 3D Mitral Annulus Quantification in Transthoracic Echocardiography and Cardiac Computed Tomography. J Am Soc Echocardiogr 2024:S0894-7317(24)00162-7. [PMID: 38556039 DOI: 10.1016/j.echo.2024.03.016] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/19/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Affiliation(s)
- Matthew Peters
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 130, Milwaukee, WI 53215, USA; Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Milwaukee Clinical Campus, 2900 W. Oklahoma Avenue, Milwaukee, WI 53215, USA
| | - Emily Tanel
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 130, Milwaukee, WI 53215, USA
| | - Nathan Marzlin
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 130, Milwaukee, WI 53215, USA; Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Milwaukee Clinical Campus, 2900 W. Oklahoma Avenue, Milwaukee, WI 53215, USA
| | - Stacie Kroboth
- Academic Affairs, Cardiovascular Research, Aurora Sinai/Aurora St. Luke's Medical Center, Advocate Aurora Health, 1020 N. 12th Street, Milwaukee WI 53233, USA
| | - Jim Kanani
- Academic Affairs, Cardiovascular Research, Aurora Sinai/Aurora St. Luke's Medical Center, Advocate Aurora Health, 1020 N. 12th Street, Milwaukee WI 53233, USA
| | - Tanvir K Bajwa
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 130, Milwaukee, WI 53215, USA; Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Milwaukee Clinical Campus, 2900 W. Oklahoma Avenue, Milwaukee, WI 53215, USA
| | - Suhail Q Allaqaband
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 130, Milwaukee, WI 53215, USA; Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Milwaukee Clinical Campus, 2900 W. Oklahoma Avenue, Milwaukee, WI 53215, USA
| | - Brianna Johnson
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 130, Milwaukee, WI 53215, USA
| | - Eric S Weiss
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 130, Milwaukee, WI 53215, USA; Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Milwaukee Clinical Campus, 2900 W. Oklahoma Avenue, Milwaukee, WI 53215, USA
| | - Daniel Harland
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 130, Milwaukee, WI 53215, USA; Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Milwaukee Clinical Campus, 2900 W. Oklahoma Avenue, Milwaukee, WI 53215, USA
| | - Renuka Jain
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 130, Milwaukee, WI 53215, USA; Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Milwaukee Clinical Campus, 2900 W. Oklahoma Avenue, Milwaukee, WI 53215, USA.
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Guglielmo M, Pavon AG. Neo-LVOT measurement in TMVR: time for Multimodality? Echocardiography 2024; 41:e15800. [PMID: 38506268 DOI: 10.1111/echo.15800] [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: 02/28/2024] [Accepted: 03/01/2024] [Indexed: 03/21/2024] Open
Affiliation(s)
- Marco Guglielmo
- Department of Cardiology, Division of Heart and Lungs, Utrecht University, Utrecht University Medical Center, Utrecht, The Netherlands
- Department of Cardiology, Haga Teaching Hospital, The Hague, Netherlands
| | - Anna Giulia Pavon
- Department of Cardiology, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
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Chang S, Koons EK, Gong H, Thorne JE, McCollough CH, Leng S. Improving Stenosis Assessment in Energy Integrating Detector CT via Learned Monoenergetic Imaging Capability. Proc SPIE Int Soc Opt Eng 2024; 12925:129252R. [PMID: 38618158 PMCID: PMC11014427 DOI: 10.1117/12.3006468] [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] [Indexed: 04/16/2024]
Abstract
Coronary CT angiography (cCTA) is a fast non-invasive imaging exam for coronary artery disease (CAD) but struggles with dense calcifications and stents due to blooming artifacts, potentially causing stenosis overestimation. Virtual monoenergetic images (VMIs) at higher keV (e.g., 100 keV) from photon counting detector (PCD) CT have shown promise in reducing blooming artifacts and improving lumen visibility through its simultaneous high-resolution and multi-energy imaging capability. However, most cCTA exams are performed with single-energy CT (SECT) using conventional energy-integrating detectors (EID). Generating VMIs through EID-CT requires advanced multi-energy CT (MECT) scanners and potentially sacrifices temporal resolution. Given these limitations, MECT cCTA exams are not commonly performed on EID-CT and VMIs are not routinely generated. To tackle this, we aim to enhance the multi-energy imaging capability of EID-CT through the utilization of a convolutional neural network to LEarn MONoenergetic imAging from VMIs at Different Energies (LEMONADE). The neural network was trained using ten patient cCTA exams acquired on a clinical PCD-CT (NAEOTOM Alpha, Siemens Healthineers), with 70 keV VMIs as input (which is nominally equivalent to the SECT from EID-CT scanned at 120 kV) and 100 keV VMIs as the target. Subsequently, we evaluated the performance of EID-CT equipped with LEMONADE on both phantom and patient cases (n=10) for stenosis assessment. Results indicated that LEMONADE accurately quantified stenosis in three phantoms, aligning closely with ground truth and demonstrating stenosis percentage area reductions of 13%, 8%, and 9%. In patient cases, it led to a 12.9% reduction in average diameter luminal stenosis when compared to the original SECT without LEMONADE. These outcomes highlight LEMONADE's capacity to enable multi-energy CT imaging, mitigate blooming artifacts, and improve stenosis assessment for the widely available EID-CT. This has a high potential impact as most cCTA exams are performed on EID-CT.
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Affiliation(s)
- Shaojie Chang
- Department of Radiology, Mayo Clinic, Rochester, MN, USA 55905
| | - Emily K Koons
- Department of Radiology, Mayo Clinic, Rochester, MN, USA 55905
| | - Hao Gong
- Department of Radiology, Mayo Clinic, Rochester, MN, USA 55905
| | | | | | - Shuai Leng
- Department of Radiology, Mayo Clinic, Rochester, MN, USA 55905
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Koons EK, Gong H, Missert A, Chang S, Winfree T, Zhou Z, McCollough CH, Leng S. Learned high-resolution cardiac CT imaging from ultra-high-resolution PCD-CT. Proc SPIE Int Soc Opt Eng 2024; 12925:129252Q. [PMID: 38606001 PMCID: PMC11008336 DOI: 10.1117/12.3006463] [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] [Indexed: 04/13/2024]
Abstract
Coronary computed tomography angiography (cCTA) is a widely used non-invasive diagnostic exam for patients with coronary artery disease (CAD). However, most clinical CT scanners are limited in spatial resolution from use of energy-integrating detectors (EIDs). Radiological evaluation of CAD is challenging, as coronary arteries are small (3-4 mm diameter) and calcifications within them are highly attenuating, leading to blooming artifacts. As such, this is a task well suited for high spatial resolution. Recently, photon-counting-detector (PCD) CT became commercially available, allowing for ultra-high resolution (UHR) data acquisition. However, PCD-CTs are costly, restricting widespread accessibility. To address this problem, we propose a super resolution convolutional neural network (CNN): ILUMENATE (Improved LUMEN visualization through Artificial super-resoluTion imagEs), creating a high resolution (HR) image simulating UHR PCD-CT. The network was trained and validated using patches extracted from 8 patients with a modified U-Net architecture. Training input and labels consisted of UHR PCD-CT images reconstructed with a smooth kernel degrading resolution (LR input) and sharp kernel (HR label). The network learned the resolution difference and was tested on 5 unseen LR patients. We evaluated network performance quantitatively and qualitatively through visual inspection, line profiles to assess spatial resolution improvements, ROIs for CT number stability and noise assessment, structural similarity index (SSIM), and percent diameter luminal stenosis. Overall, ILUMENATE improved images quantitatively and qualitatively, creating sharper edges more closely resembling reconstructed HR reference images, maintained stable CT numbers with less than 4% difference, reduced noise by 28%, maintained structural similarity (average SSIM = 0.70), and reduced percent diameter stenosis with respect to input images. ILUMENATE demonstrates potential impact for CAD patient management, improving the quality of LR CT images bringing them closer to UHR PCD-CT images.
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Affiliation(s)
- Emily K Koons
- Department of Radiology, Mayo Clinic, Rochester, MN, USA 55905
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN, USA 55905
| | - Hao Gong
- Department of Radiology, Mayo Clinic, Rochester, MN, USA 55905
| | - Andrew Missert
- Department of Radiology, Mayo Clinic, Rochester, MN, USA 55905
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN, USA 55905
| | - Shaojie Chang
- Department of Radiology, Mayo Clinic, Rochester, MN, USA 55905
| | - Tim Winfree
- Department of Radiology, Mayo Clinic, Rochester, MN, USA 55905
| | - Zhongxing Zhou
- Department of Radiology, Mayo Clinic, Rochester, MN, USA 55905
| | - Cynthia H McCollough
- Department of Radiology, Mayo Clinic, Rochester, MN, USA 55905
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN, USA 55905
| | - Shuai Leng
- Department of Radiology, Mayo Clinic, Rochester, MN, USA 55905
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN, USA 55905
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7
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Akiki E, Arghami A, Abbasi MA, El-Am EA, Ahmad A, Foley TA, Daly RC, Maleszewski JJ, Kurmann R, Klarich KW. Case Report: A myxoma with a far reach. Front Cardiovasc Med 2024; 11:1340406. [PMID: 38327492 PMCID: PMC10847281 DOI: 10.3389/fcvm.2024.1340406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/03/2024] [Indexed: 02/09/2024] Open
Abstract
A 73-year-old woman presented to the emergency department with a syncopal episode and a history of dizzy spells. A transthoracic echocardiogram demonstrated a large left atrial mass extending into the right upper pulmonary veins. Subsequently, cardiac magnetic resonance imaging and coronary computed tomography angiography with three-dimensional reconstruction and printing of the heart and mass were performed, which demonstrated a high index of suspicion for an atypical left atrial myxoma. The mass was excised robotically, and the pathology report confirmed a diagnosis of myxoma.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Kyle W. Klarich
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
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8
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Alnasser TN, Abdulaal L, Maiter A, Sharkey M, Dwivedi K, Salehi M, Garg P, Swift AJ, Alabed S. Advancements in cardiac structures segmentation: a comprehensive systematic review of deep learning in CT imaging. Front Cardiovasc Med 2024; 11:1323461. [PMID: 38317865 PMCID: PMC10839106 DOI: 10.3389/fcvm.2024.1323461] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/08/2024] [Indexed: 02/07/2024] Open
Abstract
Background Segmentation of cardiac structures is an important step in evaluation of the heart on imaging. There has been growing interest in how artificial intelligence (AI) methods-particularly deep learning (DL)-can be used to automate this process. Existing AI approaches to cardiac segmentation have mostly focused on cardiac MRI. This systematic review aimed to appraise the performance and quality of supervised DL tools for the segmentation of cardiac structures on CT. Methods Embase and Medline databases were searched to identify related studies from January 1, 2013 to December 4, 2023. Original research studies published in peer-reviewed journals after January 1, 2013 were eligible for inclusion if they presented supervised DL-based tools for the segmentation of cardiac structures and non-coronary great vessels on CT. The data extracted from eligible studies included information about cardiac structure(s) being segmented, study location, DL architectures and reported performance metrics such as the Dice similarity coefficient (DSC). The quality of the included studies was assessed using the Checklist for Artificial Intelligence in Medical Imaging (CLAIM). Results 18 studies published after 2020 were included. The DSC scores median achieved for the most commonly segmented structures were left atrium (0.88, IQR 0.83-0.91), left ventricle (0.91, IQR 0.89-0.94), left ventricle myocardium (0.83, IQR 0.82-0.92), right atrium (0.88, IQR 0.83-0.90), right ventricle (0.91, IQR 0.85-0.92), and pulmonary artery (0.92, IQR 0.87-0.93). Compliance of studies with CLAIM was variable. In particular, only 58% of studies showed compliance with dataset description criteria and most of the studies did not test or validate their models on external data (81%). Conclusion Supervised DL has been applied to the segmentation of various cardiac structures on CT. Most showed similar performance as measured by DSC values. Existing studies have been limited by the size and nature of the training datasets, inconsistent descriptions of ground truth annotations and lack of testing in external data or clinical settings. Systematic Review Registration [www.crd.york.ac.uk/prospero/], PROSPERO [CRD42023431113].
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Affiliation(s)
- Turki Nasser Alnasser
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, United Kingdom
- College of Applied Medical Science, King Saud bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
| | - Lojain Abdulaal
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, United Kingdom
| | - Ahmed Maiter
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, United Kingdom
- Department of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, United Kingdom
| | - Michael Sharkey
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, United Kingdom
| | - Krit Dwivedi
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, United Kingdom
- Department of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, United Kingdom
| | - Mahan Salehi
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, United Kingdom
| | - Pankaj Garg
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Andrew James Swift
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, United Kingdom
- Insigneo Institute, Faculty of Engineering, The University of Sheffield, Sheffield, United Kingdom
| | - Samer Alabed
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, United Kingdom
- Department of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, United Kingdom
- Insigneo Institute, Faculty of Engineering, The University of Sheffield, Sheffield, United Kingdom
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9
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Babes EE, Bustea C, Ilias TI, Babes VV, Luca SA, Luca CT, Radu AF, Tarce AG, Bungau AF, Bustea C. Multimodality Imaging Diagnosis in Infective Endocarditis. Life (Basel) 2023; 14:54. [PMID: 38255669 PMCID: PMC10821102 DOI: 10.3390/life14010054] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/20/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024] Open
Abstract
Imaging is an important tool in the diagnosis and management of infective endocarditis (IE). Echocardiography is an essential examination, especially in native valve endocarditis (NVE), but its diagnostic accuracy is reduced in prosthetic valve endocarditis (PVE). The diagnostic ability is superior for transoesophageal echocardiography (TEE), but a negative test cannot exclude PVE. Both transthoracic echocardiography (TTE) and TEE can provide normal or inconclusive findings in up to 30% of cases, especially in patients with prosthetic devices. New advanced non-invasive imaging tests are increasingly used in the diagnosis of IE. Nuclear medicine imaging techniques have demonstrated their superiority over TEE for the diagnosis of PVE and cardiac implantable electronic device infective endocarditis (CIED-IE). Cardiac computed tomography angiography imaging is useful in PVE cases with inconclusive TTE and TEE investigations and for the evaluation of paravalvular complications. In the present review, imaging tools are described with their values and limitations for improving diagnosis in NVE, PVE and CIED-IE. Current knowledge about multimodality imaging approaches in IE and imaging methods to assess the local and distant complications of IE is also reviewed. Furthermore, a potential diagnostic work-up for different clinical scenarios is described. However, further studies are essential for refining diagnostic and management approaches in infective endocarditis, addressing limitations and optimizing advanced imaging techniques across different clinical scenarios.
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Affiliation(s)
- Elena Emilia Babes
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (E.E.B.); (A.-F.R.); (A.F.B.)
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (T.I.I.); (V.V.B.)
| | - Cristiana Bustea
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Tiberia Ioana Ilias
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (T.I.I.); (V.V.B.)
| | - Victor Vlad Babes
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (T.I.I.); (V.V.B.)
| | - Silvia-Ana Luca
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania
| | - Constantin Tudor Luca
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania
| | - Andrei-Flavius Radu
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (E.E.B.); (A.-F.R.); (A.F.B.)
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Alexandra Georgiana Tarce
- Medicine Program of Study, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania;
| | - Alexa Florina Bungau
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (E.E.B.); (A.-F.R.); (A.F.B.)
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Cristian Bustea
- Department of Surgery, Oradea County Emergency Clinical Hospital, 410169 Oradea, Romania;
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10
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Fukui M, Sorajja P, Enriquez-Sarano M, Lesser JR, Bapat VN, Cavalcante JL. Cardiac MRI Uncovers Pathophysiology of Low Cardiac Output Syndrome Post-Transcatheter Mitral Valve Replacement. JACC Cardiovasc Interv 2023; 16:2927-2930. [PMID: 38092498 DOI: 10.1016/j.jcin.2023.10.018] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 09/29/2023] [Accepted: 10/10/2023] [Indexed: 12/18/2023]
Affiliation(s)
- Miho Fukui
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | | | - John R Lesser
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Vinayak N Bapat
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - João L Cavalcante
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
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11
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Jouan J, Craiem D, Soulat G, Bliah V, Masari I, Mousseaux E. Computed tomographic analysis of the morphometrics and dynamics of the tricuspid annulus in secondary functional tricuspid regurgitation. JTCVS Open 2023; 16:263-275. [PMID: 38204721 PMCID: PMC10774981 DOI: 10.1016/j.xjon.2023.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/29/2023] [Accepted: 07/17/2023] [Indexed: 01/12/2024]
Abstract
Objectives Secondary functional tricuspid regurgitation (FTR) management remains controversial mainly due to the lack of knowledge in its pathogenesis and the difficulties to measure the actual dimensions of tricuspid annulus (TA) with current imaging methods. Using a novel method based on multiphase cardiac computed tomography (CT) scan acquisition to accurately analyze the right atrioventricular junction size, we sought to explore modifications of TA morphometry and dynamics in secondary FTR. Methods Echocardiographic and cardiac CT studies were obtained from 21 patients with severe mitral regurgitation (MR group) and 21 patients with dilated cardiomyopathy (DCMP group). Using an in-house software, a 3-dimensiontal (3D) semiautomated delineation of the TA perimeter was assessed. Modifications of diameters, 2-dimensional/3D areas and perimeters were analyzed through time. These 2 groups of patients were compared with 30 healthy subjects, considering the presence of a significant (≥2+) versus nonsignificant (<2+) FTR in each group. Results Maximum TA 3D areas were 7.0 ± 1.2 cm2/m2 in healthy subjects at mid-to-late diastole and were smaller than in the MR group (9.8 ± 2.1 cm2/m2, P < .001) and the DCMP group (9.2 ± 3.0 cm2/m2, P < .001). In the MR group, patients with FTR <2+ had also larger TA areas and diameters than healthy patients (P < .01 for all 3D/2-dimensional parameters). TA shape was more circular only in the DCMP group with FTR ≥2+ compared with other patients (P < .05 for eccentricity). In multivariate analysis, both RA area (P < .001) and RV volume (P = .002) were independently related to TA dilatation. Conclusions Based on multiphase CT image analyses, TA dilatation was directly related to RV and RA enlargement. Patients with severe mitral myxomatous disease and nondysfunctional tricuspid valve had yet dilated TA, which questioned the current cut-off recommendation for concomitant tricuspid annuloplasty in this specific population.
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Affiliation(s)
- Jérôme Jouan
- Department of Cardio-thoracic Surgery, CHU Dupuytren, University of Limoges, Limoges, France
- Université Paris Cité, Paris, France
| | - Damian Craiem
- Université Paris Cité, Paris, France
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería, Favaloro University, CONICET, Buenos Aires, Argentina
| | - Gilles Soulat
- Université Paris Cité, Paris, France
- Department of Radiology, Georges Pompidou European Hospital, Paris, France
| | - Virginie Bliah
- Department of Radiology, Georges Pompidou European Hospital, Paris, France
| | - Ignacio Masari
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería, Favaloro University, CONICET, Buenos Aires, Argentina
| | - Elie Mousseaux
- Université Paris Cité, Paris, France
- Department of Radiology, Georges Pompidou European Hospital, Paris, France
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12
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Alhage EM, Coquilhat A, Viaene D. Incidental finding of an aneurysmal dilatation of pericardial patch closure of ventricular septal defect, completed by multi-modality imaging. Acta Cardiol 2023; 78:1131-1132. [PMID: 37431836 DOI: 10.1080/00015385.2023.2229598] [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: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 07/12/2023]
Affiliation(s)
- Elias Maurice Alhage
- Department of Cardiology, ASZ-Algemeen Stedelijke Ziekenhuis, Campus Aalst, Belgium
- Department of Cardiology, Vrij Universiteit Brussel (VUB), Brussel, Belgium
| | - Adrien Coquilhat
- Department of Cardiology, ASZ-Algemeen Stedelijke Ziekenhuis, Campus Aalst, Belgium
- Department of Cardiology, Universiteit Antwerpen (UZA), Antwerpen, Belgium
| | - Dries Viaene
- Department of Cardiology, ASZ-Algemeen Stedelijke Ziekenhuis, Campus Aalst, Belgium
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13
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Wilson HC, Hashemi S, Smith CA, Sallee D, Kim DW, Slesnick TC. Comparison of Cardiac Computed Tomography and Magnetic Resonance Angiography Measurements for Determination of Candidacy for Transcatheter Pulmonary Valve Replacement in Native or Postsurgical Right Ventricular Outflow Tracts. Am J Cardiol 2023; 206:98-100. [PMID: 37690151 DOI: 10.1016/j.amjcard.2023.08.107] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/11/2023] [Accepted: 08/20/2023] [Indexed: 09/12/2023]
Affiliation(s)
- Hunter C Wilson
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia; Department of Pediatrics, Division of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Sassan Hashemi
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Clayton A Smith
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia; Department of Pediatrics, Division of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Denver Sallee
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia; Department of Pediatrics, Division of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Dennis W Kim
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia; Department of Pediatrics, Division of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Timothy C Slesnick
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia; Department of Pediatrics, Division of Pediatric Cardiology, Emory University School of Medicine, Atlanta, Georgia.
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14
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Budoff MJ, Lee HS, Roy SK, Shekar C. Efficacy and Safety of Iodixanol in Computed Coronary Tomographic Angiography and Cardiac Catheterization. J Cardiovasc Dev Dis 2023; 10:449. [PMID: 37998507 PMCID: PMC10671983 DOI: 10.3390/jcdd10110449] [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: 09/29/2023] [Revised: 10/26/2023] [Accepted: 10/26/2023] [Indexed: 11/25/2023] Open
Abstract
Iodixanol is an iso-osmolar non-ionic dimeric hydrophilic contrast agent with a higher viscosity than the monomeric agents. It is the only Food and Drug Administration (FDA)-approved iso-osmolar agent in the United States, and it is the only contrast agent with an FDA-approved indication for use in cardiac computed tomographic angiography (CCTA), to assist in the diagnostic evaluation of patients with suspected coronary artery disease. In clinical studies, it has been noted to have fewer side effects and similar image quality when compared to low-osmolar contrast media. This can be attributed to the pharmacological properties of iodixanol. These contrast agents are used for coronary computed tomography angiography and cardiac catheterization. In this article, the use, tolerability, and efficacy of iodixanol are reviewed, specifically evaluating the use of CCTA and coronary angiography, including outcome studies, randomized trials, and comparisons to other contrast agents.
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Affiliation(s)
- Matthew J. Budoff
- Department of Cardiology, Lundquist Institute, Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA 90502, USA;
| | | | - Sion K. Roy
- Department of Cardiology, Lundquist Institute, Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA 90502, USA;
| | - Chandana Shekar
- Department of Cardiology, College of Medicine, Banner-University of Arizona, 1111 E McDowell Road, Phoenix, AZ 85006, USA;
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15
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Abdelradi A, Atia A, Kalot M, Sunder SS, Sharma UC. Left Atrial Appendage Volumetric and Functional Assessment Using Cardiac Computed Tomography-Derived Three-Dimensional Models. Am J Cardiol 2023; 205:360-362. [PMID: 37639762 DOI: 10.1016/j.amjcard.2023.08.032] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 07/30/2023] [Accepted: 08/05/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Amr Abdelradi
- Department of Medicine, Division of Cardiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Andrew Atia
- Department of Medicine, Division of Cardiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Mohamed Kalot
- Department of Medicine, Division of Cardiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Sunitha Shyam Sunder
- Department of Medicine, Division of Cardiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Umesh C Sharma
- Department of Medicine, Division of Cardiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.
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16
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John LA, Sauer W, Winterfield J. Discordant Late Enhancement and Wall Thinning on Cardiac CT Suggestive of Arrhythmogenic Inflammatory Cardiomyopathy. JACC Clin Electrophysiol 2023; 9:2217-2218. [PMID: 37632509 DOI: 10.1016/j.jacep.2023.07.016] [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: 04/19/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 08/28/2023]
Affiliation(s)
- Leah A John
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - William Sauer
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jeffrey Winterfield
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, USA.
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17
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Clark DP, Badea CT. MCR toolkit: A GPU-based toolkit for multi-channel reconstruction of preclinical and clinical x-ray CT data. Med Phys 2023; 50:4775-4796. [PMID: 37285215 PMCID: PMC10756497 DOI: 10.1002/mp.16532] [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: 11/20/2022] [Revised: 05/07/2023] [Accepted: 05/19/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND The advancement of x-ray CT into the domains of photon counting spectral imaging and dynamic cardiac and perfusion imaging has created many new challenges and opportunities for clinicians and researchers. To address challenges such as dose constraints and scanning times while capitalizing on opportunities such as multi-contrast imaging and low-dose coronary angiography, these multi-channel imaging applications require a new generation of CT reconstruction tools. These new tools should exploit the relationships between imaging channels during reconstruction to set new image quality standards while serving as a platform for direct translation between the preclinical and clinical domains. PURPOSE We outline and demonstrate a new Multi-Channel Reconstruction (MCR) Toolkit for GPU-based analytical and iterative reconstruction of preclinical and clinical multi-energy and dynamic x-ray CT data. To promote open science, open-source distribution of the Toolkit will coincide with the release of this publication (GPL v3; gitlab.oit.duke.edu/dpc18/mcr-toolkit-public). METHODS The MCR Toolkit source code is implemented in C/C++ and NVIDIA's CUDA GPU programming interface, with scripting support from MATLAB and Python. The Toolkit implements matched, separable footprint CT reconstruction operators for projection and backprojection in two geometries: planar, cone-beam CT (CBCT) and 3rd generation, cylindrical multi-detector row CT (MDCT). Analytical reconstruction is performed using filtered backprojection (FBP) for circular CBCT, weighted FBP (WFBP) for helical CBCT, and cone-parallel projection rebinning followed by WFBP for MDCT. Arbitrary combinations of energy and temporal channels are iteratively reconstructed under a generalized multi-channel signal model for joint reconstruction. We solve this generalized model algebraically using the split Bregman optimization method and the BiCGSTAB(l) linear solver interchangeably for both CBCT and MDCT data. Rank-sparse kernel regression (RSKR) and patch-based singular value thresholding (pSVT) are used to regularize the energy and time dimensions, respectively. Under a Gaussian noise model, regularization parameters are estimated automatically from the input data, dramatically reducing algorithm complexity for end users. Multi-GPU parallelization of the reconstruction operators is supported to manage reconstruction times. RESULTS Denoising with RSKR and pSVT and post-reconstruction material decomposition are illustrated with preclinical and clinical cardiac photon-counting (PC)CT data. A digital MOBY mouse phantom with cardiac motion is used to illustrate single energy (SE), multi-energy (ME), time resolved (TR), and combined multi-energy and time-resolved (METR) helical, CBCT reconstruction. A fixed set of projection data is used across all reconstruction cases to demonstrate the Toolkit's robustness to increasing data dimensionality. Identical reconstruction code is applied to in vivo cardiac PCCT data acquired in a mouse model of atherosclerosis (METR). Clinical cardiac CT reconstruction is illustrated using the XCAT phantom and the DukeSim CT simulator, while dual-source, dual-energy CT reconstruction is illustrated for data acquired with a Siemens Flash scanner. Benchmarking results with NVIDIA RTX 8000 GPU hardware demonstrate 61%-99% efficiency in scaling computation from one to four GPUs for these reconstruction problems. CONCLUSIONS The MCR Toolkit provides a robust solution for temporal and spectral x-ray CT reconstruction problems and was built from the ground up to facilitate translation of CT research and development between preclinical and clinical applications.
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Affiliation(s)
- Darin P. Clark
- Quantitative Imaging and Analysis Lab, Department of Radiology, Duke University, Durham, North Carolina, USA
- Center for Virtual Imaging Trials, Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University, Durham, North Carolina, USA
| | - Cristian T. Badea
- Quantitative Imaging and Analysis Lab, Department of Radiology, Duke University, Durham, North Carolina, USA
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18
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Basheer M, Saad E, Jeries H, Assy N. Liver Fat Storage Is a Better Predictor of Coronary Artery Disease than Visceral Fat. Metabolites 2023; 13:896. [PMID: 37623840 PMCID: PMC10456344 DOI: 10.3390/metabo13080896] [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: 06/16/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/26/2023] Open
Abstract
Fatty liver is one aspect of metabolic syndrome. The roles and contributions of fatty liver and visceral fat storage to coronary artery disease (CAD) are not clear. This study measured associations among visceral fat storage, fatty liver, insulin resistance, atherosclerosis, and CAD. Patients were divided into three groups: excess visceral fat (visceral fat area >330 ± 99 cm2), non-alcoholic fatty liver disease (NAFLD), and a control group. The definition of fatty liver is liver minus spleen density greater than or equal to -10. We defined early atherosclerosis as intima-media thickness of the common carotid artery >7 mm in men and >0.65 mm in women, measured with Doppler ultrasound. Visceral fat area was defined using CT (>330 ± 99 cm2). Insulin-resistance biomarkers (HOMA), CRP, and oxidant-antioxidant status (MDA-Paraoxonase) were also measured. Patients with high liver or visceral fat showed higher coronary plaque prevalence (50% (p < 0.001), 38% (p < 0.01), respectively vs. 25% in the control group), higher prevalence of coronary stenosis (30% (p < 0.001), 22% (p < 0.01) vs. 11% in the control group), higher intimal thickening (0.98 ± 0.3 (p< 0.01), 0.86 ± 0.1 (p < 0.01) vs. 0.83 ± 0.1 in the control group), higher HOMA (4.0 ± 3.0 (p < 0.005), 3.0 ± 1.0 (p < 0.001) vs. 1.5 ± 1.2 in the control group), and higher triglyceride levels (196.8 ± 103 (p < 0.005), 182.6 ± 90.87 (p < 0.005) vs. 145 ± 60 in the control group). Multiple logistic regression analysis showed that fatty liver predicted CAD (OR 2.7, 95% CI 2.3-4.9, p < 0.001) independently of visceral fat storage (OR 2.01, 95% CI 1.2-2.8, p < 0.001). Liver fat storage is a strong independent risk factor for CAD and carotid atherosclerosis and contributes more than visceral fat storage.
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Affiliation(s)
- Maamoun Basheer
- Internal Medicine Department, Galilee Medical Center, Nahariya 221001, Israel; (M.B.); (E.S.); (H.J.)
| | - Elias Saad
- Internal Medicine Department, Galilee Medical Center, Nahariya 221001, Israel; (M.B.); (E.S.); (H.J.)
- Azrieli Faculty of Medicine, Bar-Ilan University, Safad 1311502, Israel
| | - Helena Jeries
- Internal Medicine Department, Galilee Medical Center, Nahariya 221001, Israel; (M.B.); (E.S.); (H.J.)
| | - Nimer Assy
- Internal Medicine Department, Galilee Medical Center, Nahariya 221001, Israel; (M.B.); (E.S.); (H.J.)
- Azrieli Faculty of Medicine, Bar-Ilan University, Safad 1311502, Israel
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Liguori C, Lassandro G, Ferrandino G, Picchi SG, Tamburrini S, Toro G, Tamburro F, Masala S, Scaglione M. ECG-Gated CCTA in the Assessment of Post-Procedural Complications. Diagnostics (Basel) 2023; 13:2500. [PMID: 37568862 PMCID: PMC10417539 DOI: 10.3390/diagnostics13152500] [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: 05/04/2023] [Revised: 07/15/2023] [Accepted: 07/22/2023] [Indexed: 08/13/2023] Open
Abstract
INTRODUCTION The aim of our study was to assess the role of ECG-gated coronary CT angiography (CCTA) in the diagnosis, imaging follow-up, and treatment guidance in post-procedural/surgical interventions in the heart and thoracic aorta (PTCA, TAVI, PMK/ICD placement, CABGs). MATERIALS AND METHODS We retrospectively evaluated 294 ECG-gated CCTA studies performed in our center from January 2020 to January 2023. CCTA studies were acquired to detect/exclude possible complications related to the endovascular or surgical procedure. RESULTS There were 27 cases (9.2%) of post-procedural complications. Patients enrolled in the study were 18 males and 9 females (male/female ratio: 2), with age ranging from 47 to 86 years (mean age, 68.3 years). Among percutaneous coronary intervention (PCI) complications, coronary intimal dissection with ascending aorta involvement was found to be the most frequent complication after PTCA (22.2%). Vascular wall pseudoaneurysm formation (11.1%) and coronary stent misalignment or displacement (14.8%) were complications less frequently encountered after PTCA. Right atrial or ventricular perforation with associated hemopericardium were the most common complications (18.5%) after pacemaker implantation. Complications encountered after aortic valve interventions were loosening and dislocation of the prosthesis associated with aortic root pseudoaneurysm (7.4%), para-valvular leak (11.1%), and hemopericardium (7.4%). In one patient who underwent transcatheter repair of patent foramen ovale (3.7%), CTTA detected the dislocation of the Amplatzer septal occluder. CONCLUSIONS ECG-gated CCTA is a fundamental diagnostic tool for the detection of post-procedural endovascular/surgical complications to enable optimal patient management. Radiologists must be familiar with the use of cardiac synchronization in the course of CT and must be aware of all possible complications that can occur in the context of acute settings or routine follow-up studies.
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Affiliation(s)
- Carlo Liguori
- Department of Radiology, Ospedale del Mare-ASL NA1 Centro, Via Enrico Russo 11, 80147 Naples, Italy; (G.L.); (S.G.P.); (S.T.)
| | - Giulia Lassandro
- Department of Radiology, Ospedale del Mare-ASL NA1 Centro, Via Enrico Russo 11, 80147 Naples, Italy; (G.L.); (S.G.P.); (S.T.)
| | - Giovanni Ferrandino
- Department of Radiology, Ospedale del Mare-ASL NA1 Centro, Via Enrico Russo 11, 80147 Naples, Italy; (G.L.); (S.G.P.); (S.T.)
| | - Stefano Giusto Picchi
- Department of Radiology, Ospedale del Mare-ASL NA1 Centro, Via Enrico Russo 11, 80147 Naples, Italy; (G.L.); (S.G.P.); (S.T.)
| | - Stefania Tamburrini
- Department of Radiology, Ospedale del Mare-ASL NA1 Centro, Via Enrico Russo 11, 80147 Naples, Italy; (G.L.); (S.G.P.); (S.T.)
| | - Gabriella Toro
- Department of Radiology, Ospedale del Mare-ASL NA1 Centro, Via Enrico Russo 11, 80147 Naples, Italy; (G.L.); (S.G.P.); (S.T.)
| | - Fabio Tamburro
- Department of Radiology, Ospedale del Mare-ASL NA1 Centro, Via Enrico Russo 11, 80147 Naples, Italy; (G.L.); (S.G.P.); (S.T.)
| | - Salvatore Masala
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (S.M.)
| | - Mariano Scaglione
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (S.M.)
- Department of Radiology, James Cook University Hospital, Middlesbrough TS4 3BW, UK
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Anderson LR, Aldana-Bitar J, Manubolu VS, Verghese D, Alalawi L, Ramirez NR, Budoff MJ, Karlsberg RP. Encapsulated Calcified Hematoma Mimicking a Cardiac Tumor, Diagnosed 25 Years Post-Traumatic Injury. JACC Case Rep 2023; 18:101917. [PMID: 37545682 PMCID: PMC10401111 DOI: 10.1016/j.jaccas.2023.101917] [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: 02/02/2023] [Revised: 05/04/2023] [Accepted: 05/18/2023] [Indexed: 08/08/2023]
Abstract
A 45-year-old man presented with nonspecific symptoms caused by a mass compressing the right ventricle. Cardiac computed tomography accurately predicted the operative and pathologic appearance of the mass, and the final diagnosis of an encapsulated cardiac hematoma was confirmed by pathologic examination. This condition is infrequent and mimics a cardiac tumor. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Lauren R. Anderson
- Cardiovascular Research Foundation of Southern California, Beverly Hills, California, USA
| | - Jairo Aldana-Bitar
- Cardiovascular Research Foundation of Southern California, Beverly Hills, California, USA
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Venkat Sanjay Manubolu
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Dhiran Verghese
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Luay Alalawi
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Noah R. Ramirez
- Cardiovascular Research Foundation of Southern California, Beverly Hills, California, USA
| | - Matthew J. Budoff
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Ronald P. Karlsberg
- Cardiovascular Research Foundation of Southern California, Beverly Hills, California, USA
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Slipczuk L, Budoff MJ, Villines TC. Editorial: Old habits die hard: from risk calculators and stenosis evaluation to phenotyping coronary atherosclerosis using cardiac CT. Front Cardiovasc Med 2023; 10:1235144. [PMID: 37424898 PMCID: PMC10325718 DOI: 10.3389/fcvm.2023.1235144] [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: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Affiliation(s)
- Leandro Slipczuk
- Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States
| | - Matthew J. Budoff
- Department of Medicine, Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA, United States
| | - Todd C. Villines
- Cardiovascular Medicine, University of Virginia, Charlottesville, VA, United States
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Peters M, Port S, Sanders H, Sulemanjee N, Tajik AJ. Survival Into the Seventh Decade of Life Following Mustard Repair. JACC Case Rep 2023; 16:101885. [PMID: 37396333 PMCID: PMC10313480 DOI: 10.1016/j.jaccas.2023.101885] [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: 11/22/2022] [Revised: 04/20/2023] [Accepted: 04/25/2023] [Indexed: 07/04/2023]
Abstract
Atrial switch procedures (Senning and Mustard) for transposition of the great arteries have largely been abandoned for arterial switch procedures. The number of surviving patients who have undergone atrial switch procedures is declining. We present a case of the oldest known survivor (aged 67 years) of the Mustard procedure. (Level of Difficulty: Beginner.).
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Affiliation(s)
| | | | | | | | - A. Jamil Tajik
- Address for correspondence: Dr A. Jamil Tajik, Aurora Cardiovascular and Thoracic Services, Aurora St. Luke’s Medical Center, 2801 West Kinnickinnic River Parkway, Suite 880, Milwaukee, Wisconsin 53215, USA.
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23
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Nardone V, Belfiore MP, De Chiara M, De Marco G, Patanè V, Balestrucci G, Buono M, Salvarezza M, Di Guida G, D'Angiolella D, Grassi R, D'Onofrio I, Cimmino G, Della Corte CM, Gambardella A, Morgillo F, Ciardiello F, Reginelli A, Cappabianca S. CARdioimaging in Lung Cancer PatiEnts Undergoing Radical RadioTherapy: CARE-RT Trial. Diagnostics (Basel) 2023; 13:diagnostics13101717. [PMID: 37238201 DOI: 10.3390/diagnostics13101717] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Non-small-cell lung cancer (NSCLC) is a common, steady growing lung tumour that is often discovered when a surgical approach is forbidden. For locally advanced inoperable NSCLC, the clinical approach consists of a combination of chemotherapy and radiotherapy, eventually followed by adjuvant immunotherapy, a treatment that is useful but may cause several mild and severe adverse effect. Chest radiotherapy, specifically, may affect the heart and coronary artery, impairing heart function and causing pathologic changes in myocardial tissues. The aim of this study is to evaluate the damage coming from these therapies with the aid of cardiac imaging. METHODS This is a single-centre, prospective clinical trial. Patients with NSCLC who are enrolled will undergo computed tomography (CT) and magnetic resonance imaging (MRI) before chemotherapy 3 months, 6 months, and 9-12 months after the treatment. We expect to enrol 30 patients in 2 years. CONCLUSIONS Our clinical trial will be an opportunity not only to highlight the timing and the radiation dose needed for pathological cardiac tissue changes to happen but will also provide useful data to set new follow-up schedules and strategies, keeping in mind that, more often than not, patients affected by NSCLC may present other heart- and lung-related pathological conditions.
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Affiliation(s)
- Valerio Nardone
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Maria Paola Belfiore
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Marco De Chiara
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Giuseppina De Marco
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Vittorio Patanè
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Giovanni Balestrucci
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Mauro Buono
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Maria Salvarezza
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Gaetano Di Guida
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Domenico D'Angiolella
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Roberta Grassi
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Ida D'Onofrio
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
- Radiotherapy Unit, Ospedale del Mare, ASL Napoli 1 Centro, 80138 Naples, Italy
| | - Giovanni Cimmino
- Department of Translational Medical Science, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | | | - Antonio Gambardella
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Floriana Morgillo
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Fortunato Ciardiello
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Alfonso Reginelli
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Salvatore Cappabianca
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
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24
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Prandi FR, Lerakis S, Belli M, Illuminato F, Margonato D, Barone L, Muscoli S, Chiocchi M, Laudazi M, Marchei M, Di Luozzo M, Kini A, Romeo F, Barillà F. Advances in Imaging for Tricuspid Transcatheter Edge-to-Edge Repair: Lessons Learned and Future Perspectives. J Clin Med 2023; 12:jcm12103384. [PMID: 37240489 DOI: 10.3390/jcm12103384] [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: 03/22/2023] [Revised: 04/20/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
Severe tricuspid valve (TV) regurgitation (TR) has been associated with adverse long-term outcomes in several natural history studies, but isolated TV surgery presents high mortality and morbidity rates. Transcatheter tricuspid valve interventions (TTVI) therefore represent a promising field and may currently be considered in patients with severe secondary TR that have a prohibitive surgical risk. Tricuspid transcatheter edge-to-edge repair (T-TEER) represents one of the most frequently used TTVI options. Accurate imaging of the tricuspid valve (TV) apparatus is crucial for T-TEER preprocedural planning, in order to select the right candidates, and is also fundamental for intraprocedural guidance and post-procedural follow-up. Although transesophageal echocardiography represents the main imaging modality, we describe the utility and additional value of other imaging modalities such as cardiac CT and MRI, intracardiac echocardiography, fluoroscopy, and fusion imaging to assist T-TEER. Developments in the field of 3D printing, computational models, and artificial intelligence hold great promise in improving the assessment and management of patients with valvular heart disease.
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Affiliation(s)
- Francesca Romana Prandi
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
- Department of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Stamatios Lerakis
- Department of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Martina Belli
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Federica Illuminato
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Davide Margonato
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Lucy Barone
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Saverio Muscoli
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Marcello Chiocchi
- Department of Diagnostic Imaging and Interventional Radiology, Tor Vergata University, 00133 Rome, Italy
| | - Mario Laudazi
- Department of Diagnostic Imaging and Interventional Radiology, Tor Vergata University, 00133 Rome, Italy
| | - Massimo Marchei
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Marco Di Luozzo
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Annapoorna Kini
- Department of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Francesco Romeo
- Department of Departmental Faculty of Medicine, Unicamillus-Saint Camillus International University of Health and Medical Sciences, 00131 Rome, Italy
| | - Francesco Barillà
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
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25
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Estep JD, Disla JP. The Potential Role of CT Coronary Angiography and Dynamic CT MPI to Detect Early Cardiac Allograft Vasculopathy. JACC Cardiovasc Imaging 2023:S1936-878X(23)00183-3. [PMID: 37227334 DOI: 10.1016/j.jcmg.2023.03.017] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 05/26/2023]
Affiliation(s)
- Jerry D Estep
- Robert and Suzanne Tomsich Department of Cardiology, Section of Heart Failure and Cardiac Transplant Medicine and Section of General Cardiology and Imaging, Cleveland Clinic Florida, Weston, Florida, USA.
| | - Jenny P Disla
- Robert and Suzanne Tomsich Department of Cardiology, Section of Heart Failure and Cardiac Transplant Medicine and Section of General Cardiology and Imaging, Cleveland Clinic Florida, Weston, Florida, USA
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26
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Ahmed Z, Campeau D, Gong H, Rajendran K, Rajiah P, McCollough C, Leng S. High-pitch, high temporal resolution, multi-energy cardiac imaging on a dual-source photon-counting-detector CT. Med Phys 2023; 50:1428-1435. [PMID: 36427356 PMCID: PMC10033375 DOI: 10.1002/mp.16124] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 11/11/2022] [Accepted: 11/12/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To measure the accuracy of material decomposition using a dual-source photon-counting-detector (DS-PCD) CT operated in the high-pitch helical scanning mode and compare the results against dual-source energy-integrating-detector (DS-EID) CT, which requires use of a low-pitch value in dual-energy mode. METHODS A DS-PCD CT and a DS-EID CT were used to scan a cardiac motion phantom consisting of a 3-mm diameter iodine cylinder. Iodine maps were reconstructed using DS-PCD in high-pitch mode and DS-EID in low-pitch mode. Image-based circularity, diameter, and iodine concentration of the iodine cylinder were calculated and compared between the two scanners. With institutional review board approval, in vivo exams were performed with the DS-PCD CT in high-pitch mode. Images were qualitatively compared against patients with similar heart rates that were scanned with DS-EID CT in low-pitch dual-energy mode. RESULTS On iodine maps, the mean circularity was 0.97 ± 0.02 with DS-PCD in high-pitch mode and 0.95 ± 0.06 with DS-EID in low-pitch mode. The mean diameter was 2.9 ± 0.2 mm with DS-PCD and 3.1 ± 0.2 mm with DS-EID, both of which are close to the 3 mm ground truth. For DS-PCD, the mean iodine concentration was 9.6 ± 0.8 mg/ml and this was consistent with the 9.4 ± 0.6 mg/ml value obtained with the cardiac motion disabled. For DS-EID, the concentration was 12.7 ± 1.2 mg/ml with motion enabled and 11.7 ± 0.5 mg/ml disabled. The background noise in the iodine maps was 15.1 HU with DS-PCD and 14.4 HU with DS-EID, whereas the volume CT dose index (CTDIvol ) was 3 mGy with DS-PCD and 11 mGy with DS-EID. On comparison of six patients (three on PCD, three on EID) with similar heart rates, DS-PCD provided iodine maps with well-defined coronaries even at a high heart rate of 86 beats per minute. Meanwhile, there were substantial motion artifacts in iodine maps obtained with DS-EID for patients with similar heart rates. CONCLUSION In a cardiac motion phantom, DS-PCD CT can perform accurate material decomposition in high-pitch mode, providing iodine maps with excellent geometric accuracy and robustness to motion at approximately 38% of the dose for similar noise as DS-EID CT.
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Affiliation(s)
- Zaki Ahmed
- Department of Radiology, Mayo Clinic, Rochester, MN
| | - David Campeau
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN
| | - Hao Gong
- Department of Radiology, Mayo Clinic, Rochester, MN
| | | | | | | | - Shuai Leng
- Department of Radiology, Mayo Clinic, Rochester, MN
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27
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Meloni A, Frijia F, Panetta D, Degiorgi G, De Gori C, Maffei E, Clemente A, Positano V, Cademartiri F. Photon-Counting Computed Tomography (PCCT): Technical Background and Cardio-Vascular Applications. Diagnostics (Basel) 2023; 13. [PMID: 36832139 DOI: 10.3390/diagnostics13040645] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/28/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
Photon-counting computed tomography (PCCT) is a new advanced imaging technique that is going to transform the standard clinical use of computed tomography (CT) imaging. Photon-counting detectors resolve the number of photons and the incident X-ray energy spectrum into multiple energy bins. Compared with conventional CT technology, PCCT offers the advantages of improved spatial and contrast resolution, reduction of image noise and artifacts, reduced radiation exposure, and multi-energy/multi-parametric imaging based on the atomic properties of tissues, with the consequent possibility to use different contrast agents and improve quantitative imaging. This narrative review first briefly describes the technical principles and the benefits of photon-counting CT and then provides a synthetic outline of the current literature on its use for vascular imaging.
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28
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Dunning CAS, Rajiah PS, Hsieh SS, Esquivel A, Yalon M, Weber NM, Gong H, Fletcher JG, McCollough CH, Leng S. Classification of high-risk coronary plaques using radiomic analysis of multi-energy photon-counting-detector computed tomography (PCD-CT) images. Proc SPIE Int Soc Opt Eng 2023; 12465:124652T. [PMID: 37064414 PMCID: PMC10099708 DOI: 10.1117/12.2654412] [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] [Indexed: 04/18/2023]
Abstract
Coronary plaque risk classification in images acquired with photon-counting-detector (PCD) CT was performed using a radiomics-based machine learning (ML) model. With IRB approval, 19 coronary CTA patients were scanned on a PCD-CT (NAEOTOM Alpha, Siemens Healthineers) with median CTDIvol of 8.02 mGy. Five types of images: virtual monoenergetic images (VMIs) at 50-keV, 70-keV, and 100-keV, iodine maps, and virtual non-contrast (VNC) images were reconstructed using an iterative reconstruction algorithm (QIR), a quantitative kernel (Qr40) and 0.6-mm/0.3-mm slice thickness/increment. Atherosclerotic plaques were segmented using semi-automatic software (Research Frontier, Siemens). Segmentation confirmation and risk stratification (low- vs high-risk) were performed by a board-certified cardiac radiologist. A total of 93 radiomic features were extracted from each image using PyRadiomics (v2.2.0b1). For each feature, a t-test was performed between low- and high-risk plaques (p<0.05 considered significant). Two significant and non-redundant features were input into a support vector machine (SVM). A leave-one-out cross-validation strategy was adopted and the classification accuracy was computed. Fifteen low-risk and ten high-risk plaques were identified by the radiologist. A total of 18, 32, 43, 16, and 55 out of 93 features in 50-keV, 70-keV, 100-keV, iodine map, and VNC images were statistically significant. A total of 17, 19, 22, 20, and 22 out of 25 plaques were classified correctly in 50-keV, 70-keV, 100-keV, iodine map, and VNC images, respectively. A ML model using 100-keV VMIs and VNC images derived from coronary PCD-CTA best automatically differentiated low- and high-risk coronary plaques.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Shuai Leng
- ; phone 1 507 293 4233; www.mayo.edu/ctcic
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29
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Mandoli GE, Benfari G, Baggiano A, Florea R, Cameli M. Editorial: Advances in cardiac imaging and heart failure management. Front Cardiovasc Med 2023; 9:1095829. [PMID: 36698938 PMCID: PMC9869242 DOI: 10.3389/fcvm.2022.1095829] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 12/12/2022] [Indexed: 01/12/2023] Open
Affiliation(s)
- Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy,*Correspondence: Giulia Elena Mandoli ✉
| | - Giovanni Benfari
- Section of Cardiology, Department of Medicine, School of Medicine and Surgery, University of Verona, Verona, Italy
| | - Andrea Baggiano
- Peri Operative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Roxana Florea
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy,Emergency Clinical County Hospital, Arad, Romania
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
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30
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Muscogiuri G, Guglielmo M. Editorial: Multimodality imaging in the assessment of ischemic chronic coronary syndrome. Front Cardiovasc Med 2023; 10:1146050. [PMID: 37113705 PMCID: PMC10126425 DOI: 10.3389/fcvm.2023.1146050] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/28/2023] [Indexed: 04/29/2023] Open
Affiliation(s)
- Giuseppe Muscogiuri
- Department of Radiology, Istituto Auxologico Italiano IRCCS, San Luca Hospital, Milan, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
- Correspondence: Giuseppe Muscogiuri
| | - Marco Guglielmo
- Division of Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Department of Cardiology, Haga Teaching Hospital, The Hague, Netherlands
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31
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Harb SC, Krishnaswamy A, Kapadia SR, Miyasaka RL. The Inferior Vena Cava-Tricuspid Valve Anatomic Relationship: An Underrecognized Cornerstone for Transcatheter Tricuspid Valve Interventions. JACC Cardiovasc Imaging 2023; 16:118-127. [PMID: 36599557 DOI: 10.1016/j.jcmg.2022.07.023] [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] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Serge C Harb
- Department of Cardiovascular Medicine, Heart, Vascular; Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart, Vascular; Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular; Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rhonda L Miyasaka
- Department of Cardiovascular Medicine, Heart, Vascular; Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
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Almalki YE, Basha MAA, Alduraibi SK, Alshamrani K, Huneif MA, Alduraibi AK, Almedhesh SA, Alshamrani HA, Elbanna KAA, Algazzar YH, Metwally MI. Diagnostic Validity and Reliability of Low-Dose Prospective ECG-Triggering Cardiac CT in Preoperative Assessment of Complex Congenital Heart Diseases (CHDs). Children (Basel) 2022; 9. [PMID: 36553346 DOI: 10.3390/children9121903] [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] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/01/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
For the precise preoperative evaluation of complex congenital heart diseases (CHDs) with reduced radiation dose exposure, we assessed the diagnostic validity and reliability of low-dose prospective ECG-gated cardiac CT (CCT). Forty-two individuals with complex CHDs who underwent preoperative CCT as part of a prospective study were included. Each CCT image was examined independently by two radiologists. The primary reference for assessing the diagnostic validity of the CCT was the post-operative data. Infants and neonates were the most common age group suffering from complex CHDs. The mean volume of the CT dose index was 1.44 ± 0.47 mGy, the mean value of the dose-length product was 14.13 ± 5.4 mGy*cm, and the mean value of the effective radiation dose was 0.58 ± 0.13 mSv. The sensitivity, specificity, PPV, NPV, and accuracy of the low-dose prospective ECG-gated CCT for identifying complex CHDs were 95.6%, 98%, 97%, 97%, and 97% for reader 1 and 92.6%, 97%, 95.5%, 95.1%, and 95.2% for reader 2, respectively. The overall inter-reader agreement for interpreting the cardiac CCTs was good (κ = 0.74). According to the results of our investigation, low-dose prospective ECG-gated CCT is a useful and trustworthy method for assessing coronary arteries and making a precise preoperative diagnosis of complex CHDs.
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33
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Tanner R, Murphy S, Malone C, McGorrian C, Sugrue D, Barton D, Byrne R, Blake G, Margey R, Casserly IP. Correlation of aortic valve annular plane assessment by on-table three-dimensional rotational angiography and preprocedural computed tomography. Catheter Cardiovasc Interv 2022; 100:1316-1322. [PMID: 36403283 DOI: 10.1002/ccd.30469] [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: 05/09/2022] [Revised: 09/14/2022] [Accepted: 10/17/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To assess the correlation between the aortic valve annular plane (AVAP) obtained by preprocedural computed tomography (CT) with on-table three-dimensional rotational angiography (3DRA), in patients undergoing transcatheter aortic valve replacement (TAVR). BACKGROUND Accurate assessment of the AVAP is critical during TAVR procedures to enable optimal positioning and minimize complications. Most commonly, preprocedural CT has been used to determine the AVAP. However, this can differ from the actual AVAP obtained during the TAVR procedure. METHODS Consecutive TAVR patients at a single center undergoing both preprocedural CT and 3DRA were included in the study. The AVAP assessment by CT was performed using 3mensio software (Pie Medical Imaging). 3DRA assessment was performed using DynaCT (Siemens). RESULTS A total of 100 patients were included in the analysis. A difference of ≥5° and ≥10° in both the LAO/RAO and cranial/caudal components of the AVAP projection angle as assessed by CT and 3DRA was recorded in 39% and 10% of patients, respectively. The concordance correlation coefficient for the LAO/RAO and cranial/caudal implantation angles was 0.519 (95% CI: 0.377-0.661) and 0.558 (95% CI: 0.432-0.684), respectively. CONCLUSION Correlation between preprocedural CT and on-table 3DRA in the prediction of the actual AVAP at the time of TAVR implantation is moderate.
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Affiliation(s)
- Richard Tanner
- Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Sean Murphy
- Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Ciara Malone
- Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Catherine McGorrian
- Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Declan Sugrue
- Department of Cardiology, Mater Private Hospital, Dublin, Ireland
| | - David Barton
- Department of Cardiology, Mater Private Hospital, Dublin, Ireland
| | - Roger Byrne
- Department of Cardiology, Mater Private Hospital, Dublin, Ireland
| | - Gavin Blake
- Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland.,Department of Cardiology, Mater Private Hospital, Dublin, Ireland
| | - Ronan Margey
- Department of Cardiology, Mater Private Hospital, Dublin, Ireland
| | - Ivan P Casserly
- Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland.,Department of Cardiology, Mater Private Hospital, Dublin, Ireland
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Ivanovic B, Popovic J, Dukic D, Petkovic A, Petrovic O. The role of imaging in infective endocarditis. J Clin Ultrasound 2022; 50:1060-1065. [PMID: 36218208 DOI: 10.1002/jcu.23346] [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] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/02/2022] [Accepted: 09/02/2022] [Indexed: 06/16/2023]
Abstract
Infective endocarditis (IE) poses a large diagnostic and therapeutical challenge. An early diagnosis is necessary for a positive outcome. Echocardiography is initial diagnostic method when there is a possibility of IE presence. TTE and TEE are useful in detection, accurate localisation and estimation of vegetation size, and also in detection of paravalvular spreading of infection. In certain situations, there is a need for usage of complementary methods like CCT and nuclear techniques. This article will outline advantages and limitations of certain diagnostic methods in diagnosis of IE.
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Affiliation(s)
- Branislava Ivanovic
- Cardiology Clinic, University Clinical Centre of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jovana Popovic
- Cardiology Clinic, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Djordje Dukic
- Cardiology Clinic, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Ana Petkovic
- Center of Radiology and MRI, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Olga Petrovic
- Cardiology Clinic, University Clinical Centre of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
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Manohar A, Colvert GM, Ortuño JE, Chen Z, Yang J, Colvert BT, Bandettini WP, Chen MY, Ledesma-Carbayo MJ, McVeigh ER. Regional left ventricular endocardial strains estimated from low-dose 4DCT: Comparison with cardiac magnetic resonance feature tracking. Med Phys 2022; 49:5841-5854. [PMID: 35751864 PMCID: PMC9474637 DOI: 10.1002/mp.15818] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 03/17/2022] [Revised: 05/31/2022] [Accepted: 06/10/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Estimates of regional left ventricular (LV) strains provide additional information to global function parameters such as ejection fraction (EF) and global longitudinal strain (GLS) and are more sensitive in detecting abnormal regional cardiac function. The accurate and reproducible assessment of regional cardiac function has implications in the management of various cardiac diseases such as heart failure, myocardial ischemia, and dyssynchrony. PURPOSE To develop a method that yields highly reproducible, high-resolution estimates of regional endocardial strains from 4DCT images. METHODS A method for estimating regional LV endocardial circumferential( ε c c ) $( {{\epsilon }_{cc}} )$ and longitudinal (ε l l ${\epsilon }_{ll}$ ) strains from 4DCT was developed. Point clouds representing the LV endocardial surface were extracted for each time frame of the cardiac cycle from 4DCT images. 3D deformation fields across the cardiac cycle were obtained by registering the end diastolic point cloud to each subsequent point cloud in time across the cardiac cycle using a 3D point-set registration technique. From these deformation fields,ε c c and ε l l ${\epsilon }_{cc}\ {\rm{and\ }}{\epsilon }_{ll}$ were estimated over the entire LV endocardial surface by fitting an affine transformation with maximum likelihood estimation. The 4DCT-derived strains were compared with strains estimated in the same subjects by cardiac magnetic resonance (CMR); twenty-four subjects had CMR scans followed by 4DCT scans acquired within a few hours. Regional LV circumferential and longitudinal strains were estimated from the CMR images using a commercially available feature tracking software (cvi42). Global circumferential strain (GCS) and global longitudinal strain (GLS) were calculated as the mean of the regional strains across the entire LV for both modalities. Pearson correlation coefficients and Bland-Altman analyses were used for comparisons. Intraclass correlation coefficients (ICC) were used to assess the inter- and intraobserver reproducibility of the 4DCT-derived strains. RESULTS The 4DCT-derived regional strains correlated well with the CMR-derived regional strains (ε c c ${\epsilon }_{cc}$ : r = 0.76, p < 0.001;ε l l ${\epsilon }_{ll}$ : r = 0.64, p < 0.001). A very strong correlation was found between 4DCT-derived GCS and 4DCT-derived EF (r = -0.96; p < 0.001). The 4DCT-derived strains were also highly reproducible, with very low inter- and intraobserver variability (intraclass correlation coefficients in the range of [0.92, 0.99]). CONCLUSIONS We have developed a novel method to estimate high-resolution regional LV endocardial circumferential and longitudinal strains from 4DCT images. Except for the definition of the mitral valve and LV outflow tract planes, the method is completely user independent, thus yielding highly reproducible estimates of endocardial strain. The 4DCT-derived strains correlated well with those estimated using a commercial CMR feature tracking software. The promising results reported in this study highlight the potential utility of 4DCT in the precise assessment of regional cardiac function for the management of cardiac disease.
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Affiliation(s)
- Ashish Manohar
- Department of Mechanical and Aerospace Engineering, University of California San Diego, La Jolla, California, USA
| | - Gabrielle M Colvert
- Department of Bioengineering, University of California San Diego, La Jolla, California, USA
| | - Juan E Ortuño
- Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine, Madrid, Spain
- Biomedical Image Technologies Laboratory, ETSI Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain
| | - Zhennong Chen
- Department of Bioengineering, University of California San Diego, La Jolla, California, USA
| | - James Yang
- Department of Bioengineering, University of California San Diego, La Jolla, California, USA
| | - Brendan T Colvert
- Department of Bioengineering, University of California San Diego, La Jolla, California, USA
| | - W Patricia Bandettini
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Marcus Y Chen
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - María J Ledesma-Carbayo
- Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine, Madrid, Spain
- Biomedical Image Technologies Laboratory, ETSI Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain
| | - Elliot R McVeigh
- Department of Bioengineering, University of California San Diego, La Jolla, California, USA
- Department of Radiology, University of California San Diego, La Jolla, California, USA
- Department of Medicine, Cardiovascular Division, University of California San Diego, La Jolla, California, USA
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Halaby R, Vidula MK, Gillespie MJ, Herrmann HC, Chen T. Multimodality Imaging for Procedural Planning and Guidance of Percutaneous Sinus Venosus Defect Closure. JACC Cardiovasc Interv 2022; 15:e187-e188. [PMID: 35907748 DOI: 10.1016/j.jcin.2022.06.025] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 06/14/2022] [Indexed: 10/16/2022]
Affiliation(s)
- Rim Halaby
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mahesh K Vidula
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew J Gillespie
- Division of Cardiovascular Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Howard C Herrmann
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tiffany Chen
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Pack JD, Manohar A, Ramani S, Claus B, Yin Z, Contijoch FJ, Schluchter AJ, McVeigh ER. Four-dimensional computed tomography of the left ventricle, Part I: Motion artifact reduction. Med Phys 2022; 49:4404-4418. [PMID: 35588288 DOI: 10.1002/mp.15709] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 07/26/2021] [Revised: 04/20/2022] [Accepted: 04/22/2022] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Standard four-dimensional computed tomography (4DCT) cardiac reconstructions typically include spiraling artifacts that depend not only on the motion of the heart but also on the gantry angle range over which the data was acquired. We seek to reduce these motion artifacts and, thereby, improve the accuracy of left ventricular wall positions in 4DCT image series. METHODS We use a motion artifact reduction approach (ResyncCT) that is based largely on conjugate pairs of partial angle reconstruction (PAR) images. After identifying the key locations where motion artifacts exist in the uncorrected images, paired subvolumes within the PAR images are analyzed with a modified cross-correlation function in order to estimate 3D velocity and acceleration vectors at these locations. A subsequent motion compensation process (also based on PAR images) includes the creation of a dense motion field, followed by a backproject-and-warp style compensation. The algorithm was tested on a 3D printed phantom, which represents the left ventricle (LV) and on challenging clinical cases corrupted by severe artifacts. RESULTS The results from our preliminary phantom test as well as from clinical cardiac scans show crisp endocardial edges and resolved double-wall artifacts. When viewed as a temporal series, the corrected images exhibit a much smoother motion of the LV endocardial boundary as compared to the uncorrected images. In addition, quantitative results from our phantom studies show that ResyncCT processing reduces endocardial surface distance errors from 0.9 ± 0.8 to 0.2 ± 0.1 mm. CONCLUSIONS The ResyncCT algorithm was shown to be effective in reducing motion artifacts and restoring accurate wall positions. Some perspectives on the use of conjugate-PAR images and on techniques for CT motion artifact reduction more generally are also given.
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Affiliation(s)
- Jed D Pack
- Radiation Systems Lab, GE Global Research, Niskayuna, New York, USA
| | - Ashish Manohar
- Department of Mechanical and Aerospace Engineering, UC San Diego School of Engineering, La Jolla, California, USA
| | - Sathish Ramani
- Radiation Systems Lab, GE Global Research, Niskayuna, New York, USA
| | - Bernhard Claus
- Radiation Systems Lab, GE Global Research, Niskayuna, New York, USA
| | - Zhye Yin
- Radiation Systems Lab, GE Global Research, Niskayuna, New York, USA
| | - Francisco J Contijoch
- Department of Bioengineering, UC San Diego School of Engineering, La Jolla, California, USA
- Department of Radiology, UC San Diego School of Medicine, La Jolla, California, USA
| | - Andrew J Schluchter
- Department of Bioengineering, UC San Diego School of Engineering, La Jolla, California, USA
| | - Elliot R McVeigh
- Department of Bioengineering, UC San Diego School of Engineering, La Jolla, California, USA
- Department of Medicine, Division of Cardiology, UC San Diego School of Medicine, La Jolla, California, USA
- Department of Radiology, UC San Diego School of Medicine, La Jolla, California, USA
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Sozzi FB, Iacuzio L, Schiavone M, Civaia F, Carugo S, Canetta C, Levy F, Eker A. Extensive intra-myocardial calcifications: Value of multimodality imaging. Echocardiography 2022; 39:855-858. [PMID: 35505624 PMCID: PMC9322312 DOI: 10.1111/echo.15357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/06/2021] [Revised: 03/20/2022] [Accepted: 04/09/2022] [Indexed: 11/27/2022] Open
Abstract
Background Massive myocardial calcification is a very rare finding. Introduction Accurate identification and characteriation may help the clinicians to determine the etiology and clinical
significance. Results In this case, the diagnostic pathway excluded previous myocardial infarction, myocarditis, and calcium‐phosphate disorders. A possible dystrophic etiology was considered. Discussion There are no standardized imaging features available to classify specific subtypes of intra‐myocardial calcifications. The relative merits of computed tomography and cardiac magnetic resonance (CMR) in providing complimentary diagnostic information in the evaluation of calcific myocardial lesions are shown. Conclusion Knowledge of the potential etiology and their imging patterns are important to provide a concise and accurate differential diagnosis.
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Affiliation(s)
| | | | | | | | - Stefano Carugo
- Cardiology Unit, Luigi Sacco University Hospital, Milan, IT
| | - Ciro Canetta
- Cardiology Unit, Luigi Sacco University Hospital, Milan, IT
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Manohar A, Pack JD, Schluchter AJ, McVeigh ER. Four-dimensional computed tomography of the left ventricle, Part II: Estimation of mechanical activation times. Med Phys 2022; 49:2309-2323. [PMID: 35192200 PMCID: PMC9007845 DOI: 10.1002/mp.15550] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 07/24/2021] [Revised: 01/27/2022] [Accepted: 02/13/2022] [Indexed: 11/11/2022] Open
Abstract
PURPOSE We demonstrate the viability of a four-dimensional X-ray computed tomography (4DCT) imaging system to accurately and precisely estimate mechanical activation times of left ventricular (LV) wall motion. Accurate and reproducible timing estimates of LV wall motion may be beneficial in the successful planning and management of cardiac resynchronization therapy (CRT). METHODS We developed an anthropomorphically accurate in silico LV phantom based on human CT images with programmed septal-lateral wall dyssynchrony. Twenty-six temporal phases of the in silico phantom were used to sample the cardiac cycle of 1 s. For each of the 26 phases, 1 cm thick axial slabs emulating axial CT image volumes were extracted, 3D printed, and imaged using a commercially available CT scanner. A continuous dynamic sinogram was synthesized by blending sinograms from these static phases; the synthesized sinogram emulated the sinogram that would be acquired under true continuous phantom motion. Using the synthesized dynamic sinogram, images were reconstructed at 70 ms intervals spanning the full cardiac cycle; these images exhibited expected motion artifact characteristics seen in images reconstructed from real dynamic data. The motion corrupted images were then processed with a novel motion correction algorithm (ResyncCT) to yield motion corrected images. Five pairs of motion uncorrected and motion corrected images were generated, each corresponding to a different starting gantry angle (0 to 180 degrees in 45 degree increments). Two line profiles perpendicular to the endocardial surface were used to sample local myocardial motion trajectories at the septum and the lateral wall. The mechanical activation time of wall motion was defined as the time at which the endocardial boundary crossed a fixed position defined on either of the two line profiles while moving toward the center of the LV during systolic contraction. The mechanical activation times of these myocardial trajectories estimated from the motion uncorrected and the motion corrected images were then compared with those derived from the static images of the 3D printed phantoms (ground truth). The precision of the timing estimates was obtained from the five different starting gantry angle simulations. RESULTS The range of estimated mechanical activation times observed across all starting gantry angles was significantly larger for the motion uncorrected images than for the motion corrected images (lateral wall: 58 ± 15 ms vs 12 ± 4 ms, p < 0.005; septal wall: 61 ± 13 ms vs 13 ± 9 ms, p < 0.005). CONCLUSIONS 4DCT images processed with the ResyncCT motion correction algorithm yield estimates of mechanical activation times of LV wall motion with significantly improved accuracy and precision. The promising results reported in this study highlight the potential utility of 4DCT in estimating the timing of mechanical events of interest for CRT guidance.
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Affiliation(s)
- Ashish Manohar
- Department of Mechanical and Aerospace Engineering, UC San Diego School of Engineering, La Jolla, California, USA
| | - Jed D Pack
- Radiation Systems Lab, GE Global Research, Niskayuna, New York, USA
| | - Andrew J Schluchter
- Department of Bioengineering, UC San Diego School of Engineering, La Jolla, California, USA
| | - Elliot R McVeigh
- Department of Bioengineering, UC San Diego School of Engineering, La Jolla, California, USA
- Department of Radiology, University of California San Diego, La Jolla, California, USA
- Department of Medicine, Cardiovascular Division, UC San Diego School of Medicine, La Jolla, California, USA
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Vasquez Choy AL, Adebo DA, John S, Greenleaf CE, Salazar JD, Corno AF. Essential role of cardiac computed tomography for surgical decision making in children with total anomalous pulmonary venous connection and single ventricle. J Card Surg 2022; 37:1544-1549. [PMID: 35315129 DOI: 10.1111/jocs.16427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/04/2022] [Accepted: 02/23/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Total anomalous pulmonary venous connection (TAPVC) is a major risk factor in infants with single ventricle (SV). Exact definition of TAPVC anatomy is crucial for surgical planning. AIM To evaluate the role of cardiac computed tomography (CT) in this setting. METHODS Retrospective review of 13 infants who underwent TAPVC repair associated with SV from May 2016 to October 2021. Anatomy, incidence, and mechanisms of pulmonary venous obstruction (PVO) were described. Cardiac CT diagnostic yield was compared to echocardiography (echo). RESULTS Of 13 infants, median age and weight were 24 days (range 2-303 days) and 3.2 (range 2.6-9.1) kg, 8 (62%) were male, 4 (31%) premature, and 11 (85%) had heterotaxy syndrome. All infants had pre- and postoperative echo; 13 had preoperative and 8 (62%) had postoperative cardiac CT. Type of TAPVC: six (46%) supracardiac, two (15%) intracardiac, one (8%) infracardiac, and four (31%) mixed, with pulmonary veins draining in >1 confluence in nine (69%). PVO was present in 6/13 (46%) preoperatively and 5/13 (31%) postoperatively. Mechanisms of PVO: 9/11 (82%) stenosis, 1/9 (9%) membrane formation, and 1/9 (9%) external compression. The sensitivity to diagnose PVO was 45.5% for echo and 100% for cardiac CT, the specificity was 100% for both. No discrepancy was found between cardiac CT and intraoperative findings, but echo had a complete preoperative diagnosis in 1/13 (8%) (p < .00001, Fisher exact test). CONCLUSIONS Cardiac CT is essential to evaluate pre- and postoperative TAPVC in SV for surgical decision making and long term follow up.
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Affiliation(s)
- Ana L Vasquez Choy
- Division of Pediatric Cardiology, Children's Heart Institute, University of Texas Medical School at Houston, Houston, Texas, USA
| | - Dilachew A Adebo
- Division of Pediatric Cardiology, Children's Heart Institute, University of Texas Medical School at Houston, Houston, Texas, USA
| | - Sheba John
- Division of Pediatric Cardiology, Children's Heart Institute, University of Texas Medical School at Houston, Houston, Texas, USA
| | - Christopher E Greenleaf
- Division of Pediatric and Congenital Heart Surgery, Memorial Hermann Hospital, Children's Heart Institute, University of Texas Health McGovern Medical School, Houston, Texas, USA
| | - Jorge D Salazar
- Division of Pediatric and Congenital Heart Surgery, Memorial Hermann Hospital, Children's Heart Institute, University of Texas Health McGovern Medical School, Houston, Texas, USA
| | - Antonio F Corno
- Division of Pediatric and Congenital Heart Surgery, Memorial Hermann Hospital, Children's Heart Institute, University of Texas Health McGovern Medical School, Houston, Texas, USA
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Adeboye A, Alkhatib D, Butt A, Yedlapati N, Garg N. A Review of the Role of Imaging Modalities in the Evaluation of Viral Myocarditis with a Special Focus on COVID-19-Related Myocarditis. Diagnostics (Basel) 2022; 12:549. [PMID: 35204637 DOI: 10.3390/diagnostics12020549] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/03/2022] [Accepted: 02/06/2022] [Indexed: 12/12/2022] Open
Abstract
Viral myocarditis is inflammation of the myocardium secondary to viral infection. The clinical presentation of viral myocarditis is very heterogeneous and can range from nonspecific symptoms of malaise and fatigue in subclinical disease to a more florid presentation, such as acute cardiogenic shock and sudden cardiac death in severe cases. The accurate and prompt diagnosis of viral myocarditis is very challenging. Endomyocardial biopsy is considered to be the gold standard test to confirm viral myocarditis; however, it is an invasive procedure, and the sensitivity is low when myocardial involvement is focal. Cardiac imaging hence plays an essential role in the noninvasive evaluation of viral myocarditis. The current coronavirus disease 2019 (COVID-19) pandemic has generated considerable interest in the use of imaging in the early detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related myocarditis. This article reviews the role of various cardiac imaging modalities used in the diagnosis and assessment of viral myocarditis, including COVID-19-related myocarditis.
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Wang X, De Backer O, Bieliauskas G, Wong I, Bajoras V, Xiong TY, Zhang Y, Kofoed KF, Chen M, Sondergaard L. Cusp Symmetry and Coronary Ostial Eccentricity and its Impact on Coronary Access Following TAVR. JACC Cardiovasc Interv 2022; 15:123-134. [PMID: 35057982 DOI: 10.1016/j.jcin.2021.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 08/10/2021] [Revised: 11/03/2021] [Accepted: 11/09/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The aim of this study was to assess cusp symmetry and coronary ostial eccentricity and its impact on coronary access following transcatheter aortic valve replacement (TAVR) using a patient-specific commissural alignment implantation technique. BACKGROUND TAVR implantation techniques to obtain neocommissural alignment have been introduced. The impact of cusp symmetry and coronary ostial eccentricity on coronary access after TAVR remains unknown. METHODS Cardiac computed tomographic scans from 200 tricuspid aortic valves (TAVs) and 200 type 1 bicuspid aortic valves (BAVs) were studied. Cusp symmetry and coronary ostial eccentricity were assessed. In addition, the right coronary cusp/left coronary cusp and right coronary artery (RCA)/left coronary artery (LCA) ostia overlap views were calculated and compared. RESULTS Severe cusp asymmetry (>135°) was more frequent in BAVs (52.5%) than in TAVs (2.5%) (P < 0.001), with the noncoronary cusp being the most common dominant cusp. The RCA ostium was found to be more often eccentric (>20°) than the LCA ostium (28% vs 6%, respectively; P < 0.001). Considering the right/left cusp overlap view, there was <20° deviation between the right coronary cusp-left coronary cusp centered line and the RCA-LCA centered line in 95% of all patients (TAV, 97%; BAV, 93%). The right/left cusp and coronary ostia overlap view differed by <10° and <20° fluoroscopic angulation in 75% and 98% of all cases, respectively. CONCLUSIONS Using the right/left cusp overlap view to obtain commissural alignment in TAVR is also an effective approach to implant one of the transcatheter heart valve commissures in the near center between both coronary ostia in most TAVs and type 1 BAVs. Preprocedural CT assessment remains crucial to assess cusp symmetry and coronary ostial eccentricity.
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Affiliation(s)
- Xi Wang
- Department of Cardiology, West China Hospital, Sichuan University, China; The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ole De Backer
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gintautas Bieliauskas
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ivan Wong
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Vilhelmas Bajoras
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Tian-Yuan Xiong
- Department of Cardiology, West China Hospital, Sichuan University, China
| | - Yi Zhang
- Department of Cardiology, West China Hospital, Sichuan University, China
| | - Klaus Fuglsang Kofoed
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, China.
| | - Lars Sondergaard
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Ciliberti P, Ciancarella P, Bruno P, Curione D, Bordonaro V, Lisignoli V, Panebianco M, Chinali M, Secinaro A, Galletti L, Guccione P. Cardiac Imaging in Patients After Fontan Palliation: Which Test and When? Front Pediatr 2022; 10:876742. [PMID: 35652057 PMCID: PMC9149285 DOI: 10.3389/fped.2022.876742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/13/2022] [Indexed: 11/13/2022] Open
Abstract
The Fontan operation represents the final stage of a series of palliative surgical procedures for children born with complex congenital heart disease, where a "usual" biventricular physiology cannot be restored. The palliation results in the direct connection of the systemic venous returns to the pulmonary arterial circulation without an interposed ventricle. In this unique physiology, systemic venous hypertension and intrathoracic pressures changes due to respiratory mechanics play the main role for propelling blood through the pulmonary vasculature. Although the Fontan operation has dramatically improved survival in patients with a single ventricle congenital heart disease, significant morbidity is still a concern. Patients with Fontan physiology are in fact suffering from a multitude of complications mainly due to the increased systemic venous pressure. Consequently, these patients need close clinical and imaging monitoring, where cardiac exams play a key role. In this article, we review the main cardiac imaging modalities available, summarizing their main strengths and limitations in this peculiar setting. The main purpose is to provide a practical approach for all clinicians involved in the care of these patients, even for those less experienced in cardiac imaging.
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Affiliation(s)
- Paolo Ciliberti
- Department of Cardiac Surgery, Cardiology, Heart and Lung Transplantation Bambino Gesu' Children's Hospital, IRCCS, Rome, Italy
| | - Paolo Ciancarella
- Advanced Cardiothoracic Imaging Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Pasqualina Bruno
- Department of Cardiac Surgery, Cardiology, Heart and Lung Transplantation Bambino Gesu' Children's Hospital, IRCCS, Rome, Italy
| | - Davide Curione
- Advanced Cardiothoracic Imaging Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Veronica Bordonaro
- Advanced Cardiothoracic Imaging Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Veronica Lisignoli
- Department of Cardiac Surgery, Cardiology, Heart and Lung Transplantation Bambino Gesu' Children's Hospital, IRCCS, Rome, Italy
| | - Mario Panebianco
- Department of Cardiac Surgery, Cardiology, Heart and Lung Transplantation Bambino Gesu' Children's Hospital, IRCCS, Rome, Italy
| | - Marcello Chinali
- Department of Cardiac Surgery, Cardiology, Heart and Lung Transplantation Bambino Gesu' Children's Hospital, IRCCS, Rome, Italy
| | - Aurelio Secinaro
- Advanced Cardiothoracic Imaging Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Lorenzo Galletti
- Department of Cardiac Surgery, Cardiology, Heart and Lung Transplantation Bambino Gesu' Children's Hospital, IRCCS, Rome, Italy
| | - Paolo Guccione
- Department of Cardiac Surgery, Cardiology, Heart and Lung Transplantation Bambino Gesu' Children's Hospital, IRCCS, Rome, Italy
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Conte E, Mushtaq S, Mancini ME, Annoni A, Formenti A, Muscogiuri G, Gaudenzi Asinelli M, Gigante C, Collet C, Sonck J, Guglielmo M, Baggiano A, Cosentino N, Denora M, Belmonte M, Agalbato C, Esposito AA, Assanelli E, Bartorelli AL, Pepi M, Pontone G, Andreini D. Cardiac Care of Non-COVID-19 Patients During the SARS-CoV-2 Pandemic: The Pivotal Role of CCTA. Front Cardiovasc Med 2021; 8:775115. [PMID: 34901235 PMCID: PMC8652066 DOI: 10.3389/fcvm.2021.775115] [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: 09/13/2021] [Accepted: 10/15/2021] [Indexed: 11/13/2022] Open
Abstract
Aim: The aim of this study is to evaluate the potential use of coronary CT angiography (CCTA) as the sole available non-invasive diagnostic technique for suspected coronary artery disease (CAD) during the coronavirus disease 2019 (COVID-19) pandemic causing limited access to the hospital facilities. Methods and Results: A consecutive cohort of patients with suspected stable CAD and clinical indication to non-invasive test was enrolled in a hub hospital in Milan, Italy, from March 9 to April 30, 2020. Outcome measures were obtained as follows: cardiac death, ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina. All the changes in medical therapy following the result of CCTA were annotated. A total of 58 patients with a mean age of 64 ± 11 years (36 men and 22 women) were enrolled. CCTA showed no CAD in 14 patients (24.1%), non-obstructive CAD in 30 (51.7%) patients, and obstructive CAD in 14 (24.1%) patients. Invasive coronary angiography (ICA) was considered deferrable in 48 (82.8%) patients. No clinical events were recorded after a mean follow-up of 376.4 ± 32.1 days. Changes in the medical therapy were significantly more prevalent in patients with vs. those without CAD at CCTA. Conclusion: The results of the study confirm the capability of CCTA to safely defer ICA in the majority of symptomatic patients and to correctly identify those with critical coronary stenoses necessitating coronary revascularization. This characteristic could be really helpful especially when the hospital resources are limited
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Affiliation(s)
- Edoardo Conte
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.,Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Milan, Italy
| | - Saima Mushtaq
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Milan, Italy
| | | | - Andrea Annoni
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Milan, Italy
| | - Alberto Formenti
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Milan, Italy
| | - Giuseppe Muscogiuri
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Milan, Italy
| | | | - Carlo Gigante
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Milan, Italy
| | - Carlos Collet
- Cardiovascular Center Aalst, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
| | - Jeroen Sonck
- Cardiovascular Center Aalst, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium.,Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Marco Guglielmo
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Milan, Italy
| | - Andrea Baggiano
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Milan, Italy
| | - Nicola Cosentino
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Milan, Italy
| | - Marialessia Denora
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Milan, Italy
| | - Marta Belmonte
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Milan, Italy
| | - Cecilia Agalbato
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Milan, Italy
| | - Andrea Alessandro Esposito
- Foundation Istituto di Ricerca e Cura a Carattere Scientifico Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Emilio Assanelli
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Milan, Italy
| | - Antonio L Bartorelli
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Milan, Italy.,Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Mauro Pepi
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Milan, Italy
| | - Gianluca Pontone
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
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45
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John S, Schoeneberg L, Greenleaf CE, Salazar JD, Adebo DA. Pre- and post-operative cardiovascular CT in Stage I single ventricle palliation. J Card Surg 2021; 37:322-328. [PMID: 34845746 DOI: 10.1111/jocs.16162] [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: 10/23/2021] [Accepted: 11/18/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The aim of this study is to describe clinical utility of low dose cardiac computed tomography (CT) in the evaluation of single ventricle physiology before and after Stage I palliation. BACKGROUND Despite the increased utilization of CT imaging and advancement of CT technology, there are limited studies describing the routine clinical use of cardiac CT and radiation dose parameters in the single ventricle Stage I palliation. METHODS This single center, retrospective study included 57 infants with single ventricle physiology who underwent cardiac CT scans between January 1, 2016 and November 30, 2020. Patients' demographic information, diagnosis, indication, total dose length product (DLP), computed tomographic dose index volume (CTDIvol), cardiac CT findings and intraoperative or intraprocedural findings were reviewed. Estimated effective radiation dose was calculated using a previously published conversion rate. RESULTS The studies were performed using different generations of CT scanners over the 4 years period: Somatom AS 128, Somatom definition edge, Somatom Force (Siemens Medical Solutions). The studies performed with dual source scanner with prospective gated technique have lower radiation dose exposure with median effective radiation dose of 0.32 mSv. CONCLUSION Pre- and post-operative cardiovascular CT in Stage I single ventricle palliation using newer generation scanners with prospective gated technique can be done with minimal radiation exposure and good image quality. Cardiac CT is a powerful imaging modality for better management planning in this group of patients.
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Affiliation(s)
- Sheba John
- Division of Pediatric Cardiology, Children's Heart Institute, University of Texas Medical School at Houston, Houston, Texas, USA
| | - Laura Schoeneberg
- Division of Pediatric Cardiology, Children's Heart Institute, University of Texas Medical School at Houston, Houston, Texas, USA
| | - Christopher E Greenleaf
- Division of Cardiothoracic Surgery, Children's Heart Institute, Memorial Hermann Hospital, University of Texas Health McGovern Medical School, Houston, Texas, USA
| | - Jorge D Salazar
- Division of Cardiothoracic Surgery, Children's Heart Institute, Memorial Hermann Hospital, University of Texas Health McGovern Medical School, Houston, Texas, USA
| | - Dilachew A Adebo
- Division of Pediatric Cardiology, Children's Heart Institute, University of Texas Medical School at Houston, Houston, Texas, USA
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46
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Lebedev S, Fournié E, Maier J, Stierstorfer K, Kachelrieß M. Motion compensation for aortic valves using partial angle CT reconstructions motion compensation of cardiac valve CT. Med Phys 2021; 49:1495-1506. [PMID: 34822186 DOI: 10.1002/mp.15379] [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: 03/03/2021] [Revised: 09/28/2021] [Accepted: 11/02/2021] [Indexed: 11/07/2022] Open
Abstract
PURPOSE A motion compensation method that is aimed at correcting motion artifacts of cardiac valves is proposed. The primary focus is the aortic valve. METHODS The method is based around partial angle reconstructions and a cost function including the image entropy. A motion model is applied to approximate the cardiac motion in the temporal and spatial domain. Based on characteristic values for velocities and strain during cardiac motion, penalties for the velocity and spatial derivatives are introduced to maintain anatomically realistic motion vector fields and avoid distortions. The model addresses global elastic deformation, but not the finer and more complicated motion of the valve leaflets. RESULTS The method is verified based on clinical data. Image quality was improved for most artifact impaired reconstructions. An image quality study with Likert scoring of the motion artifact severity on a scale from 1 (highest image quality) to 5 (lowest image quality/extreme artifact presence) was performed. The biggest improvements after applying motion compensation were achieved for strongly artifact impaired initial images scoring 4 and 5, resulting in an average change of the scores by -0.59 ± 0.06 and -1.33 ± 0.03, respectively. In case of artifact free images, a chance to introduce blurring was observed and their average score was raised by 0.42 ± 0.03. CONCLUSION Motion artifacts were consistently removed and image quality improved.
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Affiliation(s)
- Sergej Lebedev
- X-Ray Imaging and Computed Tomography, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Siemens Healthineers, Forchheim, Germany
- Department of Physics and Astronomy, University of Heidelberg, Heidelberg, Germany
| | | | - Joscha Maier
- X-Ray Imaging and Computed Tomography, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Marc Kachelrieß
- X-Ray Imaging and Computed Tomography, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Medical Faculty, University of Heidelberg, Heidelberg, Germany
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47
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Vora K, Surana U, Ranjan A. Sinus of Valsalva Rupture or VSD Shunt: Mystery Solved by Cardiac CT. Indian J Radiol Imaging 2021; 31:748-750. [PMID: 34790329 PMCID: PMC8590545 DOI: 10.1055/s-0041-1735924] [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: 11/24/2022] Open
Abstract
Unruptured aneurysm of sinus of Valsalva is an asymptomatic pathology and diagnosed incidentally. This extremely rare anomaly can be associated with other congenital cardiac anomalies which can make the diagnosis and prognosis even more complex. We are reporting a case of a 12-year-old boy with progressive dyspnea and episodes of syncope. Multimodality imaging confirmed the diagnosis and paved the way for appropriate surgical treatment options.
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Affiliation(s)
- Keyur Vora
- Department of Cardiac Imaging, Kiran Multisuperspecialty Hospital & Research Center, Surat, Gujarat, India
| | - Uday Surana
- Department of Radiology, Kiran Multisuperspecialty Hospital & Research Center, Surat, Gujarat, India
| | - Alok Ranjan
- Department of Cardiology, Kiran Multisuperspecialty Hospital & Research Center, Surat, Gujarat, India
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48
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Qin HY, Wang C, Qian DD, Cui C, Chen ML. Epicardial Adipose Tissue Measured From Computed Tomography Predicts Cardiac Resynchronization Therapy Response in Patients With Non-ischemic Systolic Heart Failure. Front Cardiovasc Med 2021; 8:678467. [PMID: 34778385 PMCID: PMC8581137 DOI: 10.3389/fcvm.2021.678467] [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: 03/09/2021] [Accepted: 09/29/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Epicardial adipose tissue (EAT) has been linked with the pathogenesis of heart failure (HF). Limited data have been reported about the clinical value of EAT for cardiac resynchronization therapy (CRT) in non-ischemic systolic HF. We aimed to explore the values of EAT measured from CT to predict the response to CRT in patients with non-ischemic systolic HF. Methods: Forty-one patients with CRT were consecutively recruited for our study. All patients received both gated resting Single Photon Emission CT (SPECT) myocardial perfusion imaging (MPI) and dual-source multi-detector row CT scans. EAT thickness was assessed on both the parasternal short and horizontal long-axis views. The area of EAT was calculated at the left main coronary artery level. Left ventricular systolic mechanical dyssynchrony (LVMD) was measured by phase standard deviation (PSD) and phase histogram bandwidth (PBW). The definition of CRT response was an improvement of 5% in left ventricular ejection fraction (LVEF) at 6 months after CRT implantation. Results: After 6 months of follow-up, 58.5% (24 of 41) of patients responded to CRT. A greater total perfusion deficit (TPD) was observed in the left ventricle, and a narrower QRS complex was observed in the nonresponse group than in the response group (p < 0.05). Meanwhile, the systolic PSD and systolic PBW were statistically greater in the CRT group with no response than in the response group (p < 0.05). Meanwhile, the baseline QRS duration, TPD, systolic PSD, systolic PBW, EAT thicknesses of the left ventricular (LV) apex, right atrioventricular (AV) groove, and left AV groove were all significantly related to the CRT response in the univariate logistic regression analysis. Furthermore, the QRS duration and EAT thicknesses of the right AV groove and left AV groove were independent predictors of CRT response in the multivariate logistic regression analysis. Conclusions: The EAT thickness of the left AV groove in patients with non-ischemic systolic HF is associated with the TPD of LV and LV systolic dyssynchrony. The EAT thickness of the AV groove has a good predictive value for the CRT response in patients with non-ischemic systolic HF.
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Affiliation(s)
- Hui-Yuan Qin
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Cheng Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Duo-Duo Qian
- Department of Cardiology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Chang Cui
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ming-Long Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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49
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Martín M, Cuevas J, Cigarrán H, Calvo J, Morís C. Transcatheter Aortic Valve Implantation and Subclinical and Clinical Leaflet Thrombosis: Multimodality Imaging for Diagnosis and Risk Stratification. Eur Cardiol 2021; 16:e35. [PMID: 34721669 PMCID: PMC8546909 DOI: 10.15420/ecr.2021.09] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 03/21/2021] [Accepted: 07/09/2021] [Indexed: 12/31/2022] Open
Abstract
In recent years, the phenomenon of subclinical leaflet thrombosis (SLT) in patients who have undergone transcatheter aortic valve implantation has become increasingly relevant. Hypo-attenuating leaflet thickening and hypo-attenuation affecting motion diagnosed by CT are the hallmarks of SLT, and their incidence varies depending on the intensity of screening. Whether these phenomena are a surrogate for leaflet thrombosis reducing valve durability and increasing the risk of stroke is still a matter of debate. Uncertainty remains over the optimal antithrombotic therapy after TAVI and the best treatment strategy is still not confirmed. Ongoing and future trials will provide more evidence about the best strategy for the prevention and treatment of SLT.
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Affiliation(s)
- María Martín
- Cardiology Department, University Hospital of Asturias Oviedo, Asturias, Spain
| | - Javier Cuevas
- Cardiology Department, University Hospital of Asturias Oviedo, Asturias, Spain
| | - Helena Cigarrán
- Radiology Department, University Hospital of Asturias Oviedo, Asturias, Spain
| | - Juan Calvo
- Radiology Department, University Hospital of Asturias Oviedo, Asturias, Spain
| | - César Morís
- Cardiology Department, University Hospital of Asturias Oviedo, Asturias, Spain
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50
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Arar Y, Dimas VV, Nugent AW, Hussain T, Kasraie N, Reddy SRV, Zellers TM, Herbert C. Pre-procedural CT imaging aids neonatal PDA stenting for ductal-dependent pulmonary blood flow with reduction in overall procedural morbidity. Cardiol Young 2021; 32:1-6. [PMID: 34663483 DOI: 10.1017/s1047951121004133] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Indexed: 12/17/2022]
Abstract
Patent ductus arteriosus stenting for ductal-dependent pulmonary blood flow is a technically challenging neonatal procedure to maintain a stable pulmonary circulation. Pre-procedural computed tomography imaging aids in outlining ductal origin, insertion, size, course and curvature. Computed tomography imaging may add value to procedural outcomes and reduce overall procedural morbidity in neonatal patent ductus arteriosus stenting. We conducted a single centre retrospective chart review of neonates with ductal-dependent pulmonary blood flow who underwent patent ductus arteriosus stenting between January 1, 2014 and June 31, 2020. We compared patients variables between patients who underwent pre-procedural computed tomography imaging to those who did not. A total of 64 patients were referred for patent ductus arteriosus stenting with 33 (52%) obtaining pre-procedural computed tomography imaging. Average age [19 days; range 1-242 days (p = 0.85)] and weight [3.3 kg (range 2.2-6.0 kg; p = 0.19)] was not significantly different between the groups. A diagnosis of pulmonary atresia was made in 42 out of 64 (66%) patients prior to patent ductus arteriosus stenting. The cohort with pre-intervention computed tomography imaging had a significant reduction in the total number of access sites (1.2 versus 1.5; p = 0.03), contrast needed (5.9 versus 8.2 ml/kg; p = 0.008), fluoroscopy (20.7 versus 38.8 minutes; p = 0.02) and procedural time (83.4-128.4 minutes; p = 0.002) for the intervention. There was no significant difference in radiation burden between the groups (p = 0.35). Pre-procedural computed tomography imaging adds value by aiding interventional planning for neonatal patent ductus arteriosus stenting. A statistically significant reduction in the number of access sites, contrast exposure, as well as fluoroscopic and procedural time was noted without significantly increasing the cumulative radiation burden.
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Affiliation(s)
- Yousef Arar
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Pediatric Cardiology, Children's Medical Center, Dallas, Texas, USA
| | - V Vivian Dimas
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Pediatric Cardiology, Children's Medical Center, Dallas, Texas, USA
| | - Alan W Nugent
- Department of Pediatrics, Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Tarique Hussain
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Pediatric Cardiology, Children's Medical Center, Dallas, Texas, USA
| | - Nima Kasraie
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Surendranath R Veeram Reddy
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Pediatric Cardiology, Children's Medical Center, Dallas, Texas, USA
| | - Thomas M Zellers
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Pediatric Cardiology, Children's Medical Center, Dallas, Texas, USA
| | - Carrie Herbert
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Pediatric Cardiology, Children's Medical Center, Dallas, Texas, USA
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